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PubMedDate not supplied

Behavioral sequelae in young rats of acute intermittent antenatal hypoxia.

Several studies have examined behavioral sequelae of acute or chronic pre- or postnatal hypoxia. However, few of these tested a large battery of behavioral functions, particularly those following relatively mild, intermittent hypoxia. Also, in few studies were the hypoxic pups cross-fostered or the experimenter blinded as to experimental group. In addition, in almost no studies were concomitant hypoxic-induced brain biochemicals measured. The present study tested the hypotheses that mild, intermittent antenatal hypoxia can lead to long-term alterations in neurobehavioral development, as well as neurochemical changes.

Animals↗
PubMedDate not supplied

Long-term cognitive sequelae of solvent intoxication.

Memory problems lasting 8 months have previously been described for a small group of female solvent workers following an accidental workplace solvent intoxication. Three years after the intoxication the presence of longer-term residual impairment of cognitive functions was evaluated. The major residual difficulty uncovered related to the speed of processing linguistic material, with workers showing slower verification on tasks probing syntactic and semantic reasoning within the context of relatively unimpaired response execution speeds. Of particular interest was the intoxicated workers' difficulty with the conceptually more complex negative syntactic reasoning problems. This difficulty was also shared by solvent workers who were not involved in that accidental intoxication. In addition, decision fatigue was observed following prolonged responding in a continuous choice reaction time task, although ability to maintain vigilance and concentration were unaffected. Taken together, these findings indicate that a single solvent intoxication can give rise to long-term cognitive sequelae in solvent workers.

Adult↗
PubMed1996

Circadian variations of blood pressure in patients with sequelae of carbon monoxide poisoning.

It has been shown that carbon monoxide poisoning causes necrosis of the globus pallidum and the cerebral cortex, and a diffuse demyelination of the cerebral subcortical white matter, resulting in the impairment of the higher brain functions manifested as memory disturbances, apraxia, and agnosia. The purpose of the present study was to determine the effects of the lesions in the brain caused by carbon monoxide poisoning on the circadian changes in blood pressure and pulse rate. We measured the ambulatory blood pressure in 15 male patients with the sequelae of acute carbon monoxide poisoning and 16 age- and sex-matched controls. Using either brain computed tomography or brain magnetic resonance imaging, we determined that seven patients had lesions in the globus pallidum bilaterally, four had lesions in the parietotemporooccipital lobe bilaterally, and five had multiple deep white matter lesions. Circadian variations of blood pressure and pulse rate did not show any significant differences in either group. The average 24-h blood pressures were 120.8 +/- 2.2 (systolic)/74.1 +/- 1.5 mm Hg (diastolic) in the patients and 117.4 +/- 2.7/74.5 +/- 2.1 mm Hg in the controls. The daytime (6:00 to 21:00) and nighttime (21:00 to 6:00) blood pressures were 127.3 +/- 2.3/78.0 +/- 1.5 mm Hg and 109.7 +/- 2.4/67.4 +/- 1.7 mm Hg in the patients, and 121.6 +/- 2.9/77.5 +/- 2.2 mm Hg and 110.0 +/- 2.7/69.3 +/- 1.8 mm Hg in the controls, respectively. Furthermore, there were no differences in cardiovascular and plasma catecholamine responses induced by either a head-up tilt or a cold pressor test between the two groups. It is concluded that diffuse or multiple lesions in bilateral cerebral hemispheres caused by carbon monoxide poisoning per se do not affect the circadian changes in blood pressure and pulse rate observed in normotensive subjects.

Aged↗
PubMed1995

Late pulmonary sequela following burns: persistence of hyperprocalcitonemia using a 1-57 amino acid N-terminal flanking peptide assay.

Seven patients were evaluated at a mean duration of 8.4 yr after sustaining inhalational injury associated with burns. At the time of re-examination, the patients were asymptomatic and had normal chest X-rays, and arterial blood gases. Three of the seven patients had abnormally elevated serum calcitonin levels. The spirometry (FEV1) measurements showed an inverse trend to that of the serum calcitonin levels. The elevated calcitonin levels had an abnormal predominance of the procalcitonin component as assessed by several region specific antisera. The serum calcitonin also showed a significant correlation with the hormone level which had been obtained at the time of prior discharge from the hospital (r = 0.91). Although there appears to be no or minimal chronic pulmonary sequela to inhalational injury in burns by pulmonary testing, we speculate that the hyperprocalcitonemia in some of the patients may reflect a long-term hyperplastic response of the bronchio-epithelial pulmonary neuroendocrine cells. The potential significance of this and other lung-associated endocrine markers is discussed.

Biomarkers↗
PubMed2003

Prevalence of significant intraocular sequelae in blunt orbital trauma.

The purpose of this study was to describe the prevalence of significant intraocular sequelae (SIOS) and its correlation with the severity of blunt orbital trauma. Four hundred ten consecutive patients presenting to the ED who had sustained blunt orbital trauma were studied. The severity of orbital trauma was graded and SIOS was determined by the presence of an intraocular injury as listed in Table 2. The presence of SIOS was noted in 14 (41.2%) mild, 22 (59.5%) moderate, and 20 (29.4%) severe orbital trauma. In the severe group, the presence of SIOS was detected in 8 (23.5%) blowout fractures and in 12 (35.3%) non-blowout fractures. In view of the high rates of ocular complications among mild and moderate orbital injuries, such patients should have prompt ophthalmic follow up. The relatively low prevalence of SIOS in patients with severe orbital trauma could suggest a protective mechanism in this type of injury.

Adult↗
PubMed2006

Sequelae of systemic hypertension in alcohol abstainers, light drinkers, and heavy drinkers.

A link exists between alcohol intake and increased blood pressure (BP), with many studies showing increased hypertension prevalence in heavy drinkers. The harmful and beneficial effects of alcohol can confound the study of the long-term risks of alcohol-related hypertension. We therefore studied cardiovascular sequelae separately in heavy drinkers, light drinkers, and abstainers among 127,212 subjects with BP and alcohol intake ascertained at 1978 to 1985 health examinations. Subsequent cardiovascular end points included mortality risk, hospitalization risk, and outpatient diagnosis of hypertension. Analyses were performed for all subjects and stratified by 5 alcohol-drinking categories (from never drinkers to >or=3 drinks/day). With <120/80 mm Hg as the referent, Cox proportional hazards models were used to estimate relative risks and 95% confidence intervals for 3 higher BP categories (120 to 129/80 to 84, 130 to 139/85 to 89, and >or=140/90 mm Hg). The covariates were age, gender, race, body mass index, education, and smoking. The risk of all outcomes was progressively higher for increasing BP categories, with a similarly increased risk for abstainers, light drinkers, and heavy drinkers. The interaction tests for alcohol and BP were not statistically significant for the mortality and hospitalization outcomes. Interpretation was limited by an inability to separate subjects with increased BP from alcohol consumption from those with other etiologies. In conclusion, the data indicate that the risks of hypertension are similar regardless of the amount of alcohol consumption.

Adult↗
PubMed2006

[Role of lipo-filling in the treatment of sequelae in craniosynostosis surgery].

AIM: This study presents an innovative technique of correction of cranioplasty sequelae by lipo-filling in 9 patients treated for cranioplasty in childhood with a long-term follow-up. PATIENTS AND METHODS: A prospective study was conducted from January 2001 to February 2005, including all patients treated with lipo-filling technique in the Plastic Surgery department of Lille. For a period of 4 years and 5 months, 144 patients were operated on with 206 lipo-filling procedures: 30 patients for cosmetic purposes and 114 patients for reconstructive surgery. In the current investigation, we examined the 9 cases of lipo-filling which were performed in complement to craniofacial surgery. All patients presented with a sub-cutaneous fronto-temporal deformation which in 3 of the cases was associated to a frontal medial defect. The assessment of results was performed in the context of post-operative follow-up visits by an observer. RESULTS: Nine patients, with a mean age of 16,7 years and a ratio of 1 female for 2 males underwent a total of 17 lipo-filling procedures. The mean time lapse was 15,06 months. 9 patients judged the result to be good. No complication was observed. CONCLUSION: The S.R. Coleman technique of fat grafting seems to offer several advantages, namely the simplicity of the procedure itself, its apparent innocuity, its reproducibility, as well as patients and surgeons satisfaction. It appears to be an alternative of choice in the corrective surgery of craniosynostosis.

Adipose Tissue↗
PubMed2005

Prognostic factors influencing the functional outcome of total hip arthroplasty for hip infection sequelae.

To investigate factors influencing functional prognosis for patients who have undergone total hip arthroplasty for late sequelae of infective arthritis of the hip, we conducted a retrospective analysis of 75 hips. All patients had had pyogenic or tuberculous infection and later underwent total hip arthroplasty. The average follow-up period was 5.8 years (range, 3-9 years). Various clinical and radiographic measures were analyzed with respect to Harris hip scores. Younger age at the time of infection onset, preoperative leg length discrepancy greater than 1 in, fusion, severe femoral hypoplasia, and severe acetabular dysplasia were associated with poorer prognosis. The complication rate, including 1 recurrent infection, was relatively low. Previous infections seemed to predict poorer results mostly because of the consequences of infection for the development of the hip joint, rather than because of infection recurrence.

Acetabulum↗
PubMed2006

Glucocorticoid receptors in lateral septum are involved in the modulation of the emotional sequelae induced by social defeat.

The current research studied the behavior adopted in the elevated plus maze (EPM) of rats previously subjected to a social defeat using the resident-intruder paradigm. One day after defeat, intruder animals exhibited an anxiogenic-like behavior in the EPM. In addition, we also evaluated the role of the corticosteroid receptor system (minerlocorticoid - MR - and glucocorticoid - GR - receptors) from the lateral septum (LS) on the anxiety generated by social defeat. The LS is an area of the aversive circuitry that is preferentially activated in passive defensive postures, and participates - together with other brain areas - in the modulation of aversive states. Intruder animals were infused into the LS with the MR or GR antagonist (ZK 91587 and RU 38486, respectively) and then submitted to social stress. All rats were tested in the EPM 1 day later. Only the administration of the GR antagonist, but not the MR antagonist, into the LS normalized the anxiogenic response induced by defeat. Furthermore, we examined whether a single injection of corticosterone (CS) could induce the same influence on the behavior in the EPM as that observed after social defeat. Moreover, we explored the effect of local infusions of MR or GR antagonists into the LS on the behavior exhibited by CS-treated rats in a subsequent EPM exposure. CS administration also exerted an increased anxiogenic-like behavior, which was normalized only by the local infusion of the GR antagonist. Based on these findings, we suggest that CS secreted by emotionally relevant stimuli acting via GR in LS plays an important role in the modulation of the emotional sequelae induced by social defeat.

Analysis of Variance↗
PubMed2003

Prevalence and psychological sequelae of self-reported childhood physical and sexual abuse in a general population sample of men and women.

OBJECTIVE: This study examined the prevalence and psychological sequelae of childhood sexual and physical abuse in adults from the general population. METHOD: A national sampling service generated a geographically stratified, random sample of 1,442 subjects from the United States. Subjects were mailed a questionnaire that included the Traumatic Events Survey (TES) [Traumatic Events Survey, Unpublished Psychological Test, Harbor-UCLA Medical Center, Los Angeles] and the Trauma Symptom Inventory (TSI) [Trauma Symptom Inventory Professional Manual, Psychological Assessment Resources, Odessa, FL]. Of all potential subjects, 935 (64.8%) returned substantially completed surveys. RESULTS: Sixty-six men and 152 women (14.2% and 32.3%, respectively) reported childhood experiences that satisfied criteria for sexual abuse, and 103 males and 92 females (22.2% and 19.5%, respectively) met criteria for physical abuse. Twenty-one percent of subjects with one type of abuse also had experienced the other type, and both types were associated with subsequent adult victimization. After controlling for demographics, adult history of interpersonal violence, and other child abuse, childhood sexual abuse was associated with all 10 scales of the TSI, and physical abuse was related to all TSI scales except those tapping sexual issues. Sexual abuse predicted more symptom variance than did physical abuse or adult interpersonal victimization. Various aspects of both physical and sexual abuse experiences were predictive of TSI scores. Abuser sex, however, both alone and in interaction with victim sex, was not associated with additional TSI symptomatology. CONCLUSIONS: Childhood sexual and physical abuse is relatively common in the general population, and is associated with a wide variety of psychological symptoms. These relationships remain even after controlling for relevant background variables.

Adolescent↗
PubMed2004

Reduction of ischemic sequelae following spontaneous subarachnoid hemorrhage: a double-blind, randomized comparison of enoxaparin versus placebo.

BACKGROUND: Cerebral vasospasm, including its ischemic sequelae, remains a leading cause of death and disability following subarachnoid hemorrhage (SAH). This study was designed to evaluate whether the low-molecular-weight heparin (LMWH) enoxaparin reduces the occurrence of cerebral vasospasm and ischemia following spontaneous SAH. METHODS: A prospective, double-blind, randomized study was conducted in 120 consecutive patients with SAH (Hunt Hess Scale (HHS) I-III). Patients received one subcutaneous injection per day of either 20mg enoxaparin or placebo for 3 weeks following SAH. Efficacy endpoints were the occurrence of cerebral vasospasm, delayed ischemic deficit (DID), cerebral infarction, and overall outcome at 1 year following SAH. RESULTS: At 1-year follow-up, enoxaparin significantly reduced DID and cerebral infarction. Delayed ischemic deficit occurred in 8.8% of the enoxaparin group versus 66.7% of the placebo group (P<0.001), while 3.5% of vasospasm-related cerebral infarctions occurred in enoxaparin-treated patients and 28.3% in placebo-treated patients (P<0.001). Severe shunt-dependent hydrocephalus was significantly lower in the enoxaparin group (1.8% versus 16.7%; P=0.019). Compared with the placebo group, the enoxaparin group had fewer intracranial bleeding events and better overall outcomes at 1-year follow-up. Although there was potential bias as a result of patients in the placebo group being more severely affected (in terms of HHS), treatment with enoxaparin for 3 weeks improved long-term outcome following SAH. CONCLUSIONS: Enoxaparin is safe and effective in reducing cerebral vasospasm and ischemia following SAH (Hunt Hess grades I-III), resulting in a better long-term outcome for the patient.

Adult↗
PubMed2003

Sequelae of cryotherapy in breast tissue.

Cryotherapy is a novel treatment for benign and malignant breast lesions that is under evaluation. We assessed the acute and subacute outcomes of breast cryotherapy in normal goat teats using physical, microscopic, and imaging modalities. Eight goats were subjected to two freeze-thaw cycles of breast tissue producing a 2cm iceball and sacrificed either 2 or 7 weeks later. Acute skin changes were minimal unless obvious tissue injury occurred during cryotherapy; however, depigmentation developed over several weeks in dark-skinned goats despite the presence of melanocytes. By histology, breast epithelial elements could not be identified at cryotherapy sites. There was no cystic degeneration, which is common at surgical excision sites. Neither calcifications nor prominent scarring could be attributed to cryotherapy on imaging studies after 2 or 7 weeks. When compared to standard breast surgery, the sequelae of cryotherapy using histologic, radiographic, and sonographic criteria were decreased. Our study suggests that cryotherapy, with technical modifications, is feasible within breast tissue and warrants further study.

Animals↗
PubMed2005

Neurodevelopmental sequelae of intraventricular haemorrhage at 8 years of age in a regional cohort of ELBW/very preterm infants.

BACKGROUND: Major grades of intraventricular haemorrhage (IVH) are associated with adverse neurodevelopmental sequelae in early childhood but the extent of problems in specific cognitive areas, such as executive function, and the contribution of lesser grades of IVH to neurodevelopmental problems at school age are not well described. AIMS: To determine the neuromotor, cognitive and educational outcome of extremely low birthweight (ELBW, birthweight <1000 g) or very preterm (<28 weeks) infants at 8 years of age related to the severity of IVH diagnosed in the newborn period. DESIGN: Regional cohort study. PATIENTS: Consecutive surviving children of either birthweight <1000 g or gestational age <28 weeks born in the state of Victoria in 1991 or 1992. MAIN OUTCOME MEASURES: Neurological impairments and disabilities, cognitive function and academic progress. RESULTS: Of 298 consecutive ELBW/very preterm survivors 270 (90.6%) with cranial ultrasound data were assessed at 8 years of age. Cerebral palsy, poor motor performance and major neurosensory disability were more prevalent with increasing severity of IVH. Cognitive functioning across domains was worse with increasing severity of IVH. Most of the differences were attributable to the few (n=6) survivors who had grade 4 IVH; there were few substantial differences between survivors with lesser grades of IVH. CONCLUSIONS: Neurodevelopmental dysfunction at school age in ELBW/very preterm survivors varies little with increasing severity of IVH, with the exception of grade 4 IVH.

Child↗
PubMed2006

The renal sequelae of a novel triphasic approach to blood loss reduction during hepatic resection.

AIMS: To report our novel triphasic approach to minimising blood loss during hepatic resection and the renal sequelae. METHODS: Fifty consecutive patients (median age 63.3 years, range 37-86) underwent hepatic resection. Triphasic approach consisted of: pre-operative bowel preparation with no supplementary fluids; intraoperative intravenous fluid restriction with low central venous pressure (<5 cmH2O) and continuous selective occlusion of the left or right portal structures and corresponding hepatic vein/s. The following variables were analysed: blood loss; transfusion requirements; perioperative renal function; perioperative morbidity and mortality. RESULTS: Median estimated blood loss was 330 mL (range 50-1200). No patient was transfused intraoperatively, with two patients transfused post-operatively. Median intraoperative urine output prior to hepatic re-perfusion was 28.4 mL/h (range 13.3-40.0) with no patient developing renal impairment. Morbidity occurred in 22% of patients with no documented hepatic failure. There was zero 30-day mortality. CONCLUSIONS: Pre-operative dehydration and intraoperative fluid restriction combined with continuous selective vascular occlusion minimizes blood loss during hepatic resection with no consequent detriment to renal function.

Adult↗
PubMed2006

Successful whole blood exchange by apheresis in a patient with acute cyclosporine intoxication without long-term sequelae.

Acute cyclosporine A (CsA) intoxication after organ transplantation may occur during the changeover from one form of drug to another, or from miscalculation of dosage. Sometimes, it may cause severe hepatotoxicity, nephrotoxicity and neurotoxicity. However, the therapeutic plasma exchange for the CsA intoxication was not established. Here, we present a case of very severe CsA intoxication after cardiac transplantation who recovered from intoxication without long-term sequelae via whole blood exchange; therapeutic erythrocytapheresis followed by total plasma exchange.

Blood Component Removal↗
PubMed2005

A case of the otogenic variant of Lemierre's syndrome with atypical sequelae and a review of pediatric literature.

We report a case of an 8-year-old girl who presented with the clinical picture of Lemierre's syndrome (LS) secondary to bilateral mastoiditis. She developed unilateral sensorineural hearing loss (SNHL) along with internal jugular vein (IJV) thrombosis, septic arthritis of her ankle and cervical fasciitis. Combined antimicrobial, anticoagulant and surgical treatment helped reverse all the effects of the sequelae, including nearly all the hearing loss. This is a unique case of this uncommon variant of the syndrome and with an uncommonly reported complication. The literature indicates that pediatric cases are a minority and enforces that successful management rests on awareness of the condition, vigil and promptness of communication of a multidisciplinary pediatric team.

Ankle Joint↗
PubMed2004

Brachytherapy versus surgery in carcinoma of tonsillar fossa and/or soft palate: late adverse sequelae and performance status: can we be more selective and obtain better tissue sparing?

PURPOSE: To report on the tumor control, adverse late normal tissue sequelae, and functional performance in patients with tonsillar fossa and/or soft palate (SP) tumors. The aim of the study is to validate the use of a more selective clinical target volume in conjunction with highly conformal radiotherapy (RT) techniques to better spare the surrounding normal tissues. METHODS AND MATERIALS: Between 1986 and 2001, T1-T3 tonsillar fossa/SP tumors were treated in the Erasmus Medical Center using external beam radiotherapy (EBRT) to 46 Gy in 2-Gy fractions to the primary tumor and neck, followed by brachytherapy (BT) to the primary. Neck dissection was performed for node-positive disease (BT group; 104 patients). If BT was not feasible, patients underwent surgery and postoperative RT (PORT) to a dose of 50-70 Gy in 2-Gy fractions (surgery group; 86 patients). Local control, regional control, disease-free survival, and overall survival were determined. Late side effects were scored using the Radiation Therapy Oncology Group criteria. Univariate and multivariate Cox regression analyses were performed for regional failure (RF), with the parameters gender, age, site, TN stage, modality, dose, and overall treatment time. Recurrences in the contralateral neck were also related to significant ipsilateral involvement of the base of tongue and/or involvement of the SP crossing the midline. To determine the performance status scale scores and degree of xerostomia, a survey was conducted among patients living with no evidence of disease and a minimum of 2 years of follow-up. For that purpose, a research nurse interviewed patients regarding eating in public, normalcy of diet, normalcy of speech, and xerostomia. RESULTS: The tumor control rates after BT vs. surgery at 5 years were 88% vs. 88% for local control; 93% vs. 85% for regional control; 57% vs. 52% for disease-free survival; 67% vs. 57% for overall survival; and 5% vs. 6% for RF. No patient had RF in the contralateral untreated N0 neck (0 of 14 vs. 0 of 15). Multivariate Cox regression analysis for RF was statistically significant for Stage T2 vs. T3 (hazard ratio 0.09) and for the dose to the neck >46 Gy (hazard ratio, 8.7; 95% confidence interval, 1.3-57.1). The significant late side effects in the BT group vs. surgery group were ulcer in 39% vs. 7% (p = 0.001) and trismus in 1% vs. 21% (p = 0.005). The performance status scale scores and response to questions regarding xerostomia for BT vs. surgery revealed no statistically significant differences for eating in public, normalcy of diet, normalcy of speech, and xerostomia. The mean visual analog score for xerostomia was 5.5 in the BT group vs. 6 in the surgery group. CONCLUSION: Excellent locoregional control was obtained in T1-T3 tonsillar fossa and/or SP tumors. The rate at 10 years was 84% (BT group) vs. 78% (surgery group). However, adverse late side effects were not negligible. In addition to modality-specific side effects (ulcer/trismus), both treatment groups were significantly affected by xerostomia. Only 6 recurrences (4%) were observed in the 149 electively treated contralateral necks, and no relapses were seen in the 29 untreated contralateral necks. We, therefore, suggest that it is not necessary to treat the contralateral neck, unless the tumor extends beyond the midline of the soft palate (uvula) or beyond the lateral one-third of the ipsilateral base of the tongue. Moreover, with the currently available CT-based neck level definitions, more conformal contours (i.e., tighter boundaries) around the clinical target volume can be designed. In this way, critical structures such as the temporomandibular joint and part of the pterygoid muscles can be avoided more easily. Also, when using highly conformal treatment techniques (e.g., intensity-modulated RT), one can further reduce the dose to the major salivary glands and oral mucosa. We believe these measures will lead to less trismus and less xerostomia.

Adult↗
PubMed2006

Physical methods of torture and their sequelae: a Sri Lankan perspective.

Methods of torture vary from country to country and sometimes within regions in the same country. Knowing torture methods used in a country or region assists in evaluating injuries, scars and other chronic sequelae of torture. Medical records of 100 victims of torture examined between 1998 and 2001 in the Judicial Medical Officer's Office in Colombo, Sri Lanka, were perused to gather data on torture methods used in Sri Lanka during that period. Altogether 68 methods of torture had been used on these victims. They included assault with blunt and sharp weapons, burns with lighted cigarettes, 'dry submarino', kicking, 'wet submarino', 'hanging', electric torture, 'falaka' and many more. However, only 18% of victims had any physical residual effects, highlighting the typical objective of torture, which is inflicting maximum pain without causing serious injury or death.

Adolescent↗