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PubMed2002

Posttraumatic sequelae in a community hit by an avalanche.

The posttraumatic sequelae for 104 adult inhabitants from the town of Flateyri, Iceland, were studied 10 weeks after an avalanche hit the town killing 20 people. Eighty-seven adults from the neighboring town of Thingeyri constituted a control group. On the basis of the General Health Questionnaire (GHQ-30), 25% of the Flateyri group (twice as many than in Thingeyri) reached a level of psychiatric caseness. The most common symptoms were intrusive thoughts and feelings, tension, sadness, and anxiety. The loss of family members was associated with symptomatology. A high number of former life events correlated more strongly with distress symptoms than with the individual appraisal of these events. Distress symptoms were related to gender, age, and education.

Adult↗

PubMed1990

Long-term sequelae of treatment for testicular germ cell tumours.

Seventy-four patients previously treated in our department for germ cell tumour of the testis underwent a series of tests to determine the frequency of long-term therapeutic complications. All had received cisplatin-based chemotherapy as part of their treatment. There was a significant deterioration in renal function throughout the group. Eighteen (24%) had supine blood pressure greater than systolic 140 mmHg or diastolic 90 mmHg after treatment but hypertension did not correlate with renal impairment. Raynaud's phenomenon was common after chemotherapy (26/74) as was persistent sensory neuropathy (23/74). Although 34% had testosterone levels below the normal range, only six patients had a low free testosterone index with one testis still in situ; 18 patients have fathered children after chemotherapy. Approximately half of the patients completed a psychosexual questionnaire and some 30% of them admitted to sexual problems which they attributed to their treatment. Long-term sequelae of cisplatin-based chemotherapy for testicular malignancy are frequent and persistent, and follow-up of these patients should include prospective measurement of changes in blood pressure.

Adolescent↗

PubMed1996

Risk factors for intellectual and educational sequelae of cranial irradiation in childhood acute lymphoblastic leukaemia.

Long-term cognitive and educational sequelae have been inconsistently reported in children who received cranial irradiation (CRT) to prevent central nervous system (CNS) disease in acute lymphoblastic leukaemia (ALL). This study investigates a large and representative sample of survivors of ALL and compares them with non-irradiated survivors of cancer and healthy control children to determine the effect of CRT on cognitive and educational ability. Three groups of children were studied: Group 1 (n=100) survivors of ALL treated with chemotherapy and CRT, group 2 (n=50) children with a variety of malignancies treated with chemotherapy alone, group 3(n=100) healthy children. Cognitive and educational abilities of these groups were evaluated using standardised psychometric techniques. Significant differences in cognitive and educational abilities were found between the children in group 1 (chemotherapy + CRT) and the two control groups, with the children receiving CRT performing less well in a range of tests. Greatest differences were detected for tasks dependent on language function including verbal IQ, reading and spelling. Within group 1 a younger age at treatment (less than 5 years) and a higher dose of CRT (24 Gy vs 18 Gy) were predictive of poor long-term outcome for cognitive and education ability. In contrast, children who received chemotherapy alone, with or without intrathecal methotrexate, performed similarly to healthy controls. No gender differences were detected for these measures.

Adolescent↗

PubMed1988

Treatment with cisapride of the gastrointestinal and urological sequelae of spinal cord transection: case report.

We describe the case of a paraplegic patient who suffered traumatic spinal cord injury at the level of the twelfth thoracic vertebra. Within a short period of time following the injury, urinary (neuropathic bladder) and gastrointestinal (atomic colon) sequelae arose. Treatment with Cisapride (R 51 619, Janssen Pharmaceutica) was undertaken in an attempt to increase colonic motility and to reduce urinary retention. These goals were reached rapidly with a dose of 10 mg q.i.d.; the effect has been maintained for at least 18 months since starting the therapy.

Bisacodyl↗

PubMed1993

The causes, sequelae and attempts at prevention of cervical spine injuries in Poland.

There are certain differences between the causes of spinal injuries in Poland and in the developed countries of the West. The most common causes of injuries to the cervical spine in Poland are: falls from a horse-cart, diving into shallow water and automobile accidents. This paper presents an analysis of the causes of cervical spine injuries in a series of 1937 patients treated at the Spinal Cord Injury Department of the Metropolitan Rehabilitation Center in Konstancin, Poland, in the years between 1965 and 1991, admitted to hospital within the first hours or days after spinal injury. The relations between the mechanism of injury and the cause of injury, as well as the neurological sequelae of the injuries, are analysed.

Accidental Falls↗

PubMed2001

Vertical-split fracture of mandibular condyle and its sequelae.

A case of vertical-split fracture of the right mandibular condyle and its sequelae is presented. The patient was a 16-year-old female being assessed for orthodontic treatment. Orthopantomograph and plain joint view radiographs showed a remodelled condyle which had suffered trauma 10 years previously. This type of fracture is unusual in nature but has not led to any secondary lack of growth, restriction of movement or facial asymmetry.

Adolescent↗

PubMed2003

Biologic sequelae of c-Jun NH(2)-terminal kinase (JNK) activation in multiple myeloma cell lines.

Although c-Jun NH(2)-terminal kinase (JNK) is activated by treatment with therapeutic agents, the biologic sequelae of inhibiting constitutive activation of JNK has not yet been clarified. In this study, we examine the biologic effect of JNK inhibition in multiple myeloma (MM) cell lines. JNK-specific inhibitor SP600125 induces growth inhibition via induction of G1 or G2/M arrest in U266 and MM.1S multiple myeloma cell lines, respectively. Neither exogenous IL-6 nor insulin-like growth factor-1 (IGF-1) overcome SP600125-induced growth inhibition, and IL-6 enhances SP600125-induced G2/M phase in MM.1S cells. Induction of growth arrest is mediated by upregulation of p27(Kip1), without alteration of p53 and JNK protein expression. Importantly, SP600125 inhibits growth of MM cells adherent to bone marrow stromal cells (BMSCs). SP600125 induces NF-kappaB activation in a dose-dependent fashion, associated with phosphorylation of IkappaB kinase alpha (IKKalpha) and degradation of IkappaBalpha. In contrast, SP600125 does not affect phosphorylation of STAT3, Akt, and/or ERK. IKK-specific inhibitor PS-1145 inhibits SP600125-induced NF-kappaB activation and blocks the protective effect of SP600125 against apoptosis. Our data therefore demonstrate for the first time that inhibiting JNK activity induces growth arrest and activates NF-kappaB in MM cells.

Anthracenes↗

PubMed1996

The anterior alveolus: its importance in limiting orthodontic treatment and its influence on the occurrence of iatrogenic sequelae.

Delineating the limits of orthodontic treatment in nongrowing individuals is important when making treatment decisions, especially in borderline orthodontic-surgical cases. The labial and lingual cortical plates at the level of the incisor apex may represent the anatomic limits of tooth movement. Cephalometric films of 107 adults were measured to determine the width of alveolar bone anterior and posterior to the incisor apex in each arch. Thin alveolar widths were found both labial and lingual to the mandibular incisors in groups of Class I, II, and III individuals with high SN-MP angle and in a group of Class III average SN-MP individuals. Thin alveolar widths were also found lingual to the maxillary incisors in a Class II high angle group. Clinical cases are presented showing that orthodontic tooth movement may be limited in patients with narrow alveolar bone widths and that these patients are likely to experience increased iatrogenic sequelae.

Adult↗

PubMed1998

Perioperative allogeneic blood transfusion does not cause adverse sequelae in patients with cancer: a meta-analysis of unconfounded studies.

BACKGROUND: There is controversy over whether perioperative allogeneic red blood cell transfusions are associated with an increased risk of cancer recurrence, postoperative infection or death in patients with cancer undergoing surgery. METHODS: A systematic meta-analysis was performed to answer this question. Studies were identified from electronic databases (Medline 1966-1997, Cancerlit 1983-1997, Current Contents, Cinahl 1982-1996, Healthstar 1990-1997, Bioabstracts 1990-1996 and Embase), by hand search of the bibliographies of identified studies and relevant journals, and by contact with experts in the field. All randomized controlled trials or prospective cohort studies with active comparator controls (autologous or leucocyte-depleted allogeneic blood) were eligible for inclusion if they reported on mortality, infection or recurrence rate in patients with cancer undergoing potentially curative surgical resection. The validity of the identified studies was assessed by means of a standardized scale, and data abstraction was carried out by two investigators independently. A random effects model was used for data synthesis. RESULTS: Of the 2172 references identified, only 17 studies fulfilled the inclusion criteria. After exclusion of duplicate publications, six randomized controlled trials and two prospective cohort studies with appropriate concurrent controls were included in the analysis. The summary risk ratios were 0.95 (95 per cent confidence interval (c.i.) 0.79-1.15) for all-cause mortality and 1.06 (95 per cent c.i. 0.88-1.28) for cancer recurrence, the two endpoints that were appropriate to combine statistically. There was significant heterogeneity (explainable by differences in study design and patient characteristics) in the postoperative infection data and the summary risk ratio was 1.00 (95 per cent c.i. 0.76-1.32) for the four studies that were appropriate to subject to meta-analysis. Given the sample sizes of these eight studies, this meta-analysis had insufficient power to detect a relative difference of less than 20 per cent in the frequency of death, cancer recurrence or infection between the allogeneic and control transfusion arms. CONCLUSION: Although more studies are required before a definitive statement can be made, at this time there is no evidence that allogeneic blood transfusion increases the risk of clinically important adverse sequelae in patients with cancer undergoing surgery.

Cohort Studies↗

PubMed2002

Sequelae of otitis media with effusion among children with cleft lip and/or cleft palate.

Otitis media with effusion (OME) is common among children with cleft palate, and may lead to such long-term consequences as hearing loss, tympanic membrane retraction, and chronic otitis media (COM). In total, 104 children with cleft lip and/or palate treated for OME at our institution were reviewed. Mean duration of follow-up was 6.9 years, and mean age at latest follow-up was 9.6 years. The incidence of COM was 19%, and the incidence of cholesteatoma was 1.9%. Ears showing such long-term sequelae of OME as hearing loss, tympanic membrane retraction, and chronic otitis media, were noted to have undergone a significantly greater number of ventilation tube insertions than ears not showing these sequalae. Our findings would suggest that a conservative approach to the management of OME in children with cleft palate is more likely to be beneficial in the long term.

Child↗

PubMed1996

Nerve conduction velocity in human limbs with late sequelae after local cold injury.

Cold-induced neuropathy may play a dominant role in the long-term sequelae with cold sensitivity after local cold injuries (LCIs). Somatosensory functions were assessed and nerve conduction velocity (NCV) and motor distal delay (MDD) were measured in the limbs of 31 Norwegian former soldiers with persistent cold intolerance 3-4 years after the primary LCI. NCV measurements were performed in 24 lower and 16 upper extremities. NCV was related to degree of overall subjective complaints quantified by means of a visual analogue scale (VAS). Motor (MNCV) and sensory conduction velocity (SNCV) in the lower extremities and SNCV in the hands were significantly decreased compared with controls. MDD was pathologically increased in the feet. NCV of the forearms ranged from normal to significant reduction. The more pronounced effect on the lower extremities may be caused by deeper cooling of the calves compared with forearms for several reasons. No significant associations were found between VAS and NCV except for the right median nerve. NCV measurements may provide objective findings in cold-injured patients and in those with few or no conspicuous clinical signs.

Adult↗

PubMed2000

'Ilko dacowo:' canine enucleation and dental sequelae in Somali children.

OBJECTIVE: To assess the prevalence of primary canine enucleation and associated dental sequelae in Somali children resident in Sheffield. DESIGN: Cross-sectional survey. SETTING: Somali religious education classes and homework groups, selected primary and secondary schools, and the Charles Clifford Dental Hospital, Sheffield (1998-99). SUBJECTS AND METHODS: The target population were all Somali children aged between 4 and 17 years. Subjects were interviewed to obtain background sociodemographic data and an oral examination was performed. The status of the canine in each quadrant was noted, in addition to the presence of any dental anomalies in adjacent teeth. Features indicative of a history of attempted canine enucleation included: absence of primary canines, localized developmental defects affecting primary or permanent canines and lower lateral permanent incisors, and retention of lower primary lateral incisors with distal eruption of permanent lateral incisors. RESULTS: A total of 260 children were included in the study, comprising 56.5% of the target population. The mean age of the subjects was 9.7 years with an equal male and female distribution. According to the criteria devised, 82 (31.5%) of the subjects were considered to exhibit one or more of the dental features suggestive of a previous history of canine enucleation. There was no significant difference in prevalence according to gender or birthplace (UK, Somalia or another country), but a positive history was greater in subjects whose mother did not speak English. In addition to anomalies involving canines, lower permanent incisors were commonly missing (5.0% of children aged over 9 years). CONCLUSION: The suspected continuation of canine enucleation in UK-born Somali children raises important oral health issues. Culturally sensitive education is indicated to discourage this harmful ritual practice.

Adolescent↗

PubMed1998

The Dorothy Russell Memorial Lecture. The molecular and cellular sequelae of experimental traumatic brain injury: pathogenetic mechanisms.

The mechanisms underlying secondary or delayed cell death following traumatic brain injury (TBI) are poorly understood. Recent evidence from experimental models of TBI suggest that diffuse and widespread neuronal damage and loss is progressive and prolonged for months to years after the initial insult in selectively vulnerable regions of the cortex, hippocampus, thalamus, striatum, and subcortical nuclei. The development of new neuropathological and molecular techniques has generated new insights into the cellular and molecular sequelae of brain trauma. This paper will review the literature suggesting that alterations in intracellular calcium with resulting changes in gene expression, activation of reactive oxygen species (ROS), activation of intracellular proteases (calpains), expression of neurotrophic factors, and activation of cell death genes (apoptosis) may play a role in mediating delayed cell death after trauma. Recent data suggesting that TBI should be considered as both an inflammatory and/or a neurodegenerative disease is also presented. Further research concerning the complex molecular and neuropathological cascades following brain trauma should be conducted, as novel therapeutic strategies continue to be developed.

Animals↗

PubMed2000

Pulmonary sequelae in long-term survivors of bronchopulmonary dysplasia.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a common problem in premature babies. Long-term sequelae are the main concerns. METHODS: A retrospective review of all BPD children born in Queen Mary Hospital, a teaching hospital of the University of Hong Kong, from January 1987 to December 1995 was conducted. Children with cerebral palsy, immunodeficiency, congenital heart disorders, renal or liver failure were excluded from analysis. Chest radiography (CXR), electrocardiogram (ECG) and pulse oximetry were routinely performed. RESULTS: Fifty-five children completed the study. The female to male ratio was 1:1.1. The mean gestational age was 28 weeks. Twenty-five children were born with a birthweight of less than 1001 g. Mean age at assessment was 5.4 years. Twenty-four children (44%) demonstrated signs or symptoms of current asthma. Only seven children managed to perform the spirometry satisfactorily. One child had low forced vital capacity and one had hyperresponsive airway. The only risk factor found to be associated with current asthma was the birth month, with those children born early in the year at higher risk of developing current asthma. Seventeen of 48 children (35%) had a bodyweight below the third percentile at the corrected age of 1 year. Eleven of these seventeen children (65%) demonstrated catch-up growth at assessment. Abnormal CXR was found in 25 of 40 children (63%). All had normal pulse oximetry and ECG. CONCLUSIONS: Bronchopulmonary dysplasia children had a significantly higher risk than the general population of developing current asthma (odds ratio 4.7; 95% confidence interval 3.4-6.5; P<0.0001). The importance of birth month suggests that early life experience is important in the pathogenesis of asthma, even in BPD children. The long-term growth of BPD children was much better than previously reported.

Asthma↗

PubMed2001

Neuro-ophthalmological sequelae of horse-related accidents.

PURPOSE: The aim of this study was to highlight the neuro-ophthalmological dangers associated with horse riding, and working around horses, and the importance of wearing adequate headgear to protect the rider from neuro-ophthalmic injuries. It raises the questions of whether the current laws regarding helmet use are satisfactory, and whether helmets currently used are of an adequate standard. METHODS: The records over a 20-year period of one neuro-ophthalmologist in Adelaide were reviewed producing 22 patients with neuro-ophthalmological sequelae of head injuries as a result of horse-related accidents. RESULTS: There were 22 patients (16 female, six male), one of whom was involved in three separate accidents, Of these, seven were professional riders and 15 amateur. In 20 of the 24 accidents, patients were either thrown or fell from the horse. Helmets were worn in 15 of the accidents. All the patients had closed head injuries of varying severity. The most common neuro-ophthalmological complication found was a fourth-nerve palsy in 11 patients. Five patients had a significant loss of vision and two of these were severe enough to warrant a blind pension. CONCLUSIONS: Horse riding and working around horses constitute an occupation or recreation with inherent dangers. Previous studies have shown that wearing of protective headgear reduces the risk and severity of head injuries, and helmet use should be vigorously promoted. The current laws and practices regarding helmet use are not uniform and seem to be inadequate. The current standard for equestrian safety helmets (AS/NZS 3838:1998) embodies improvements on earlier helmet standards and certainly increases the rider's chances of surviving a severe impact. Nevertheless, serious brain injuries have occurred in wearers of approved helmets, and further research is desirable to ensure the optimum degree of protection compatible with rider acceptance.

Accidental Falls↗

PubMed2000

The relationship between self-reports and objective measures of disability in patients with late sequelae of poliomyelitis: a validation study.

OBJECTIVE: To establish the validity of 2 objective measures of disability based on 2 self-reports in individuals with the late sequelae of poliomyelitis (LSP). DESIGN: Nonexperimental research design. SETTING: Regional ambulatory clinic specializing in the management of patients with LSP. PARTICIPANTS: Seventeen community dwellers with LSP. INTERVENTION: Completion of 2 exercise tests: the 6-minute walk (6-MW) test and a steady-rate walking test to calculate the cardiorespiratory conditioning index (CRCI), and 2 health status questionnaires: the Sickness Impact Profile (SIP) and Medical Outcomes Study Short-Form 36 (SF-36). MAIN OUTCOME MEASURES: 6-MW distance and the CRCI, and scores from the physical dimensions of the SIP and the SF-36. RESULTS: The 6-MW distance correlated significantly with the physical dimension scores of both the SIP (r = -.57, p < .05) and the SF-36 (r = .67, p < .05). Significant correlations were also observed between the CRCI and the physical dimension scores of the SIP (r = -.51, p < .05) and the SF-36 (r = .70, p < .01). The 2 objective measures correlated significantly with each other (r = .51, p < .05) as did the 2 physical dimension scores of the SIP and the SF-36 (r = -.80, p < .01). CONCLUSIONS: Although objective measures of disability corroborated self-reports of patients with LSP and, thus, supported their validity, each measure has a distinct role in clinical decision making.

Analysis of Variance↗

PubMed2002

Late reproductive sequelae following treatment of childhood cancer and options for fertility preservation.

The successful treatment of childhood cancer can be associated with impaired gonadal function in adulthood. Chemotherapy and radiotherapy may damage germ-cell spermatogonia, resulting in impaired spermatogenesis or sterility in the male, or may hasten oocyte depletion with truncated fecundity and premature menopause in the female. The only established option in current clinical practice for preserving male fertility is cryopreservation of spermatozoa. The only strategy currently available for preserving female fertility is cryopreservation of embryos. Harvesting and storage of ovarian cortical tissue from girls and young women before potentially gonadotoxic chemotherapy has been available in a number of centres but there have been no live births and the procedure remains experimental. Standards for best practice in the cryopreservation of gonadal tissue, including the criteria for providing a service, patient identification and selection, standard operating procedures and requirements for safe storage, remain to be defined. Recent advances in assisted reproduction may circumvent natural conception barriers and the implications of impaired DNA integrity may be manifest as an increased risk of congenital abnormalities and chromosomal disorders in the offspring. In this chapter we consider the late reproductive sequelae following treatment for childhood cancer and options for fertility preservation.

Antineoplastic Agents↗

PubMed2002

Influence of infection with Chlamydia trachomatis on pregnancy outcome, infant health and life-long sequelae in infected offspring.

This chapter deals with genital chlamydial infections in pregnancy and postpartum. There is increasing evidence that Chlamydia trachomatis infection may result in a number of adverse pregnancy outcomes, including early and late abortion, intrauterine infections of the fetus, stillbirth, prematurity, premature rupture of the membranes (PROM) and postpartum endometritis. Ectopic pregnancy is commonly associated with a previous tubal chlamydial infection where immunological reactions seem to play a role. C. trachomatis infection may be acquired as an intrauterine infection, as well as during transit through the birth channel, and this may result in neonatal conjunctivitis and/or pneumonia. The role of chlamydial infection in the sudden death syndrome has also been considered, but evidence so far is minimal. Neonatal chlamydial infection may cause life-long sequelae, such as obstructive lung disease. Genital chlamydial infections have been associated with problems in insemination and attempts at in vitro fertilization. The chapter also deals with screening of pregnant women for C. trachomatis and the treatment of infected mothers and their offspring.

Chlamydia Infections↗