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At least 847 records · Page 47Linked to original sources
PubMed2001

The sequelae of salvaged nondegenerative peripheral vertical medial meniscus tears with anterior cruciate ligament reconstruction.

PURPOSE: To determine the clinical sequelae of nondegenerative peripheral vertical medial meniscus tears treated with abrasion and trephination alone (stable tears) or suture repair (unstable tears). Type of Study: Cohort follow-up. METHODS: At the time of anterior cruciate ligament reconstruction, 548 patients had nondegenerative peripheral vertical medial meniscus tears that were either left unsutured or repaired. Of 548 menisci, 233 were stable and were abraded and trephined (AT group), 139 were stable and left in situ (Situ group), and 176 were unstable and were repaired with sutures (Suture group). An unstable tear was defined as a torn meniscus that could be displaced into the intercondylar notch with a probe. Patients who had no medial or lateral meniscal tears at the time of ACL reconstruction served as a control population (No Tear group, n = 526). Subjective follow-up was obtained with a modified Noyes questionnaire. RESULTS: Objective follow-up was obtained at a mean of 4.8 +/- 1.7 years postoperatively. Subjective follow-up was obtained at a mean of 7.3 +/- 3.4 years postoperatively. At a mean of 3.7 years (range, 4 months to 10.7 years) after the reconstruction, a subsequent arthroscopy was required for 14 patients (6.0%) in the AT group, 15 patients (10.8%) in the Situ group, 24 patients (13.6%) in the Suture group, and 15 patients (2.9%) in the No Tear group; these numbers were not statistically significant. The mean total subjective score was not statistically significantly different between groups. CONCLUSIONS: Repaired unstable peripheral vertical medial meniscus tears have a failure rate of 13.6%, most retears occurring more than 2 years after repair. Of stable peripheral vertical medial meniscus tears treated with abrasion and trephination, most (94%) remain asymptomatic without stabilization.

Journal Article↗
PubMed2001

Risk factors for and sequelae of headaches in schoolchildren with clinical implications from a psychosocial perspective.

Functional headache, by definition, is a headache not associated with organic diseases. It is a common symptom in school children and can cause potentially serious health problems, affecting their growth and development. Therefore, this report synthesizes the literature about functional headaches in schoolchildren from a psychosocial perspective. This report examines the research on risk factors and sequelae of headaches in children, presents a framework to guide the conceptualization of this phenomenon, and suggests an application of this framework for clinical practice.

Adaptation, Psychological↗
PubMedDate not supplied

Technical aspects and postoperative sequelae of spinal and epidural anesthesia: a prospective study of 3,230 orthopedic patients.

BACKGROUND AND OBJECTIVES: Major complications after spinal or epidural anesthesia are extremely rare. The occurrence of less serious and transient sequelae and complaints may be underestimated if there is no established organization for the systematic and continuous surveillance of patients after anesthesia. This study was designed to evaluate the possible relationship between various block-related occurrences and the intra- and postoperative side effects and complaints. METHODS: This prospective study included 3,230 orthopedic patients operated on under neuraxial block. The block was performed by single-dose (single-shot spinal anesthesia [SPIN], 80.6%), continuous spinal anesthesia (CSA, 10.3%), or combined spinal and epidural anesthesia (CSE, 9.1%) technique. The patient position during surgery and a detailed description of block performance and equipment, as well as all intraoperative problems, were immediately recorded. Every patient was given a standardized questionnaire to be completed and returned after 1 week. RESULTS: The overall incidence of paresthesia was 12.8%, being most frequent during spinal catheter insertion with multiple attempts. Postoperative sensory disturbances (numbness, dysesthesia) occurred unrelated to paresthesia elicited by the puncture or catheterization. The failure rates (SPIN, 1.0%; CSA, 1.5%; and CSE, 1.0%) were quite low. Asystole with successful resuscitation, occurred in 1 patient with CSE but, overall, hemodynamic perturbations were more common with the continuous techniques. On the first postoperative day, decreased sensation of the skin was significantly more frequent after the continuous techniques, still present in 6.5% of SPIN patients, 6.1% of CSA patients, and 17.2% of CSE patients 1 week after surgery. These disturbances were also related to the use of a tourniquet and lateral position of the patient during surgery. The frequency of postdural puncture headache (PDPH) was similar for the different techniques (SPIN, 0.9%; CSA, 1.5%; and CSE, 1.7%). About one third of the patients reported strong postoperative pain on the day after the operation, and 5.6% continued to report this at 1 week. CONCLUSIONS: Although sensory changes were quite frequent, they were mild and transient. Rather than having been caused by the anesthetic technique, per se, a "nonanesthetic" reason (position, tourniquet, immobilization) should also be considered as their origin. Sensory disturbances, as well as strong pain for at least a week, were reported by several patients, and to become aware of these problems and improve the quality of treatment, a universal regional anesthesia follow-up system is recommended.

Adolescent↗
PubMed2001

The sequelae of reflex sympathetic dystrophy.

This paper presents the results of a retrospective analysis of 94 patients who were assessed at a mean of 11 months after successful treatment of reflex sympathetic dystrophy (RSD) of the hand. Fifty-four percent still complained of pain related to the weather, and many complained of cold intolerance (44%), slight pain after use (34%), nail and hair growth changes (34%), sensory disturbances (34%) and stiffness of fingers in the morning (28%). There were also complaints of reduced finger extension, pain and loss of movement in the shoulder joint and hand swelling after use, and 78% of patients had significantly reduced grip strength. These results suggest that, in spite of resolution of the acute RSD problem, significant long term sequelae of RSD continue to impair function of the hand in a proportion of patients.

Adult↗
PubMed2000

[Late sequelae of fractures of the distal third of the forearm during the growth period].

Fractures to the distal third of the forearm are the most common fractures of the upper extremity, with the majority occurring between the age of ten and 14 years. With the exception of the rare epiphyseal fractures, they have a favourable prognosis. The present study investigates the frequency and extent of potential clinical and radiological late sequelae of fractures in the distal third of the forearm during growth. Of the patients treated at the Innsbruck University Department of Traumatology from 1980 to 1992, 220 patients of a growing age with 232 closed fractures in the distal third of the forearm were followed up. The radius alone was affected in 60% of these cases; the radius and the ulna in 40%. Fractures of the ulna alone were not present. The mean age of the patients at the time of injury was nine years (range one to 16 years) and the mean time of follow-up ten years (range five to 16 years). In addition to the patient's subjective assessment, the right and left sides were compared with regard to mobility of the wrist and rotational movement of the forearm. Based on standard X-rays, the frontal (radio-ulnar) and lateral (dorso-palmar) radial joint angle as well as the difference in the radio-ulnar plane were compared with the contralateral side. Clinical and radiological findings were summarised into an overall result. 19% of the patients reported pain in the injured wrist. Mobility of the wrist in the sagittal and/or frontal plane was limited in 5% of patients and rotation of the forearm was limited in 16% of patients. A statistically significant accumulation of limited rotation was seen after physeal fractures of the ulna ("one-way" ANOVA-test, p = 0.0033). A difference between the left and right side in regard to the frontal radial joint angle was seen in 6% of patients and a difference in the lateral radial joint angle was registered in 2% of patients. A difference in the radio-ulnar plane was observed in 37% of patients. In the presence of relative ulna-plus variance, 75% of patients complained of pain in the ulnocarpal compartment of the wrist. In these patients, dynamic magnetic resonance tomography revealed a compression of the ulnocarpal disk between the proximal carpal bones and the head of the ulna, as well as degeneration in the central portion of the disk. The overall outcome was very good in 72%, good in 19%, moderate in 6% and poor in 3% of patients. The younger the children had been at the time of injury, the more favourable were the results (chi-square test, p = 0.009). Children older than ten years of age with an angulatory deformity of more than 20 degrees and/or fragment dislocation over half of the breadth of the shaft at fracture consolidation showed the poorest results. Further factors having a negative influence on the outcome were repeated reduction manoeuvres and an additional fracture of the ulna.

Adolescent↗
PubMed2000

Recovery, persistence, and sequelae in hepatitis C virus infection: a perspective on long-term outcome.

Hepatitis C has emerged in recent years as the most common basis for liver disease in the United States, having infected an estimated 3.9 million people in this country and an estimated 170 million worldwide. Currently, it is the predominant reason for undergoing liver transplantation. The disease it causes is characterized by silent onset in most infected individuals, a high rate of viral persistence, and the potential for development of ever-worsening chronic liver disease, ranging from chronic hepatitis to cirrhosis and occasionally to hepatocellular carcinoma. Such progression, when it occurs, is also most commonly a silent process that may take 20-40, and occasionally even more, years to reach its end point. Because of these characteristics, it has been exceedingly difficult to accurately assess the natural history. Efforts to accomplish this have consisted of retrospective, prospective, and cohort studies. The most concerning data have derived from the retrospective study approach, generally performed at tertiary referral centers. Because these centers commonly attract persons with existing chronic liver disease, they have tended to describe a high rate of progression to cirrhosis and cancer. This "referral bias" is avoided in the prospective and cohort study approach, and data derived from these studies indicate a lower rate of progression and a correspondingly higher rate of either recovery or minimal liver disease. In this review, we briefly describe potential mechanisms of viral persistence; present detailed information on outcomes that have derived from retrospective, prospective, and cohort studies, involving both adults and children; examine the data regarding progression of fibrosis and of progression to hepatocellular carcinoma; consider cofactors that might enhance liver disease progression; and report the emerging data that suggest that spontaneous viral clearance may be higher than is currently believed. We conclude with the view that severe, life-threatening, progressive liver disease clearly occurs in a sizable minority (perhaps 30%) of chronically infected persons but speculate that fibrosis progression is neither linear or inevitable and hence that most hepatitis C virus carriers will have either a stable nonprogressive course or such indolent progression that they will die from an unrelated disease before the severe sequelae of hepatitis C become manifest or will have a sustained "curative" response to therapy. Although this view provides reasonable hope to the hepatitis C virus-infected individual, it does not deny the enormous burden this infection presents as the result of its high prevalence and global distribution. The sheer magnitude of the infected population will result in a large number with severe life-threatening liver disease even if the proportion of infected individuals that develop progressive disease is relatively small.

Acute Disease↗
PubMed2004

Selective and sequential therapy of oculomotor and palpebral sequelae resulting from biopsy of dorsal midbrain sarcoidosis.

BACKGROUND: Biopsy of a dorsal mesencephalon lesion often leads to neuro-ophthalmological complications, namely dorsal mesencephalic syndrome, skew deviation, IV (th) palsy, or Horner's syndrome. HISTORY AND SIGNS: A 26-year-old man underwent a biopsy of the quadrigeminal plate for a lesion which revealed to be neurosarcoidosis. Post-operative complications included a left homonymous hemianopia, a left III (rd) nucleus palsy, a bilateral IV (th) palsy and a bilateral internuclear ophthalmoplegia. Palpebral fissures were narrowed to 2 mm on both sides. In primary gaze there was 24 degrees of exotropia, 17 degrees of right hypertropia and 30 degrees of exyclorotation. THERAPY AND OUTCOME: After 24 months of stable evolution, three oculomotor surgical procedures were performed including: surgery on both horizontal muscles of the left eye; shortening of both superior oblique muscles; resection of the right lateral rectus muscle, and posterior fixation of an inferior rectus muscle. Bilateral brow suspension on the frontal muscle of both superior eyelids was then performed. Evolution was favorable with a binocular single field of vision measuring 17 degrees horizontally and 20 degrees vertically centered on the primary gaze. Palpebral fissures measured 7 to 8 mm in primary gaze. CONCLUSIONS: The neuro-ophthalmological sequelae which followed the biopsy of a neurosarcoidosis lesion of the quadrigeminal plate were so severe that this patient was completely handicapped. A four-step surgery correcting the horizontal, torsional, vertical components, then the bilateral ptosis allowed the patient to recover both a satisfying function and esthetical aspect.

Adult↗
PubMed2006

[The Tsunami of 2004: Diagnosis of trauma sequelae in primary care].

This report amplifies specific needs and concerns related to primary care for patients with trauma-related disorders who seek help at private practices. The review focuses on potential psychological sequelae in victims of mass emergencies, such as the Tsunami-Disaster of December 26, 2004 in the Indian Ocean. General recommendations for treatment of traumatically stressed patients are proposed, particular features of such treatment are outlined. Furthermore, potential comorbid disorders and possible future courses of trauma-related disorders are outlined. Finally, frequently used psychodiagnostic screening-methods in current psychotraumatology are introduced.

Algorithms↗
PubMed1989

[Psychological sequelae of persecution. The survivor syndrome].

In the present decennium, the fifth after the end of the Nazi holocaust, the psychological sequelae in the survivors are far from being overcome, and this chapter of psychiatry is not yet closed. The clinical symptomatology of the survivor's syndrome had only gradually been described during a period of about 20 postwar years. Among the particularities of what survivors experienced were their being outlawed, discrimination, defamation, total absence of rights, loss of individuality, life threatening over a long period, being uprooted, the fact of little number of survivors in one's family and elsewhere, lack of grave for the victims, loss of language, culture and home and many others. Characteristics of the survivor's syndrome are continuing anxiety of being persecuted, struggle against memory, tension feeling, rumination over past, low self esteem, irritability, feeling of survivor's guilt, lack of initiative, retreat in apathy, unability of gaiety and to enjoy the pleasures of life, and return of the persecution in dreams among others. Discussions on care and treatment for the aging survivors now is still vivid in many countries. As a consequence of the holocaust experience remains our knowledge that even a fully built up and equilibrated personality can completely be altered, if circumstances are forcing. Further on it has become more clear that there is a transmission if in altered form of the personality changes to at least the second and third generations. In spite of its many difficulties and setbacks psychiatric help is possible, so that there has developed psychiatry of the persecuted as a new branch of psychiatry.

Adaptation, Psychological↗
PubMed1986

[Sequelae of craniocerebral injuries in a neurologic patient sample--an attempt at interpreting post-traumatic headache].

The sequelae of a head injury that had occurred at least six months previously, were examined in 457 patients. Neurological deficiencies, psychoorganic disturbances and disability caused by the injury correlated positively with its severity. Posttraumatic epilepsies were diagnosed approximately equally often in patients with minor head injuries and in those with more severe ones. It is probable that epilepsies have been diagnosed too often in patients with minor head injuries. Headache occurs significantly more often in patients with minor head injuries. This cannot be explained by the selection of patients alone. A hypothesis explaining the development of posttraumatic headache is presented and discussed.

Brain Concussion↗
PubMed1994

[Long-term psychological sequelae of spontaneous abortion: do medical management, recent pregnancy and delivery really help in coping with grief?].

86 patients with spontaneous abortion were interviewed and followed up in a longitudinal study with an interview and standardised questionnaires shortly after the D&C at 7, 13 and 24 months later. Our results indicate profound and long-term adverse psychological sequelae. For most of the patients, a spontaneous abortion was considered to be of major importance. Without regard to the gestational age or ultrasonographic image, the embryo is represented early in fantasies and dreams as a child. The severity of grief reactions following abortion did not correlate well with gestational age or a new pregnancy. Mourning is still present 24 months after the abortion. While grief decreases continuously during the first 7 months following abortion, despair remains constant and self-reproachful coping shows even a statistically significant increase between months 13 and 24. The reason is, because 20% of patients develop a pathological grief reaction with an increase in depression, self-reproachful coping and physical complaints. This risk group of patients, who needs closer and more detailed observation and guidance, may be recognised as early as at the time of abortion.

Abortion, Spontaneous↗
PubMed1996

Alloimmune thrombocytopenia of the newborn: neurodevelopmental sequelae.

Alloimmune thrombocytopenia of the newborn (AITN) is due to the transplacental passage of maternal antibodies directed against fetal platelet antigens, most commonly PLA, (HPA-1a). Sensitization and clinical manifestations of disease can occur in the first pregnancy. It carries a mortality rate of 15%, usually due to intracranial hemorrhage (ICH). Twenty-four cases of AITN were reviewed, five of whom had radiological evidence of ICH in utero. Petechiae and/or bruising were present in 14 babies. Platelet counts at birth ranged from 5 to 206 x 10(9)/L. One infant died. The duration of follow-up for the four survivors of ICH ranged from 15 to 71 months. All had serious neurodevelopmental sequelae, including severe mental retardation, cortical blindness, seizures, and cerebral palsy. The emotional and financial cost created by the care of these children is immeasurable. Steps to identify and prevent AITN should be part of routine prenatal care if we are to reduce the morbidity and mortality caused by this disorder.

Antigens, Human Platelet↗
PubMed1990

[Apathy syndrome as a sequela of postoperative irradiation of brain tumors in children].

The somnolence syndrome is a postirradiation syndrome in children. It is to be found after cranial irradiation of chemotherapeutically treated children with ALL (acute lymphocytic leukaemia). Rarely, however, it is a radiation sequela of operated cerebral tumors. We report on such a case of somnolence syndrome, review the literature and discuss the diagnostic and therapeutic problems.

Arousal↗
PubMed1983

[Treatment of sequelae of burns on the trunk].

The management of burn scars of the trunk is discussed, in respect of the specific problems related to different areas such as the axilla, thorax and back, the female breast and the perineum as well as the external genitalia. Special emphasis is placed on the different aspects of burn sequelae of the female breast with regard to pre- and postpuberty age. The prevention and therapy of the burn scar carcinoma are dealt with.

Axilla↗
PubMed1993

Somatosensory evoked potentials and cognitive sequelae in children with closed head-injury.

In search of a prognostic indicator for residual cognitive function loss in children after closed head-injury, the somatosensory evoked potential P300 has been studied in a prospective follow-up study of 17 patients with mild and moderately severe head-injuries. The P300 response was measured in the acute phase after patients regained consciousness. In addition the duration of coma and of post-traumatic amnesia were recorded. An age-matched control group of 20 healthy children supplied age-related normative evoked potential data. During a two-years follow-up period the presence of residual disorders in various faculties was evaluated at fixed time intervals after discharge. Correlation analyses revealed that, where the duration of coma and of post-traumatic amnesia qualify as general predictors of sequelae, the long-latency somatosensory evoked potential P300 correlated specifically with long-term deficits in the field of school performance.

Achievement↗
PubMed2000

Injury to the major airways during subtotal esophagectomy: incidence, management, and sequelae.

OBJECTIVE: The objective of this study was to gain insight into the incidence and sequelae of injury to the major airways during subtotal esophagectomy. METHODS: We performed an analysis of 383 consecutive patients undergoing this procedure between 1993 and 1999. Indications were adenocarcinoma (220), squamous cell carcinoma (121), and other (42). Transhiatal resection was done in 269 (70%) patients and transthoracic resection in 114 (30%). RESULTS: There were 4 men and 2 women (median age 57 years; range 45 to 68 years) with injury to the major airways, recognized during surgery in 5 patients and on the first postoperative day in the other. Five lesions occurred during transhiatal resection (5 of 269 = 1.8%) and 1 during transthoracic resection (1 of 114 = 0.8%; P =.67). The injury occurred proximal to the carina in 5 patients and in the left main bronchus in the other. All injuries could be closed primarily. The defect was covered with pericardium in 1 patient and with pleura in 2 patients. In all cases the gastric tube was placed over the defect. Pulmonary complications developed in 4 patients. Patients with tracheal injury required artificial ventilation for a longer period (median 6 days vs 1 day; P =.02) and stayed longer in the intensive care unit (median 11 vs 3 days; P <.01) than patients without such injury, although hospital time was not significantly prolonged (median 23 vs 16 days; P =.09). There was no associated mortality. CONCLUSION: Tracheobronchial injury is a rare complication of subtotal esophagectomy. It can be managed effectively by primary closure and apposition of vital tissue (gastric tube) to the defect. It is associated with pulmonary complications, leading to prolonged assisted ventilation and stay in the intensive care unit, but mortality is rare.

Adenocarcinoma↗
PubMed1986

Late hemodynamic sequelae of deep venous thrombosis.

Twenty-nine limbs in 19 patients who had deep venous thrombosis documented by phlebography were studied by hemodynamic techniques 2 to 13 years later (mean, 7 years). Two limbs were found to be "normal." Nine limbs were hemodynamically obstructed; the remaining 18 limbs had developed reflux abnormality. All of the nine limbs with obstruction demonstrated symptoms of severe swelling or ulceration. In contrast, limbs with valve reflux were either asymptomatic or had only mild to moderately severe symptoms. Correspondingly, the reflux hemodynamic derangement was also mild, with reflux confined to a single level (commonly the popliteal valve). The implications of the differences in clinical presentation and hemodynamic profile between this group with post-thrombotic valve reflux and the typical patient with stasis caused by chronic venous insufficiency are explored. The natural history of stasis sequelae of deep venous thrombosis has apparently changed somewhat since the introduction of anticoagulation therapy.

Arm↗
PubMed1989

Neurologic sequelae of unilateral carotid artery occlusion: immediate and late.

Over a 7-year period (1980 to 1987) 24 patients (18 men: mean age 67 years; range, 52 to 78 years, and six women: mean age 67 years; range, 46 to 82 years) undergoing serial carotid artery duplex scans were observed to progress to unilateral carotid artery occlusion. The occlusions were associated with ipsilateral strokes in six (25%), ipsilateral transient ischemic attacks in four (16%), and the onset of nonhemispheric symptoms in one (5%). Thirteen patients had no symptoms. Follow-up ranged from 4 months to 96 months (mean 39.4 months). Late neurologic events comprised two strokes, three transient ischemic attacks and the onset of nonhemispheric symptoms in six, which in some were disabling. Thirteen patients had no symptoms. Three deaths occurred (one was stroke related). For late events by life-table analysis, the average annual rate over the first 2 years for stroke was 10% and for transient ischemic attack 13%. The combined rate for transient ischemic attack and stroke was 20% per annum. For nonhemispheric symptoms the rate for the first year was 31%. It is concluded that unilateral carotid artery occlusion is associated with an unacceptable incidence of immediate neurologic sequelae and that such patients continue to have a high rate of late neurologic deficits at follow-up. Therefore it seems appropriate that patients who are observed to progress to high-grade stenosis and are therefore at risk for immediate occlusion should undergo prophylactic carotid endarterectomy.

Aged↗