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PubMed1994

Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy.

PURPOSE: To examine behavioral dimensions of treatment outcomes for patients receiving cranial irradiation. Radiation encephalopathy is one of these and refers to significant cognitive and emotional dysfunction following radiation therapy to the brain. Issues of definition, estimated incidence, pathophysiologic mechanisms, and recommended research designs are reviewed in relationship to functional neurobehavioral outcomes. PATIENTS AND METHODS: Twenty-nine studies of adults receiving therapeutic cranial irradiation (TCI) involving 748 patients and 18 studies of prophylactic cranial irradiation (PCI) involving 368 patients are reviewed. Assessment of patient outcomes are summarized for research published since 1980, with specific attention to adverse changes in cognitive and emotional functioning. RESULTS: Analyses revealed that 213 TCI patients and 100 PCI patients showed encephalopathy attributed to radiation. Manifestations of the late delayed effects of radiotherapy on brain function are related to patient age, total dose of irradiation, fraction sizes, and timing of chemotherapy. Radiation encephalopathy appears to be more common than the pathologic tissue injury of radiation necrosis. Accurate diagnosis of these neurobehavioral sequelae can require follow-up over a period of years with sensitive assessment procedures. CONCLUSIONS: It is likely that the true incidence of treatment-related side effects of cranial irradiation in adults who survive more than 6 months without brain tumor growth or recurrence has been significantly underestimated. Research designs that include formal neuropsychologic assessment in conjunction with other neurodiagnostic tests can provide more comprehensive evaluation of long-term neurobehavioral outcomes.

Brain↗
PubMed1995

Cognitive sequelae of treatment in childhood acute lymphoblastic leukemia: cranial radiation requires an accomplice.

PURPOSE: We evaluated cognitive sequelae of treatment for childhood acute lymphoblastic leukemia (ALL). CNS therapy consisted of cranial irradiation (CRT) or no radiation. Children were also randomized to single intravenous high-dose methotrexate (HD-MTX) or conventional-dose methotrexate (CD-MTX) during induction, and all patients received intrathecal (IT) and systemic continuation chemotherapy. PATIENTS AND METHODS: Sixty-six patients treated for ALL on Dana-Farber Cancer Institute protocol 87-01 were evaluated by standardized cognitive and achievement tests. These children had been assigned at diagnosis to a standard-risk (SR) or high-risk (HR) group and received no CRT or 18 Gy CRT, respectively. All patients were randomized to receive MTX during remission induction, either as CD-MTX (40 mg/m2) or HD-MTX (4 g/m2) with leucovorin rescue. RESULTS: There was no difference in cognitive outcomes between radiated and unirradiated patients (P > .4). However, the HD-MTX/CRT combination was associated with decreased intelligence quotient (IQ estimate, 9.3 points) for girls only (P < .08). A specific deficit in verbal coding and memory was documented for all patients (P < .0001). CONCLUSION: We conclude the following: (1) 18 Gy CRT per se was not an independent toxic agent for cognitive outcome; (2) HD-MTX during induction was associated with IQ decline in girls, but only when it was followed by CRT; and (3) impairment of verbal memory and coding was a consistent finding that was independent of CRT, which implicates some component of chemotherapy, possibly prednisone, as a CNS toxin.

Analysis of Variance↗
PubMed1996

Late psychosocial sequelae in Hodgkin's disease survivors: a French population-based case-control study.

PURPOSE: To evaluate late psychosocial sequelae in long-term survivors of Hodgkin's disease (HD) in the population of Calvados, France. PATIENTS AND METHODS: Ninety-three patients issued from the Calvados General Tumor Registry, treated from 1978 to 1990, free of relapse and second malignancy since January 1991, were enrolled onto cross-sectional case-control study. One hundred eighty-six healthy controls, matched for sex, age, and residency, were selected at random from electoral rolls. Two self-administered questionnaires were mailed in the spring of 1995. RESULTS: Compared with controls, HD patients reported (1) more physical (P < .001), role (P < .001), and cognitive (P = .015) functioning impairments, as well as dyspnea (P < .001) and chronic fatigue (P = .025), while no statistical difference was found in global health status; (2) to be more often childless (P = .04), fewer divorces or separations (P = .013), fewer changes in relationships with friends (P = .012), similar proportions at work but less ambitious professional plans (P < .001), and greater difficulties in borrowing from banks (P < .001); (3) a slight increase in the number of visits to a general practitioner (P = .05) and greater consumption of medical resources (mainly thyroid extracts, P = .05). CONCLUSION: The study demonstrated that French long-term HD survivors have good global health status and good psychologic, familial, and professional status, although difficulties in borrowing from banks remain a major limitation in daily life. Although physical, role, and cognitive functioning impairments persist that might limit their activities, HD survivors seem to have learned to cope with problems related to their disease and its treatment.

Activities of Daily Living↗
PubMed2000

Long-term sequelae of prefrontal cortex damage acquired in early childhood.

Frontal lobe dysfunction is often invoked as a contributing factor in developmental disorders characterized by chronic maladaptive behavior, but interpretation of relevant neuropsychological findings has been hampered by the limited information available regarding the consequences of focal prefrontal damage early in life. We describe here the long-term behavioral and cognitive sequelae of damage to prefrontal cortex in two young adult patients who had sustained their brain damage prior to 16 months of age. In the context of normal neurological examinations, both cases had remarkable histories of impaired decision making, behavioral dyscontrol, social defects, and abnormal emotion. Performances were primarily normal on a broad range of neuropsychological measures (intellect, memory, language, academic achievement, visual perception, and visuoconstruction), but selective impairments of executive function were evident. Early dysfunction in the prefrontal region may result in severe and chronic social maladjustment despite largely normal cognitive abilities. These findings can help inform neuropsychological evaluation of patients with possible prefrontal dysfunction in the setting of developmental disabilities or early brain trauma.

Adult↗
PubMed1999

Homesickness in preadolescent and adolescent girls: risk factors, behavioral correlates, and sequelae.

Examined homesickness in 117 girls ages 8 to 16 during a 2-week stay at summer camp. (Homesickness is the distress or impairment caused by an actual or anticipated separation from home. It is characterized by acute longing and preoccupying thoughts of home and attachment objects.) Elevated preseparation levels of homesickness, high expectations of homesickness, negative separation attitudes, low decision control, and little previous separation experience predicted in-camp levels of homesickness. During the separation, homesickness was associated with insecure interpersonal attitudes, negative initial impressions of the novel environment, high perceived distance from home, and low perceived control. Female surrogate caregivers rated homesick girls as having lower social status and more somatic complaints, social problems, and externalizing behavior than less homesick girls. Although the prevalence, intensity, and longitudinal course of homesickness in girls did not differ from analogous samples of boys, girls' profile of risk factors, correlates, and sequelae is unique in its mixed behavioral presentation and small correlations with age and experience.

Adolescent↗
PubMed2002

Neuropsychological and psychiatric sequelae of pallidotomy for PD: clinical trial findings.

OBJECTIVE: To evaluate the neuropsychological and psychiatric sequelae of unilateral posterior pallidotomy for treatment of PD. METHODS: Patients with idiopathic PD completed baseline and 3- and 6-month assessments after random assignment to an immediate surgery (n = 17) or medical management (n = 16) group. RESULTS: Compared with the medical management group, the immediate surgery group with single lesions centered on the posterior internal pallidum showed superior naming and response inhibition, better verbal recall at 6 months, but greater distractibility, a tendency toward lower phonemic fluency, and a transient (3 months' only) semantic fluency deficit. The group with left lesions had more neuropsychological deficits than the group with right lesions or the medical management group, although these occurred mainly at 3 (but not 6) months. At 6 months, the patients with left lesions showed better verbal memory retention than the patients with right lesions. On most measures, the pattern of individual clinical change did not differ as a function of surgery or lesion laterality, with the exception of a higher frequency of decline in phonemic fluency in the patients with left lesions at 6 months. Although psychiatric status did not change overall, a history of depression tended to increase the risk of a depressive episode following surgery. CONCLUSIONS: Well-targeted, uncomplicated, unilateral pallidotomy does not produce overall neuropsychological or psychiatric change, although there are subtle changes on specific measures sensitive to frontal lobe function.

Aged↗
PubMedDate not supplied

Intraoperative awakening for early recognition of possible neurologic sequelae during Harrington-rod spinal fusion.

To permit early recognition of possible cord trauma due to spinal fusion with Harrington-rod instrumentation, 42 patients were awakened introperatively for testing voluntary motor function of the limbs. N2O-O2-curare and morphine were used for anesthesia in all patients. In 5 patients, who refused IV induction, halothane was given for induction only. Only 1 patient had any complaint referrable to being awakened intraoperatively. The awakening caused no displacement of Harrington rods in any patient. No neurologic sequelae were found.

Adolescent↗
PubMed1984

Sequelae associated with head injuries in patients who were not hospitalized: a follow-up survey.

Data about sequelae associated with head injuries in patients presenting at a suburban hospital but not hospitalized were collected from emergency department medical records and two follow-up telephone interviews. During the study period 669 patients with head injuries were discharged from the emergency department. Of these, 288 were asked to participate in the study, 275 (95%) agreed, and 262 (91%) were eventually contacted. Participants and nonparticipants were compared on six variables and differed significantly only on age--younger patients were more likely to be included. Forty-eight hours after trauma, 52% of the respondents suffered headaches, 14% complained of dizziness, and 13% complained of drowsiness. One week after trauma, the complaints were headaches in 27%, dizziness in 11%, and drowsiness in 9%. Twenty-seven per cent had not resumed normal activity at 48 hours after trauma, and 13% had not at 1 week. Sixty-six per cent of the patients followed the patient instructions regarding head injuries.

Adolescent↗
PubMed1992

Acute myocardial infarction in a young adult as possible sequela of Kawasaki disease--a case report of successful intracoronary thrombolytic therapy and histological study of an aneurysm.

Emergency coronary angiography in a 28-year-old male suffering an acute anteroseptal myocardial infarction revealed complete obstruction of the left anterior descending artery in association with multiple aneurysms of the 3 major coronary arteries. Successful intracoronary thrombolytic treatment with urokinase infusion directly into the infarct-related artery was performed 2 h after the onset. Follow-up left ventriculogram showed preservation of left ventricular wall motion. Fifty days after the infarction, he underwent aorto-coronary bypass surgery. Histological examination of the biopsy specimen obtained from the aneurysm of the distal portion of the right coronary artery revealed that the 3-layer architecture of the arterial wall had been completely lost. The wall was replaced by fibrotic tissue, with slight mononuclear cell infiltration around the small vessels, but no acute inflammatory reaction or atheromatous change was seen. In spite of the presence of the coronary risk factors of hypertension and hyperlipidemia, angiography revealed no evidence of atherosclerosis of systemic arteries. It is suggested that the coronary aneurysms in this case are possible sequelae of Kawasaki disease in childhood.

Adult↗
PubMed1994

Surgical treatment of ventricular septal defect and its sequelae in adults.

We operated on 20 adult patients with ventricular septal defect (VSD). In 7 of these cases (aged 36 to 51 years, average 42.6 years), VSD was accompanied by sequelae other than pulmonary hypertension. Concomitant procedures in type-I VSD included a suspension of the prolapsed aortic cusp in 2 patients, a repair of the ruptured sinus of Valsalva in 2, and a new procedure for active infective endocarditis, described below, in 2. In this latter procedure, the aortic valve and infected Valsalva sinus were excised, and the pulmonary valve and the right ventricular wall to which the infection had extended were thoroughly debrided. The resulting defect was closed with a single patch, and a prosthetic valve was inserted in the position of the original aortic valve using this patch as part of the annulus. Another patient with the type-II VSD underwent concomitant tricuspid valve replacement for infective endocarditis. In the mean follow-up period of 77.1 months, 6 patients have been doing well in New York Heart Association class I, and the remaining patient with Valsalva repair remained in class II due to dilated cardiomyopathy.

Adult↗
PubMed1985

Untoward sequelae of prolonged intubation.

Laryngeal sequelae following prolonged endotracheal intubation are being observed with increasing frequency as this technique of airway management is being employed for extended periods of time. Many etiologic factors have been implicated in the development of these problems with the exact reasons being as yet unknown. After reviewing the records of 372 consecutive patients intubated over an 18-month period, we have observed an increased frequency of these complications in the diabetic female patient and suggest that early tracheostomy should be considered in these individuals when the use of prolonged intubation is anticipated. The possible pathophysiology of this problem in the diabetic, as well as the non-diabetic intubated patient, and its possible prevention will be discussed.

Adult↗
PubMed1990

Head and neck sequelae of cardiac transplantation.

Cardiac transplantation has become the treatment of choice for end-stage cardiomyopathies. In 1987, nearly 2000 cardiac transplants were performed in the United States. Otolaryngologists will be asked with increasing frequency to evaluate and treat these patients. The otolaryngology service at Loyola University Medical Center has been involved in the follow-up and treatment of head and neck complications in 100 transplant patients. Sixty percent of these patients manifest head and neck sequelae. The results of this review are presented. The otolaryngologist should be aware of the special features of this patient population that require modification of the treatment approach, such as 1. the need to avoid the drugs erythromycin, trimethoprim/sulfamethoxazole, and ketoconazole, 2. the need to preserve the right internal jugular vein, and 3. the high risk of silent myocardial infarction. A discussion of these treatment modifications is provided. All patients should be treated in close communication with the medical transplant treatment team.

Candidiasis↗
PubMed1991

Uvulopalatopharyngoplasty: evaluation of postoperative complications, sequelae, and results.

A study of 71 patients with obstructive sleep apnea syndrome was performed to evaluate the effectiveness, complications, and late sequelae of uvulopalatopharyngoplasty. Postoperative immediate complications were of minor importance. In 96% of the patients, the snoring was improved; it was completely resolved in 48%. The postoperative apnea index remained pathologic in all patients who underwent postoperative polysomnography, although mild improvement was noted. Seventy-four percent of our patients felt a subjective postoperative improvement which was not always confirmed by the polysomnographic examination. A record of improvement was obtained in 64% of the operated patients. Our results establish the beneficial effect of uvulopalatopharyngoplasty, which is the recommended surgical procedure for obstructive sleep apnea syndrome.

Adult↗
PubMed2006

Testis and antler dysgenesis in sitka black-tailed deer on Kodiak Island, Alaska: Sequela of environmental endocrine disruption?

It had been observed that many male Sitka black-tailed deer (Odocoileus hemionus sitkensis) on Kodiak Island, Alaska, had abnormal antlers, were cryptorchid, and presented no evidence of hypospadias. We sought to better understand the problem and investigated 171 male deer for phenotypic aberrations and 12 for detailed testicular histopathology. For the low-lying Aliulik Peninsula (AP), 61 of 94 deer were bilateral cryptorchids (BCOs); 70% of these had abnormal antlers. Elsewhere on the Kodiak Archipelago, only 5 of 65 deer were BCOs. All 11 abdominal testes examined had no spermatogenesis but contained abnormalities including carcinoma in situ-like cells, possible precursors of seminoma; Sertoli cell, Leydig cell, and stromal cell tumors; carcinoma and adenoma of rete testis; and microlithiasis or calcifications. Cysts also were evident within the excurrent ducts. Two of 10 scrotal testes contained similar abnormalities, although spermatogenesis was ongoing. We cannot rule out that these abnormalities are linked sequelae of a mutation(s) in a founder animal, followed by transmission over many years and causing high prevalence only on the AP. However, based on lesions observed, we hypothesize that it is more likely that this testis-antler dysgenesis resulted from continuing exposure of pregnant females to an estrogenic environmental agent(s), thereby transforming testicular cells, affecting development of primordial antler pedicles, and blocking transabdominal descent of fetal testes. A browse (e.g., kelp) favored by deer in this locale might carry the putative estrogenic agent(s).

Alaska↗
PubMed2005

Late orthopaedic sequelae following meningococcal septicaemia. A multicentre study.

Between 1990 and 2001, 24 children aged between 15 months and 11 years presented with late orthopaedic sequelae after meningococcal septicaemia. The median time to presentation was 32 months (12 to 119) after the acute phase of the disease. The reasons for referral included angular deformity, limb-length discrepancy, joint contracture and problems with prosthetic fitting. Angular deformity with or without limb-length discrepancy was the most common presentation. Partial growth arrest was the cause of the angular deformity. Multiple growth-plate involvement occurred in 14 children. The lower limbs were affected much more often than the upper. Twenty-three children underwent operations for realignment of the mechanical axis and limb-length equalisation. In 15 patients with angular deformity around the knee the deformity recurred. As a result we recommend performing a realignment procedure with epiphysiodesis of the remaining growth plate when correcting angular deformities.

Adolescent↗
PubMed2004

Appraisal theory and emotional sequelae of first visit to colposcopy following an abnormal cervical screening result.

OBJECTIVES: Attendance at colposcopy following an abnormal cervical smear is potentially a highly distressing event. This study evaluates the role of cognitive appraisal components (Lazarus, 1991; Smith et al., 1993) in explaining emotional reactions to this event. We also compare the psychological sequelae of immediate treatment at first colposcopy (See and Treat, ST) vs. colposcopy with treatment deferred to a later date (Diagnose and Defer, DD). METHOD: One thousand and eighty-five women referred for colposcopy completed a questionnaire assessing appraisal and emotion following their attendance. Clinical data were abstracted from medical records and social deprivation scores were estimated from postal code information based on normative data. RESULTS: Diagnosis and cognitive appraisals were each significantly associated with emotion, together accounting for between 3 and 15% of variance in different emotions. Specific patterns of appraisal explained specific emotions in line with theoretical predictions. Women with Cervical Intraepithelial Neoplasia (CIN) 2 or CIN 3 undergoing 'ST' were less anxious, less embarrassed and significantly more relieved compared with a matched sample of women undergoing 'DT', and perceived their first appointment as more motivationally congruent. CONCLUSION: Diagnosis, motivationally incongruent experiences and low emotion-focused coping potential are the most important determinants of anxiety after colposcopy. 'See and Treat' appears to have a positive psychological impact by increasing motivational congruence.

Adolescent↗
PubMed1992

Long-term sequelae after recovery from cytomegalovirus pneumonia in allogeneic bone marrow transplant recipients.

The clinical course of cytomegalovirus (CMV) pneumonia in seven consecutive bone marrow transplant (BMT) recipients during a 24-month period was studied. Retrospective analysis of clinical data on the recipients with CMV pneumonia during the illness and prospective follow-up of those who recovered from the pneumonia was performed. Those who had CMV as the sole pathogen and with lymphocytosis in the BAL or the peripheral blood during the illness recovered from the pneumonia. On the contrary, those who had mixed bacterial or fungal infection with peripheral lymphopenia died. Persistent lymphocytosis in the BAL and the peripheral blood, in the absence of CMV infection, was observed in the survivors. Two subsequently developed restrictive lung disease and two had relapse of their primary malignancy. These data suggest that CMV pneumonia in BMT patients is associated with significant long-term sequelae. The phenomenon of persistent lymphocytosis in the BAL and the peripheral blood, in the absence of CMV infection, supports Grundy's hypothesis that CMV pneumonia in BMT recipients is an immunopathologic condition.

Bone Marrow Transplantation↗
PubMed1997

Ventilatory support during exercise in patients with pulmonary tuberculosis sequelae.

STUDY OBJECTIVE: The aim of this study was to determine whether intermittent positive pressure ventilation through a nasal mask (NIPPV) applied during exercise in patients with pulmonary tuberculosis sequelae (PTS) could improve arterial blood gas measurements, ameliorate breathlessness, and increase exercise endurance. PATIENTS: Seven PTS patients with a severe restrictive ventilatory defect (mean [SD] vital capacity, 1.02 [0.25] I) enrolled in this study had experienced NIPPV previously, and were familiar with the procedure. DESIGN: The patients underwent four constant-load cycle ergometer tests in the supine position to tolerance. The tests were performed with and without NIPPV, while breathing normoxic air (Air) or supplemental oxygen (O2; 35%). NIPPV was delivered during exercise in a controlled, volume-cycled mechanical ventilation mode, and the ventilator settings were modulated manually to meet patients' respiratory demands as estimated from the airway pressure waveform and the patient's breathlessness. RESULTS: All patients matched their breathing to the ventilator cycle during most of the exercise while receiving NIPPV. NIPPV significantly prolonged their exercise endurance time, from a mean (SD) of 180 (58) s to 310 (96) s in Air, and from 227 (64) s to 465 (201) s in O2. During exercise, NIPPV effectively decreased their breathlessness and significantly improved arterial blood gas measurements. CONCLUSIONS: NIPPV applied during exercise can effectively support ventilation, significantly ameliorate breathlessness, and consequently improve exercise endurance in patients with PTS.

Aged↗