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PubMed1984

Post-transplant obliterative bronchiolitis and other late lung sequelae in human heart-lung transplantation.

Since March 1981, 19 patients have undergone heart-lung transplantation for end-stage pulmonary vascular disease, with 14 long-term survivors. In five of the survivors, obstructive airway disease has developed with the superimposition of a progressive restrictive ventilatory defect in three of them. None of these five patients showed a tendency for spontaneous improvement of flow rates. Biopsy and postmortem material was available in four of the five patients and showed obliterative bronchiolitis (OB) in three. A fourth patient showed clinical and physiologic data consistent with obliterative bronchitis, but histologic material was not available. Obstructive lung disease without restrictive features developed in a fifth patient, but no histologic evidence of OB was found at transbronchial biopsy. In addition to OB, recurrent lung infections were found in all patients, significant pleural fibrosis in two patients, and bronchiectasis in one patient. Despite these long-term sequelae of human heart-lung transplantation, ten of the 14 surviving patients are leading relatively normal lives.

Adult↗
PubMedDate not supplied

Endocrine sequelae of childhood craniopharyngioma.

The endocrine sequelae of 62 children with craniopharyngioma were studied retrospectively. These patients were followed for a median duration of 3 years (range 1 to 10 years). Eighteen patients had a long-term follow-up for more than 5 years (range 5 to 10 years). Complete surgical resection was achieved in 30 patients and 32 patients had residual tumor. Twenty-five patients had recurrence or progression of the residual tumor and were treated with radiotherapy. Presenting complaints suggestive of endocrinopathy were infrequent. The most common presenting symptoms were headache, nausea and vomiting, followed by growth failure. Pre-operatively, growth hormone deficiency was the most commonly encountered pituitary hormonal deficiency; however postoperatively, most children had diabetes insipidus. Multiple pituitary hormonal deficiencies were more frequently observed in children treated with extensive radical surgery than in those treated with conservative surgery and radiotherapy. The endocrine morbidity associated with craniopharyngioma and its different management modalities remains high; however, it is manageable with appropriate hormonal replacement therapy.

Adolescent↗
PubMed2003

Sequelae of severe respiratory syncytial virus infection in infancy and early childhood among Alaska Native children.

OBJECTIVE: In 1993-1996, we conducted a nested case-control study to determine risk factors for hospitalization with respiratory syncytial virus (RSV) infection among Alaska Native infants and young children. In the current study, we returned to former RSV case-patients and their control subjects during 1999-2001 to determine whether children who are hospitalized with RSV at <2 years of age are more likely to develop chronic respiratory conditions. METHODS: For each former RSV case-patient and control subject from remote villages in southwest Alaska, we reviewed medical records, interviewed parents, performed physical examinations and spirometry, collected sera, and analyzed chest radiographs. Case-patients were identified through surveillance for RSV hospitalization, and matched control subjects without lower respiratory infection (LRI)-related hospitalization were identified. RESULTS: Hospitalization for RSV infection was associated with a significant increase in wheezing, LRIs, and asthma diagnosis during the first 4 years of life. The association decreased with age and was no longer significant by 5 years of age. However, hospitalization for RSV infection was associated with increased respiratory symptoms and increased chronic productive cough at 5 to 8 years of age. Children who were hospitalized with RSV were not more likely at follow-up to have allergies, eczema, or a positive family history of asthma. CONCLUSIONS: Severe RSV infection in infancy may produce airway injury, which is manifested in chronic productive cough with or without wheezing and recurrent LRIs. Although the association of RSV infection with wheezing seems to be transient, children remain at higher risk for chronic productive cough at 5 to 8 years of age. RSV prevention modalities may prevent sequelae that occur early and later in childhood.

Age Factors↗
PubMed2004

Long-term pulmonary sequelae in children who were treated with extracorporeal membrane oxygenation for neonatal respiratory failure.

OBJECTIVE: Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for neonates with intractable respiratory failure, but the long-term pulmonary outcome is unknown. Our aim was to investigate the long-term pulmonary sequelae of these children. STUDY DESIGN: We studied 50 children at 11.1 +/- 1.1 years (mean +/- SD) who had been treated with neonatal ECMO for meconium aspiration syndrome (38%), sepsis (18%), sepsis with pneumonia (12%), congenital diaphragmatic hernia (12%), congenital heart disease (8%), persistent pulmonary hypertension of the newborn (6%), and respiratory distress syndrome (4%) and 27 healthy controls (10.8 +/- 1.6 years). All subjects completed a respiratory questionnaire and performed pulmonary function and graded cardiopulmonary exercise testing. RESULTS: Neonatal ECMO survivors had hyperinflation (median residual volume: 131%), airway obstruction (median forced expired volume in 1 second: 79%), lower oxygen saturation with exercise, and lower peak oxygen consumption than controls. The ECMO group achieved similar exercise minute ventilation to controls, with more rapid and shallow breathing. ECMO survivors had an increased frequency of exercise-induced bronchospasm. Those who required higher inspired oxygen tension and ventilator pressures after weaning from ECMO had lower forced expired volume in 1 second and oxygen saturation values. CONCLUSION: Neonatal ECMO survivors experience lung injury lasting into later childhood. Lung dysfunction correlates with the extent and duration of barotrauma and oxygen exposure as neonates.

Adolescent↗
PubMed1989

[Nursing care and the neurological sequelae of measles].

The neurological sequelae after measles can be encephalitis or subacute sclerosing pan-encephalitis (SSPE). The encephalitis is lethal in 15-18% of the patients, that can rest handicapped at 25%. The SSPE is always lethal. The social and economical consequences of these problems are emphasised. It is suggested nursing care by Leavell & Clark levels of prevention.

Encephalitis↗
PubMed2000

Neuropsychological sequelae in Kleine-Levin syndrome: case report.

Kleine-Levin syndrome is characterized by periodic hypersomnia, hyperphagia, sexual disinhibitions and behavioral disturbances. The prognosis is generally benign, with normal cognitive and social functions after the episodes. We describe a typical case of Kleine-Levin syndrome associated with apparent academic decline, neuropsychological sequelae and personality alterations after the second episode of the illness. Further research in the natural history of Kleine-Levin syndrome is needed, for example, to determine whether early intervention would improve long-term prognosis.

Adolescent↗
PubMed1994

Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective.

Severe, symptomatic hyponatremia is often treated urgently to increase the serum sodium to 120 to 130 mmol/L. Recently, this approach has been challenged by evidence linking "rapid correction" (> 12 mmol/L per day) to demyelinating brain lesions. However, the relative risks of persistent, severe hyponatremia and iatrogenic injury have not been well quantified. Data were sought on patients with serum sodium levels < or = 105 mmol/L from the membership of the American Society of Nephrology. Respondents were given a report form asking specific questions regarding the cause of hyponatremia, presenting symptoms, rate of correction, and neurologic sequelae. Data on 56 patients were analyzed. Fourteen developed posttherapeutic complications (10 permanent, 4 transient) after correction to a serum sodium > 120 mmol/L. Eleven of these 14 patients (including 3 with documented central pontine myelinolysis) had a biphasic course in which neurologic findings initially improved and then worsened on the second to sixth day. Posttherapeutic complications were not explained by age, sex, alcoholism, presenting symptoms, or hypoxic episodes. Increased chronicity of hyponatremia and a high rate of correction in the first 48 h of treatment were significantly associated with complications. No neurologic complications were observed among patients corrected by < 12 mmol/L per 24 h or by < 18 mmol/L per 48 h or in whom the average rate of correction to a serum sodium of 120 mmol/L was < or = 0.55 mmol/L per hour. It was concluded that patients with severe chronic hyponatremia are most likely to avoid neurologic complications when their electrolyte disturbance is corrected slowly.

Adult↗
PubMed1994

Chronic neurological sequelae to organophosphate pesticide poisoning.

OBJECTIVES: This work was undertaken to determine whether there are any chronic neurological sequelae to acute organophosphate pesticide poisoning. METHODS: California surveillance data were used in a study of neurological function among 128 men poisoned by organophosphate pesticides in California from 1982 to 1990 and 90 referents. Tests included a neurological physical examination, 5 nerve conduction tests, 2 vibrotactile sensitivity tests, 10 neurobehavioral tests, and 1 postural sway test. RESULTS: After correcting for confounding, the poisoned group performed significantly worse than the referent group on two neurobehavioral tests (sustained visual attention and mood scales). When the data were restricted to men with documented cholinesterase inhibition (n = 83) or to men who had been hospitalized (n = 36), the poisoned subjects also showed significantly worse vibrotactile sensitivity of finger and toe. Significant trends of increased impairment were found with increased days of disability on a wide spectrum of tests of both central and peripheral nerve function. CONCLUSIONS: While these findings are limited by low response rates and by small sample sizes for specific pesticides, this study was based on a large surveillance database and is the largest study to date of the chronic effects of organophosphate pesticide poisoning. The evidence of some long-term effects of poisoning is consistent with two prior studies.

Adolescent↗
PubMed1996

Sleep oxygen desaturation in late sequelae of pulmonary tuberculosis.

Thirty-eight patients with late sequelae of pulmonary tuberculosis (TB seq.) were studied to clarify the characteristics of sleep desaturation in comparison with 40 patients with chronic obstructive pulmonary disease (COPD). While awake, the TB seq. group had a lower % VC and a higher PaCO2. In both groups, the sleep lowest SaO2 was positively correlated with the awake SaO2. The regression line between the sleep lowest SaO2 and the awake baseline SaO2 in the TB seq. group was located below that in the COPD group. Awake PaCO2 was negatively related to the sleep lowest SaO2 only in the TB seq. group. These results indicate that the sleep lowest SaO2 values were lower in TB seq. than in COPD patients with the same levels of SaO2 while awake. Sleep studies are necessary to reveal the indication for nocturnal oxygen therapy in TB seq. patients, especially when they are hypercapnic in spite of their good awake oxygenation.

Aged↗
PubMed1998

Nocturnal oxyhemoglobin desaturation and prognosis in chronic obstructive pulmonary disease and late sequelae of pulmonary tuberculosis. Respiratory Failure Research Group in Japan.

We prospectively examined the survival rate of 67 chronic obstructive pulmonary disease (COPD) and 74 late sequelae of pulmonary tuberculosis (TB seq) patients to clarify whether nocturnal oxyhemoglobin desaturation (NOD) could be one of the independent factors determining their mortality. The sleep monitoring of arterial oxygen saturation (SpO2) and pulmonary function tests were assessed in all patients at the time of registration. Forty % of COPD and 24% of TB seq died as the direct result of deterioration of chronic respiratory failure during the 7-year observation period. Cox's proportional hazards analysis showed that NOD was an independent prognostic factor in both groups, and this was especially prominent when evaluated in terms of sleep lowest SpO2 in COPD and 85% desaturation time in TB seq. No significant prognostic factor was observed among age, vital capacity percent predicted (%VC), forced expiratory volume in one second (FEV(1.0)%) and partial pressure of carbon dioxide (PaCO2). We conclude that the degree of NOD can affect mortality in COPD and TB seq.

Blood Gas Analysis↗
PubMed2006

Exercise training for the improvement of exercise performance of patients with pulmonary tuberculosis sequelae.

OBJECTIVE: To examine whether exercise training using nontreadmill walking is effective for the improvement of exercise performance of patients with pulmonary tuberculosis sequelae (PTS) characterized by restrictive ventilatory defect. PATIENTS AND METHODS: Fourteen patients with stable PTS hospitalized for assessment of exertional dyspnea in Fukujuji Hospital from April 1997 to March 1999 were enrolled in this observational study. All patients underwent baseline pulmonary function tests, arterial blood-gases analysis and exercise tests for initial assessment. Four patients were excluded because of hypoxemia during the initial treadmill test. The remaining 10 patients who stopped exercising because of symptom limitations became candidates for the exercise training. The patients were instructed to perform daily walking exercise training in a hallway in the hospital for 2 weeks. The training was started at their maximum walking speeds during the treadmill test, and walking speed was gradually increased as the patients gained confidence. After finishing the exercise training, the patients performed pulmonary function tests, arterial blood-gases analysis was done, and exercise tests were conducted in identical fashion to the baseline protocol. RESULTS: There were no significant changes in pulmonary function tests and arterial blood-gases analysis after the exercise training. Exercise tolerance improved with a significant increase in peak oxygen uptake (from 13.6+/-2.8 to 14.8+/-2.8 ml/kg/min, p<0.01) and distance covered in a 6-minute walk (from 399+/-62 to 467+/-65 m, p<0.01) after the exercise training. CONCLUSION: The exercise training we conducted is shown to be a safe and effective modality for the improvement of exercise performance of patients with PTS.

Adult↗
PubMed1991

Diffuse axonal injury and early intracranial sequelae in severe head injury.

The importance of diffuse axonal injury (DAI) and early intracranial sequelae was studied in 107 patients with diffuse and focal brain injuries. Comprehensive neuropathological study was also undertaken in 24 fatal patients. The mortality rate was clearly the highest in traumatic subarachnoid hemorrhage, followed by acute subdural hematoma, cerebral contusion with delayed hematoma formation, traumatic intracerebral hematoma, diffuse cerebral swelling, DAI with classical features, and finally nearly normal on computed tomographic scans. The mean flow velocities in the middle cerebral artery recorded by transcranial Doppler ultrasound were variable in diffuse brain injury, but commonly decreased on the hematoma side depending on increased intracranial pressure and decreased cerebral perfusion pressure in focal brain injury. Deep-seated hemorrhagic lesions did not expand in diffuse brain injury, but sizable hematoma developed within 24 hours in focal brain injury. The platelet count was significantly lower in patients with poor outcomes in focal brain injury. Histological evidence of classical DAI was found in eight (50%) of 16 cases with focal brain injury. DAI of varying severity is the common subjacent lesion in patients with severe head injury, but the final outcome varies greatly with different lesion types.

Axons↗
PubMed1990

Sequelae of attempted suicide by cyanide ingestion: a case report.

A twenty-eight-year-old man presented emergently after ingesting 800 mg of potassium cyanide in a suicide attempt. He survived only with intensive medical and psychiatric intervention, and went on to develop severe parkinsonian symptoms, including profound micrographia and hypersalivation. Bilateral, symmetrical basal ganglial abnormalities were demonstrated with magnetic resonance imaging. Survival following cyanide poisoning is rare; the clinical, radiologic, and neuropathologic sequelae in other documented cases are reviewed.

Adult↗
PubMed1995

Neuropsychiatric sequelae of stroke and traumatic brain injury: the role of psychostimulants.

OBJECTIVE: The primary purpose of this article is to review certain neuropsychiatric sequelae of stroke and traumatic brain injury (TBI), and the role of the psychostimulants methylphenidate (MPD) and dextroamphetamine (DAMP) in their treatment. METHOD: A general review of the topic is presented. Controlled and uncontrolled studies involving the use of the psychostimulants are discussed. These consist of 11 studies listed with Medline 2000 that deal specifically with stroke or head injury, with the oldest study reviewed dating back to 1984. Studies concerning the use of psychostimulants in the medically or neurologically ill are reviewed to the extent that they are pertinent. RESULTS: The current literature consists primarily of uncontrolled case studies. However, these are reviewed and found to suggest a role for the use of the psychostimulants, which is discussed. CONCLUSIONS: In general, these drugs appear to be a reasonable treatment choice for certain types of mood, behavior, and cognitive symptoms following brain injury. However, it is noted that larger scale controlled studies are needed to adequately assess the clinical usefulness of these drugs.

Brain Damage, Chronic↗
PubMedDate not supplied

Enduring psychiatric and neuropsychologic sequelae in the post-encephalitis patient.

Initial presentations of encephalitis are sometimes misdiagnosed as psychoses due to the predominance of psychiatric symptoms and frequently negative neurological work-ups. It is likely that many of these errors are never discovered. The patient described herein is an exception. Her symptoms, diagnosis, and treatment have now been followed for nearly two years and suggest not only that the initial diagnosis was in error but also that both psychiatric and organic symptoms can endure as sequelae of encephalitis. Questions regarding optimal treatment and reasons for clinical improvement are addressed.

Adult↗
PubMed1978

Sequelae of metrizamide myelography in 200 examinations.

Twenty pediatric and 180 adult patients underwent myelography using metrizamide (Amipaque). All patients were examined and interviewed before and after the studies. New or exacerbated symptoms attributed to metrizamide myelography were graded according to severity. After the procedure, 51 of 200 patients were unchanged from baseline. Headache was the most common complaint, with an overall incidence of 62%. Nausea and/or vomiting occurred in 38%. Back or leg pain, neck stiffness, temperature elevation, and a variety of less common manifestations were also observed. The incidence of sequelae was higher than in comparable Scandinavian studies with this contrast medium.

Adolescent↗
PubMed1993

Late CT findings in brain trauma: relationship to cognitive and behavioral sequelae and to vocational outcome.

OBJECTIVE: The purpose of this study was to determine the degree of correlation between cerebral atrophy observed on CT scans after severe blunt brain trauma and later neuropsychological status, as well as to evaluate the relative prognostic values of a number of indexes of cerebral atrophy. MATERIALS AND METHODS: The study group comprised 32 previously healthy men 18-65 years old who had severe blunt trauma of the brain (initial scores on Glasgow coma scale of 7 or less). Their cognitive and behavioral statuses were evaluated when the patients were discharged from the hospital, which occurred when the recovery process showed a plateau. Overall vocational status was evaluated 1 year after discharge. The clinical evaluation was performed by a multidisciplinary team. Multiple linear indexes derived from brain CT scans obtained about 3 months after injury in patients with blunt brain trauma were correlated with cognitive and behavioral sequelae of brain damage and with vocational placement, as evaluated by a rehabilitation team about 1 year after trauma. RESULTS: A high correlation was found between the width of the third ventricle and outcome. The prognostic value of the width of the third ventricle was superior to that of any other index studied, and it correlated best with late cognitive status (Spearman r = .57, p < .01). CONCLUSION: The width of the third ventricle is a useful prognostic index in cases of diffuse brain trauma. It indicates diencephalic atrophy, caused either by diffuse axonal injury or by hypoxia. It may indicate a role of diencephalic structures in higher cortical functions.

Adolescent↗
PubMed2003

Pathogenesis, pathology and pathophysiology of pulmonary sequelae of bronchopulmonary dysplasia in premature infants.

The incidence of bronchopulmonary dysplasia (BPD), defined as oxygen need at 36 weeks of postmenstrual age, is about 30% for infants with birth weights<1000 grams and is now infrequent in infants with >1200 grams birth weight and >30 weeks gestation. The pathogenesis of BPD is multifactorial, with cytokines appearing to play a key role in initiation, propagation and resolution of this process. The pathology of BPD seen in the pre-surfactant era was remarkable for the presence of airway injury, inflammation and parenchymal fibrosis; pathology of "new" BPD reveals more uniform inflation and less marked fibrosis with both small and large airways being free of epithelial metaplasia, smooth muscle hypertrophy and fibrosis. There is, however, an arrest in acinar development.Up to 50% of infants with BPD require readmission to the hospital for lower respiratory tract illness in the first year of life. There are significant effects on lung mechanics, gas exchange and pulmonary vasculature. Pulmonary outcome in BPD include normalization of pulmonary mechanics and lung volumes over time as somatic and lung growth occurs whereas abnormality of the small airway persists. Airway hyper-responsiveness has been reported in long-term survivors of BPD, with no decrease in exercise capacity. The majority of the radiological findings reveal persistence of mild to moderate abnormalities long term. BPD is a result of dynamic processes involving inflammation, injury, repair and maturation. Infants with BPD have significant pulmonary sequelae during childhood and adolescence; whether the pulmonary dysfunction in these patients will predispose them to obstructive lung disease as older adults, remains to be seen.

Bronchopulmonary Dysplasia↗