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PubMed1990

[Analysis of sequelae of the latissimus dorsi flap removal. Report of 44 cases reviewed and tested].

Since Tanzini, the latissimus dorsi muscle flap has been widely used in plastic surgery. Based on the experience of two plastic surgery units, we decided to try to define the sequelae of this operation. In order to simplify our analysis we only considered free flaps. Out study is based on 42 patients (26 pure muscular flaps and 16 musculo-cutaneous flaps). The sequelae were analysed in terms of aesthetic and functional criteria. The aesthetic sequelae appeared to be minima in the case of pure muscular flaps, but more severe in the case of musculo-cutaneous flaps. Functional sequelae in the shoulder were observed on muscle testing in 30% of cases, although there were no repercussions on sport or work activities. Analysis of spinal posture demonstrated a modification in the frontal plane in 40% of cases although this could not be clearly attributed to the donor site. On the basis of this study, we can conclude that the latissimus dorsi flap retains an important place in the therapeutic arsenal of plastic surgery due to its reliability and its minor cicatricial and functional sequelae at the donor site.

Back↗
PubMed1990

[Tuberculosis sequelae: clinical aspects].

We studied the pulmonary diseases which had developed as consequent deformities after healing of tuberculosis, which we called tuberculosis sequelae. Results are described as follows. 1. The frequency of tuberculosis sequelae was about 6% in the patients with pulmonary diseases admitted to our hospital. 2. 93 cases of them consisted of 4 groups, which were 39 of repeated bacterial infection of lower respiratory tract, 23 of pulmonary aspergilloma, 13 of atypical mycobacteriosis and 28 of chronic respiratory failure. 3. Patients with tuberculosis sequelae were distributed more in the younger age group than others with resembled pulmonary diseases. The men to women ratio was about 2:1. Patients with pulmonary aspergilloma were younger than those with atypical mycobacteriosis. 4. Death rate in tuberculosis sequelae was about 5% per year. 46% of patients with atypical mycobacteriosis and 44% with chronic respiratory failure died within 4 years. 5. In chest X-ray findings, fibrosis and shrinkage of the lung, compensatory pulmonary emphysema, deformity or dilatation of bronchi, bulla formation and residual tuberculous cavities were recognized in 40 to 65% of the cases. Severe pleural thickness or past thoracoplasty were frequently recognized in the patients with chronic respiratory failure. All the patients with pulmonary aspergilloma had one or more residual cavities. 6. The frequency of systemic complications was not more than in the control population matched by age. Comparatively, serum IgG and IgA were elevated and PHA-induced lymphocyte activation was not lowered in the patients with pulmonary aspergilloma and atypical mycobacteriosis. From these results, the main factor in the development of tuberculosis sequelae seemed to be local defects of the chest.

Adult↗
PubMed1990

[Tuberculosis sequelae: pathological findings].

Pathological examination of tuberculosis sequelae was carried out to clarify the nature and pathogenesis of sequela. Twenty-one cases were chosen from autopsied cases in the past 15 years; male 20, female 1, and age ranged from 43 to 78 and mean age was 59 years. Sequela cases were divided into two subgroups; low lung function subgroup (LLFS) and non-low lung function subgroup (NLLFS). LLFS had 10 cases and mean age was 55 years. Ten cases of bilateral fibrotic cavities, 10 cases of bilateral upper lobe atelectatic indurations, 4 cases of pneumonectomy, 4 cases of thoracoplasty, and others were basic lesions of sequela. Lobar atelectatic induration was formed of organized destructive pneumonia and suspected to follow the tuberculous granulomatous pneumonia. Seven cases of localized emphysema, 11 cases of bullae were seen as the secondary change. Mean heart weight was 335 gr and left ventricle + septum: right ventricle (LV+S: RV) ratio decreased to 1.24 among LLFS and mean heart weight 273 gr and Lv+S: RV ratio was 2.35 in NLLFS. Remaining of cavities were observed in 15 cases and Aspergillus infection was seen in 11 cases (7 cases formed fungus ball, 4 cases showed semi-invasive growth and 2 out of 4 showed necrotizing pneumonia and formed direct cause of the death). Terminal infection was seen in 10 cases. According to our data, chronic lung failure with cor pulmonale, secondary fungus infection in the remained cavity, and terminal infectious pneumonia were serious consequence of tuberculosis sequela.

Adult↗
PubMed1986

Sequelae of acute bacterial meningitis in children treated for seven days.

The sequelae of acute bacterial meningitis in children who were treated with ampicillin or chloramphenicol for seven days during the period January 1979 to June 1983 were assessed prospectively. The 235 patients (117 boys and 118 girls) ranged in age from four days to 18 years (mean 26.4 months). Haemophilus influenzae type b was isolated in 70% of patients, Streptococcus pneumoniae in 20%, and Neisseria meningitidis in 10%. The mortality rate was 6.4%. No relapses occurred. Of the 220 survivors, 171 had neurologic psychometric, audiologic, and ophthalmologic assessments performed for a minimum of 1 year following their illness. One hundred thirty-six (80%) children had no detectable sequelae; 20% had mild to severe handicaps. The frequency of sequelae was greatest among children with S pneumoniae meningitis (57%) and least among children with N meningitidis (0%). The sequelae observed included: sensorineural hearing loss (12.9%), developmental delay (5.3%), speech defect (4.7%), motor defect (3.0%), hydrocephalus (1.7%), and seizure disorder (1%). The frequency of observed sequelae among these patients is similar to that previously reported in children treated for ten to 14 days. Our findings indicate that seven days of intravenous antibiotic therapy is adequate for the treatment of bacterial meningitis in children.

Adolescent↗
PubMed1989

[Permanent sequelae of injuries in the otorhinolaryngology field].

The present retrospective study was aimed to scrutinize constant traumatic sequelae in otorhinolaryngology on 586 traumatic reports, which have been documented by the Bohemian State Insurance starting from 1965 to 1985. Constant sequelae appeared to be subsequent both to individual damages of otorhinolaryngologic organs and multiple traumas, from them 59.4% affected the ear region. Most frequently were presented the partial hearing loss, deafness, and labyrinth lesions especially in multiple traumas. As to the nasal area, the amount of 22.7 per cent consisted of external nasal shape deformities with the disordered passage, and olfactory disorders in multiple traumas. The remaining 17.9% sequelae was concerned with the anatomical and functional lesions of other otorhinolaryngologic organs. To determine features and the extent of constant sequelae, most current diagnostical approaches and consiliary examinations were used. However, the objective assessment of olfactory disorders and tinnitus aurium is stated to be still diagnostically intricated. Both the simulation and aggravation were found out in 2.5% of insurers. Other relations were also studied, e.g.: insurer vice versa physician. In addition to other causes, the most frequent ones represented an underestimation of traumatic consequences all along with their erroneous treatment, low levelled outpatient care of ORL specialists as to the multiple trauma management outside ORL service. In many instances, the injured subjects were not appropriately recommended to provide them with simple and effective surgical treatment of yet manifested constant sequelae. The proper expertize activity was complicated with the defective trauma documentation, terminology variants and erroneous regulations dealing with the recompensation of injuries.

Adolescent↗
PubMed1978

Neurological and intellectual sequelae of Reye's syndrome.

Eleven survivors of Reye's syndrome ranging in age from 9 months to 12 years were evaluated for neurological and psychoeducational sequelae. Seven children showed significant neuropsychological sequelae, ranging from severe global psychomotor retardation to mild specific perceptual and/or language impairments and from spastic quadriplegia and decorticate posturing to mild dysarthria. The severity of sequelae was inversely related to age of the child at onset of the disease. Whereas those children developing the syndrome when they were less than 1 year of age were seriously impaired, 3 children developing it in late childhood sustained no sequelae. Biochemical and neurological status at disease onset did not predict neuropsychological outcome. The results parallel the pattern of sequelae for other encephalopathies and suggest the importance for both child and family of early developmental evaluation following recovery from the disease.

Child↗
PubMed1983

Sequelae of meningococcal disease - studied about six weeks after hospital admission.

As part of a greater project (MenOPP), the type, distribution and frequency of sequelae after meningococcal disease (MCd) were estimated on the basis of examinations carried out about six weeks after hospital admission. Well documented sequelae were found in about 18% of 102 MCd cases compared to about 3% in 61 control patients. In 18 control patients with meningitis/septicemia due to other bacteria, the sequelae frequency was 11%. Our MCd sequelae results correspond with many of those published during the last few years. The frequency of uncertain sequelae was about the same (16%) in the MCd and the control group patients. A routine examination six weeks and one year after a MCd episode seems to be useful for the individual patient and for the research on better prophylaxis and improved treatment.

Female↗
PubMed1995

Prognostic factors of early sequelae and fatal outcome of Japanese encephalitis.

A clinical case control study to identify prognostic factors present at hospital admission associated with early sequelae and fatal outcome of acute Japanese encephalitis (JE) was carried out in Gusi county, Henan Province, central China from June to September 1991. A total of 70 patients with laboratory-confirmed acute JE were studied, of whom 3 cases died and 33 cases had neurological or psychiatric sequelae at the end of three months follow-up. The results showed that acute JE at younger age, with higher body temperature, high white cell count in CSF, and deep coma present at hospital admission were markers for unfavorable outcomes (sequelae or fatal). A history of the vaccination was not correlated with the early sequelae and fatal outcome of the disease. The paper suggests that early diagnosis and treatment and universal JE vaccination for all susceptible populations are keys for decreasing incidence of sequelae and fatal outcome of acute JE.

Acute Disease↗
PubMed1997

[Periventricular leukomalacia and persistent hyperechogenicity: relationship between ultrasound findings and sequelae].

OBJECTIVES: The objective of this study was to know the incidence of periventricular leukomalacia and persistent periventricular echodensities in neonates with a birth weight < 1,500 g and to correlate cranial ultrasound findings with the developmental outcome of these babies at 18 months of corrected age. PATIENTS AND METHODS: We performed a cohort study of 319 newborns weighing 1500 g or less who were admitted to the Neonatal Intensive Care Unit of "12 de Octubre" Hospital between July 1990 and April 1994. Scans were performed while they were hospitalized and 183 surviving infants were followed up to 18 months of corrected age. Relative risks (rr) and 95% confidence intervals (95% CI) were calculated for sequelae according to neonatal cranial ultrasound abnormalities. Ninety-six infants with normal scans were considered as the control group. Persistent periventricular echodensities were classified as mild, moderate or severe. RESULTS: The incidence of periventricular leukomalacia was 3% (10/319) and of persistent periventricular echodensites was 11.2% (36/319). The percentage of sequelae was 5% for control infants, 15.6% (rr = 3, CI 95% = 0.94-8.8) for persistent periventricular echodensities, independent of its severity, 50% (rr = 9.7, CI 95% = 2.6-35) for moderate persistent periventricular echodensities and 78% (rr = 15.6, CI 95% = 6-38) for periventricular leukomalacia. CONCLUSIONS: Periventricular leukomalacia multiplies the number of sequelae by 15. Persistent periventricular echodensities, independent of its severity, does not multiply the number of sequelae significantly. However, moderate persistent periventricular echodensities multiply the number of sequelae by 9.

Echoencephalography↗
PubMed1997

The pattern of neurological sequelae of childhood cerebral malaria among survivors in Calabar, Nigeria.

OBJECTIVE: To determine the pattern and long term outcome of neurological complications following cerebral malaria (CM) in a group of Nigerian children treated in Calabar. DESIGN: Prospective, follow up study. SETTING: Children's emergency room (CHER) of the University of Calabar Teaching Hospital (UCTH) located in a malaria-holoendemic rainforest belt of south eastern Nigeria. SUBJECTS: Survivors among 45 children with CM treated between February and December, 1991. All received intravenous quinine infusion and supportive care. Survivors (39) were followed up until detected neurological sequelae had resolved. RESULTS: Case fatality rate was 13.3%, 95% CI. Eleven (28.2%) of the survivors developed neurological sequelae. Prolonged coma, focal seizures and abnormal posturing (decorticate/decerebrate) were associated with increased risk of sequelae. Commonest neurological sequelae were cortical blindness (3/11), speech disorders (3/11: aphasia or echolalia) and motor abnormalities (5/11: dyskinesia/hemiplegia). Eight cases recovered completely from the neurological deficits within a mean period of three (1.3) weeks. One persisted with hyperactivity and attention deficit, had a remarkable improvement at the sixth month of follow up but developed secondary dyslexia and other learning disabilities by the third year of follow up. CONCLUSION: Although short lived, neurological sequelae of CM appear common among these Nigerian children. This problem could significantly add to the burden of childhood disability in Nigeria. Early diagnosis, use of appropriate drugs and large scale malaria control programmes can prevent malady.

Central Nervous System Diseases↗
PubMed1992

Protocol for the prevention and treatment of oral sequelae resulting from head and neck radiation therapy.

In addition to the desired antitumor effects, head and neck radiation therapy induces damage in normal tissues that may result in oral sequelae such as mucositis, hyposalivation, radiation caries, taste loss, trismus, soft-tissue necrosis, and osteoradionecrosis. These sequelae may be dose-limiting and have a tremendous effect on the patient's quality of life. Current policies to prevent these sequelae primarily are based on clinical experience and show great diversity. A protocol for the prevention and treatment of oral sequelae resulting from head and neck radiation therapy, based on fundamental research and data derived from the literature, is presented. The protocol is particularly applicable in centers with a dental team. This team should be involved at the time of initial diagnosis so that a successful preventive regimen is an integral part of the overall cancer treatment regimen.

Clinical Protocols↗
PubMed2005

Psychologic and social sequelae of secondary lymphedema: a review.

BACKGROUND: The psychological and social sequelae of secondary lymphedema (SLE) have been an underrecognized and little-researched complication of treatment for breast carcinoma. The reported incidence and prevalence of SLE varied widely (0-48%). Reported reasons for the differences are related to the lack of standard diagnostic and universal assessment criteria. METHODS: A comprehensive, computerized search was performed. All combinations of the following keywords were used: arm lymphedema, arm swelling, breast cancer, psychological and social, and quality of life (QOL). Eighteen studies were identified. RESULTS: The literature supported the view that SLE leads to psychological and social sequelae. Psychological sequelae included frustration, distress, depression and anxiety. Social sequelae comprised changes in role function, lack of social support and pain and disability. Pain was a significant predictor of psychological and social morbidity. These experiences resulted in diminution of QOL, particularly psychological and social health. This was particularly worrisome because women must attend daily to the precautions and treatments for SLE. CONCLUSIONS: Researchers should use psychological and social measures along with physiologic parameters when evaluating the impacts of SLE. Clinicians should work to develop standardized primary prevention programs and limb circumference should be measured at the time of breast carcinoma diagnosis. Gaps in knowledge related to intra/interethnic diversity, poverty, and comorbidities of women with breast carcinoma-related SLE need to be explored. The combined efforts of researchers and clinicians would reinforce awareness and knowledge for women at risk and provide important baseline data for research and practice.

Adaptation, Psychological↗
PubMed1987

Long-term sequelae of cancer treatment on the central nervous system in childhood.

Increasing numbers of children with cancer, including those with acute lymphocytic leukemia and medulloblastoma, are experiencing long-term disease control. As survival increases, so does the recognition that the treatment used to prolong survival may have significant detrimental effects on the central nervous system (CNS). Because of the slow replication rate of most constituents of the CNS, these effects tend to be delayed. Radiotherapy, and to a lesser extent, chemotherapy (primarily methotrexate) have been implicated in the causation of such sequelae. The pathogenesis of CNS damage is only partially understood and evidence suggests that direct effects on intracranial endothelial cells and brain white matter and immunologic mechanism play a role. A spectrum of clinical syndromes may occur, including radionecrosis, necrotizing leukoencephalopathy, mineralizing microangiopathy with dystrophic calcification, cerebellar sclerosis and spinal cord dysfunction. The two most common forms of sequelae are neuropsychological and neuroendocrinologic damage. The frequency, degree of and etiology of neurocognitive dysfunction is less than completely elucidated. Radiotherapy has been implicated as the major cause of damage, but the relationship between radiotherapy and the type of damage caused and the volume and dose of radiotherapy and degree of cognitive damage is unclear. Cognitive deficits are progressive in nature. Younger children are more likely to suffer the severest damage; but no patient of any age is free of risk of damage. Growth hormone impairment is the most common form of neuroendocrinologic dysfunction. There is increasing evidence that children with cancer who are long-term survivors are at increased risk for the development of secondary CNS tumors; possibly due, in part, to previous treatment. Much work needs to be done to characterize the sequelae which may occur, develop means of earlier detection, investigate ways to ameliorate sequelae and devise less toxic treatment.

Antineoplastic Agents↗
PubMedDate not supplied

Physical sequelae and self-perceived attachment in adult survivors of childhood cancer.

The association between the physical sequelae of childhood cancer and self-reported attachment behavior was investigated in 97 adult survivors. Attachment was assessed using standardized self-report questionnaires. Functional disability and cosmetic sequelae of the cancer and its treatment were evaluated by the attending oncologist using a standardized rating scale. Results suggest that attachment is not significantly associated with physician-rated physical sequelae, but may be related to the time of onset of the functional deficits, independent of the current age or age at diagnosis. Further, survivors with functional sequelae in adulthood describe themselves as more insecure in their relationships in general and more ambivalent in their relationship with their parents. These findings, if replicated, suggest that the duration of the functional deficits as well as the developmental stage of the individual when they began may be important variables which affect the survivor's capacity to develop and maintain intimate relationships that are secure and satisfying.

Activities of Daily Living↗
PubMedDate not supplied

Effects of gamma-globulin on the cardiac sequelae of Kawasaki disease.

Our aim was to delineate the effect of various factors, such as sex, age, serum albumin levels, and the timing of gamma-globulin (GG) therapy, on cardiac sequelae of Kawasaki disease. The patients with Kawasaki disease who were reported at the 1995-1996 nationwide survey and received 2000 mg/kg at specified hospitals were selected as the subjects of the study. A total of 2221 patients actually received the basic dose. The relationships of the GG therapy with the cardiac sequelae, sex, age, timing of GG administration (the date of initiation and duration of the regimen following disease onset), and serum albumin levels were examined by using logistic regression analysis. The odds ratios for the cardiac sequelae in patients with Kawasaki disease were high in males (1.63), in those under the age of 1 year (1.54), and in those with a serum albumin level <3.2 g/dl (2.64). The odds ratio was low in those who received GG before day 8 of the illness (0.69) or in those for whom the administration period was for 2 days or less (0.67). To prevent cardiac sequelae of Kawasaki disease it is desirable that GG therapy be started as soon as possible and completed within 2 days.

Age Distribution↗
PubMed1982

Relation of concentrations of Haemophilus influenzae type b in cerebrospinal fluid to late sequelae of patients with meningitis.

Forty-four patients with Haemophilus influenzae type b meningitis had follow-up evaluations approximately one year after hospital discharge. Patients with greater than or equal to 10(7) colony-forming units of H. influenzae type b per milliliters CSF had significantly greater frequencies of speech impairment (P less than 0.001), hearing loss (P = 0.04), and moderate or severe neurologic sequelae (P less than 0.01). Patients with greater than or equal to 1 microgram H. influenzae b antigen/ml CSF had a greater incidence of hearing loss (P = 0.03) but not of speech abnormalities (P = 0.06) or other neurologic sequelae (P = 0.64). Glucose concentrations less than 10 mg/dl correlated with the incidence of hearing loss (P = 0.02) and speech impairment (P = 0.02). "Partial" antibiotic therapy, CSF protein concentrations, and number of CSF polymorphonuclear leukocytes did not correlate well with sequelae. These data indicate that pretreatment concentrations of H. influenzae b and glucose concentrations in CSF were the best predictors of late sequelae of patients with H. influenzae b meningitis.

Adolescent↗
PubMed1985

Sequelae of acquired cytomegalovirus infection in premature and sick term infants.

To assess the risk of long-term sequelae after acquired cytomegalovirus (CMV) infection in premature and sick term infants, 55 CMV infected patients were matched prospectively with 55 control patients and these matched pairs were evaluated at 3 years of age. Sensorineural hearing losses were present in four of 43 CMV infected patients (all mild-moderate) and in two of 43 controls (one severe). The incidence of neurologic sequelae was not increased in CMV infected patients with birth weight greater than 2000 gm. Among patients with birth weight less than 2001 gm, moderately abnormal EEGs were found in four (17%) of 23 CMV infected patients and in one (4%) of 23 controls, and severe handicaps occurred in four (14%) of 29 CMV infected patients and in two (7%) of 29 controls. Severe handicaps in premature infants were significantly (P less than 0.05) associated with early onset of CMV excretion (less than 8 weeks of age) and severe cardiopulmonary disease. Among the premature infants who were documented early excretors, three of 13 had severe neuromuscular impairment, four of 13 had severe handicaps (DQ less than 70, severe neuromuscular impairment, or profound loss of vision or hearing), and an additional four had DQs of 70 to 79. Among their matched control subjects, none of 13 had severe neuromuscular impairment, two of 13 had severe handicaps, and an additional two had DQs between 70 and 79. None of the premature infants who were documented late excretors (greater than or equal to 8 weeks of age) had any neurologic sequelae. The risk of neurologic sequelae and handicap may be increased in premature infants with onset of CMV excretion in the first 2 months of life.

Cytomegalovirus Infections↗
PubMed2000

Direct medical cost of pelvic inflammatory disease and its sequelae: decreasing, but still substantial.

OBJECTIVE: To estimate direct medical costs and average lifetime cost per case of pelvic inflammatory disease (PID). METHODS: We estimated the direct medical expenditures for PID and its three major sequelae (chronic pelvic pain, ectopic pregnancy, and infertility) and determined the average lifetime cost of a case of PID and its sequelae. We analyzed 3 years of claims data of privately insured individuals to determine costs, and 3 years of national survey data to determine number of cases of PID, chronic pelvic pain, and ectopic pregnancy. We developed a probability model to determine the average lifetime cost of a case of PID. RESULTS: Direct medical expenditures for PID and its sequelae were estimated at $1.88 billion in 1998: $1.06 billion for PID, $166 million for chronic pelvic pain, $295 million for ectopic pregnancy, and $360 million for infertility associated with PID. The expected lifetime cost of a case of PID was $1167 in 1998 dollars. The majority of those costs ($843 per case) represent care for acute PID rather than diagnosis and treatment of sequelae. Approximately 73% of cases will not accrue costs beyond the treatment of acute PID. CONCLUSION: The direct medical cost of PID is still substantial. The majority of PID related costs are incurred in the treatment of acute PID. Because most PID-related costs arise in the first year from treatment of acute PID infection, strategies that prevent PID are likely to be cost-effective within a single year.

Cost of Illness↗