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PubMed1999

Developmental, cognitive, and behavioral sequelae of child abuse.

There is growing interest in the neurologic, behavioral, and cognitive effects of child abuse and neglect. This article explores the literature on the short and long term sequelae of physically and sexually abused and neglected children, along with controversies generated by the studies themselves. Recommendations are made for swift and ongoing intervention in cases of child abuse to protect young victims from potentially devastating effects.

Age Factors↗
PubMed1999

Neurobehavioral manifestations and sequelae of HIV and other infections.

Central nervous system infections in children and adolescents involve a wide spectrum of illnesses, ranging from acute self-limited diseases, such as enteroviral meningitis, to severe diffuse or focal infections (i.e., arboviral encephalitis) resulting in devastating neurologic sequelae. All the clinical manifestations of CNS infections occur to some degree secondary to toxic mediators such as cytokines. These factors are neurotoxic and produce clinical manifestations such as encephalopathy, motor abnormalities, and seizures. Many of these diseases also produce radiculoneuropathies and vasculopathies (stroke). As a result, chronic neurologic conditions may result and are frequently associated with psychiatric disturbances and situational depression.

AIDS Dementia Complex↗
PubMed1999

[Prognostic criteria of speech rehabilitation in patients with sequelae after ischemic stroke].

Structural analysis concerning a complex of both neuropsychologic and clinical data of the patients with sequelae of ischemic stroke was performed. It was revealed, that a character of the local alterations of electric activity (EA) on EEG, testifying a functional state of cerebral structures, was an important prognostic criterion of the efficiency of neurorehabilitation. The local EA changes in form of groups of theta-waves and sharp waves of alpha- and theta-activities were prognostically favourable signs; meanwhile polymorphic slow-wave was unfavourable background for performing a restorative education. An analysis of the speech disorders revealed that both semantic and dynamic aphasias occur more frequently after ischemic stroke. A semantic aphasia was always accompanied by the dynamic one and each form may be both leading and secondary. It may be dependent on location of a focus (according to EEG) as well as on the character and manifestation of the accompanying neuropsychologic symptomatology.

Adolescent↗
PubMed1999

[Doppler ultrasonography in children with sequelae of acute neuroinfections].

Transcranial dopplerography was performed in 125 children with late (1-3 years) neurologic sequelae of acute neuroinfections. Decreased blood flow velocity (BFV) in middle cerebral arteries of (0.61 of the value in control group) was found in patients with movement disorders. Impairment of the intracranial venous outflow together with both acceleration and asymmetry of blood flow in basal veins was prevalent in children with intracranial hypertension and hydrocephaly syndrome. Hyperconstriction of cerebral vessels together with a low BFV (30% of the initial value) was observed during hyperventilation on the side of the lesion in patients with epileptic syndrome. In children with cerebrasthenic syndrome the effect of cavinton treatment depended on the type of changes in cerebral blood flow: positive effect was found in patients with asymmetric decrease of BFV in anterior cerebral arteries.

Acute Disease↗
PubMed1999

[An analysis of nutritional status and pulmonary hypertension in patients with sequela of pulmonary tuberculosis and chronic obstructive pulmonary disease].

The prognostic value of hypercapnia and/or pulmonary hypertension differs in patients with sequela of pulmonary tuberculosis (TBseq) and those with chronic obstructive pulmonary disease (COPD) who are receiving home oxygen therapy (HOT). In an attempt to identify the factors, if any, that might explain this difference, we first compared nutritional status, respiratory function test results, dyspnea indexes, and other data for hypercapnic patients (PaCO2 > or = 45 Torr) and normocapnic patients (PaCO2 < 45 Torr) receiving HOT. Second, we examined the relationship between the degree of pulmonary hypertension and several respiratory function parameters for patients in each disease category. In 44 patients with TBseq, nutritional status estimated by body mass index and serum albumin was significantly better in the hypercapnic patients than in the normocapnic patients. However, this difference was not observed in 37 patients with COPD. In 30 patients with TBseq, the degree of pulmonary hypertension correlated significantly only with PaO2; in 32 patients with COPD, however, significant correlations were observed not only with PaO2 but also with PaCO2, %VC, and FEV1. These differences distinguishing groups of patients with the 2 diseases may provide an explanatory basis for the difference in prognostic value of hypercapnia and/or pulmonary hypertension in patients receiving HOT.

Aged↗
PubMed1999

[Little known sequelae of sprains of the cervical spine].

After cervical sprain not only pain and neuropsychological disturbances may occur, but also the following sequelae: cervical dystonia, and torticollis, dizziness, hearing loss for low frequencies, dysphonia and globus. Except for dystonia the symptoms often respond to manipulation of a blocked articulation between occiput and atlas or axis and the third cervical vertebra.

Cervical Vertebrae↗
PubMed1976

Sequelae of dental extraction during quinine-induced thrombocytopenia.

The pathogenesis and treatment of quinine-induced thrombocytopenia is discussed. The case presented involved the sequelae of a dental extraction performed during an episode of acute thrombocytopenia. A complete medical history and knowledge of current medications and their possible side effects are of paramount importance before any patient is treated.

Aged↗
PubMed1976

Neurological sequelae after lithium intoxication.

Severe lithium intoxication was seen in a 57-year-old woman despite close monitoring of blood lithium levels over 23 months. High blood lithium levels were aggravated by drug induced hyponatremia. Neurological sequelae were still present six months after admission,

Female↗
PubMedDate not supplied

[Survival with no sequelae after near-drowning with very poor signs for prognosis including persistent bilateral non-reactive mydriasis].

INTRODUCTION: The outcome of cases of near-drowning and initially poor prognostic signs are usually discouraging because of the severity of the consequent encephalopathy in most survivors. However, good recovery has been described, in spite of bad prognostic factors initially. It is difficult to establish the predictors of poor outcome which would enable one to decide when to establish and maintain advanced cardio-pulmonary resuscitation measures (CPR), since each case of near-drowning is different. CLINICAL CASE: A four year old boy survived near-drowning in cold water without sequelas but with initial signs of very poor prognosis, including prolonged immersion time, coma, severe metabolic acidosis, hyperglycemia and persistent bilateral arreactive mydriasis. DISCUSSION: The beneficial effect of hypothermia is well known, and explains (at least partially) survival in cases of apparently irreversible near-drowning. Potential benefits are reduced metabolic demand which prevents the adverse effects of hypoxia and the 'diving reflex' which short-circuits the blood supply to vital organs such as the brain and heart. We consider that the persistently arreactive pupils were not due to hypoxia, but rather to bilateral uncal compression of the third cranial nerves due to cerebral edema secondary to initial hypoxia and water intoxication. CONCLUSION: This observation is yet another argument for the establishment and maintenance of aggressive manoeuvers of CPR and treatment in all children who have nearly-drowned, independently of the apparent seriousness or irreversibility.

Brain Edema↗
PubMedDate not supplied

[Neuropsychological sequelae of head injury].

INTRODUCTION AND DEVELOPMENT: Traumatic brain injury (TBI) neuropsychological sequelae are consequence of the combination of focal and diffuse cerebral lesions. Foci of concussion usually involves frontal lobes. Fronto-basal lesions produces important changes in mood, personality and behavior, and dorsolateral lesions impairment of executive functions (lack of planning, flexibility and use of strategies). Left temporal concussion can produce aphasia. Hippocampal and parahippocampal atrophy are essentially responsible of memory dysfunctions. Diffuse axonal damage is related to impairment of attention, speed of mental processing and frontal lobe functions. The development of neuroimaging techniques, especially tridimensional magnetic resonance acquisition and analysis, allows accurate anatomo-functional correlates. Genetic variables can explain in part individual differences in the degree of memory impairment and the relationship of TBI with Alzheimer's disease. CONCLUSIONS: The TBI percussion model performed in rat and mouse allows the study of the interrelationship among structural damage, memory changes, genetic factors, and the effects of pharmacological treatment.

Brain↗
PubMed1999

[The use of prodigiozan in the combined therapy of the sequelae of mild craniocerebral trauma].

Based on findings secured with the aid of instrumental and immunological techniques (electroencephalography, echoencephalography, roentgenoencephalography) a total of 57 patients with sequelae of mild craniocerebral injury were examined. Used in the study as an immunomodulating agent was prodigiosan. The drug was found to improve the bioelectrical activity of the brain, and to increase the amplitude of blood filling as evidenced by neurophysiological investigations. Moreover, prodigiosan makes for reduction of vegetovascular disorders and epileptic seizures, returning the level of neurospecific proteins to normal.

Adjuvants, Immunologic↗
PubMed2000

[In search of strategies for preventing brain damage as a sequela of bacterial meningitis].

Multiplication of bacteria within the central nervous system compartment triggers a host response with an overshooting inflammatory reaction which leads to brain parenchyma damage. Some of the inflammatory and neurotoxic mediators involved in the processes leading to neuronal injury during bacterial meningitis have been identified in recent years. As a result, the therapeutic approach to the disease has widened from eradication of the bacterial pathogen with antibiotics to attenuation of the detrimental effects of host defences. Corticosteroids represent an example of the adjuvant therapeutic strategies aimed at downmodulating excessive inflammation in the infected central nervous system. Pathophysiological concepts derived from an experimental rat model of bacterial meningitis revealed possible therapeutic strategies for prevention of brain damage. The insights gained led to the evaluation of new therapeutic modalities such as anticytokine agents, matrix metalloproteinase inhibitors, antioxidants, and antagonists of endothelin and glutamate. Bacterial meningitis is still associated with persistent neurological sequelae in approximately one third of surviving patients. Future research in the model will evaluate whether the neuroprotective agents identified so far have the potential to attenuate learning disabilities as a long-term consequence of bacterial meningitis.

Animals↗
PubMed2000

Tricuspid aortic valve with partial commissural fusion: prelminary report of an apparently common cause of aortic ejection sounds with potential for serious sequelae, illustrated by two cases.

We report the cases of 2 patients whose tricuspid aortic valves were found to have partial commissural fusion. Both patients experienced complications that were probably related to this abnormality: bacterial endocarditis in 1 instance and a lacunar stroke in the other. In order to illustrate the similarity of physical findings, we also describe the case of a 3rd patient, who had a typical bicuspid aortic valve. Tricuspid aortic valve with partial commissural fusion has been described in autopsy series and has been predicted to cause an ejection sound, but we could find no previously published description of this lesion in living patients. We wish to alert others to the possible presence of aortic commissural fusion, to its potential for serious and likely preventable sequelae, and to the ability of carefully performed transthoracic high-resolution digital echocardiography to demonstrate this condition when its characteristics are found on physical examination.

Aortic Valve↗
PubMedDate not supplied

[Facial nerve paralysis as a sequelae of chronic suppurative otitis].

INTRODUCTION: Facial palsy can be a consequence of untreated chronic suppurative otitis media. This disease can last for many years manifesting as partial deafness and ear effusion resulting in palsy after spreading of pathological process in the surrounding cranial structures. The patient with facial palsy cannot rise his forehead, nor close his eye on the involved side, while his cheek and lips just fall. MATERIAL AND METHODS: This retrospective research included patients operated for chronic suppurative otitis media with facial palsy during the last ten years. We have examined data on duration of disease, time of development of facial palsy and relations with other otogenic complications. RESULTS: We described 19 patients with this otogenic complication. Most of them--13 (68%) had symptoms of chronic suppurative otitis media for several years. In some cases, we found other otogenic complications, like acute mastoiditis in 4 (21%), meningitis in 4 (21%), cerebral abscesses in 1 (5%) and cerebellar abscesses in 1 (5%). All patients were operated and the pathological process was completely removed. During operation we found polypoid formations in 9 (47%) patients, granulation tissue in 8 (42%) and cholesteatoma in 7 (37%) cases. In 16 (84.2%) we did not find any visible defects on facial nerve canal, in 2 (10%) cases pathological process destroyed the canal in the tympanic region, and in 1 (5%) facial nerve was partially bare in tympanic and mastoid region. 16 (84.2%) patients have fully recovered, in 2 (10%) cases sequelae remained and in 1 (5%) patient, who had meningitis and cerebral abscess, there were no signs of recovery. DISCUSSION: Facial paralysis as an otogenic complication, can originate from acute otitis media and secretory otitis media. The pathological process in chronic suppurative otitis media causes changes in mucous of middle ear, manifested by edema, submucous fibrosis and infiltration with chronic inflammation cells. Progressive spreading of these inflammation changes causes osteitis, which provokes invasion and bone destruction of inner ear, durae or facial canal and development of palsy. The sex of patients is not relevant. The significant data concern the duration of disease since 13 (68%) patients have suffered from chronic otitis for several years. This points out the silent character of the disease. The clinical picture of all patients with peripheral facial palsy is identical, no matter of etiology, so they are often wrongly classified and treated as Bell's palsy. That is the reason for imperative examination of middle ear in every patient with respective symptoms. Late and inadequate treatment is a common cause of further progressiveness of disease, which causes development of other otogenic complications that can jeopardize life of patient. Acute mastoiditis is the most frequently mentioned, but we also recorded the most severe complications as otogenic meningitis and cerebral and cerebellar abscesses. It is possible that bacterial toxins penetrate and provoke neuritis with bigger or smaller edema. On the other side, it is commonly considered that facial palsy appears with cholesteatoma of middle ear. Cholesteatoma directly distracts bones and provokes inflammation and also makes compression on nerve itself. Our research showed that there were no visible bone defects in most of the cases 16 (84%), but process developed through cracks, and only in 2 (10%) defect was in tympanic part of canal and in 1 (5.8%) facial nerve was bare in tympanic and partially in mastoid part two centimeters in length. Pathological process was operationally removed without opening the facial canal, because removal of the process provides decompression and relieve of nerve. Operation is followed by medicamentous treatment (antibiotics, corticosteroids). This treatment succeeded with full recovery in 16 (84.2%) patients, partial recovery in 2 (10%) and only one did not have any signs of recovery. CONCLUSION: Otogenic facial

Chronic Disease↗
PubMed1975

Psychological sequelae of elective abortion.

A mild, short, depressive and guilt ridden period following abortion is quite common, but a severe psychological reaction is rare. The indication for the abortion and the preabortal psychological state of the patient are the two most important factors. Almost all reported instances of postabortion psychoses have occurred in patients who had severe preabortal psychiatric problems. Women undergoing abortion for socioeconomic or psychosocial indications appear to be at minimal risk for long-term negative psychological sequelae. In contrast, women in whom abortion is carried out because of exposure to rubella and the risk of fetal malformation, maternal organic disease or the prenatal diagnosis of a genetically defective fetus are at greater risk and may need supportive psychotherapy.

Abortion, Illegal↗
PubMed2000

A comparison of commonly used anti-emetics for the prevention of emetic sequelae after a major gynaecological surgery.

STUDY DESIGN: Prospective, randomized, double-blind, placebo-controlled study involving one hundred ASA I-II patients undergoing major gynaecological surgery. OBJECTIVE: To study anti-emetic efficacy of intravenous (IV) ondansetron (4 mg), droperidol (2.5 mg), metoclopramide (10 mg), and placebo. PATIENTS AND METHODS: 100ASA physical status I-II undergoing major gynaecological surgery were randomized to receive intravenously (IV), one of the four test drugs 10 minutes before the end of anaesthesia. The incidence of postoperative nausea and vomiting following a standard anaesthetic technique was assessed. RESULTS: A significantly large number of patients who received ondansetron (88%) and droperidol (72%) were free of emetic sequelae when compared to placebo (41%); p < 0.05 (power of this observation is approximately 80% at the given significance level). Metoclopramide was ineffective. Patients given droperidol were significantly more sedated than those receiving ondansetron; p < 0.05. This is not surprising, as the dose of droperidol used in this study was higher than that currently recommended because we found lower doses to be ineffective in controlling nausea and vomiting in this group of patients. CONCLUSION: It was concluded that, of the drugs studied ondansetron is the best choice for anti-emetic prophylaxis after major gynaecological surgery.

Adult↗
PubMed2000

The developmental sequelae of nonorganic failure to thrive.

The developmental sequelae of infant failure to thrive (FTT) were examined in an unreferred group of 6-year-olds with a history of severe nonorganic growth retardation, sampled from a 1-year birth cohort in an inner-city area of South London. Children who failed to thrive in infancy (weight below the third centile for at least 3 months) and their pairwise matched comparisons were originally studied at 15 months, and 42 cases and 42 controls (89.5% of the sample) were followed up. At 6 years, previously growth-retarded children were considerably smaller than matched comparisons, in terms of body mass index (BMI), and height and weight for age Z scores. History of FTT explained substantial variance in weight and BMI at 6 years, with maternal height also contributing to variation in height for age. Child cognitive functioning at 6 years was examined using the McCarthy Scales: cases had more limited quantitative and memory skills than comparisons, but there was no intergroup variation in general cognitive performance. In contrast to analyses of physical development, failure to thrive did not account for cognitive functioning; maternal IQ was the sole significant predictor of performance on all indices of child cognitive abilities. At 15 months, earlier growth faltering was linked to limitations in mental development, but these findings were not confirmed by the follow-up data: the timing of FTT was not related to cognitive abilities at 6 years. Results correspond to past research indicating that nonorganic failure to thrive is associated with persistent limitations in physical stature. There was little evidence of cognitive disadvantage for case group children at school age, suggesting that the adverse effects of early malnutrition on cognitive functioning appear to diminish over time.

Age Factors↗
PubMed2000

Late sequelae after high midface trauma.

The upper midface area comprises mainly the naso-orbito-ethmoidal (NOE) region which plays a paramount role in facial expression. Fractures of this area often result in neglected bony defects in the fragile periorbital region with major secondary impairments such as traumatic telecanthus, orbital dystopia, and/or enophthalmos. Permanent cranial nerve deficits also can occur as the result of post-traumatic/post-operative sequelae. Seventy-one patients (age range 7-78 years) with severe high midface trauma, treated from January 1989 to December 1996, were reviewed with a minimum follow-up of 2 years. The patient population has been distributed according to the fracture type in three groups: Group 1 (n = 35): Isolated NOE with/without associated central midface injury; Group 2 (n = 22): NOE associated with craniofacial injury and Group 3 (n = 14): NOE associated with orbital displacement. The estimated post-surgical parameters included qualitative and quantitative data from the long-term clinical evaluation. Persistent headache and/or concentration difficulties were mainly noted in Group 1. Smell reduction or anosmia was reported mainly in Group 2. Deficits of the trigeminal and/or the facial nerve were found in Group 3. Enophthalmos and/or telecanthus were predominantly seen with injuries associated with orbital displacement.

Adolescent↗