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PubMed2001

[Long-term sequelae of malignant tumors in childhood: consequences of late side-effects].

110 children with malignant diseases (leukemia excepted) who survived 5-20 years (median 9) post-therapy were followed (1996-1998). Median age during follow-up was 15 years (range 5-23). The most common malignancies were brain tumors, lymphoma, retinoblastoma and Wilm's tumor. The 174 late side-effects included endocrine disorders (19%), cognitive impairment (14%), orthopedic dysfunction (12%), alopecia (12%), dental damage (11%), psychological (8%) and neurological (8%) disturbances, and azoospermia or amenorrhea (5%). There was no cardiac or renal damage and no second malignancy. 29% of side-effects were severe. There was significant reduction in quality of life in 54 (49%), in 27 of whom it was severe enough to require psychological intervention. Treatment of brain tumor caused 98 late side-effects in 28 patients (sequelae-to-patient ratio [SPR] 3.3). Most cognitive, endocrine and neurological disorders, and most cases of alopecia, dental and psychological difficulties were in these patients. There were frequent late complications in those treated for retinoblastoma (SPR 1.8), and bone or soft tissue sarcomas (SPR 0.8). Those treated for Wilm's tumor had few side-effects (SPR 0.4). Late side effects were most frequent after radiation, reaching as high as SPR 2.4. It averaged only 0.5 in those treated with chemotherapy alone or in combination with surgery. Reduction of late side-effects in these patients requires using less toxic modalities, as long as cure rate is not compromised. When considering secondary strategies, screening for early detection of late complications would enable immediate solutions, such as hormonal replacement or providing compensating skills for post-treatment disability.

Adolescent↗

PubMed2001

Practitioner review: psychological sequelae of head injury in children and adolescents.

Many children suffer an injury to the head at some time, but relatively few of these cause major problems. However, in a few cases the sequelae can be far reaching. This review considers how to evaluate the significance of a head injury. Factors to consider are (1) injury variables: cause, severity and type of injury; (2) child variables: premorbid functioning, age, and developmental level of the child both at injury and at assessment; and (3) the cognitive, behavioural, and emotional problems that may arise. Parental beliefs and knowledge about the injury as well as the overall effect of an injury on the family as a whole are also considered.

Adolescent↗

PubMed2000

[Clinical manifestations of delayed sequelae of closed craniocerebral injuries in patients of older age].

Disclosed in the remote period in patients at older ages, who had survived closed craniocerebral injury (CCCI) were asthenic, liquorohypertensive, vestibular syndromes, posttraumatic encephalopathy, epileptoid syndrome, all of which are manifestations of traumatic condition of the brain. It is the premorbid state together with the presence of concomitant somatic conditions including the vascular factor that are believed to play a major part in the formation of delayed sequence. CCCI is considered to be a factor promoting the origination and aggrevation of the existing chronic somatic conditions. Hence, CCCI and its sequelae can be regarded as a risk factor for vascular diseases.

Age Factors↗

PubMed1975

Chronic thallitoxicosis: treatment of the choreiform sequelae.

A case of chronic thallium poisoning of 10 to 15 years' duration is presented in detail. The exact duration could not be determined. Treatment of the choreiform sequelae with levodopa is described for the first time. A system for classification of thallium poisoning is proposed.

Adult↗

PubMed2001

[Investigation to sequelae of acute encephalopathy].

We investigated 22 children with sequelae of acute encephalopathy. The patients were divided into 4 groups; group I with almost complete recovery (2 cases), group II with mild mental deterioration (4 cases), group III with severe mental deterioration (8 cases) and group IV with severe mental deterioration and severe physical disabilities (8 cases). There was no difference between 4 groups with regard to the past history, and status at the onset. The period of rehabilitation in hospital was different, being 0.4 month in group I, 2.6 months in group II, 3.0 months in group III and 3.6 months in group IV. The rehabilitation approach consisted mainly of medical therapy and range of motion exercise in the early stage followed trainings for walking and cognition. Family support was essential during the entire course. Evaluation with the functional independence measure was very useful for the rehabilitation.

Activities of Daily Living↗

PubMed2002

Late normal tissue sequelae in the second decade after high dose radiation therapy with combined photons and conformal protons for locally advanced prostate cancer.

PURPOSE: We determined the long-term normal tissue effects of 77.4 Gy. delivered to the prostate in patients with locally advanced prostate cancer. METHODS AND MATERIALS: Between 1976 and 1992, 167 men with stages T3 to 4 prostate cancer were treated on protocol with 50.4 Gy. photons at 1.8 Gy. per fraction using a 4-field box arrangement, followed by a conformal perineal proton boost of 27 Gy. (cobalt Gy. equivalent) in 11 fractions. The chart was reviewed and 39 of the 42 surviving patients were interviewed. Median followup was 13.1 years (range 7 to 23). Normal tissue morbidity was recorded using Radiation Therapy Oncology Group criteria and the late effects normal tissue scale. RESULTS: The actuarial incidence of grade 2 or greater genitourinary morbidity was 59% at 15 years. However, these grade 2 or greater problems persisted to the time of the interview in only 7 of 39 cases. The actuarial incidence of grade 2 or greater hematuria was 21% at 5 years and 47% at 15. For grade 3 or greater hematuria the risk was 3% and 8% at 5 and 15 years, respectively. No patient required cystectomy but 1 required diversion for morbidity. Urethral stricture and urinary incontinence with pads needed developed in 4 and 3 men, respectively. This particular morbidity was strongly associated with previous or subsequent prostate surgery. The actuarial incidence of grade 2 or greater gastrointestinal morbidity was 13% at 5 and 15 years, while grade 1 rectal bleeding occurred in another 41%. CONCLUSIONS: High dose conformal radiation to the prostate is followed by a high rate of low grade rectal bleeding but a low rate of grade 2 or higher gastrointestinal morbidity. This rate is stable and does not increase beyond 5 years. Genitourinary morbidity continues to develop well into the second decade after treatment, although high grade morbidity is uncommon. These findings do not suggest that the modern trend toward high dose prostate treatment with conformal techniques will result in a high incidence of serious and permanent late sequelae but it appears that hematuria will be common.

Aged↗

PubMed2001

Permanent sequelae after burns and tested procedures to influence them.

Although permanent sequelae of deep burns always persist, they can be very favourably influenced if we start soon after the injury. There are several possibilities: very early rehabilitation by positioning and supports prevents the shortening of tendons and ligaments surrounding the large joints and thus reduces post-traumatic oedema. By selecting the correct surgical technique at the right moment, we achieve an optimal course of healing and scar formation. Great attention must be paid to infection and its prevention. After healing it is important to apply compressive aids soon, preferably in combination with silicone and similar materials. For lubrication it is better to use creams with a high water content. Ensure the optimal mental well-being of affected patients. If the patient communicates well, do not hesitate to use psychoanalytic methods to reduce emotional and verbal blocks related to the injury.

Burns↗

PubMed2002

[Shoulder fusion for sequelae secondary to brachial plexus palsy].

PURPOSE OF THE STUDY: We examined clinical and radiological outcome in fifteen patients who underwent shoulder fusion after brachial plexus palsy. MATERIAL AND METHODS: This retrospective analysis included 15 patients who underwent shoulder fusion between 1981 and 1997 for the treatment of sequelae secondary to brachial plexus palsy. There were 13 men and two women, mean age 24.6 years (range 18-33 years). The right shoulder was fused in nine cases and the dominant shoulder in ten. There was one obstetric paralysis and one paralysis secondary to a cervical neurinoma. Eleven patients were motorcycle accident victims and two were automobile accident victims. The patients were installed in the lateral supine position with 30 degrees antepulsion and 60 degrees abduction, measured from the axillary axis of the scapula, and internal rotation. All patients had internal fixation by plate through a posterior approach. The same observer examined all the patients at last follow-up. Clinical and radiological findings were recorded and the position of the arthodesis was analyzed. RESULTS: There was one case of delaved fusion and one case of late humeral fracture. The arthrodesis position was abduction 52 degrees, internal rotation 20 degrees, flexion 20 degrees (means). Hand-mouth and hand-pocket movements were possible for all patients. Seven had no pain. Active motion was: 48 degrees abduction, 46 degrees antepulsion, 40 degrees internal rotation, 4.6 degrees external rotation, 23 degrees retropulsion. For 13 patients, mean lifting force was 5.2 kg.

Adolescent↗

PubMed2002

Cystic paracervical mass as an unusual sequela of graft-versus-host disease. A case report.

BACKGROUND: Bone marrow transplantation is used in the treatment of a variety of malignancies. One common sequela is graft-versus-host disease (GvHD.) CASE: A case of vaginal GvHD in a postmenopausal woman manifested as a 2-cm, cystic, paracervical mass. The patient was followed with consecutive pelvic ultrasounds and pelvic examinations until 27 months after transplantation, when the mass increased in size to 4 x 3 cm. Exploratory laparotomy with total abdominal hysterectomy revealed a 3 x 3-cm phlegmon within the proximal part of the vagina. Presumably, this resulted from vaginal GvHD, causing a midvaginal stricture with obstruction of cervical/uterine effluent. CONCLUSION: An awareness of the gynecologic manifestations of GvHD is critical for clinicians caring for women undergoing bone marrow transplantation.

Bone Marrow Transplantation↗

PubMed2002

Lung hernia as a sequela to limited-access mitral valve surgery.

We report a case of a 36-year-old man who developed a lung hernia after a minimally invasive mitral valve repair. Lung hernias are uncommon. Most are acquired and may be classified as traumatic, spontaneous, pathologic, or postoperative. In theory, minimal-access surgical techniques should decrease the likelihood of herniation, in comparison with open thoracotomy. Our review of the literature revealed only 2 reports of this sequela in association with this surgical procedure. Repair was performed due to persistent symptoms, including pleurisy and dyspnea, and interference with the patient's daily activities. Surgical repair led to complete resolution of these problems.

Adult↗

PubMed1975

[Para- and tetraplegia caused by decompression accident (deep sea diving). Study of 9 cases with more or less severe sequelae].

The authors report 9 cases of para and tetraplegia due to decompression sickness following deep sea diving. Poor technique was the cause of 8 of these cases, but one remained totally unexplained. The sequelae were serious; 3 dorsal paraplegias, which were functionally complete, 4 incomplete tetraplegias giving rise to permanent disability. In 2 cases there remained some spasticity of the lower limbs, in some cases associated with genito-urinary disorders. The authors review recent physiopathological theories. -- Blood disturbances may be due to the presence of gas bubbles which aggress the organism and give rise to coagulation disorders. -- The formation of the bubbles may be the cause of the spinal lesions, e.g. liberation in situ, gas embolism; the bubbles may form in various parts of the circulation and may cross the pulmonary barrage. Bubbles probably form in the lung itself, in the pulmonary veins and in the aorta, including the spinal capillaries. There is some slowing of the circulation, secondary to increased pressure, and pulmonary stasis may also play a harmful role. Finally, the dorsal spinal segments, which are the most poorly vascularised, are particularly exposed. This corresponds to the clinical findings. As far as treatment is concerned, the authors emphasize that recompression with hyperbaric equipment, should be carried out as an emergency, especially in unconsciuos subjects, together with other appropriate treatment. Such facts are important now that deep sea diving is becoming more and more commonly practised.

Adult↗

PubMed2002

[The psychological (long-term) sequelae of abortion].

This article aims to review the available literature on the short and long-term psychological sequelae of abortion. This subject remains controversial. The most common reactions women experienced after pregnancy loss were grief, depression and anxiety. From the reviewed literature it seems that those reactions are more common following spontaneous abortion than after therapeutic abortion. Risk factors for these reactions include past psychiatric history, social and cultural attitude, poor social support, history of previous therapeutic abortion, the fact that the current abortion is the result of medical or genetic problem, no living children, or being a single woman. Most of the reviewed papers deal with short-term reactions and raise the need for long term research (more than 2 years). Only one such paper was found. It is recommended that all those who treat women that had an abortion should be aware of its psychological consequences and help identify and refer high-risk women for treatment.

Abortion, Induced↗

PubMed2002

Laypersons' expectation of the sequelae of whiplash injury. A cross-cultural comparative study between Canada and Lithuania.

BACKGROUND: The objective of the present study is to compare the frequency and nature of expected 'whiplash' symptoms in Lithuania (a country where the late whiplash syndrome is rare or unknown) with that in Canada. MATERIAL/METHODS: A symptom checklist was administered to 2 subject groups selected from local companies in Kaunas, Lithuania, and Edmonton, Canada, respectively. Subjects were asked to imagine having suffered a neck sprain (whiplash injury) with no loss of consciousness in a motor vehicle accident, and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist. RESULTS: In both the Lithuanian and Edmontonian groups, the pattern of symptoms anticipated closely resembled the acute symptoms commonly reported by accident victims with acute neck sprain, but while up to 50% of Edmontonians also anticipated symptoms to last months or years, very few Lithuanian subjects selected any symptoms as likely to persist. CONCLUSIONS: In Lithuania, despite the documented occurrence of neck sprain symptoms in some 50% of individuals following motor vehicle accidents, there is a very low rate of expectation of any sequelae from this injury. What current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Lithuania may, in part, determine the low prevalence of the late whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the late whiplash syndrome are needed.

Accidents, Traffic↗

PubMed2003

[Congenital heart disease in adults: residua, sequelae, and complications of cardiac defects repaired at an early age].

Nowadays, it is estimated that 85% of the infants born with congenital heart disease (CHD) will survive to adulthood, thanks mainly to surgical or therapeutic procedures performed during infancy or childhood. The clinical profile and disease pattern of adults with CHD is changing. The prevalence of certain adult CHDs, such as tetralogy of Fallot, transposition of the great arteries or univentricular heart, is rising, but these conditions have practically become new diseases as a result of therapy. Most surviving patients present residua, sequelae, or complications, which can progress during adult life. These disorders can present electrophysiological disturbances, valvular disease, persistent shunts, myocardial dysfunction, pulmonary or systemic vascular disease, problems caused by prosthetic materials, infectious complications, thromboembolic events, or extravascular disorders involving multiple organs or systems. In tetralogy of Fallot, the most striking problems that affect long-term prognosis are pulmonary valve regurgitation, right ventricle dysfunction, and atrial or ventricular arrhythmias. The main problems appearing after physiological atrial repair of transposition of the great arteries are related to right ventricular function, since it is structurally unprepared for systemic circulation, and atrial arrhythmias. Surgical repair of univentricular heart using Fontan techniques should be considered a palliative procedure that does not modify the underlying structural disorder and exposes the postoperative patient to severe complications and problems. The increase in the number of patients with CHD who will reach adulthood in the coming decades makes it necessary to carefully consider the new healthcare demands that are being generated, who should be responsible for them, and how and where solutions can be found.

Adult↗

PubMed2003

Orthopaedic sequelae in neurologically recovered obstetrical brachial plexus injury. Case study and literature review.

PURPOSE: Description of shoulder sequelae in obstetrical brachial plexus injury (OBPI) patients who had spontaneous functional recovery, in the context of historical and current conservative methods of treatment. METHOD: Case study of a baby with serious complications, followed by a review of the literature from 1900 until 2001 about conservative treatment of OBPI with respect to the prevention of shoulder complications. RESULTS: Description of contractures and bony deformities did not show important discrepancies over time, other than more detailed images because of new technical possibilities. There is no agreement on the explanation of the development of these deformities. Secondary changes caused by muscular imbalance and longstanding contracture are recognized by all authors. A primary osteoarticular lesion was recognized as a possible cause in the beginning of the twentieth century, then forgotten for a long time and only in the 1980s had gained interest again. The main change in treatment concerns the use of arm braces. This was strongly recommended in the first half of the twentieth century, then advised against and is at this moment not anymore mentioned. CONCLUSIONS: There is no consensus on the cause of contractures and bony deformities in children with OBPI. Conservative methods of treatment have changed over the years, without research on the outcome of these treatment changes.

Birth Injuries↗

PubMed2002

Osteogenic distraction and orthognathic surgery to correct sequelae of ankylosis of the temporomandibular joint: a case report.

A 17-year-old female patient presented with sequelae to ankylosis of the temporomandibular joint, which included vertical maxillary protrusion, anterior open bite, labial incompetence, micrognathia, undefined neck angle, facial asymmetry, Class II molar relationship, and Class III canine relationship. She presented with the following cephalometric and soft tissue data: SNA angle = 78 degrees, SNB angle = 70 degrees, incisor-nasion-point A = 11 degrees, incisor-nasion-point B = 33 degrees, Frankfort-mandibular plane angle = 43 degrees, occlusal plane = 25 degrees, subnasale-stomion = 20 mm, stomion superius-stomion inferius = 9 mm, stomion inferius-soft tissue menton = 30 mm, neck angle = 144 degrees, and chin projection = 10 mm. Orthognathic surgery and mandibular osteogenic distraction were employed, specifically Le Fort I osteotomy to decrease a vertical excess of 12 mm, augmentation genioplasty of 17 mm, and bilateral extraoral distractors of bidirectional vector for a 14-mm augmentation of the mandible. The result was satisfactory with minimal adverse complications.

Adult↗

PubMed2002

Serratia marcescens in the neonatal intensive care unit: re-emphasis of the potentially devastating sequelae.

BACKGROUND: It is known that infections with Serratia marcescens can take a progressive course in preterm infants and that meningoencephalitis with this pathogen exhibits an extremely bad neurologic prognosis. METHODS AND RESULTS: We report on five cases of septicemia with Serratia marcescens in preterm infants during a nosocomial outbreak. Three patients developed meningoencephalitis with brain abscesses. Mild clinical and laboratory findings of infection contrasted with destructive findings on MRI scan. All five patients survived, those with isolated bacteremia without neurologic sequelae. CONCLUSION: When Serratia marcescens is isolated from any source in a neonatal intensive care unit, preventive measures including strict hygiene and cohorting of infants must be implemented immediately since this pathogen seems to exhibit specific affinity for the central nervous system and Serratia marcescens meningoencephalitis takes a progressive and destructive course despite antibiotic therapy.

Anti-Bacterial Agents↗

PubMed2003

Laypersons' expectation of the sequelae of whiplash injury: a cross-cultural comparative study between Canada and Greece.

BACKGROUND: The objective of the present study is to compare the frequency and nature of expected 'whiplash' symptoms in Greece [a country where the chronic whiplash syndrome is rare or unknown] with that in Canada. MATERIAL/METHODS: A symptom checklist was administered to 2 subject groups selected from local companies in Patras Greece, and Edmonton, Canada, respectively. Subjects were asked to imagine having suffered a neck sprain [whiplash injury] with no loss of consciousness in a motor vehicle collision, and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist. RESULTS: In both the Greek and Edmontonian groups, the pattern of symptoms anticipated closely resembled the acute symptoms commonly reported by accident victims with acute neck sprain, but while up to 50% of Edmontonians also anticipated symptoms to last months or years, very few Greek subjects selected any symptoms as likely to persist. CONCLUSIONS: In Greece, despite the documented occurrence of neck sprain symptoms in individuals following motor vehicle collisions, there is a very low rate of expectation of any sequelae from this injury. What current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Greece may, in part, determine the low prevalence of the chronic whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the chronic whiplash syndrome are needed.

Accidents, Traffic↗