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Late sequelae of proximal humerus fractures.

Proximal humerus fractures, both minimally displaced and complex, are subject to the development of complications. Late sequelae of such injuries include refractory shoulder stiffness, osteonecrosis, malunion, nonunion, and heterotopic bone formation. A prompt, accurate diagnosis and proper treatment protocol can decrease the occurrence and severity of such complications. When complications do occur, treatment options to improve outcome should be implemented.

Fracture Fixation↗

Permanent incisors traumatized through predecessors: sequelae and possible management.

This report describes the sequence of events following a traumatic dental injury to primary maxillary anterior teeth of a five-year old male during a bicycle accident. The development of the affected teeth during the subsequent ten years was studied from the radiographic records. A detailed account of the clinical and radiographic findings as well as the physio-pathologic changes that have taken place is discussed. In view of the inevitable prognosis of dentitions that sustain traumatic injury during the formative years preventive measures and feasible dental management are proposed. These precautionary measures are aimed to circumvent the sequelae that were experienced in the present case, and avoid predictable complications.

Bicycling↗

Selective inhibition of cyclooxygenase-2 (COX-2) reduces prostaglandin E2 production and attenuates systemic disease sequelae in experimental pancreatitis.

BACKGROUND/AIMS: Prostaglandins and prostaglandin-derived mediators play an important role in mediating the systemic inflammatory response in acute pancreatitis. COX (cyclooxygenase) is the key enzyme of prostaglandin synthesis. Whereas COX-1 produces prostaglandin mediators for physiological reactions, COX-2 is overexpressed in acute pancreatitis. The aim of this study was to investigate whether a selective COX-2 inhibitor alters prostaglandin production and attenuates systemic disease sequelae in severe acute pancreatitis in rats. METHODOLOGY: Severe acute pancreatitis was induced in 36 rats by standardized intraductal infusion of bile salt and intravenous cerulein infusion. Six hours after acute pancreatitis induction, rats were randomized to receive either no COX inhibition (saline), nonselective COX inhibition by indomethacin (3 mg/kg, i.v.) or selective COX-2 inhibition by NS-398 (10 mg/kg, i.v.). Serum concentrations of prostaglandin E2 were measured before and after acute pancreatitis induction and 24 hrs after starting therapy. Routine cardiorespiratory and renal parameters were monitored to assess organ function. RESULTS: Animals treated with the selective COX-2 inhibitor had significantly lower prostaglandin E2 values (211 +/- 17 vs. 366 +/- 37 and 435 +/- 13 pg/mL), produced more urine (18 +/- 4 vs. 13 +/- 3 and 12 +/- 3 mL/6-24 h) and had significantly fewer episodes of respiratory distress (defined as a pO2 < 80 mmHg or pCO2 > 50 mmHg for > 15 min; 12 vs. 57 and 71%) during the observation period than animals without or with nonselective COX inhibition. CONCLUSIONS: Selective inhibition of COX-2 reduces prostaglandin E2 serum levels in this model of acute pancreatitis. This together with improved renal and respiratory function suggests an attenuation of the systemic response to pancreatic injury. COX-2 inhibition may be another step toward optimizing therapy in severe acute pancreatitis.

Animals↗

[Intradialysis hypotension: causes and sequelae].

AIM: To study causes and sequelae of intradialysis hypotension (IH) in patients with terminal renal failure (TRF). MATERIAL AND METHODS: Forty one patients with TRF on chronic hemodialysis (CH) were divided into two groups. The study group consisted of 24 patients with episodes of IH. Seventeen patients of the control group had no IH. All the patients were examined with assessment of protein-energy deficiency, residual renal function, left-ventricular hypertrophy, diastolic function of the heart. Hemodialysis effectiveness was estimated by Kt/V index. Survival of the patients was calculated according to Kaplan-Meier method. RESULTS: In the study group IH episodes occurred in spite of low ultrafiltration velocity (8-10 ml/min). Those patients of the study group who had IH associated with polyneuropathy and left-ventricular hypertrophy had IH episodes more often and sharper falls of arterial pressure. Long-term IH decreased survival significantly. CONCLUSION: Repeated episodes of IH deteriorate effectiveness of hemodialysis because of acute coronary syndrome, acute disorder of cerebral circulation, complications of deficient dialysis syndrome (pericarditis, hyperkaliemia, pulmonary edema, congestive heart failure).

Adolescent↗

Annular pancreas; peptic ulcer as late postoperative sequela.

Two cases of annular pancrease with late postoperative sequelae of duodenal and gastric ulcer are presented. In each case operation was limited to the annulus. Because symptoms are not permanently relieved by this procedure and subsequent peptic ulceration is not prevented, it is suggested that partial gastric resection be performed and decompression of the duodenal stump be effected by resection of the pancreatic ring.

Amputation Stumps↗

[An investigation of sequelae of paralytic poliomyelitis in some districts of inner Mongolia autonomous region].

Three hundreds and twelve sequelae of paralytic poliomyelitis were diagnosed among 163,013 lame children under 12 years of age. The prevalence of paralytic poliomyelitis was 1.91%. The result showed that although the morbidity of poliomyelitis has greatly decreased since the programme on immunization against polio were introduced, there were still a number of unreported cases. Of the cases diagnosed, ninety-three per cent were those who were unvaccinated and were mostly infected in the first four years of life.

Child↗

The 1952 outbreak of encephalitis in California; long term neurologic and psychiatric studies of sequelae.

For fuller understanding of the nature of infectious encephalitis, continuing study must be made of patients with regard to possible neurological sequelae or aberrations in behavior. The large outbreak of encephalitis in California in 1952 having offered opportunity for follow-up observation of a large series of patients, many of them children who had convulsions during the acute phase of the disease, pilot studies already have been started and funds are being sought for extending the scope of the investigation over a period of years. In early observations of patients included in the pilot study, changes in emotional and behavior patterns were noted in some instances. Thus far, with the exception of two infants who had recurrence of convulsions, patients who recovered apparently free of residual effects have remained so. Further neurological and psychiatric investigation should be carried out.

Animals↗

Western equine encephalitis in infants; a report on three cases with sequelae.

Approximately one-third of the laboratory-confirmed cases of Western equine encephalitis occur in children under the age of 10. The present paper describes three instances of Western equine encephalomyelitis virus infection in infants under one year of age, together with the resultant sequelae. The difficulties associated with diagnosis of central nervous system disturbances in very young children are discussed, and it is pointed out that in view of the frequent occurrence of clinical infections with the arthropod-borne encephalitis viruses these agents should be given serious consideration as a cause of acute central nervous system infection in childhood and as the possible etiology for obscure, severe neurological disturbances in the pediatric age groups.

Animals↗

[Viral hepatitis sequelae].

The viral hepatitis is a serious public health problem worldwide. Some problem is hepatitis B, particularly superinfection HBV-HDV and least hepatitis C (HCV), because they are transmitted via parenteral routes. About 20% of patients becomes a chronic carrier. Some chronic carriers are healthy: and they have no functional deficiencies. Others however, chronic active hepatitis develops and can lead to cirrhosis of the liver and finally to hepatocellular carcinoma, that is one of the major cancers of the world today. The immunocomplexes play a role in pathogenesis of several syndromes, such as: polyarthritis nodosa, glomerulonephritis, acrodermatitis. In the study based on questionnaires mailed 645 persons after acute viral hepatitis they were observed: cholecystitis--13.9%, stomach and/or duodenum ulcer--11.5%, and cholelithiasis--8.1%. An important results of the investigation is the conclusion that hepatitis caused distinct decrease of the health condition and change of the lifestyle. After the viral hepatitis 9% of patients shifted to a lighter job for a time, 3.8% for good and 5.6% patients after hepatitis B were receiving disability payment. In the light of the problems discussed here the vaccination would prevent not only the acute liver illness but also the sequelae of the disease.

Adult↗

Inhibitory effect of prostaglandin E1 on laurate-induced peripheral vascular occlusive sequelae in rabbits: optimized topical formulation with beta-cyclodextrin derivative and penetration enhancer HPE-101.

Prostaglandin E1 (PGE1) and its inclusion complexes with beta-cyclodextrin (beta-CyD) and O-carboxymethyl-O-ethyl-beta-cyclodextrin (CME-beta-CyD) were made as topical preparations. The PGE1 preparations, when applied with a penetration enhancer, 1-[2-(decylthio)ethyl]azacyclopentane-2-one (HPE-101), markedly increased the regional blood flow in the ear of rabbits and were longer acting than when administered by the intravenous route. Topical application of the PGE1 preparations significantly protected rabbits against laurate-induced peripheral vascular occlusive sequelae; the protective potency increased in the order of PGE1 alone = beta-CyD complex < CME-beta-CyD complex preparation. The PGE1 preparations elicited skin reactions such as erythema and oedema depending on their vasodilating actions. These reactions disappeared gradually after removal of the preparations, and hence may not be serious obstacles for their safe use. These results suggest that combinations of CME-beta-CyD and HPE-101 work synergistically to facilitate the entry of PGE1 into the skin, and consequently enhance the therapeutic potential of PGE1 in the topical preparation tested.

Administration, Topical↗

[Painful sequelae of Wallenberg's syndrome].

Twenty-seven out of 45 patients who had Wallenberg's syndrome were re-examined as out-patients. Nineteen were complaining of pain on the side opposite to that with loss or temperature and pain sensations or trigeminal deficit. The follow-up showed that pain was both intense and disabling and its treatment was disappointing. The most striking finding was the high frequency of painful sequelae to Wallenberg's syndrome, since they affected almost one out of two patients. The occurrence of these painful symptoms, usually after lesion of the spinothalamic tract, is difficult to explain.

Arm↗

THE OCULAR SEQUELAE OF THIRD CRANIAL NERVE PALSY.

The ocular sequelae in nineteen patients who had suffered from a complete paralysis of the third cranial nerve were analyzed. In eleven of these patients, the paralysis was associated with an aneurysm of the internal carotid artery system. None of the cases in this group showed complete recovery of the third nerve function; however, six recovered sufficiently to permit binocular single vision in most fields of gaze. Two cases of aberrant regeneration of the third nerve were diagnosed.Trauma accounted for four cases of third nerve paralysis. One of these recovered completely and one showed features of aberrant regeneration. Of the cases of oculomotor paralysis associated with herpes zoster ophthalmicus, encephalitis, or an obscure etiology (two cases), all recovered completely.

Carotid Artery Diseases↗

THE NEUROLOGICAL SEQUELAE OF ELECTRICAL INJURY.

Electricity is a potentially very dangerous commodity. Community safeguards, however, result in remarkably efficient control of this hazard. Mortality figures appear to be small and constant. No satisfactory morbidity figures are available with regard to general and neurological complications in non-fatal cases. Study of relevant features of such electrical phenomena as voltage level, resistance factors, current pathway, current diffusion and grounding reveals many difficulties in reconstruction of the sequence of events involved in these injuries. These features underline our frequent inability to understand the mechanisms of initiation of unconsciousness and even of differentiation between death by cardiac arrest and death by respiratory paralysis. Fourteen cases of electrical injury with a variety of neurological complications and sequelae are discussed, and the findings in these cases are compared with those of other observers. An attempt is made to present a comprehensive picture of immediate, secondary and late neurological effects, and to illustrate some of the pathological findings in electrocution material.

Accidents↗

SEQUELAE OF BACTERIAL MENINGITIS IN INFANTS.

Electroencephalograms, developmental tests and intelligence tests indicated that six of ten children under two years of age who had purulent meningitis, had apparent permanent neurological damage. The data suggested that this damage may be related in part to the occurrence of subdural effusions. Serial electroencephalograms and developmental tests appeared useful for suggesting which patients might retain a high risk of compromised brain function. The lack of further decrease in mortality from this disease in recent years may be because of cases in which meningitis is "secondary" to a primary disease of the central nervous system-that is, due to operation for brain tumor or myelomeningocele which affords direct entry of organisms. The incidence of permanent sequelae following this disease may not be decreasing.

Brain↗

Sequelae of minor traumatic brain injury.

Minor traumatic brain injury is the most common type of traumatic encephalopathy, with approximately 290,000 to 325,000 new cases occurring each year. Recent research has suggested that both anatomic factors (acceleration-deceleration injury, contusions) and neurotransmitter factors (cholinergic systems) may contribute to the pathologic sequelae. Symptoms may be broadly categorized as physical, behavioral/affective, cognitive and integrative. Patients with mild brain injury may demonstrate significant attention and information-processing impairments in the absence of apparent neurologic problems. Most symptoms abate within the first few months, but a sizable subgroup of patients remain symptomatic up to one year or more. Evidence suggests that patients whose symptoms persist are not simply "neurotic." Rehabilitation efforts should focus on proper evaluation, reassurance, education, support and monitoring of progress.

Animals↗

Plantar puncture wounds in children: analysis of 80 hospitalized patients and late sequelae.

BACKGROUND: Puncture wounds in the feet of children present a clinical dilemma. OBJECTIVES: To evaluate our approach, we reviewed the charts and all available images of 80 children admitted to our institution because of plantar punctures from 1988 to 1999. METHODS: The charts of 80 children were reviewed retrospectively. RESULTS: Three groups of patients were found: 59 with superficial cellulitis, 11 with retained foreign bodies, and 10 with osteoinyelitis and/or septic arthritis. There was a significant presentation delay in patients from the second and third groups. Most common organisms were Staphylococcus aureus or Group A Streptococcus. Of the 80 children, 34 were treated surgically and 46 were treated with antibiotic therapy alone. All patients with osteomyelitis and septic arthritis were re-examined; at follow-up, all but one were asymptomatic apart from residual radiologic sequelae in four. CONCLUSIONS: Patients with an established infection 24-36 hours after a plantar puncture should be admitted to hospital for parenteral antibiotic therapy. Delayed presentation is a significant marker for deep-seated infection. Further infection or relapse after initial improvement suggests the presence of osteomyelitis or a retained foreign body. A bone scan is advisable in all patients with suspected osteomyelitis: a positive bone scan necessitates aggressive early debridement combined with appropriate antibiotics; while negative bone scan, X-ray and exploration suggest that the infection is due to a foreign body, which can be detected by computed tomography.

Adolescent↗

[The hormonal functions regulating carbohydrate metabolism in participants in the cleanup of the sequelae of the accident at the Chernobyl Atomic Electric Power Station with a neurocirculatory dystonia syndrome].

Radioimmunoassay revealed in participants of Chernobyl disaster sequelae preclinical changes of some hormonal functions: moderate increase of the basal concentration of blood insulin, somatotropin, C-peptide against the background of persistent hypercortisolemia. Increase of the level of "hyperglycemic" hormones (cortisol, somatotropin, C-peptide) is explained by adaptative and compensatory reactions of the body in response to lesioning effects of ionizing radiation and other negative factors of the Chernobyl accident. Relative hyperinsulinemia is, apparently, compensating the total hyperglycemic effect of these hormones leading to stabilization of the blood sugar level.

Accidents↗

Traffic accident injuries of children: the need for prospective studies of psychiatric sequelae.

This paper presents a literature review of epidemiological data relevant to traffic accidents of children, including their personality and behavioral predisposition, social factors, association with risk taking behavior, rehabilitation, and incidence of post traumatic stress syndrome. The need for prospective studies of psychiatric sequelae of such accidents is highlighted. Three case vignettes are presented.

Accidents, Traffic↗