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[Anterior iliac bone grafts: techniques and sequelae. Report on 107 cases and review of the literature].

The anterior iliac crest is the harvest site preferred by many authors because of the quantity and quality of bone obtainable and the simplicity of harvesting techniques. The purpose of the present paper is to present a review of anterior iliac crest harvesting techniques and to illustrate the most serious sequelae reported in the literature. A clinical series is also presented in order to evaluate what is, in our experience, the degree of morbility connected with this donor site. We have controlled 107 patients who underwent bone harvesting from the anterior iliac crest between 1980 and 2000, investigating minor complications such as walking deficiency (immediate and long-term) the formation of seromas, haematomas, adynamic ileus and more serious complications such as retroperitoneal haemorrhages, abdominal hernias, ileus fractures, nervous lesions (immediate and long-term). From our survey it emerged that, among the major complications, incidentally rarely reported in the international literature, we found only a small percentage of cases involving damage to nervous structures. Minor complications were also limited and the only problem remains difficulty in walking after the operation which resolves fully in almost all cases. We can therefore state that the anterior iliac crest remains, to date, an excellent site for harvesting and there is no significant morbility and the surgeon has numerous techniques available for reducing the incidence of complications to the minimum.

Adolescent↗

[Functional sequelae in tibial shaft fractures with compartment syndrome following primary treatment with urgent fasciotomy].

In a retrospective study on 28 patients, the incidence, nature and severity of the sequelae after severe lower leg trauma were studied. All patients had a tibial shaft fracture with a complete or impending compartment syndrome, treated with an urgent stabilisation and an adequate decompressive fasciotomy. In a thorough clinical examination, performed 17 months after trauma, the mobility of the knee and ankle joint, the perimetry of the lower leg and foot, and the muscle strength of all lower leg muscles were measured. Contractures were noticed, superficial sensibility was tested and an evaluation of march was done. More than one fourth of the patients showed late functional disabilities, mainly because of limitation of the dorsiflexion of the ankle joint, reduction of the muscle strength of the foot extensors, contractures of the foot flexors and abnormal superficial sensibility. The more severe the primary soft tissue trauma was, the more severe the functional disabilities were. The severity of the soft tissue damage, resulting from the trauma itself, is the most important factor for the late functional result after lower leg trauma. The compartment syndrome is certainly an aggravating factor when it is not treated by urgent fasciotomy. But this does not mean that all patients with lower leg fracture and compartment syndrome, treated with urgent fasciotomy, will show excellent functional end results.

Adolescent↗

[A clinico-diagnostic evaluation of the sequelae of craniocerebral trauma by using computed tomography].

The authors analyzed sequelae of head injuries in persons of call-up age (16-23 years) using computer tomography. Neurological, psychopathological, clinico-laboratory methods, electroencephalography, rheoencephalography, echoencephalography and lumbar puncture were also carried out. The obtained data indicate that these subjects who sustained head injuries showed pronounced polymorphous posttraumatic disorders in the nervous system. These data should be considered in the examination of call-up age persons.

Adolescent↗

[Acromegaly. Treatment of the causal factor and the oral sequelae].

During the last few years, a 64-years-old man experienced a progressive enlargement of his hands, feet, and tongue and an alteration in the position of his frontal teeth. In a university medical clinic acromegaly was diagnosed, based on external features, serum tests, and an oral glucose tolerance test. A pituitary microadenoma was discovered. The most common oral features of acromegaly are a prognatic mandible, interdental spaces, macroglossy, and everted, swollen lips. In this article the primary treatment and the possible oral sequelae are described.

Acromegaly↗

[Risk factors and reproductive sequelae associated with Chlamydia trachomatis infection in infertile women].

OBJECTIVE: To assess the clinical and sexual lifestyle characteristics associated with Chlamydia trachomatis infection among women diagnosed with infertility. MATERIAL AND METHODS: Study subjects were women with an infertility diagnosis attending the infertility clinic at the National Institute of Perinatology. Endocervical specimens from 309 women were examined for Chlamydia trachomatis using the direct immunofluorescence method. Vaginal culture samples were taken before initiating treatment. The presence of other sexually-transmitted infections was also assessed. Demographic, sexual behavioral, historical, and clinical data were collected for each subject. RESULTS: Seventy-seven women (24.9%) were infected with C trachomatis. Of these women, 70 (90.9%) had only one sexual partner, 58 (75.3%) were married, and 19 (24.7%) were single or had a common-law sex partner. Intrauterine device (IUD) was the main contraceptive method used in 15 women (19.5%). A coinfection with other sexually-transmitted microorganisms was detected in 41 of these patients (53.2%). Nineteen (24.7%) women had undergone tubal ligation. Among women with C trachomatis infection, reproductive sequelae were found: 24 (31.2%) women had had abortions and 50 (64.9%) had had a miscarriage. In 26 women cervical abnormalities were detected (33.8%); 50 (64.9%) had purulent vaginal discharge and 14 (18.1%) had pelvic pain. Bivariate analysis revealed that the risk factors for C trachomatis infection in women with infertility were: having a sex partner (OR = 2.96, 95% CI 1.22-7.5, p = 0.008), common-law union (OR = 3.68, p = 0.03), and IUD use (OR = 2.42, p = 0.01). CONCLUSIONS: A consistent relationship between C trachomatis infection and infertility was found. Infection with C trachomatis in women with infertility was associated with having one single sexual partner, marital status, and IUD use. The presence of ectropion and friability of the cervix may signal C trachomatis infection. Identification and presumptive therapy should be evaluated as measures to prevent and control C trachomatis infection in patients at risk. The English version of this paper is available at:http://www.insp.mx/salud/index.html.

Adolescent↗

[The articular sequelae of rheumatic fever: Jaccoud's dislocation arthritis. A case report].

A case of rheumatic fever with severe heart involvement, in which articular rheumatoid-like features involving both hands appeared many years after clinical onset, is described. After reviewing the articular sequelae of rheumatic fever and describing the clinical features of each form, the authors point out the main differences between rheumatic fever and rheumatoid arthritis, and diagnose Jaccoud's arthritis.

Arthritis, Rheumatoid↗

[Tick-borne encephalitis: clinical, pathological aspects and sequelae].

The etiologic agent of tick-borne encephalitis (TBE) is virus belonging to Flaviviridae. The infection of humans is caused by bites of infected ticks. The disease is reported mainly in endemic regions. TBE is characterised by seasonal increase in the incidence of the disease. Depending on localizaiton of the inflammatory process in the central nervous system following clinical forms might be specified: meningitis, encephalomeningitis, meningoencephaloradiculitis and meningoencephalomyelitis. After TBE there are serious sequelae observed e.g. various neurological syndromes, mental and intellectual disorders.

Encephalitis, Tick-Borne↗

[Analysis of relation between the usage of corticosteroid in treatment and arthralgia as a sequela of SARS patients].

OBJECTIVE: To analyze relation between the use of corticosteroids in the treatment for severe acute respiratory syndrome (SARS) patients and arthralgia as a sequela. METHODS: Clinical date of 30 SARS patients without other diseases in whom corticosteroid was used were reviewed including total dosage, duration of use, the highest dosage and its duration, and speed of reduction in dosage. The information about arthralgia was investigated one month after discharge of SARS patients from the hospital. RESULTS: The average total dosage of methylprednisolone was (4 244.16+/-2 292.30) mg, and the duration of use of the treatment was (25.36+/-5.88) days (ranging from 12 to 35 days). The maximum dosage was (321.33+/-174.03) mg/d, and the duration of its use was (7.73+/-4.08) days. The speed of reduction of dosage of corticosteroids was (21.33+/-10.18) mg/d. There were 26 of 30 patients (86.67 percent) experienced arthralgia symptom during convalescence. In 3.6 percent of patients arthralgia occurred within one month after SARS, 53.85 percent of the patients experienced low-grade arthralgia. By unifactor analysis, the total dosage and its duration of use, the highest dosage and its duration, speed of reduction of dosage of corticosteroids were correlated with the degree of arthralgia, respectively. The duration of arthralgia was correlated with the total dosage, the duration of high dosage, and high dosage. Age was not correlated with either the degree or the persisting time of arthralgia. The degree of arthralgia was only correlated with the total dosage, and the duration of arthralgia was correlated with administration time of glucocorticosteroids by multifactor analysis. CONCLUSION: There is a dosage- effect relation between the degree of arthralgia and the total dosage of corticosteroid, and a time-effect relation between the duration of arthralgia and length of the use of corticosteroids.

Adrenal Cortex Hormones↗

Trochanteric arthroplasty in the treatment of sequelae after septic arthritis of the hip in infancy.

The authors describe 17 patients submitted to trochanteric arthroplasty between 1979 and 1999 at the Division of Pediatric Orthopaedics and Traumatology of the Rizzoli Orthopaedic Institute. There were 9 females and 8 males aged from 1 to 8 years (mean of 4) affected with the sequelae of septic arthritis of the hip with complete destruction of the epiphysis and of the femoral neck (types IVB and V according to the Hunka classification system). Mean follow-up was 9 years (minimum 1, maximum 23). Surgery is described and indications are discussed: this is the only type of treatment that may be offered in place of conservative treatment.

Child↗

[Emotional reactions common sequelae of stroke].

Emotional reactions are important sequelae of stroke. Mood disorders, such as depression, anxiety, post-traumatic stress syndrome and emotionalism, occur during the first post-stroke year, each of them in approximately 20-30% of patients. They often overlap, and prevalence estimates differ on account of differences in definitions; study populations; exclusion criteria and time of assessment. The risk seems to be greatest, at least for depression, in the first months after stroke. Some patients recover spontaneously but symptoms persist in up to one third. Pharmacological treatment can have a positive effect that also applies to rehabilitation, quality of life and cardiovascular mortality. However, study findings are not uniform and conclusive therapeutic and preventive intervention trials on mood disorders after stroke are urgently needed.

Affect↗

Rehabilitation for postpolio sequelae.

BACKGROUND: Postpolio sequelae (PPS) are new, late manifestations that occur many years after the initial poliomyelitis infection. Recurrence of symptoms and fear of reactivation of the polio virus is particularly distressing to polio survivors. OBJECTIVE: This article outlines the diagnosis, pathophysiology, and management of PPS disabilities using a case vignette. DISCUSSION: Clinical features of PPS include fatigue, joint and muscle pain, new muscular weakness and bulbar symptoms. Diagnosis can be complicated particularly in nonparalytic cases of poliomyelitis. Disabilities in PPS may not be obvious to the observer but significantly affect the quality of life of the PPS patient. Previous rehabilitation intervention focussed on physical effort and determination to overcome disability at all costs. The treatment in PPS is now modified, and aggressive physical measures that may exacerbate muscle weakness are avoided. Most disabilities in PPS can be well managed with rehabilitation interventions that address limitations in patient activities of daily living, mobility and cardiopulmonary fitness.

Aged↗

Clinical and hemodynamic sequelae of lower-extremity, deep-vein thrombosis after total joint arthroplasty.

To determine the long-term sequelae of lower-extremity deep-vein thrombosis (DVT) after total hip or knee arthroplasty, 25 patients with venographically proven lower-extremity DVT were studied. A study group of 16 patients was available 14 months postoperatively. The results of clinical and hemodynamic evaluation were compared with those of a randomly selected group of patients who had negative venographic findings after total joint arthroplasty. There were no statistically significant differences in calf pain or swelling between the two groups. The presence of venous varicosities and pigmentation were unreliable indicators of the post-thrombotic syndrome. There were no statistically significant differences in vein patency, valve competency, and venous recovery times. There was a high incidence of hemodynamic abnormalities in the historically uninvolved extremities of patients with postoperative DVT.

Aged↗

Somatosensory evoked potentials in the neurological sequelae of treated vitamin B12 deficiency.

10 patients with chronic sequelae from vitamin B12 deficiency showed a characteristic profile of abnormalities of median and peroneal somatosensory evoked potentials: mild to moderately slow peripheral conduction to Erb's point, normal conduction or mild slowing across the cervical portion of the median somatosensory evoked potentials, and absence or severe slowing of impulse propagation along the spinal cord with the peroneal somatosensory evoked potentials. These findings are compared with those of other published series of somatosensory evoked potentials in vitamin B12 deficiency. These results shed light on the chronic physiological and anatomical residuals in the nervous system of patients treated for vitamin B12 deficiency.

Adult↗

Complications and sequelae of thyroidectomy and an analysis of surgeon experience and outcome.

Theodor Kocher is credited with refining the technique of thyroidectomy and reducing the incidence of postoperative hemorrhage. He also recognized the importance of preservation of the parathyroid glands. His accomplishments led to a reduction in surgical mortality, from 50% to less than 4.5%. Additional improvements in technique have reduced the mortality rate to near zero. Morbidity, however, remains a concern for surgeons who perform thyroid surgery. Complications and sequelae of thyroid surgery are reviewed, including recurrent and superior laryngeal nerve injury, temporary hypocalcemia, permanent hypoparathyroidism, thyroid storm, bleeding, wound infection, and hypothyroidism. The association between the volume of thyroidectomies performed by a surgeon and outcome is also discussed in this chapter.

Clinical Competence↗

Physical and psychological sequelae of female genital mutilation: a case report.

BACKGROUND: One harmful traditional practice that has resisted change in many African countries is female genital mutilation (FGM), otherwise known as female circumcision. This is usually associated with many complications. This report highlights a combination of physical and psychological sequelae associated with female circumcision. METHOD: Case-note of a patient managed for complications of female genital mutilation was used with a review of the relevant literature. RESULT: A 17-year old, married, illiterate farmer who had complete labial fusion following circumcision is presented. She had a total of six failed repairs, with psychological trauma, prior to her presentation in this hospital. A successful vulval reconstructive surgery was preformed and she was able to start a normal life with her husband. CONCLUSION: FGM carries very high morbidity. All supporters [corrected] of reproductive health should initiate programmes to stop this harmful and dehumanizing practice.

Adolescent↗

Myasthenia gravis in a child with sequelae of opsoclonus-myoclonus syndrome.

Immune-mediated myasthenia gravis occurred in a 13-month-old girl who had sequelae of an opsoclonus-myoclonus syndrome. She had an abnormal Raji cell assay along with elevated antiacetylcholine receptor and antithyroglobulin antibodies. No evidence of an associated malignancy was found with either condition. Clearly, the co-occurrence of two diseases within a single patient does not establish a common pathogenesis. Nevertheless, this is a provocative association and may point to an immunologically mediated process in the opsoclonus-myoclonus syndrome.

Female↗

Pseudobulbar paralysis--a sequelae of cerebral malaria.

Demyelination may be a pathogenic mechanism of post-malarial neurological sequelae. It can cause pseudobulbar palsy, which has not been documented earlier. In the present communication we report two cases of pseudobulbar palsy after cerebral malaria with evidence of demyelination.

Adolescent↗

Threshold retinopathy of prematurity: ocular changes and sequelae following cryotherapy.

PURPOSE: To determine ocular changes and sequelae following cryotherapy for threshold retinopathy of prematurity (ROP). METHODS: This is a retrospective study of 49 eyes of 26 premature babies with threshold ROP treated with cryotherapy between 1995 and 1998. All eyes included in the study had favourable structural outcome after cryotherapy. Follow-up examination of all babies was done 12 - 62 months (average 28 months) after cryotherapy. Visual axis, fixation pattern, anterior segment examination, cycloplegic refraction and dilated fundus examination with indirect ophthalmoscopy were undertaken in all eyes during follow-up. RESULTS: Posterior pole retinal residuae observed following cryotherapy were tortousity of blood vessels in 32 (65.3%), narrow temporal arcade in 22 (44.89%), temporal crescent in 17 (34.69%), disc drag in 13 (26.53%) and macular heterotopia in 7 (14.28%) eyes. Myopia was observed in 20 (40.82%) eyes and strabismus in 5 (19.23%) babies. The significant risk factor for ocular changes was ROP with more clock hours of involvement (p < 0.05). Higher period of gestation was associated with posterior pole changes (p< 0.05). CONCLUSIONS: All premature babies with threshold ROP treated with cryotherapy require frequent and long-term follow up to look for retinal residuae, refractive status, and ocular motility disorders.

Cryotherapy↗