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PubMed2001

Neurologic sequelae after severe falciparum malaria in adult travelers.

Severe falciparum malaria usually occurs in nonimmune patients, namely children in endemic areas or travelers returning from tropical areas. It generally has one of two outcomes: rapid death or cure without sequelae. Neurologic sequelae have been reported in children but have not been described in detail in adults. The purpose of this study was to determine the clinical spectrum, neuroimaging aspects and long-term outcome of these sequelae. We describe six imported cases of severe malaria with neurologic sequelae in adults, seen in a Parisian university hospital over a 10-year period. The most striking findings were neuropsychological disorders, in particular memory impairment and diffuse white matter damage on magnetic resonance imaging. Only three of the patients had made a full recovery after 6 months.

Adult↗
PubMed1990

Long-term sequelae of conservative treatment by surgery, brachytherapy, and chemotherapy for vulval and vaginal rhabdomyosarcoma in children.

Between 1970 and 1978, 17 girls with rhabdomyosarcoma (RMS) of the vulva or vagina were treated at the Institut Gustave-Roussy (IGR) by conservative treatment including surgery, brachytherapy, and chemotherapy. Twelve pubescent or postpubescent girls were studied for long-term sequelae. Eleven of 12 patients have had a normal puberty, two have a total of three healthy children, 11 have normal menses, and 10 normal menarche (one after hormonal replacement). Only one patient underwent hysterectomy following low-dose brachytherapy. Five girls have no vaginal complications, and three are sexually active. Three have had minimal vaginal sequelae, which required surgical correction to permit sexual intercourse. Four girls sustained serious sequelae (colorectal, vaginal, urethral, and ureteral stenosis). These sequelae, secondary to irradiation, are potentially avoidable in the future given the current advances in brachytherapy and improvements in dosimetry. This conservative treatment is useful and appropriate for girls with RMS of vulvar or vaginal origin when complete remission cannot be obtained with chemotherapy and partial colpectomy.

Adolescent↗
PubMed2005

Heparin-induced skin lesions and other unusual sequelae of the heparin-induced thrombocytopenia syndrome: a nested cohort study.

BACKGROUND: Heparin-induced thrombocytopenia (HIT) is caused by platelet-activating, heparin-dependent IgG antibodies (HIT-IgG). Although HIT is known to predispose the patient to thrombosis, the relationship between the formation of HIT-IgG and various other unusual clinical sequelae putatively linked with the HIT syndrome, such as heparin-induced skin lesions and acute anaphylactoid reactions following treatment with an IV heparin bolus, is not clear. METHODS: We used data from a clinical trial of postoperative heparin prophylaxis to compare the frequency of one or more predefined unusual clinical sequelae developing in 20 patients who formed platelet-activating HIT-IgG with 80 control patients who did not form HIT-IgG (nested cohort study). RESULTS: Five of the 20 patients in whom HIT-IgG developed had one or more unusual clinical sequelae, compared with none of 80 control patients (25% vs 0%, respectively; odds ratio, infinity; 95% confidence interval, 4.3 to infinity; p < 0.001). The unusual complications included heparin-induced erythematous or necrotic skin lesions (n = 4), an anaphylactoid reaction following IV heparin bolus use (n = 1), and warfarin-associated venous limb ischemia (n = 1). Thrombocytopenia, as it is conventionally defined (ie, platelet count fall to < 150 x 10(9) cells/L) developed in only one of these five patients. CONCLUSIONS: Certain unusual clinical sequelae, such as heparin-induced skin lesions, are strongly associated with the formation of HIT-IgG and should be considered as manifestations of the HIT syndrome, even in the absence of thrombocytopenia as conventionally defined.

Anaphylaxis↗
PubMed1984

Skull fracture and the low risk of intracranial sequelae in minor head trauma.

The presence of skull fracture has been associated with a higher risk of intracranial sequelae than if a fracture were not present. This is true for the total population of head-injury patients. However, reanalysis of the patient selection criteria data from two large published series on skull imaging in head trauma revealed that this increased risk factor for intracranial sequelae did not apply to a specific subset of minor-head-trauma patients. The patients in this subset were characterized by the presence of one or more of five "low-yield" criteria: (1) asymptomatic (no complaints), (2) headaches, (3) dizziness, (4) scalp hematoma, and (5) scalp laceration. All other criteria were absent. Results of the reanalysis showed (from a total population of 3031 head-trauma patients) a subset of 1184 patients characterized by these five criteria. In these 1184 minor-head-trauma patients there were 19 fractures, all linear, with none depressed or basilar. There were no intracranial sequelae. This change in the concept of fracture as a risk factor for intracranial sequelae has major implications in the future development of strategies for selecting patients for not having skull films or head computed tomograms.

Brain Injuries↗
PubMed1988

Occurrence of sequelae in Bell's palsy.

The occurrence of sequelae in 330 patients with Bell's palsy followed up for more than 6 months was investigated. At least one of five kinds of sequelae (synkinesis, crocodile tears syndrome, spasm, contracture, tinnitus and/or hearing loss during facial movement) was observed in 30 of the 330 cases (9.1%). Sequelae occurred at 23.9-39.0 weeks (mean) after onset of palsy and at scores of 30-34 points (mean; full score 40 points). The incidence of sequelae was correlated to the degree of facial nerve dysfunction.

Facial Muscles↗
PubMed1999

The treatment of the long-term sequelae of child abuse.

The literature on the long-term sequelae of sexual and physical abuse is reviewed. Abused children are at risk of long-term adverse psychological sequelae related to the abuse per se and not just as a consequence of other associated background factors. There is some specificity relating the type of psychological outcome to the type of abuse experienced. Physical abuse is just as traumagenic as sexual abuse in the long-term. Whatever the efficacy of specific psychological treatments, there are broad general service measures that will prevent both abuse and re-abuse and therefore impact on long-term sequelae. The studies on the effectiveness of intervention to prevent psychological sequelae of abuse are systematically appraised. There are few well-conducted and adequately controlled studies of the efficacy of treatment for abused children. Where a corpus of studies does exist, e.g. group therapy for sexually abused children, treatment for abused children appears to be as effective for children whose problems arise from other causes. Studies have also shown that abusive parenting can be changed by training.

Adolescent↗
PubMed1999

The Ilizarov technique for treatment of sequelae of childhood-acquired bone and joint infection.

Bone and joint infections in childhood can result in various sequelae including deformity and limb length discrepancy (LLD). Management of these sequelae is difficult and must be individualized. In this study, we retrospectively examined the efficacy of treatment with Ilizarov techniques in 30 patients suffering from sequelae of bone and joint infections in childhood, treated from 1989 to 1994. These cases comprised 17 hip infections, two septic shoulders, and 11 cases of osteomyelitis (4 femurs, 5 tibiae, 1 humerus, and 1 forearm). All patients had some evidence of LLD. There were 13 cases of hip deformity and 10 cases of unstable hips. There were also 10 cases of angular deformity and five of nonunion of bone. The mean age at treatment was 21 years. Twenty-eight patients underwent Ilizarov lengthening procedures and 18 of them underwent deformity or instability correction simultaneously. Two patients underwent Ilizarov deformity correction only. Various techniques were used, including Schanz osteotomy plus mid-shaft femoral lengthening and distraction callotasis with and without an intramedullary nail. Postoperative complications included stiffness of joints in six patients, pin tract infection in six, fracture in five, malunion in five, nonunion in four, callus shortening in four, nerve palsy in two, and over-lengthening in one. The mean duration of follow-up was 72 months. The average length gain was 6.6 cm in shortened bones, with a mean external fixator index of 40.5 days/cm. All patients were satisfied with the functional and cosmetic results. We conclude that Ilizarov techniques are effective in treating sequelae of childhood infections of bones and joints.

Adult↗
PubMed2000

[Psychological sequelae in longterm cancer survivors].

AIM: To analyze the psychological sequelae in long-term survivors of childhood cancer and to establish the relationship between the changes produced in both cognitive (intelligent quotient) and emotional factors (anxiety and depression) and diagnostic and therapeutic variables as well as in sensorial sequelae (visual and auditory). METHODS: One hundred and thirty eight survivors were evaluated. Of these 73 had had acute leukemia and 65 had had solid tumour (nephroblastoma or sympathetic nervous system tumour) diagnosed before the age of 15 years. Elapsed time since diagnosis was at least 10 years and duration of therapy was more than two years. Demographic and social data of the survivors, their parents and siblings, diagnosis, number of relapses and treatment given were obtained from medical records and from individual interviews at the time of assessment. Cognitive and emotional dimensions and the tools used to measure them were intelligent quotient (Wechsler Intelligence Scale for children and Wechsler Adult Intelligence Scale), anxiety features and state (State-Trait Anxiety Inventory for children and adults) and depressive symptoms (Minnesota Multiphasic Personality Inventory Depression subscale). Ophthalmologic assessment included visual acuity, measurement of intraocular pressure and ophthalmoscopic examination. Audiologic evaluation included tonal audiometry for frequencies from 125 to 8,000 Hz. RESULTS: Total, verbal and performance intelligent quotients were 102, 106 and 105 respectively for the whole sample. Five percent of survivors scored under 70 (mental deficiency), and 6.5 % over 129 (gifted). The scores of solid tumour survivors were higher than those of leukemia survivors who were cranially irradiated at dosages >= 24 Gy (108 vs 98; p = 0.03), and were similar to those of leukemia survivors irradiated at lower dosages (102) or who had not been irradiated (109). Intelligent quotient correlated positively with age at diagnosis and negatively with cumulated intrathecal methotrexate and cranial irradiation dosages. Survivors of acute leukemia who relapsed scored 14 points less than those who had not relapsed. The most affected cognitive areas were comprehension, arithmetic ability, attention, visual and verbal memory, causative reasoning and visual-motor coordination. No relationship was found between sensory sequelae and cognitive capacities, probably due to the mildness of the sequelae. The prevalence of depression was greater in cancer survivors than in the general population but that of anxiety was lower. CONCLUSIONS: Intelligent quotient was within normal limits. Lower scores were related to cranial radiotherapy, age at diagnosis and relapses. Emotionally, the survivors coped successfully with cancer, depressive symptoms being more prevalent than in the general population and anxiety almost negligible.

Adolescent↗
PubMed1992

Neuropsychiatric sequelae of head injuries.

Based on the above review several general points can be highlighted: Head injuries are extremely common, affecting probably close to 2,000,000 people in this country each year. The most common are nonmissile, closed-head injuries, the majority of which occur in association with motor vehicle accidents. Virtually all studies of head injury suggest a peak incidence in the 15 to 24 years of age group. Coarse measures of outcome suggest that the very young and the elderly have poorer outcomes. Because of improved acute care, however, a large number of young, otherwise healthy patients are surviving head injuries with a variety of profound neuropsychiatric sequelae. Because of the mechanics of brain injury in acceleration-deceleration injuries, certain brain injury profiles are common including orbitofrontal, anterior and inferior temporal contusions, and diffuse axonal injury. The latter particularly affects the corpus callosum, superior cerebellar peduncle, basal ganglia, and periventricular white matter. The neuropsychiatric sequelae follow from the above injury profiles. Cognitive impairment is often diffuse with more prominent deficits in rate of information processing, attention, memory, cognitive flexibility, and problem solving. Prominent impulsivity, affective instability, and disinhibition are seen frequently, secondary to injury to frontal, temporal, and limbic areas. In association with the typical cognitive deficits, these sequelae characterize the frequently noted "personality changes" in TBI patients. In addition, these changes can exacerbate premorbid problems with impulse control. Marked difficulties with substance use, sexual expression, and aggression often result. The constellation of symptoms, which make up the postconcussive syndrome, are seen across the whole spectrum of brain injury severity. Even in so-called mild or minor head injury, these symptoms are likely to have an underlying neuropathologic, neurochemical, or neurophysiologic cause. Higher than expected rates of certain psychopathologic disorders occur in the TBI population, including psychotic syndromes and depressive syndromes. Manic syndromes also are associated with TBI; however, the incidence has not been established. Assessment and treatment of the neuropsychiatric sequelae is a complex and challenging process. The mixture of diffuse and focal injuries, the combination of cognitive, language, somatic, and behavioral difficulties do not fit easily into current diagnostic categories.

Age Factors↗
PubMed2005

[Evaluation of respiratory failure due to sequelae of tuberculosis].

Though the mortality of tuberculosis in Japan has been extremely rapidly depressed from about 150 deaths per 100,000 in 1950 down to about 4 in 1985 during the period of a couple of decades after the World War II. However, the declining trend of the mortality and the morbidity seem to be leveling off now and the morbidity of the tuberculosis remain on the almost same level which are much higher than that of the developed countries. We have to make the progress in the field of the new diagnostic technique and the creation of the new drugs applying the most frontier science and the social system supporting the completion of the treatment for every patient. On the other hand, it is also very important to take care of those who have been suffering from the sequelae of the pulmonary tuberculosis, which include chronic respiratory failure, cor pulmonale, and non-TB chronic pulmonary secondary infections. Among the sequelae we focus to the respiratory failure. Among the patients with various chronic respiratory diseases, there are many who are not hypoxic at rest but are hypoxic during physical exercise in the daily life. The pulmonary exercise test by treadmill or ergometer which needs a lot of work is the standard method to detect the exercise hypoxia. But this test is too complicated to come into wide use in the daily clinical study in Japan. Another exercise test has been eagerly expected for a long period. We newly developed a method to detect the exercise hypoxia in the patients' daily life without burdening the additional physical activities. The device of the new method consists of a portable pulse oxymeter with a built-in accelerometer which measures the oxygen saturation percutaneously and also measures simultaneously the vertical acceleration of the subject's physical movement by the accelerometer. The appropriate evaluation of exercise hypoxia of the patients with respiratory disturbances due to pulmonary tuberculosis sequelae, especially exercise hypoxia, should be performed widely all over the daily clinical examination by such a method as described in this report. Further the system of the evaluation of the exercise respiratory disturbances should be introduced in the various social regimen which concern with the disability due to the respiratory disturbances. We wish our society will be more matured society in which the patients with respiratory disturbances can afford to fully enjoy their lives. Both the frontier science against the tuberculosis and the measures against the sequelae of the pulmonary tuberculosis are one of our important challenges today.

Exercise Test↗
PubMedDate not supplied

[Sequelae of septic hip arthritis in infancy].

Septic arthritis of the hip represents a serious pathological condition which results in severe sequelae and high invalidity. The most serious sequelae are seen in neonatal and infantile period, when normal growth and development are brutally disturbed, followed by proximal femoral destruction and acetabular dysplasia, which in return result in anatomical limb shortening and functional deficiency. In order to achieve an adequate approach to the treatment of septic hip arthritis sequelae, different classification systems have been developed. Two of them are the most cited in literature: classification according to Hunka, and that according to Choi and associates. In this article, the authors compared both classification systems, presented their similarities and differences, and expanded them in view of treatment options applicable to each category. Although both classifications are based on radiographic findings, it has been shown that they clearly tell between treatment options relevant to particular type of sequelae of the septic hip arthritis, thus representing a useful tool in making decision about adequate treatment.

Arthritis, Infectious↗
PubMedDate not supplied

[Irreversible neurologic sequelae caused by lithium].

Lithium therapy can induce acute toxic reactions especially during overdosage. Exceptionally, permanent neurologic sequelae persist after the acute toxic reaction. These sequelae are more often cerebellar symptoms. Dementia, parkinsonian syndromes, choreoathetosis, brain stem syndromes and peripheral neuropathies have also been described. They are defined as irreversible if they persist more than two months after the interruption of lithium treatment. These neurologic complications occur frequently after voluntary or accidental poisoning but they may be observed even if the serum lithium dosage is below toxic level. Risk factors other than overdose are not well identified. Neurologic lesions induced by lithium can occur in the first days of the treatment as well as after years of maintenance therapy. Age and psychiatric diagnosis do not seem to be correlated with an increased risk of lithium induced neurotoxicity. Sex may be a risk factor, because of an overrepresentation of women among the case reports. The lithium-neuroleptic combination is another possible (although controversial) risk factor precipitating the occurrence of irreversible neurologic sequelae. Haloperidol was first implicated, but it has been shown that others neuroleptics, in combination with lithium, can induce similar toxic reactions. Intercurrent somatic illness with pyrexia often precedes the acute toxic reaction, and special attention must be paid to patients treated by lithium when they become hyperthermic. Major surgery, concurrent treatment with diuretics, renal failure, low food intake or low-salt diet are more uncommon precipitating factors. Available pharmacological treatments have not yet proved to be helpful. Even when the lesions are irreversible, a functional improvement can be obtained by rehabilitation. Thirty one cases of irreversible neurologic sequelae are reviewed.

Female↗
PubMed1990

[Study of the characteristics of the integrative activity of the brain in sequelae of severe cranio-cerebral injury].

Integrative activity of the brain (psycho-vegeto-somatic+ regulation of functions) was studied in 50 persons with sequelae of grave craniocerebral injury (GCCI). In the acute period of CCI, 19 patients were diagnosed to have brain contusion of severe degree and 31 brain compression. CCI standing had been 1.5 month to 8 years by the moment of investigation. In 6 persons with sequelae of GCCI, socio-labour adaptation was complete, in 5, it was relative, in 17 insufficient and in 22, clearly broken (disadaptation). Persons with sequelae of GCCI have been shown to manifest psycho-vegeto-somatic+ disintegration pointing to dysfunctions of the nonspecific brain systems. The author discusses the influence on integrative brain activity in GCCI sequelae of factors such as CCI standing, the character of socio-labour adaptation, lateralization of primary brain injury.

Adolescent↗
PubMed1990

[The sports, the child and accidents. III. Long-term sequelae].

Sports-related injuries in children and adolescents are an emergent health problem in our country, because of their incidence and severity. Nevertheless information is lacking on possible long term sequelae. This topic has been studied in 220 out of 1040 6-15 years old children, prospectively registered during 1985 in our hospital because of acute sports injuries. Selection for the follow-up was based on injuries severity, assessed according to the Abbreviated Injury Scale. Subjective and/or objective sequelae have been observed at a clinical control three years after the accident, in 68 out of the 220 controlled children (30.9%). The prevalence of the sequelae was similar in males and females, but quite different according to the age, being higher in children older than 14, the type of sports activity and the site of the injuries, with higher prevalence of those of the ankle and knee rather than of the wrist. Prevention of sports-related injuries and their possible sequelae is well established in Sports Medicine, but not yet fully applied to children. Pediatricians must sensitize the school and sports clubs to the problem.

Adolescent↗
PubMed1989

[The sequelae of radiotherapy: possibilities of medical therapy].

The possibilities of medical treatment for the sequelae of radiotherapy of the various organs and apparatus are examined. Medical therapy may be utilised as a support in cases in which a favourable course is possible spontaneously, as a support in cases with chronic changes not liable to develop favourably, in cases with prospects of radical treatment, with substitutive purposes based therefore on the administration of substances that are missing as a result of the sequelae, as in the case of hormones after irradiation of endocrine organs, and finally for preventive purposes. The variously acting pharmacological substances applied locally or introduced generally which permit biological recovery, albeit partially, are recalled. The reversibility of certain sequelae, especially of those caused by the association with radiotherapy, must be borne in mind for adequate medical treatment. Medical treatment is hindered by the fact that many sequelae are caused by processes that are involved in the acute phase and which lead irreversible organic damage with few or no clinical signs. Nevertheless, when evolution is not yet complete, the anti-inflammatory substances, especially steroids, and anticoagulants of the heparin type, may prove to be very useful.

Cardiovascular System↗
PubMed1989

[Sequelae of radiosurgical treatment in patients having undergone Wertheim radical hysterectomy].

The sequelae from therapeutic treatment in a series of 361 patients subjected to Wertheim's hysterectomy, 125 of whom had a lumbo-aortic lymphadenectomy, have been studied. All these patients underwent postoperative external beam irradiation and intracavitary radium or caesium. Twenty-six cases of functional vesical disturbance, 12 of iliac lymphocele, 24 of parametritis, 4 of bladder vaginal fistula, 35 of ureteral fistula, 16 of ureteral fibrosis, 6 of lymphedema of the lower limbs and 1 of rectal ulcer were found. In some types of sequelae, the most important cause was surgery, with greater evidence if the operation was more extensive. For other types of sequelae the most important cause was radiotherapy for dystrophy and fibrosis of the irradiated tissues, leading to occlusion of lymphatic vessels, and intestinal and ureteral fibrosis. Recovery was easier with better results if the causes of sequelae were prevalently from surgery. The clinical findings were later and recovery more difficult if the causes were prevalently from radiotherapy.

Female↗
PubMed1987

Poliomyelitis: late and unusual sequelae.

The purpose of this study is to provide a thorough and comprehensive description of the late onset manifestations of poliomyelitis (PM). In addition, unusual findings, seen in the post-poliomyelitis period, have been presented to further increase awareness of the potential diversity of the problem. The scope of PM sequelae is broad. Following a description of acute PM, the various sequelae are addressed categorically. These include neurologic, vascular, orthopedic, respiratory, sleep and psychologic problems; as well as less commonly recognized maladies. Different theories for PM sequelae have been proposed. Thorough electrodiagnostic testing can frequently confirm or negate the clinical impression. The pathophysiology of vascular problems, as well as the correlation between respiratory involvement, sleep disorders, and hypertension, is reviewed. Orthopedic problems and spinal deformities are discussed. Since overuse weakness is frequently present in these patients, the role of slowly progressive non-fatiguing exercise in their rehabilitation is emphasized. Of significance are the emotional concerns demonstrated by this group of patients. Further considerations include those sequelae not readily recognized in relation to PM. A brief overview of present epidemiologic trends in the United States, and the immunologic effects of vaccination, is presented.

Blood Circulation↗
PubMed1988

Neurological sequelae and fatality as prognostic measures in 875 cases of bacterial meningitis.

Based on a review of medical records, we have analysed the outcome after bacterial meningitis among 875 patients admitted during the period 1966-1976. The outcome was evaluated not only by fatality during admission or within 4 weeks after discharge, but also by neurological sequelae at the time of discharge. These two types of outcome were determined and compared in subgroups of patients categorised according to a number of features of prognostic significance. This has allowed us to quantify the clinical conditions and features with regard to the severity of the prognosis. In most subgroups of patients, the frequencies of fatality and sequelae followed the same patterns: High frequencies were associated with pneumococcal meningitis, rare bacterial aetiologies, increasing age, affected consciousness on admission, pneumonia on admission, convulsions during admission, and respiratory problems during admission. For some prognostic features, a correlation could be established with high sequelae rates, but not with high fatality rates. This was the case with increased duration of disease symptoms before admission, with alcoholism and with previous head trauma. Thus, this correlation revealed the importance of early hospitalisation. We find that the analysis of sequelae not only supports, but also adds important prognostic information to the results obtained by an analysis of fatality itself in this large retrospective clinical study.

Adolescent↗