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Sequelae
Kinds of Sequelae Selected AbstractsPARTNER AWARENESS REGARDING THE ADULT SEQUELAE OF CHILDHOOD SEXUAL ABUSE FOR PRIMARY AND SECONDARY SURVIVORSJOURNAL OF MARITAL AND FAMILY THERAPY, Issue 2 2003Noelle S. Wiersma This qualitative study investigates factors that may facilitate or impede awareness within couples regarding the sequelae of chuildhood sexual abuse for adult females and their partner. Six couples were interviewed about perceived effects of the abuse for self and partner and their perceptions regarding their awareness of these effects. Transcribed data were analyzed using grounded-theory methodolgy. Emergent themes regarding potential barriers to and facilitators of agreement are outlined in the context of the expressive and receptive abilities and motivations of each partner in communicating about the abuse. Preliminary implications for marriage and family therapy and further research are provided. [source] Pulmonary Regurgitation after Tetralogy of Fallot Repair: Clinical Features, Sequelae, and Timing of Pulmonary Valve ReplacementCONGENITAL HEART DISEASE, Issue 6 2007Naser M. Ammash MD ABSTRACT Pulmonary regurgitation following repair of tetralogy of Fallot is a common postoperative sequela associated with progressive right ventricular enlargement, dysfunction, and is an important determinant of late morbidity and mortality. Although pulmonary regurgitation may be well tolerated for many years following surgery, it can be associated with progressive exercise intolerance, heart failure, tachyarrhythmia, and late sudden death. It also often necessitates re-intervention. Identifying the appropriate timing of such intervention could be very challenging given the risk of prosthetic valve degeneration and the increased risk of reoperation. Comprehensive informed and regular assessment of the postoperative patient with tetralogy of Fallot, including evaluation of pulmonary regurgitation, right heart structure and function, is crucial to the optimal care of these patients. Pulmonary valve replacement performed in an experienced tertiary referral center is associated with low operative morbidity and mortality and very good long-term results. Early results of percutaneous pulmonary valve replacement are also promising. [source] Hyperbaric Oxygen Does Not Prevent Neurologic Sequelae after Carbon Monoxide PoisoningACADEMIC EMERGENCY MEDICINE, Issue 1 2002Benjamin Gilmer MS Abstract Delayed neurologic sequelae occur in up to 40% of severe carbon monoxide (CO) poisonings. Conflicting clinical data support the efficacy of hyperbaric oxygen (HBO) therapy in the acute treatment of CO poisoning. Objective: To determine whether oxygen therapy reduces neurologic sequelae after CO poisoning in mice. Methods: Male Swiss-Webster mice were exposed to CO at 1,000 ppm for 40 minutes and then 50,000 ppm until loss of consciousness (LOC) (4-9 additional minutes). Total time of both phases of CO exposure was 40-49 minutes. Treatment included HBO with 3 atmospheres (ATA) 100% oxygen, normobaric oxygen (NBO) with 1 ATA 100% oxygen, or ambient air 15 minutes after LOC. All animals underwent passive avoidance training and memory was assessed by measuring step-down latency (SDL) and step-up latency (SUL) seven days following CO exposure. Results: Carbon monoxide poisoning induced significant memory deficits (SDLCO= 156 sec; SULCO= 75%) compared with nonpoisoned (NP) animals (SDLNP= 272 sec; SULNP= 100%). Both HBO and NBO did not prevent these neurologic sequelae. Furthermore, no significant neurobehavioral differences were found between HBO and NBO. Histologic examination of the CA1 layer of the hippocampus for pyknotic cells showed significant damage from CO in the air-treated animals (9.6%) but not in the nonpoisoned animals (3.8%). No significant neuroprotection was seen histologically with NBO and HBO compared with ambient air. Conclusions: These results suggest that HBO is not effective in preventing neurologic sequelae in mice and that there is no benefit of HBO over NBO following severe CO neurotoxicity. [source] Palatal adhesion: The treatment of unilateral palatal paralysis after high vagus nerve injuryHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2002James L. Netterville MD Abstract Background Resection of skull base tumors commonly necessitates intraoperative sacrifice of lower cranial nerves at the level of the jugular foramen. Sequelae of unilateral vagus nerve loss include ipsilateral laryngeal paralysis, ipsilateral palatal and pharyngeal paralysis, and velopharyngeal incompetence (VPI) marked by hypernasal speech and nasopharyngeal reflux of liquids during swallowing. Methods Palatal adhesion (PA), a procedure whereby the unilaterally paralyzed palate is attached to the posterior pharyngeal wall, decreases the size of the velopharyngeal port and minimizes the symptoms. This study assessed the outcome of PA in 31 patients with VPI secondary to proximal vagus nerve injury. Results PA decreased postoperative nasality in 96% of patients. Nasopharyngeal reflux was significantly improved in 83%. Three patients (11%) had minor wound breakdown postoperatively, all of which healed completely with conservative management. Conclusion PA offers a favorable result with minimal concomitant morbidity and is recommended for patients with VPI secondary to unilateral proximal vagus nerve paralysis. © 2002 Wiley Periodicals, Inc. Head Neck 24: 721,730, 2002 [source] Study of Japanese encephalitis and other viral encephalitis in Nepali childrenPEDIATRICS INTERNATIONAL, Issue 6 2007AJIT RAYAMAJHI Abstract Background: A hospital-based prospective cross-sectional study was conducted in children aged 1 month,14 years to identify the proportion of viral encephalitis due to Japanese encephalitis (JE) and compare the clinico-laboratory profile and outcome of JE with that of other viral encephalitis (non-JE). Methods: All probable cases of viral encephalitis on clinical and laboratory evaluation were confirmed as JE on anti-JE IgM in cerebrospinal fluid (CSF) and/or serum. Patients not having anti-JE IgM in CSF and/or serum were diagnosed as having non-JE. Results: Of 94 cases, 58 were JE and 36 non-JE. Although practice of rearing pigs at home was associated with JE (P = 0.0001), significantly higher serum creatinine, protein, aspartate aminotransferase and CSF protein levels were observed in non-JE. Longer duration of fever was associated with complete recovery in JE whereas shorter duration of fever was associated with recovery in non-JE. Risk of neurological sequelae (P = 0.01), especially hemiparesis (P = 0.03) was significantly more in JE. Sequelae were observed at 6 weeks follow up in 18.8% of JE and 13.9% of non-JE. Conclusion: JE was the most common cause of viral encephalitis in eastern Nepal and should be suspected in encephalitic patients having pig rearing at home and neurological sequelae. Although duration of hospitalization and complication were higher in JE, final outcome was similar to non-JE. Longer duration of fever in JE and shorter duration of fever in non-JE correlated with recovery, while altered sensorium and focal neurological deficit were independent predictors of sequelae at 6 weeks only in JE and not in non-JE. [source] Mediating Pathways Explaining Psychosocial Functioning and Revictimization as Sequelae of Parental Violence Among Adolescent MothersAMERICAN JOURNAL OF ORTHOPSYCHIATRY, Issue 2 2009Taryn Lindhorst PhD Adolescent mothers are at high risk for negative life events, such as previous childhood physical abuse, impaired psychosocial functioning, and young adulthood revictimization. However, little is known about the potential pathways in these events; hence, little is known about opportunities for intervention. This study used structural equation modeling to investigate mediators of the effects of parental child abuse on later psychosocial functioning and revictimization (in the form of intimate partner violence and sexual violence) among adolescent mothers, with longitudinal data spanning 2.4 years. On psychological distress in the final time period, parental physical child abuse had an early and then maintained effect but also effects mediated by earlier psychological distress and revictimization. Psychological distress rather than substance use appeared as the primary psychosocial factor mediating the effects of parental violence on both future distress and revictimization. For prevention of further psychosocial impairment and revictimization, these findings indicate the need for early intervention with adolescent mothers who come from abusive families and who display higher levels of psychological distress. [source] Practitioner Review: Psychological Sequelae of Head Injury in Children and AdolescentsTHE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 2 2001Judith A. Middleton 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. [source] Early Laryngeal Inhalation Injury and its Correlation with Late SequelaeTHE LARYNGOSCOPE, Issue 2 2006Tulio A. Valdez MD Abstract Objective: Inhalation injury can permanently alter normal laryngeal function. The aim of this study was to examine the early changes in voice, swallowing, and breathing in laryngeal inhalation injuries. Study Design: This was a prospective analysis of nine patients with inhalation injuries at a tertiary care institution. Methods: Laryngeal function of patients admitted for inhalation injury requiring intubation was documented using videostroboscopy and swallowing evaluation by the speech pathology service. Bronchoscopy was used to classify the degree of inhalation injury. Association among total body surface area, facial burns, severity of laryngotracheal injuries, and loss of function was attempted. Results: All three patients with severe tracheal inhalation injury presented persistent hoarseness at 1-year follow up with abnormal videostroboscopy findings. No association was found between inhalation injury and total body surface area burned. None of the patients in this series presented permanent swallowing dysfunction. Conclusion: The otolaryngologist plays an important role in the initial and long-term management of inhalation injuries. Inhalation injuries should be managed in a multidisciplinary fashion. There may be a correlation between the degree of tracheal injury and laryngeal injury and hoarseness. [source] Sequelae of otitis media with effusion among children with cleft lip and/or cleft palate1CLINICAL OTOLARYNGOLOGY, Issue 6 2002P. Sheahan Otitis media with effusion (OME) is common among children with cleft palate, and may lead to such long-term consequences as hearing loss, tympanic membrane retraction, and chronic otitis media (COM). In total, 104 children with cleft lip and/or palate treated for OME at our institution were reviewed. Mean duration of follow-up was 6.9 years, and mean age at latest follow-up was 9.6 years. The incidence of COM was 19%, and the incidence of cholesteatoma was 1.9%. Ears showing such long-term sequelae of OME as hearing loss, tympanic membrane retraction, and chronic otitis media, were noted to have undergone a significantly greater number of ventilation tube insertions than ears not showing these sequalae. Our findings would suggest that a conservative approach to the management of OME in children with cleft palate is more likely to be beneficial in the long term. [source] Gait disturbance interpreted as cerebellar ataxia after MMR vaccination at 15 months of age: a follow-up studyACTA PAEDIATRICA, Issue 1 2000A-M Plesner Measles, mumps and rubella (MMR) vaccination was included in the Danish childhood vaccination programme in 1987. During the following 10-y period, 550 notification records of adverse events after MMR vaccination at 15 mo of age have been registered, and a total of 41 notifications have included "gait disturbance". This corresponds to a frequency of 8 per 100 000 doses of MMR vaccine used for 15-mo-old children. The symptoms and signs are characteristic of cerebellar ataxia. In 28 notifications, the descriptions by the doctors included only "gait disturbance", while in 13 an additional interpretation was included. Thirty-two parents (78%) filled in a questionnaire and 26 (63%) agreed to participate in a clinical follow-up study. The gait disturbance symptoms mainly occurred 7,14 d after the vaccination, and the duration was median 1,2 wk (range 1 d to more than 4 mo). One-third of the children had symptoms lasting more than 2 wk. Significantly more children with long duration of symptoms had some kind of complaint or clinical signs at the follow-up in 1997. Gait disturbance registered after MMR vaccination seems to be more frequent than hitherto reported. Most cases are mild and short-lasting and a longer duration of symptoms seems to be predictive of late sequelae. A clinical diagnosis of cerebellar ataxia after MMR and the exact frequency of this adverse event remains to be tested in prospective studies. [source] Management of a Fetal Intrapericardial Teratoma: A Case Report and Review of the LiteratureCONGENITAL HEART DISEASE, Issue 1 2010Angela M. Fagiana MD ABSTRACT Intrapericardial teratomas are rare but potentially fatal. With prenatal ultrasound, early diagnosis and decision for treatment can be accomplished. However, the decision becomes to treat prenatally vs. waiting until the neonatal period for definitive surgical management. The most common sequelae of intrapericardial teratomas are pericardial effusion and often progression to hydrops. It is these sequelae that tend to guide management. Presented here is a case report of the diagnosis and management of a twin fetus with an intrapericardial teratoma, as well as a review of the literature. [source] Fontan Operation and the Single VentricleCONGENITAL HEART DISEASE, Issue 1 2007Jamil A. AboulHosn MD ABSTRACT The Fontan operation has gone through multiple incarnations since Fontan and Baudet's initial description in 1971. Through the medical dossier of a patient with a single ventricle, we plot the history of medical, surgical, and percutaneous interventions over the past 40 years, specifically focusing on the Fontan procedure, its development, indications, sequelae, and complications. Cardiac computed tomography with angiography is highlighted as a noninvasive imaging tool for the evaluation of the complex Fontan circulation. [source] Incontinence in the aged: contact dermatitis and other cutaneous consequencesCONTACT DERMATITIS, Issue 4 2007Miranda A. Farage Urinary and faecal incontinence affects a significant portion of the elderly population. The increase in the incidence of incontinence is not only dependent on age but also on the onset of concomitant ageing issues such as infection, polypharmacy, and decreased cognitive function. If incontinence is left untreated, a host of dermatological complications can occur, including incontinence dermatitis, dermatological infections, intertrigo, vulvar folliculitis, and pruritus ani. The presence of chronic incontinence can produce a vicious cycle of skin damage and inflammation because of the loss of cutaneous integrity. Minimizing skin damage caused by incontinence is dependent on successful control of excess hydration, maintenance of proper pH, minimization of interaction between urine and faeces, and prevention of secondary infection. Even though incontinence is common in the aged, it is not an inevitable consequence of ageing but a disorder that can and should be treated. Appropriate clinical management of incontinence can help seniors continue to lead vital active lives as well as avoid the cutaneous sequelae of incontinence. [source] Frequency of intrusive luxation in deciduous teeth and its effectsDENTAL TRAUMATOLOGY, Issue 4 2010Vivian Carvalho Second, to investigate the sequelae of total and partial intrusive luxation in the primary anterior teeth and in their successors and finally, to establish whether the sequelae on both deciduous and permanent teeth were related to the child's age at the time of the intrusion. Data collected from records of 169 boys and 138 girls, all between the ages of zero and 10 years, who were undergoing treatment during the period of March 1996 to December 2004. The sample was composed of 753 traumatized deciduous teeth, of which 221 presented intrusive luxation injury. Children with ages ranging from one to 4 years were the most affected with falls being the main cause of intrusion. Of all intruded teeth 128 (57.9%) were totally intruded and 93 (42.1%) partially. Pulp necrosis/premature loss and color change were the most frequent sequelae in both total and partial intrusions. Concerning permanent dentition, the most common disturbances were color change and/or enamel hypoplasia. Both types of intrusion caused eruption disturbance. Total intrusion was the most frequent type of intrusive luxation. There was no significant correlation between the child's age at the time of intrusion and the frequency of subsequent sequela on primary injured teeth (P = 0.035), between the age at the time of injury and the developmental disturbances on permanent teeth (P = 0.140). [source] Assessment of traumatic injuries to primary teeth in general practise and specialized paediatric dentistryDENTAL TRAUMATOLOGY, Issue 2 2010Carl Gösta Rasmusson Materials and methods:, A total of 323 children with traumatic injuries, 184 boys and 139 girls aged 7,83 months, participated in the study. All the children had first presented at a Public Dental Service clinic where they were examined by general dentists who decided, based on the severity of the trauma, to assign each child to one of the following two groups: Group A , recommended for treatment at the general practise (166 children with 257 traumatized incisor teeth). Group B , recommended for referral to a specialist in paediatric dentistry (157 children with 261 traumatized incisor teeth). Even in Group A, the specialist controlled the treatment decisions. The clinical diagnose and follow-up followed the recommendations presented by Andreasen & Andreasen. Results:, The distribution of trauma by age was similar in both groups, with about 60% occurring between 1 and 3 years. More injured teeth were extracted in children in Group B (n = 111) than in Group A (n = 33). A higher percentage of intruded primary incisors were recorded in Group B (24%) compared with Group A (16%). Similarly, the percentage of concussions/subluxations, lateral luxations and complicated crown fractures was higher in Group B than in Group A. Conclusions:, The group referred for specialist treatment had more severe injuries and needed more complicated treatment than the group recommended for care by general dentists. However, the rate of sequelae in permanent successors was the same in both. [source] Change in supporting tissue following loss of a permanent maxillary incisor in childrenDENTAL TRAUMATOLOGY, Issue 6 2007Helen D. Rodd Abstract,,, Alveolar bone resorption is an inevitable consequence of tooth loss and may be detrimental to long-term dental aesthetics and function. The aim of the present study was to quantify the degree of tissue resorption following the loss of a permanent incisor in a young population. The study group comprised 11 boys and five girls who all required the extraction of a permanent maxillary central incisor due to trauma-related sequelae. Mean age at tooth loss was 10.8 years. Upper alginate impressions were taken at regular intervals following tooth loss and were cast in yellow dental stone. Study models were sectioned longitudinally through the mid-point of both the maxillary incisor socket and the contra-lateral incisor to provide a thin plaster section. Digital photographs were acquired of the edentulous (A1) and dentate (A2) surfaces of this section and image analysis software was employed to quantify the surface area of both A1 and A2. At 3 months postextraction, mean A1 was 15.7% less than mean A2. By 6 months mean A1 had further reduced and was 25.3% less than that of the corresponding dentate alveolus. However, at subsequent time intervals following tooth extraction (>6 months), tissue loss appeared to stabilise with an overall reduction in tissue area remaining at 22%. This reduction in supporting tissue area was found to be highly statistically significant (P = 0.002, anova). Furthermore, girls appeared to have an overall greater degree of tissue loss than boys (P = 0.015). Further research is indicated to explore factors influencing the degree of tissue loss following incisor extraction and the benefit of therapeutic interventions in limiting this resorption. [source] Avulsion of primary teeth and sequelae on the permanent successorsDENTAL TRAUMATOLOGY, Issue 6 2005Pia Christophersen Abstract,,, The purpose of the present study was to determine the frequency of avulsion of primary teeth and the location of the avulsed tooth in a representative population of Danish children. Also, the frequency and the type of developmental disturbances in the permanent successors were assessed and related to age at the time of injury. The material included dental records of 4238 children from three clinics in Municipal Dental Health Services near Copenhagen, Denmark. The children were born between 1 January 1983 and 31 December 2000. Thirty-five children (0.8%) were identified as having avulsed in all 44 primary teeth most frequently the maxillary incisors (89%). Thirty-three fully erupted permanent successors were included in the study, the prevalence of developmental disturbances was 30% (10 teeth). The results showed the risk of developmental disturbances in the permanent successors to be more frequent the younger the age at the time of injury (P = 0.04). Discolouration affected all 10 permanent teeth, but also hypoplasia and horizontal enamel hypoplasia were found. [source] Odontoma-like malformation in a permanent maxillary central incisor subsequent to trauma to the incisor predecessorDENTAL TRAUMATOLOGY, Issue 5 2005Paulo Nelson-Filho Abstract,,, This report describes a case of a patient (1 year and 8 months old) with traumatic avulsion of the maxillary right primary central incisor and morphological changes in the germ of the permanent successor. One year after the trauma, an odontoma-like malformation developed. This malformation was removed 6 years after trauma and orthodontic treatment was started. Clinical follow-up and periodic radiographs are necessary after traumatic avulsion of primary teeth to monitor possible sequelae in the permanent successor. An odontoma-like malformation requires a multidisciplinary approach. [source] Federal University of Santa Catarina follow-up management routine for traumatized primary teeth , part 1DENTAL TRAUMATOLOGY, Issue 6 2004Mariane Cardoso Abstract,,, The objective of this study was to verify if the follow-up management routine of traumatized primary teeth set up by Federal University of Santa Catarina, which performs clinical and radiographic assessments (15 and 45 days; 4, 8 and 12 months) after the oral trauma, enabled an early diagnosis of sequelae which would indicate the need for endodontic intervention, as well as the influence a type of trauma and the child's age could have in the severity of the sequelae. In this study 52 sets of records were used of patients being seen in the last 6 months, with a total of 70 teeth that were receiving follow-up treatment. Patients returned for regular visits set up by the management routine, where clinical and radiographic examinations were performed to check for sequelae, which justified endodontic intervention. Mobility (51.2%) and crown discoloration (25.6%) were the most common sequelae found in the patient's first appointment. In the follow-up visits, replacement root resorption (22.5%) was the second most common sequela found, suggesting endodontic intervention. No significant association was found between severe sequelae, types of trauma and a child's age (,2 = 0.3, P = 0,8613). During the intervals of the follow-up visits, it was noticed that between 46 days and 8 months a higher number of sequelae were diagnosed (P < 0.05). The diagnosis of sequelae such inflammatory and replacement root resorption, which can lead to an early loss of a primary tooth, are frequent and that the interval between the follow-up visits has to be changed, suggesting the setting up of management routine 2. The study also concluded that the type of trauma and the child's age are not fundamental factors in the diagnosis of severe sequelae. [source] Influence of surgical repositioning of mature permanent dog teeth following experimental intrusion: a histologic assessmentDENTAL TRAUMATOLOGY, Issue 6 2002R. F. Cunha Abstract,,, The aim of this study was to evaluate, through histologic examination, the effect of surgical repositioning of intruded dog teeth upon the pulpal and surrounding tissues. Thirty teeth in 10 adult dogs, aged 2,3 years, were used. Fifteen teeth were intruded, surgically repositioned and fixed using orthodontics wire, composite resin, and enamel acid conditioning. All these teeth served as the experimental group. The remaining intruded teeth were not treated (control group). The animals were sacrificed to allow observations at 7, 15, and 30 post-operative days. The maxillary and mandibular archs were removed and processed for histologic exam. Based on the methodology and observed results, we concluded that: pulpal necrosis, external root resorption and ankylosis were common sequelae to severe traumatic intrusion; a careful immediate surgical repositioning of severed intruded permanent tooth with complete root formation has many advantages with few disadvantages. [source] Previous experience of spontaneous or elective abortion and risk for posttraumatic stress and depression during subsequent pregnancyDEPRESSION AND ANXIETY, Issue 8 2010Lydia Hamama Abstract Background: Few studies have considered whether elective and/or spontaneous abortion (EAB/SAB) may be risk factors for mental health sequelae in subsequent pregnancy. This paper examines the impact of EAB/SAB on mental health during subsequent pregnancy in a sample of women involved in a larger prospective study of posttraumatic stress disorder (PTSD) across the childbearing year (n=1,581). Methods: Women expecting their first baby completed standardized telephone assessments including demographics, trauma history, PTSD, depression, and pregnancy wantedness, and religiosity. Results: Fourteen percent (n=221) experienced a prior elective abortion (EAB), 13.1% (n=206) experienced a prior spontaneous abortion (SAB), and 1.4% (n=22) experienced both. Of those women who experienced either an EAB or SAB, 13.9% (n=220) appraised the EAB or SAB experience as having been "a hard time" (i.e., potentially traumatic) and 32.6% (n=132) rated it as their index trauma (i.e., their worst or second worst lifetime exposure). Among the subset of 405 women with prior EAB or SAB, the rate of PTSD during the subsequent pregnancy was 12.6% (n,51), the rate of depression was 16.8% (n=68), and 5.4% (n,22) met criteria for both disorders. Conclusions: History of sexual trauma predicted appraising the experience of EAB or SAB as "a hard time." Wanting to be pregnant sooner was predictive of appraising the experience of EAB or SAB as the worst or second worst (index) trauma. EAB or SAB was appraised as less traumatic than sexual or medical trauma exposures and conveyed relatively lower risk for PTSD. The patterns of predictors for depression were similar. Depression and Anxiety, 2010.© 2010 Wiley-Liss, Inc. [source] Side Effects and Complications of Fractional Laser Photothermolysis: Experience with 961 TreatmentsDERMATOLOGIC SURGERY, Issue 3 2008EMMY M. GRABER MD BACKGROUND A novel 1,550-nm erbium-doped laser (Fraxel, Reliant Technologies Inc.) has been shown to be effective in the treatment of photodamaged skin and scars with minimal postoperative recovery; however, studies evaluating its side effects and complication rates have been limited. PURPOSE The purpose was to determine the frequency and range of side effects and complications associated with fractional photothermolysis treatment. METHODS A retrospective evaluation of 961 successive 1,550-nm erbium-doped laser treatments in patients of various skin phototypes (I,V) was conducted in a single center. Side effects and complications of treatment, including time of onset and duration, were identified and tabulated. Patient demographics and laser parameters were also assessed. RESULTS Seventy-three treatments (7.6%) resulted in development of complications. The most frequent complications were acneiform eruptions (1.87%) and herpes simplex virus outbreaks (1.77%). Side effects and complications were equally distributed across different ages, skin types, body locations, laser parameters, and underlying skin conditions, except for postinflammatory hyperpigmentation, which occurred with increased frequency in patients with darker skin phototypes. CONCLUSIONS Fractional laser skin treatment is associated with a relatively low complication rate. Side effects and complications observed in this study were temporary and did not result in long-term or significantly severe sequelae (e.g., scarring). [source] The Treatment of Melasma with Fractional Photothermolysis: A Pilot StudyDERMATOLOGIC SURGERY, Issue 12 2005Cameron K. Rokhsar MD Background. Melasma is a common pigmentary disorder that remains resistant to available therapies. Facial resurfacing with the pulsed CO2 laser has been reported successful but requires significant downtime, and there is a risk of adverse sequelae. Objective. To determine if melasma will respond to a new treatment paradigm, fractional resurfacing. Methods. Ten female patients (Fitzpatrick skin types III,V) who were unresponsive to previous treatment were treated at 1- to 2-week intervals with the Fraxel laser (Reliant Technologies, Palo Alto, CA, USA). Wavelengths of 1,535 and 1,550 nm were both used, and 6 to 12 mJ per microthermal zone with 2,000 to 3,500 mtz/cm2 were the treatment parameters. Four to six treatment sessions were performed. Responses were evaluated according to the percentage of lightening of original pigmentation. Two physicians evaluated the photographs, and each patient evaluated her own response. Results. The physician evaluation was that 60% of patients achieved 75 to 100% clearing and 30% had less than 25% improvement. The patients' evaluations agreed, except for one patient, who graded herself as 50 to 75% improved as opposed to the physician grading of over 75%. There was one patient with postinflammatory hyperpigmentation and no patient with hypopigmentation. No downtime was necessary for wound healing. Conclusions. Fractional resurfacing affords a new treatment algorithm for the treatment of melasma that combines decreased risk and downtime with significant efficacy. This treatment modality deserves further exploration to maximize benefits. RELIANT technologies LOANED THE FRAXEL LASER FOR THE STUDY. RICHARD E. FITZPATRICK, MD, IS A PAID CONSULTANT FOR RELIANT AND A STOCKHOLDER. [source] Aggressive and Neglected Basal Cell CarcinomaDERMATOLOGIC SURGERY, Issue 11 2005Ali Asilian MD Background. Basal cell carcinoma (BCC) is the most common cutaneous malignancy and usually has a benign coarse. Rarely, examples of aggressive and neglected types of this tumor are seen. Objective. To present an interesting and dramatic example of how some people neglect their tumors and how devastating the sequelae can be. Methods. We report a 58-year-old man with an extensive BCC and signs of cranial nerve involvement. Results. The patient had a large, infected ulcer on his scalp. He also had skull bone destruction, osteomyelitis, mastoiditis, cranial nerve paralysis, and radiographic features of the skull base and upper cervical soft tissue involvement. Pathologic studies revealed an infiltrating form of BCC. Conclusions. If left untreated and neglected, as in this case, BCC can become inoperable and complicated. ALI ASILIAN, MD, AND BANAFSHE TAMIZIFAR, MD, HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [source] Minocycline-Induced Hyperpigmentation Treated with a 755-nm Q-Switched Alexandrite LaserDERMATOLOGIC SURGERY, Issue 9 2004Tina S. Alster MD Background. Cutaneous pigmentation associated with minocycline therapy is an unusual adverse effect for which few successful treatments have been described. The pigment changes may persist for years, despite cessation of therapy, and is often cosmetically disfiguring, causing significant embarrassment and psychological depression in those affected. Few safe and effective treatments have been described in the past; however, recent pigment-specific laser technology has shown promise in the treatment of this condition. Objective. The objective was to describe a series of patients with minocycline-induced hyperpigmentation who were successfully treated with a 755-nm Q-switched alexandrite laser. Methods. Six patients with minocycline-induced hyperpigmentation on the face or legs were treated with a Q-switched alexandrite laser on a bimonthly basis until pigmentation was eradicated. Results. Cutaneous pigmentation resolved completely in all patients in an average of four laser sessions. Side effects were limited to transient purpura and mild desquamation without scarring or dyspigmentation. Conclusion. Minocycline-induced cutaneous pigmentation can be effectively cleared without risk of adverse sequelae by Q-switched alexandrite (755-nm) laser irradiation. [source] Injecting 1000 Centistoke Liquid Silicone With Ease and PrecisionDERMATOLOGIC SURGERY, Issue 3 2003Anthony V. Benedetto DO, FACP BACKGROUND Since the Food and Drug Administration approved the use of the 1000 centistoke liquid silicone, Silikon 1000, for intraocular injection, the off-label use of this injectable silicone oil as a permanent soft-tissue filler for facial rejuvenation has increased in the United States. Injecting liquid silicone by the microdroplet technique is the most important preventive measure that one can use to avoid the adverse sequelae of silicone migration and granuloma formation, especially when injecting silicone to improve small facial defects resulting from acne scars, surgical procedures, or photoaging. OBJECTIVE To introduce an easy method for injecting a viscous silicone oil by the microdroplet technique, using an inexpensive syringe and needle that currently is available from distributors of medical supplies in the United States. METHOD We suggest the use of a Becton Dickinson 3/10 cc insulin U-100 syringe to inject Silikon 1000. This syringe contains up to 0.3 mL of fluid, and its barrel is clearly marked with an easy-to-read scale of large cross-hatches. Each cross-hatch marking represents either a unit value of 0.01 mL or a half-unit value of 0.005 mL of fluid, which is the approximate volume preferred when injecting liquid silicone into facial defects. Because not enough negative pressure can be generated in this needle and syringe to draw up the viscous silicone oil, we describe a convenient and easy method for filling this 3/10 cc diabetic syringe with Silikon 1000. RESULTS We have found that by using the Becton Dickinson 3/10 cc insulin U-100 syringe, our technique of injecting minute amounts of Silikon 1000 is facilitated because each widely spaced cross-hatch on the side of the syringe barrel is easy to read and measures exact amounts of the silicone oil. These lines of the scale on the syringe barrel are so large and clearly marked that it is virtually impossible to overinject the most minute amount of silicone. CONCLUSION Sequential microdroplets of 0.01 cc or less of Silikon 1000 can be measured and injected with the greatest ease and precision so that inadvertent overdosing and complications can be avoided. [source] Decreased Tear Expression with an Abnormal Schirmer's Test Following Botulinum Toxin Type A for the Treatment of Lateral Canthal RhytidesDERMATOLOGIC SURGERY, Issue 2 2002Seth L. Matarasso MD background. Inactivation of muscles of facial expression by chemodenervation with botulinum toxin remains an off-label indication. Nevertheless, it continues to be a safe and effective technique to improve dynamic rhytides and is the treatment of choice for the hypertrophic lateral fibers of the orbicularis oculi muscle that can cause the superimposed crow's feet. objective. Although infrequent and self-limiting, the complication of unexpected muscle weakness from toxin diffusion or erroneous placement is documented. methods. However, injection into the pretarsal portion of the orbicularis oculi muscle resulting in unilateral ocular irritation and diminished tear expression as evidenced by a dry eye and an abnormal Schirmer's test has rarely been reported. Direct injection into the pretarsal fibers of the muscle as opposed to diffusion of the toxin into the muscle fibers or the lacrimal gland was consistent with the onset of action of the toxin and the prolonged duration of the ocular symptoms. results. Treatment consisted of ocular lubrication until the effects of the toxin dissipated and muscle tone returned. Subsequent treatment did not result in a result in a recurrence of adverse sequelae. conclusions. Facial muscles are small, not isolated, and often have fibers that interdigitate. An important factor in the administration of botulinum toxin is the identification of the muscles responsible for the corresponding rhytide. Precise knowledge of muscular anatomy and function will aid in minimizing this and other potential complications. [source] Treatment of Varicose and Telangiectatic Leg Veins: Double-Blind Prospective Comparative Trial Between Aethoxyskerol and SotradecolDERMATOLOGIC SURGERY, Issue 1 2002Mitchel P. Goldman MD background. One hundred twenty-nine patients were treated with either polidocanol (POL) or sodium tetradecyl sulfate (STS) to compare the efficacy and adverse sequelae of each agent. objective. To determine the safety and efficacy of two sclerosing solutions. methods. Each patient's leg veins that did not have incompetence from the saphenofemoral junction (SFJ) were divided into three categories by size (<1 mm, 1,3 mm, 3,6 mm). Each leg was randomly treated with either 0.25%, 0.5%, or 1.5% of STS or 0.5%, 1.0%, or 3% of POL respective of size. An independent, three-panel, blindly randomized photographic examination was obtained pretreatment and at 4 and 16 weeks. Patient satisfaction index and overall clinical improvement assessment were also obtained. results. All patients had an average of 70% improvement and were 70,72% satisfied in all vein categories treated with either solution. There was no significant difference in adverse effects between each group except for a decrease in ulcerations and swelling in the POL group. conclusion. Both STS and POL are safe and effective sclerosing solutions for varicose and telangiectatic leg veins. [source] Complications of Expanded Polytetrafluoroethylene (e-PTFE) Facial ImplantDERMATOLOGIC SURGERY, Issue 9 2001Harold J. Brody MD Implantation of the expanded polytetrafluoroethylene (e-PTFE) implant to achieve correction of nasolabial folds or thinning lip has been fraught with complications in spite of patient acceptance since its introduction in 1997. The four most frequent postoperative complications are extrusion, movement, infection, and swelling. In examination of 86 insertions of the 3.2 mm tubular implants, these sequelae are generally manageable for the physician and patient. If the patient understands possible courses of healing, both physician and patient satisfaction may be achieved. [source] Comparison of Long-Pulsed Diode and Long-Pulsed Alexandrite Lasers for Hair Removal: A Long-Term Clinical and Histologic StudyDERMATOLOGIC SURGERY, Issue 7 2001Christiane Handrick MD Background. Unwanted facial and body hair is a common problem, generating a high level of interest for treatment innovations. Advances in laser technology over the past several years has led to the development and distribution of numerous red and infrared lasers and light sources to address this issue. Despite the impressive clinical results that have been reported with the use of individual laser hair removal systems, long-term comparative studies have been scarce. Objective. To compare the clinical and histologic efficacy, side effect profile, and long-term hair reduction of long-pulsed diode and long-pulsed alexandrite laser systems. Methods. Twenty women with Fitzpatrick skin types I,IV and dark terminal hair underwent three monthly laser-assisted hair removal sessions with a long-pulsed alexandrite laser (755 nm, 2-msec pulse, 10 mm spot) and a long-pulsed diode laser (800 nm, 12.5 msec or 25 msec, 9 mm spot). Axillary areas were randomly assigned to receive treatment using each laser system at either 25 J/cm2 or 40 J/cm2. Follow-up manual hair counts and photographs of each area were obtained at each of the three treatment visits and at 1, 3, and 6 months after the final laser session. Histologic specimens were obtained at baseline, immediately after the initial laser treatment, and 1 and 6 months after the third treatment session. Results. After each laser treatment, hair counts were successively reduced and few patients found it necessary to shave the sparsely regrown hair. Optimal clinical response was achieved 1 month after the second laser treatment, regardless of the laser system or fluence used. Six months after the third and final treatment, prolonged clinical hair reduction was observed with no significant differences between the laser systems and fluences used. Histologic tissue changes supported the clinical responses observed with evidence of initial follicular injury followed by slow follicular regeneration. Side effects, including treatment pain and vesiculation, were rare after treatment with either laser system, but were observed more frequently with the long-pulsed diode system at the higher fluence of 40 J/cm2. Conclusion. Equivalent clinical and histologic responses were observed using a long-pulsed alexandrite and a long-pulsed diode laser for hair removal with minimal adverse sequelae. While long-term hair reduction can be obtained in most patients after a series of laser treatments, partial hair regrowth is typical within 6 months, suggesting the need for additional treatments to improve the rate of permanent hair removal. [source] | |||||||||||||||||||||||||||||||||||||||||||||||||