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Adverse Sequelae (adverse + sequelae)

Distribution by Scientific Domains

Medical Sciences	94%

Selected Abstracts

Closure of the Greater Saphenous Vein with Endoluminal Radiofrequency Thermal Heating of the Vein Wall in Combination with Ambulatory Phlebectomy: Preliminary 6-Month Follow-up

DERMATOLOGIC SURGERY, Issue 5 2000
Mitchel P. Goldman MD
Background. Incompetence of the saphenofemoral junction with reflux into the greater saphenous vein is one cause of chronic venous hypertension which may lead to the development of varicose and telangiectatic leg veins. Therefore treatment is necessary. Objective. To evaluate a novel method for closing the incompetent greater saphenous vein at its junction with the femoral vein through an endoluminal approach. Methods. Ten patients with reflux at the saphenofemoral junction into the greater saphenous vein were treated with radiofrequency heating of the vein wall through an endoluminal catheter. Patients were evaluated at 3 and 6 months to determine treatment efficacy as well as adverse sequelae. Results. All treated patients achieved complete closure of the saphenofemoral junction and greater saphenous vein. Complete treatment took an average of 20 minutes. Adverse sequelae were minimal, with 2 of 12 patients having mild erythema for 2,3 days. Conclusion. Endoluminal radiofrequency thermal heating of an incompetent greater saphenous vein has been shown to be easily accomplished and efficacious throughout the 6-month follow-up period. [source]

The Treatment of Melasma with Fractional Photothermolysis: A Pilot Study

DERMATOLOGIC SURGERY, Issue 12 2005
Cameron 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]

Minocycline-Induced Hyperpigmentation Treated with a 755-nm Q-Switched Alexandrite Laser

DERMATOLOGIC SURGERY, Issue 9 2004
Tina 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 Precision

DERMATOLOGIC SURGERY, Issue 3 2003
Anthony 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 Rhytides

DERMATOLOGIC SURGERY, Issue 2 2002
Seth 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 Sotradecol

DERMATOLOGIC SURGERY, Issue 1 2002
Mitchel 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]

Comparison of Long-Pulsed Diode and Long-Pulsed Alexandrite Lasers for Hair Removal: A Long-Term Clinical and Histologic Study

DERMATOLOGIC SURGERY, Issue 7 2001
Christiane 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]

Q-Switched Ruby Laser Treatment for Postsclerotherapy Hyperpigmentation

DERMATOLOGIC SURGERY, Issue 7 2000
Alireza Tafazzoli
Background. One of the most common adverse sequelae of sclerotherapy is cutaneous hyperpigmentation. Objective. We used the Q-switched ruby laser to treat postsclerotherapy hyperpigmentation. Methods. Eight patients developed pigmentation lasting more than 1 year (1,2 years on average) after sclerotherapy treatment for reticular and telangiectatic veins in the legs ranging in size from 0.2 to 4 mm in diameter. All patients were treated with a Q-switched ruby laser at 694 nm, 4 mm beam size, and fluence range of 5.6,10.5 J/cm2. Results. Ninety-two percent of lesions lightened after treatment. There was significant (75,100%) resolution of hyperpigmentation in 58% of treated areas, 25% improvement in 33% of treated areas, and no improvement in the remaining areas. Conclusion. Our impression is that given a choice of lasers, the Q-switched ruby laser provides the greatest efficacy for treating postsclerotherapy hyperpigmentation. [source]

Closure of the Greater Saphenous Vein with Endoluminal Radiofrequency Thermal Heating of the Vein Wall in Combination with Ambulatory Phlebectomy: Preliminary 6-Month Follow-up

Association between oestradiol and puerperal psychosis

ACTA PSYCHIATRICA SCANDINAVICA, Issue 2 2000
A. Riecher-Rössler
Objective: Postpartum psychiatric disorders with long-lasting adverse sequelae are common during the childbearing years. These disorders can be severe and resistant to conventional psychiatric treatment methods. We present two consecutive cases with puerperal psychosis who were refractory to conventional treatment methods but responded successfully to oestrogen therapy. Method: Serum oestradiol concentration was measured by radioimmunoassay and the documented oestradiol deficiency replaced with physiological oestradiol sublingually. The treatment effect was evaluated by the Brief Psychiatric Rating Scale. Results: In both cases the baseline oestradiol concentration was low (28 and 69 pmol/L). During the treatment with oestradiol, there was a concomitant elevation of the concentration of serum oestradiol, which coincided with the decline in psychotic symptoms. Conclusion: The observation of low serum oestradiol together with psychotic symptoms and successful treatment with oestradiol suggests that oestradiol may have a causal relevance to puerperal psychosis and significance in the treatment of this condition. [source]

Poverty, underdevelopment and infant mental health,

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 4 2003
LM Richter
Abstract: Very great advances have occurred in disciplinary and professional knowledge of infant development and its influence on subsequent development. This expertise includes the ways in which early experiences affect the capacity of mature individuals for social adjustment and productive competence, and promising methods of intervention to promote infant mental health and prevent adverse sequelae of risk conditions. However, very little of this knowledge has been applied in work among infants and children living in conditions of poverty and underdevelopment. This lack of application continues despite the enormous threats to the well-being of infants and young children brought about by the combined effects of poverty and the AIDS pandemic, especially in southern Africa. Protein,energy malnutrition, maternal depression, and institutional care of infants and small children are cited as illustrative of areas in which interventions, and their evaluation, are desperately needed in resource-poor countries. An argument is made for the critical importance of considering and addressing psychological factors in care givers and children in conditions of extreme material need. An example is provided of a simple intervention model based on sound developmental principles that can be implemented by trained non-professionals in conditions of poverty and underdevelopment. [source]

An Unusual Complication of Sinus Arrest Following Right-Sided Stellate Ganglion Block: A Case Report

PAIN PRACTICE, Issue 3 2004
Ashok K. Saxena MD
Abstract: We present a case of a 29-year-old female patient who had presented to us for the management of her chronic right shoulder,hand pain and developed a sinus arrest following a right-sided stellate ganglion block (RSGB). This patient on receiving a diagnostic RSGB via the anterior paratracheal (C6) approach developed sinus arrest followed by apnea and unconsciousness. On institution of resuscitative measures involving tracheal intubation, positive pressure ventilation, cardiac massage, and intravenous atropine, spontaneous cardiac activity recovered in about 3 minutes. Other signs and symptoms resolved fully in a total of 10 minutes. She had persistent postural hypotension lasting for about 24 hours requiring bed rest and was discharged about 36 hours after the procedure, without any adverse sequelae. As the sinus node is supplied by the right-sided sympathetic chain, its blockade probably resulted in unopposed parasympathetic activity leading to asystole. Available evidence of the role of right stellate ganglion in regulation of cardiac electrophysiology and functioning is also discussed. [source]

Physical and emotional development, appetite and body image in adolescents who failed to thrive as infants

THE JOURNAL OF CHILD PSYCHOLOGY AND PSYCHIATRY AND ALLIED DISCIPLINES, Issue 5 2006
R.F. Drewett
Background:, Previous studies suggest that failure to thrive in infancy may be associated with adverse sequelae in childhood. Although cognitive abilities have been extensively investigated, little systematic research is available on other aspects of development. Methods:, Eighty-nine children who failed to thrive as infants and 91 controls were followed up when twelve years old and examined using anthropometric measurement, self-ratings of appetite and body image, the Dutch Eating Behaviour Questionnaire, the Self-perception Profile for Children, The Revised Children's Manifest Anxiety Scale, the parent and child form of the Mood and Feelings Questionnaire and the parent and teacher's form of the Child Behavior Checklist. Results:, The children who failed to thrive were significantly shorter and lighter at twelve and had significantly lower BMIs, but they did not go into puberty any later. They were more likely to rate their appetite as lower than their best friend's, were generally more satisfied with their body shape, and had significantly lower restraint score on the Dutch Eating Behaviour Questionnaire. They were not significantly different from controls on any of the measures reflecting anxiety, depression or low self-esteem. Conclusions:, Failure to thrive in infancy is not associated with adverse emotional development in childhood. [source]

Correlation of Local Interleukin-1beta Levels with Specific IgA Response Against Gardnerella vaginalis Cytolysin in Women with Bacterial Vaginosis

AMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 5 2002
SABINA CAUCI
PROBLEM:,Mucosal immune system activation may represent a critical determinant of adverse sequelae correlated with bacterial vaginosis, as HIV sexual transmission, upper genital tract infections, cervicitis, endometritis, postsurgical infections, and adverse pregnancy outcomes as preterm delivery (PTD), low birth weight (LBW). METHOD OF STUDY:,Levels of interleukin-1beta (IL-1beta), anti- Gardnerella vaginalis hemolysin (Gvh) IgA, pH, Nugent score, and number of leukocytes were measured in vaginal fluids of 60 fertile women with bacterial vaginosis and of 64 healthy controls. RESULTS:,Vaginal IL-1beta levels were nearly 13-fold higher in women with bacterial vaginosis (BV) and were associated with anti-Gvh IgA response. IL-1beta was positively correlated with leukocyte counts in the smear both in healthy and bacterial vaginosis positive women. CONCLUSIONS:,Induction of the proinflammatory cytokine IL-1beta may be a necessary event to elicit an innate immune response to control anaerobic genital tract infections. High levels of vaginal IL-1beta are associated with mounting of an antigen-specific mucosal immune response in women with bacterial vaginosis. Parallel induction of innate and adaptive immune response may be associated with protection from ascent of micro-organisms to the upper genital tract, and from acquiring viral infection through the vaginal tract. [source]

rFV11a and paediatric open-heart surgery: thrombosis in the cardiopulmonary bypass circuit in spite of adequate markers of anticoagulation

ANAESTHESIA, Issue 6 2009
N. A. Chambers
Summary Recombinant activated factor V11 (rFV11a) is a relatively new procoagulant agent and its place in surgical practice continues to be investigated. We report the use of rFV11a to help manage bleeding in the operating theatre in a neonate, following weaning from cardiopulmonary bypass for arterial switch procedure, when bleeding continued in spite of maximal medical therapy and apparent exclusion of a surgical cause of bleeding. In this patient administration of rFV11a failed to facilitate haemostasis and cardiopulmonary bypass was re-instituted allowing location and repair of a small awkward surgical source. Separation from this additional 20 min of bypass was successful but a large thrombus was noted in the membrane oxygenator of the extracorporeal circuit in spite of the presence of adequate ,laboratory' markers of anticoagulation in the pump blood. No adverse sequelae to the patient occurred. [source]

LONG-TERM OUTCOMES AFTER LAPAROSCOPIC BILE DUCT EXPLORATION: A 5-YEAR FOLLOW UP OF 150 CONSECUTIVE PATIENTS

ANZ JOURNAL OF SURGERY, Issue 6 2008
Andrew J. M. Campbell-Lloyd
Background: The treatment of common bile duct stones discovered at routine intraoperative cholangiography includes postoperative endoscopic retrograde cholangiography or intraoperative laparoscopic common bile duct exploration. Given the equivalence of short-term outcome data for these two techniques, the choice of one over the other may be influenced by long-term follow-up data. We aimed to establish the long-term outcomes following laparoscopic common bile duct exploration and compare this with endoscopic retrograde cholangiography. Methods: One hundred and fifty consecutive patients underwent laparoscopic common bile duct exploration between March 1998 and March 2006 carried out by a single surgeon. All were prospectively studied for 1 month followed by a late-term phone questionnaire ascertaining the prevalence of adverse symptoms. Patients presented with a standardized series of questions, with reports of symptoms corroborated by review of medical records. Results: In 150 patients, operations included laparoscopic transcystic exploration (135), choledochotomy (10) and choledochoduodenostomy (2). At long-term follow up (mean 63 months), 116 (77.3%) patients were traceable, with 24 (20.7%) reporting an episode of pain and 18 (15.5%) had more than a single episode of pain. There was no long-term evidence of cholangitis, stricture or pancreatitis identified in any patient. Conclusion: Laparoscopic bile duct exploration appears not to increase the incidence of long-term adverse sequelae beyond the reported prevalence of postcholecystectomy symptoms. There was no incidence of bile duct stricture, cholangitis or pancreatitis. It is a safe procedure, which obviates the need and expense of preoperative or postoperative endoscopic retrograde cholangiography in most instances. [source]

Blunt atrial transseptal puncture using excimer laser in swine,

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS, Issue 4 2007
Abdalla A. Elagha MD
Abstract Objectives: We describe a new approach that may enhance safety of atrial transseptal puncture using a commercially available laser catheter that is capable of perforation only when energized. We test this approach in swine. Background: Despite wide application, conventional needle transseptal puncture continues to risk inadvertent nontarget perforation and its consequences. Methods: We used a commercial excimer laser catheter (0.9-mm Clirpath, Spectranetics). Perforation force was compared in vitro with a conventional Brockenbrough needle. Eight swine underwent laser transseptal puncture under X-ray fluoroscopy steered using a variety of delivery catheters. Results: The 0.9-mm laser catheter traversed in vitro targets with reduced force compared with a Brockenbrough needle. In vitro, the laser catheter created holes that were 25,30% larger than the Brockenbrough needle. Laser puncture of the atrial septum was successful and accurate in all animals, evidenced by oximetry, pressure, angiography, and necropsy. The laser catheter was steered effectively using a modified Mullins introducer sheath and using two different deflectable guiding catheters. The mean procedure time was 15 ± 6 min, with an average 3.0 ± 0.8 sec of laser activation. There were no adverse sequelae after prolonged observation. Necropsy revealed discrete 0.9-mm holes in all septae. Conclusion: Laser puncture of the interatrial septum is feasible and safe in swine, using a blunt laser catheter that perforates tissues in a controlled fashion. © 2007 Wiley-Liss, Inc. [source]