Unusual Sequelae Research Articles

Opisthotonus and other unusual neurological sequelae after outpatient anaesthesia

Four patients who developed unusual neurological sequelae after outpatient anaesthesia are described. Propofol is strongly implicated as the cause. All four patients were female with no previous history of psychiatric disorder or neurological disease, unpremedicated, and had procedures of duration less than 20 minutes. Hyperreflexia and hypertonicity were present postoperatively and the reactions appeared to be triggered by an external stimulus. Three patients were examined by a neurologist and had a normal electroencephalograph. Two patients were on the same operating list; quality control was carried out on the anaesthetic agents used, and blood samples sent for toxicology showed no abnormalities. Mechanisms underlying these reactions are discussed.

Pseudoelephantiasis of the Penis Following Donovanosis

Pseudoelephantiasis of the penis, an unusual sequel of longstanding donovanosis with otherwise characteristics clinical expression, is reported in a young man. The diagnosis was confirmed by the demonstration of Donovan bodies in Giemsa stained tissue smears and tissue sections.

Medial Rectus Injury After Pterygium Excision

<h3>To the Editor.</h3> —Extraocular muscle injury is an unusual sequela of pterygium surgery, although the area of dissection is just adjacent to these structures.^1-3We have seen three patients who experienced the acute onset of horizontal diplopia following excision of a nasal pterygium. In all patients, noncomitant exotropia and marked adduction deficiency were observed. <h3>Report of Cases.</h3><h3>—Case 1.</h3> —A 53-year-old woman noted horizontal diplopia immediately following excision of an extensive nasal pterygium of the left eye. When seen on the fourth postoperative day, adduction was possible only to the midline, with observably slow nasal saccades and exotropia (Fig 1). The nasal sclera of the eye operated on was bare from the limbus for about 9 mm. On the following day, surgical exploration was performed. The traction test indicated no restrictions. The left medial rectus was found to be disinserted and was reattached just behind its original insertion

Otitic hydrocephalus: An uncommon complication of a common condition

A 14-year-old girl presented with bilateral sixth nerve palsies and papilledema after a two-week history of ear drainage and progressive right-sided temporal headache. A computed tomography scan of the head was normal, as were plain films of the mastoids. Lumbar puncture revealed a markedly elevated opening pressure with an otherwise normal cerebrospinal fluid examination, and she was given the diagnosis of pseudotumor cerebri. Despite treatment with acetazolamide, prednisone, and repeated lumbar punctures, her symptoms worsened. A magnetic resonance imaging study revealed thrombosis of the right sigmoid sinus, and repeat computed tomography showed evidence of mastoiditis. Definitive therapy consisted of a right mastoidectomy and antimicrobial therapy, to which the patient responded promptly. This case illustrates an unusual sequela of otitis media--termed otitic hydrocephalus--that resulted from obstruction of the sigmoid sinus. Although otitis media is generally a benign illness, clinicians must be alert to suppurative complications, which may evolve insidiously.

Prolonged recumbency in a small horse (Equus caballus var roccianus) with unusual sequelae.

Prolonged recumbency in a small horse (Equus caballus var roccianus) with unusual sequelae.

Necrotizing temporal fascitis following permanent waving: An unusual sequela

A rare case of necrotizing fascitis of the scalp as a consequence of permanent waving is described. One should be aware of this or other complications in compromised patients.

Case report: Renal cell carcinoma — An unusual presentation and sequel

A 30 year old woman presented with an abscess in the renal fossa 4 years after nephrectomy for an incidentally discovered renal cell carcinoma.

Cold-induced immersion injury: A potential hazard of the cold pressor test

Cold pressor stimulation is an easy and frequently performed form of stress testing in conjunction with nuclear cardiac imaging. 1 Complications appear uncommon. We describe an unusual sequel to this test.

Unusual Sequelae of Colon Interposition for Esophageal Reconstruction: Late Obstruction Requiring Reoperation

Colon interposition has become a favored technique for esophageal reconstruction. Late morbidity is generally related either to technical problems associated with the procedure or to the development of new disorders in the transposed segment. Two patients are discussed who were seen with obstruction of colon interposition grafts ten and five years after esophageal reconstruction. In the first patient, a volvulus of the interposed colon associated with a chronically narrowed area distal to the looped segment resulted in obstruction. In the second patient, the redundant intrathoracic segment of the colon interposition became kinked at the diaphragmatic hiatus leading to dilatation and incomplete emptying. Both patients underwent successful reoperations and are doing well 10 and 12 months later. The causes and possible prevention of these and other late complications of colon interposition are discussed.

Tuberculous Main-Stem Bronchial Stenosis Treated With Sleeve Resection

The unusual complication of bronchial stenosis from scarring due to tuberculosis developed in a 33-year-old woman, despite otherwise effective antibiotic therapy. She then was treated successfully with conservative surgical management by sleeve resection of the involved segment. This unusual sequela and its workup contain important implications for the management of tuberculosis.

Rapid fluid replacement: A new methodology

The ability to replace fluids rapidly is frequently the limiting factor in the survivability of trauma patients. We describe a fluid infusion system that provides approximately a fourfold increase in flow rates over currently available percutaneous systems. It incorporates a 14 French (4.5-mm internal diameter) catheter introduced into a central vein by the Seldinger technique, and a manifold that allows fluid from five separate IV bags to flow into the patient through one line. In vitro tests demonstrated a gravity flow rate of more than 850 mL/min normal saline and a flow rate under pressure of more than 2.0 L/min. Packed red blood cells diluted to 42% hematocrit flowed at 1,725 mL/min under pressure. In vivo testing in dogs demonstrated a maximum gravity flow rate of approximately 650 mL/min, and a pressurized flow rate of more than 1,600 mL/min normal saline. No unusual sequelae of large-bore catheterization were detected.

Adhesion in the biologic environment.

There are good reasons to believe that adhesion of particulate matter in all wet, salty, biochemically active circumstances follows a common pattern, and that such adhesion can be effectively controlled by adjusting the surface properties - especially surface energy--of the substrate involved. One of the most compelling proofs of, at least, the bioengineering utility of surface energy modification to maximize or minimize biological adhesion is the successful, now long-term, implantation of total artificial hearts. These pumps, and the related intra-aortic balloons and left ventricular assist devices, do not accumulate blood clots or thrombotic masses during their contact with natural blood. Since surfaces contacting blood have received most careful scrutiny for more than a decade, the instruction gained from examining the usual and unusual sequelae of blood cell adhesion to nonphysiologic surfaces has been most valuable in revealing the general features of biological adhesion in other, less well-studied, circumstances. The initial events of blood contact with foreign solid surfaces are briefly reviewed, and the impressive similarities of these events to sequences in oceanic fouling of heat exchangers, cell culture experiments and dental plaque formation are highlighted. A unifying concept, based on control of the surface free energy through an empirical correlate called the "critical surface tension," is presented as an explanation for the common features of biological adhesion in all of Nature's domains.

Cystic adenomatoid dysplasia of the lung

Cystic adenomatoid dysplasia of the lung is an unusual lesion, only 142 cases having been reported in the English literature by 1979. This review describes 32 additional previously unreported patients treated at our institution. The male:female ratio was 1.4:1 and lesions were equally distributed in both lungs. The age range at presentation was 1 day-14 yr. This large experience identifies two distinct modes of presentation. Ten patients presented as newborns with acute progressive respiratory distress secondary to mediastinal displacement and pulmonary compression as a result of the expanding cystic lesion. This group of patients ranged from 1 to 28 days with a mean of 9.4 days of age. Of the remaining patients, varying from 2 mo to 14 yr, half were under 1 yr. The presentation in this group was generally different. Unresolving pulmonary infiltrate (5) or recurrent respiratory infection localized to the same portion of the lung (7) prompted the diagnosis of a pulmonary developmental abnormality. Three children in this group had failure to thrive. Progressive dyspnea was not a characteristic finding. Specific lobar or segmental resection effectively eradicated the disease process. All of the last 30 patients resected have survived without unusual sequelae. Cystic adenomatoid dysplasia should be considered in the differential diagnosis of progressive respiratory disease in the neonate or of recurrent or persistent pneumonic processes in the same segment of the lung in the older child.

The pathology of vitreous hemorrhage. I. Gross and histological appearances.

• Vitreous hemorrhages were induced in rabbits by the intravitreal injection of 0.2 ml of autogenous whole blood, and the progressive reabsorption of the blood from the vitreous was followed by ophthalmoscopy, gross pathological examination, and histology. On gross examination, the blood clot remained as a discrete mass for four to six weeks, after which it became considerably reduced in size. The presence of blood exerted severe destructive effects on the gel structure of the vitreous, including posterior detachment of the solid vitreous, liquefaction of the gel, the appearance of prominent vitreous bands, and the formation of a pseudocapsule by the detached vitreous around the blood clot. Small blood deposits remained in several eyes for many weeks. The inflammatory response to intravitreal blood as seen by histology was unusual in several respects. The cellular reaction was low grade, and in particular no polymorphonuclear cells were observed, only mononuclear cells. Aggregates of round cells or multinucleate giant cells were found in association with intact unphagocytosed RBCs after many weeks, which may indicate that macrophages within the vitreous were inefficient. No fibrosis occurred in the rabbit vitreous even with long-standing residual vitreous blood deposits. It is suggested that fibrosis is an unusual sequel to vitreous hemorrhage and is associated with ocular diseases in which vitreous hemorrhage may be an incidental occurrence.

An unusual sequel to dystocia in a bitch

An unusual sequel to dystocia in a bitch

The Postoperative Myelogram

Either arachnoriditis or dural/arachnoidal tears may cause symptoms in the postoperative spinal patient. Surgery and myelography as causes of arachnoiditis are discussed. Intradural arachnoid cyst formation and intramedullary cavitation may present as unusual sequelae of arachnoiditis. Extra-dural cysts and cerebrospinal fluid fistulas resulting from dural/arachnoidal tears are unusual postoperative complications presenting striking myelographic features. Their mechanisms of formation, clinical significance, and radiographic features are discussed.

A second look at delayed splenic rupture.

From 1968 to 1976, 314 patients were treated by splenectomy for blunt splenic injuries. Three hundred four of these were operated on within 24 hours. All had typical splenic lacerations with intraperitoneal bleeding from the time of injury. This was true also of seven of the ten operated on after 24 hours. In only three of this late group was the evidence in favor of possible delayed rupture of a subcapsular hematoma. These data support our conclusion that delayed rupture is an unusual sequel to blunt splenic trauma, and that most patients thought to have delayed rupture of the spleen have, instead, delayed recognition of splenic rupture.

Identity of cowdry type B inclusions and nuclear bodies: Observations in reovirus encephalitis

This report describes the investigation of the pathogenesis of an unusual sequel of reovirus encephalitis in suckling rats. Intracerebral inoculation of reovirus types 1, 2, and 3 into suckling rats induced, in addition to viral cytoplasmic inclusions, distinctive intranuclear bodies corresponding most closely to those designated by Cowdry (1934) as type B inclusions. The latter were seen in cells free of reovirus inclusions and unlike the conventional reactions to these viruses, were readily observed in weanlings, were unassociated with inflammatory features, and persisted for extended periods without cytolytic effects. To test the hypothesis that another viral agent was responsible for production of these nuclear changes, attempts were made to induce this change by inoculation of tissue preparations obtained from infected animals beyond the period of active reovirus encephalitis. These were uniformly negative. Furthermore, strains of reovirus from various sources all induced this nuclear change. Electron microscopic studies of the choroid plexus yielded no evidence of a second virus but instead demonstrated that the inclusions were composed of granular aggregates, sometimes enclosed in lamellar membranes, characteristic of the structures called nuclear bodies. These studies expand the perspectives of the nature and pathogenesis of this cellular lesion and provide an optical indicator which facilitates its identification and study. They suggest that the well-known Cowdry B inclusion has as its electron microscopic counterpart, the nuclear body.

Unusual sequelae to surgical repositioning of an impacted premolar

A case of surgical repositioning of a permanent premolar with subsequent premature eruption and an unusual root development is reported. Possible treatment methods to avoid these problems are discussed.

Unusual sequelae following blunt trauma to renal pedicle

A case is reported of a nine-year-old boy who received blunt trauma to the renal pedicle. Results of initial urinalysis and intravenous pyelogram were normal, and the injury was diagnosed only after severe hypertension and hypertensive encephalopathy developed.