Unusual Sequelae Research Articles

UNUSUAL SEQUELA OF MECONIUM PERITONITIS IN AN INFANT: MASSIVE CONTRALATERAL EXTENSION OF A HERNIAL SAC

Meconium peritonitis may result in a number of genital manifestations, including inguinal and scrotal or labial hydrocele containing meconium or calcifications and hard tumor-like scrotal masses.1–3 We describe a patient with an unusual sequela of meconium peritonitis involving massive extension of a processes vaginalis to the contralateral anterior abdominal wall. To our knowledge this condition has not been reported previously.

Clinical characteristics of patients with constrictive pericarditis after coronary bypass surgery.

Constrictive pericarditis (CP) is an unusual sequela of cardiac surgery, so the present study evaluated the clinical characteristics of patients with CP after coronary artery bypass grafting (CABG). Four hundred and sixty-three patients who underwent isolated CABG between January 1989 and March 1999 were examined retrospectively. The first choice of treatment for postoperative pericardial effusion was non-steroid anti-inflammatory agents, and an increased dose of diuretics. The second treatment choice was corticosteroids or pericardial drainage. When CP was suspected during the follow-up period (mean, 54+/-31 months), cardiac catheterization was carried out to establish the diagnosis. Of the 463 patients undergoing CABG, there were 11 (2.4%) who developed CP after surgery. The median time to the onset of symptoms after CABG was 4 weeks (range, 3-96 weeks). On univariate and multivariate analysis, normal left ventricular ejection fraction, warfarin administration, and early postoperative pericardial effusion were significantly associated with a greater potential of postoperative CP. The effusion was bloody in all cases of pericardial drainage despite warfarin therapy. Not draining the postoperative effusive pericardial effusion was a risk factor for the development of CP. Pericardial drainage for patients with significant effusion after CABG is important for the prevention of subsequent CP, especially in those patients being treated with warfarin or with normal left ventricular function.

CENTRAL PRECOCIOUS PUBERTY: An Overview of Diagnosis, Treatment, and Outcome

Central precocious puberty (CPP) is physiologically normal puberty beginning early. It is the consequence of early increased regulation of gonadotropin releasing hormone (GnRH) stimulation of pituitary gonadotropin release causing pubertal changes and accelerated growth. GnRH stimulation testing is the definitive diagnostic test--pubertal gonadotropin responses being indicative of CPP. Among patients with progressive CPP, GnRH analogue therapy is effective by decreased regulation of gonadotropin secretion. Pubertal progression is stopped, and accelerated growth rate and compromised adult height are precluded or alleviated. Outcome data have not identified unusual sequelae.

Anterior dislocation of a posterior chamber intraocular lens after blunt trauma

An 85-year-old man developed an anterior dislocation of a posterior chamber intraocular lens (IOL) after blunt trauma. The dislocated IOL was exchanged for an anterior chamber IOL. Visual acuity was 20/40 at the 6 month follow-up. This case presents an unusual sequela of trauma to a pseudophakic eye and discusses management issues that should be considered.

Peduncular hallucinosis: an unusual sequel to surgical intervention in the suprasellar region

Peduncular hallucinations are formed visual images often associated with sleep disturbance, and are caused by lesions in the midbrain, pons and diencephalon. In the present study, we report two patients who developed peduncular hallucinations following surgery in the suprasellar region. In one of these, the peduncular hallucinations were a sequele to endoscopic third ventriculostomy, while in the other, they were due to diencephalon and mid-brain compression by postoperative clot following excision of a hypothalamic astrocytoma.

Peduncular hallucinosis: an unusual sequel to surgical intervention in the suprasellar region

Peduncular hallucinosis: an unusual sequel to surgical intervention in the suprasellar region

Hip Arthroscopy in Legg-Calve-Perthes Disease

Summary: The case of a 7-year-old boy with Legg-Calve-Perthes disease is presented. He had a prominent island of superficial epiphyseal ossification in his right femoral head, an unusual finding in Legg-Calve-Perthes disease. Hip arthroscopy was used successfully to identify and treat the lesion. After the procedure, the patient had a reduction in pain and an increase in range of hip motion. We believe that this case demonstrates the effective use of hip arthroscopy in the treatment of this unusual sequela of Legg-Calve-Perthes disease.0749-8063/99/1501-1792$3.00/0

Isolated bilateral first rib fractures—an unusual sequel of whiplash injury

Fractures of the first rib are extremely rare and are more commonly associated with either multiple rib fractures or life-threatening injuries. First rib fractures are commonly caused by direct trauma, violent muscular contraction or by chronic stress. We present a case of isolated bilateral rib fracture in an elderly patient, in the absence of multiple trauma, where the mechanism of injury appears to be a whiplash injury.

Posttraumatic hepatic cyst—An unusual sequela of liver injury in the era of imaging

Nonoperative management of blunt liver injury in children has become a generally accepted form of therapy unless vital signs deteriorate or associated injury requires emergency operation. Serial monitoring of the liver with computed tomographic (CT) scans or abdominal ultrasonography contributes much to the management of these children. A persistent intrahepatic hematoma that goes unnoticed for years and eventually results in a cyst with a thick wall that contains viscous yellowish green fluid and sludge occurred occasionally before the era of CT or ultrasound imaging, but it is unusual in modern times. We report on a 7-year-old girl who suffered blunt abdominal trauma that resulted in a grade IV liver injury. five years later she had a large posttraumatic cyst of the liver that caused abdominal pain. She is now asymptomatic, after decortication of the cyst wall, evacuation of the contents, and filling the residual space with omentum.

Herniation of the Urinary Bladder: A Complication of Traumatic Pubic Symphysis Diastasis

Bladder rupture and urethral disruption are relatively common injuries associated with pelvic trauma; however, bladder herniation into a public symphysis diastasis is an unusual sequelae of pelvic trauma. We report a case of anterior bladder wall herniation into a traumatic pubic diastasis and review the literature. Recommendations focusing on avoiding possible urinary bladder complications associated with closed reduction and external fixation of the diastasis are offered.

Delayed Jejunal Artery Pseudoaneurysm: An Unusual Sequela of Penetrating Abdominal Trauma

Posttraumatic pseudoaneurysm of the mesenteric vasculature is rare. The authors describe the case of a forty-seven-year-old man with a jejunal artery pseudoaneurysm eleven years after a stab wound to the abdomen. The patient underwent exploratory laparotomy and ligation of the pseudoaneurysm. Late sequelae of missed superior mesenteric artery injury include superior mesenteric arteriovenous fistula and pseudoaneurysm.

Leiomyosarcoma of the Uterus Metastatic to Brain: A Case Report and a Review of the Literature

Central nervous system metastases are an unusual sequela of uterine sarcomas. A single brain metastasis from a leiomyosarcoma occurred in a 60-year-old woman, 6.5 years after hysterectomy and more than 2 years following the diagnosis of bilateral lung metastases, treated by combination chemotherapy. After resection of the cerebral metastasis, she was treated with brain radiation therapy and survived 2.5 years. Only seven other cases of uterus leiomyosarcoma metastatic to the brain have been published.

Long-Term Survival in Patients with Glioblastoma Multiforme

Few patients with glioblastoma multiforme survive more than 5 years. To identify the factors associated with long-term survival, patients with primary supratentorial glioblastoma multiforme diagnosed between 1969 and 1985 were identified from our computer data base. Twenty-two (5%) of the 449 patients identified survived at least 5 years after surgical diagnosis. There were 12 female and 10 male patients, with a mean age of 39.2 years (range, 15 to 63 yr). Twenty patients had a subtotal resection, and 2 had a gross total resection. The median duration of survival was 9.4 years. As of August 1, 1992, 10 patients were alive 5.2 to 13.6 years after diagnosis, and 1 patient was lost to follow-up after 9.4 years. Ten patients died from their tumors; 2 patients with stable tumors died, 1 from a ruptured intracranial aneurysm and 1 from erythromycin-induced hepatitis. Unusual sequelae were noted in irradiated areas in several cases. One patient had a scalp sarcoma and a basal cell carcinoma, and three patients had strokes; each of these events occurred more than 5 years after diagnosis. We conclude that among patients with glioblastoma multiforme, long-term survival is most likely for those who have a long disease-free interval after the initial diagnosis and receive multimodal therapy, including aggressive tumor removal. Other factors associated with long-term survival were younger age and high Karnofsky scores.

Left-atrium-to-right-ventricle shunting after surgery for atrioventricular septal defect: an unusual sequel detected by transesophageal echocardiography

A 25-yr-old female who had undergone surgery for common atrium and atrioventricular septal defect at the age of 9, was found to have residual shunting at the level of the atrioventricular junction. Precordial echocardiography failed to assess the direction of the shunt. Transesophageal echocardiography showed dehiscence of the atrial patch at the level of the atrioventricular junction. Through this defect left-atrium-to right ventricle shunting occurred in diastole, whereas in systole the defect was closed by the juxtaposition of the anterior tricuspid valve leaflet.

Unusual sequelae after percutaneous mitral valvuloplasty: A Doppler echocardiographic study

Percutaneous mitral valvuloplasty is a promising new technique for the treatment of mitral stenosis, with a relatively low complication rate reported to date. To assess the sequelae of this procedure, Doppler echocardiographic studies were prospectively performed before and after percutaneous mitral valvuloplasty in a series of 172 patients (mean age 53 ± 17 years). After balloon dilation, mitral valve area increased from 0.9 ± 0.3 to 2 ± 0.8 cm2(p < 0.0001), mean gradient decreased from 16 ± 6 to 6 ± 3 mm Hg (p < 0.0001) and mean left atrial pressure decreased from 24 ± 7 to 14 ± 6 mm Hg (p < 0.0001).Although most patients were symptomatically improved, six (4%) were identified who had unusual sequelae evident on Doppler echocardiographic examination immediately after percutaneous mitral valvuloplasty. These included rupture of a posterior mitral valve leaflet, producing a flail distal leaflet portion with severe mitral regurgitation detected on Doppler color flow mapping (n = 1); asymptomatic rupture of the chordae tendineae attached to the anterior mitral valve leaflet with systolic anterior motion of the ruptured chordae into the left ventricular outflow tract (n = 1); a double-orifice mitral valve (n = 1); and evidence of a tear in the anterior mitral valve leaflet (n = 3), producing on both pulsed Doppler ultrasound and color flow mapping a second discrete jet of mitral regurgitation in addition to regurgitation through the main mitral valve orifice. All six patients made a satisfactory recovery and none has required mitral valve replacement.In a small percent of cases, percutaneous mitral valvuloplasty may produce unusual disruption of the mitral valve and supporting apparatus that may be readily detected by Doppler echocardiographic studies.

Acute theophylline intoxication

We describe a case of intentional acute theophylline intoxication with cardiac, cerebral, and gastrointestinal features of moderate-to-severe toxicity. The unusual metabolic and hematologic sequelae included hypokalemia, hyperglycemia, metabolic acidosis, extreme neutrophilia, increased creatinine levels attributed to muscle damage, and hematuria. The implications of these unusual findings for the management of acute theophylline intoxication include the recognition that these effects can be due to intoxication per se and do not necessarily indicate a primary endocrine disorder or infection.

Recurrent Prolonged Erections and Priapism as a Sequela of Priapism: Pathophysiology and Management

Veno-occlusive priapism may be associated with prolonged corporeal ischemia, subsequent fibrosis of the corpora and impotence. We report on 6 patients who presented with an unusual sequela of veno-occlusive priapism, recurrent episodes of prolonged erections or priapism. In all cases the subsequent episodes were idiopathic and veno-occlusive, occurred with a frequency ranging from several times per day to once per month and were symptomatically disabling. Pharmacocavernosometry ruled out mechanical occlusion of corporeal venous drainage by demonstrating elevated flows to maintain intracavernosal pressures following smooth muscle contraction and markedly decreased flow rates following smooth muscle relaxation. Treatment of the recurrent episodes with intracavernous self-injection of phenylephrine resulted in successful detumescence. The use of oral phenylpropanolamine reduced the frequency and duration of the recurrences, and markedly reduced the need for adrenergic self-injection. It is proposed that this syndrome may develop secondary to the initial ischemic episode, resulting in a functional alteration of the adrenergic and/or endothelialmediated mechanisms that control penile tumescence and maintain penile flaccidity.

Unusual neurological sequelae

AnaesthesiaVolume 45, Issue 12 p. 1096-1096 Free Access Unusual neurological sequelae N.D. Edwards, N.D. Edwards Morriston Hospital, Swansea SA6 5LBSearch for more papers by this authorA. Biswas, A. Biswas Morriston Hospital, Swansea SA6 5LBSearch for more papers by this author N.D. Edwards, N.D. Edwards Morriston Hospital, Swansea SA6 5LBSearch for more papers by this authorA. Biswas, A. Biswas Morriston Hospital, Swansea SA6 5LBSearch for more papers by this author First published: December 1990 https://doi.org/10.1111/j.1365-2044.1990.tb14930.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume45, Issue12December 1990Pages 1096-1096 RelatedInformation

Observations on the Pathophysiology of Nelson's Syndrome: A Report of Three Cases

Abstract Nelson's syndrome is generally regarded as an unusual sequela of primary bilateral adrenalectomy when performed for Cushing's disease. It is classically defined by cutaneous hyperpigmentation, considerably elevated adrenocorticotropic hormone (ACTH) levels, and an enlarged sella turcica. In this report, we present three cases initially treated by transsphenoidal sellar exploration for Cushing's disease. In two of these cases, remission of hypercortisolism did not occur after the initial pituitary exploration. A microadenomectomy was performed in one case and, in the other, no microadenoma was found. In both, Nelson's syndrome occurred after adrenalectomy. A second transsphenoidal operation and radiotherapy were required to control tumor growth. In another case, transsphenoidal adenomectomy of an ACTH-secreting tumor initially led to a remission of hypercortisolism for 4 years, but recurrent Cushing's disease necessitated adrenalectomy, and again Nelson's syndrome occurred. The documentation of a pre-existing ACTH-secreting basophilic pituitary microadenoma before adrenalectomy, as seen in two of our cases, has not been previously reported, and these observations of “non-classical” courses have major implications for the pathophysiology of Nelson's syndrome.

Observations on the pathophysiology of Nelson??s syndrome

Nelson's syndrome is generally regarded as an unusual sequela of primary bilateral adrenalectomy when performed for Cushing's disease. It is classically defined by cutaneous hyperpigmentation, considerably elevated adrenocorticotropic hormone (ACTH) levels, and an enlarged sella turcica. In this report, we present three cases initially treated by transsphenoidal sellar exploration for Cushing's disease. In two of these cases, remission of hypercortisolism did not occur after the initial pituitary exploration. A microadenomectomy was performed in one case and, in the other, no microadenoma was found. In both, Nelson's syndrome occurred after adrenalectomy. A second transsphenoidal operation and radiotherapy were required to control tumor growth. In another case, transsphenoidal adenomectomy of an ACTH-secreting tumor initially led to a remission of hypercortisolism for 4 years, but recurrent Cushing's disease necessitated adrenalectomy, and again Nelson's syndrome occurred. The documentation of a pre-existing ACTH-secreting basophilic pituitary microadenoma before adrenalectomy, as seen in two of our cases, has not been previously reported, and these observations of "non-classical" courses have major implications for the pathophysiology of Nelson's syndrome.