Long-term sequelae of pneumococcal meningitis in children

The purpose of this study was to assess the long-term effects of pneumococcal meningitis in children. From 1967 to 1988, a total of 90 children were admitted to the Hospital for Infectious Diseases, Thessaloniki, Greece, with the diagnosis of pneumococcal meningitis. Sixteen patients died in the hospital as a direct result of meningitis. Eleven others were excluded from the study (neurologic deficits prior to onset of meningitis, two; death subsequent to hospitalization, two; recurrent meningitis, seven). Of the remaining 63 survivors, we were able to evaluate 47 patients (75%). Evaluation was performed 4 to 23 years (mean 12.3 +/- 5.8 years) after discharge. Forty patients returned to hospital for evaluation, and seven were evaluated by their primary physicians, who sent information by a standardized questionnaire. The following examinations were carried out: history, physical and neurologic examination, ophthalmologic and hearing evaluation, and psychometric testing. Fourteen patients (30%) had at least one neurologic handicap; nine (19%) had mental retardation, eight (17%) hearing loss, seven (15%) seizure disorder, five (11%) motor defects, and one each (2%) behavioral problems and visual impairment. The presence of coma was the strongest predictor of increased morbidity. The high frequency of long-term sequelae observed in our study supports the need of an effective vaccine.     

Long-term neuro-endocrine sequelae after treatment for childhood medulloblastoma

The occurrence of neuro-endocrine deficiencies following craniospinal irradiation for medulloblastoma is well known, but data concerning the spectrum and prevalence of endocrine abnormalities in adulthood are scarce. We studied endocrine function in 20 (median age 25 years) adult subjects, 8-25 years (median 16 years) after therapy. The radiation dose to the whole cranium and spinal axis was 35 +/- 2.6 Gray (mean +/- standard deviation) with a boost to the posterior fossa of 18 +/- 3.7 Gray. 13 subjects had received additional chemotherapy. In 15 of 20 (75%) subjects, endocrine abnormalities were observed. In 14 (70%), growth hormone (GH) secretion was impaired; 7 (35%) subjects had an absolute GH deficiency, while 7 (35%) showed subnormal responses to insulin-induced hypoglycaemia. In contrast, only 20% (4) of these subjects showed impairment of the hypothalamus-pituitary-thyroid (HPT) axis, while 15% (3) showed central impairment of hypothalamus-pituitary-gonadal (HPG) function. Central impairment of the HPG axis was associated with impaired GH secretion in all cases. Central adrenal insufficiency was not observed. Basal levels of prolactin were normal in all subjects. Young age at treatment was a determinant of GH deficiency in adulthood (P = 0.014). Neither post-treatment interval, nor the use of chemotherapy were determinants of central endocrine impairment in adulthood. In long-term survivors of medulloblastoma, GH deficiency has a high prevalence. In contrast, impairment of the HPG and HPT axis is less common, while central adrenal insufficiency was not observed.     

Long-term sequelae of therapy for childhood acute lymphoblastic leukaemia

Childhood ALL has provided the model for basic therapeutic principles in the past and now provides the model for late effects studies. Common threads which run throughout the literature in this area of clinical research are the importance of young age with increased vulnerability to long-term treatment induced sequelae and the relatively large contribution of radiation as compared with chemotherapy in the pathogenesis of adverse sequelae. Previous retrospective studies of long-term childhood ALL survivors focused on neuropsychologic changes and anatomic changes in the CNS after cranial irradiation. More recent retrospective studies have made the following new observations: (i) the high frequency of significant short adult stature in those less than 6 years of age at diagnosis who received 24 Gy cranial irradiation; (ii) actuarial risk of 2.5% of developing a second malignancy with approximately one-half of secondary malignancies occurring in the CNS in children 5 years of age or less who received cranial irradiation; (iii) the association of secondary ANLL with epipodophyllo-toxin use, and (iv) delayed cardiac toxicity despite anthracycline dosage reduction. Current therapy regimens, especially in high-risk patients, are both more successful and more intensive than those used in the past. While it will be another decade before many of the long-term sequelae begin to emerge, one can anticipate, based on current experience, some of the problems that will occur.     

Long-term psychological sequelae of smoking cessation and relapse.

The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect. However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term neurological sequelae of hemolytic-uremic syndrome: a preliminary report

Seven patients with hemolytic-uremic syndrome who had major neurological symptoms during the acute illness were neurologically and cognitively evaluated prospectively several years after recovery from the illness. Four patients showed evidence of subtle neurological sequelae, including posturing, clumsiness, poor fine-motor coordination, hyperactivity, and distractibility. Psychoeducational evaluation of all seven subjects revealed mean scores within the average range in cognitive abilities, academic achievement, single word receptive vocabulary, visual/motor planning, overall adaptive functioning, and hyperactivity. The lapse of time (minimum of 7 years) between the acute illness and the psychometric evaluation could have been responsible for our normal results.     

Long-term effects of behavioral versus insight-oriented therapy with inpatient alcoholics.

Assessed the relative effects of behavioral treatment involving both covert sensitization and relaxation training vs insight-oriented treatment consisting of transactional analysis (TA) with 113 male and female alcoholic inpatients (21–73 yrs). Ss were assigned in randomized blocks to 1 of 4 groups: (a) milieu treatment control group or 1 of 3 experimental groups, each of which included the milieu treatment, (b) behavioral group, (c) TA group, (d) combined group, involving both TA and behavioral treatment. Four-year follow-up interviews yielded data on the Quantity Frequency Index scale, abstinence, and an overall clinical adjustment scale for 5 posttreatment periods. Differences between behavioral and TA treatment were significant or approached significance at 6 mo and 1? yrs after treatment, but not thereafter. Strong and consistent trends were evident favoring the behavioral approach on all 3 measures across all 5 follow-up periods. The strength of the milieu treatment was also supported, and the need for long-term follow-up studies beyond 6 mo is stressed. (70 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term study of patients with pulmonary tuberculosis sequelae after bilateral thoracoplasty-airway obstruction and its causes

Chest roentgenograms and results of pulmonary-function tests in patients with pulmonary tuberculosis sequelae 30 years after bilateral thoracoplasty were studied retrospectively to detect airway obstruction in these patients and to determine its causes. For periods of more than 10 years, vital capacity (VC) changed at a rate of 15.5 +/- 5.0 ml/year, and forced expiratory volume in one second as a percent of VC (FEV1%) changed at a rate of 0.546% +/- 0.380% per year (n = 13). Thirty years after thoracoplasty, the VC was 920 +/- 180 ml (%VC = 28.4% +/- 5.3%), and the FEV1% was 66.2% +/- 13.7% (n = 21). Thus, mild airway obstruction was found in about half of the cases. For each patient, the distance from the hilum to the diaphragm was measured along the mid-clavicular line on the side with fewer ribs resected, and this distance was divided by the patient's height. The results of that computation was found to be significantly and negatively related to FEV1% (r = -0.681, which suggests that longer bronchi in the lower and middle lobes on that side were associated with lower values of FEV1%. These findings are similar to those in patients with pulmonary tuberculous sequelae after total pneumonectomy. Over an average of 26 years, scoliosis, the vertebra showing the most bending, the intrapulmonary lesion, and the position of the diaphragm did not change, but the cardio-thoracic ratio increased.     

Long-term follow-up of a cognitive–behavioral therapy for anxiety-disordered youth.

This study examined the long-term effects of a psychosocial treatment for anxiety-disordered youth. Clients (N?=?36) who had completed treatment 3.35 years earlier (on average) were reassessed using self- and parent-report instruments as well as structured diagnostic interviews. Results indicated that previously documented treatment gains were maintained. An examination of participants' recalled events within therapy suggested that the therapeutic relationship, games and activities, and discussion of problems were salient treatment components. Theoretically important components of treatment were also recalled by clients, and some were found to be related to long-term positive outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term sequelae of childhood sexual abuse: Perceived family environment, psychopathology, and dissociation.

105 abused and nonabused women were examined for patterns of adult psychopathology associated with childhood sexual abuse and to test the extent to which these patterns are independent of other pathogenic properties of the family environment. Clinical and nonclinical Ss completed the Family Environment Scale, the MMPI, the Rorschach, and the Stanford Hypnotic Susceptibility Scale. Greater nonspecific impairment among abused women may be a consequence, at least in part, of pathogenic family structure rather than sexual abuse per se. However, MMPI and Rorschach responses suggest sexual abuse may render victims especially vulnerable to specific disturbances involving soma and self. Abuse was associated with greater use of dissociation, but covariance analysis revealed this effect to be accounted for by family pathology. There was no evidence that sexual trauma is associated with hypnotizability. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term studies of metopic synostosis: frequency of cognitive impairment and behavioral disturbances

The most evident immunosuppressive effect of cyclosporin A (CsA) on T cells is suppression of interleukin-2 (IL-2) production through the suppression of type-2B serine/threonine-specific phosphatase, calcineurin. To test whether suppression of IL-2 production is a major mechanism of CsA-mediated suppression of allograft rejection, we treated allogeneic skin-grafted mice with CsA and IL-2, and observed that IL-2 did not override the suppressive effect of CsA. Specific cytotoxic T lymphocyte (CTL) activity and natural killer (NK) activity of the spleens were increased by treatment with IL-2, and CsA significantly suppressed the killing activity. We also found that CsA-treatment decreased the expression of lck kinase of T cells and the production of IL-2 in response to concanavalin A (ConA), with minimum effect on IL-4 production. These results suggest that T cell dysfunctions other than decreased production of IL-2 are essential for suppressive effect of CsA on skin allograft rejection.     

Retinopathy of prematurity

Retinopathy of prematurity (ROP) is a disease characterized by abnormal growth of retinal blood vessels in the eyes of premature infants. It is especially severe in the tiniest, most premature infants, whose chances of survival have increased with advances in neonatal care. Infants in whom ROP is diagnosed during the perinatal period are at risk for ocular abnormalities and for deficits in visual function. This article reviews the classification of ROP, summarizes current recommendations for screening of ROP in the perinatal period, and describes recent findings with respect to ocular and visual acuity outcomes of infants with ROP.     

Retinopathy of prematurity

Research studies have provided advancements in knowledge regarding retinopathy of prematurity. Examination identifies premature infants with threshold disease that indicates need for treatment. It is hoped that timely evaluation and treatment will reduce the incidence of ROP-related blindiness.     

Long-term potentiation facilitates behavioral responding to single-pulse stimulation of the perforant path.

Three experiments, with 32 male hooded Sprague-Dawley rats, examined whether long-term potentiation (LTP) could enhance the stimulus properties of electrical brain stimulation. In Exp I, a paradigm was developed in which single-pulse stimulation of the perforant path (PP) could acquire control over operant responses. Evoked potentials were recorded from the dentate gyrus (DG) to measure the postsynaptic consequences of the stimulus and to monitor synaptic efficacy in the PP–DG synapses. Exp II confirmed the relation between the amount of evoked activity and acquisition rate and also showed that transecting the PP impaired performance. In Exp III, high-frequency stimulation of the PP produced LTP and accelerated subsequent acquisition of behavioral responding to PP stimulation. Results document a link between increases in synaptic efficacy and changes in behavior and thereby demonstrate the ability of LTP to serve as at least 1 component of the neural bases of learning and memory. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term estrogen therapy worsens the behavioral and neuropathological consequences of chronic brain inflammation.

Alzheimer's disease (AD) is accompanied by chronic neuroinflammation and occurs with greater incidence in postmenopausal women. The increased incidence may be delayed by estrogen replacement therapy (ERT). The authors investigated the interaction of chronic ERT and lipopolysaccharide (LPS)-induced neuroinflammation in the female rat. Ovariectomy did not impair water maze performance; however, addition of chronic ERT or neuroinflammation resulted in an impairment that became exacerbated by the simultaneous occurrence of both conditions. Chronic LPS activated microglia, which was not reduced by ERT. Intact females receiving LPS infusion were not impaired in the water maze and had significantly fewer activated microglia. Results suggest that chronic ERT in postmenopausal women may exacerbate the memory impairment induced by the chronic neuroinflammation associated with AD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral effects of prematurity

This report reviews the evidence for an increased incidence of behavior and social problems in infants and children born prematurely. The contribution of biological and social factors to the development of behavior problems in this population is also examined. The available evidence indicates that preterms more often than full-terms exhibit negative temperament characteristics, symptoms of Attention-Deficit Hyperactivity Disorder, and lower levels of social competence. The risk for these problems appears to be limited to those infants with a birth weight of less than 1,500 g. Adverse social conditions also impact the expression of these problems. Preterms do not appear to be at as much risk for emotional or conduct problems or abnormal attachment to their mothers. Both the experience of a preterm birth and the characteristics of the infant can alter the perceptions and behavior of parents. Appropriate interventions should involve the child, the parents, and the school.     

Aesthetic sequelae of septoplasty

BACKGROUND: Low bone mineral content (BMC) has been reported in patients with inflammatory bowel disease. The aim of the present study was to measure BMC in patients with Crohn's disease. METHODS: BMC was monitored for a mean period of 5.5 years in 108 patients. The patients were divided into two groups: group A, patients with the colon preserved; group B, patients with a resected colon. The mean length of the resected small intestine was 90 cm. RESULTS: The BMC of the lumbar spine expressed as Z-score ((actual value-mean)/s) was significantly reduced: mean Z-score for group A, -0.51, P < 0.05; group B, -0.80, P < 0.001. The BMC of the femoral neck was significantly reduced: mean Z-score for group A, -1.24, P < 0.001; group B, -1.23, P < 0.001. A Z-score below -2.0 of spine or femoral neck BMC was found in 10% and 23% of the patients, respectively. The BMC of the femoral neck decreased significantly in both groups during the study period (group A, -2.2%, P < 0.001; group B, -1.21%, P < 0.05). The BMC of the lumbar spine did not change. There was an inverse correlation between the initial Z-score and the rate of change in BMC (P < 0.05). We found no correlation between Z-score or change in BMC and period of prednisolone treatment. Moreover, there was no correlation between the length of the resected small intestine and BMC or annual percentage change in BMC. CONCLUSION: At inclusion the BMC of the spine and femoral neck was low in patients with Crohn's disease. During the study significant bone loss was only demonstrated in the femoral neck. BMC or rate of change in BMC was not related to treatment with steroids or length of the resected small intestine.