Conservative Treatment (conservative + treatment)

Distribution by Scientific Domains
Distribution within Medical Sciences

Terms modified by Conservative Treatment

  • conservative treatment option

  • Selected Abstracts


    Conservative Treatment with Nipple-Areolar Resection for Subareolar Breast Cancer

    THE BREAST JOURNAL, Issue 1 2006
    Franceschini Gianluca MD
    No abstract is available for this article. [source]


    Conservative treatment of paediatric mandibular fracture by the use of orthodontic appliance and rubber elastics: report of a case

    DENTAL TRAUMATOLOGY, Issue 1 2005
    Petter J. E. Gawelin
    Abstract,,, Treatment principles of paediatric mandibular fractures may differ from the treatment of the adult population in that a conservative approach is in most cases advocated before the use of internal rigid fixation with plates and screws. This is because of a relative high risk of disturbed facial skeletal growth and risk of damaging unerupted teeth. Knowledge of conservative treatment options is essential in order to minimize these risks and one option is presented in this paper. This case report describes a 5-year-old girl that sustained an open fracture of the mandible and who was successfully treated by the means of applying orthodontic brackets and an arch bar combined with ligatures and rubber elastics. [source]


    Neurological complications in two children with Lemierre syndrome

    DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 8 2010
    BASHEER PEER MOHAMED
    Lemierre syndrome is a distinct clinical syndrome comprising oropharyngeal sepsis and fever, internal jugular vein thrombosis and remote septic metastases caused by Fusobacterium species. The mortality rate was historically high and although use of antibiotics led to a dramatic fall in incidence, a resurgence has been seen recently. A 14-year-old male developed Lemierre syndrome after tonsillitis. There was extensive leptomeningitis, especially over the clivus, causing 6th and 12th cranial nerve palsies, a clinical feature termed the ,clival syndrome'. He also developed an epidural abscess in the cervical spine, which was unsafe for surgical drainage. Conservative treatment with an extended course of antibiotics and anticoagulation for jugular vein thrombosis led to a good recovery. A 15-year-old female developed Lemierre syndrome after a persistent sore throat lasting 7 weeks. She had palsy of the 12th cranial nerve from clival osteomyelitis. She was treated with a 6-week course of antibiotics and anticoagulants leading to almost full recovery at 3-month review. Awareness of the potential neurological complications of Lemierre syndrome and prompt management are crucial in reducing morbidity and mortality in this ,forgotten disease'. [source]


    Effect of tamsulosin on the number and intensity of ureteral colic in patients with lower ureteral calculus

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2005
    SEFA RESIM
    Abstract Background: We aimed to objectively determine whether tamsulosin as an ,1 -blocker was effective in patients who had ureterolithiasis located in the lower part of the ureter. Methods: Sixty patients with lower ureteral calculi (juxtavesical or intramural portion) were included in the present study. Conservative treatment, such as hydration and tenoxicam as a non-steroidal anti-inflammatory drug, was given to group 1 (30 patients). Group 2 (30 patients) was given tamsulosin (0.4 mg daily) in addition to the conservative treatment. All patients were followed up and questioned about the numbers and intensity of ureteral colic, and the rates of spontaneous passage after the procedure. Results: Spontaneous passage was observed in 22 of the 30 patients in group 1 (73.3%) and 26 of the 30 patients in group 2 (86.6%). The difference within groups 1 and 2 was not significant (P = 0.196). The difference between both groups was not statistically significant either, with the stone diameter being 6 mm (P = 0.635) or >6 mm (P = 0.407). As group 1 patients were passing their stones, they had more ureteral colic episodes than group 2 patients. This difference was statistically significant and correlated well with the administration of tamsulosin (P = 0.038). Group 1 patients reported higher scores according to a visual analog scale than group 2 patients. Also, this difference was statistically significant (P = 0.000). Conclusions: We think that the treatment of ,1 -blockers decreased the number of ureteral colic episodes and the intensity of pain during spontaneous passage at the lower ureteral calculi. Also, it will be beneficial to patients' quality of life. [source]


    Conservative treatment of childhood phimosis with topical conjugated equine estrogen ointment

    INTERNATIONAL JOURNAL OF UROLOGY, Issue 1 2000
    Naoko Yanagisawa
    Abstract Purpose: To assess the application of topical conjugated equine estrogen for the treatment of boys with phimosis. Methods: Fifteen boys with phimosis were included in the study. Conjugated equine estrogen (Premarin®) 0.1% ointment was applied on the prepuce once daily. The treatment was continued until the prepuce was fully retractable. The patient was examined each second week up to a maximum treatment of 8 weeks. Retractability and the appearance of the foreskin were graded before and after treatment. Results: Thirteen of 15 boys (87%) referred with phimosis were successfully treated with conjugated equine estrogen ointment. An adverse effect of gynecomastia was seen in one boy (7%). Conclusion: Conjugated equine estrogen ointment application for phimosis may be an alternative to surgery. [source]


    4. Cervical Radicular Pain

    PAIN PRACTICE, Issue 1 2010
    FIPP, Jan Van Zundert MD
    Abstract Cervical radicular pain is defined as pain perceived as arising in the arm caused by irritation of a cervical spinal nerve or its roots. Approximately 1 person in 1,000 suffers from cervical radicular pain. In the absence of a gold standard, the diagnosis is based on a combination of history, clinical examination, and (potentially) complementary examination. Medical imaging may show abnormalities, but those findings may not correlate with the patient's pain. Electrophysiologic testing may be requested when nerve damage is suspected but will not provide quantitative/qualitative information about the pain. The presumed causative level may be confirmed by means of selective diagnostic blocks. Conservative treatment typically consists of medication and physical therapy. There are no studies assessing the effectiveness of different types of medication specifically in patients suffering cervical radicular pain. Cochrane reviews did not find sufficient proof of efficacy for either education or cervical traction. When conservative treatment fails, interventional treatment may be considered. For subacute cervical radicular pain, the available evidence on efficacy and safety supports a recommendation (2B+) of interlaminar cervical epidural corticosteroid administration. A recent negative randomized controlled trial of transforaminal cervical epidural corticosteroid administration, coupled with an increasing number of reports of serious adverse events, warrants a negative recommendation (2B,). Pulsed radiofrequency treatment adjacent to the cervical dorsal root ganglion is a recommended treatment for chronic cervical radicular pain (1B+). When its effect is insufficient or of short duration, conventional radiofrequency treatment is recommended (2B+). In selected patients with cervical radicular pain, refractory to other treatment options, spinal cord stimulation may be considered. This treatment should be performed in specialized centers, preferentially study related. [source]


    Conservative treatment of L -asparaginase-associated lipid abnormalities in children with acute lymphoblastic leukemia,

    PEDIATRIC BLOOD & CANCER, Issue 5 2010
    Hofit Cohen MD
    Abstract Objective To determine the incidence and clinical consequences of asparaginase-associated lipid abnormalities in children with acute lymphoblastic leukemia (ALL). Methods Sixty-five newly diagnosed children and adolescents aged 0.4,21 years with ALL or lymphoblastic lymphoma were retrospectively evaluated for lipid abnormalities. They were treated according to the ALLIC-BFM 2002 protocol between 2002 and 2005. Fasting cholesterol levels were measured in all patients and triglycerides (TG) in 42/65 patients. Results Prior to treatment, mean cholesterol level was 149,±,50,mg/dl, and increased to maximal level 274,±,124,mg/dl during treatment. Mean TG level during treatment was 459,±,526,mg/dl (range 54,3,009). Twelve patients (28%) had TG levels <200,mg/dl, 18 (43%) had 200,400,mg/dl, 3 (7%) had 400,600,mg/dl, 4 (10%) between 600 and 1,000,mg/dl, and 5 (12%) patients had >1,000,mg/dl. No association was found between TG levels and age or gender. One of the 12 patients with TG >400,mg/dl developed left saggital sinus thrombosis and left frontal lobe infarct. TG level at the time of the event was 2,640,mg/dl. None of the five patients with TG levels >1,000,mg/dl developed pancreatitis. Children with TG levels between 400 and 600,mg/dl were treated by fasting. Fibrates and heparin were added to those with levels >600,mg/dl. Lipid abnormalities normalized in all children upon completion of asparaginase treatment. Conclusions Abnormalities of lipid profile in children with ALL during asparaginase therapy are relatively common. We recommend measuring TG before and during asparaginase treatment. Initiation of conservative treatment could prevent further increase of TG and decrease the risk of potential complications. Pediatr Blood Cancer 2010;54:703,706. © 2010 Wiley-Liss, Inc. [source]


    Conservative treatment of spontaneous tracheal rupture

    PEDIATRIC PULMONOLOGY, Issue 7 2006
    Ahmet Akyol MD
    Abstract Spontaneous tracheobronchial ruptures are uncommon injuries, especially in the pediatric age group. Tracheal injuries, independent of their origin, may be life-threatening. Here we present the first report of a 14-year-old boy who presented with subcutaneous emphysema, pneumomediastinum, and pneumothorax on day 3, due to spontaneous posterior tracheal-wall rupture following paroxysmal productive coughing. The diagnosis was established using a computed tomography scan of the chest, and tracheobronchoscopy and esophagoscopy under general anesthesia. He was endotracheally intubated and ventilated in the intensive care unit. Such tracheal defects, bridgeable by an endotracheal tube, may permit conservative treatment. The patient was discharged on day 10, and follow-up revealed no late complications. Pediatr Pulmonol. 2006; 41: 690,693. © 2006 Wiley-Liss, Inc. [source]


    Pressure cutaneous ulcer over a pacemaker successfully treated with left subcostal transplantation in an extremely thin patient

    THE JOURNAL OF DERMATOLOGY, Issue 8 2006
    Manabu HAMADA
    ABSTRACT Implantation of a permanent cardiac pacemaker is becoming common with the increase in the elderly population. A cutaneous ulcer over the pacemaker is a rare complication. Most such cases previously reported demonstrate non-specific granuloma histologically, negative patch testing of materials used in the device, and no growth in the bacterial culture taken from the generator pocket. To date, the conventional treatments often result in a disap-pointing outcome. We describe an extremely thin 79-year-old Japanese male with a pressure cutaneous ulcer caused by the presence of a pacemaker device. This patient was referred to us with a 1-month history of repeated cutaneous ulcer and exposure of the cardiac pacemaker in the left pectoral area. Conservative treatment was not effective. Treatment with left subcostal implantation of a new pacemaker, which was not wrapped, and disposition of the electrodes in the subcutaneous tissue of the thorax was successful. Cutaneous manifestations have not recurred for 5 years. Considering the poor condition of the patient, subcostal translocation of the pacemaker was a simple and acceptable treatment for pressure cutaneous ulcer over the pacemaker. [source]


    Pseudotumor of Infancy and Congenital Muscular Torticollis: 170 Cases,

    THE LARYNGOSCOPE, Issue 4 2001
    Julie L. Wei MD
    Abstract Objectives To review pseudotumor of infancy (POI) and congenital muscular torticollis (CMT) and to suggest an algorithm for treatment. Study Design Retrospective review of cases from 1962 to 1998 at a tertiary care center. Methods Patients included in this study were 81 boys and 89 girls who had a diagnosis of POI (n = 38) or CMT (n = 132) before 24 months of age. Results For all patients, the mean age at diagnosis was 4 months; 54.1% had the left side of the neck affected, over 90% had a head tilt, and 2.4% had feeding difficulty as a result of the disorder. Plagiocephaly was present in 39.5% of patients with POI and 63.6% of patients with CMT; a neck mass, in 63.2% and 18.2%, respectively; and facial asymmetry, in 7.9% and 15.9%, respectively. All patients had a complete physical examination; 54.1% had plain cervical radiography, 4.1%, computed tomography, and 2.9%, ultrasonography. Passive range of motion was the initial treatment recommended for 65.3% of patients. Conservative treatment failed for 16 patients; subsequently, they had surgical treatment. Follow-up data were available for 159 patients; 85.5% experienced total resolution and 14.5% experienced subtotal resolution or long-term abnormality. Conclusions Children diagnosed with POI or CMT should be treated and observed for at least 12 months or until symptoms resolve. If symptoms persist 1 year after diagnosis despite conservative therapy, surgical treatment should be considered. The majority of children with POI or CMT experience total resolution of symptoms. [source]


    Conservative treatment of a cervical horizontal root fracture and a complicated crown fracture: a case report

    AUSTRALIAN DENTAL JOURNAL, Issue 3 2008
    I Belobrov
    Abstract This case report describes successful long-term conservative management of a cervical root fracture and a complicated crown fracture of the maxillary central incisors in a 12-year-old patient. A mineral trioxide aggregate partial pulpotomy was performed on the maxillary right central incisor, while the maxillary left central incisor was splinted to the neighbouring lateral incisor using an acid-etch technique. Both teeth remained asymptomatic throughout the 3.5 years of a review period, with the cervical root fracture having mostly healed with the formation of a calcified tissue between the fragments. Two different treatment methods were used for two different injuries that resulted in pulp preservation in both cases. This in turn has provided for normal root development to occur while also allowing for preservation of bone. [source]


    Conservative treatment of patients with periapical lesions associated with extraoral sinus tracts

    AUSTRALIAN ENDODONTIC JOURNAL, Issue 3 2007
    Janir Alves Soares phd
    Abstract This paper describes the clinical courses of three cases with extra-oral sinus tract formation, from diagnosis and treatment to short-term follow-up and evaluation. All teeth involved had periradicular radiolucent areas noted on radiographic examination and extra-oral sinus tracts appearing on the chin with exudation and unpleasant aesthetic appearance. The adopted treatment protocol included treating the sinus tract surface simultaneously with the root canal therapy. After root canal shaping using 5.25% sodium hypochlorite solution, calcium hydroxide-based pastes associated with different vehicles were inserted into the root canal for 4 months, and were changed monthly. All the sinus tracts healed in 7 to 10 days. The apical lesions were completely repaired in a maximum period of 24 months. The treatment adopted provided a complete healing of the periapical lesions in a short follow-up period. Surgical repair of the cutaneous sinus tract was therefore unnecessary. [source]


    Elbow joint luxation in a 1-month-old foal

    AUSTRALIAN VETERINARY JOURNAL, Issue 1-2 2008
    LM Rubio-Martínez
    This paper reports on luxation of the elbow joint without concomitant fracture in a 1-month-old foal. Conservative treatment, with closed reduction and full-limb bandaging, including caudal and lateral splints, seemed successful initially, however, failed to provide enough stability and luxation recurred, and open reduction and surgical placement of prosthetic collateral ligaments was required. Luxation of the elbow joint should be considered when acute non-weight bearing forelimb lameness occurs associated with pain and swelling in the area of the elbow in young foals. Closed reduction failed to provide sufficient joint stability. [source]


    Conservative treatment of urge urinary incontinence in women: a systematic review of randomized clinical trials

    BJU INTERNATIONAL, Issue 3 2000
    L.C.M. Berghmans
    Objective,To assess the efficacy of physical therapies for first-line use in the treatment of urge urinary incontinence (UUI) in women, using a systematic review of randomized clinical trials (RCTs). Materials and methods,A computer-aided and manual search was carried out for RCTs published between 1980 and 1999 investigating the treatment of UUI defined by the keywords ,physical therapies', e.g. bladder (re)training (including ,behavioural' treatment), pelvic floor muscle (PFM) exercises, with or without biofeedback and/or electrical stimulation. The methodological quality of the included trials was assessed using methodological criteria, based on generally accepted principles of interventional research. Results,Fifteen RCTs were identified; the methodological quality of the studies was moderate, with a median (range) score of 6 (3,8.5) (maximum possible 10). Eight RCTs were considered of sufficient quality, i.e. an internal validity score of 5.5 points on a scale of 0,10, and were included in a further analysis. Based on levels-of-evidence criteria, there is weak evidence to suggest that bladder (re)training is more effective than no treatment (controls), and that bladder (re)training is better than drug therapy. Stimulation types and parameters in the studies of electrical stimulation were heterogeneous. There is insufficient evidence that electrical stimulation is more effective than sham electrical simulation. To date there are too few studies to evaluate effects of PFM exercise with or without biofeedback, and of toilet training for women with UUI. Conclusion,Although almost all studies included reported positive results in favour of physical therapies for the treatment of UUI, more research of high methodological quality is required to evaluate the effects of each method in the range of physical therapies. [source]


    A prospective evaluation of occult disorders in obstructed defecation using the ,iceberg diagram'

    COLORECTAL DISEASE, Issue 9 2006
    M. Pescatori
    Abstract Objective, Surgical treatment of constipation and obstructed defecation (OD) carries frequent recurrences, as OD is an ,iceberg syndrome' characterized by ,underwater rocks' or occult diseases which may affect the outcome of surgery. The aim of this study was to evaluate occult disorders in order to alert the clinician of these and minimize failures. Method, One hundred consecutive constipated patients with OD symptoms, 81 female patients, median age 52 years, underwent perineal examination, proctoscopy, anorectal manometry, and anal/vaginal ultrasound. Anorectal physiology and imaging tests were also carried out when indicated, as well as psychological and urogynaecological consultation. Symptoms were graded using a modified 1,20 constipation score. Both evident (e.g. rectocele) and occult (e.g. anismus) diseases were prospectively evaluated using a novel ,iceberg diagram'. The type of treatment, whether conservative or surgical, was also recorded. Results, Fifty-four (54%) patients had both mucosal prolapse and rectocele. All patients had at least two occult OD-related diseases, 66 patients had at least three: anxiety-depression, anismus and rectal hyposensation were the most frequent (66%, 44% and 33% respectively). The median constipation score was 11 (range 2,20), the median number of ,occult disorders' was 5 (range 2,8). Conservative treatment was carried out in most patients. Surgery was carried out in 14 (14%) patients. Conclusion, The novel ,iceberg diagram' allowed the adequate evaluation of OD-related occult diseases and better selection of patients for treatment. Most were managed conservatively, and only a minority were treated by surgery. [source]


    Bilateral Motor Cortex Stimulation for the Relief of Central Dysesthetic Pain and Intentional Tremor Secondary to Spinal Cord Surgery: A Case Report

    NEUROMODULATION, Issue 4 2002
    Roberto Fabian Rodríguez MD
    Abstract Objectives. Our objective was to describe and analyze through a third party disinterested observer the results obtained by using motor cortex stimulation (MCS) for the treatment of central dysesthetic diffuse-distal type of paraplegic pain and intentional tremor secondary to the total removal of a cervical ependymoma. Design. Retrospective case report with discussion. Methods. A 69-year-old female, who after satisfactory removal of a cervical ependymoma, developed a central dysesthetic diffuse-distal type of paraplegic pain and intentional tremor associated with mild cerebellar deficit. Neurologic compromise became so intense that it prevented the patient from leading an independent lifestyle. Conservative treatments failed and a unilateral trial of MCS was performed. After a four-day satisfactory unilateral trial, a bilateral electrode, Resume II (Medtronic, Inc., Minneapolis, MN), was inserted through a small craniotomy and a dual-channel RF activated receiver was implanted. During the second month of follow-up an independent observer personally interviewed the patient and assessed results through a multimodal approach, encompassing several analog scales used to measure the different components of the painful experience; a daily life activities scale and drug intake. Results. Evoked painful phenomena were dramatically improved, but the steady component of pain was only moderately relieved. The patient's tremor improved to allow for the performance of simple movements such as independent eating. Conclusion. In this single case report MCS was extremely useful in eliminating almost all of the patient's pain-evoked phenomena. Both steady burning pain and tremor were also improved. This is only one case report and MCS warrants further investigation as to its utility in controlling central dysesthetic pain in paraplegia and postchordotomy dysesthesias. [source]


    The conservative treatment of pediatric mandibular fracture with prefabricated surgical splint: a case report

    DENTAL TRAUMATOLOGY, Issue 4 2007
    Ceyda Kocabay
    Abstract,,, The use of rigid fixation in children is controversial and may cause growth retardation along cranial suture lines. Intermaxillary fixation for mandibular fractures should be used cautiously as bony ankylosis in the temporomandibular joint (TMJ) and trismus may develop. The high osteogenic potential of the pediatric mandible allows non-surgical management to be successful in younger patients with conservative approaches. In this case, successful conservative treatment of mandibular fracture of a 3-year-old patient is presented. [source]


    Factors affecting treatment outcomes following complicated crown fractures managed in primary and secondary care

    DENTAL TRAUMATOLOGY, Issue 4 2006
    N. G. Jackson
    Abstract,,, The aims of this retrospective observational study were to determine the factors which affect treatment provision and the Median Survival Time (MST) for maintenance of tooth vitality following complicated crown fracture. The survey was carried out for patients treated at Newcastle Dental Hospital (NDH) according to departmental guidelines over a 2-year period following the introduction of a new protocol for management of these types of injuries. Seventy-three cases of complicated crown fracture were identified in 69 children with a mean age of 10.3 years (SD = 2.5 years). Seventy-one percent of the fractures occurred in males (M:F ratio was 2.5:1). Fifty-one percent of the complicated crown fractures were in immature teeth. Of the 73 traumatised teeth, 45% presented initially in general dental practice (GDP), 37% at the dental hospital and 8% at local accident and emergency departments with the remaining 10% seen at other or unrecorded locations. Of the 41 fractures, which presented initially at a location other than the dental hospital, 38% were referred to the dental hospital without the provision of an emergency pulp bandage. The overall definitive treatments provided for the 37 open apex teeth included pulp cap (19%), partial pulpotomy (32%), cervical pulpotomy (8%) and pulpectomy (35%), while for the 36 closed apex teeth it was pulp cap (28%), pulpotomy (11%), and pulpectomy (61%). Of the 30 teeth, which underwent vital pulp therapy (18 open and 12 closed apex), the MST for the 15 teeth treated with pulp caps was 1460 days (95% CI: 1067, 1853) while for the 15 teeth treated with pulpotomies it was 1375 days (95% CI: 964, 1786). There was no statistically significant difference in the MST between teeth treated with pulp caps and pulpotomies. In conclusion, the proportion of patients referred to secondary care with complicated crown fractures without provision of a pulp bandage is of some concern. More conservative treatment of closed apex teeth sustaining complicated crown fractures, utilizing vital pulp therapy techniques would appear to be appropriate. [source]


    LONG-TERM OUTCOME OF ENDOSCOPIC PAPILLOTOMY FOR CHOLEDOCHOLITHIASIS WITH CHOLECYSTOLITHIASIS

    DIGESTIVE ENDOSCOPY, Issue 2 2010
    Tatsuya Fujimoto
    Aim:, To assess long-term outcome of endoscopic papillotomy alone without subsequent cholecystectomy in patients with choledocholithiasis and cholecystolithiasis. Methods:, Retrospective review of clinical records of patients treated for choledocholithiasis and cholecystolithiasis from 1976 to 2006. Of 564 patients subjected to endoscopic papillotomy and endoscopic stone extraction, 522 patients (279 men, 243 women; mean age 66.2 years) were followed up and predisposing risk factors for late complications were analyzed. Results:, The mean duration of follow up was 5.6 years. Cholecystitis and recurrent choledocholithiasis occurred in 39 (7.5%) and 60 (11.5%) patients, respectively. Cholecystitis, including one severe case, resolved with conservative treatment. Recurrent choledocholithiasis was successfully treated endoscopically except in one case. Pneumobilia was found to be a significant risk factor for cholecystitis (P = 0.019) and recurrent choledocholithiasis (P = 0.013). Biliary tract cancer occurred in 16 patients; gallbladder cancer in 13 and bile duct cancer in three. Gallbladder cancer developed within 2 years after endoscopic papillotomy in seven of the 13 patients (53.8%). Conclusion:, Pneumobilia was the only significant risk factor for cholecystitis and recurrent choledocholithiasis in our study population. As for the long-term outcome, it was unclear whether endoscopic papillotomy contributed to the occurrence of biliary tract cancer. [source]


    Colonic perforation after endoscopic biopsy of a submucosal tumor: successful conservative treatment

    DIGESTIVE ENDOSCOPY, Issue 4 2002
    Kuang-I.
    Colonoscopy is a powerful diagnostic and therapeutic procedure with a recognized risk of complications ranging from perforation to hemorrhage and septicemia. Perhaps the most dangerous complication associated with this procedure is bowel perforation. Although some colonic perforations can be treated medically, prompt surgery is generally preferred to minimize morbidity and mortality. We present a case of colonic perforation resulting from bite biopsy followed by mucosal resection of a submucosal tumor. Perforation occurred in a delayed manner despite prophylactic closure of the mucosal defect by the replacement of endoclips. The patient recovered spontaneously after antibiotic treatment and reduction of oral intake. We carried out successful conservative medical treatment of a minor iatrogenically induced bowel perforation without operation. [source]


    Laparoscopic paraesophageal hernia repair: quality of life outcomes in the elderly

    DISEASES OF THE ESOPHAGUS, Issue 8 2008
    E. J. Hazebroek
    SUMMARY Paraesophageal hernias (PEH) occur when there is herniation of the stomach through a dilated hiatal aperture. These hernias occur more commonly in the elderly, who are often not offered surgery despite the failure of medical treatment to address mechanical symptoms and life-threatening complications. The aim of this study was to assess the impact of laparoscopic repair of PEH on quality of life in an elderly population. Data were collected prospectively on 35 consecutive patients aged >70 years who had laparoscopic repair of a symptomatic PEH between December 2001 and September 2005. The change in quality of life was assessed using a validated questionnaire, the Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD), and by patient interviews. Patients were assessed preoperatively, and at 6 weeks, 6 months, 12 months, 1 year, and 2 years postoperatively. Mean patient age was 77 years (range 70,85); mean American Society of Anesthesiologists class was 2.7 (range 1,3). There were 28 women and 7 men. There was one readmission for acute reherniation, which required open revision. Total complication rate was 17.1%. All complications were treated without residual disability. There was no 30-day mortality, and median hospital stay was 3 days (range 2,14). Completed questionnaires were obtained in 30 of 35 patients (85.7%). There was a significant improvement in quality of life, as measured with QOLRAD, at all postoperative time points (P < 0.001). Laparoscopic PEH repair can be performed with acceptable morbidity in symptomatic patients refractory to conservative treatment and is associated with a significant improvement in quality of life. Our data support elective repair of symptomatic PEH in the elderly, a population who may not always be referred for a surgical opinion. [source]


    Management of advanced mandibular osteoradionecrosis with free flap reconstruction

    HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 10 2001
    David W. Chang MD
    Abstract Background The purpose of this study was to assess the effectiveness of free tissue transfer for treatment of advanced mandibular osteoradionecrosis (ORN) in head and neck cancer patients. Methods We reviewed 29 patients who were treated for advanced mandibular ORN by radical resection and reconstruction with free flaps at our institution. All patients had either failed to respond to conservative treatment, including hyperbaric oxygen therapy and debridement or had pathological fracture due to ORN. Results Twenty-four vascularized bone (17 fibula, five iliac, and two scapula), four rectus abdominis myocutaneous, and one radial forearm fasciocutaneous free flaps were used. The complications occurred in 6 of 29 patients (21%). A total of four flaps (14%) were lost. The mean follow-up was 2 years 9 months. All patients had complete resolution of ORN symptoms. No evidence of ORN recurrence was observed in any patient. Conclusion For advanced osteoradionecrosis of the mandible, radical resection followed by reconstruction using free flap provides a reliable means of obtaining good wound healing with acceptable aesthetic and functional results. © 2001 John Wiley & Sons, Inc. Head Neck 23: 830,835, 2001. [source]


    Atypical Spontaneous Intracranial Hypotension (SIH) With Nonorthostatic Headache

    HEADACHE, Issue 2 2007
    Doo-Sik Kong MD
    Background.,Some patients with spontaneous intracranial hypotension (SIH) often do not demonstrate typical orthostatic headache, which is contrary to the typical SIH syndrome. They usually have an obscure and intermittent headache, regardless of their positional change. Object.,The objective of this study is to investigate the clinical course of atypical SIH that manifests with diffuse pachymeningeal enhancement, but no orthostatic headaches. Methods.,Between January 1997 and December 2005, we observed a total of 6 patients who revealed atypical presentations including nonpostural headaches and normal cerebrospinal fluid (CSF) pressure, despite the diffuse pachymeningeal enhancement seen on their MR images. For a comparison of the clinical features and the disease course, 13 other SIH patients with typical clinical manifestations were selected as a control group. Results.,Cerebrospinal fluid leakage sites were confirmed in only one patient through a variety of diagnostic tools; in contrast, definite focal CSF leakage sites were found in 12 of 13 patients with typical SIH. The 6 atypical SIH patients were treated with conservative treatment, including strict bed rest and intravenous hydration for 2 to 3 weeks. After a mean follow-up of 12 months, their headaches were gradually relieved after 2 to 3 weeks of conservative treatment only. Conclusions.,All SIHs do not necessarily show the typical clinical manifestations. The atypical finding of SIH such as nonorthostatic headache or normal CSF pressure may be the result of a normal physiologic response to the typical SIH as a compensatory reaction. Therefore, when faced with patients showing findings compatible with SIH on the brain MR images, regardless of nonpostural headache, atypical SIH should be suspected. [source]


    Chylous effusions complicating lymphoma: a serious event with octreotide as a treatment option

    HEMATOLOGICAL ONCOLOGY, Issue 2 2003
    J. Evans
    Abstract Chylous effusions have an identical appearance to milk and occur when the thoracic duct is blocked. Since chyle represents direct absorption of fat from the small intestine lacteals, it is rich in fat, calories, vitamins and immunoglobulins. Drainage of this milk-like fluid from any cavity (chest or abdomen) results in rapid weight loss and profound cachexia. The recognition of this milk-like fluid as chyle is urgent for the implementation of the correct treatment. In adults, lymphoma is one of the commonest malignancies to cause blockages in the thoracic duct. Once the diagnosis is made, conservative treatment with strict dietary adjustment often fails to prevent weight loss or resolve the underlying cause. Since the condition is uncommon, no guidelines exist. Many surgeons recommend early surgical intervention before the patient becomes too weak. Surgery may also fail. We report the case of a 62-year-old man with chylous effusions and a weight loss of 30,kg. The nature of the effusion was unrecognized for the first 16 weeks. Upon diagnosis, dietary adjustment was made and a lymphangiogram organized with a view to surgery. Literature searches revealed two cases in which somatostatin was used after surgical procedures failed. We therefore used octreotide (a synthetic analogue of somatostatin). We report complete resolution of the condition within 72,h leading to the resumption of a normal diet and discharge within 2 weeks. Copyright © 2003 John Wiley & Sons, Ltd. [source]


    Paraoxonase-1 (PON1) activity as a risk factor for atherosclerosis in chronic renal failure patients

    HEMODIALYSIS INTERNATIONAL, Issue 4 2008
    Saeed Abdelwhab SAEED
    Abstract Paraoxonase is a high-density lipoprotein-associated enzyme and has been shown to reduce the susceptibility to low-density lipoprotein peroxidation. This study aimed to investigate the activity of serum paraoxonase in uremic patients on hemodialysis (HD) and in the predialysis period, and to evaluate the correlations of vascular disease with paraoxonase activity. Thirty patients with chronic renal failure (CRF) undergoing HD (group 1), 30 patients with CRF under conservative treatment (group 2), and 30 healthy controls (group 3) were included. Basal, salt-stimulated, and arylesterase activity were tested by UV spectrophotometry. Serum lipid parameters were determined. B-Mode Doppler ultrasound was used to assess common carotid intima-media thickness (IMT). Basal paraoxonase, salt-stimulated, and arylesterase activity showed no significant difference between group 1 and group 2. However, it was significantly lower in group 1 and in group 2 than controls. Carotid IMT was significantly higher in group 1 than group 2 and both were significantly higher than controls. Basal paraoxonase-1 (PON1), salt-stimulated PON1, and arylesterase activity correlate with BUN, but only basal PON1 and salt-stimulated PON1 correlate with serum albumin. Linear regression showed that the most significant determinant of carotid IMT was PON1 arylesterase activity in group 1 and arylesterase activity and basal PON1 activity in group 2. Patients with CRF, whether under HD or conservative treatment, have reduced basal and stimulated paraoxonase activities, and this could be an important factor causing increased vascular disease in those patients. Modifying this factor can be of great value to protect against this common complication. [source]


    Invasive bladder carcinoma: A pilot study of conservative treatment with accelerated radiotherapy and concomitant cisplatin,

    INTERNATIONAL JOURNAL OF CANCER, Issue 6 2001
    Abderrahim Zouhair M.D.
    Abstract From November 1992 to December 1997, 25 patients (inoperable or refusing cystectomy) were included in a prospective study to assess the feasibility, tolerance, and curative potential of accelerated radiotherapy (RT) and concomitant cisplatin. Median age was 74 years (range 49,86). Stage distribution was as follows: 1 T1, 10 T2, 8 T3, and 6 T4. Two patients had clinically positive pelvic nodes. The goal was to deliver a total dose of 40 Gy to the whole pelvis and bladder in 4 weeks using a concomitant boost of 20 Gy to the tumor or to the whole bladder during the third and fourth weeks (total dose 60 Gy), with daily cisplatin (6 mg/m2) before RT for patients with creatinine clearance > 50 ml/min. All but one patient completed the RT protocol. Daily cisplatin was sucessfully delivered in 18 patients. One patient presented with grade III ototoxicity. Diarrhea was scored grade III in two and grade IV in two patients. Acute urinary toxicity was scored grade III in one patient. Posttreatment late effects included bladder grade II and grade III in two patients and one patient, respectively; large bowel grade III in one; urethral grade III in one; and femoral head radionecrosis in one. Four-year overall and disease-specific survival rates were 23% and 35%, respectively. The latter was 60% for patients with T2 tumors. The 4-year actuarial locoregional control rate for all patients was 61%. In summary, accelerated RT and concomitant cisplatin is feasible with acceptable tolerance even in relatively old patients. Although outcome was better for patients with low-stage tumors, local control and survival rates appeared similar to those of standard RT schedules for a similar patient population. © 2001 Wiley-Liss, Inc. [source]


    Comparison of three conservative treatment protocols in carpal tunnel syndrome

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2006
    O. Baysal
    Summary The aim of this study was to investigate and compare the therapeutic effect of three different combinations in the conservative treatment of carpal tunnel syndrome (CTS) by means of clinical and electrophysiological studies. The combinations included tendon- and nerve-gliding exercises in combination with splinting, ultrasound treatment in combination with splinting and the combination of ultrasound, splinting, tendon- and nerve-gliding exercises. A total 28 female patients (56 wrists) with clinical and electrophysiologic evidence of bilateral CTS were studied. In all patient groups, the treatment combinations were significantly effective immediately and 8 weeks after the treatment. The results of the long-term patient satisfaction questionnaire revealed that symptomatic improvement is more prominent in the group treated with splinting, exercise and ultrasound therapy combination. Our results suggest that a combination of splinting, exercise and ultrasound therapy is a preferable and an efficacious conservative type of treatment in CTS. [source]


    Eosinophilic gastroenteritis: presentation of two patients with unusual affect of terminal ileum and caecum with manifestations of acute abdomen and literature review

    INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2004
    A. Charalabopoulos
    Summary Eosinophilic gastroenteritis is a rare disease; the long-term personal history with digestive symptoms and the course of the disease with relapses and remissions is the key for the disease to be suspected. Endoscopy, CT scan and sonographic studies may provide important indirect signs of the disease and in combination with histological examination the diagnosis can be achieved. The administration of corticosteroids is an important factor for the treatment or the remission of the disease. In this study two cases with unusual location of the disease, on the terminal ileum and caecum, are presented and a literature review is attempted. The disease process, clinical and laboratory findings as well as the surgical approach used are described. Eosinophilic gastroenteritis is a very rare disease with its surgical complications. The disease is a non-surgical disease, thus presurgical diagnosis is important because the entity discussed can be under control by conservative treatment. A high disease suspicious index must be kept in the physicians' mind. [source]


    Cutaneous manifestations of chikungunya fever: observations made during a recent outbreak in south India

    INTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 2 2008
    Arun C. Inamadar MD
    Background, Chikungunya fever is an Aedes mosquito-borne Arbo viral illness with significant morbidity. Methods, In a recent outbreak of the disease in south India, the dermatologic manifestations of 145 patients attending a tertiary care hospital were recorded. Results, All age groups were affected, including newborns. Some of the cutaneous features were observed during the acute stage of the illness, and others during convalescence or thereafter. Pigmentary changes were found to be the most common cutaneous finding (42%), followed by maculopapular eruption (33%) and intertriginous aphthous-like ulcers (21.37%). Lesions with significant morbidity were generalized vesiculobullous eruptions (2.75%), found only in infants, lymphedema, and intertriginous aphthous-like ulcers. Exacerbation of existing dermatoses, such as psoriasis, and unmasking of undiagnosed Hansen's disease were observed. A perivascular lymphocytic infiltrate was a consistent histopathologic finding in all types of skin lesions. All patients responded well to symptomatic, conservative treatment. Conclusions, The cutaneous findings hitherto not reported may be the result of the African genotype of the virus detected during this outbreak in India. [source]


    Stent-protected angioplasty in asymptomatic carotid artery stenosis vs. endarterectomy: SPACE2 , a three-arm randomised-controlled clinical trial

    INTERNATIONAL JOURNAL OF STROKE, Issue 4 2009
    T. Reiff
    Moderate to severe (,70%) asymptomatic stenosis of the extracranial carotid artery leads to an increased rate of stroke of approximately 11% in 5 years. Patients with asymptomatic carotid stenosis, however, are also at a higher risk of nonstroke vascular events. The estimated annual risks of such events in patients with asymptomatic stenosis are 7% for a coronary ischaemic event and 4,7% for overall mortality. The superiority of carotid endarterectomy compared with medical treatment in symptomatic carotid disease is established, provided that the surgical procedure can be performed with a perioperative morbidity and mortality of <6%. The advantage of carotid endarterectomy for asymptomatic patients is less established. An alternative treatment, carotid artery stenting, has been developed. This treatment is used frequently in both symptomatic and asymptomatic patients. In the last decade, major advantages in medical primary prevention of cerebrovascular and cardiovascular disease have been accomplished. The control groups in the large trials for asymptomatic carotid artery disease (ACAS and ACST) originate from more than a decade ago and, for the most part, have not received a medical primary prevention strategy that would now be considered the standard according to current national and international guidelines. For this reason, a three-arm trial (SPACE2; http://www.space-2.de) with a hierarchical design and a recruitment target of 3640 patients is chosen. Firstly, a superior trial of intervention (carotid artery stenting or carotid endarterectomy) vs. state-of-the-art conservative treatment is designed. In case of superiority of the interventions, a noninferiority end-point will be tested between carotid artery stenting and carotid endarterectomy. This trial is registered at Current Controlled Trials ISRCTN 78592017. [source]