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Nonsurgical Management (nonsurgical + management)

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Medical Sciences	100%

Selected Abstracts

Nonsurgical Management of Parapharyngeal Space Infections: A Prospective Study

THE LARYNGOSCOPE, Issue 5 2002
Jean-Yves Sichel MD
Abstract Objective/Hypothesis Parapharyngeal infections, which can potentially cause life-threatening complications, may, in certain cases, be treated conservatively with no need for surgical drainage. A review of the literature reveals that the most recommended treatment of parapharyngeal infection is surgical drainage combined with intravenous antibiotic therapy. Several retrospective reports recommend conservative treatment with no surgical drainage. Study Design Prospective, nonrandomized. Methods A prospective study was performed on all patients with an infection limited to the parapharyngeal space. Results Twelve patients presented with clinical and radiological diagnosis of parapharyngeal infection during a 5-year period. Five patients showed obvious presence of pus in other spaces and therefore were excluded. Seven patients with no gross extension into other spaces and with no respiratory distress or septic shock were treated with intravenous amoxicillin-clavulanic acid for 9 to 14 days (average period, 11 days). All patients except one were children. All were cured with conservative management, and no surgical drainage was needed. None had any complications. Conclusion Our results confirm the effectiveness of nonsurgical treatment of infections limited to the parapharyngeal space, at least in the pediatric population. [source]

Value of Transesophageal 3D Echocardiography as an Adjunct to Conventional 2D Imaging in Preoperative Evaluation of Cardiac Masses

ECHOCARDIOGRAPHY, Issue 6 2008
Silvana Müller M.D.
Background: This study sought to compare three-dimensional (3D) and two-dimensional (2D) transesophageal echocardiography (TEE) to assess intracardiac masses. It was hypothesized that 3D TEE would reveal incremental information for surgical and nonsurgical management. Methods: In 41 patients presenting with intracardiac masses (17 thrombi, 15 myxomas, 2 lymphomas, 2 caseous calcifications of the mitral valve and one each of hypernephroma, hepatocellular carcinoma, rhabdomyosarcoma, lipoma, and fibroelastoma), 2D and 3D TEE were performed, aiming to assess the surface characteristics of the lesions, their relationship to surrounding structures, and attachments. Diagnoses were made by histopathology (n = 28), by computed tomography (n = 8), or by magnetic resonance imaging (n = 5). Benefit was categorized as follows: (A) New information obtained through 3D TEE; (B) helpful unique views but no additional findings compared to 2D TEE; (C) results equivalent to 2D TEE; (D) 3D TEE missed 2D findings. Results: In 15 subjects (37%), 3D TEE revealed one or more items of additional information (category A) regarding type and site of attachment (n = 9, 22%), surface features (n = 6, 15%), and spatial relationship to surrounding structures (n = 8, 20%). In at least 18% of all intracardiac masses, 3D TEE can be expected to deliver supplementary information. In six patients, additional findings led to decisions deviating from those made on the basis of 2D TEE. In 11 subjects (27%), 3D echocardiographic findings were categorized as "B." Conclusions: Information revealed by 3D imaging facilitates therapeutic decision making and especially the choice of an optimal surgical access prior to removal of intracardiac masses. [source]

Management and outcomes of facial paralysis from intratemporal blunt trauma: A systematic review,,

THE LARYNGOSCOPE, Issue 7 2010
John J. Nash MD
Abstract Objectives/Hypothesis: To systematically review the existing literature on outcomes and management of facial paralysis resulting from intratemporal blunt trauma. Study Design: Systematic review of the literature. Methods: Thirty-five articles met our inclusion criteria. Outcome variables analyzed included severity of paralysis, time of onset of paralysis, surgical or nonsurgical management, steroid use, and final facial nerve function. Results: All studies were classified as level 4 evidence as defined by the Oxford Centre for Evidence-Based Medicine. There was marked variation in the quality of the studies with inconsistent outcome measures, diagnostic testing, and follow-up, thus ruling out a formal meta-analysis. In an exploratory pooling of data, 612 cases had sufficient follow-up and facial movement grading for some evaluation of trends. In 189 patients who were followed observationally, 66% achieved an outcome equivalent to House-Brackmann (HB) I, 25% achieving HB II-V, and two patients an HB VI score. Among 83 patients treated with steroids, 67% achieved HB I, 30% HB II-V, and no patients with HB VI. In 340 patients treated surgically, 23% achieved HB I postoperatively, 58% were graded as HB II-V, and 9% with HB grade VI postoperatively. No patient presenting with partial paralysis had an HB VI outcome. Conclusions: The role of surgery versus nonsurgical interventions for this clinical entity remains inconclusive. Level 4 evidence studies predominate and are further hindered by poor description of outcome measures and incomplete data reporting. Exploratory pooling of data without formal meta-analysis suggests the need to compare any intervention to the natural course of healing, which overall appears to be favorable. Laryngoscope, 2010 [source]

Head and Neck Cancer: The Importance of Oxygen ,

THE LARYNGOSCOPE, Issue 5 2000
David J. Terris MD
Abstract Objectives To use recently introduced polarographic technology to characterize the distribution of oxygenation in solid tumors, explore the differences between severe hypoxia and true necrosis, and evaluate the ability to predict treatment outcomes based on tumor oxygenation. Study Design Prospective, nonrandomized trial of patients with advanced head and neck cancer, conducted at an academic institution. Methods A total of 63 patients underwent polarographic oxygen measurements of their tumors. Experiment 1 was designed to determine whether a gradient of oxygenation exists within tumors by examining several series of measurements in each tumor. Experiment 2 was an analysis of the difference in data variance incurred when comparing oxygen measurements using oxygen electrodes of two different sizes. Experiment 3 compared the proportion of tumor necrosis to the proportion of very low (,2.5 mm Hg) polarographic oxygen measurements. Experiment 4 was designed to explore the correlation between oxygenation and treatment outcomes after nonsurgical management. Results No gradient of oxygenation was found within cervical lymph node metastases from head and neck squamous cell carcinomas (P > .9). Tumor measurements achieved with larger (17 ,m) electrodes displayed smaller variances than those obtained with smaller (12 ,m) electrodes, although this difference failed to reach statistical significance (P = .60). There was no correlation between tumor necrosis and the proportion of very low (,2.5 mm Hg) oxygen measurements. There was a nonsignificant trend toward poorer locoregional control and overall survival in hypoxic tumors. Conclusions Hypoxia exists within cervical lymph node metastases from head and neck squamous carcinomas, but the hypoxic regions are distributed essentially randomly. As expected, measurements of oxygen achieved with larger electrodes results in lowered variance, but with no change in overall tumor mean oxygen levels. Polarographic oxygen measurements are independent of tumor necrosis. Finally, oxygenation as an independent variable is incapable of predicting prognosis, probably reflecting the multifactorial nature of the biological behavior of head and neck cancers. [source]

Outcome and survival with nonsurgical management of renal cell carcinoma

BJU INTERNATIONAL, Issue 7 2003
A.D. Baird
OBJECTIVE To document long-term survival in patients with renal cell carcinoma (RCC) in whom the primary tumour was left in situ and treatment limited to palliative and symptomatic measures. PATIENTS AND METHODS All patients with a diagnosis of RCC from January 1994 to January 1999 and in whom the primary tumour was left in situ were identified from hospital records (nine women and 16 men, mean age 69 years). The tumour stage was T1,T4. RESULTS The mean survival overall was 19.3 months; patients with locally advanced disease, i.e. stage , T3a, had a mean survival of 16.9 months. CONCLUSIONS There is renewed interest in the management of advanced RCC, with data supporting cytoreductive nephrectomy with systemic biological therapy. These results confirm that such patients with or without metastatic disease can survive for a considerable period with no aggressive surgical or systemic measures, and such intervention may offer no significant advantage in outcome and survival over supportive treatment alone. [source]