[Dental gel Cholisal at the stage of conservative treatment of inflammatory periodontal diseases]. / Stomatologicheskii gel' Kholisal na etape konservativnogo lecheniya vospalitel'nykh zabolevanii parodonta.

PURPOSE OF THE STUDY: To study the effectiveness of using the drug Cholisal as part of the conservative treatment of chronic periodontitis. MATERIAL AND METHODS: We selected 100 patients aged 35 to 65 years of both sexes with a diagnosis of moderate chronic periodontitis in the acute phase with a periodontal pocket depth of 3.5-5 mm. Depending on the tactics of conservative treatment of CGP, patients were divided into two groups of 50 people. In the main group, in addition to standard treatment, the dental gel Cholisal was used, and in the control group, therapy was standard. 10 days after professional hygiene, patients in both groups were examined and underwent an index assessment of the condition of periodontal tissues and adherence to treatment. RESULTS: In patients of the control group, 10 days from the start of treatment, the depth of periodontal pockets in the control group decreased slightly from 4.7±0.28 mm to 4.2±0.21 mm (p=0.074), and the Green-Vermillion hygiene index decreased by 25.3±1.79% (p=0.041), Silnesse-Loe plaque index by 59.1±2.16% (p<0.001), PMA index by 51.5±1.92% (p<0.001) and Muhlemann-Cowell bleeding index by 42.2±1.75% (p<0.001). In the main group, the effectiveness of treatment of chronic periodontitis with conservative therapy using Cholisal was higher. There was a statistically significant decrease in the depth of periodontal pockets from 4.8±0.23 mm to 3.5±0.19 mm (p=0.043), the Green-Vermillion hygiene index decreased by 47.6±2.13% (p=0.0003), Silnesse-Loe plaque index by 78.2±3.05% (p<0.001), PMA index by 69.4±2.74% (p<0.001) and Muhlemann-Cowell bleeding index by 66.9±1.62% (p<0.001). CONCLUSIONS: The use of the drug Cholisal in the conservative treatment of chronic periodontitis has shown convincing positive dynamics in both subjective and objective assessments, which suggests its effective use.

Effectiveness of orthotic treatment for adolescent idiopathic scoliosis: a scoping review protocol of systematic reviews.

INTRODUCTION: Spinal orthosis is a common conservative treatment for adolescent idiopathic scoliosis (AIS), and a large body of compelling evidence from systemic review studies strongly supports the use of spinal orthosis treatment in patients with this condition. To further improve our understanding of the available data, the aim of this study is to develop and propose a protocol for a scoping review of systematic reviews of studies that investigated the effectiveness of orthotic treatment in patients with AIS. Systematic synthesis and understanding of the data will improve the efficacy of spinal orthosis treatment in this patient population. METHOD AND ANALYSIS: Using the scoping review methodological framework proposed by Arksey and O'Malley in 2005, we developed and herewith propose a scoping review protocol to evaluate systematic reviews of studies that investigated the effectiveness of orthotic treatment in AIS. Our proposed scoping review proposal is briefly described, as follows. A search of seven online databases will be conducted to identify systematic reviews published in English language from 1 January 2000 to 31 December 2023, and grey literature and reference lists of included articles will also be searched. A two-stage screening process consisting of a title and abstract screening and a full-text review will be used to determine articles' eligibility. All eligible articles will be extracted, charted and evaluated using Assessing the MeaSurement Tool to Assess systematic Reviews Version 2 (AMSTAR-2) critical appraisal tool. The charted data will be quantitatively analysed and summarised, and qualitatively analysed using narrative synthesis. ETHICS AND DISSEMINATION: No primary data will be collected; therefore, ethics approval is not required. Findings will be disseminated through national and international conferences and publication in a peer-reviewed journal.

The past, present and future of the conservative treatment of distal radius fractures.

The distal radius fracture is a common fracture with a prevalence of 17% on the emergency departments. The conservative treatment of distal radius fractures usually consists of three to six weeks of plaster immobilization. Several studies show that one week of plaster immobilization is safe for non- or minimally displaced distal radius fractures that do not need reduction. A shorter period of immobilization may lead to a better functional outcome, faster reintegration and participation in daily activities. Due to upcoming innovations such as three-dimensional printed splints for distal radius fractures, a patient specific splint can be produced which may offer more comfort. Furthermore, these three-dimensional printed splints are expected to be more environmental friendly in comparison with traditional plaster casts.

Improving Kyphotic Postures and Neck Pain in Young Adults: A Meta-Analysis of Exercise-Based Interventions.

The study aimed to review the findings concerning the effects of exercises on Cobb angle and pain in patients suffering from cervical pain caused by thoracic kyphosis. Two investigators separately conducted a systematic review of the electronic literature from 2018 till 2022. PubMed, MEDLINE, Web of Science, Science Direct, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, and Scopus were among the electronic databases that were accessed. This meta-analysis included 5 studies, published between 2019 and 2022. A sample size of 261 patients; included in 5 studies were estimated on Cobb angle and pain. The between-groups pooled random SMD for Cobb angle and pain showed a larger effect size of -2.146 and -1.126, respectively. The findings suggested that physical therapy exercise may result in larger changes among the Cobb angle and neck pain of kyphotic patients. Key Words: Exercise, Physical therapy, Cobb angle, Pain, Thoracic kyphotic angle, Conservative management.

[Epiploic appendagitis: an often-overlooked diagnosis]. / Appendagite épiploïque : un diagnostic souvent oublié.

Epiploic appendagitis is an etiology only coming at last of differential diagnoses in the face of acute abdominal pain. The typical patient is often a man between 20 and 50 years old, presenting with non-radiating abdominal pain with nausea, vomiting and inappetence with or without a mild febrile state. Biological assessment most of the time does not show any inflammatory syndrome, although slight elevations in sedimentation rate and CRP are possible. The key imaging for the diagnosis remains the abdominal CT. The treatment is initially conservative via short-term anti-inflammatory treatment. Surgical sanction remains reserved for situations that do not yield to conservative treatment or worsen despite the latter.

L'appendagite épiploïque est une étiologie n'arrivant qu'en queue de peloton des diagnostics différentiels face à une douleur abdominale aiguë. Le patient type est un homme entre 40 et 50 ans, présentant des douleurs abdominales non irradiantes avec nausées, vomissements et inappétence, avec ou sans un léger état fébrile. Le bilan biologique ne montre souvent pas de syndrome inflammatoire bien que de discrètes élévations de la CRP sont possibles. L'imagerie clé pour le diagnostic reste le CT-scan abdominal injecté. La prise en charge est initialement conservatrice via un traitement anti-inflammatoire de courte durée. La sanction chirurgicale reste réservée aux situations ne cédant pas au traitement conservateur ou se péjorant malgré ce dernier.

Successful outpatient conservative management of chyle leak after laparoscopic left hemicolectomy.

Chyle leak is a pathological extravasation of chyle into the peritoneal cavity after a surgical injury. It is an uncommon complication in colorectal surgery. In most cases, conservative treatment is effective, although it often entails prolonged hospital stays. We present the case of a 60-year-old female with chyle leak after laparoscopic left hemicolectomy with complete mesocolic excision who underwent successful outpatient conservative management. We found no other cases of successful conservative outpatient treatment in the consulted literature. Adequate outpatient management may provide significant benefits by reducing hospital costs and improving patient´s quality of life, while maintaining the possibility of starting adjuvant treatment if indicated.

Comparison of percutaneous vertebroplasty and conservative treatment for one level thoracolumbar osteoporotic compression fracture in a 3-year study.

The efficacy of Mesh optimized versus standard percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures. Grid optimization (102 cases; 38 men, 64 women aged 67.3 ± 8.5) and traditional PVP groups (94 cases) were identified from 196 PVP patients treated from May 2016 to 2019. The optimal puncture site and angle forced bone cement into both groups before surgery. The main indexes were operation time, X-ray fluoroscopy times, bone cement injection volume, leakage, VAS, and injured vertebrae height. Preoperative general data were equivalent between groups (P > 0.05). All patients survived surgery without spinal cord injury, incision infection, pulmonary embolism, or death. The mesh optimization group had improved operation time (34.8 ± 6.5 min), fluoroscopy times (29.5 ± 5.5), bone cement injection volume (5.3 ± 2.1 ml), and bone cement permeability greater (3.9 percent; 4/98) than the standard PVP group (P < 0.05). Similarly, the grid optimization group had superior VAS scores (1.1 ± 0.6; 1.0 ± 0.3; and 0.9 ± 0.2) than the standard PVP group at 3 days, 3 months, and the last follow-up visit (P < 0.05). On day three after surgery, both had similar heights of injured vertebra's anterior and middle edges (P > 0.05). However, in the mesh optimization group, measurements improved to 1.8 ± 0.4 mm and (1.8 ± 0.3) mm by month three and to 1.7 ± 0.3 mm at last follow-up (P < 0.05). Mesh-optimized PVP with a mesh locator treats osteoporotic vertebral compression fractures more safely and effectively than regular PVP.

Conservative Management of Partial Thickness Rotator Cuff Tears: A Systematic Review.

BACKGROUND: Conservative management has emerged as an attractive option for partial thickness rotator cuff tears (PT-RCTs). A single algorithmic treatment strategy for patients with symptomatic PT-RCT has not yet been developed. This systematic review aims to ascertain whether a conservative approach to PT-RCTs yields positive results in terms of clinical outcomes and functional recovery. METHODS: This is a systematic review of the literature on patients with PT-RCTs receiving conservative treatment with physiotherapy, platelet-rich plasma (PRP) injections, collagen injections, hyaluronic acid (HA) injections, or corticosteroids injections coupled with polydeoxyribonucleotide (PDRN). Outcomes such as the Visual Analog Scale (VAS) for pain, American Shoulder and Elbow Surgeons and Constant-Murley Score evaluations, as well as the Shoulder Pain and Disability Index and Euro Quality of Life-5D questionnaires were reported following a conservative approach. RESULTS: Eleven studies were included. Six articles explored the outcomes of patients with PT-RCT treated with PRP injections. Significant improvements in VAS for pain were observed. Two studies examined collagen injections and reported variations in VAS for pain and Constant-Murley Score. Sodium hyaluronate and HA injections were studied in two other articles, showing notable improvements in American Shoulder and Elbow Surgeons scores. Corticosteroid and PDRN injections also displayed favorable outcomes. In addition, physical therapy protocols demonstrated improvements in VAS for pain and strength, particularly with eccentric rehabilitation. CONCLUSIONS: Conservative management of PT-RCTs, involving physical therapy, PRP injections, collagen injections, corticosteroid injections, HA injections, and PDRN in jections, demonstrates favorable clinical outcomes. In addition, favorable results are observed in terms of decreased tear width and improved strength recovery, at least during a short-term follow-up. Unfortunately, long-term insight into the structural integrity of conservatively treated rotator cuff tendons following a partial injury has not been thoroughly evaluated yet. STUDY DESIGN LEVELS OF EVIDENCE: Level IV-systematic review.

Odontoid fracture in geriatric patients - analysis of complications and outcome following conservative treatment vs. ventral and dorsal surgery.

BACKGROUND: Different treatment options are discussed for geriatric odontoid fracture. The aim of this study was to compare the treatment options for geriatric odontoid fractures. METHODS: Included were patients with the following criteria: age ≥ 65 years, identification of seniors at risk (ISAR score ≥ 2), and odontoid fracture type A/B according to Eysel and Roosen. Three groups were compared: conservative treatment, surgical therapy with ventral screw osteosynthesis or dorsal instrumentation. At a follow-up examination, the range of motion and the trabecular bone fracture healing rate were evaluated. Furthermore, demographic patient data, neurological status, length of stay at the hospital and at the intensive care unit (ICU) as well as the duration of surgery and occurring complications were analyzed. RESULTS: A total of 72 patients were included and 43 patients could be re-examined (range: 2.7 ± 2.1 months). Patients with dorsal instrumentation had a better rotation. Other directions of motion were not significantly different. The trabecular bone fracture healing rate was 78.6%. The patients with dorsal instrumentation were hospitalized significantly longer; however, their duration at the ICU was shortest. There was no significant difference in complications. CONCLUSION: Geriatric patients with odontoid fracture require individual treatment planning. Dorsal instrumentation may offer some advantages.

Omental infarction in an overweight child: conservative treatment is a safe approach.

A previously healthy but overweight (body mass index (BMI) of 24.4) adolescent boy presented with fever and significant right-sided abdominal pain. An abdominal ultrasound scan revealed an omental infarction (OI), which was treated conservatively. OI has been described in overweight teenage children with abdominal trauma but can be missed if not considered. A missed diagnosis could result in an unnecessary laparotomy or laparoscopic surgery. Although CT is the gold standard for diagnosis, ultrasonography is an effective approach to identifying OI in children. The benefits of early diagnosis of OI by abdominal ultrasound include a shorter hospital stay and a reduction in unnecessary investigations and surgery.

Foot biomechanics in patients with advanced subtalar- and mid-tarsal joint osteoarthritis and poorly responding to conservative treatment.

BACKGROUND: A comprehensive insight into the effects of subtalar- and mid-tarsal joint osteoarthritis on lower limb's biomechanical characteristics during walking is lacking. Our goal was to assess joint kinematics and kinetics and compensatory mechanisms in patients with subtalar and mid-tarsal joint osteoarthritis. METHODS: Patients with symptomatic and radiographically confirmed osteoarthritis of the subtalar and mid-tarsal (n = 10) and an asymptomatic control group (n = 10) were compared. Foot joint kinematics and kinetics during the stance phase of walking were quantified using a four-segment foot model. RESULTS: During pre-swing phase, the tibio-talar range of motion in the sagittal plane of the patient group decreased significantly (P = 0.001), whereas the tarso-metatarsal joint range of motion in the sagittal plane was greater in the pre-swing phase (P = 0.003). The mid-tarsal joint showed lower transverse plane range of motion in the patient group during the loading response and pre-swing phase (P < 0.001 resp. P = 0.002). The patient group showed a lower Tibio-talar joint peak plantarflexion moment (P = 0.004), peak plantarflexion velocity (P < 0.001) and peak power generation in the sagittal plane (P < 0.001), and a lower mid-tarsal joint peak adduction and abduction velocity (P < 0.001 resp. P < 0.001) and peak power absorption (P < 0.001). CONCLUSIONS: These findings suggest that patients with subtalar and mid-tarsal joint osteoarthritis adopt a cautious walking strategy potentially dictated by pain, muscle weakness, kinesiophobia and stiffness. Since this poorly responding population faces surgical intervention on the short term, we recommend careful follow-up after fusion surgery since biomechanical outcome measures associated to this post-surgical stage is lacking.

Conservative management of pneumopericardium: A case of unexpected success.

A 79-year-old male with severe aortic stenosis was admitted with syncope and cranioencephalic traumatism with major nasal hemorrhage. While being prepared for surgical aortic valve replacement, a high-degree atrioventricular block was detected and a definite pacemaker was implanted.

Conservative management of a suspected triangular fibrocartilage complex injury utilizing strength training exercises: A case report.

OBJECTIVE: The purpose of this case report is to describe the conservative chiropractic management of a patient with a suspected triangular fibrocartilage complex (TFCC) injury. CLINICAL PRESENTATION: A 36-year-old Brazilian Jiu-Jitsu black belt athlete sought care for left-sided diffuse ulnar pain (numeric pain scale 5/10) with a notable bump over the ulna and weakness when grappling. A working diagnosis of suspected TFCC injury was made. INTERVENTION AND OUTCOME: The patient was treated with forearm and grip strength exercises to rehabilitate the pain and strength loss. Following 6 visits and a home exercise program for 8 weeks, his numeric pain scale decreased to 0/10. CONCLUSION: In this case, it is evident that Triangular fibrocartilage complex injury was successfully treated conservatively without the need for surgical intervention or passive care modalities.

Síndrome de Duane: a propósito de un caso / Duane syndrome: a case report

El síndrome de Duane es una enfermedad poco frecuente en la cual se observa retracción del globo ocular y limitación de los movimientos horizontales. Presentamos el caso de un paciente de 11 años que acudió a Urgencias debido a una desviación ocular supuestamente de reciente instauración. En la exploración se objetiva un déficit en la abducción y la aducción, así como cierre de la fisura palpebral en la aducción forzada. Se diagnostica de síndrome de Duane tipo III y se decide manejo conservador con observación y seguimiento (AU)

Duane syndrome is a rare condition, whose clinical presentation involves retraction of the eyeball upon attempted abduction, and limitation of horizontal movements. We present the case of an 11-year-old patient who presented to the Emergency Department with a recent-onset ocular deviation. Examination revealed a deficit in abduction and adduction, as well as closure of the palpebral fissure in forced adduction. The patient was diagnosed with Duane syndrome type III, and conservative management with observation and follow up was decided. (AU)

[Surgery, Antibiotic Treatment or Both?]

INTRODUCTION: The 90-year-old female patient with underlying rheumatoid arthritis and spinal canal stenosis was admitted to hospital for pain control. The clinical exam of the lower abdomen was impressively painful and the inflammatory parameters were significantly increased. For further diagnosis a computer tomography was performed, showing a covered perforated appendicitis with a perityphlitic abscess. The conservative therapy with abscess drainage and antibiotics was successful.

Indwelling Needle Puncture and Irrigation in the Conservative Treatment of Breast Abscess During Non-Lactation Period.

The objective of this study is to observe the effect of indwelling needle puncture and irrigation in the conservative treatment of breast abscesses in the non-lactation period. Non-lactating breast abscess patients were treated at the Daping Medical Breast Surgery Clinic, Chongqing. In the Incisive drainage group, 21 patients were treated with conventional incision and drainage. In the Indwelling needle group, 20 patients were treated by puncture and irrigation with a 20 G indwelling needle. The pain VAS scores and wound satisfaction in the Indwelling needle group were significantly lower than those in the Incisive drainage group (P < 0.001), and the cure time and complications were also significantly lower in the Indwelling needle group (P < 0.05). The cure rates of the two groups were similar (P > 0.05). There was a difference in the duration of illness, location, and number of pus cavities between the treatment failure and the treatment recovery (P < 0.05). However, there was no difference in the size of the pus cavity and the maximum amount of pus aspiration (P > 0.05). The indwelling needle can be used as an effective tool for puncture and irrigation of single breast abscess in a non-lactation period, potentially for non-invasive treatment of breast abscesses.

[Overweight and obesity in adults: general principles of treatment and conservative management]. / Übergewicht und Adipositas bei Erwachsenen: allgemeine Behandlungsgrundsätze und konservatives Management.

The prevalence of overweight and obesity is steadily increasing in Austria as well as internationally. Obesity in particular is associated with multiple health risks, comorbidities, functional disability, and social stigma. Obesity is an independent, complex, chronic disease and should be treated as such by a multidisciplinary team of appropriately qualified personnel. In addition to recent international guidelines, this consensus paper outlines the overall principles of the management of overweight and obesity and provides guidance for the diagnosis and conservative treatment, focusing on lifestyle modifications and pharmacotherapy. Using the "5A" framework of behavioral health intervention, guidelines for a structured, pragmatic, and patient-centered medical care of adults with overweight or obesity are presented.

Spontaneous rupture of the extensor pollicis longus tendon after conservative treatment of a non-displaced distal radius fracture in an adolescent.

A spontaneous rupture of the extensor pollicis longus (EPL) tendon after a fracture of the distal radius is a known complication in adults. In contrast, there are a paucity of reports concerning EPL tendon ruptures in children and adolescents. The authors present a case of a spontaneous rupture of the EPL tendon in a 15-year-old girl after a non-displaced distal radius fracture. The patient had no predisposing factors including rheumatoid arthritis or steroid injection. During surgery, the EPL tendon was found to be ruptured at the extensor retinaculum (third compartment). Extensor indicis proprius (EIP) to EPL transfer was performed. At the 18-month follow-up, the patient was asymptomatic and showed satisfactory thumb function, with normal active extension.

La rotura espontánea del tendón del extensor largo del pulgar (EPL) tras una fractura distal del radio es una complicación conocida en adultos. En cambio, son escasos los informes sobre roturas del tendón del EPL en niños y adolescentes. Los autores presentan un caso de rotura espontánea del tendón del EPL en una niña de 15 años tras una fractura distal del radio no desplazada. La paciente no presentaba factores predisponentes como artritis reumatoide o inyección de esteroides. Durante la intervención quirúrgica, se descubrió que el tendón del EPL estaba roto a la altura del retináculo extensor (tercer compartimento). Se realizó una transferencia del extensor indicis proprius (EIP) al EPL. A los 18 meses de seguimiento, el paciente estaba asintomático y mostraba una función satisfactoria del pulgar, con una extensión activa normal.

Management of Extra-articular Scapular Fractures: A Narrative Review and Proposal of a Treatment Algorithm.

The management of scapular fractures can be either conservative or operative, but it is still unclear how to choose the treatment option. Scapular fractures can be classified anatomically into four types: scapular spine, scapular body, and scapular neck where the treatment is conservative most of the time except for certain indications that are specific to each one, and inferior angle of the scapula where the operative treatment yields the best results but conservative treatment can be contemplated in some cases.