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1.
BMC Musculoskelet Disord ; 25(1): 431, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38831305

RESUMO

BACKGROUND: This study aimed to assess the outcomes of conservative management in patients with thoracolumbar fractures classified with a Thoracolumbar Injury Classification and Severity (TLICS) score of 4 or 5, and to analyze initial imaging findings and clinical risk factors associated with treatment failure. METHODS: In this retrospective analysis, patients with thoracolumbar fractures and a TLICS score of 4 or 5, determined through MRI from January 2017 to December 2020, were included. Patients undergoing conservative treatment were categorized into two groups: Group 1 (treatment success) and Group 2 (treatment failure), based on initial and 6-month follow-up outcomes. Clinical data were compared between the two groups. Initial radiological assessments included three kyphosis measurements (Cobb angle, Gardner angle, and sagittal index [SI]), anterior and posterior wall height, and central canal compromise (CC). Additionally, risk factors contributing to treatment failure were analyzed. RESULTS: The conservative treatment group comprised 84 patients (mean age, 60.25 ± 15.53; range 22-85; 42 men), with 57 in Group 1 and 27 in Group 2. Group 2 exhibited a higher proportion of women, older age, and lower bone mass density (p = 0.001-0.005). Initial imaging findings in Group 2 revealed significantly greater values for Cobb angle, SI, and CC (p = 0.001-0.045 or < 0.001; with cutoff values of 18.2, 12.8, and 7.8%, respectively), and lower anterior wall height (p = 0.001), demonstrating good to excellent interobserver agreement (0.72-0.99, p < 0.001). Furthermore, osteoporosis was identified as a significant risk factor (odds ratio = 5.64, p = 0.008). CONCLUSION: Among patients with TLICS scores of 4 or 5, those experiencing conservative treatment failure exhibited unfavorable initial radiological findings, a higher proportion of women, advanced age, and osteoporosis. Additionally, osteoporosis emerged as a significant risk factor for treatment failure.


Assuntos
Tratamento Conservador , Vértebras Lombares , Fraturas da Coluna Vertebral , Vértebras Torácicas , Falha de Tratamento , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/lesões , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/lesões , Adulto , Idoso , Fraturas da Coluna Vertebral/diagnóstico por imagem , Fraturas da Coluna Vertebral/terapia , Fatores de Risco , Idoso de 80 Anos ou mais , Adulto Jovem , Imageamento por Ressonância Magnética
2.
ScientificWorldJournal ; 2024: 7446251, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38854678

RESUMO

This paper explores the role of botulinum neurotoxin in aiding fracture recovery through temporary muscle paralysis. Specifically, it investigates the effects of botulinum neurotoxin-induced paralysis of the sternocleidomastoid muscle on clavicle fractures in rats. The research aims to assess safety, effectiveness, and the impact on fracture healing. Healthy male Albino Wistar rats were divided into four groups: clavicle fracture, botulinum neurotoxin injection, both, and control. Surgeries were conducted under anaesthesia, and postoperatively, animals were monitored for 28 days. Euthanasia and radiological assessment followed, examining fracture healing and muscle changes, while tissues were histopathologically evaluated. The modified Lane-Sandhu scoring system was used for the radiographic evaluation of clavicle fractures, and the results varied from complete healing to nonunion. Histopathological examination at 28 days postfracture showed fibrous tissue, mesenchymal cells, and primary callus formation in all groups. Despite varied callus compositions, botulinum neurotoxin administration did not affect clavicle healing, as evidenced by similar scores to the control group. Several studies have explored botulinum neurotoxin applications in fracture recovery. Research suggests its potential to enhance functional recovery in certain types of fractures. Theoretical benefits include managing muscle spasticity, aiding reduction techniques, and preventing nonunion. However, botulinum neurotoxin's transient effect and nonuniversal applications should be considered. The present study found that botulinum toxin had no clear superiority in healing compared to controls, while histological evaluation showed potential adverse effects on muscle tissue. Further research is essential to understand its risk-benefit balance and long-term effects.


Assuntos
Toxinas Botulínicas Tipo A , Consolidação da Fratura , Fraturas Ósseas , Ratos Wistar , Animais , Toxinas Botulínicas Tipo A/farmacologia , Toxinas Botulínicas Tipo A/administração & dosagem , Ratos , Masculino , Consolidação da Fratura/efeitos dos fármacos , Fraturas Ósseas/tratamento farmacológico , Tratamento Conservador/métodos , Clavícula/lesões , Clavícula/efeitos dos fármacos , Modelos Animais de Doenças
3.
Ann Saudi Med ; 44(3): 141-145, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38853473

RESUMO

BACKGROUND: Medical treatment, expectant approaches, and surgical treatment options are available in the treatment of ectopic pregnancy. Regardless of the treatment, in addition to its effectiveness, the main concern is to limit the risk of relapse and preserve fertility. OBJECTIVES: Determine the impact of medical or surgical treatment for ectopic pregnancy on future fertility. DESIGN: Retrospective. SETTING: Department of obstrtrics and gynecolgy at Ankara Etlik Zübeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey. PATIENTS AND METHODS: Patients who were treated for ectopic pregnancy between June 2016 and November 2019 were allocated into two groups. Expectant approach or medical treatment by methotrexate constituted the conservative treatment group while salpingectomy by laparoscopy indicated the surgical treatment group. MAIN OUTCOME MEASURES: Fertility rates within two years following treatment were evaluated according to treatment options. SAMPLE SIZE: 202 patients. RESULTS: Of the 202 patients, 128 had medical treatment and 74 patients had surgical treatment for ectopic pregnancy. Of 272 diagnosed with ectopic pregnancy, 70 were excluded for various reasons. Parity and unemployment rate was significantly higher in the surgical treatment (P=.006 and P=.12, respectively). Moreover, ectopic mass size and serum ß-hCG levels were significantly higher in the surgical treatment group (P<.001 and P<.001, respectively). There were no significant differences between the conservative and surgical treatment groups in time to pregnancy (17.0 months vs 19.0 months, P=.255). Similarly, there was no significant difference between the conservative and surgical treatment groups with respect to history of infertility (P=.12). There were no significant differences between the conservative and surgical treatment groups in terms of live birth (51.6% vs 44.6%) and ectopic pregnancy (2.3% vs 1.4%) (P=.72 for both). There was no significant difference between the conservative and surgical treatment groups with respect to infertility rate (35.9% vs 41.9%, P=.72) and admittance to the IVF program (3.9% vs 6.8%, P=.39) following ectopic pregnancy treatment. CONCLUSIONS: Reproductive outcomes did not differ significantly in women undergoing expectant management, medical treatment, and surgery for ectopic pregnancy. This finding suggests that clinicians should not hesitate to act in favor of surgical treatment for ectopic pregnancy even if there were concerns for future fertility. LIMITATIONS: Retrospective study.


Assuntos
Abortivos não Esteroides , Tratamento Conservador , Laparoscopia , Metotrexato , Gravidez Tubária , Salpingectomia , Humanos , Feminino , Gravidez , Estudos Retrospectivos , Adulto , Metotrexato/uso terapêutico , Metotrexato/administração & dosagem , Salpingectomia/métodos , Tratamento Conservador/métodos , Gravidez Tubária/cirurgia , Laparoscopia/métodos , Abortivos não Esteroides/administração & dosagem , Abortivos não Esteroides/uso terapêutico , Turquia , Fertilidade , Gonadotropina Coriônica Humana Subunidade beta/sangue , Preservação da Fertilidade/métodos
4.
JAMA Netw Open ; 7(6): e2415102, 2024 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-38842810

RESUMO

Importance: Moyamoya disease (MMD) is a rare chronic cerebrovascular disease, and the outcomes of bypass management in adult patients remain controversial. Objective: To categorize adult MMD based on asymptomatic, ischemic, and hemorrhagic onset and compare the outcomes (death, hemorrhagic stroke [HS], and ischemic stroke [IS]) of bypass surgery (direct or indirect) with those of conservative management. Design, Setting, and Participants: This retrospective, nationwide, population-based longitudinal cohort study used Korean National Health Insurance Research data to identify adults (aged ≥15 years) with MMD who were diagnosed between January 1, 2008, and December 31, 2020, and followed up until December 31, 2021 (median follow-up, 5.74 [IQR, 2.95-9.42] years). A total of 19 700 participants (3194 with hemorrhagic, 517 with ischemic, and 15 989 with asymptomatic MMD) were included. Data were analyzed from January 2 to April 1, 2023. Exposures: Bypass surgery and conservative management. Main Outcomes and Measures: Death constituted the primary outcome; secondary outcomes consisted of HS or IS. Kaplan-Meier survival curve and Cox proportional hazards regression analysis were applied. The propensity score-matching and stratified analyses were performed to control covariate effects. Results: A total of 19 700 patients (mean [SD] age, 45.43 [14.98] years; 12 766 [64.8%] female) were included. Compared with conservative management, bypass was associated with a reduced risk of death (adjusted hazard ratio [AHR], 0.50 [95% CI, 0.41-0.61]; P < .001) and HS (AHR, 0.36 [0.30-0.40]; P < .001) in hemorrhagic MMD; reduced risk of IS (AHR, 0.55 [95% CI, 0.37-0.81]; P = .002) in ischemic MMD; and reduced risk of death (AHR, 0.74 [95% CI, 0.66-0.84]; P < .001) in asymptomatic MMD. However, bypass was associated with an increased risk of HS (AHR, 1.76 [95% CI, 1.56-2.00]; P < .001) in asymptomatic MMD. Both direct and indirect bypass demonstrated similar effects in hemorrhagic and asymptomatic MMD, except only direct bypass was associated with a reduced risk of IS (AHR, 0.52 [95% CI, 0.33- 0.83]; P = .01) in ischemic MMD. After stratification, bypass was associated with a reduced risk of death in patients younger than 55 years with ischemic (AHR, 0.34 [95% CI, 0.13- 0.88]; P = .03) and asymptomatic (AHR, 0.69 [95% CI, 0.60-0.79]; P < .001) MMD, but an increased risk of HS in patients 55 years or older with ischemic MMD (AHR, 2.13 [95% CI, 1.1-4.16]; P = .03). Conclusions and Relevance: The findings of this cohort study of bypass outcomes for patients with MMD emphasize the importance of tailoring management strategies in adult patients based on onset types.


Assuntos
Revascularização Cerebral , Doença de Moyamoya , Humanos , Doença de Moyamoya/cirurgia , Doença de Moyamoya/mortalidade , Doença de Moyamoya/complicações , Feminino , Masculino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Revascularização Cerebral/métodos , Estudos Longitudinais , Resultado do Tratamento , AVC Isquêmico/cirurgia , AVC Isquêmico/mortalidade , AVC Isquêmico/epidemiologia , Tratamento Conservador/estatística & dados numéricos , Tratamento Conservador/métodos , Adulto Jovem
5.
BMJ Case Rep ; 17(6)2024 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-38871644

RESUMO

Spontaneous pampiniform plexus thrombosis is an extremely rare condition. Its aetiology and pathophysiology are unknown, and its diagnosis remains challenging. We present the first case of an adolescent patient with bilateral spontaneous pampiniform plexus thrombosis. He presented with a 2-day history of bilateral testicular pain. Biochemical investigations were unremarkable, and the patient did not have any risk factors. Ultrasound of the scrotum demonstrated bilateral pampiniform plexus thrombosis. He was managed conservatively and repeat scrotal ultrasound 3 months later revealed complete resolution. This case adds to the minimal literature on spontaneous pampiniform plexus thrombosis, supporting diagnosis via scrotal ultrasound while recommending conservative management without the use of anticoagulation for patients with no pre-existing coagulopathy.


Assuntos
Escroto , Humanos , Masculino , Adolescente , Escroto/diagnóstico por imagem , Ultrassonografia , Tratamento Conservador , Trombose/diagnóstico por imagem , Trombose/diagnóstico , Trombose/tratamento farmacológico , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/tratamento farmacológico
6.
Sci Rep ; 14(1): 13460, 2024 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-38862648

RESUMO

In conservative treatment for proximal humerus fractures (PHFs), the immobilization position of the affected arm should not be determined uniformly. The aim of this study is to investigate the optimal immobilization position for conservative treatment of different types of PHFs. We hypothesized that the optimal position minimizing the deforming force in PHFs depends on the fracture components involved. PHF models involving either the surgical neck (SN) or greater tuberosity (GT) were created using 12 fresh-frozen cadaveric shoulders. In the SN model, the deforming forces on the pectoralis major muscle were measured in full adduction by increasing external rotation. In the GT model, the deforming force of the supraspinatus muscle was measured in neutral rotation by decreasing abduction, and the deforming force of the infraspinatus muscle was measured in full adduction by increasing internal rotation, respectively. In the SN model, the deforming force of the pectoralis major muscle increased significantly with external rotation from full internal rotation to neutral rotation (P = 0.006), indicating that the arm should be placed in full internal rotation. In the GT model, the deforming force of the supraspinatus muscle increased significantly with adduction from 45° of abduction to full adduction (P = 0.006); the deforming force of the infraspinatus muscle increased significantly with internal rotation from neutral rotation to full internal rotation (P = 0.006). These findings should be considered when placing the arm in abduction and neutral rotation so as to minimize the deforming force by either the supra or infraspinatus muscle. In conservative treatment for PHFs, the affected arm should be placed in a position that minimizes the deforming force on the fracture components involved.


Assuntos
Cadáver , Tratamento Conservador , Fraturas do Ombro , Humanos , Fraturas do Ombro/terapia , Fenômenos Biomecânicos , Idoso , Masculino , Feminino , Tratamento Conservador/métodos , Idoso de 80 Anos ou mais , Imobilização/métodos , Pessoa de Meia-Idade , Amplitude de Movimento Articular
7.
J Orthop Trauma ; 38(7): 351-357, 2024 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-38837911

RESUMO

OBJECTIVES: To compare the clinical, radiographic, and patient-reported outcomes of nonoperative and operative treatment of adolescents with comminuted "Z-type" midshaft clavicle fractures. DESIGN: Prospective observational cohort. SETTING: Eight tertiary care pediatric centers. PATIENT SELECTION CRITERIA: Patients aged 10-18 years who were treated either operatively or nonoperatively for a diaphyseal clavicle fracture between 2013 and 2017 were screened/enrolled at the time of injury. The current subcohort analysis was derived from a larger adolescent clavicle study population of 907 patients. OUTCOME MEASUREMENTS AND COMPARISONS: Complications and validated patient-reported outcome measures (PROs):(ASES, QuickDASH, Marx Shoulder Activity Score, EQ-5D, EQ-VAS, and patient satisfaction score) were compared between operative and nonoperative cohorts. RESULTS: Eighty-one patients (69 male [85.2%], 12 female; average age 15 years [11.1-18.7]; 78 with sports participation [96.2%]) were followed through bony healing and return to sports, while 59 patients (73%) completed 2-year follow-up with PROs, 26 of whom were treated nonoperatively and 33 treated operatively. All demographic and fracture characteristics were similar (P > 0.05) between the 2-year follow-up cohorts except for fracture shortening, which was greater in the operative cohort (23 vs. 29 mm, P = 0.01). After controlling for this potential confounder through both regression and propensity matched subgroup analysis, nonoperative versus operative cohorts showed no difference in rates of nonunion (0%), delayed union (0% vs. 2.3%, P = 1.0), symptomatic malunion (2.7% vs. 0%, P = 0.4), refracture (2.7% vs. 2.2%, P = 1.0), unexpected subsequent surgery (5.4% vs. 11.4%, P = 0.45), or clinically significant complications (5.4% vs. 16%, P = 0.17). There were no differences in any PROs between cohorts, both before and after controlling for the difference in fracture shortening (all P-values >0.05). CONCLUSIONS: In this prospective comparison of complications and 2-year PROs in adolescents with comminuted Z-type clavicle fractures, nonoperative and operative treatment yielded similar outcomes. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Clavícula , Fraturas Cominutivas , Humanos , Clavícula/lesões , Clavícula/cirurgia , Adolescente , Masculino , Feminino , Estudos Prospectivos , Fraturas Cominutivas/cirurgia , Criança , Medidas de Resultados Relatados pelo Paciente , Resultado do Tratamento , Consolidação da Fratura , Estudos de Coortes , Tratamento Conservador/métodos , Fixação Interna de Fraturas
8.
Acta Ortop Mex ; 38(3): 135-141, 2024.
Artigo em Espanhol | MEDLINE | ID: mdl-38862142

RESUMO

INTRODUCTION: pelvic fracture in children is considered one of the most important injuries due to its high mortality. They are rare, but have a major impact on patients' functional outcomes. OBJECTIVE: to evaluate the clinical evolution and functional grade in pediatric patients with pelvic fractures who have already been treated, either conservatively or surgically. MATERIAL AND METHODS: descriptive-cross-sectional-retrospective study. Sample of 24 patients, aged five to 16 years with pelvic fracture, treated from 2016 to 2021. Clinical and functional outcome was assessed using the Barthel index and hip range of motion, as well as surgical or conservative treatment, accompanying lesions and injury mechanism. RESULTS: to find out if there is an association between the Torode and Zieg classifications with the Barthel index and hip range of motion, an association analysis was performed with the 2 statistic, obtaining a 2 value = 19.213. with p = 0.004 for the Barthel index and a 2= 14.253 with p = 0.0026 for hip ranges of motion; these results indicate that there is statistically significant association. CONCLUSION: the most frequent type of pelvic fracture in pediatric patients treated is type III on the Torode and Zieg scale, which according to the Barthel index is associated with a degree of independence and complete hip mobility arches, so the clinical and functional outcome in these patients is high in severe injuries.


INTRODUCCIÓN: la fractura de pelvis en edad pediátrica es considerada de las lesiones más importantes debido a su alta mortalidad; son poco frecuentes, pero tienen gran impacto en el resultado funcional de los pacientes. OBJETIVO: evaluar la evolución clínica y grado funcional en niños con fracturas de pelvis tratados de forma conservadora o quirúrgica. MATERIAL Y MÉTODOS: estudio descriptivo-transversal-retrospectivo. Muestra de 24 pacientes, de cinco a 16 años de edad, con fractura de pelvis, tratados del 2016 al 2021. Se valoró el resultado clínico y funcional mediante el índice de Barthel y arcos de movilidad de cadera, tratamiento quirúrgico o conservador, lesiones acompañantes y mecanismo de lesión. El análisis estadístico se realizó con el software IBM SPSS Statistics®. RESULTADOS: se realizó un análisis de asociación mediante 2 entre las clasificaciones de Torode y Zieg con el índice de Barthel y arcos de movilidad de cadera, obteniendo un valor de 2 = 19.213 con p = 0.004 para índice de Barthel y un valor de 2= 14.253 con p = 0.0026 para arcos de movilidad de cadera; estos resultados indican que hay una asociación estadísticamente significativa. CONCLUSIÓN: el tipo de fractura de pelvis más frecuente en pacientes tratados es el tipo III en la escala de Torode y Zieg, la cual, según el índice de Barthel, se asocia con un grado de independencia y arcos de movilidad de cadera completos, por lo que el resultado clínico y funcional en estos pacientes es alto en lesiones severas.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Humanos , Criança , Ossos Pélvicos/lesões , Adolescente , Masculino , Feminino , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Fraturas Ósseas/classificação , Estudos Transversais , Pré-Escolar , Estudos Retrospectivos , Centros de Atenção Terciária , Amplitude de Movimento Articular , Tratamento Conservador/métodos , Resultado do Tratamento
9.
J Bodyw Mov Ther ; 39: 463-468, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38876669

RESUMO

INTRODUCTION: To identify factors influencing the better and worse changes in the Western Ontario Rotator Cuff Index of patients undergoing conservative treatment for supraspinatus tendon tear. METHODS: The study included 30 patients with supraspinatus tendon tear who underwent conservative treatment. The average duration of intervention was 35.4 days. The Western Ontario Rotator Cuff Index, shoulder range of motion, isometric muscle strength, supraspinatus tendon thickness, thickness of the supraspinatus, infraspinatus, and teres minor muscles, and acromiohumeral interval were assessed before and after the intervention. In the statistical analyses, change in the Western Ontario Rotator Cuff Index was the dependent variable, and the amount of change in each measurement variable before and after the intervention was the independent variable. RESULTS: The average Western Ontario Rotator Cuff Index improved from 1067 at pre-treatment to 997 at post-treatment, but without a significant difference (p = 0.29). A multiple regression analysis revealed that supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption had a significant effect on the change in the Western Ontario Rotator Cuff Index (R2 = 0.44, p < 0.01). CONCLUSION: Supraspinatus tendon thickness and muscle strength in shoulder external rotation at 90° scaption were important factors for the Western Ontario Rotator Cuff Index score in the early stages of conservative treatment for patients with supraspinatus tendon tear.


Assuntos
Tratamento Conservador , Força Muscular , Amplitude de Movimento Articular , Lesões do Manguito Rotador , Humanos , Feminino , Masculino , Lesões do Manguito Rotador/terapia , Lesões do Manguito Rotador/fisiopatologia , Pessoa de Meia-Idade , Força Muscular/fisiologia , Amplitude de Movimento Articular/fisiologia , Tratamento Conservador/métodos , Adulto , Idoso , Manguito Rotador/fisiopatologia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/fisiologia , Modalidades de Fisioterapia
10.
Eur Rev Med Pharmacol Sci ; 28(11): 3771-3780, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38884512

RESUMO

OBJECTIVE: Fractures of the proximal humerus (PHF) are commonly treated conservatively. Evidence suggests that a period of immobilization of one week or less may lead to some advantages compared to a traditional 3-4 weeks of immobilization. The purpose of this systematic review was to assess the clinical and radiological results in the case of early rehabilitation vs. delayed rehabilitation after PHF. MATERIALS AND METHODS: In July 2023, a literature search was carried out on the PubMed, MEDLINE, and Embase databases to identify all the randomized trials comparing early rehabilitation vs. delayed rehabilitation after PHF. The following data were extracted from each included study: patients' demographics, study design and level of evidence, follow-up times, treatment groups, evaluation scores adopted, and overall clinical and radiological findings. The quality of the trials was assessed using the Cochrane Risk of Bias Assessment. RESULTS: A total of 5 studies, including 378 patients and dealing with early vs. delayed rehabilitation in case of conservative treatment of PHF, were included in this study. Early rehabilitation was started within 1 week and consisted mainly of pendulum exercise and progressive passive mobilization. Early rehabilitation was associated with better pain and functional scores within the first 3 months in 3 studies. No difference in pain or function was reported at 6 months or longer follow-up, and no differences in complications rate were observed between early vs. delayed rehabilitation groups. CONCLUSIONS: This systematic review suggests that early mobilization within one week in case of conservative treatment of PHF leads to improved function recovery and reduced pain, especially in the first months of rehabilitation, without differences at longer follow-up and without increasing complications rate. Reducing immobilization time could accelerate function recovery and regaining independence in daily life activities.


Assuntos
Imobilização , Fraturas do Ombro , Humanos , Fraturas do Ombro/reabilitação , Fraturas do Ombro/terapia , Tratamento Conservador , Fatores de Tempo
11.
J Orthop Surg Res ; 19(1): 346, 2024 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-38858737

RESUMO

BACKGROUND: Despite fractures of Isolated Weber B being prevalent, there is a lack of clarity regarding the relative effectiveness of surgical versus conservative treatment. This systematic review and meta-analysis aimed to investigate the clinical effects and complications of surgical versus conservative treatment of the Isolated Weber B ankle fractures. METHODS: This study involved thorough searches across multiple electronic databases, including PubMed, Cochrane, Embase, and Web of Science, to identify all relevant publications on Isolated Weber B ankle fractures repaired through surgical versus conservative treatment. Through a comprehensive meta-analysis, several outcomes were evaluated, including post-operative function, complications and reoperation rate. RESULT: Six articles involving 818 patients who met the inclusion criteria. Among these participants, 350 were male and 636 were female. 651 patients received conservative treatment, while 396 underwent surgical intervention. The findings indicate no significant differences in OMAS, FAOQ, PCS, MCS scores, and return to work between surgical and non-surgical treatments for isolated Weber B ankle fractures. However, compared with surgical treatment, non-surgical treatment has a higher AOFAS score(MD = -5.31, 95% CI = [-9.06, -1.55], P = 0.20, I2 = 39%), lower VAS score(MD = 0.72, 95% CI = [0.33, 1.10], P = 0.69, I2 = 0%), lower complication rate (RR = 3.06, 95% CI = [1.58, 6.01], P = 0.05, I2 = 54%), and lower reoperation rate(RR = 8.40, 95% CI = [1.57, 45.06], P = 0.05, I2 = 67%).


Assuntos
Fraturas do Tornozelo , Humanos , Fraturas do Tornozelo/terapia , Fraturas do Tornozelo/cirurgia , Resultado do Tratamento , Tratamento Conservador/métodos , Feminino , Masculino , Reoperação/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Adulto
12.
Medicine (Baltimore) ; 103(18): e37896, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38701288

RESUMO

RATIONALE: Low-velocity penetrating head injury (PHI) is rare, comprising 0.2% to 0.4% of head traumas, but can be devastating and is associated with significant morbidity and mortality. No previous case of very-low-velocity PHI due to self-inflicted stabbing with a gimlet has been reported. PATIENT CONCERNS: A 62-year-old man was admitted to the hospital with bleeding head and abdominal wounds after stabbing his abdomen with a gimlet, and then hammering the same gimlet into his forehead and removing the gimlet himself. DIAGNOSES: Upon examination at admission, stab wounds were present on the forehead and the right upper quadrant. Computed tomography (CT) of the head revealed a bone defect in the left frontal bone and showed the intracranial path of the gimlet surrounded by mild hemorrhage and pneumocephalus. Magnetic resonance imaging (MRI) confirmed a small amount of hemorrhage with pneumocephalus but no vascular injury. INTERVENTIONS: Conservative treatment without surgery. OUTCOMES: Follow-up MRI on hospital day 58 showed no abscess or traumatic intracranial aneurysm. The patient achieved full recovery of motor and mental functions with conservative treatment and was discharged on hospital day 69. LESSONS: Very-low-velocity PHI might be successfully treated with conservative treatment.


Assuntos
Traumatismos Cranianos Penetrantes , Ferimentos Perfurantes , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Cranianos Penetrantes/diagnóstico por imagem , Traumatismos Cranianos Penetrantes/complicações , Traumatismos Cranianos Penetrantes/psicologia , Ferimentos Perfurantes/complicações , Ferimentos Perfurantes/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Comportamento Autodestrutivo/psicologia , Imageamento por Ressonância Magnética , Tratamento Conservador/métodos
13.
BMC Musculoskelet Disord ; 25(1): 379, 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38745277

RESUMO

BACKGROUND: Biomarkers that predict the treatment response in patients with knee osteoarthritis are scarce. This study aimed to investigate the potential role of synovial fluid cell counts and their ratios as biomarkers of primary knee osteoarthritis. METHODS: This retrospective study investigated 96 consecutive knee osteoarthritis patients with knee effusion who underwent joint fluid aspiration analysis and received concomitant intra-articular corticosteroid injections and blood tests. The monocyte-to-lymphocyte ratio (MLR) and neutrophil-to-lymphocyte ratio (NLR) were calculated. After 6 months of treatment, patients were divided into two groups: the responder group showing symptom resolution, defined by a visual analog scale (VAS) score of ≤ 3, without additional treatment, and the non-responder group showing residual symptoms, defined by a VAS score of > 3 and requiring further intervention, such as additional medication, repeated injections, or surgical treatment. Unpaired t-tests and univariate and multivariate logistic regression analyses were conducted between the two groups to predict treatment response after conservative treatment. The predictive value was calculated using the area under the receiver operating characteristic curve, and the optimal cutoff value was determined. RESULTS: Synovial fluid MLR was significantly higher in the non-responder group compared to the responder group (1.86 ± 1.64 vs. 1.11 ± 1.37, respectively; p = 0.02). After accounting for confounding variables, odds ratio of non-responder due to increased MLR were 1.63 (95% confidence interval: 1.11-2.39). The optimal MLR cutoff value for predicting patient response to conservative treatment was 0.941. CONCLUSIONS: MLR may be a potential biomarker for predicting the response to conservative treatment in patients with primary knee osteoarthritis.


Assuntos
Tratamento Conservador , Linfócitos , Monócitos , Osteoartrite do Joelho , Líquido Sinovial , Humanos , Osteoartrite do Joelho/terapia , Osteoartrite do Joelho/diagnóstico , Estudos Retrospectivos , Masculino , Feminino , Líquido Sinovial/citologia , Pessoa de Meia-Idade , Idoso , Resultado do Tratamento , Tratamento Conservador/métodos , Injeções Intra-Articulares , Biomarcadores/análise , Biomarcadores/sangue , Valor Preditivo dos Testes , Contagem de Leucócitos
14.
Neurosurg Rev ; 47(1): 236, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38802695

RESUMO

Pituitary apoplexy is a rare and potentially life-threatening clinical syndrome. Patients may present with severeneuro-ophthalmologic or endocrine symptoms. Current evidence is unclear whether conservative or surgicalmanagement leads to the best neuroendocrine outcomes. This study aimed to compare neuroendocrine outcomesbetween surgical and conservative treatments in a single center. Cases of patients with pituitary apoplexy whoreceived transsphenoidal surgery or conservative management in Songklanagarind Hospital between January 1,2005 and December 31, 2022 were retrospectively reviewed. A propensity score matching method was used toadjust bias from treatment selection (surgery or conservative treatment). Differences in visual field, visual acuity,cranial nerve, and endocrine outcomes between the surgical and conservative treatment groups were analyzedusing logistic regression analysis. This study included 127 patients, with 98 and 29 patients in the surgical and theconservative treatment group, respectively. The optimal matching method was used for propensity score matching.Compared to the conservative group, the surgically treated patients had a significantly higher rate of visual fieldrecovery (odds ratio (OR): 12.89, P = 0.007). However, there were no statistical differences in the recovery rate ofpreoperative visual acuity, cranial nerve, and endocrine deficits between the groups. Transsphenoidal surgery wasassociated with a higher rate of visual field recovery when compared to the conservative treatment for pituitaryapoplexy patients. Careful selection of appropriate treatment based on the patient's presentation andneuroendocrine status will result in the best outcomes while avoiding unnecessary surgical intervention.


Assuntos
Tratamento Conservador , Apoplexia Hipofisária , Pontuação de Propensão , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Apoplexia Hipofisária/cirurgia , Apoplexia Hipofisária/terapia , Tratamento Conservador/métodos , Idoso , Adulto , Estudos Retrospectivos , Resultado do Tratamento , Procedimentos Neurocirúrgicos/métodos , Acuidade Visual/fisiologia , Neoplasias Hipofisárias/cirurgia , Recuperação de Função Fisiológica
15.
Nutrients ; 16(10)2024 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-38794736

RESUMO

INTRODUCTION: Chronic kidney disease is a degenerative and increasingly prevalent condition that includes metabolic abnormalities and is associated with a higher risk of sarcopenia. The conservative approach points primarily to controlling metabolic issues and reducing the risk of malnutrition and sarcopenia, slowing the progression of kidney disease. The present study aims to evaluate the effect of a low-protein diet on malnutrition and sarcopenia. METHODS: A total of 45 patients (33 male and 12 female) aged over 70 with chronic kidney disease stage 4-5 in conservative management were considered. All patients had a dietary assessment and prescription of personalized low-protein dietary plans (≤0.6 g protein/kg) and a follow-up control between 4 and 6 months. In preliminary and follow-up evaluations, anthropometric data, blood examinations, body composition results, muscle strength, physical performance, and a 3-day food diary were collected. RESULTS: In the follow-up period, a significant weight loss (p = 0.001) and a decrease in body mass index (p = 0.002) were recorded. Food diaries revealed a significant reduction in protein, sodium, potassium, and phosphorus intake (p < 0.001), with a significant reduction in urea (p < 0.001) and proteinuria (p = 0.01) without any impact on lean mass (p = 0.66). Considerable variations in adherence between food diaries and the prescribed diet were also noted. CONCLUSIONS: Providing a personalized low-protein diet led to significant benefits in a short period without worsening the patient's nutritional status.


Assuntos
Dieta com Restrição de Proteínas , Insuficiência Renal Crônica , Sarcopenia , Humanos , Masculino , Feminino , Insuficiência Renal Crônica/dietoterapia , Insuficiência Renal Crônica/terapia , Idoso , Sarcopenia/dietoterapia , Dieta com Restrição de Proteínas/métodos , Idoso de 80 Anos ou mais , Tratamento Conservador/métodos , Índice de Massa Corporal , Composição Corporal , Estado Nutricional , Desnutrição/dietoterapia , Força Muscular , Redução de Peso
16.
Jt Dis Relat Surg ; 35(2): 410-416, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38727122

RESUMO

Congenital radial head subluxation is relatively rare and may be overlooked due to mild symptoms. The diagnosis mainly relies on imaging and history. Observation is an option for those with insignificant symptoms, while surgical intervention, such as ulnar osteotomy or arthroscopy, is often required when dysfunction exists. A 30-year-old man was admitted with congenital radial head dislocation, which was treated with manipulative repositioning. During follow-up, the patient regained the original mobility of the elbow joint and had no recurrence of dislocation. In conclusion, in adults with congenital dislocation of the radial head, we recommend conservative treatment as a first step.


Assuntos
Tratamento Conservador , Articulação do Cotovelo , Luxações Articulares , Rádio (Anatomia) , Humanos , Masculino , Adulto , Articulação do Cotovelo/cirurgia , Articulação do Cotovelo/diagnóstico por imagem , Luxações Articulares/congênito , Luxações Articulares/terapia , Luxações Articulares/cirurgia , Luxações Articulares/diagnóstico por imagem , Tratamento Conservador/métodos , Rádio (Anatomia)/anormalidades , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Amplitude de Movimento Articular , Resultado do Tratamento , Manipulação Ortopédica/métodos
17.
Ann Card Anaesth ; 27(1): 85-88, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38722131

RESUMO

ABSTRACT: Tracheal rupture is a very rare but life-threatening complication of endotracheal intubation. It is more common in women and patients older than 50 years old. Overinflation of endotracheal tube cuff and tracheal wall weakening are the most important pathogenetic mechanisms. Laceration sites are located in the posterior membranous wall in most cases. Subcutaneous and mediastinal emphysema and respiratory distress are the most common manifestations. A 55-year-old female presented with postoperative subcutaneous and mediastinal emphysema without dyspnea because of a tear in the posterior tracheal wall. The diagnosis was based on clinical manifestation, chest computer tomography scans (CT), and endoscopic findings. A conservative approach by broad-spectrum antibiotic therapy was decided because of patients' vital signs stability and the absence of esophageal injury. The follow-up showed that there was no lesion in the posterior tracheal wall. Our case showed that in clinically stable patients without mediastinitis and with spontaneous breathing, conservative management of tracheal tears is a safe procedure.


Assuntos
Tratamento Conservador , Intubação Intratraqueal , Lacerações , Tomografia Computadorizada por Raios X , Traqueia , Humanos , Feminino , Pessoa de Meia-Idade , Intubação Intratraqueal/efeitos adversos , Traqueia/lesões , Traqueia/diagnóstico por imagem , Tratamento Conservador/métodos , Lacerações/terapia , Lacerações/etiologia , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/terapia , Enfisema Mediastínico/diagnóstico por imagem , Enfisema Subcutâneo/etiologia , Enfisema Subcutâneo/terapia , Enfisema Subcutâneo/diagnóstico por imagem , Complicações Pós-Operatórias/terapia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Antibacterianos/uso terapêutico
18.
World J Urol ; 42(1): 317, 2024 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-38740620

RESUMO

PURPOSE: To review the literature on the topic, to suggest a common line of treatment applicable across a wide community of specialists, and to contribute in maintaining the high level of interest in this disease. METHODS: A comprehensive and exhaustive review of the literature was performed, identifying hundreds of articles on the topic. RESULTS: Peyronie's disease is a condition that has been recognized, studied, and treated for centuries; despite this, if one excludes surgery in cases in which the deformity is stable, no clear treatment (or line of treatment) is available for complete relief of signs and symptoms. Treatment options were divided into local, oral, and injection therapy, and a wide variety of drugs, remedies, and options were identified. CONCLUSIONS: Low-intensity extracorporeal shock wave therapy, vacuum therapy, penile traction therapy, phosphodiesterase type 5 inhibitors, hyaluronic acid, and collagenase of Clostridium histolyticum may be recommended only in specific contexts. Further studies on individual options or potential combinations are required.


Assuntos
Tratamento Conservador , Induração Peniana , Induração Peniana/terapia , Humanos , Masculino , Tratamento Conservador/métodos , Tratamento por Ondas de Choque Extracorpóreas/métodos , Inibidores da Fosfodiesterase 5/uso terapêutico , Tração/métodos , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/uso terapêutico , Colagenase Microbiana/uso terapêutico , Colagenase Microbiana/administração & dosagem , Guias de Prática Clínica como Assunto
19.
Stomatologiia (Mosk) ; 103(2): 24-31, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38741531

RESUMO

PURPOSE OF THE STUDY: To study the effectiveness of 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 stage with a periodontal pocket depth of 3.5-5 mm. Depending on the tactics of conservative treatment of periodontitis, patients were divided into two groups of 50 people. In the main group, Cholisal dental gel was used as part of complex conservative treatment, and in the control group, Metrogil-denta gel was used. To assess the effectiveness of treatment, a dental examination of patients was carried out with an index assessment of the condition of periodontal tissues and a biochemical analysis of the content of arachidonic acid and prostaglandin E2 in gingival blood, comparing the indicators before treatment and 14 days after the start of treatment. RESULTS: When the drug Cholisal was included in complex treatment, 14 days from the start of treatment, patients experienced a statistically significant decrease in the depth of periodontal pockets from 4.7±0.32 mm to 3.6±0.19, and the Green-Vermillion hygiene index by 60.7%, Silness-Loe plaque index by 73.1%, PMA index by 68.8%, Muhlemann-Cowell bleeding index by 68.0% (p<0.001 compared to baseline). When Metrogil-denta gel was used in complex therapy, the effectiveness of treatment was lower: the depth of periodontal pockets did not change significantly (from 4.5±0.22 mm to 4.2±0.17 mm, p>0.05), reduction in the hygiene index Green-Vermillion was 51.9%, Silness-Loe plaque index - 64.0%, PMA index - 43.7%, Muhlemann-Cowell bleeding index - 45.8% (p<0.001 compared to baseline, p<0.001 compared to the main group). A laboratory study showed that in patients of the main group, after completing a course of conservative treatment, the content of biomarkers of inflammation significantly decreased compared to the initial level (p<0.05), while in patients of the control group the content of arachidonic acid and prostaglandin E2 in the gingival blood during the study period did not change significantly (p>0.05 compared to the initial level). CONCLUSIONS: The use of the drug Cholisal in the conservative treatment of chronic periodontitis has demonstrated more pronounced positive dynamics of clinical and biochemical parameters compared to traditional therapy, which suggests its high effectiveness.


Assuntos
Periodontite Crônica , Dinoprostona , Géis , Humanos , Pessoa de Meia-Idade , Feminino , Masculino , Adulto , Periodontite Crônica/terapia , Idoso , Dinoprostona/sangue , Tratamento Conservador , Índice Periodontal , Ácido Araquidônico , Resultado do Tratamento , Gengiva/patologia , Bolsa Periodontal/terapia
20.
BMC Oral Health ; 24(1): 593, 2024 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-38778282

RESUMO

BACKGROUND: Self-assessment (SA) is an interactive course that endorses the accomplishment of learning objectives through learners' identification of insufficiencies in their didactic knowledge and pre-clinical skills. This study was planned to determine whether there is any improvement in the faculty assessment (FA) score following the implementation of SA in the Pre-clinical Conservative Dentistry Course. METHODS: Fifty-four first-semester dental students were given an introductory lecture followed by a demonstration for Class I Cavity Preparation in typhodont mandibular first molar. At the end of the demonstration, the Scoring Rubric (SR) was explained point-wise in the prepared cavities. During the next session, all students performed Class I cavity preparation and they were given an assessment sheet to enter their scores (SA1). All teeth were evaluated by the Grading Faculties in a blinded manner (FA1). Each participant was explained the difference in their respective SA1 from FA1 and their queries were resolved individually. During the next sessions, Students and Grading Faculties followed the same protocol and scores were recorded as SA2, FA2, SA3 and FA3. RESULTS: The mean score of SA1 was significantly higher than that of FA1 (p < 0.001). However, no significant difference was obtained between SA and FA in the second (p = 0.352) and third (p = 0.434) assessments. In contrast with first assessment, mean marks obtained in FA were higher compared to SA in both second and third assessments. There was a statistically significant improvement in mean marks obtained by the students over time (p < 0.001). CONCLUSION: SA endorsed student-faculty communication and enhanced student's poise and technical skills in operative pre-clinical dentistry.


Assuntos
Competência Clínica , Educação em Odontologia , Avaliação Educacional , Autoavaliação (Psicologia) , Estudantes de Odontologia , Humanos , Educação em Odontologia/métodos , Avaliação Educacional/métodos , Preparo da Cavidade Dentária/métodos , Masculino , Docentes de Odontologia , Feminino , Tratamento Conservador
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