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1.
Clin Podiatr Med Surg ; 39(1): 129-142, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34809791

RESUMO

Tarsal coalitions are recognized as a congenital anomaly whereby the two or more bones of the hindfoot and midfoot are fused resulting in limitation of foot motion and pain. Tarsal coalitions were found to be the cause of painful flatfeet in adolescents and young adults. Developing a clinical understanding of tarsal coalitions as well as developing a step-wise conservative and surgical approach for their treatment can alleviate patient symptomatology and provide excellent long-term benefits. Conservative treatment consists of immobilization, NSAIDs, and casting for symptomatic patients, and surgical treatment for symptomatic tarsal coalition consists of resection and/or arthrodesis.


Assuntos
Pé Chato , Ossos do Tarso , Coalizão Tarsal , Adolescente , Artrodese , Tratamento Conservador , Humanos , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/cirurgia , Coalizão Tarsal/diagnóstico por imagem , Coalizão Tarsal/cirurgia , Adulto Jovem
2.
Braz. j. oral sci ; 20: e219022, jan.-dez. 2021. ilus
Artigo em Inglês | LILACS, BBO - Odontologia | ID: biblio-1254545

RESUMO

Minimally invasive dentistry is based on conservative techniques for the treatment of initial caries lesions, the so-called white spot lesions. One of the conservative maneuvers includes the use of enamel resin infiltrant: a low viscosity material that penetrates the enamel pores to stop lesion progression. Aim: Therefore, this case report aimed to describe the clinical case of a 28-year-old female patient under routine consultation, in which a radiographic examination showed the presence of two incipient caries lesions in the left upper premolars. Methods: The application of a resin infiltrating agent (Icon®, DMG ­ Hamburg, Germany) was chosen as treatment to stop caries lesions progression. Conclusion: The use of this conservative technique can be considered a promising approach for the prevention of dental tissue wear, and the resin infiltrant is considered an effective material


Assuntos
Humanos , Feminino , Resinas Compostas , Cárie Dentária , Tratamento Conservador
3.
Cir Cir ; 89(S1): 23-27, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34762618

RESUMO

An 83-year-old female patient presented to the Emergency Department with shortness of breath, difficulty swallowing and left-sided chest pain following a vomiting attempt. A rupture in the left lower third of the esophagus, with hydropneumothorax, pneumomediastinum, and subcutaneous emphysema was revealed by chest X-ray, thoracic computed tomography scan, and contrast esophagography. The patient was successfully treated conservatively with closed thoracostomy, intravenous fluids, parenteral nutrition, and broad-spectrum antibiotics coverage. Following the successful conservative treatment, the patient developed a distal esophageal stenosis which was treated with an intra-esophageal self-expanding stent.


Assuntos
Perfuração Esofágica , Estenose Esofágica , Idoso de 80 Anos ou mais , Tratamento Conservador , Perfuração Esofágica/complicações , Perfuração Esofágica/diagnóstico por imagem , Perfuração Esofágica/cirurgia , Estenose Esofágica/complicações , Estenose Esofágica/cirurgia , Feminino , Humanos , Doenças do Mediastino , Ruptura Espontânea , Stents
4.
J Int Med Res ; 49(11): 3000605211057866, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34772310

RESUMO

OBJECTIVE: The treatment strategy and timing of ureteropelvic junction obstruction (UPJO) in infants remain controversial. This study aimed to compare the effect of early surgical treatment (EST) and conservative treatment (CT) on neonates and infants with UPJO and their recovery of renal function and morphology. METHODS: Eighty neonates and infants with severe hydronephrosis were enrolled in this study. They received early pyeloureteroplasty or CT. Diethylenetriamine pentaacetate was used to assess renal function. RESULTS: There were no significant differences in renal function or renal indices at baseline between the two groups. At 3 and 6 months of follow-up, the anteroposterior diameter of the renal pelvis and the Society of Fetal Urology grade in the EST surgery group were significantly lower compared with those at baseline. The thickness of the renal cortex was greater in the EST group than in the CT group at 3 and 6 months of follow-up. After follow-up for 6 months, renal function in the EST group was significantly better than that in the CT group. CONCLUSION: EST accelerates the recovery of renal morphological and functional indices in neonates and infants with severe hydronephrosis.


Assuntos
Hidronefrose , Ureter , Obstrução Ureteral , Tratamento Conservador , Humanos , Hidronefrose/diagnóstico por imagem , Hidronefrose/cirurgia , Lactente , Recém-Nascido , Pelve Renal , Estudos Retrospectivos , Resultado do Tratamento , Obstrução Ureteral/diagnóstico por imagem , Obstrução Ureteral/cirurgia
5.
Foot Ankle Clin ; 26(4): 873-901, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34752242

RESUMO

Tarsal coalition is determined by an absence of segmentation between one or more foot bones. The main symptom is activity-related foot pain, usually dorsolateral for calcaneonavicular coalitions and medial for talocalcaneal ones. At presentation, a symptomatic tarsal coalition must be treated conservatively for at least 6 months. If the conservative treatment fails and the foot is still painful, resection is the treatment of choice. Advantage of surgery is to restore mobility and reduce the risk of subsequent degenerative arthritis. Common pitfalls of surgery include failure to recognize associated coalitions, inadequate or extensive resection, and injury of adjoining bones.


Assuntos
Sinostose , Ossos do Tarso , Coalizão Tarsal , Tratamento Conservador , Humanos , Sinostose/diagnóstico por imagem , Sinostose/cirurgia , Ossos do Tarso/diagnóstico por imagem , Ossos do Tarso/cirurgia , Coalizão Tarsal/diagnóstico por imagem , Coalizão Tarsal/cirurgia
6.
Health Technol Assess ; 25(62): 1-126, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34780323

RESUMO

BACKGROUND: There is informal consensus that simple compression fractures of the body of the thoracolumbar vertebrae between the 10th thoracic vertebra and the second lumbar vertebra without neurological complications can be managed conservatively and that obvious unstable fractures require surgical fixation. However, there is a zone of uncertainty about whether surgical or conservative management is best for stable fractures. OBJECTIVES: To assess the feasibility of a definitive randomised controlled trial comparing surgical fixation with initial conservative management of stable thoracolumbar fractures without spinal cord injury. DESIGN: External randomised feasibility study, qualitative study and national survey. SETTING: Three NHS hospitals. METHODS: A feasibility randomised controlled trial using block randomisation, stratified by centre and type of injury (high- or low-energy trauma) to allocate participants 1 : 1 to surgery or conservative treatment; a costing analysis; a national survey of spine surgeons; and a qualitative study with clinicians, recruiting staff and patients. PARTICIPANTS: Adults aged ≥ 16 years with a high- or low-energy fracture of the body of a thoracolumbar vertebra between the 10th thoracic vertebra and the second lumbar vertebra, confirmed by radiography, computerised tomography or magnetic resonance imaging, with at least one of the following: kyphotic angle > 20° on weight-bearing radiographs or > 15° on a supine radiograph or on computerised tomography; reduction in vertebral body height of 25%; a fracture line propagating through the posterior wall of the vertebra; involvement of two contiguous vertebrae; or injury to the posterior longitudinal ligament or annulus in addition to the body fracture. INTERVENTIONS: Surgical fixation: open spinal surgery (with or without spinal fusion) or minimally invasive stabilisation surgery. Conservative management: mobilisation with or without a brace. MAIN OUTCOME MEASURE: Recruitment rate (proportion of eligible participants randomised). RESULTS: Twelve patients were randomised (surgery, n = 8; conservative, n = 4). The proportion of eligible patients recruited was 0.43 (95% confidence interval 0.24 to 0.63) over a combined total of 30.7 recruitment months. Of 211 patients screened, 28 (13.3%) fulfilled the eligibility criteria. Patients in the qualitative study (n = 5) expressed strong preferences for surgical treatment, and identified provision of information about treatment and recovery and when and how they are approached for consent as important. Nineteen surgeons and site staff participated in the qualitative study. Key themes were the lack of clinical consensus regarding the implementation of the eligibility criteria in practice and what constitutes a stable fracture, alongside lack of equipoise regarding treatment. Based on the feasibility study eligibility criteria, 77% (50/65) and 70% (46/66) of surgeons participating in the survey were willing to randomise for high- and low-energy fractures, respectively. LIMITATIONS: Owing to the small number of participants, there is substantial uncertainty around the recruitment rate. CONCLUSIONS: A definitive trial is unlikely to be feasible currently, mainly because of the small number of patients meeting the eligibility criteria. The recruitment and follow-up rates were slightly lower than anticipated; however, there is room to increase these based on information gathered and the support within the surgical community for a future trial. FUTURE WORK: Development of consensus regarding the population of interest for a trial. TRIAL REGISTRATION: Current Controlled Trials ISRCTN12094890. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 62. See the NIHR Journals Library website for further project information.


Assuntos
Tratamento Conservador , Fraturas Ósseas , Adulto , Estudos de Viabilidade , Humanos , Inquéritos e Questionários , Avaliação da Tecnologia Biomédica
7.
Ann Palliat Med ; 10(10): 10434-10443, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34763489

RESUMO

BACKGROUND: It is important to investigate the risk factors of the failure of conservative treatment for cesarean scar pregnancy in order to improve the success rate of treatment and preserve the fertility of patients. This article aims to investigate these factors by meta-analysis, so as to serve as a clinical reference. METHODS: PubMed, MEDLINE, Embase, and the Cochrane Library databases were searched. Literatures related to the treatment of cesarean scar pregnancy (CSP) were selected. Literatures were screened according to the inclusion and exclusion criteria, and the quality was evaluated. RevMan 5.3.5 software was used to conduct the meta-analysis on the factors of treatment failure. RESULTS: A total of 7 articles were included in this study, involving 251 patients. Among them, there were 79 (31.5%) cases of conservative treatment failure. The results of the meta-analysis showed that more than 2 cesarean sections [OR =1.79, 95% CI: (0.94, 3.42), P=0.08], mass type CSP [OR =4.06, 95% CI: (2.11, 7.81), P<0.0001], serum ß-hCG value <20,000 U/L [OR =1.81, 95% CI: (0.92, 3.54), P=0.09], and pregnancy time over 3 years from last cesarean section [OR =4.12, 95% CI: (1.29, 13.08), P=0.02] were the risk factors for the failure of conservative treatment of CSP. DISCUSSION: A total of 7 studies were included in this meta-analysis. The results showed that more than 2 cesarean sections, mass type CSP, serum ß-hCG value <20,000 U/L, and pregnancy time over 3 years from last cesarean section were risk factors for the failure of conservative treatment of CSP. Patients with the above risk factors should be screened and informed of the possibility of conservative treatment failure in a timely manner, and different methods should be considered for treatment.


Assuntos
Cesárea , Gravidez Ectópica , Cesárea/efeitos adversos , Cicatriz/patologia , Tratamento Conservador , Feminino , Humanos , Gravidez , Gravidez Ectópica/terapia , Fatores de Risco
8.
Vestn Otorinolaringol ; 86(5): 114-118, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34783484

RESUMO

Nasal septum perforations complete elimination is possible only with surgical treatment. However, most of perforation symptoms and clinical manifestations can be reduced with conservative treatments, thus improving the patient's quality of life. This article presents a short review of publications and our own clinical examples of nasal septum perforation conservative treatment methods in children and adults. Palliative methods and preparing for surgical closure are described.


Assuntos
Perfuração do Septo Nasal , Adulto , Criança , Tratamento Conservador , Humanos , Perfuração do Septo Nasal/diagnóstico , Perfuração do Septo Nasal/etiologia , Perfuração do Septo Nasal/cirurgia , Septo Nasal/cirurgia , Plásticos , Qualidade de Vida
9.
Ann Ital Chir ; 92: 518-520, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34795113

RESUMO

We report the case of a patient who presented after a motorcycle accident a grade IV kidney lesion primarily treated with a NOM, which failed. We discuss the possibility at admission to select a subgroup of patients with a high grade (IV and V) kidney trauma in whom NOM might fail. KEY WORDS: Kidney Trauma, High grade renal trauma, Non operative management.


Assuntos
Tratamento Conservador , Ferimentos não Penetrantes , Acidentes , Humanos , Escala de Gravidade do Ferimento , Rim/lesões , Motocicletas , Estudos Retrospectivos , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/terapia
11.
J Hand Surg Asian Pac Vol ; 26(4): 644-653, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34789094

RESUMO

Background: No consensus exists regarding the management of complete collateral ligament injuries of the proximal interphalangeal joint (PIPJ) of fingers. Methods: We aimed to systematically review the outcomes of Acute (< 1 month) surgical repairs of these injuries. Outcomes assessed included Stability, Pain, Range-of-Motion and Return to Function. The Modified Coleman Methodology Score (MCMS) was utilised in critical appraisal. Results: 70 patients with complete collateral ligament injuries of the PIPJ were identified in 5 studies. 49 were managed operatively and 21 non-operatively. All trials were methodologically flawed with a mean MCMS of 50.4, corresponding to a "Poor" Level of evidence. Conclusions: Whilst acute surgical repair of complete collateral ligament injuries of finger PIPJs are a described viable management option with promising results, there is insufficient high-quality evidence to inform current practice. Based on the current literature, no evidence-based conclusions can be made regarding superiority of acute surgical repair over conservative management or one method of surgical repair over another. Further high level studies are required.


Assuntos
Ligamentos Colaterais , Articulações dos Dedos , Ligamentos Colaterais/cirurgia , Tratamento Conservador , Articulações dos Dedos/diagnóstico por imagem , Articulações dos Dedos/cirurgia , Humanos , Amplitude de Movimento Articular , Ruptura
12.
Br J Hosp Med (Lond) ; 82(9): 1-7, 2021 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-34601925

RESUMO

Scaphoid fractures are common and can cause significant morbidity if treated incorrectly. Thus, a working knowledge of the initial assessment and management of scaphoid fractures by non-specialists is crucial to allow quick diagnosis and avoid potentially catastrophic complications of scaphoid fracture. This article summarises the anatomy of the scaphoid, discusses methods to assess for scaphoid fractures and delineates management plans (conservative or operative) for fractures of the scaphoid based on location of vascular compromise. This article can also help the clinician predict which fractures may not unite with conservative management and therefore need referral to a specialist orthopaedic surgeon for possible surgery.


Assuntos
Fraturas Ósseas , Osso Escafoide , Traumatismos do Punho , Tratamento Conservador , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Humanos , Encaminhamento e Consulta , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia
13.
BMJ Case Rep ; 14(10)2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34649857

RESUMO

Traumatic dental injuries result in damage to many dental and periradicular structures. They can be conservatively managed depending on the extent of the injury. Maxillary central incisors are most commonly involved in traumatic dental injuries mainly because of their anterior and protrusive positioning. The treatment of immature permanent teeth with severe internal resorption poses a lot of challenges to the clinician. The objective of the present article is to report successful management of traumatised maxillary central incisor with incomplete root formation and severe internal resorption in a 10-year-old boy using triple antibiotic paste, mineral trioxide aggregate and fibre-reinforced composite.


Assuntos
Incisivo , Materiais Restauradores do Canal Radicular , Compostos de Alumínio , Antibacterianos/uso terapêutico , Compostos de Cálcio , Criança , Tratamento Conservador , Combinação de Medicamentos , Humanos , Masculino , Óxidos , Silicatos
14.
BMJ Case Rep ; 14(10)2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706907

RESUMO

Isolated cervical aplasia (ESHRE/ESGE U0C4V0) is a rare condition with an incidence of approximately 1:100,000 births.This congenital malformation of the female genital tract represents an impairment of the outflow tract and is an inevitable cause of infertility. Patients usually present with pelvic pain or haematometra and surgical treatment is needed. Conservative management is the first line of approach, allowing for future fertility. However, complications are not negligible. Choosing the best surgical technique remains controversial as few follow-up studies have been published.We describe a case report of isolated cervical aplasia diagnosed in a 16-year-old patient, managed by a canalisation procedure using a Foley catheter. Following failure of this approach, a levonorgestrel intrauterine system was inserted, which remained efficient after 4 years.This case adds to the few reports of success in the management of this challenging clinical entity and might guide clinicians to avoid non-conservative approaches in young patients.


Assuntos
Anormalidades Urogenitais , Doenças do Colo do Útero , Adolescente , Tratamento Conservador , Feminino , Genitália Feminina , Humanos
15.
J Pak Med Assoc ; 71(Suppl 5)(8): S32-S34, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34634012

RESUMO

OBJECTIVE: To determine the effect of soft Transforaminal Interbody Lumbar Interbody Fusion (sTLIF) in postoperative discitis not responding to conservative treatment. Methods: This cross-sectional study was conducted in Department of Spine Surgery, CMH Rawalpindi from August 2016 to July 2019. Patients who underwent discectomy were observed and those presenting with postoperative discitis were included in the study. Pain was noted on visual analogue scale before and after the intervention and differences in two readings were noted. Data was collected on predesigned proforma. Statistical analysis was done on SPSS 20.0. RESULTS: Mean age of these patients was 45±12.34 years. The mean pain score on VAS before treatment was 8.33±0.65 and after treatment was 2±0.95. There was statistically significant reduction in pre-treatment and post-treatment pain on VAS (p=0.000). CONCLUSIONS: Postoperative discitis is present among a small number of patients after spine surgery and pain is significantly reduced after the treatment of discitis with TLIF.


Assuntos
Discite , Fusão Vertebral , Adulto , Tratamento Conservador , Estudos Transversais , Humanos , Vértebras Lombares/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento
16.
Rev Med Suisse ; 17(754): 1740-1744, 2021 Oct 13.
Artigo em Francês | MEDLINE | ID: mdl-34644017

RESUMO

Acute diverticulitis is the most common complication of diverticular disease, increasing in industrialized countries and in young people under 45 years of age. The modified Hinchey classification remains the most widely used and includes simple diverticulitis, i.e. localized inflammation without sepsis, and complicated diverticulitis from pericolic abscess to stercoral peritonitis. Recent studies recommend conservative management of uncomplicated forms. This article summarizes the management of simple acute left-sided diverticulitis based on the new recommendations and focusing on antibiotic treatment, outpatient or inpatient management and indications for colonoscopy.


Assuntos
Doença Diverticular do Colo , Diverticulite , Peritonite , Doença Aguda , Adolescente , Antibacterianos/uso terapêutico , Tratamento Conservador , Diverticulite/tratamento farmacológico , Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/terapia , Humanos , Peritonite/tratamento farmacológico
17.
Rev. ADM ; 78(5): 283-290, sept.-oct. 2021. ilus
Artigo em Espanhol | LILACS | ID: biblio-1348323

RESUMO

Los cambios en la vida, así como también en el campo de la Odontología, deben ser para mejorar siempre en todos los aspectos posibles. Y muchos de los cambios recientes en la Odontología Restauradora están encaminados a la utilización de materiales estéticos para remplazo de restauraciones metálicas previas, sin generar certeza total de ser mejores opciones. Esto ha generado un marcado incremento en la tendencia a practicar, más enfáticamente, el remplazo de restauraciones previas (AU)


Changes in life, as so in the field of Dentistry, should always be for the improvement on most possible aspects. Many of the recent changes in Restorative Dentistry are focus on the use of cosmetic materials to replace previous metallic restorations, without total certainty of being better options. This has generated a marked increase in the tendency to practice, more emphatically, the replacement of previous restorations (AU)


Assuntos
Humanos , Masculino , Feminino , Falha de Restauração Dentária , Cárie Dentária/terapia , Materiais Dentários , Restauração Dentária Permanente , Recidiva , Ligas Metalo-Cerâmicas , Estética Dentária , Tratamento Conservador
18.
Am J Cardiol ; 159: 52-58, 2021 11 15.
Artigo em Inglês | MEDLINE | ID: mdl-34656314

RESUMO

Despite advances in percutaneous coronary interventions (PCI), a subgroup of acute coronary syndrome (ACS) patients are still managed medically by a conservative approach. We sought to characterize a contemporary, large-scale, real-world cohort of ACS patients treated conservatively via pharmacological management, without PCI. Data was gathered from the ACS Israeli Survey (ACSIS) between 2000 and 2016, encompassing all consecutive patients admitted to cardiology wards with an ACS diagnosis. Included were 3,543 conservatively managed patients with non-ST elevation ACS (NSTE-ACS). Patients with ST elevation MI or those who underwent any coronary revascularization (PCI or bypass surgery) were excluded. Primary endpoints were 30-day major adverse cardiovascular events (MACE) and 1-year mortality. The study cohort was divided to 4 time-periods. Over 2 decades, medically managed NSTE-ACS patients remained of similar age (67 ± 13 years, p = 0.78), but had more atherosclerotic risk-factors and comorbidities. During time, patients were more often referred to diagnostic angiography and treated with statins, ACE-I/ARBs, and P2Y12 inhibitors (p < 0.001 for each). Over time, there were less in-hospital complications such as kidney injury and heart failure. The rate of 30-day MACE decreased (from 20.7% to 10.3%, earliest to latest period, p < 0.001). Compared with the earliest period, the latest period was associated with a reduction in 1-year mortality (14.7% to 11.6%; adjusted HR 0.65, 95% CI 0.47 to 0.90). In conclusion, Over 2 decades, in medically managed NSTE-ACS patients, short term prognosis has significantly improved while 1-year mortality demonstrated improvement only recently, likely due to incremental benefits of medical management.


Assuntos
Síndrome Coronariana Aguda/terapia , Tratamento Conservador , Síndrome Coronariana Aguda/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Eletrocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
19.
Ned Tijdschr Geneeskd ; 1652021 08 12.
Artigo em Holandês | MEDLINE | ID: mdl-34523826

RESUMO

Proximal humeral fractures affect 1.5-3% of all childhood fractures. Usually, these fractures can be treated conservatively depending on age and fracture displacement. The proximal growth plate has a great potential for remodeling. The aim of this article is to clarify which degree of displacement can be accepted in case of non-operative treatment. A 12-year-old girl and a 13-year-old boy presented at the ER after falling from a pony and a climbing frame, respectively. Both had a severely displaced proximal humeral fracture with 80-90 degrees angulation of the humeral head relative to the shaft. Both patients were treated conservatively and follow-up x-rays of the shoulder showed complete remodeling of the humeral head with full functional recovery of the shoulder. Due to the remodeling capacity the proximal humerus, severely displaced fractures in children can be treated nonoperatively in most cases. Unnecessary surgical interventions should be avoided.


Assuntos
Fraturas do Úmero , Fraturas do Ombro , Adolescente , Animais , Placas Ósseas , Criança , Tratamento Conservador , Feminino , Fixação Interna de Fraturas , Cavalos , Humanos , Úmero , Masculino , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/terapia , Resultado do Tratamento
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