A male patient in his 70s was undergoing anticoagulation therapy for cerebral embolism due to atrial fibrillation. He suddenly started vomiting with abdominal pain and melena. Further examination ...revealed incomplete embolism of the superior mesenteric artery (SMA), ischemic enterocolitis, and hepatic portal venous gas (HPVG). No signs of shock or peritoneal irritation were observed. Therefore, he was conservatively treated. The follow-up computed tomography was repeatedly performed, which revealed improvements in ischemic enterocolitis and in HPVG. The patient was discharged at 21 day post admission. When patients present with HPVG induced by ischemic enterocolitis with incomplete embolism of the SMA, they can be conservatively treated under restricted conditions.
PERI-IMPLANTITIS: NON-SURGICAL TREATMENT Štefanatný, M; Starosta, M; Žižka, R ...
Czech Stomatology & Practical Dentistry / Ceská stomatologie a Praktické zubni lékarstvi,
9/2023, Letnik:
123, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Introduction: The aim of this article is to present and summarize the non-surgical treatment options in management of peri-implant diseases and compare the effectiveness of the treatment with/without ...adjunctive use of antibiotics. Methods: A search was conducted in the PubMed- MEDLINE, Scopus, Embase, and Google Scholar databases, and available repositories, followed by a hand search. The relevant clinical studies, reviews, and consensuses about the non-surgical peri-implant therapy published between 1990-2022 in English language were included. Conclusion: Based on the available information, it can be said that there is a great diversity in the treatment of dental implants affected by peri-implantitis. Studies testing different therapeutic protocols are rare and highly heterogeneous. Stabilization of peri-implant disease after the treatment without systemic or local antibiotics is possible, but the reduction of probing depth around the dental implant using only the non-surgical therapy is still insufficient. Non-surgical treatment is therefore successful particularly in solving the peri-implant mucositis and also as a conditioning before surgical therapy.
Treating chronic diffuse sclerosing osteomyelitis (DSO) is challenging and many treatments have been reported. However, we know of no standard protocol or guidelines. In this systematic review of ...relevant publications we provide an overview of the different treatments used. We made an electronic search of PubMed, Medline, Embase, Web of Science, and the Cochrane Library databases, for papers that described the treatment of DSO of the mandible. The search yielded 48 papers that applied to all inclusion criteria, resulting in 16 case reports, 13 case series, 18 retrospective clinical cohort studies, and one randomised controlled trial. Reported treatment options included different operations; the use of antibiotics, anti-inflammatories, and antiresorptive medication; conservative treatment; and hyperbaric oxygen. Surgical treatment resulted in a low success rate and was associated with higher morbidity than other treatments. Conservative treatment, and that of bisphosphonates, yielded more promising results, so conservative treatment and bisphosphonates seem to be the most promising therapeutic options. However, because of the high risk of bias, no firm conclusions can be drawn, and larger studies with clear inclusion criteria and specified endpoints are needed.
Abstract Introduction Chronic subdural hematoma (CSDH) is common and more prevalent in the aged population. Surgical intervention is the treatment of choice, but its outcomes may not be satisfactory ...because of recurrence and physical infirmity associated with aging. Aberrant angiogenesis and localized inflammation contribute to the formation of CSDH. Atorvastatin is active in promoting angiogenesis and modulating inflammation. We hypothesize that atorvastatin is effective in reducing CSDH and have tested the hypothesis in a preliminary prospective study of small cohort of patients. Methods Twenty-three patients with CT- or MRI-confirmed CSDH were recruited from three regional medical centers and evaluated using Markwalder's Grading Scale (MGS) and the Glasgow Coma Scale (GCS). These patients received oral atorvastatin 20 mg/day for 1–6 months (3.02 ± 1.77 months) and were followed for 3 to 36 months (18.62 ± 13.13) after the therapy. Hematoma volume, neurological functions and daily activities (measured using the Activities of Daily Life-the Barthel Index scale, ADL-BI) were compared before and after treatment with Linear Trend Chi-Square test. Results Twenty-two of the 23 patients experienced improvements in symptoms, and the reduction in hematoma volume from 48.70 ± 20.38 ml to 16.64 ± 14.28 ml (paired-sample t -test, p < 0.01) within the first month of the treatment. Hematoma was completely resolved in 17 patients (77.3%) and shrank by more than 73.99% ± 11.17% in 5 patients (22.7%) 3 months after the treatment was initiated. One patient experienced an initial relief of symptoms, but his condition deteriorated with an enlarged hematoma during the 4th week of treatment and underwent surgery. At 6 months, 18 patients presented no hematoma by CT or MRI and four patients, whose hematoma was completely resolved at 3 months, were not followed. None of these 22 patients relapsed during the entire follow-up period of 3–36 months. All have improved MGS, GCS, and ADL-BI. No atorvastatin-related side effects were documented. Conclusion Results of this preliminary prospective study show that the oral administration of atorvastatin is safe and effective in treating CSDH, offering a cost-effective alternative to surgery. A prospective randomized clinical trial is required to validate the effect of atorvastatin.
Objetivo: Reportamos un caso clínico con presentación atípica de una úlcera duodenal benigna que simula el cuadro clínico y radiológico de una neoplasia de páncreas.Material y Métodos: Presentamos el ...caso de un varón de 83 años que debuta con un cuadro clínico de astenia e ictericia mucocutánea. En estudio de imagen se identifica una masa en cabeza pancreática. En estudio endoscópico de observa úlcera duodenal benigna penetrada a cabeza de páncreas que condiciona obstrucción de vía biliar.Discusión y Conclusiones: El manejo de estos pacientes suele ser quirúrgico porque desarrollan un deterioro asociado a sepsis o perforación. Si la situación clínica lo permite se puede intentar un tratamiento conservador. En nuestro caso el paciente precisó un mes de hospitalización con antibioticoterapia intravenosa de amplio espectro, reposo alimentario, nutrición parenteral y tratamiento con inhibidores de la bomba de protones para la resolución del cuadro. La penetración o fistulización a la cabeza del páncreas es una complicación grave e infrecuente de la enfermedad ulcerosa péptica. Su manejo puede ser conservador en casos seleccionados donde no exista perforación de la úlcera a la cavidad peritoneal, ni exista deterioro séptico ni hemodinámico.
Carpal tunnel syndrome (CTS) is a widely distributed upper limb nerve compression. CTS is relatively easy to recognise with timely diagnosis of symptoms. The elimination of risks and professional ...conservative therapy can prevent the radical interventions.
In our study we worked with 8 patients, 7 of them had signs of CTS in both hands. The diagnosis was based on history, physical examinations and an electroneurographia test (ENG). All of the patients completed a questionnaire about their subjective symptoms before the objective physical examinations. The used physiotherapy was modified for the severity of the symptoms. Advice on workplace task modification was given to all patients.
Main symptoms are tingling, numbness, nocturnal pain and weakness in the distribution of the median nerve in the hand. Objective results represented a decrease in the range of motion, waste of force in the hand and thenar atrophy. After the treatment the waste of the abductor pollicis has disappeared in all patients, weakness and deficits of motion were found in one person. We recognised a significant improvement in the specific tests.
Occupational factors, overstrain of the hands are important causes of CTS. Loss of sensory feedback and pain is more often presented than motor function loss. After the treatment the symptoms of patients were reduced or disappeared.
CTS can be often effectively treated with complex physiotherapy and workplace task modifications, but there isn’t a complete recovery in all cases.
Objective
A meta-analysis was conducted to analyze the incidence of typical and atypical headaches and outcomes following various treatments in patients with Chiari I malformation.
Background
...Headache is the most common symptom of Chiari malformation, which can be divided into typical and atypical subgroups to facilitate management. Much controversy surrounds the etiology, prevalence and optimal therapeutic approach for both types of headaches.
Method
We identified relevant studies published before 30 July 2022, with an electronic search of numerous literature databases. The results of this study were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.
Result
A total of 1913 Chiari malformation type I CIM patients were identified, 78% of whom presented with headache, within this group cephalgia was typical in 48% and atypical in 29% of patients, and migraine was the most common type of atypical headache. The ratio of typical/atypical headaches with international classification of headache disorders diagnosis was 1.53, and without international classification of headache disorders diagnosis was 1.56, respectively. The pooled improvement rates of typical headaches following conservative treatment, extradural decompression and intradural decompression were 69%, 88%, and 92%, respectively. The corresponding improvement rates for atypical headaches were 70%, 57.47%, and 69%, respectively. The complication rate in extradural decompression group was significantly lower than in intradural decompression group (RR, 0.31; 95% CI: 0.06–1.59, I2 = 50%, P = 0.14). Low reoperation rates were observed for refractory headaches in extradural decompression and intradural decompression groups (1%).
Conclusion
The International Classification of Headache Disorders can assist in screening atypical headaches. extradural decompression is preferred for typical headaches, while conservative therapy is optimal for atypical headaches. A definite correlation exists between atypical headaches and Chiari Malformation Type I patients with higher prevalence than in the general population. Importantly, decompression is effective in relieving headaches in this particular patient population.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
To assess the hygienic maintenance of the tissues affected by an increase/restoration of the emergence profile, through conservative-periodontal therapy on minor vestibular recessions (Class I ...Miller) with and without abrasions of the CEJ.
Seven recruited subjects aged 22 to 46 years, were analyzed with a total of 50 dental elements. 47 with a vestibular recession -17 with abrasion/recession, 3 only with abrasion. Conservative therapy has been implemented to restore/increase the thickness of the CEJ. The following values have been recorded: N of recessions belonging to the I class Miller/RT1 (Cairo et al); 17 elements with class B+ abrasion. Impressions to record the differences in the emergence profiles before and after conservative therapy. 30 dental elements had type 1 phenotype (thin and festooned), 20 dental elements had type 2 phenotype (intermediate). Clinical protocol: professional oral hygiene session, home hygiene motivation and education, class V fillings, check after 60 days for access to mucogingival surgery. Periodontal probing and Plaque Index were assessed at T0 and T1 (2 months after conservative therapy).
The combined restorative-periodontal treatment allows changing of the emergence profile. The reduction of the recession was influenced by different phenotypes. Probing depth decreased significantly between T0 and T1. Plaque Index (PI) decreased statistically significantly (p=0.012).
Modification of the emergence profile, obtained through conservative therapy, was easily maintained from the hygienic point of view by the patients. Furthermore, it could provide mechanical protection and support to the gingival margin favoring a reduction of food impaction at the cervical level.
Background:Spontaneous isolated superior mesenteric artery (SMA) dissection is a rare condition, and its clinical and angiographic courses are poorly defined. We aimed to monitor the morphological ...characteristics of spontaneous isolated SMA dissection using computed tomography (CT) over 2 years of follow-up, including the recovery process via vascular remodeling, and identify the factors that affect vascular remodeling using univariate analysis.Methods and Results:We retrospectively reviewed the medical records and morphological findings of 59 consecutive patients with spontaneous isolated SMA dissection between October 2007 and July 2014, which included 36 symptomatic and 23 asymptomatic patients. Surgical intervention with open laparotomy was required in 3 patients during the follow-up period; 41 patients who received conservative treatment were followed up over 2 years with regular CT. Complete remodeling was achieved in 16 of 25 symptomatic patients who were treated conservatively (64.0%). A patent false lumen and aneurysmal formation on an initial CT scan were identified as negative factors that affected remodeling in patients with spontaneous isolated SMA dissection.Conclusions:Conservative management of spontaneous isolated SMA dissection is associated with a good prognosis, both clinically and morphologically. Surgical intervention is only required in patients with severe intestinal ischemia or rapid aneurysmal enlargement. (Circ J 2016; 80: 1452–1459)
Blunt renal artery injury (BRAI) is rare and its optimal management strategy is unknown. We present a case of bilateral BRAI treated by percutaneous transluminal angioplasty (PTA) and conservative ...therapy. A male in his 40s was struck by a truck and transferred to our hospital. Contrast-enhanced computed tomography (CECT) and angiography revealed right renal artery disruption, unenhanced right kidney, and an intimal flap in the dorsal branch of the left renal artery, with delayed enhancement in the dorsal part of the right kidney. A stent was placed in the dorsal branch of the left renal artery, but the occluded part of the right renal artery was not passable. As the left kidney was sufficiently preserved by PTA, the right renal artery injury was treated conservatively. Postoperative hypertension was managed by medication. Four months after the injury, the serum creatinine level was 1.12 mg/dl and the stent was patent on CECT.
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