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)
Highlights • Risk factors for pelvic insufficiency fractures are identified. • Identification of potential risk factors opens up new preventive strategies. • Outcome after convervative treatment is ...rather poor. • Comparing the autonomous state before and after pelvic fracture, a high loss of autonomy was observed.
Purpose
Purpose of this study was to evaluate the mid- to long-term outcome after conservatively treated first-time posterior shoulder dislocations and to determine structural defects associated with ...failure.
Methods
In this multi-centric retrospective study, 29 shoulders in 28 patients with first-time acute posterior shoulder dislocation (Type A1 or A2 according to the ABC classification) and available cross-sectional imaging were included. Outcome scores as well as radiological and magnetic resonance imaging were obtained at a mean follow-up of 8.3 ± 2.7 years (minimum: 5 years). The association of structural defects with redislocation, need for secondary surgery, and inferior clinical outcomes were analysed.
Results
Redislocation occurred in six (21%) shoulders and nine shoulders (31%) underwent secondary surgery due to persistent symptoms. The posttraumatic posterior glenohumeral subluxation was higher in the redislocation group compared to the no redislocation group; however, statistical significance was not reached (61.9 ± 12.5% vs. 50.6 ± 6.4%). Furthermore, a higher adapted gamma angle was observed in the failed conservative treatment group versus the conservative treatment group, similarly without statistically significant difference (97.8° ± 7.2°, vs. 93.3° ± 9.7°). The adapted gamma angle was higher than 90° in all patients of failed conservative therapy and the redislocation group. An older age at the time of dislocation showed a significant correlation with better clinical outcomes (SSV:
r
= 0.543,
p
= 0.02; ROWE:
r
= 0.418,
p
= 0.035 and WOSI:
r
= 0.478,
p
= 0.045). Posterior glenohumeral subluxation after trauma correlated with a worse WOSI (
r
= − 0.59,
p
= 0.02) and follow-up posterior glenohumeral decentring (
r
= 0.68,
p
= 0.007). The gamma angle (
r
= 0.396,
p
= 0.039) and depth of the reverse Hill–Sachs lesion (
r
= 0.437,
p
= 0.023) correlated significantly with the grade of osteoarthritis at follow-up.
Conclusion
Conservative treatment is a viable option in patients with an acute traumatic posterior shoulder dislocation with good outcome after mid- and long-term follow-up especially in patients with centred joint, low gamma angle, and middle or old age.
Level of evidence
IV.
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.
Cervical giant cell tumor of the bone (GCTB) is a rare, primary benign bone tumor in pediatric patients. Surgery remains the primary choice for treating resectable cervical GCTB. Additional adjuvant ...therapeutic options are available for patients with unresectable cervical GCTB, including the anti-RANKL monoclonal antibody, denosumab. We represented a case incidentally found in a 7-year-old female, who complained severe craniocervical pain, grade 2-3 dysphagia, dysphonia, hypesthesia, and extremity weakness. The patient showed an impressive clinical response to denosumab, both clinically and radiologically, without adverse events or recurrence. To date, this is the youngest patient ever reported to have a progressive Enneking stage II C3 GCTB treated with denosumab alone. Denosumab can be administered as a single and conservative therapy for pediatric patients with unresectable upper cervical GCTB, avoiding the risks and morbidity of surgical and radiative treatment.
Introduction: Incidence of use for various renal replacement therapies is well known, but no data are available on the use of conservative treatment. Objective: To assess the proportion of patients ...with chronic kidney failure receiving conservative treatment. Results: From July 1, 2013 to June 30, 2014, 232 patients with stage 5 CKD were seen in the Nephrology Department. After having received information on the existing therapeutic options and having known the opinion of their physicians, 81 patients (35%) selected haemodialysis, 56 (24%) preferred peritoneal dialysis, 5 (2%) selected a preemptive transplant from a living donor, and in 90 (39%) a conservative treatment option was selected. In a univariate analysis using logistic regression, variables associated to a preference for conservative treatment were age, Charlson index excluding age, walking difficulties, and the level of functional dependendce, with the first three factors achieving statistical significance in a multivariate analysis. Presence of a severe disease with a poor prognosis was the main reason for selecting a conservative treatment (49%), with the second one being symple, patients refusal to receive a renal replacement therapy (26%). Mortality rate was 8.2/100 patient-months in conservative therapy group versus 0.6/100 patient-months in patients receiving renal replacement therapy (p < 0.001). In patients receiving conservative therapy, baseline glomerular filtration rate at the time of study enrollment was the only variable showing a significant impact on survival. Conclusions: About 39% of patients with stage 5 CKD seen over a 1-year period in the Nephrology Department received conservative therapy. Age, co-morbidity, and functional disability were the factors associated to selecting a conservative therapy option.
A 10-year-old neutered male Siberian Husky presented with parapa- resis and severe lethargy. On physical examination, the patient was unable to weight-bear and walk and exhibited significant muscle ...mass loss in both hind- limbs and generalized truncal alopecia with a dull coat of hair. On neurological examination, cranial lumbar vertebral pain, hind limb cross-extensor reflex, de- layed hindlimb postural reaction, upper motor neuron bladder dysfunction, and total absence of cutaneous trunci reflex were identified. Computed tomography revealed diffuse idiopathic skeletal hyperostosis and spondylosis deformans of the cervical and thoracolumbar vertebrae. In addition, a generalized decrease in bone mineral density of the vertebrae was identified. Magnetic resonance imaging showed hyperplasia of the epidural fat compressing the spinal cord in the thoracolumbar region and concurrent mild multiple intervertebral disc herni- ations. No specific findings were observed in cerebrospinal fluid analysis. Blood analysis of thyroid function revealed decreased total T4 and free T4 levels, and increased TSH levels. The patient was tentatively diagnosed with spinal epidural lipomatosis (SEL) secondary to hypothyroidism. The patient was treated with levothyroxine, firocoxib, and gabapentin. Clinical signs gradually improved, and the patient showed normal ambulation 40 days after treatment initiation. SEL is extremely rare in dogs. To the best of our knowledge, this is the first case report of SEL secondary to hypothyroidism that was treated conservatively. Secondary SEL can be sufficiently managed by treating the underlying cause, if possible. KCI Citation Count: 0
Introduction: This study aimed to evaluate the 10-year clinical outcomesof endoscope-assisted, minimally invasive surgical (MIS) decompression for lumbar spinal canal stenosis (LSS) with lumbar ...degenerative spondylolisthesis (DS) and to compare the radiographic changes in patients who underwent this procedure with those who underwent conservative therapy at 10-year follow-up.Methods: Between April 2007 and April 2010, 347 consecutive patients with DS and evidence of LSS underwent conservative treatment first from 2 to 4 weeks. The 114 patients who failed conservative treatment were then treated surgically by endoscope-assisted MIS decompression. Of them, 91 patients were followed for more than 10 years (group S), and 146 of the 233 patients treated conservatively were followed for more than 10 years (group C). Clinical outcomes of endoscope-assisted MIS decompression were assessed using the Short Form Health Survey-36 score (SF-36), the Roland Morris Disability Questionnaire (RDQ), and the neurological leg symptoms of the Japanese Orthopaedic Association Score (JOA score). Radiographic changes of the two groups were assessed by %slip, dynamic %slip, range of motion (ROM), and the height of the disc (DH) on plain radiographs.Results: Significant improvements in clinical outcomes on the SF-36, RDQ, and neurological leg symptoms of the JOA were observed. Radiographic assessment did not show significant differences in the assessed items between the two groups at baseline and after last treatment. Both groups had significantly decreased ROM and DH.Conclusions: The 10-year clinical outcomes of endoscope-assisted MIS decompression for DS were generally good. Furthermore, on radiographic comparison, the progress of spondylolisthesis after this procedure was virtually the same as in the natural course of the disease at 10-year follow-up.
Objective To investigate the clinical manifestations, diagnostics, and treatment of chylothorax following neck dissection for oral cancer. Methods The clinical data of 3 patients with chylothorax ...after neck dissection for oral cancer from January 2020 to May 2021 in the Stomatological Center of Xiangya Hospital, Central South University, were retrospectively analyzed in detail, and the relevant literature was reviewed. The risk factors, clinical manifestations, diagnostics, treatment, and prognosis of chylothorax were summarized. Results The 3 patients were all male patients with oral cancer aged 42-63 years. Their clinical manifestations were progressive dyspnea 2-5 days after cervical lymphadenectomy. Chest X-ray, B-ultrasound, and/or CT showed unilateral or bilateral pleural effusion, and the diagnosis was confirmed after a positive chylous test of pleural puncture fluid. There was 1 case with left chylothorax (1 case after left neck dissection) and 2 cases with bilateral chylothorax (1 case after left nec
Gastric perforation due to a hiatal hernia is a rare cause of acute abdominal pain that often requires surgical intervention. Conservative management for this condition is an effective option in ...certain cases, although fewer reports of this exist. Herein, we report a unique case of gastric perforation caused by a recurrent hiatal hernia that was successfully treated with conservative management.
A 74-year-old man developed a high fever and an elevated inflammatory response on the third day after a laparoscopic paraesophageal hernia repair using a mesh. Computed tomography confirmed the recurrence of the hiatal hernia, with gastric fundal prolapse into the mediastinum and surgical emphysema in the gastric wall. This was followed by a gastric perforation within the mediastinum. The patient was treated using an ileus tube through the perforation site.
In similar cases, if the clinical symptoms are mild, there are no signs of serious infection, and the perforation remains in the mediastinum and can be appropriately drained, conservative treatment is considered an option.
Under favorable conditions, conservative management can be an option for gastric perforation in patients with recurrent hiatal hernias, which is a serious potential postoperative complication.
•Conservative therapy can be effective for gastric perforation in recurrent hiatal hernias•Ileus tube has a good balance of flexibility and rigidity for mediastinal drainage•Strong abdominal pressure should be avoided after giant hiatal hernia repair
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