Clinical outcomes and prognostic factors for cavernous hemangiomas of the spinal cord: a retrospective cohort study

2019 ◽  
Vol 31 (2) ◽  
pp. 271-278 ◽  
Author(s):  
Narihito Nagoshi ◽  
Osahiko Tsuji ◽  
Daisuke Nakashima ◽  
Ayano Takeuchi ◽  
Kaori Kameyama ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Surgical Intervention ◽  
Lesion Size ◽  
Sudden Onset ◽  
Neurological Function ◽  
Neurological Injury ◽  
Prognostic Indicators ◽  
Asymptomatic Patients ◽  
Surgical Data ◽  
Unstable Gait

OBJECTIVEIntramedullary cavernous hemangioma (CH) is a rare vascular lesion that is mainly characterized by the sudden onset of hemorrhage in young, asymptomatic patients, who then experience serious neurological deterioration. Despite the severity of this condition, the therapeutic approach and timing of intervention for CH remain matters of debate. The aim of this study was to evaluate the clinical characteristics of CH patients before and after surgery and to identify prognostic indicators that affect neurological function in these patients.METHODSThis single-center retrospective study included 66 patients who were treated for intramedullary CH. Among them, 57 underwent surgery and 9 patients received conservative treatment. The authors collected demographic, symptomology, imaging, neurological, and surgical data. Univariate and multivariate logistic regression analyses were performed to identify the prognostic indicators for neurological function.RESULTSWhen comparing patients with stable and unstable gait prior to surgery, patients with unstable gait had a higher frequency of hemorrhagic episodes (52.4% vs 19.4%, p = 0.010), as assessed by the modified McCormick Scale. The lesion was significantly smaller in patients who underwent conservative treatment compared with surgery (2.5 ± 1.5 mm vs 5.9 ± 4.1 mm, respectively; p = 0.024). Overall, the patients experienced significant neurological recovery after surgery, but a worse preoperative neurological status was identified as an indicator affecting surgical outcomes by multivariate analysis (OR 10.77, 95% CI 2.88–40.36, p < 0.001). In addition, a larger lesion size was significantly associated with poor functional recovery in patients who had an unstable gait prior to surgery (8.6 ± 4.5 mm vs 3.5 ± 1.6 mm, p = 0.011).CONCLUSIONSOnce a hemorrhage occurs, surgical intervention should be considered to avoid recurrence of the bleeding and further neurological injury. In contrast, if the patients with larger lesion presented with worse preoperative functional status, surgical intervention could have a risk for aggravating the functional deficiencies by damaging the thinning cord parenchyma. Conservative treatment may be selected if the lesion is small, but regular neurological examination by MRI is needed for assessment of a change in lesion size and for detection of functional deterioration.

scholarly journals Relative Efficacy of Three of Nonsurgical Treatments for Calcific Tendinitis: Physical Therapy vs Steroid Injection vs Ultrasound-Guided Aspiration

2021 ◽  
Vol 9 (7_suppl4) ◽  
pp. 2325967121S0021
Author(s):  
Mauricio Drummond ◽  
Caroline Ayinon ◽  
Albert Lin ◽  
Robin Dunn
Keyword(s):  
Physical Therapy ◽  
Rotator Cuff ◽  
Conservative Treatment ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Corticosteroid Injection ◽  
Calcific Tendinitis ◽  
Ultrasound Guided ◽  
Calcium Deposits

Objectives: Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) that accounts for up to 7% of cases of shoulder pain1. The most common conservative treatments typically include physical therapy (PT), corticosteroid injection (CSI), or ultrasound-guided aspiration (USA). When conservative management fails, the patient may require arthroscopic surgery to remove the calcium with concomitant rotator cuff repair. The purpose of this study was to characterize the failure rates, defined as the need for surgery, of each of these three methods of conservative treatment, as well as to compare post-operative improvement in patient-reported outcomes (PROs) – including subjective shoulder values (SSV) and visual analog scale (VAS) pain scores – based on the type of pre-operative conservative intervention provided. A secondary aim was to compare post-operative range of motion (ROM) outcomes between groups that failed conservative management. We hypothesized that all preoperative conservative treatments would have equivalent success rates, PROs, and ROM. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12122 shoulders. JAMA. 1941;116(22):2477-2489. Methods: A retrospective review of all patients who were diagnosed with calcific tendinitis at our institution treated among 3 fellowship trained orthopedic surgeons between 2009 and 2019 was performed. VAS, SSV, and ROM in forward flexion (FF) and external rotation (ER) was abstracted from the medical records. Scores were recorded at the initial presentation as well as final post-operative follow-up visit for those who underwent surgery. The conservative treatment method utilized by each patient was recorded and included PT, CSI, or USA. Failure of conservative management was defined as eventual progression to surgical intervention. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. A p<0.05 was considered to be statistically significant. Results: 239 patients diagnosed with calcific tendinitis were identified in the study period with mean age of 54 years and follow up of at least 6 months. In all, 206 (86.2%) patients underwent a method of conservative treatment. Of these patients, 71/239 (29.7%) underwent PT, 67/239 (28%) attempted CSI, and 68/239 (28.5%) underwent USA. The overall failure rate across all treatment groups was 29.1%, with injections yielding the highest success rate of 54/67 (80.6%). Physical therapy saw the highest failure rate, with 26/71 (36.7%) proceeding to surgical intervention. Patients undergoing physical therapy were statistically more likely to require surgery compared to those undergoing corticosteroid injection (RR 1.88, p= 0.024). Of all 93 patients who underwent surgery, VAS, SSV, ROM improved significantly in all groups. On average, VAS decreased by 4.02 points (6.3 to 2.3), SSV increased by 33 points (51 to 84), FF improved by 13.8º, and ER improved 8.4º between the pre- and post-operative visits (p<0.05). The 33 patients who did not attempt a conservative pre-operative treatment demonstrated the largest post-operative improvement in VAS (-6.00), which was significantly greater than those who previously attempted PT (-3.33, p<0.05). There was a trend towards greater improvement in SSV in the pre-operative PT group (45 to 81) compared to others, but this did not reach statistical significance (p=0.47). Range of motion was not significantly affected by the method of pre-operative conservative intervention. Conclusions: Conservative treatment in the form of physical therapy, corticosteroid injection, and ultrasound-guided aspiration is largely successful in managing calcific tendinitis of the shoulder. Of these, PT demonstrated the highest rate of failure in terms of requiring surgical management. PRO improvement varied among the conservative modalities used, however patients who did not attempt conservative management experienced the greatest improvements following surgery. If surgery is necessary following failed conservative treatment, excellent outcomes can be expected with significant improvements in ROM and PROs. This information should be considered by the surgeon when deciding whether to recommend conservative treatment for the management of calcific tendinitis, as well as which specific method to employ.

scholarly journals May-Thurner Syndrome Is Aggravated by Pregnancy

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 222
Author(s):  
Kuntharee Traisrisilp ◽  
Manatsawee Manopunya ◽  
Tanop Srisuwan ◽  
Wisit Chankhunaphas ◽  
Theera Tongsong
Keyword(s):  
Conservative Treatment ◽  
Renal Agenesis ◽  
Iliac Vein ◽  
Vein Thrombosis ◽  
Left Lower Extremity ◽  
Asymptomatic Patients ◽  
Pregnancy And Postpartum ◽  
Anticoagulant Prophylaxis ◽  
The Right ◽  
Deep Vein

This study aims to emphasize that asymptomatic patients with undiagnosed and asymptomatic May-Thurner syndrome (MTS) may firstly develop severe compression during pregnancy. A 40-year-old woman, G1P0, at 22 weeks of twin gestation presented with left lower extremity edema and pain. One twin was structurally normal while the other had bilateral renal agenesis with oligohydramnios. Magnetic resonance venography (MRV) revealed severe compression of the left iliac vein by the right iliac artery without evidence of deep vein thrombosis (DVT). Conservative treatment with anticoagulant prophylaxis was instituted throughout the rest of pregnancy and postpartum period. She was also complicated with severe pre-eclampsia, a cesarean section was performed due to a prolapsed cord at 27 weeks of gestation, and she gave birth to a surviving baby weighing 1100 g. In conclusion, this case report provides evidence that pregnancy can disclose a subtle May-Thurner anatomy to be symptomatic without DVT. Successful pregnancy outcomes could be achieved with conservative treatment and anticoagulant prophylaxis.

Sonographic Discovery of Segmental Testicular Infarction

2021 ◽  
pp. 875647932110649
Author(s):  
Kelly Pham
Keyword(s):  
Conservative Treatment ◽  
Testicular Torsion ◽  
Treatment Process ◽  
Surgical Intervention ◽  
Treatment Approach ◽  
Accurate Diagnosis ◽  
Sonographic Diagnosis ◽  
Testicular Infarction ◽  
Segmental Testicular Infarction

The prevalence of segmental testicular infarction is extremely uncommon and very few cases have been reported in literature. Clinical and sonographic presentation of this condition can mimic testicular neoplasms or testicular torsion. Therefore, accurate diagnosis of segmental testicular infarction is imperative in the treatment process. This case study presents the sonographic diagnosis of testicular infarction in a 49-year-old man who reported mild testicular tenderness. A conservative treatment approach was used, saving the patient unnecessary surgical intervention.

scholarly journals Hemoperitoneum due to Splenic Laceration Caused by Colonoscopy: A Rare and Catastrophic Complication

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Shiao-Han Chen ◽  
Jiann-Ruey Ong ◽  
Hon-Ping Ma ◽  
Po-Shen Chen
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Splenic Flexure ◽  
Splenic Injury ◽  
Underlying Disease ◽  
Sudden Onset ◽  
Health Examination ◽  
Asymptomatic Patients ◽  
Grade Ii

Numerous studies suggest that in asymptomatic patients, routine follow-up CT is not indicated due to the insignificant findings found on these patients. A 53-year-old man, who denied any underlying disease before, underwent colonoscopy for routine health examination. Sudden onset of abdominal pain around left upper quarter was mentioned at our emergency department. Grade II spleen laceration was found on CT scan. Splenic injury was found few hours later on the day of colonoscopy. It might result from the extra tension between the spleen and splenic flexure which varies from different positions of patients.

scholarly journals Life-threatening spontaneous hematoma of the chest wall treated with packing and delayed chest closure

2019 ◽  
pp. 01-03
Author(s):  
Francesco Mongelli ◽  
Francesco Proietti ◽  
Miriam Patella ◽  
Stefano Cafarotti
Keyword(s):  
Conservative Treatment ◽  
Minimally Invasive ◽  
Surgical Intervention ◽  
Endovascular Embolization ◽  
Minimally Invasive Techniques ◽  
Life Threatening ◽  
Thoracic And Abdominal ◽  
Invasive Techniques ◽  
Anticoagulated Patients ◽  
Spontaneous Hematoma

Bleeding of the thoracic and abdominal wall most commonly occur in anticoagulated patients [1]. The management is based on anticoagulant therapy reversal which is mostly effective [2]. If conservative treatment is insufficient, good results are provided by endovascular embolization techniques [2,3]. The need of surgical intervention is extremely rare and limited to cases in which minimally invasive techniques are unsuccessful or somehow contraindicated [4].

scholarly journals Neonatal intestinal obstruction: report

2000 ◽  
Vol 6 (1) ◽  
pp. 187-193
Author(s):  
G. A. Nasir ◽  
S. Rahma ◽  
A. H. Kadim
Keyword(s):  
Mortality Rate ◽  
Conservative Treatment ◽  
Intestinal Obstruction ◽  
Imperforate Anus ◽  
Surgical Intervention ◽  
Duodenal Atresia ◽  
Colonic Atresia ◽  
Neonatal Intestinal Obstruction ◽  
Age Range ◽  
Surgical Unit

We reviewed 36 cases of neonatal intestinal obstruction admitted to our surgical unit over a 10-year period, 1986-1996, for surgical intervention following the failure of conservative treatment. There were more males than females and the age range was 12 hours-26 days. Imperforate anus was the main cause of the obstruction [27.8%] followed by duodenal atresia [13.9%] and colonic atresia and meconium ileus [11.1% each]. There were 8 deaths following surgery [22% mortality rate], the main causes being aspiration pneumonia, septicaemia and hypothermia

scholarly journals Spontaneous resolution of large non-traumatic bilateral acute-on-chronic subdural hematoma

2017 ◽  
Vol 31 (1) ◽  
pp. 8-16
Author(s):  
D. Adam ◽  
D. Iftimie ◽  
Gina Burduşa ◽  
Cristiana Moisescu
Keyword(s):  
Conservative Treatment ◽  
Subdural Hematoma ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neurological Status ◽  
Spontaneous Resolution ◽  
Subdural Hematomas ◽  
Gcs Score

Abstract Background and importance: Chronic subdural hematomas are a frequently encountered neurosurgical pathology, especially in the elderly. They often require surgical evacuation, but recent studies have shown good results with conservative treatment in selected cases. Clinical presentation: We report the case of a 72-year old patient that developed large, non-traumatic, bilateral, acute-on-chronic subdural hematoma after repeated abdominal surgery for appendicular carcinoma. He presented an abdominal wound infection and good neurological status (GCS score of 14 points), factors that indicated the delay of surgical intervention. Subsequent clinical and radiological improvement forestalled the operation altogether and he presented complete spontaneous resolution of subdural hematomas at only 5 months after diagnosis. Conclusion: Although surgical treatment is performed in the majority of chronic subdural hematomas, in clinically and radiologically selected cases, the operation can be avoided. The hematoma can present resolution, either spontaneously or with the help of conservative treatment.

scholarly journals Prevention and conservative treatment of nasopharyngeal tonsil hypertrophy

2021 ◽  
Vol 20 (1) ◽  
pp. 56-60
Author(s):  
G. I. Markov ◽  
◽  
A. L. Klochikhin ◽  
V. A. Romanov ◽  
M. G. Markov ◽  
...  
Keyword(s):  
Conservative Treatment ◽  
Nasal Cavity ◽  
Mucous Membrane ◽  
Conservative Therapy ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Whole Body ◽  
Fungal Flora ◽  
Sparing Effect ◽  
Pharyngeal Tonsil

The aim of this work is to draw the attention of otorhinolaryngologists to the advantages of early conservative treatment of children with hypertrophy of the nasopharyngeal tonsil - adenoids. In childhood, a significant part of the protective and informational functions lies on the pharyngeal tonsil, since it is in the path of inhaled air. Unfavourable environmental conditions exacerbate its functional failure. Pathology of the lymphopharyngeal ring is highly prevalent and occupies a leading place among ENT diseases in children. Each person has a certain own microflora on the nasal mucosa from birth. In most cases, monoflora is determined on the mucous membrane of the nasal cavity, and only 2-3% is due to the combination of two types of microbial and fungal flora. For more than twenty years, we have been using the tactics of a sparing effect on the mucous membrane when using medicinal mixtures on a protective basis. Conservative treatment of 245 children aged 3 to 6 years with grade 1 – 2 adenoiditis was carried out, which made it possible to avoid surgical intervention in this group of children. When choosing a drug mixture, the sensitivity of the microflora of the patient’s nasal cavity was considered according to the results of a smear from the mucous membrane. Adenoidectomy is an operation with potentially undesirable consequences for the whole body, therefore, effective timely conservative therapy can reduce the risks and harms of surgery for pediatric patients.

scholarly journals Haglund’s disease: surgical outcome of calcaneal osteotomy

2017 ◽  
Vol 3 (2) ◽  
pp. 278 ◽  
Author(s):  
Veerabhadra Javali ◽  
Virupaksha N. Reddy
Keyword(s):  
Conservative Treatment ◽  
Surgical Outcome ◽  
Surgical Intervention ◽  
Lateral Approach ◽  
Lateral View ◽  
Aofas Score ◽  
Postoperative Score ◽  
Calcaneal Osteotomy ◽  
The Mean

<p class="abstract"><strong>Background:</strong> The aim of the present study was to assess the surgical outcome of Haglund’s disease by calcaneal osteotomy<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> 23 cases of Haglund’s disease who failed to respond to conservative treatment were considered for surgery. Parallel pitch lines were drawn in the lateral view radiograph of the calcaneum and the bursal projection to be resected was assessed. All cases were surgically treated with calcaneal osteotomy through lateral approach and followed.<strong></strong></p><p class="abstract"><strong>Results:</strong> 23 cases of Haglund’s disease were treated with this procedure and 21 were available for follow up. The mean follow-up was 15 months. <span>The mean preoperative AOFAS score of 60.57 points (SD= 3.23) and postoperative score of 88.71 points (SD= 3.92) was obtained. </span>Three minor complications were noted<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> The results of the current study suggest that calcaneal ostectomy produces outcomes that justify surgical intervention in cases of Haglund’s disease<span lang="EN-IN">.</span></p>

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