Long-Term Follow-Up After Non-operative Management of Blunt Splenic and Liver Injuries: A Questionnaire-Based Survey

Frontal sinus fractures are usually associated with traumatic brain injury and nasoorbitoethmoidal fractures. Much of the available evidence is retrospective, and management algorithms vary. In general, nondisplaced fractures without nasofrontal outflow tract (NFOT) obstruction may be managed with clinical and radiographic follow-up whereas fracture displacement, NFOT obstruction, and persistent CSF leaks are indications for operative management. The bicoronal incision and bifrontal craniotomy allow for proper access to the frontal sinus. If there is NFOT obstruction, the sinus should be cranialized or possibly obliterated if only the anterior table is fractured. The NFOT and sinus are packed with bone chips, fat, or muscle and then sealed with a pericardial graft, fascial graft, or synthetic dural substitute. Inadequate cranialization or obliteration can result in mucocele or mucopyocele, intracranial extension of which can lead to brain abscess or meningitis. Complications can occur years after the initial injury so long-term follow-up is necessary.

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Massive inguinoscrotal herniation of the bladder: challenges in non-operative management

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa540 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Kelvin Adasonla ◽

Joseph Gabriel ◽

Mohammed Kamil Quraishi ◽

Graham Watson

Keyword(s):

Obstructive Uropathy ◽

Kidney Injury ◽

Operative Management ◽

Bilateral Hydronephrosis ◽

Non Operative Management ◽

Term Management ◽

Repeat Imaging ◽

Urinary Sepsis

Abstract Massive inguinoscrotal hernias containing the bladder are rare but can present with significant complications such as obstructive uropathy and urinary sepsis. A comorbid 71-year-old gentleman presented with an enlarging inguinoscrotal mass and an acute kidney injury (AKI). Imaging revealed a large inguinoscrotal hernia containing the bladder, and bilateral hydronephrosis. Renal function improved on urethral catheterization. Admitted under general surgery originally, the patient declined any surgical intervention and had his catheter removed as an outpatient, without urological follow up. He represented 6 months later with urinary sepsis and a new AKI. Repeat imaging revealed a progression of the bilateral hydronephrosis. Subsequently admitted under urology, bilateral nephrostomies as well as a catheter were inserted. Once stable, he was discharged with both as part of his long-term management. Non-operative management of this condition may occasionally be necessary, and so requires effective multidisciplinary decision making. Real-world organizational and geographical factors contributed to the challenges in this case.

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Renal Shell injuries with Retaining renal shell fragments due to improvised explosive devices. Acute conservative approach and long term follow-up

10.21203/rs.3.rs-142874/v1 ◽

2021 ◽

Author(s):

Murat Zor ◽

Bahadir Topuz ◽

Engin Kaya ◽

Sercan Yilmaz ◽

Sinan Akay ◽

...

Keyword(s):

Renal Injury ◽

Medical Records ◽

Operative Management ◽

Complication Rates ◽

Long Term Follow Up ◽

Grade 3 ◽

One Year ◽

Non Operative Management ◽

Shell Fragments

Abstract Introduction: Among penetrating injuries, renal shrapnel injuries consist of a rarity of renal gunshot injuries. Due to the paucity of cases reported in the literature, there is no consensus regarding the management of renal shrapnel injuries and retaining renal shell fragments. In this study we aimed to report our non-operative management experience of renal shrapnel injuries who had also retaining renal shell fragments.Material and Methods: We retrospectively evaluated the medical records of renal shrapnel injuries that had also retaining renal shell fragments. All hemodynamically stable patients managed non-operatively and included to the study. The medical records of age, renal injury grade according to AAST, presenting pulse, systolic blood pressure, transfusion requirement, complications and need for adjuvant procedures, non-operative management success and mortality was reviewed. Complication rates due to retaining renal shell fragments were assessed by interviewing via telephone at the end of the first year of injury. The patients asked for plumbism symptoms and any surgical intervention for these foreign bodies.Results: A total of 8 patients with retaining renal shell fragments due to renal shrapnel injuries were included to the study. Mean patient age was 27,8 years. Mean follow-up period was 38.7±15.1 months. All patients were male. AAST renal injury scores were grade 1 one, grade 2 two, grade 3 four, grade 4 one patient. All patients were successfully managed non-operatively and discharged on the 7th day without any complication. No symptoms of plumbism and surgery necessity secondary to retaining renal shell fragments were seen in at least one year follow-up.Conclusion: Our study demonstrates that non-operative management of renal shrapnel injuries with retaining renal shell fragments lead low complication rates and high chance of renal preservation. However, we must keep in mind that this kind of management is safe in experienced trauma centers that have experienced staff.

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Long-Term Follow-up of Arthroscopic Treatment of Lateral Epicondylitis

The American Journal of Sports Medicine ◽

10.1177/0363546507311599 ◽

2008 ◽

Vol 36 (2) ◽

pp. 254-260 ◽

Cited By ~ 106

Author(s):

Champ L. Baker ◽

Champ L. Baker

Keyword(s):

Case Series ◽

Lateral Epicondylitis ◽

Operative Management ◽

High Rate ◽

Functional Score ◽

Level Of Evidence ◽

Long Term Follow Up ◽

The Mean

Background In a previously published report of the authors’ arthroscopic technique of operative management of recalcitrant lateral epicondylitis, they demonstrated short-term success with the procedure in their patients. Hypothesis Arthroscopic management of patients with lateral epicondylitis can produce clinical improvement and have successful long-term outcomes. Study Design Case series; Level of evidence, 4. Methods Forty patients (42 elbows) with lateral epicondylitis who had not responded to nonoperative management were treated with arthroscopic resection of pathologic tissue. Thirty of these patients (30 elbows) were located for extended follow-up. At a mean follow-up of 130 months (range, 106–173 months), patients were asked to use a numeric scale to rate their elbow pain from 0 (no pain) to 10 (severe pain). Patients were also asked to rate their elbows according to the functional portion of the Mayo Clinic Elbow Performance Index. Results The mean pain score at rest was 0; with activities of daily living, 1.0; and with work or sports, 1.9. The mean functional score was 11.7 out of a possible 12 points. No patient required further surgery or repeat injections after surgery. One patient continued to wear a counterforce brace with heavy activities. Twenty-three patients (77%) stated they were “much better,” 6 patients (20%) stated they were “better,” and 1 patient (3%) stated he was the same. Twenty-six patients (87%) were satisfied, and 28 patients (93%) stated they would have the surgery again if needed. Conclusion Arthroscopic removal of pathologic tendinosis tissue is a reliable treatment for recalcitrant lateral epicondylitis. The early high rate of success in patients was maintained at long-term follow-up.

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Plate fixation of midshaft clavicle fractures for delayed union and non-union is a cost-effective intervention but functional deficits persist at long-term follow-up

Shoulder & Elbow ◽

10.1177/1758573221990367 ◽

2021 ◽

pp. 175857322199036

Author(s):

Ben Fox ◽

Nicholas David Clement ◽

Deborah J MacDonald ◽

Michael Robinson ◽

Jamie A Nicholson

Keyword(s):

Functional Outcome ◽

Cost Effective ◽

Operative Management ◽

Matched Cohort ◽

Non Union ◽

Oxford Shoulder Score ◽

Non Operative Management ◽

Shoulder Score

Background The primary aim of this study was to compare the long-term functional outcome of midshaft clavicle fracture fixation for delayed (≥3 month) and non-union (≥6 month) compared to a matched cohort of patients that achieved union with non-operative management. The secondary aim was to assess cost-effectiveness of fixation. Methods A consecutive series of patients over 10-years were retrospectively reviewed using the QuickDASH, Oxford Shoulder Score and EuroQol five-dimension summary index (EQ-5D). These patients were compared to a matched cohort that achieved union after non-operative management using propensity score matching. Results Sixty patients (follow-up 79%, n = 60/76) at 4.1 years post-operative (1.1–10.0 years) had a QuickDASH of 16.5 (95% CI 11.6–21.5), Oxford Shoulder Score 41.5 (39.0–44.1) and EQ-5D 0.7621 (0.6822–0.8421). One in five patients were dissatisfied with their final outcome ( n = 13/60). Functional outcome was inferior following fixation when compared to patients that united with non-operative management (QuickDASH 16.5 vs. 5.5, p < 0.001 and EQ-5D 0.7621 vs. 0.9073, p = 0.001). However, significant improvements were found when compared to pre-operative scores (QuickDASH p < 0.001 and EQ-5D p < 0.001). The cost per QALY for fixation was £5624.62 for the study cohort. Conclusions Clavicle fixation for delayed and non-union is a cost-effective intervention but outcomes are worse compared to patients that unite with non-operative management.

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Lateral compression splint, a guide for stabilization of mandibular arch in case of dentoalveolar fracture of children

Update Dental College Journal ◽

10.3329/updcj.v3i2.18001 ◽

2014 ◽

Vol 3 (2) ◽

pp. 55-60 ◽

Cited By ~ 1

Author(s):

Sheikh Md Shahriar Quader ◽

Mohammad Shamsuzzaman ◽

Abdul Gofur ◽

Shakila Fatema ◽

Mohammad Aminur Rahman

Keyword(s):

Internal Fixation ◽

Closed Reduction ◽

Operative Management ◽

Facial Trauma ◽

Potential Growth ◽

Lower Treatment ◽

Long Term Follow Up ◽

Tooth Buds

Children (below 13 yrs of age) are usually susceptible to cranio facial trauma because of their greater cranial mass to body ratio. When compared to adults, the pattern of fractures and frequency of associated injuries are similar but the overall incidence is much lower. Treatment is usually performed without delay and can be limited to observation or closed reduction in non-displaced or minimally displaced fractures. Operative management should involve minimal manipulation and may be modified by the stage of skeletal and dental development. Open reduction and rigid internal fixation is indicated for severely displaced fractures. When tooth buds within the mandible do not allow internal fixation with plates and screws, this can be achieved with a mandibular compression splint fixed to the teeth, to the mandible with circum-mandibular wire. Children require long-term follow-up to monitor potential growth abnormalities. A case of a 9-year-old boy with fractured body of mandible managed by closed reduction using occlusal acrylic splint and circum mandibular wiring is presented. DOI: http://dx.doi.org/10.3329/updcj.v3i2.18001 Update Dent. Coll. j: 2013; 3 (2): 55-60

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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