Early versus late surgical management of complicated appendicitis in children: A statewide database analysis with one-year follow-up

Category: Midfoot/Forefoot Introduction/Purpose: Morton’s neuroma is a common condition affecting the foot and is associated with chronic pain and disability. Conservative management including a combination of orthotic input; injection or physiotherapy, and surgical excision are current treatment options. There is a paucity of literature regarding patient related outcome measures (PROMs) data in patients managed conservatively. We sought to compare conservative with surgical management of Morton’s neuroma using PROMs data in patients with follow-up to one year. Methods: Prospective data collection commenced from April 2016. Patients included had to have a confirmed Morton’s neuroma on ultrasound scan. Patient demographics including age, sex and BMI were collected. The primary outcome measures were the Manchester Foot Score for pain (MOX-FQ), EQ time trade off (TTO) and EQ visual analogue scale (VAS) taken pre-operatively; at 26-weeks and at 52-weeks post-operatively. Results: 194 patients were included overall: 79 patients were conservatively managed and 115 surgically managed. 19 patients were converted from conservative to surgical management. MOX-FQ pain scores: pre-op conservative 52.15, surgical 61.56 (p=0.009), 6-months conservative 25.1, surgical 25.39 (p=0.810), 12 months conservative 18.54, surgical 20.52 (p=0.482) EQ-TTO scores: pre-op conservative 0.47, surgical 0.51 (p=0.814), 6-months conservative 0.41, surgical 0.49 (p=0.261), 12 months conservative 0.26, surgical 0.37 (p=0.047) EQ-VAS scores: pre-op conservative 63.84, surgical 71.03 (p=0.172), 6-months conservative 46.10, surgical 52.51 (p=0.337), 12 months conservative 30.77, surgical 37.58 (p=0.227) Satisfaction at 12 months: conservative 17 (21.5%), surgical 32 (27.8%) p=0.327 Conclusion: This is one of the first studies investigating long-term PROMs specifically in conservative management for Morton’s neuroma patients. There was no significant difference in pain score and EQ-VAS between all conservative treatments and surgical management at 12 months There was no significant difference in satisfaction at 12 months between conservative and surgical groups.

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MANAGEMENT OF ACUTE APPENDICITIS DURING THE EARLY PHASE OF THE COVID-19 PANDEMIC: A SINGLE NHS CENTRE STUDYONE YEAR FOLLOW UP STUDY.

10.36106/ijsr/5430960 ◽

2021 ◽

pp. 87-89

Author(s):

Yamen Jabri ◽

Md Mahfooz Buksh ◽

Alicia Skrervin

Keyword(s):

Operative Treatment ◽

Open Surgery ◽

Ct Scanning ◽

Disease Recurrence ◽

Diagnostic Value ◽

Complicated Appendicitis ◽

Risk Patients ◽

Risk Of Disease ◽

One Year

Introduction: Early during the COVID-19 pandemic, the royal college of surgeons advised to use Non-Operative Treatment of appendicitis NOTA or otherwise open surgery for appendicitis. This study has explored the resulted management differences, and the outcome after one year follow up. Methods: Retrospective study covering Pre-pandemic data over March-May,2019 & COVID-19 pandemic data over March-May,2020. We compared the outcome of non-operative treatment approach (NOTA), open and laparoscopic surgical outcome between the 2 groups. Results: The number of admissions was lower in the COVID compared to the Pre-COVID Group (35 vs 43). In the COVID group had more CT scanning of the abdomen and pelvis (65.7% vs 42.2%; p=0.036). There was no difference in the diagnostic value for these imaging methods between the 2 groups (87.5% vs 86.6%) During COVID period Signicantly fewer patients underwent surgery (77.1 vs 92.8; p<0.04), There were signicantly more complicated appendicitis cases in the COVID group compared to Pre-COVID group (59.2 vs 28.2; p:0.021). There was in reduction LOS when comparing Laparoscopic to NOTA (1.7 vs 2.6 days; p:0.03). There has been higher complication rate in the open and NOTA treatments compared to Laparoscopic, but this was not statistically signicant (24.3 % vs 14.8%; p: 0.29). In the NOTA group 41 % of the patients had emergency or interval appendectomy in after one year follow up period. Conclusions: There was a tendency towards conservative approach/open surgery during the pandemic. Our study suggests that Laparoscopic surgery should remain the preferred method of management of appendicitis during COVID-19 pandemic considering the more complicated appendicitis. NOTA should be limited to selected high risk patients. accepting the risk of disease recurrence and need for further interval or emergency surgery

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Non-surgical management of an extraoral cutaneous sinus tract of odontogenic origin

BMJ Case Reports ◽

10.1136/bcr-2020-234699 ◽

2020 ◽

Vol 13 (7) ◽

pp. e234699

Author(s):

Lynn Lilly Varghese ◽

Auric Bhattacharya ◽

Praveena Sharma ◽

Abhishek Apratim

Keyword(s):

Case Report ◽

Surgical Management ◽

Dental Pulp ◽

Complete Resolution ◽

Sinus Tract ◽

Odontogenic Origin ◽

One Year ◽

Minimal Scar ◽

Cutaneous Sinus

Chronic apical periodontitis associated with dental pulp necrosis is the main cause of odontogenic extraoral cutaneous sinus openings. These tracts are often initially misdiagnosed unless the treating clinician considers a dental aetiology. This case report of a 19-year-old woman describes the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin. Non-surgical conservative endodontic therapy was opted as the involved teeth were restorable. One month after the completion of obturation, there was closure of the sinus tract. One year follow-up showed complete resolution of the sinus tract with minimal scar formation.

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Non-surgical management of endodontic failure - An observational study

Journal of Chitwan Medical College ◽

10.3126/jcmc.v5i1.12561 ◽

2015 ◽

Vol 5 (1) ◽

pp. 18-22

Author(s):

K Prajapati ◽

N Joshi

Keyword(s):

Observational Study ◽

Surgical Management ◽

Treatment Method ◽

Final Outcome ◽

One Year

In the present study, possibility of non-surgical endodontic re-treatment for correction of symptomatic endodontic failure with and without periradicular pathosis was evaluated both clinically and radiologically. The main objective of this study was also to assess, verify and establish the non-surgical re-treatment method as primary approach to resolve endodontic failures irrespective of sex. A total 69 cases of endodontic failure with or without periapical pathosis were studied of which 24 (34.78%) were male and 45 (65.21%) were female .The mostly affected teeth were Mandibular 1st molars 19 in number (27.53%) followed by Maxillary central incisors 17 in number (24.63%). After one year follow up, the final outcome was success- 47 (75.80%), doubtful- 2 (3.22%) and failure-13 (20.96%).DOI: http://dx.doi.org/10.3126/jcmc.v5i1.12561

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Ultrasound Examination and Navigation for Repeat/Delayed Reconstruction of the Ankle Extensor Tendons

Diagnostics ◽

10.3390/diagnostics11081408 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1408

Author(s):

Kamal Mezian ◽

Karolína Sobotová ◽

David Zámečník ◽

Levent Özçakar

Keyword(s):

Surgical Management ◽

Surgical Repair ◽

Ultrasound Examination ◽

Penetrating Injury ◽

Unique Case ◽

Extensor Tendons ◽

The Third ◽

One Year ◽

Delayed Reconstruction

Herein, we describe a 46-year-old woman with persistent pain and weakness in her left ankle/foot one year after surgical repair of all three ankle extensor tendons following a penetrating injury. This report presents a unique case whereby US imaging played a paramount role in the diagnosis and surgical management of a previous nonanatomic repair of the ankle extensor tendons after a penetrating injury one year prior. The above-quoted findings were subsequently corrected with end-to-end sutures. On the third postoperative month follow-up, the patient was free of any complaints or complications.

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Predictors of Outcomes of Non-Surgical Management for Acetabular Labral Tears

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967118s00008 ◽

2018 ◽

Vol 6 (3_suppl) ◽

pp. 2325967118S0000

Author(s):

William Conaway ◽

Scott D. Martin ◽

Ravi Agrawal

Keyword(s):

Surgical Management ◽

Statistical Significance ◽

Alpha Angle ◽

Operative Management ◽

Cartilage Defects ◽

Labral Tears ◽

One Year ◽

Non Operative Management ◽

Tönnis Grade

Objectives: Acetabular labral tears are increasingly recognized as a source of hip pain in the younger, active population. Due to a significant focus on surgical intervention, there has been limited investigation on the predictive factors and natural history of non-surgical management of these injuries. Many reports recommend a trial of non-operative management with a variety of modalities including physical therapy, education, non-steroidal anti-inflammatories (NSAIDs), intra-articular injections, and activity modification. However, there is limited data supporting these claims as few studies have explored non-surgical management. Additionally, the authors were not able to find any studies on factors that portend outcomes of non-operative management. We hypothesized that patients with more significant bony FAI pathology or more severe osteoarthritis would have poorer outcomes. Methods: Eighty patients with acetabular labral tears, confirmed by MRI, receiving a minimum of one year of non-surgical management were identified. Subjects completed baseline patient reported outcome measures (PROMs: mHHS, HOS-ADL, HOS-SS, iHOT-33). Sixty five (81.25%) patients completed the same one-year follow-up functional outcomes measures in addition to a satisfaction questionnaire (37F, 28 M). Chart review was conducted to obtain demographic information and radiographic information (Tonnis grade, alpha angle, center edge angle, chondral damage, cartilage defects, cysts, and subchondral edema). Statistical significance ( p<0.05) was determined t-test, anova, or Wilcoxon rank-sum. Results: Average follow up time was 24 months (R:18-30). The mean age was 41.7(R:18-57), average BMI was 26.2 (R18-39), and average Tonnis grade was 0.6 (R0-2). At follow-up, overall patients experienced a significant improvement in functional outcomes (mHHS: 66.6 vs 75.18, HOS-ADL: 75.7 vs 85.8, HOS-SS: 54 vs 69.7, iHOT-33: 47.9 vs 65.4). There was a positive correlation between baseline PROMs and follow-up PROMs as well as a negative correlation between baseline PROMs and change in PROMs over time. Tonnis grade, chondral damage, and cartilage defects portended significantly worse outcomes across all PROMs at follow-up. Presence of cysts or subchondral edema was also correlated with worse outcomes but these findings did not reach statistical significance. (Table 2). Alpha angle >55 (cam lesion) resulted in significantly worse outcomes across all PROMs although CEA>40 (pincer lesion) only reached significance for the HOS ADL and SSS. CEA< 25 (dysplasia) trended toward worse outcomes but did not reach significance. (Table1) Conclusion: Due to the limited healing potential of the labrum, the associated anatomical defects of FAI, and the potential for progression to osteoarthritis, there has been a focus on surgical intervention for FAI and labral tears. Despite a lack of evidence for its use, non-surgical management is frequently cited as the first step to treatment. As we found in a previous analysis, patients with symptomatic labral tears can experience functional improvement after minimum one year of non-surgical management. Those with signs of higher grade arthritis performed significantly worse that their less arthritic counterparts. Those with larger cam and pincer lesions also improved less than patients with less significant bony morphology. This study can help inform surgeons and their patients when they present with hip pain and inquire about non-surgical management. [Table: see text][Table: see text]

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Surgical management of bilateral immobile vocal folds and long-term follow-up

The Journal of Laryngology & Otology ◽

10.1017/s0022215100137685 ◽

1997 ◽

Vol 111 (5) ◽

pp. 474-477 ◽

Cited By ~ 13

Author(s):

A. K. Gupta ◽

S. B. S. Mann ◽

Nitin Nagarkar

Keyword(s):

Surgical Management ◽

Spontaneous Recovery ◽

Vocal Folds ◽

Traumatic Group ◽

Long Term Follow Up ◽

Group A ◽

One Year ◽

Laser Cordectomy

AbstractSixty-one cases of bilateral immobile vocal folds were classified as traumatic (52.46 per cent), idiopathic (39.34 per cent) or iatrogenic (8.20 per cent). During follow-up the idiopathic group of patients had a better prognosis (p<O.O5) compared to the traumatic or iatrogenic group. A spontaneous recovery was seen in 58.33 per cent of cases in the idiopathic group, 56.25 per cent in the traumatic group and 40.0 per cent in the iatrogenic group within a period of one year. Patients who failed to show spontaneous recovery were either subjected to arytenoidectomy with fold lateralization, endoscopic fold lateralization or laser cordectomy, showing 70.0 per cent, 66.67 per cent and 80.0 per cent recovery respectively. These cases have been discussed.

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Retrospective Database Analysis of Patterns of Zoledronic Acid (ZOL) Treatment in Patients with Multiple Myeloma (MM) and Malignant Bone Lesions (BM).

Blood ◽

10.1182/blood.v114.22.4944.4944 ◽

2009 ◽

Vol 114 (22) ◽

pp. 4944-4944

Author(s):

Donna Spencer ◽

Satyin Kaura ◽

Jose Ricardo Perez ◽

Henry J Henk

Keyword(s):

Health Plan ◽

First Year ◽

Database Analysis ◽

Employment Equity ◽

Anti Cancer ◽

Equity Ownership ◽

Retrospective Database Analysis ◽

One Year ◽

Retrospective Database

Abstract Abstract 4944 Background MM patients with BM may be treated with a variety of anti-cancer and bone treatments. The purpose of this study was to examine the use of ZOL, a therapy administered intravenously to reduce or delay skeletal complications, in the real-world treatment of adult patients with MM and BM. Of special interest to the study was the use of ZOL in the context of bortezomib (BOR) and lenalidomide (LEN). Methods Claims-based analysis of commercial and Medicare data from a large US managed care plan and a 45-health plan database was conducted to examine the use of ZOL in the treatment of adult patients (18 years and older) with MM and BM. Patients with at least one claim for ZOL and evidence of MM diagnosis and BM diagnosis were included. The identification period was 7/1/03 – 7/31/08 for the large US commercial health plan, 7/1/03 – 12/31/07 for the Medicare plan, and 7/1/04 – 6/30/08 for the 45-health plan database. The sequencing, number, and duration of ZOL treatments were analyzed. Continuous enrollment in the health plan for six months before and three months following the index date was required. Patients were followed until they disenrolled from the plan (including due to death), or the end of the study's follow-up period. Results The study sample included 8,632 of which 4,260 patients were enrolled in their health plan for at least one year following ZOL initiation, with a median follow-up length of 21.2 months (range = 12 months to 5.3 years). Among the 4,260 patients, 38.7% were men, the mean age was 60.7 ± 11.9 years, and the average Charlson comorbidity index score was 5.4 (SD=2.2). Accounting for variable follow-up during the study period, patients had an average of 7.01 ZOL administrations per person year. Approximately 63.5% (n=2,707) patients were still receiving ZOL at the end of the first year following ZOL initiation. The majority of patients (90.2%, n=3,841) treated with ZOL were not treated with either BOR or LEN. Approximately 93.0% of these cases received other types of anti-cancer treatments (e.g., melphalan, thalidomide, prednisone, and other chemotherapies) at some point during the study period. For 345 (8.1%) patients, BOR or LEN initiation followed the start of ZOL, and 185 (53.6%) of these cases started BOR or LEN within the first year following initiation of ZOL. Among those initiating BOR or LEN, the median time from ZOL initiation was 337 days (range = 5 to 1,594 days). In 19 (0.4%) cases, ZOL was started at the same time as BOR or LEN, and in 55 (1.3%) cases, ZOL treatment followed BOR or LEN initiation. Conclusions According to this retrospective database analysis, the vast majority of patients with MM and BM who initiate ZOL do not go on to receive BOR or LEN within the year following ZOL initiation. Among patients enrolled in the health plan for at least one year following ZOL initiation, the majority of patients remained on ZOL treatment. As anticipated, this study showed that the overwhelming proportion of MM patients with BM using ZOL were being treated with anti-cancer therapies, but only approximately 10.0% with either BOR or LEN. Disclosures Kaura: Novartis: Employment, Equity Ownership. Perez:Novartis: Employment, Equity Ownership.

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SURGICAL MANAGEMENT OF INTRACRANIAL MENINGIOMAS

The Professional Medical Journal ◽

10.29309/tpmj/2007.14.01.3644 ◽

2007 ◽

Vol 14 (01) ◽

pp. 170-176

Author(s):

TARIQ AHNIAD ◽

INAMULLAH ASGHAR ◽

AKMAL HUSSAIN ◽

Sibef Hasan ◽

Habib Sultan

Keyword(s):

Surgical Management ◽

Total Removal ◽

Medical College ◽

Simpson Grade ◽

Intracranial Meningiomas ◽

Grade Ii ◽

One Year ◽

Study Setting ◽

Neurovascular Structures

Objective: To study the surgical management and outcome of patients having intracranial meningiomas. Design: A retrospective study. Setting: The Department of Neurosurgery Punjab Medical College & Allied Hospital, Faisalabad. Duration From April 2004 to October 2005. Materials & Methods:Thirty patients suffering from intracranial meningiomas diagnosed on CT-scan and managed surgically were included in this study. Simpson grade I removal was possible in 21 patients. Grade II removal was done in Three patients while grade 111 removal was possible in four patients, grade IV removal was done in one patient and grade V in one patient. Post operative XRT was given in cases having grades II, 111, IV and V removal. Follow up was done at six monthly intervals. Outcome was assessed as Good .Fair, and poor depending upon clinical and radiological examinations. RESULTS: Out of 30 patients only one had recurrence after one year of follow up which was removed surgically and postoperative XRT was given.Twenty four patients had good outcome while 5 patients had fair outcome and one had poor outcome. CONCLUSION. Study showed that Simpson grade 1 removal of tumor is still effective treatment in the management of meningiomas. Postoperative XRT is used in Simpson grade 2, 3, 4 and 5 in which gross total removal is not possible due to involvement of neurovascular structures.

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Nonoperatively Managed Stage 5 Osteochondral Talar Lesions

Foot & Ankle International ◽

10.1177/107110070202300712 ◽

2002 ◽

Vol 23 (7) ◽

pp. 651-654 ◽

Cited By ~ 72

Author(s):

Carl Shearer ◽

Richard Loomer ◽

Doug Clement

Keyword(s):

Clinical Outcome ◽

Surgical Management ◽

Lesion Size ◽

Degenerative Changes ◽

Osteochondral Lesions ◽

Poor Correlation ◽

X Rays ◽

One Year ◽

Better Than

Thirty-five ankles in 34 subjects with non-surgically managed stage 5 (chronic) osteochondral lesions of the talus (OLT) were reassessed an average of 38 months post diagnosis—88 months post symptom onset. The overall clinical result was rated good or excellent in 54%, fair in 17% and poor in 29%. Six patients opted for surgery—arthroscopic drilling—after a trial of one year of nonsurgical treatment and were therefore rated as poor. Tomogram or CT scans at the time of diagnosis and follow-up were compared in 25 patients. We found no significant change in lesion size and there was a poor correlation between change in lesion size and clinical outcome. X-rays performed at follow-up on 20 patients showed mild degenerative changes in 13 of 20 ankles with OLT. No correlation was found between the presence of degenerative changes and the clinical outcome. We conclude that: Non-surgical management of stage 5 OLT is a viable option with little or no risk of developing significant osteoarthritis. Most lesions remain radiographically stable. There is a poor correlation between changes in lesion size and clinical outcome. However, the few patients with lesions which decrease significantly in size tend to do well and those with lesions which increase significantly in size do poorly. The development of mild radiographic changes of OA does not correlate with clinical outcome. The general course of stage 5 OLT is benign with over half of the patients improving to good or excellent results with non-surgical management. Lateral lesions tend to do better than medial ones. Adult onset lesions tend to do better than juvenile onset lesions.

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