Acute Abdomen in Pediatric Patients With Lassa Fever: Prevalence and Response to Nonoperative Management

2018 ◽  
Vol 8 (6) ◽  
pp. 519-524 ◽  
Author(s):  
George O Akpede ◽  
Adewale E Adetunji ◽  
Ernest O Udefiagbon ◽  
Sylvester O Eluehike ◽  
Angela I Odike ◽  
...  
Keyword(s):  
Acute Abdomen ◽  
Pediatric Patients ◽  
Nonoperative Management ◽  
Lassa Fever ◽  
Nonoperative Treatment ◽  
Response To Treatment

Abstract Few reports on the prevalence of acute abdomen (AAbd) in pediatric patients with Lassa fever (LF) are available, and no firm policy on its management exists. Here, we report on its prevalence in and the response to treatment among a cohort of children with confirmed LF. Six (10.3%) of 58 children with LF had AAbd, whereas 6 (2.8%) of 215 children with AAbd had LF. Nonoperative treatment was successful in 5 of the 6 children with both AAbd and LF. We conclude that AAbd is not uncommon in pediatric patients with LF, and it could be responsive to nonoperative treatment. Testing for LF in all children with febrile AAbd might be justified in areas in which LF is endemic.

Mapping efficacious deep brain stimulation for pediatric dystonia

2021 ◽  
pp. 1-11
Author(s):  
Ailish Coblentz ◽  
Gavin J. B. Elias ◽  
Alexandre Boutet ◽  
Jurgen Germann ◽  
Musleh Algarni ◽  
...  
Keyword(s):  
Deep Brain Stimulation ◽  
Clinical Outcome ◽  
Brain Stimulation ◽  
Pediatric Patients ◽  
Rating Scale ◽  
Structural Connectivity ◽  
Response To Treatment ◽  
Internal Globus Pallidus ◽  
Probabilistic Map ◽  
Deep Brain

OBJECTIVEThe objective of this study was to report the authors’ experience with deep brain stimulation (DBS) of the internal globus pallidus (GPi) as a treatment for pediatric dystonia, and to elucidate substrates underlying clinical outcome using state-of-the-art neuroimaging techniques.METHODSA retrospective analysis was conducted in 11 pediatric patients (6 girls and 5 boys, mean age 12 ± 4 years) with medically refractory dystonia who underwent GPi-DBS implantation between June 2009 and September 2017. Using pre- and postoperative MRI, volumes of tissue activated were modeled and weighted by clinical outcome to identify brain regions associated with clinical outcome. Functional and structural networks associated with clinical benefits were also determined using large-scale normative data sets.RESULTSA total of 21 implanted leads were analyzed in 11 patients. The average follow-up duration was 19 ± 20 months (median 5 months). Using a 7-point clinical rating scale, 10 patients showed response to treatment, as defined by scores < 3. The mean improvement in the Burke-Fahn-Marsden Dystonia Rating Scale motor score was 40% ± 23%. The probabilistic map of efficacy showed that the voxel cluster most associated with clinical improvement was located at the posterior aspect of the GPi, comparatively posterior and superior to the coordinates of the classic GPi target. Strong functional and structural connectivity was evident between the probabilistic map and areas such as the precentral and postcentral gyri, parietooccipital cortex, and brainstem.CONCLUSIONSThis study reported on a series of pediatric patients with dystonia in whom GPi-DBS resulted in variable clinical benefit and described a clinically favorable stimulation site for this cohort, as well as its structural and functional connectivity. This information could be valuable for improving surgical planning, simplifying programming, and further informing disease pathophysiology.

Length of Nonoperative Treatment and Risk of Pleural Empyema in the Management of Pancreatitis-induced Pancreaticopleural Fistula

2013 ◽  
Vol 79 (6) ◽  
pp. 614-619 ◽  
Author(s):  
Michael Schweigert ◽  
Norbert Solymosi ◽  
Attila Dubecz ◽  
Dietmar Ofner ◽  
Hubert J. Stein
Keyword(s):  
Surgical Intervention ◽  
Nonoperative Management ◽  
Case Reports ◽  
English Literature ◽  
Fistulous Tract ◽  
Pleural Empyema ◽  
Nonoperative Treatment ◽  
Endoscopic Stenting ◽  
Septic Complications ◽  
Ascending Infection

Pancreaticopleural fistula is a very uncommon complication of pancreatitis resulting from pancreatic duct disruption with leakage of pancreatic secretions into the pleural cavity. Initial conservative treatment fails in a significant number of cases. Ascending infection through the fistulous tract results in pleural empyema. The aim of this study is to investigate the relation between lengths of nonoperative management and risk of pleural empyema. The retrospective study includes our own experience as well as all case reports identified by a systematic review of the English literature from 1954 to 2012. Inclusion criteria were acute or chronic pancreatitis, whereas tumorous fistulization or complications of pancreatic surgery were kept out. A total of 113 patients were identified. There were 86 men and 27 women. The mean age was 46.5 years and 78 patients had a history of alcoholism. The mortality rate was 1.8 per cent (two of 113). Non-operative management including interventional therapy and endoscopic stenting was successful in only 40 cases (36%), whereas 73 patients (64%) finally underwent surgery. The most common procedure was distal pancreatectomy (32 of 73). Pleural empyema occurred in 17 cases. Successful nonoperative management had a mean length of 5.5 weeks, whereas surgery was performed after an average of 10.9 weeks of failed conservative efforts. Initial nonoperative therapy was significantly longer in patients eventually sustaining empyema (17 weeks, P < 0.001) and all needed surgical intervention. Prolonged nonoperative treatment is associated with a noteworthy risk of septic complications such as pleural empyema. Further improvement seems achievable by reducing the time gap between fruitless conservative efforts and surgical intervention.

scholarly journals Clinical Utility of an MRI-Based Classification System for Operative Versus Nonoperative Management of Ulnar Collateral Ligament Tears: A 2-Year Follow-up Study

2019 ◽  
Vol 7 (4) ◽  
pp. 232596711983978 ◽  
Author(s):  
Prem N. Ramkumar ◽  
Heather S. Haeberle ◽  
Sergio M. Navarro ◽  
Salvatore J. Frangiamore ◽  
Lutul D. Farrow ◽  
...  
Keyword(s):  
Classification System ◽  
Odds Ratio ◽  
Clinical Utility ◽  
Nonoperative Management ◽  
Ulnar Collateral Ligament ◽  
Nonoperative Treatment ◽  
Rehabilitation Program ◽  
Collateral Ligament ◽  
Baseball Players

Background: A recently introduced classification system of medial ulnar collateral ligament (UCL) tears accounting for location and severity has demonstrated high interobserver and intraobserver reliability, but little is known about its clinical utility. Purpose: The primary purpose of this study was to assess the relationship of the magnetic resonance imaging (MRI)–based classification system in predicting which athletes had success with nonoperative versus operative treatment after completing a standardized rehabilitation program. A secondary objective included return to play (RTP) and return to prior performance (RPP) analyses of baseball players. Study Design: Cohort study; Level of evidence, 3. Methods: After an a priori power analysis, 58 consecutive patients with UCL tears and a minimum of 2-year follow-up were retrospectively divided into 2 groups: those who successfully completed operative treatment and those who completed nonoperative treatment. The MRI-based classification stages accounting for UCL tear location and severity were compared between the nonoperative and operative groups. A subanalysis for baseball players, including RTP and RPP, was performed. Results: A total of 58 patients (40 baseball players [34 pitchers]) met inclusion criteria. Of these patients 35 (32 baseball players [27 pitchers]) underwent surgery, and 23 (8 baseball players [7 pitchers]) underwent nonoperative management. No patients in the nonoperative arm crossed over to surgery after completing the rehabilitation program. Patients with distal tears (odds ratio, 48.0; P = .0004) and complete tears (odds ratio, 5.4; P = .004) were more likely to undergo surgery. Baseball players, regardless of position, were confounding determinants of operative management, although there was no difference in RTP and RPP between treatment arms. Conclusion: A 6-stage MRI-based classification system addressing UCL tear location and severity may help early decision making, as patients likely to fail nonoperative treatment have complete, distal tears, whereas those with proximal, partial tears may be more amenable to nonoperative management.

DECISION MAKING IN PEDIATRIC SPINAL DEFORMITY

Neurosurgery ◽  
2008 ◽  
Vol 63 (suppl_3) ◽  
pp. A54-A68 ◽  
Author(s):  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
Mark F. Abel ◽  
Christopher P. Ames
Keyword(s):  
Decision Making ◽  
Spinal Deformity ◽  
Pediatric Patients ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Nonoperative Treatment ◽  
Treatment Modalities ◽  
Decision Making Process ◽  
History Of ◽  
Diagnosis And Classification

ABSTRACT OBJECTIVE To review the concepts involved in the decision-making process for management of pediatric patients with spinal deformity. METHODS The literature was reviewed in reference to pediatric deformity evaluation and management. RESULTS Pediatric spinal deformity includes a broad range of disorders with differing causes, natural histories, and treatments. Appropriate categorization of pediatric deformities is an important first step in the clinical decision-making process. An understanding of both nonoperative and operative treatment modalities and their indications is requisite to providing treatment for pediatric patients with spinal deformity. The primary nonoperative treatment modalities include bracing and casting, and the primary operative treatments include nonfusion instrumentation and fusion with or without instrumentation. In this article, we provide a review of pediatric spinal deformity classification and an overview of general treatment principles. CONCLUSION The decision-making process in pediatric deformity begins with appropriate diagnosis and classification of the deformity. Treatment decisions, both nonoperative and operative, are often predicated on the basis of the age of the patient and the natural history of the disorder.

scholarly journals Long-Term Outcomes of Scaphoid Malunion

Hand ◽  
2016 ◽  
Vol 12 (1) ◽  
pp. 26-30 ◽  
Author(s):  
Blake P. Gillette ◽  
Peter C. Amadio ◽  
Sanjeev Kakar
Keyword(s):  
Nonoperative Management ◽  
Corrective Osteotomy ◽  
Nonoperative Treatment ◽  
Long Term Outcomes ◽  
Single Institution ◽  
Surgical Evaluation ◽  
Long Term Follow Up ◽  
The Mean

Background: The optimal treatment of patients with a scaphoid malunion remains controversial. The long-term outcomes of operative and nonoperative management have not been established. Methods: We conducted a retrospective review of the outcomes of all scaphoid malunions treated at single institution over a 30-year period. This included patients who underwent corrective osteotomy, salvage procedures (ie, dorsal cheilectomy, radial styloidectomy, and scaphoidectomy with midcarpal fusion), and those who refused operative intervention. The Mayo Wrist Score was determined at the time of surgical evaluation. Patient-Rated Wrist Evaluation (PRWE) and Disabilities of the Arm, Shoulder and Hand (QuickDASH) surveys were sent to all patients for long-term follow-up. Results: Seventeen patients had follow-up at a mean 21.4 years (range, 12-30 years). The mean initial lateral intrascaphoid angle was 58°. Of the 17 patients, 11 proceeded with surgery and 6 opted for nonoperative management. A corrective osteotomy was performed in 4 patients. Of the remaining 7 surgical patients, 5 patients underwent procedures such as cheilectomy and radial styloidectomy, whereas 2 patients had a scaphoidectomy with midcarpal fusion. The final mean PRWE and QuickDASH scores for corrective osteotomy, salvage procedures, and nonoperative treatment were 23 and 6, 18 and 10, and 33 and 22, respectively. Conclusion: Long-term outcomes were similar between operative and nonoperative management.

Sacroiliac joint pain in the pediatric population

2012 ◽  
Vol 9 (6) ◽  
pp. 602-607 ◽  
Author(s):  
Ivan Stoev ◽  
Alexander K. Powers ◽  
Joan A. Puglisi ◽  
Rebecca Munro ◽  
Jeffrey R. Leonard
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Response To Treatment ◽  
Home Exercise ◽  
Dramatic Improvement ◽  
Minor Trauma ◽  
Low Back ◽  
Si Joint

Object The sacroiliac (SI) joint can be a pain generator in 13%–27% of cases of back pain in adults. These numbers are largely unknown for the pediatric population. In children and especially girls, development of the pelvic girdle makes the SI joint prone to misalignment. Young athletes sustain repeated stress on their SI joints, and sometimes even minor trauma can result in lasting pain that mimics radiculopathy. The authors present a series of 48 pediatric patients who were evaluated for low-back pain and were found to have SI joint misalignment as the cause of their symptoms. They were treated with a simple maneuver described in this paper that realigned their SI joint and provided significant improvement of symptoms. Methods A retrospective review of the electronic records identified 48 patients who were referred with primary complaints of low-back pain and were determined to have SI joint misalignment during bedside examination maneuvers described here. Three patients did not have a record of their response to treatment and were excluded. Patients were evaluated by a physical therapist and had the realignment procedure performed on the day of initial consultation. The authors collected data regarding the immediate effect of the procedure, as well as the duration of pain relief at follow-up visits. Results Eighty percent of patients experienced dramatic improvement in symptoms that had a lasting effect after the initial treatment. The majority of them were given a home exercise program, and only 2 of the 36 patients who experienced significant relief had to be treated again. Fifty-three percent of all patients had immediate and complete resolution of symptoms. Three of the 48 patients had missing data from the medical records and were excluded from computations. Conclusions Back pain is multifactorial, and the authors' data demonstrate the potential importance of SI joint pathology. Although the technique described here for treatment of misaligned SI joints in the pediatric patients is not effective in all, the authors have observed significant improvement in 80% of cases. Often it is difficult to determine the exact cause of back pain, but when the SI joint is suspected as the primary pathology, the authors have described a simple and effective bedside treatment that should be attempted prior to the initiation of further testing and surgery.

scholarly journals Comparative effectiveness of treatment options for displaced midshaft clavicle fractures

2021 ◽  
Vol 2 (8) ◽  
pp. 646-654
Author(s):  
John R. Martin ◽  
Patrick E. Saunders ◽  
Mark Phillips ◽  
Sean M. Mitchell ◽  
Michael D. Mckee ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Nonoperative Management ◽  
Meta Analysis ◽  
Treatment Options ◽  
Nonoperative Treatment ◽  
Cochrane Library ◽  
Surgical Fixation ◽  
Clavicle Fractures ◽  
And Function ◽  
Compression Plating

Aims The aims of this network meta-analysis (NMA) were to examine nonunion rates and functional outcomes following various operative and nonoperative treatments for displaced mid-shaft clavicle fractures. Methods Initial search strategy incorporated MEDLINE, PubMed, Embase, and the Cochrane Library for relevant randomized controlled trials (RCTs). Four treatment arms were created: nonoperative (NO); intramedullary nailing (IMN); reconstruction plating (RP); and compression/pre-contoured plating (CP). A Bayesian NMA was conducted to compare all treatment options for outcomes of nonunion, malunion, and function using the Disabilities of the Arm Shoulder and Hand (DASH) and Constant-Murley Shoulder Outcome scores. Results In all, 19 RCTs consisting of 1,783 clavicle fractures were included in the NMA. All surgical options demonstrated a significantly lower odds ratio (OR) of nonunion in comparison to nonoperative management: CP versus NO (OR 0.08; 95% confidence interval (CI) 0.04 to 0.17); IMN versus NO (OR 0.07; 95% CI 0.02 to 0.19); RP versus NO (OR 0.07; 95% CI: 0.01 to 0.24). Compression plating was the only treatment to demonstrate significantly lower DASH scores relative to NO at six weeks (mean difference -10.97; 95% CI -20.69 to 1.47). Conclusion Surgical fixation demonstrated a lower risk of nonunion compared to nonoperative management. Compression plating resulted in significantly less disability early after surgery compared to nonoperative management. These results demonstrate possible early improved functional outcomes with compression plating compared to nonoperative treatment. Surgical fixation of mid-shaft clavicle fractures with compression plating may result in quicker return to activity by rendering patients less disabled early after surgery. Cite this article: Bone Jt Open 2021;2(8):646–654.

scholarly journals Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury?

2018 ◽  
Vol 46 (9) ◽  
pp. 2103-2112 ◽  
Author(s):  
Elizabeth Wellsandt ◽  
Matthew J. Failla ◽  
Michael J. Axe ◽  
Lynn Snyder-Mackler
Keyword(s):  
Nonoperative Management ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Quadriceps Strength ◽  
Nonoperative Treatment ◽  
Joint Effusion ◽  
Long Term Outcomes ◽  
Radiographic Outcomes ◽  
Anterior Cruciate

Background: Current practice patterns for the management of anterior cruciate ligament (ACL) injury favor surgical reconstruction. However, long-term outcomes may not differ between patients completing operative and nonoperative treatment of ACL injury. Differences in outcomes between operative and nonoperative treatment of patients in the United States is largely unknown, as are outcomes in long-term strength and performance measures. Purpose: To determine if differences exist in 5-year functional and radiographic outcomes between patients completing operative and nonoperative treatment of ACL injury when both groups complete a progressive criterion-based rehabilitation protocol. Study Design: Cohort study; Level of evidence, 2. Methods: From an original group of 144 athletes, 105 participants (mean ± SD age, 34.3 ± 11.4 years) with an acute ACL rupture completed functional testing (quadriceps strength, single-legged hop, and knee joint effusion testing; patient-reported outcomes) and knee radiographs 5 years after ACL reconstruction or completion of nonoperative rehabilitation. Results: At 5 years, patients treated with ACL reconstruction versus rehabilitation alone did not differ in quadriceps strength ( P = .817); performance on single-legged hop tests ( P = .234-.955); activity level ( P = .349-.400); subjective reports of pain, symptoms, activities of daily living, and knee-related quality of life ( P = .090-.941); or presence of knee osteoarthritis ( P = .102-.978). When compared with patients treated nonoperatively, patients treated operatively did report greater global ratings of knee function ( P = .001), and lower fear ( P = .035) at 5 years but were more likely to possess knee joint effusion ( P = .016). Conclusion: The current findings indicate that favorable outcomes can occur after both operative and nonoperative management approaches with the use of progressive criterion-based rehabilitation. Further study is needed to determine clinical algorithms for identifying the best candidates for surgical versus nonoperative care after ACL injury. These findings provide an opportunity to improve the educational process between patients and clinicians regarding the expected clinical course and long-term outcomes of operative and nonoperative treatment of ACL injuries.

scholarly journals Effectiveness of Non-operative Treatment of Symptomatic Accessory Navicular in Pediatric Patients

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0034
Author(s):  
Malynda Messer ◽  
Candice Brady ◽  
Kristin Cola ◽  
Jaime Rice-Denning
Keyword(s):  
Pain Relief ◽  
Operative Treatment ◽  
Pediatric Patients ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Nonoperative Treatment ◽  
Type I ◽  
First Line ◽  
Complete Pain Relief ◽  
Accessory Navicular

Category: Midfoot/Forefoot Introduction/Purpose: Initial management of symptomatic accessory naviculae in pediatric patients is nonoperative. Common first line treatments include casting, shoe wear modification, limiting strenuous activities, and nonsteroidal anti-inflammatories. When nonoperative treatments fail to mitigate symptoms, surgery is indicated. Surgical treatment of symptomatic accessory navicular bones has been extensively studied. However, the efficacy of nonoperative treatment for alleviating pain or preventing surgery in effected patients has not been established. We believe that nonoperative treatment is frequently unsuccessful or does not give lasting pain relief, thus questioning whether surgery could be offered as first line treatment. Our study retrospectively reviews outcomes of adolescents treated non-operatively for symptomatic accessory naviculae in an effort to provide clinicians success rates for their discussion of treatment options with patients and their families. Methods: This is an IRB approved, retrospective study of adolescent patients diagnosed and treated non-operatively for symptomatic accessory navicular bones at Cincinnati Children’s Hospital Medical Center between the dates 8/1/2006 and 8/24/2016. Medical records were used to identify demographic information, type, duration, and total trials of conservative treatment, additional foot comorbidities, response to conservative management, and surgery if non-operative management failed. Included patients were under 18 years of age with medial sided foot pain, radiographic evidence of an accessory navicular, and had undergone at least 1 course of non-operative treatment. Patients with previously operated on accessory naviculars or other diagnosed painful foot conditions were excluded. Outcome measures consisted of pain relief, no surgical intervention, or need for surgical intervention. Available radiographic imaging for each patient was also used to identify type of accessory navicular and determine pes planus incidence. Statistical analysis using measures of central tendency was then performed. Results: 169 patients were included, with 226 symptomatic accessory naviculae. Average age at diagnosis was 11.8 years, with 78.2% females, and 22% males. 53 (32%) were left symptomatic accessory naviculae, 56 (33%) right, and 60 (36%) bilateral. Type II accessory naviculae were most frequent (72.7%), with Type I and Type III in 9.7% and 17.4%, respectively. 56% were chronic in nature, with 31% due to acute injury. Average number of non-operative trials was 2.08, with 28% experiencing complete pain relief, 30% requiring surgical intervention, and 41% that did not require surgical intervention, but were without documented pain relief. Of those that achieved complete pain relief, average length of non-operative treatment was 8.03 months. Conclusion: Results of this study can be used by clinicians to frame discussions surrounding treatment options for symptomatic accessory navicular bones with both patients and their families. Further research is warranted to determine the necessary duration and type of non-operative treatment, among those most commonly used, that is most successful in providing pain relief.

Early Uncomplicated Appendicitis—Who Can We Treat Nonoperatively?

2018 ◽  
Vol 84 (2) ◽  
pp. 174-180 ◽  
Author(s):  
Mark C. Horattas ◽  
Ileana K. Horattas ◽  
Elya M. Vasiliou
Keyword(s):  
Clinical Practice ◽  
Scoring System ◽  
Selection Criteria ◽  
Nonoperative Management ◽  
Nonoperative Treatment ◽  
The Other ◽  
Nonoperative Therapy ◽  
Uncomplicated Appendicitis ◽  
Scoring Algorithm ◽  
Appendicitis Score

This study evaluated nonoperative treatment for mild appendicitis and reviewed selection criteria to be used in introducing this option into clinical practice. A retrospective review of 73 consecutive cases of appendicitis treated by a single surgeon from 2011 to 2013 was completed. Patients who were diagnosed with mild appendicitis meeting the criteria of an APPENDICITIS scoring algorithm proposed in this manuscript were considered for nonoperative management. An additional 17 patients with mild appendicitis were offered and successfully treated nonoperatively between 2014 and 2016 and reviewed. Of these original 73 patients, 37 had moderate to severe appendicitis and directly underwent appendectomy. The remaining patients were diagnosed with mild appendicitis and considered eligible for nonoperative management. Of these, 14 patients were offered nonoperative therapy. Thirteen responded successfully; one patient responded partially, but later opted for surgery. In 2014, this scoring system and preliminary results were shared with the other surgeons in our department. Nonoperative management was then selectively adopted by a few of the surgeons from 2014 to 2016 with another 17 patients (APPENDICITIS score of 0 or 1) being offered and successfully managed nonoperatively. Patients with mild or early appendicitis can be successfully managed nonoperatively. A proposed APPENDICITIS scoring system may provide a helpful mnemonic for successfully selecting patients for this option.

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