scholarly journals Vaginal Extrusion of Transobturator Tape 6 Years after Procedure: How Long Should Be the Follow-Up Period after Vaginal Sling Surgeries?

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Chanchal Singh ◽  
Roy Ng Kwok Weng
Keyword(s):  
Stress Incontinence ◽  
Conservative Management ◽  
Outpatient Clinic ◽  
Standard Of Care ◽  
Transobturator Tape ◽  
Synthetic Material ◽  
Sling Procedure ◽  
Vaginal Erosion

A 77-year-old lady presented to the gynaecology outpatient clinic with vaginal extrusion (3C/T3/S1) six years after a transobturator suburethral sling procedure (TOT). The entire tape was spontaneously extruded vaginally and the vaginal erosion healed with conservative management. Midurethral tapes, currently the standard of care in the management of urodynamic stress incontinence (USI), are associated with a risk of erosion and extrusion of the synthetic material. The present case highlights the importance of the long-term followup after any sling procedure as erosion and/or extrusion may arise at any time following the procedure.

Vaginocutaneous fistula: A rare long-term complication of transobturator tape procedure for stress urinary incontinence

2020 ◽  
pp. 039156032094726
Author(s):  
Uygar Micoogullari ◽  
Cem Yucel ◽  
Volkan Ulker ◽  
Mehmet Zeynel Keskin ◽  
Orcun Celik
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Transobturator Tape ◽  
Female Stress Urinary Incontinence ◽  
Complication Rates ◽  
Sling Procedure ◽  
Long Term Follow Up ◽  
Delayed Complications

Introduction: Synthetic mid-urethral slings are currently the most common performed surgical procedure for the treatment of female stress urinary incontinence. The transobturator mid-urethral sling technique has been widely accepted owing to its high success and low complication rates. Although complications are rarely seen, it may cause significant morbidity. Case presentation: We report a case of vaginocutaneous fistula following transobturator mid-urethral sling procedure and a successful reconstruction with transvaginal sling excision and fistula closure. Conclusion: Vaginocutaneous fistula is a known but rarely seen long-term complication of transobturator tape. With an increased use of mesh, various delayed complications can be seen in the long-term follow-up. This case showed us the need for longer and detailed studies that evaluate the effectiveness and safety of the transobturator tape procedure.

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

The Conservative Management of Bennett’s Fracture-Dislocation: A 26-Year Follow-Up

1990 ◽  
Vol 15 (3) ◽  
pp. 291-294
Author(s):  
P. J. LIVESLEY
Keyword(s):  
Conservative Management ◽  
Fracture Dislocation ◽  
Range Of Movement ◽  
Term Outcome ◽  
Long Term Outcome ◽  
The Poor ◽  
Bennett’S Fracture ◽  
Hand Radiographs

Seventeen patients who had suffered a Bennett’s fracture-dislocation have been reviewed with an average follow up of 26 years. All were treated conservatively. At review, only seven patients had symptoms, but all had a decreased range of movement and grip strength. Twelve had a characteristic deformity in the hand. Radiographs showed persistent subluxation of the first carpo-metacarpal joint and marked degenerative changes. We suggest that, in the light of the poor long-term outcome, this injury should not be managed conservatively but by some operative means.

scholarly journals Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature

2016 ◽  
Vol 64 (2) ◽  
pp. 212-218
Author(s):  
Paulo de Camargo MORAES ◽  
Luiz Alexandre THOMAZ ◽  
Milena Bortolotto Felippe SILVA ◽  
José Luiz Cintra JUNQUEIRA ◽  
Rubens Gonçalves TEIXEIRA
Keyword(s):  
Conservative Management ◽  
Three Dimensional ◽  
Clinical Aspect ◽  
Dental Extraction ◽  
Review Of Literature ◽  
Nonoperative Therapy ◽  
Exposed Bone ◽  
Regular Review

ABSTRACT Osteoradionecrosis of jaws is one of the most serious complications of radiation therapy for head and neck malignancies. The management of osteoradionecrosis continues to be debated and there are few cases which can be resolved with conservative management. This paper presents a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man and highlights the conservative therapeutic management and 3-year follow-up period. We combined a conservative nonoperative therapy, including long-term antibiotic therapy and daily irrigation with chlorhexidine mouthrinses in a case of osteoradionecrosis after a dental extraction affecting the mandible of a 58-year-old man. At the follow-up, clinical aspect was resolved. A CBCT scan image and a three-dimensional (3D) reconstructed image revealed bone remodeling in a 3-year follow-up period .No sign of exposed bone could be seen. Follow-up 3 years later revealed that the conservative management posed was successful for osteoradionecrosis and the patient is currently under regular review.

Long-term effectiveness of CBT for anxiety disorders in an adult outpatient clinic sample: A follow-up study

2013 ◽  
Vol 51 (2) ◽  
pp. 82-86 ◽  
Author(s):  
Jennifer DiMauro ◽  
Janine Domingues ◽  
Geraldine Fernandez ◽  
David F. Tolin
Keyword(s):  
Anxiety Disorders ◽  
Outpatient Clinic ◽  
Follow Up Study ◽  
Clinic Sample ◽  
Adult Outpatient

scholarly journals Organ damage in patients treated with belimumab versus standard of care: a propensity score-matched comparative analysis

2019 ◽  
Vol 78 (3) ◽  
pp. 372-379 ◽  
Author(s):  
Murray B Urowitz ◽  
Robert L Ohsfeldt ◽  
Ronald C Wielage ◽  
Kari A Kelton ◽  
Yumi Asukai ◽  
...  
Keyword(s):  
Propensity Score ◽  
Lupus Erythematosus ◽  
Damage Index ◽  
Standard Of Care ◽  
Organ Damage ◽  
Systemic Lupus ◽  
American College Of Rheumatology ◽  
Damage Progression

ObjectivesThe study (206347) compared organ damage progression in patients with systemic lupus erythematosus (SLE) who received belimumab in the BLISS long-term extension (LTE) study with propensity score (PS)-matched patients treated with standard of care (SoC) from the Toronto Lupus Cohort (TLC).MethodsA systematic literature review identified 17 known predictors of organ damage to calculate a PS for each patient. Patients from the BLISS LTE and the TLC were PS matched posthoc 1:1 based on their PS (±calliper). The primary endpoint was difference in change in Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI) score from baseline to 5 years.ResultsFor the 5- year analysis, of 567 (BLISS LTE n=195; TLC n=372) patients, 99 from each cohort were 1:1 PS matched. Change in SDI score at Year 5 was significantly lower for patients treated with belimumab compared with SoC (−0.434; 95% CI –0.667 to –0.201; p<0.001). For the time to organ damage progression analysis (≥1 year follow-up), the sample included 965 (BLISS LTE n=259; TLC n=706) patients, of whom 179 from each cohort were PS-matched. Patients receiving belimumab were 61% less likely to progress to a higher SDI score over any given year compared with patients treated with SoC (HR 0.391; 95% CI 0.253 to 0.605; p<0.001). Among the SDI score increases, the proportion of increases ≥2 was greater in the SoC group compared with the belimumab group.ConclusionsPS-matched patients receiving belimumab had significantly less organ damage progression compared with patients receiving SoC.

scholarly journals Management of appendicitis during COVID-19 pandemic; short-term outcomes

2020 ◽  
Vol 65 (4) ◽  
pp. 144-148
Author(s):  
Radhakrishnan Ganesh ◽  
James Lucocq ◽  
Neville Ogbonnia Ekpete ◽  
Noor Ul Ain ◽  
Su Kwan Lim ◽  
...  
Keyword(s):  
Conservative Management ◽  
Short Term ◽  
Mri Scan ◽  
Operative Outcomes ◽  
Uncomplicated Appendicitis ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Surgical Conditions

Background and aim COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19. Methods Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups. Results One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups. Conclusion CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.

Long-Term Update of Stereotactic Radiosurgery for Benign Spinal Tumors

Neurosurgery ◽  
2018 ◽  
Vol 85 (5) ◽  
pp. 708-716 ◽  
Author(s):  
Alexander L Chin ◽  
Dylann Fujimoto ◽  
Kiran A Kumar ◽  
Laurie Tupper ◽  
Salma Mansour ◽  
...  
Keyword(s):  
Stereotactic Radiosurgery ◽  
Cumulative Incidence ◽  
Standard Of Care ◽  
Incidence Rates ◽  
Spinal Tumors ◽  
Secondary Malignancy ◽  
Intracranial Tumors ◽  
Symptom Response

Abstract BACKGROUND Stereotactic radiosurgery (SRS) for benign intracranial tumors is an established standard of care. The widespread implementation of SRS for benign spinal tumors has been limited by lack of long-term data. OBJECTIVE To update our institutional experience of safety and efficacy outcomes after SRS for benign spinal tumors. METHODS We performed a retrospective cohort study of 120 patients with 149 benign spinal tumors (39 meningiomas, 26 neurofibromas, and 84 schwannomas) treated with SRS between 1999 and 2016, with follow-up magnetic resonance imaging available for review. The primary endpoint was the cumulative incidence of local failure (LF), with death as a competing risk. Secondary endpoints included tumor shrinkage, symptom response, toxicity, and secondary malignancy. RESULTS Median follow-up was 49 mo (interquartile range: 25-103 mo, range: 3-216 mo), including 61 courses with >5 yr and 24 courses with >10 yr of follow-up. We observed 9 LF for a cumulative incidence of LF of 2%, 5%, and 12% at 3, 5, and 10 yr, respectively. Excluding 10 tumors that were previously irradiated or that arose within a previously irradiated field, the 3-, 5-, and 10-yr cumulative incidence rates of LF were 1%, 2%, and 8%, respectively. At last follow-up, 35% of all lesions had decreased in size. With a total of 776 patient-years of follow-up, no SRS-related secondary malignancies were observed. CONCLUSION Comparable to SRS for benign intracranial tumors, SRS provides longer term local control of benign spinal tumors and is a standard-of-care alternative to surgical resection.

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