Clinical Analysis of Pyocele of Tunica Vaginalis in 56 Newborns

2021 ◽  
pp. 1-6
Author(s):  
Tian-Qu He ◽  
Li-Hui Zhu ◽  
Chuang-Ye Li ◽  
Qian-Long Peng ◽  
Jian-Cheng Zu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Recovery Time ◽  
Pathogenic Bacteria ◽  
Color Doppler ◽  
Tunica Vaginalis ◽  
Term Infants ◽  
Surgical Exploration ◽  
Clinical Recovery

<b><i>Objective:</i></b> This study aimed to explore the clinical characteristics, treatment methods, and prognosis of neonatal pyocele of tunica vaginalis and to provide a reference for the clinical treatment. <b><i>Methods:</i></b> A total of 56 newborns with pyocele of tunica vaginalis were admitted to our hospital due to the scrotal emergency from January 2015 to January 2020. Our study retrospectively analyzed these 56 cases. Of the 56 cases, including 32 full-term infants and 24 premature infants, age ranged from 1 to 27 days. Initially, conservative treatment (intravenous antibiotic treatment) was applied to 42 cases, and surgery to 14 cases. Then, 7 underwent surgical exploration during the conservative treatment, and 2 cases with initial surgical treatment experienced orchiectomy because of complete necrosis. For 56 cases, the average follow-up time was 18 months. <b><i>Results:</i></b> The clinical recovery time of cases with conservative treatment ranged from 8 to 17 days, with an average of 11.02 ± 2.31 days. The clinical recovery time of cases with surgery ranged from 6 to 15 days, with an average of 9.28 ± 2.78 days. During the follow-up, for 56 cases, except for the 2 cases with orchiectomy, the testicular position and Doppler flow both went back to normal, of the 42 cases with initial conservative treatment, 1 case experienced testicular retardation, of the 14 cases with initial surgical treatment, 2 cases experienced testicular retardation, and hydrocele of 42 cases were self-healed. <b><i>Conclusions:</i></b> Neonatal pyocele of tunica vaginalis is mostly secondary to intra-abdominal infection. Color Doppler ultrasound is helpful for the diagnosis. The percutaneous aspiration is a way of collecting pathogenic bacteria during the conservative treatment. If the color Doppler suggests testicular involvement, surgical exploration should be performed.

scholarly journals Effect of childhood overweight on distal metaphyseal radius fractures treated by closed reduction

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu Liu ◽  
Chunjie Liu ◽  
Dongmei Guo ◽  
Ning Wang ◽  
Ying Zhao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Closed Reduction ◽  
Pediatric Population ◽  
Normal Weight ◽  
Medical Community ◽  
Overweight Children ◽  
Radius Fractures

Abstract Background The medical community has recognized overweight as an epidemic negatively affecting a large proportion of the pediatric population, but few studies have been performed to investigate the relationship between overweight and failure of conservative treatment for distal radius fractures (DRFs). This study was performed to investigate the effect of overweight on the outcome of conservative treatment for DRFs in children. Methods We performed a retrospective study of children with closed displaced distal metaphyseal radius fractures in our hospital from January 2015 to May 2020. Closed reduction was initially performed; if closed reduction failed, surgical treatment was performed. Patients were followed up regularly after treatment, and redisplacement was diagnosed on the basis of imaging findings. Potential risk factors for redisplacement were collected and analyzed. Results In total, 142 children were included in this study. The final reduction procedure failed in 21 patients, all of whom finally underwent surgical treatment. The incidences of failed final reduction and fair reduction were significantly higher in the overweight/obesity group than in the normal-weight group (P = 0.046 and P = 0.041, respectively). During follow-up, 32 (26.4%) patients developed redisplacement after closed reduction and cast immobilization. The three risk factors associated with the incidence of redisplacement were overweight/obesity [odds ratio (OR), 2.149; 95% confidence interval (CI), 1.320–3.498], an associated ulnar fracture (OR, 2.127; 95% CI, 1.169–3.870), and a three-point index of ≥ 0.40 (OR, 3.272; 95% CI, 1.975–5.421). Conclusions Overweight increases the risk of reduction failure and decreases the reduction effect. Overweight children were two times more likely to develop redisplacement than normal-weight children in the present study. Thus, overweight children may benefit from stricter clinical follow-up and perhaps a lower threshold for surgical intervention.

Surgical Treatment of a Symptomatic Diaphyseal Tibiofibular Synostosis in a Professional Rugby Player: A Case Report and Literature Review

2021 ◽  
pp. 1-7
Author(s):  
Guillaume Mirouse ◽  
Houssam Bouloussa ◽  
Hervé Silbert ◽  
Emad Lotfalizadeh ◽  
Arnaud Dubory
Keyword(s):  
Conservative Treatment ◽  
Recovery Time ◽  
Sport Activity ◽  
Unknown Origin ◽  
Rugby Player ◽  
Interosseous Membrane ◽  
Case Presentation ◽  
Senior Patients ◽  
Return To Competition

Context: Diaphyseal tibiofibular synostosis (DTS) is a rare pathology with unknown origin especially occurring in intensive sport athletes. No therapeutic guideline has been well established in the literature. Case Presentation: A rare case of DTS in a 26-year-old professional rugby player has been described. A 5-month exhaustive conservative treatment including physiotherapy and oral medication has been achieved but failed. Management and Outcomes: Following the conservative treatment failure, the DTS has been widely removed including the adjacent interosseous membrane, and the patient could return to competition at the same level after 5 months of convalescence. No recurrence has been revealed at a 35-month follow-up at least. Conclusion: In accordance with the literature data and even if the pathophysiology remains obscure, resection of DTS seems to be the adapted treatment to allow and to reduce professional athletes’ recovery time at the same sport level. The resection including a part of the tibiofibular interosseous membrane could avoid the occurrence of recurrence. Conservative treatment should be reserved for senior patients with a low sport activity.

scholarly journals Grisel’s Syndrome in Children: Two Case Reports and Systematic Review of the Literature

2020 ◽  
Vol 2020 ◽  
pp. 1-11
Author(s):  
Nicole Pini ◽  
Martina Ceccoli ◽  
Patrizia Bergonzini ◽  
Lorenzo Iughetti
Keyword(s):  
Systematic Review ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Early Diagnosis ◽  
Head And Neck ◽  
Case Reports ◽  
Atlantoaxial Joint ◽  
Review Of The Literature ◽  
Grisel’S Syndrome

Background and Objective. Grisel’s syndrome is a rare syndrome characterized by nontraumatic rotatory subluxation of the atlantoaxial joint. It usually affects children and typically presents with torticollis after ear, nose, and throat (ENT) surgery or head and neck infections. In the pediatric literature, there is only a small amount of available data; moreover, no systematic review has been previously done with focus on the pediatric population. We report our experience of two cases, and we provide a systematic review on Grisel’s syndrome in children in order to offer a deeper insight about its clinical presentation, its current diagnosis, and principles of treatment. Case Reports and Review. We describe two boys of 9 and 8 years old, who developed atlantoaxial subluxation after adenoidectomy. Considering the early diagnosis, a conservative treatment was chosen, with no recurrence and no sequelae at follow-up. We identified 114 case reports, of which 90 describe children, for a total of 171 pediatric patients. Of the 154 cases in which cause was reported, 59.7% presented a head and neck infection and 35.7% had previous head and neck surgery. There is no sex prevalence (49.7% males versus 50.2% females). Mean delay in diagnosis is 33 days. Eight % of the patients had neurological impairment of the 165 cases which mentioned treatment, 96% underwent a conservative treatment, of whom the 8.8% recurred with the need of surgery. As a whole, 12% underwent surgery as a first- or second-line treatment. 3 6% of the patients whose follow-up was reported developed a sequela, minor limitation of neck movement being the most frequent. Conclusion. Grisel’s syndrome should be suspected in children with painful unresponsive torticollis following ENT procedures or head and neck inflammation. CT scan with 3D reconstruction is the gold standard for diagnosis, allowing the identification of the subluxation and the classification according to the Fielding–Hawkins grading system. Surgical treatment is indicated in case of high-grade instability or failure of conservative treatment. Review of the literature shows how early diagnosis based on clinical and radiological evaluation is crucial in order to avoid surgical treatment and neurologic sequelae.

Surgical treatment of spontaneous spinal cerebrospinal fluid leaks

1998 ◽  
Vol 88 (2) ◽  
pp. 243-246 ◽  
Author(s):  
Wouter I. Schievink ◽  
Vittorio M. Morreale ◽  
John L. D. Atkinson ◽  
Fredric B. Meyer ◽  
David G. Piepgras ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Intracranial Hypotension ◽  
Csf Leak ◽  
Preoperative Imaging ◽  
Content Type ◽  
Surgical Exploration ◽  
Fine Print ◽  
Csf Leaks

Object. Spontaneous spinal cerebrospinal fluid (CSF) leaks are an increasingly recognized cause of intracranial hypotension and may require neurosurgical intervention. In the present report the authors review their experience with the surgical management of spontaneous spinal CSF leaks. Methods. Between 1992 and 1997, 10 patients with spontaneous spinal CSF leaks and intracranial hypotension were treated surgically. The mean age of the seven women and three men was 42.3 years (range 22–61 years). Preoperative imaging showed a single meningeal diverticulum in two patients, a complex of diverticula in one patient, and a focal CSF leak alone in seven patients. Surgical exploration in these seven patients demonstrated meningeal diverticula in one patient; no clear source of CSF leakage could be identified in the remaining six patients. Treatment consisted of ligation of the diverticula or packing of the epidural space with muscle or Gelfoam. Multiple simultaneous spinal CSF leaks were identified in three patients. Conclusions. All patients experienced complete relief of their headaches postoperatively. There has been no recurrence of symptoms in any of the patients during a mean follow-up period of 19 months (range 3–58 months; 16 person-years of cumulative follow up). Complications consisted of transient intracranial hypertension in one patient and leg numbness in another patient. Although the disease is often self-limiting, surgical treatment has an important role in the management of spontaneous spinal CSF leaks. Surgery is effective in eliminating the headaches and the morbidity is generally low. Surgical exploration for a focal CSF leak, as demonstrated on radiographic studies, usually does not reveal a clear source of the leak. Some patients may have multiple simultaneous CSF leaks.

Asymptomatic lipomas of the medullary conus: surgical treatment versus conservative management

2014 ◽  
Vol 14 (3) ◽  
pp. 245-254 ◽  
Author(s):  
Giuseppe Talamonti ◽  
Giuseppe D'Aliberti ◽  
Michele Nichelatti ◽  
Alberto Debernardi ◽  
Marco Picano ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Statistical Significance ◽  
Tethered Cord ◽  
Conus Medullaris ◽  
Tethered Cord Syndrome ◽  
Prophylactic Surgery ◽  
Long Term Results

Object The goal of this study was to compare long-term results of surgery with the outcomes of conservative treatment in patients with asymptomatic lipomas of the conus medullaris. Methods The parents of 56 consecutive children with a diagnosis of asymptomatic lipoma of the conus medullaris underwent detailed neurosurgical consultation. The pros and cons of both prophylactic surgery and conservative treatment were carefully presented. Both options were offered, and the parents were free to choose the preferred management. A total of 32 children underwent surgical treatment, and 24 were conservatively treated. Afterward, all patients entered the same protocol of serial neurological and urological follow-up at the Centro Spina Bifida. The mean follow-up periods were 9.7 years in the surgical treatment group and 10.4 years in the conservative treatment group. Results Permanent surgical morbidity was 3.1% (1 patient). During follow-up, tethered cord syndrome occurred in 9.7% of the surgically treated patients (3 of 32 patients) and in 29.1% of the conservatively managed children (7 of 24 patients). This difference did not result in statistical significance, but a clear trend in favor of surgery emerged. Young age at surgery and a cord/sac ratio < 50% appeared to be determining factors in the prevention of subsequent tethered cord syndrome. Conclusions The small size of this series does not provide enough statistical evidence that surgical treatment can really improve the natural history of asymptomatic lipomas of the conus medullaris. Nevertheless, surgery appears at least advisable since it reduces by 75% the odds of TCS (p = 0.067), which is quite close to statistical significance.

scholarly journals Traumatic lesions of internal saphenous nerve and branches

2009 ◽  
Vol 67 (3b) ◽  
pp. 897-899
Author(s):  
Flávio Freinkel Rodrigues ◽  
Issac Skartz ◽  
Diego Cassol Dozza ◽  
Maurício Moscovici ◽  
Mendel Suchmacher
Keyword(s):  
Surgical Treatment ◽  
Surgical Technique ◽  
Conservative Treatment ◽  
Saphenous Nerve ◽  
Nerve Lesion ◽  
Vascular Disorder ◽  
Total Pain ◽  
Traumatic Lesions ◽  
Rare Lesion

OBJECTIVE: To show a rare lesion that sometimes simulates vascular disorder of the lower extremities. METHOD: Three patients were operated and the follow-up period was eight months, the surgical technique was neurotomy of the infrapatellar and descendent branches. RESULTS: In two cases there were almost total pain resolution, and in other case improvement only. CONCLUSION: Surgical treatment yields good results in this type of internal saphenous nerve lesion, and could be useful as an alternative to conservative treatment.

scholarly journals Decompressive craniectomy versus conservative treatment: limits and possibilities in malignant stroke

2020 ◽  
Vol 78 (6) ◽  
pp. 349-355
Author(s):  
Isaac Holanda Mendes MAIA ◽  
Thaissa Pinto de MELO ◽  
Fabrício Oliveira LIMA ◽  
João José de Freitas CARVALHO ◽  
Francisco José Arruda MONT’ALVERNE ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Decompressive Craniectomy ◽  
Statistical Significance ◽  
Northeastern Brazil ◽  
Malignant Infarction ◽  
To Receive ◽  
Surgical Group

ABSTRACT Background: Malignant infarction of the middle cerebral artery (MCA) occurs in a subgroup of patients with ischemic stroke and early decompressive craniectomy (DC) is one of its treatments. Objective: To investigate the functional outcome of patients with malignant ischemic stroke treated with decompressive craniectomy at a neurological emergency center in Northeastern Brazil. Methods: Prospective cohort study, in which 25 patients were divided into two groups: those undergoing surgical treatment with DC and those who continued to receive standard conservative treatment (CT). Functionality was assessed using the modified Rankin Scale (mRS), at follow-up after six months. Results: A favorable outcome (mRS≤3) was observed in 37.5% of the DC patients and 29.4% of CT patients (p=0.42). Fewer patients who underwent surgical treatment died (25%), compared to those treated conservatively (52.8%); however, with no statistical significance. Nonetheless, the proportion of patients with moderate to severe disability (mRS 4‒5) was higher in the surgical group (37.5%) than in the non-surgical group (17.7%). Conclusion: In absolute values, superiority in the effectiveness of DC over CT was perceived, showing that the reduction in mortality was at the expense of increased disability.

scholarly journals Influence of Surgical Treatment on Complications, Readmissions and Clinical Progress of Breast Cancer in Women Participating in Breast Cancer Screening Programs

2021 ◽  
Author(s):  
Lidia Blay ◽  
Anna Jansana ◽  
Javier Louro ◽  
Joana Ferrer ◽  
Marisa Baré ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Cancer Screening ◽  
Conservative Treatment ◽  
Breast Cancer Screening ◽  
Breast Surgery ◽  
Surgical Techniques ◽  
Screening Programs ◽  
Hazard Ratios

Abstract BackgroundComplications and readmissions derived from surgical treatment of breast cancer have been scarcely evaluated. The studies that compare mastectomy with conservative, usually focus only in recurrence and/or mortality and sometimes the results are discordant in some aspects. The aim of this study was to analyze complications and readmissions, recurrence and mortality, according to the surgical treatment received in the mammary gland.Methods This multicenter study included 1086 women diagnosed with breast cancer from the CaMISS cohort study of women aged between 50 and 69 years participating in 4 breast cancer screening programs in Spain between 2000 and 2009 with a follow up until 2014. Multivariate models were used to estimate the adjusted odds ratio of breast surgery (mastectomy vs conservative treatment) for complications and readmissions and hazard ratios for recurrences and mortality.Results Primary breast surgical treatment consisted of conservative treatment in 821 women (80.1%) and mastectomy in 204 (19.9%). Mastectomy was associated with readmissions, recurrences and mortality but this association was not statistically significant on multivariate adjusted analysis (ORa=1.51 [95%CI 0.89-2.57], HRa=1.37 [95%CI 0.85-2.19] and HRa=1.52 [95%CI 0.95-2.43] respectively). In our sample, the variables with greatest impact on complications, recurrences and mortality were stages III and IV (ORa=4.4 [95%CI 1.22-16.16], HRa=7.96 [95%CI 3.32-19.06] and HRa=3.92 [95%CI 1.77-8.67]). Conclusion Complications, readmissions, recurrence and mortality were similar in both surgical techniques. These results support that surgical treatment for breast cancer can be adapted to professional and health system circumstances, and to the surgical needs and desires of each patient.

Treatment of spontaneous anterior interosseous nerve palsy

2020 ◽  
Vol 132 (4) ◽  
pp. 1243-1248
Author(s):  
Narihito Kodama ◽  
Kosei Ando ◽  
Yoshinori Takemura ◽  
Shinji Imai
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Symptom Onset ◽  
Nerve Palsy ◽  
Manual Muscle Test ◽  
Anterior Interosseous Nerve ◽  
The Mean ◽  
Initial Recovery ◽  
Grade 3

OBJECTIVEThe purpose of this study was to clarify the clinical outcomes of spontaneous anterior interosseous nerve palsy (AINP) treated nonsurgically or surgically.METHODSThe authors retrospectively evaluated the clinical course of 27 patients affected with AINP, treated nonsurgically or surgically. Thirteen patients underwent surgical treatment (interfascicular neurolysis), and 14 patients underwent conservative nonsurgical treatment. The mean patient age at the onset of symptoms was 49 years (range 17–77 years). The mean follow-up duration from onset to the latest follow-up examination was 23 months (range 12–38 months).RESULTSIn 12 of 14 patients receiving conservative treatment, signs of recovery from the palsy were obtained within 6 months. These patients showed a recovery of manual muscle test (MMT) grade ≥ 3. In contrast, 2 patients who took more than 12 months from symptom onset to initial recovery showed poor recovery (MMT grade ≤ 2). Surgical treatment was performed in 13 patients because of no sign of recovery from palsy. The mean period from symptom onset to the operation was 8.4 months (range 6–14 months). Ten of 13 patients who underwent surgical treatment within 8 months after symptom onset showed good recovery, with MMT grade ≥ 4. However, 3 patients who underwent surgical treatment more than 12 months after onset showed recovery with MMT grade ≤ 3.CONCLUSIONSConservative treatment for AINP may be continued when patients show signs of recovery within 6 months after symptom onset. In contrast, surgical treatment may be performed within 8 months from the onset of symptoms when the patients show no recovery signs for 6 months.

scholarly journals A Case of Pincer Nail Successfully Treated with Tazarotene 0.1% Gel

2020 ◽  
Vol 12 (2) ◽  
pp. 114-118 ◽  
Author(s):  
Laura Vollono ◽  
Ester Del Duca ◽  
Sara Mazzilli ◽  
Luca Bianchi ◽  
Terenzio Cosio ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Therapeutic Agent ◽  
Functional Limitation ◽  
Common Condition ◽  
Invasive Procedures ◽  
Nail Bed ◽  
Temporary Relief ◽  
First Case

Pincer nail is a common condition characterized by excessive transverse nail curvature, progressively pinching the nail bed distally, resulting in cosmetic discomfort, pain and functional limitation. Treatment is difficult and often unsatisfactory. Surgical treatment performed by experienced physicians provides good outcomes. However, patients usually hesitate to undergo invasive procedures, preferring conservative treatments. Unfortunately, these mainly offer only temporary relief and recurrence rate is high. Topical tazarotene has been used in several nail conditions, but its potential remains not fully elucidated. We herewith present a case of pincer nails in a 35-year-old woman successfully treated with tazarotene 0.1% gel applied topically twice a day for 3 months who did not experience recurrence at 1-year follow-up. At 1-year follow-up, no recurrence has been observed. To our knowledge, this is the first case of pincer nails successfully treated with tazarotene 0.1% gel. With our report, we suggest topical tazarotene as a novel, effective conservative treatment of milder cases of this common, albeit disturbing condition. Although our report may not be sufficient to generalize the results, it paves the way for larger studies investigating the potential of this fast, noninvasive therapeutic agent.

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