Optimization of complex conservative treatment to patients of advanced and old age with atherosclerosis obliterans of lower limb arteries Stage II

ObjectiveTo evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT).DesignSystematic review.Eligibility criteriaRandomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated.ResultsModerate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting.ConclusionLow level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

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conservative treatment of stage II breast cancer patients with simultaneous mammoplastic operations

European Journal of Cancer ◽

10.1016/s0959-8049(98)80207-4 ◽

1998 ◽

Vol 34 ◽

pp. S52

Author(s):

V. Ostapenko ◽

T. Pipirienė ◽

K. Valuckas

Keyword(s):

Breast Cancer ◽

Conservative Treatment ◽

Cancer Patients ◽

Stage Ii ◽

Breast Cancer Patients

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Outcome of Asymptomatic Osteochondritis Dissecans of the Capitellum in Adolescent Baseball Players

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967117s00121 ◽

2017 ◽

Vol 5 (3_suppl3) ◽

pp. 2325967117S0012

Author(s):

Tetsuya Matsuura ◽

Toshiyuki Iwame ◽

Naoto Suzue ◽

Koichi Sairyo

Keyword(s):

Conservative Treatment ◽

Osteochondritis Dissecans ◽

Early Stage ◽

Stage I ◽

Stage Ii ◽

Radiological Outcome ◽

Loose Bodies ◽

Baseball Players ◽

Complete Repair

Objectives: Osteochondritis dissecans (OCD) of the capitellum is a well-recognized cause of elbow pain and disability in adolescent baseball players. OCD is classified into three different stages based on AP radiographs of the elbow in 45°flexion. Stage I was characterized by radiolucent areas. In stage II, nondisplaced fragments were present. Loose bodies and sclerotic change indicated stage III. Matsuura et al performed the conservative treatment on 101 patients with stage I or II lesions. Conservative treatment consisted of discontinuation of heavy use of the elbow for at least 6 months. Of 101 patients, 84 were diagnosed as stage I, with a mean age of 11.3 years and 17 were in stage II, with a mean age of 13.9 years. Of the 84 patients in stage I, healing was observed in 90.5%. In stage II, the incidence of healing decreased to 52.9%. Mean period required for healing was 14.9 months in stage I and 12.3 months in stage II. These results suggest that conservative treatment is recommended for the early stage lesions. However, little is known about the outcome of conservative treatment for asymptomatic OCD patients. The purpose of this study was to investigate 2year follow-up outcome of asymptomatic OCD in adolescent baseball players. Methods: We retrospectively reviewed 33 baseball players aged 9-12 years (mean, 11.3 years) with asymptomatic OCD. There were 23 stage I lesions and 10 stage II lesions. We recommended the conservative treatment including stop throwing to all the players. Sixteen players (48.5%) agreed to our advice. The remaining 17 players did not follow the authors’ advice. Twelve players (36.4%) changed position or throwing side and 5 players (15.1%) did not change throwing level. Two years later, subjects were evaluated clinically and radiographically. Radiological outcome was divided into 3 types, complete repair, incomplete repair, and failure. Results: Stop throwing produced complete repair in 93.7%, incomplete repair in 6.3%, and none of the failure. Changing position or throwing side produced complete repair in 41.7%, incomplete repair in 25%, and failure in 33.3%. Not changing throwing level produced complete repair in 20%, none of incomplete repair, and failure in 80% ( Table 1 ). Players with complete or incomplete repair had not any symptom at the follow-up. On the other hand, all the players with failure had symptom such as pain and/or catching. Six of 8 players (75%) with symptom needed operation. [Table: see text] Conclusion: Even in the asymptomatic early stage OCD, it is desirable to stop throwing until the healing is observed.

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The Effect of Lumbar Sympathetic Ganglion Block on Gynecologic Cancer-Related Lymphedema

January 2018 - Pain Physician ◽

10.36076/ppj.2013/16/345 ◽

2013 ◽

Vol 4;16 (4;7) ◽

pp. 345-352

Author(s):

Hahck Soo Park

Keyword(s):

Quality Of Life ◽

Conservative Treatment ◽

Cancer Treatment ◽

Pain Score ◽

Lower Limb ◽

Sympathetic Ganglion ◽

Gynecological Cancer ◽

Gynecologic Cancer ◽

Ganglion Block

Background: Eighteen to 25% of patients after gynecological cancer treatment suffer from lower limb lymphedema (LLL) that decreases the quality of life of gynecological cancer survivors. Lumbar sympathetic ganglion block (LSGB) is widely used in practice for the evaluation and management of sympathetically mediated pain in the lower limbs. Several articles have suggested that sympathetic ganglion block could be an effective treatment for lymphedema. Objectives: To investigate the effect of LSGB on patients with secondary lymphedema related to the treatment of gynecologic cancer, who do not respond to a conservative treatment. Study Design: Prospective clinical study. Setting: A single academic medical center, outpatient setting. Methods: Eighteen patients with stage II lower limb lymphedema who did not response to the conservative treatment were recruited. The patients underwent fluoroscopy-guided LSGB 3 times at 2-week intervals. The circumference of the thigh and calf was measured in the upright position at the first visit and 2 weeks after each session of LSGB. The pain score of the lower limb was checked at the same time by a numeric rating scale (NRS) from 0 to 10. The patients were asked about their satisfaction with the procedure at the last follow-up visit. The Wilcoxon signed rank test was used for data analysis. Significance was accepted at a P-value less than 0.05/3. Results: The circumferences of affected thighs and calves decreased from 56.38 ± 4.77 and 35.33 ± 3.51cm to 54.42 ± 5.27 and 34.41 ± 3.35cm, respectively, in a significant manner after 3 consecutive LSGBs (P < 0.05/3). The maximal decrease after the third LSGB was 4 cm in the thigh and 2cm in the calf. The pain score also showed a significant decrease after 3 consecutive LSGBs from 2.17 to 1.28. The tightness and heaviness of the affected limb decreased after the first LSGB in 15 patients (83.3%) and after the second LSGB in 2 patients (11.1%). Five of 18 patients (27.8%) answered that the result of the LSGB met their expectations, 10 (55.6%) answered they would undergo the same treatment for the same outcome, 2 (11.1%) answered they did not improve as much as they had hoped, and they would not undergo the same treatment for the same outcome, and only one patient (5.6%) answered the LSGB showed no effect. Limitations: This study lacks a placebo control group and has only 18 patients. We did not evaluate the quality of life of the patients. Conclusion: We suggest that LSGB can be one of the treatment options for patients suffering from LLL after gynecologic cancer treatment. Our result could provide a basis for a randomized controlled trial in future investigations. The pain physicians can play an important role as one of the multidisciplinary team for a comprehensive treatment of LLL. Key words: Lumbar sympathetic ganglion block;gynecologic cancer;lymphedema

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Combined Conservative Treatment and Lymphatic Venous Anastomosis for Severe Lower Limb Lymphedema with Recurrent Cellulitis

Annals of Vascular Surgery ◽

10.1016/j.avsg.2015.01.037 ◽

2015 ◽

Vol 29 (6) ◽

pp. 1318.e11-1318.e15 ◽

Cited By ~ 6

Author(s):

Makoto Mihara ◽

Hisako Hara ◽

Hiromi Tsubaki ◽

Takiko Suzuki ◽

Naomi Yamada ◽

...

Keyword(s):

Conservative Treatment ◽

Lower Limb ◽

Venous Anastomosis

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Lethal outcome of bilateral pulmonary embolism combined with ascending varicophlebitis of the lower limb. Case report

Orvosi Hetilap ◽

10.1556/oh.2015.30130 ◽

2015 ◽

Vol 156 (16) ◽

pp. 644-649

Author(s):

Imre Nagy ◽

Levente Skribek ◽

Anna Barbara Dienes ◽

Csaba Rédei ◽

Márton Tar

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Case Report ◽

Conservative Treatment ◽

Lower Limb ◽

Thromboembolic Events ◽

Lethal Outcome

The authors review the history and risk factors of thrombophlebitis of the lower limb, and describe the main points of surgical and conservative treatment of varicophlebitis. They present the case of a 71-year-old woman who had ascending varicophlebitis and bilateral pulmonary embolism. The authors draw attention to important points: patients must be followed after phlebitis of the lower limb, and their thrombotic factors must be examined to prevent the new thromboembolic events. Orv. Hetil., 2015, 156(16), 644–649.

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Outcomes of fertility-sparing surgery for stage II and III serous borderline ovarian tumors

Journal of International Medical Research ◽

10.1177/0300060519865850 ◽

2019 ◽

Vol 47 (10) ◽

pp. 4895-4903 ◽

Cited By ~ 1

Author(s):

Ziyang Lu ◽

Bin Li ◽

Chao Gu

Keyword(s):

Conservative Treatment ◽

Tumor Metastasis ◽

Clinical Status ◽

Ovarian Tumors ◽

Stage Ii ◽

Borderline Ovarian Tumors ◽

Fertility Sparing ◽

Age At Surgery ◽

Lost To Follow Up

Objective This study was performed to assess the feasibility of conservative treatment for stage II or III serous borderline ovarian tumors (BOTs). Methods Twenty-one patients were treated conservatively for advanced serous BOTs from 2006 to 2017. Two patients were lost to follow-up. The patients’ clinical status, surgical results, fertility results, and oncological outcomes were collected. Results The patients’ median age at surgery was 28 years (range, 22–37 years). The median follow-up interval was 74 months (range, 16–214 months). Among the 19 patients who were followed up, 8 had stage II tumors and 11 had stage III tumors. Sixteen patients had noninvasive peritoneal implants. Two patients developed tumor metastasis to the fallopian tubes and one developed metastasis to the pelvic lymph nodes and omentum. The total recurrence rate was 26.3%. Seventeen (89.5%) patients were nulliparous. Four of 10 patients who wished to preserve their fertility obtained natural pregnancy. No patients died of their disease. Conclusions This study supports the efficacy of conservative treatment for advanced BOTs with respect to its favorable fertility result. The overall prognosis is not changed by conservative treatment.

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Conservative treatment for intermittent claudication

Russian Medical Inquiry ◽

10.32364/2587-6821-2021-5-4-212-217 ◽

2021 ◽

Vol 5 (4) ◽

pp. 212-217

Author(s):

M.R. Kuznetsov ◽

◽

I.V. Reshetov ◽

S.V. Sapelkin ◽

N.V. Yasnopol’skaya ◽

...

Keyword(s):

Conservative Treatment ◽

Intermittent Claudication ◽

Lower Limb ◽

Management Strategy ◽

Evidence Base ◽

Walking Distance ◽

Atherosclerotic Plaques ◽

Antithrombotic Effect ◽

The Common ◽

Russian Medical

This paper discusses the issues emerging during the treatment of lower-limb arterial diseases and intermittent claudication. According to the international and Russian guidelines, the common management strategy for intermittent claudication is as follows: conservative treatment is recommended in patients without limiting intermittent claudication who can walk 30 m or more without pain. Drugs that are prescribed is these patients are addressed. No large well-designed studies on most of these drugs were conducted, therefore, it is challenging to assess their efficacy in patients with intermittent claudication. The authors focus on cilostazol that has the largest evidence base. This drug is included in the Russian and international clinical guidelines. Several students demonstrate that cilostazol provides antithrombotic effect, stabilizes atherosclerotic plaques, prevents hyperplasia of neointima and restenosis after vascular procedures, improves lipid metabolism, and significantly increases pain-free walking distance (intermittent claudication distance). Recent studies show that cilostazol can be used in the complex treatment for COVID-19 due to pleiotropic mechanism of action. KEYWORDS: lower-limb arterial diseases, intermittent claudication, conservative treatment, cilostazol, COVID-19, restenosis, antiplatelet therapy. FOR CITATION: Kuznetsov M.R., Reshetov I.V., Sapelkin S.V., Yasnopol’skaya N.V. Conservative treatment for intermittent claudication. Russian Medical Inquiry. 2021;5(4):212–217 (in Russ.). DOI: 10.32364/2587-6821-2021-5-4-212-217.

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