Canalicular Curettage to the Rescue: a report of three cases

Introduction: Canalicular curettage is a surgical procedure used to remove canalicular contents and debris from canaliculi. It is usually indicated for chronic, persistent or recalcitrant canalicular diseases with no resolution of symptoms after conservative management. We describe 3 different cases of persistent canalicular diseases which needed canalicular curettage to rescue from the conditions leading to successful outcomes. Cases and observations:• Case 1: A 45-year-old male presented with recurrent punctal granuloma 3 months after DCR surgery. Canalicular exploration and curettage with one-snip punctoplasty following excision of the mass revealed a segment of remnant silicone stent. There was no recurrence of mass in subsequent follow up visits.• Case 2: A 35-year-old female presented with recurrent canaliculitis for last 6 months. Canalicular curettage revealed multiple small calcified masses of varying size and shape. The patient had good postoperative recovery and showed no recurrence of symptoms.• Case 3: A 32-year-old female presented with gradually increasing pedunculated mass arising out of punctum for last one month. Excision of mass with canalicular curettage was done. Biopsy proved it to be squamous papilloma of the canaliculi. There was no recurrence of mass. Conclusion: Canalicular curettage is a simple, safe and effective surgical intervention to rescue from the recalcitrant canalicular conditions like canaliculitits, retained foreign bodies, canalicular neoplasms leading to successful outcomes.

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Relative Efficacy of Three of Nonsurgical Treatments for Calcific Tendinitis: Physical Therapy vs Steroid Injection vs Ultrasound-Guided Aspiration

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00210 ◽

2021 ◽

Vol 9 (7_suppl4) ◽

pp. 2325967121S0021

Author(s):

Mauricio Drummond ◽

Caroline Ayinon ◽

Albert Lin ◽

Robin Dunn

Keyword(s):

Physical Therapy ◽

Rotator Cuff ◽

Conservative Treatment ◽

Conservative Management ◽

Surgical Intervention ◽

Corticosteroid Injection ◽

Calcific Tendinitis ◽

Ultrasound Guided ◽

Calcium Deposits

Objectives: Calcific tendinitis of the shoulder is a painful condition characterized by the presence of calcium deposits within the tendons of the rotator cuff (RTC) that accounts for up to 7% of cases of shoulder pain1. The most common conservative treatments typically include physical therapy (PT), corticosteroid injection (CSI), or ultrasound-guided aspiration (USA). When conservative management fails, the patient may require arthroscopic surgery to remove the calcium with concomitant rotator cuff repair. The purpose of this study was to characterize the failure rates, defined as the need for surgery, of each of these three methods of conservative treatment, as well as to compare post-operative improvement in patient-reported outcomes (PROs) – including subjective shoulder values (SSV) and visual analog scale (VAS) pain scores – based on the type of pre-operative conservative intervention provided. A secondary aim was to compare post-operative range of motion (ROM) outcomes between groups that failed conservative management. We hypothesized that all preoperative conservative treatments would have equivalent success rates, PROs, and ROM. Bosworth B. Calcium deposits in the shoulder and subacromial bursitis: a survey of 12122 shoulders. JAMA. 1941;116(22):2477-2489. Methods: A retrospective review of all patients who were diagnosed with calcific tendinitis at our institution treated among 3 fellowship trained orthopedic surgeons between 2009 and 2019 was performed. VAS, SSV, and ROM in forward flexion (FF) and external rotation (ER) was abstracted from the medical records. Scores were recorded at the initial presentation as well as final post-operative follow-up visit for those who underwent surgery. The conservative treatment method utilized by each patient was recorded and included PT, CSI, or USA. Failure of conservative management was defined as eventual progression to surgical intervention. Statistical analysis included chi-square, independent t test and ANOVA. Descriptive statistics were used to report data. A p<0.05 was considered to be statistically significant. Results: 239 patients diagnosed with calcific tendinitis were identified in the study period with mean age of 54 years and follow up of at least 6 months. In all, 206 (86.2%) patients underwent a method of conservative treatment. Of these patients, 71/239 (29.7%) underwent PT, 67/239 (28%) attempted CSI, and 68/239 (28.5%) underwent USA. The overall failure rate across all treatment groups was 29.1%, with injections yielding the highest success rate of 54/67 (80.6%). Physical therapy saw the highest failure rate, with 26/71 (36.7%) proceeding to surgical intervention. Patients undergoing physical therapy were statistically more likely to require surgery compared to those undergoing corticosteroid injection (RR 1.88, p= 0.024). Of all 93 patients who underwent surgery, VAS, SSV, ROM improved significantly in all groups. On average, VAS decreased by 4.02 points (6.3 to 2.3), SSV increased by 33 points (51 to 84), FF improved by 13.8º, and ER improved 8.4º between the pre- and post-operative visits (p<0.05). The 33 patients who did not attempt a conservative pre-operative treatment demonstrated the largest post-operative improvement in VAS (-6.00), which was significantly greater than those who previously attempted PT (-3.33, p<0.05). There was a trend towards greater improvement in SSV in the pre-operative PT group (45 to 81) compared to others, but this did not reach statistical significance (p=0.47). Range of motion was not significantly affected by the method of pre-operative conservative intervention. Conclusions: Conservative treatment in the form of physical therapy, corticosteroid injection, and ultrasound-guided aspiration is largely successful in managing calcific tendinitis of the shoulder. Of these, PT demonstrated the highest rate of failure in terms of requiring surgical management. PRO improvement varied among the conservative modalities used, however patients who did not attempt conservative management experienced the greatest improvements following surgery. If surgery is necessary following failed conservative treatment, excellent outcomes can be expected with significant improvements in ROM and PROs. This information should be considered by the surgeon when deciding whether to recommend conservative treatment for the management of calcific tendinitis, as well as which specific method to employ.

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A propensity-adjusted comparison of middle meningeal artery embolization versus conventional therapy for chronic subdural hematomas

Journal of Neurosurgery ◽

10.3171/2020.9.jns202781 ◽

2021 ◽

pp. 1-6

Author(s):

Joshua S. Catapano ◽

Andrew F. Ducruet ◽

Candice L. Nguyen ◽

Tyler S. Cole ◽

Jacob F. Baranoski ◽

...

Keyword(s):

Treatment Failure ◽

Conservative Management ◽

Conventional Therapy ◽

Surgical Intervention ◽

Middle Meningeal Artery ◽

Adjusted Analysis ◽

Subdural Hematomas ◽

Tertiary Center ◽

Meningeal Artery

OBJECTIVEMiddle meningeal artery (MMA) embolization is a promising treatment strategy for chronic subdural hematomas (cSDHs). However, studies comparing MMA embolization and conventional therapy (surgical intervention and conservative management) are limited. The authors aimed to compare MMA embolization versus conventional therapy for cSDHs using a propensity-adjusted analysis.METHODSA retrospective study of all patients with cSDH who presented to a large tertiary center over a 2-year period was performed. MMA embolization was compared with surgical intervention and conservative management. Neurological outcome was assessed using the modified Rankin Scale (mRS). A propensity-adjusted analysis compared MMA embolization versus surgery and conservative management for all individual cSDHs. Primary outcomes included change in hematoma diameter, treatment failure, and complete resolution at last follow-up.RESULTSA total of 231 patients with cSDH met the inclusion criteria. Of these, 35 (15%) were treated using MMA embolization, and 196 (85%) were treated with conventional treatment. On the latest follow-up, there were no statistically significant differences between groups in the percentage of patients with worsening mRS scores. Of the 323 total cSDHs found in 231 patients, 41 (13%) were treated with MMA embolization, 159 (49%) were treated conservatively, and 123 (38%) were treated with surgical evacuation. After propensity adjustment, both surgery (OR 12, 95% CI 1.5–90; p = 0.02) and conservative therapy (OR 13, 95% CI 1.7–99; p = 0.01) were predictors of treatment failure and incomplete resolution on follow-up imaging (OR 6.1, 95% CI 2.8–13; p < 0.001 and OR 5.4, 95% CI 2.5–12; p < 0.001, respectively) when compared with MMA embolization. Additionally, MMA embolization was associated with a significant decrease in cSDH diameter on follow-up relative to conservative management (mean −8.3 mm, 95% CI −10.4 to −6.3 mm, p < 0.001).CONCLUSIONSThis propensity-adjusted analysis suggests that MMA embolization for cSDH is associated with a greater extent of hematoma volume reduction with fewer treatment failures than conventional therapy.

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Importance of Panchakarma treatment in Ayurveda

Ayurline: International Journal of Research in Indian Medicine ◽

10.52482/ayurline.v5i03.556 ◽

2021 ◽

Vol 5 (03) ◽

Author(s):

Vivek Shirke

Keyword(s):

Conservative Management ◽

Surgical Procedure ◽

Surgical Intervention ◽

Holistic Approach ◽

The Body ◽

Health Science ◽

The Other ◽

Human Being ◽

The Future

The main objective of health science is to provide better health to every human being. Indian system of medicine commonly known as Ayurveda has a holistic approach towards the disease and provides treatment without affecting the other parts of the body. Similarly, it is effective in preventing an individual from getting diseased in the future. In Ayurveda, diseases can be classified into two basic categories such as -ailments treated or managed by Shodhan therapy and the ailments treated by surgical intervention. Further, it’s suggested that in conditions where surgery is indicated, one can try Shodhan or Panchkarma therapies before performing surgery or/ if the patient is not fit for surgery or not willing to undergo a surgical procedure. Similarly, Acharya has specified that physician should not advocate Surgery in diseases which can be treated by Shodhan and Shaman therapies (conservative management). Panchakarma is a combination of five procedures of purification- Vamana (Emesis), Virechana (Purgation), Niroohavasti (Decoction enema), Nasya (instillation of medicine through nostrils), and Anuvasanavasti (Oil enema). These procedures aim at plucking away the deep-rooted imbalances in the body.

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Risk Factors for Failure of Nonoperative Treatment for Unilateral Cervical Facet Fractures

Asian Spine Journal ◽

10.4184/asj.2017.11.3.356 ◽

2017 ◽

Vol 11 (3) ◽

pp. 356-364 ◽

Cited By ~ 4

Author(s):

Carola Francisca van Eck ◽

Mitchell Stephen Fourman ◽

Amir Mohamad Abtahi ◽

Louis Alarcon ◽

William Fielding Donaldson ◽

...

Keyword(s):

Risk Factors ◽

Conservative Management ◽

Radiographic Progression ◽

Surgical Intervention ◽

Nonoperative Management ◽

Classification Systems ◽

Retrospective Clinical Study ◽

Radicular Symptoms ◽

Time Of Presentation

<sec><title>Study Design</title>Retrospective clinical study.</sec><sec><title>Purpose</title>The purpose of this study was to determine what percentage of patients who underwent nonoperative management of unilateral non-displaced or minimally displaced facet fractures progressed radiographically and to determine what percentage of patients required surgical intervention and to identify risk factors for failure of conservative management.</sec><sec><title>Overview of Literature</title>According to most commonly used classification systems, unilateral, non-and minimally displaced facet fractures are be amendable to nonoperative management.</sec><sec><title>Methods</title>A retrospective review of the Trauma Registry of a Level I trauma center was performed to identify all patients diagnosed with a non- or minimally displaced unilateral facet fracture which was managed nonoperatively. Several demographic variables and clinical outcomes were recorded. Using computed tomography scanning and plain radiographs, fracture pattern, listhesis, displacement, angle and percentage of the facet that included the fracture were determined. Radiographic progression was defined as the occurrence of listhesis of more than 10% of the anterior-posterior dimensions of the inferior vertebral body during radiographic follow-up. Failure of conservative management was defined as a patient requiring surgical intervention after initially being managed nonoperatively.</sec><sec><title>Results</title>Seventy-four patients were included. Fifteen patients (20%) progressed radiographically. However, only 2 developed radicular symptoms and none developed myelopathy or other catastrophic cord related symptoms. Seven patients (9%) underwent surgery. Indications for surgery included significant radiographic progression and/or radicular symptoms. Risk factors for failure of conservative management included presence of radiculopathy at the time of presentation, a higher body mass index, increased Injury Severity Score, greater initial fracture displacement and more than 2 mm of listhesis.</sec><sec><title>Conclusions</title>Patients with non-displaced or minimally displaced facet fractures who do not have neurological symptoms at the time of presentation can safely be managed conservatively with careful observation and follow-up.</sec>

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Conservative management of early uncomplicated appendicitis in children

International Surgery Journal ◽

10.18203/2349-2902.isj20170855 ◽

2017 ◽

Vol 4 (3) ◽

pp. 1024 ◽

Cited By ~ 1

Author(s):

Sunil Kumar Maini ◽

Neeraj Kumar Jain ◽

Manjari Goel Jain ◽

Vicky Khobragade

Keyword(s):

Abdominal Pain ◽

Acute Appendicitis ◽

Conservative Management ◽

Medical Management ◽

Surgical Intervention ◽

Lower Abdominal Pain ◽

Primary Treatment ◽

Research Centre ◽

Uncomplicated Appendicitis

Background: Right lower abdominal pain management in children is a challenging task for the surgeon. Most of the time right lower abdominal pain ends up in acute appendicitis. For long time appendicetomy was the treatment of choice. However surgical intervention has its own disadvantages such as pain, scarring, adhesions, hernia development and venous thrombosis disease. Anxiety and fear of surgery were also two difficulties in obtaining consent for surgery. Parents often request and insist for medical management. Their unwillingness for surgical intervention was the most important reason for medical management of uncomplicated acute appendicitis.Methods: Our prospective observational study was conducted in the Department of General Surgery, R.K.D.F. Medical College and Research Centre, Bhopal, Madhya Pradesh, India during period of January 2014 to January 2016 and follow up was done till December 2016. Our target group was children under 16 years. A total of 92 children with complaint of right lower abdominal pain attended the hospital for treatment. Routine investigations including ultrasonography of abdomen were performed for all the patients. Out of 92 patients diagnosis of acute appendicitis was made in 74 patients, Surgery was performed in 32 patients, while remaining 42 patients were treated conservatively and the results were analyzed.Results: In this study of 92 patients of pain in right iliac fossa below 16 years, 74 (80.43%) were diagnosed as acute appendicitis. 32 (43.24%) Patients were operated earlier. 42 (56.75%) Patient were treated conservatively. Out of 42 patients, 12 (16.21%) patients were operated within 1 year, 30 (40.54%) Patients didn’t require any surgical intervention during 1 year follow up. In present study, significant role of antibiotic was found in conservative management of acute appendicitis in children. So it can be concluded that conservative management of acute appendicitis in children can be attempted under observation.Conclusions: Antibiotics are both effective and safe as primary treatment for patients with uncomplicated acute appendicitis. Initial antibiotic treatment merits consideration as a primary treatment option for early uncomplicated appendicitis. Appendicectomy should be done but conservative management of acute appendicitis in children can be attempted under observation.

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Radiological and clinical outcomes of pituitary apoplexy: comparison of conservative management versus early surgical intervention

Journal of Neurosurgery ◽

10.3171/2020.9.jns202899 ◽

2021 ◽

pp. 1-9

Author(s):

Matthew J. Shepard ◽

M. Harrison Snyder ◽

Sauson Soldozy ◽

Leonel L. Ampie ◽

Saul F. Morales-Valero ◽

...

Keyword(s):

Clinical Outcomes ◽

Median Time ◽

Conservative Management ◽

Pituitary Apoplexy ◽

Surgical Intervention ◽

Early Surgery ◽

High Dose ◽

Visual Outcomes ◽

Early Surgical Intervention

OBJECTIVE Early surgical intervention for patients with pituitary apoplexy (PA) is thought to improve visual outcomes and decrease mortality. However, some patients may have good clinical outcomes without surgery. The authors sought to compare the radiological and clinical outcomes of patients with PA who were managed conservatively versus those who underwent early surgery. METHODS Patients with symptomatic PA were identified. Radiological, endocrinological, and ophthalmological data were reviewed. Patients with progressive visual deterioration or ophthalmoplegia were candidates for early surgery (within 7 days). Patients without visual symptoms or whose symptoms improved on high-dose steroids were treated conservatively. Log-rank and univariate analysis compared clinical and radiological outcomes between those receiving early surgery and those who underwent intended conservative management. RESULTS Sixty-four patients with PA were identified: 47 (73.4%) underwent intended conservative management, while 17 (26.6%) had early surgery. Patients receiving early surgery had increased rates of impaired visual acuity (VA; 64.7% vs 27.7%, p = 0.009); visual field (VF) deficits (64.7% vs 19.2%, p = 0.002); and cranial neuropathies (58.8% vs 29.8%, p < 0.05) at presentation. Tumor volumes were greater in the early surgical cohort (15.1 ± 14.8 cm3 vs 4.5 ± 10.3 cm3, p < 0.001). The median clinical and radiological follow-up visits were longer in the early surgical cohort (70.0 and 64.4 months vs 26.0 and 24.7 months, respectively; p < 0.001). Among those with VA/VF deficits, visual outcomes were similar between both groups (p > 0.9). The median time to VA improvement (2.0 vs 3.0 months, p = 0.9; HR 0.9, 95% CI 0.3–3.5) and the median time to VF improvement (2.0 vs 1.5 months; HR 0.8, 95% CI 0.3–2.6, p = 0.8) were similar across both cohorts. Cranial neuropathy improvement was more common in conservatively managed patients (HR 4.8, 95% CI 1.5–15.4, p < 0.01). Conservative management failed in 7 patients (14.9%) and required surgery. PA volumes spontaneously regressed in 95.0% of patients (38/40) with successful conservative management, with a 6-month regression rate of 66.2%. Twenty-seven patients (19 in the conservative and 8 in the early surgical cohorts) responded to a prospectively administered Visual Function Questionnaire-25 (VFQ-25). VFQ-25 scores were similar across both cohorts (conservative 95.5 ± 3.8, surgery 93.2 ± 5.1, p = 0.3). Younger age, female sex, and patients with VF deficits or chiasmal compression were more likely to experience unsuccessful conservative management. Surgical outcomes were similar for patients receiving early versus delayed surgery. CONCLUSIONS These data suggest that a majority of patients with PA can be successfully managed without surgical intervention assuming close neurosurgical, radiological, and ophthalmological follow-up is available.

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Transscrotal orchidopexy for palpable cryptorchid testis: follow-up and outcomes

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2018.191 ◽

2018 ◽

Vol 40 (2) ◽

Author(s):

Alfonso Papparella ◽

Giovanni Cobellis ◽

Laura De Rosa ◽

Carmine Noviello

Keyword(s):

Surgical Intervention ◽

Inguinal Canal ◽

Demographic Data ◽

Postoperative Recovery ◽

Testicular Atrophy ◽

Undescended Testes ◽

Operative Complications ◽

Cryptorchid Testis ◽

The Mean

We retrospectively reviewed the results of transscrotal orchidopexy in the surgical management of palpable testis. From January 2014 to June 2017, 130 male children with a total of 140 palpable undescended testes (UDT) underwent transscrotal orchidopexy. The charts were retrospectively reviewed for demographic data, preoperative position and mobility of the testis, patency of the peritoneal vaginal duct (PVD), and post-operative complications. The resting position of the testis and its traction towards the scrotum were assessed before surgery and under anaesthesia. The mean age of the patients was 4.6 years. The position of the testis assessed at surgery was in most cases at the external inguinal ring (62.8%), at the neck of the scrotum (15.7%), in the inguinal canal (12.8%), or in an ectopic position (8,5%). A PVD was found in 66 testes (47.1%). Two surgical cases required an inguinal incision. In each patient, the postoperative course was unremarkable. The testicle at 1-year follow-up was in a scrotal position in 134 cases, but 6 patients required a second surgical intervention for re-ascent of the testis. No testicular atrophy or inguinal hernias were observed. Transscrotal orchidopexy is a simple and effective procedure for the treatment of palpable UDT. The incidence of complications is low and manageable, with rapid postoperative recovery and early resumption of normal activities.

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Duodenocolic fistula by nail ingestion in a child

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa187 ◽

2020 ◽

Vol 2020 (8) ◽

Author(s):

Iroukora Kassegne ◽

Kokou Kouliwa Kanassoua ◽

Tamegnon Dossouvi ◽

Yawod Efoe-Ga Amouzou ◽

Aboza Sakiye ◽

...

Keyword(s):

Foreign Body ◽

Primary Closure ◽

Foreign Bodies ◽

Clinical Observation ◽

Surgical Intervention ◽

Outpatient Management ◽

Abdominal Radiography ◽

Duodenocolic Fistula ◽

Nail Removal

Abstract Unintentional foreign body ingestion is common among children. Normally, these ingested foreign bodies pass spontaneously. Only few of them may lead to complications such as fistula, which requires surgical intervention. We are reporting a case of accidental construction nail ingestion in a 3-year-old male child, for 30 days, without any symptoms. Diagnosis of duodenocolic fistula by construction nail was made on clinical examination and abdominal radiography features. He underwent surgical intervention, with nail removal, dudenal and colic primary closure. The follow-up was uneventful. We recommend emergently retrieval of sharp-pointed and long-ingested foreign bodies like a construction nail. Conservative outpatient management by clinical observation is not appropriate for this kind of foreign bodies. It may lead to complications such as perforation and fistula.

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CLINICAL MANAGEMENT OF VARIOUS TYPES OF DEVIATED NASAL SEPTUM

10.36106/ijsr/3133271 ◽

2021 ◽

pp. 1-3

Author(s):

Shambhu Sharan Gupta ◽

Satish Kumar ◽

Debarshi Jana

Keyword(s):

Conservative Management ◽

Nasal Septum ◽

Surgical Intervention ◽

Cross Sectional Study ◽

Common Condition ◽

Sectional Study ◽

Deviated Nasal Septum ◽

Cross Sectional ◽

Post Surgery

Deviated nasal septum is a common condition, which is quite often asymtomatic, but may present with persistent morbidity in some. In this prospective cross sectional study, 100 patients with deviated nasal septum were included who were symptomatic. 48 patients needed surgical intervention while 52 were managed conservatively. Results were compared on follow up. 96% cases reported improvement in nasal obstruction post surgery, compared to 79% following conservative management.

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Torsion of a Large Appendix Testis Misdiagnosed as Pyocele

Case Reports in Urology ◽

10.1155/2015/430871 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Susanta Meher ◽

Satyajit Rath ◽

Rakesh Sharma ◽

Prakash Kumar Sasmal ◽

Tushar Subhadarshan Mishra

Keyword(s):

Conservative Management ◽

Testicular Torsion ◽

Surgical Intervention ◽

Postoperative Recovery ◽

Acute Epididymitis ◽

Early Features ◽

Appendix Testis

Torsion of the appendix testis is not an uncommon cause of acute hemiscrotum. It is frequently misdiagnosed as acute epididymitis, orchitis, or torsion of testis. Though conservative management is the treatment of choice for this condition, prompt surgical intervention is warranted when testicular torsion is suspected. We report a case of torsion of a large appendix testis misdiagnosed as pyocele. Emergency exploration of it revealed a large appendix testis with torsion and early features of gangrene. After excision of the appendix testis, the wound was closed with an open drain. The patient had an uneventful and smooth postoperative recovery.

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