scholarly journals Evidence-based management of central cord syndrome

2013 ◽  
Vol 35 (1) ◽  
pp. E6 ◽  
Author(s):  
Nader S. Dahdaleh ◽  
Cort D. Lawton ◽  
Tarek Y. El Ahmadieh ◽  
Alexander T. Nixon ◽  
Najib E. El Tecle ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Current Treatment ◽  
Timing Of Surgery ◽  
Evidence Based ◽  
Class Iii ◽  
Medical Subject Headings ◽  
Central Cord Syndrome

Object Evidence-based medicine is used to examine the current treatment options, timing of surgical intervention, and prognostic factors in the management of patients with traumatic central cord syndrome (TCCS). Methods A computerized literature search of the National Library of Medicine database, Cochrane database, and Google Scholar was performed for published material between January 1966 and February 2013 using key words and Medical Subject Headings. Abstracts were reviewed and selected, with the articles segregated into 3 main categories: surgical versus conservative management, timing of surgery, and prognostic factors. Evidentiary tables were then assembled, summarizing data and quality of evidence (Classes I–III) for papers included in this review. Results The authors compiled 3 evidentiary tables summarizing 16 studies, all of which were retrospective in design. Regarding surgical intervention versus conservative management, there was Class III evidence to support the superiority of surgery for patients presenting with TCCS. In regards to timing of surgery, most Class III evidence demonstrated no difference in early versus late surgical management. Most Class III studies agreed that older age, especially age greater than 60–70 years, correlated with worse outcomes. Conclusions No Class I or Class II evidence was available to determine the efficacy of surgery, timing of surgical intervention, or prognostic factors in patients managed for TCCS. Hence, there is a need to perform well-controlled prospective studies and randomized controlled clinical trials to further investigate the optimal management (surgical vs conservative) and timing of surgical intervention in patients suffering from TCCS.

scholarly journals Emphysematous pyelonephritis: outcomes of conservative management and literature review

2018 ◽  
pp. bcr-2018-225931 ◽  
Author(s):  
Stuart Deoraj ◽  
Fady Zakharious ◽  
Ashraf Nasim ◽  
Constantinos Missouris
Keyword(s):  
Escherichia Coli ◽  
Literature Review ◽  
Conservative Management ◽  
Poor Prognosis ◽  
Surgical Intervention ◽  
Supportive Therapy ◽  
Current Treatment ◽  
Renal Parenchyma ◽  
Emphysematous Pyelonephritis

Emphysematous pyelonephritis (EPN) is a rare, necrotising infection of the renal parenchyma, predominantly associated with Escherichia coli infection and unless promptly recognised and dealt with, it carries a poor prognosis. The current treatment is one of antimicrobial therapies together with nephrectomy in a majority of patients. We report an elderly man with multiple comorbidities with a diagnosis of EPN whose condition improved with antimicrobial and supportive therapy, and no surgical intervention was required.

Management, clinical outcomes, and complications of acute cannula-related peripheral vein phlebitis of the upper extremity: A retrospective study

2014 ◽  
Vol 30 (6) ◽  
pp. 381-388 ◽  
Author(s):  
SE Dunda ◽  
E Demir ◽  
OJ Mefful ◽  
G Grieb ◽  
A Bozkurt ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Treatment Group ◽  
Upper Extremity ◽  
Surgical Intervention ◽  
Clinical Symptoms ◽  
Treatment Options ◽  
Current Treatment ◽  
Peripheral Vein ◽  
Cubital Fossa ◽  
Hand Region

Objective Acute phlebitis due to peripheral vein catheter use is frequently observed in clinical practice, and requires surgical therapy in severe cases. In this retrospective study, we aimed to increase awareness, evaluate current treatment options, and develop recommendations to optimize treatment outcomes. Methods A total of 240 hospitalized patients with a diagnosis of upper extremity phlebitis from 2006 to 2011 were evaluated in terms of initial clinical features, parameters, co-morbidities and treatment regimes. Severity of phlebitis was graded according to the Baxter scale by assessing clinical symptoms such as pain, erythema, induration, swelling, or palpable venous cord (grade 0–5). Patients were divided in two subgroups: conservative ( n = 132) and operative ( n = 108) treatment. Results Surgical intervention rates and severity were higher for cannula insertion in the cubital fossa region than for cannula insertion in the forearm and hand region ( p < 0.05). Baxter scale grades were higher in the surgical treatment group than in the conservative treatment group (4.47 vs. 2.67, respectively). Conclusions The cubital fossa region is vulnerable to severe phlebitis and is not recommended as the first site of choice for cannulation. Phlebitis of Baxter scale grade 4 or 5 should be considered for early surgical intervention.

scholarly journals A Comparison of Treatment Options for Carpal Boss: A Critically Appraised Topic

2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Megan Collins ◽  
Matthew Rivera
Keyword(s):  
Conservative Treatment ◽  
Range Of Motion ◽  
Case Studies ◽  
Conservative Management ◽  
Surgical Intervention ◽  
Case Reports ◽  
Treatment Options ◽  
Surgical Interventions ◽  
Increased Risk

Context: Carpal bossing is a bony growth or mass that typically occurs at the 2nd or 3rd carpometacarpal joint. Carpal bossing is often overlooked placing the patient at an increased risk for pain or injury, such as osteoarthritis or inflammatory joint disease if left untreated. Individuals such as combat sport athletes who experience repetitive trauma to this area are at a high risk to develop carpal bossing. The literature suggests conservative or surgical interventions to manage symptoms. The goal of this systematic review is to synthesize the current literature for clinical knowledge and intervention outcomes for carpal bossing. Methods: A systematic search of the literature was performed across 3 electronic databases (Science Direct, PubMed, and EBSCOhost) to identify articles that investigated the effects of surgical intervention or conservative management for carpal bossing. A combination of the keywords and Boolean operators (Carpal Bossing, Carpal Boss, Surgical Intervention, Wedge Resection, Excision, Conservative Treatment, and Intervention) related to the research question were used. The search was restricted to full text, human studies (including cadaveric studies) research, and manuscripts available in English. Articles were included if they examined the effect of either conservative or surgical interventions for the treatment of carpal bossing. Articles were excluded from the review if the study did not examine carpal bossing treatment options or did not include pain, range of motion, strength, or functional measures of the hand and wrist. Two independent reviewers used the Joanna Briggs Institute Checklist for Case Reports and the Checklist for Case Studies to appraise the quality of the articles. A score of 50% was used to remove low-quality studies. The Strength of Recommendation Taxonomy (SORT) method was used to grade the evidence for the articles included. Results: After the initial search, 10 articles met the inclusion criteria, while 3 were eliminated due to low quality appraisal scores. The average scores for case reports and case studies were 5.5/7 or 7.5/9 respectively. There was a total of 58 participants across the 7 studies. Generally speaking, conservative treatment reduced average daily pain and patients were able to return to full participation within 2 weeks. Conversely, patients undergoing surgical intervention experienced episodic pain, including over the surgical incision, typically averaging 2/10 on the visual analog scale. Findings from the surgical intervention showed inconsistent measurements for wrist/hand strength and range of motion. There is level C evidence on the treatment for carpal bossing. Conclusion: The limited evidence suggests conservative management may reduce pain and improve clinical outcomes. However, clinicians should consider the level C evidence with skepticism as the quality of evidence on this topic is low. Further investigations should be performed with more rigor.

Pediatric hydrocephalus: systematic literature review and evidence-based guidelines. Part 5: Effect of valve type on cerebrospinal fluid shunt efficacy

2014 ◽  
Vol 14 (Supplement_1) ◽  
pp. 35-43 ◽  
Author(s):  
Lissa C. Baird ◽  
Catherine A. Mazzola ◽  
Kurtis I. Auguste ◽  
Paul Klimo ◽  
Ann Marie Flannery
Keyword(s):  
Systematic Review ◽  
Task Force ◽  
Treatment Options ◽  
Evidence Based ◽  
Moderate Degree ◽  
Class Iii ◽  
Insufficient Evidence ◽  
Pediatric Hydrocephalus ◽  
Programmable Valve ◽  
Evidence Based Guidelines

Object The objective of this systematic review was to examine the existing literature to compare differing shunt components used to treat hydrocephalus in children, find whether there is a superior shunt design for the treatment of pediatric hydrocephalus, and make evidence-based recommendations for the selection of shunt implants when placing shunts. Methods Both the US National Library of Medicine PubMed/MEDLINE database and the Cochrane Database of Systematic Reviews were queried using MeSH headings and key words chosen to identify publications comparing the use of shunt implant components. Abstracts of these publications were reviewed, after which studies meeting the inclusion criteria were selected. An evidentiary table was compiled summarizing the selected articles and quality of evidence. These data were then analyzed by the Pediatric Hydrocephalus Systematic Review and Evidence-Based Guidelines Task Force to consider evidence-based treatment recommendations. Results Two hundred sixty-nine articles were identified using the search parameters, and 43 articles were recalled for full-text review. Of these, 22 papers met the study criteria for a comparison of shunt components and were included in the evidentiary table. The included studies consisted of 1 Class I study, 11 Class II studies, and 10 Class III studies. The remaining 21 articles were excluded. Conclusions An analysis of the evidence did not demonstrate a clear advantage for any specific shunt component, mechanism, or valve design over another. Recommendation: There is insufficient evidence to demonstrate an advantage for one shunt hardware design over another in the treatment of pediatric hydrocephalus. Current designs described in the evidentiary tables are all treatment options. Strength of Recommendation: Level I, high degree of clinical certainty. Recommendation: There is insufficient evidence to recommend the use of a programmable valve versus a nonprogrammable valve. Programmable and nonprogrammable valves are both options for the treatment of pediatric hydrocephalus. Strength of Recommendation: Level II, moderate degree of clinical certainty.

scholarly journals Lichen Planus and Its Management: An Update and Observation

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
Lichen Planus ◽  
Large Scale ◽  
Treatment Options ◽  
Current Treatment ◽  
Evidence Based ◽  
Aggressive Treatment ◽  
Ongoing Trial ◽  
Or Management ◽  
Cutaneous Disease ◽  
Different Types

Lichen planus (LP) is an inflammatory muco-cutaneous disease characterised by shiny, flat-topped papules and plaques. It affects around 1% of the population. The disease is usually self-limiting and benign in nature. However, some varieties of LP may cause considerable discomfort and recalcitrant in nature. So, treatment depends on appreciating the type, severity and nature of the disease. There are a good numbers of options for treating different types of LP. Few types of LP are difficult to treat and needs aggressive treatment to prevent complications like hair or nail loss. Author examined and summarized the published literature involving the treatment or management of LP. It is found that the large scale, evidence based trials are only few in number. At present, it is quite difficult to standardisation of treatment. This review outlines the ongoing trial and current treatment options. It is needed to assimilation and summarization of the recent findings to treat the critical cases in a more effective way

Trichotillomania

2001 ◽  
Vol 18 (4) ◽  
pp. 137-139 ◽  
Author(s):  
Martin J O'Sullivan ◽  
H Paul Redmond
Keyword(s):  
Literature Search ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Current Treatment ◽  
Resonance Imaging ◽  
Young Females ◽  
Pubmed Database ◽  
Structural Abnormalities ◽  
Uncommon Condition ◽  
The Brain

AbstractTrichotillomania is a relatively uncommon condition that classically occurs in young females. It can result in trichobezoar formation, which is usually managed successfully by surgical intervention, although rarely it can be fatal. This article presents a brief review of trichotillomania. A literature search was performed for ‘trichotillomania’ using the PubMed database, and relevant papers and their references were researched. This review commences by defining the condition and considering its presentation and its prevalence. Diagnostic dilemmas including differential diagnosis and the uncertainty about structural abnormalities in the brain as indicated by magnetic resonance imaging findings are then reviewed. Finally we examine the current treatment options of this interesting condition.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

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