Role of Conservative Management in Emphysematous Pyelonephritis - A Retrospective Study

Abstract Background Although gall bladder perforation (GBP) is not common, it is considered a life-threating condition, and the possibility of occurrence in cases of acute cholecystitis must be considered. The aim of this study was to assess the role of multi-slice computed tomography (MSCT) in the assessment of GBP. Results It is a retrospective study including 19 patients that had GBP out of 147, there were 11 females (57.8%) and 8 males (42.1%), aged 42 to 79 year (mean age 60) presented with acute abdomen or acute cholecystitis. All patients were examined with abdominal ultrasonography and contrast-enhanced abdominal MSCT after written informed consent was obtained from the patients. This study was between January and December 2018. Patients with contraindications to contrast-enhanced computed tomography (CT) (pregnancy, acute kidney failure, or allergy to iodinated contrast agents) who underwent US only were excluded. Patients with other diagnoses, such as acute diverticulitis of the right-sided colon or acute appendicitis, were excluded. The radiological findings were evaluated such as GB distention; stones; wall thickening, enhancement, and defect; pericholecystic free fluid or collection; enhancement of liver parenchyma; and air in the wall or lumen. All CT findings are compared with the surgical results. Our results revealed that the most important and diagnostic MSCT finding in GBP is a mural defect. Nineteen patients were proved surgically to have GBP. Conclusion GBP is a rare but very serious condition and should be diagnosed and treated as soon as possible to decrease morbidity and mortality. The most accurate diagnostic tool is the CT, MSCT findings most specific and sensitive for the detection of GBP and its complications.

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ROLE OF PHYSICAL THERAPY IN THE TREATMENT OF POSTERIOR ANKLE IMPINGEMENT IN PEDIATRIC ATHLETES - A PROSPECTIVE STUDY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00082 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0008

Author(s):

Adam Saloom ◽

Nick Purcell ◽

Matthew Ruhe ◽

Jorge Gomez ◽

Jonathan Santana ◽

...

Keyword(s):

Physical Therapy ◽

Prospective Study ◽

Conservative Management ◽

Pediatric Patients ◽

Weight Bearing ◽

Return To Sport ◽

Time To Surgery ◽

Ankle Impingement ◽

Posterior Ankle Impingement

Background: Posterior ankle impingement (PAI) is a known cause of posterior ankle pain in athletes performing repetitive plantarflexion motion. Even though empirically recommended in adult PAI, there is minimal literature related to the role of conservative physical therapy (PT) in pediatric patients. Purpose: To identify patient characteristics and determine if there is a difference in pediatric patients with PAI who were successful with conservative PT and those who were unsuccessful, requiring surgical intervention. Methods: Prospective study at a tertiary children’s hospital included patients <18 years diagnosed with PAI and underwent PT. Patients who received PT at an external facility were excluded. Collected data included demographics, initial presentation at PT evaluation, treatment throughout PT, patient presentation at PT discharge, time to return to sport (RTS) from initial PT evaluation (if successful), time to surgery from initial PT evaluation (if unsuccessful). Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores were collected. Group comparisons were conducted using independent t-tests or chi-square analyses (alpha level set at .05). Results: 31 (12 males, 19 females) patients diagnosed with PAI were enrolled with a mean age 12.61 years (range: 8-17). Gymnastics, football, and basketball were the most commonly implicated sports (42% patients). All patients underwent initial conservative PT for an average of 16.24 weeks (9.23 visits ±7.73). 20/31(64.5%) patients failed conservative management and underwent arthroscopic debridement. PAI pathology was predominantly bony in 61.3% and soft tissue 38.7%. Between the successful PT group and unsuccessful PT group, there was no difference in the proportion of athletes/non-athletes (p=.643). Average RTS time for successful group was 11.47 weeks and average time to surgery for unsuccessful group was 17.82 weeks. There were no significant differences in sex (p=.332), age (p=.674), number of PT visits (p=.945), initial weight-bearing status (p=.367), use of manual therapy (p=.074) including manipulation (p=.172) and mobilization (p=.507), sport (p=.272), initial evaluation ankle ROM (p>.05). Initial AOFAS scores for pain, function, alignment, or total were not significantly different (p=.551, .998, .555, .964 respectively). Conclusion: The first prospective study in pediatric patients with PAI demonstrates that even though success of PT is not dependent on age, sex, sport or PAI pathology, a notable proportion of patients who undergo PT do not need surgery. Conservative management including PT should be the initial line of management for PAI. PT treatment and surgery (if unsuccessful with PT) allowed patients to return to prior level of activity/sports. Tables/Figures: [Table: see text]

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Role of Octreotide in Conservative Management of Chyle Leak Post Neck Dissection in Cases of Head Neck Cancer: A Retrospective Analysis

Indian Journal of Otolaryngology and Head & Neck Surgery ◽

10.1007/s12070-021-02746-y ◽

2021 ◽

Author(s):

Vikas Gupta ◽

Gunjan Dwivedi ◽

Rajeev Chugh ◽

Pankaj Kumar Sahu ◽

Devendra Kumar Gupta ◽

...

Keyword(s):

Neck Dissection ◽

Retrospective Analysis ◽

Neck Cancer ◽

Conservative Management ◽

Head Neck Cancer ◽

Chyle Leak ◽

Head Neck

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Rough Dental Implant Surfaces and Peri-Implantitis: Role of Phase-Contrast Microscopy, Laser Protocols, and Modified Home Oral Hygiene in Maintenance. A 10-Year Retrospective Study

Applied Sciences ◽

10.3390/app11114985 ◽

2021 ◽

Vol 11 (11) ◽

pp. 4985

Author(s):

Gianluigi Caccianiga ◽

Gérard Rey ◽

Paolo Caccianiga ◽

Alessandro Leonida ◽

Marco Baldoni ◽

...

Keyword(s):

Retrospective Study ◽

Phase Contrast ◽

Vertical Movement ◽

Subgingival Plaque ◽

Phase Contrast Microscopy ◽

Implant Surface ◽

Total Percentage ◽

Contrast Microscopy

The aim of this study was to evaluate two different kinds of rough implant surface and to assess their tendency to peri-implantitis disease, with a follow-up of more than 10 years. Data were obtained from a cluster of 500 implants with Ti-Unite surface and 1000 implants with Ossean surface, with a minimum follow-up of 10 years. Implants had been inserted both in pristine bone and regenerated bone. We registered incidence of peri-implantitis and other causes of implant loss. All patients agreed with the following maintenance protocol: sonic brush with vertical movement (Broxo), interdental brushes, and oral irrigators (Broxo) at least two times every day. For all patients with implants, we evaluated subgingival plaque samples by phase-contrast microscopy every 4 months for a period of more than 10-years. Ti-Unite surface implants underwent peri-implantitis in 1.6% of the total number of implants inserted and Ossean surface implants showed peri-implantitis in 1.5% of the total number of implants. The total percentage of implant lost was 4% for Ti-Unite surfaces and 3.6% for Ossean surfaces. Strict control of implants leads to low percentage of peri-implantitis even for rough surfaces dental implants.

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Role of Multiple Comorbidities and Therapies in Conditioning the Clinical Severity of DRESS: A Mono-Center Retrospective Study of 25 Cases

International Journal of Molecular Sciences ◽

10.3390/ijms22137072 ◽

2021 ◽

Vol 22 (13) ◽

pp. 7072

Author(s):

Andrea Toniato ◽

Chiara Gamba ◽

Jan Walter Schroeder ◽

Valeria Fabbri ◽

Scarlett Valeria Bernal Ortiz ◽

...

Keyword(s):

Risk Factors ◽

Drug Reaction ◽

Retrospective Study ◽

Clinical Severity ◽

Severe Reaction ◽

Skin Involvement ◽

Inflammatory State ◽

Reaction Severity ◽

Clinical Conditions

DRESS/DiHS is a complex and potentially fatal drug reaction. Little is known about risk factors and elements that can help to identify patients with a severe reaction early. The aim of the study was to investigate those factors favoring the disease and its severity by analyzing the clinical conditions and therapies preceding the reaction. We conducted a retrospective analysis on patients admitted to our center between 2010 and 2020 who were discharged with a diagnosis of DRESS. We used the RegiSCAR diagnostic criteria. We defined the severity of DRESS using the criteria of Mizukawa et al. We included 25 patients (15 females) with a median age of 66 years. Skin involvement, eosinophilia, and liver injury were the most important aspects. Allopurinol was found to be the most involved drug. Reaction severity was significantly associated with the number of daily medications (p=0.0067) and an age of at least 68 years (p=0.013). In addition, 75% of severe cases had at least three comorbidities in history, and most of the severe cases were female. In our study the advanced age, the high number of comorbidities and home therapies, and the inflammatory state were found to be predisposing elements to the development of the disease and its severity.

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Effects of COVID-19 Lockdown on Otitis Media With Effusion in Children: Future Therapeutic Implications

Otolaryngology ◽

10.1177/0194599820987458 ◽

2021 ◽

pp. 019459982098745

Author(s):

Mirko Aldè ◽

Federica Di Berardino ◽

Paola Marchisio ◽

Giovanna Cantarella ◽

Umberto Ambrosetti ◽

...

Keyword(s):

Retrospective Study ◽

Otitis Media ◽

Outpatient Clinic ◽

Otitis Media With Effusion ◽

Tertiary Level ◽

Vestibular Disorders ◽

Therapeutic Implications ◽

History Of ◽

Clinic Population

Objective To evaluate the role of social isolation during the lockdown due to the SARS-CoV-2 outbreak (severe acute respiratory syndrome coronavirus 2) in modifying the prevalence of otitis media with effusion (OME) and the natural history of chronic OME. Study Design Retrospective study. Setting Tertiary level referral audiologic center. Methods We assessed the prevalence of OME among children aged 6 months to 12 years who attended the outpatient clinic for hearing or vestibular disorders during 2 periods before the lockdown, May-June 2019 (n = 350) and January-February 2020 (n = 366), and the period immediately after the lockdown, May-June 2020 (n = 216). We also compared the disease resolution rates between a subgroup of children with chronic OME (n = 30) who were diagnosed in summer 2019 and reevaluated in May-June 2020 and a similar subgroup (n = 29) assessed in 2018-2019. Results The prevalence of OME in this clinic population was 40.6% in May-June 2019, 52.2% in January-February 2020, and 2.3% in May-June 2020. Children with chronic OME had a higher rate of disease resolution in May-June 2020 (93.3%) than those examined in May-June 2019 (20.7%, P < .001). Conclusion Closure of schools and the physical distancing rules were correlated with a reduction in the prevalence of OME and favored the resolution of its chronic forms among children who attended the outpatient clinic. These data could suggest that in the presence of chronic OME, keeping young children out of group care settings for a period might be beneficial to allow for OME resolution.

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Sonographic Signs of Adenomyosis in Women with Endometriosis Are Associated with Infertility

Journal of Clinical Medicine ◽

10.3390/jcm10112355 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2355

Author(s):

Dean Decter ◽

Nissim Arbib ◽

Hila Markovitz ◽

Daniel S. Seidman ◽

Vered H. Eisenberg

Keyword(s):

Laparoscopic Surgery ◽

Retrospective Study ◽

Statistical Analysis ◽

Conservative Management ◽

Transvaginal Ultrasound ◽

Control Group ◽

Study Group ◽

Control Groups ◽

Increased Risk ◽

And Control

We compared the prevalence of ultrasound signs of adenomyosis in women with endometriosis who underwent surgery to those who were managed conservatively. This was a retrospective study of women evaluated at a tertiary endometriosis referral center who underwent 2D/3D transvaginal ultrasound. Adenomyosis diagnosis was based on the presence of at least three sonographic signs. The study group subsequently underwent laparoscopic surgery while the control group continued conservative management. Statistical analysis compared the two groups for demographics, symptoms, clinical data, and sonographic findings. The study and control groups included 244 and 158 women, respectively. The presence of any, 3+, or 5+ sonographic signs of adenomyosis was significantly more prevalent in the study group (OR = 1.93–2.7, p < 0.004, 95% CI; 1.24–4.09). After controlling for age, for all findings but linear striations, the OR for having a specific feature was higher in the study group. Women in the study group with ≥ 5 sonographic signs of adenomyosis had more than twice the risk of experiencing infertility (OR = 2.31, p = 0.012, 95% CI; 1.20–4.45). Sonographic signs of adenomyosis are more prevalent in women with symptomatic endometriosis who underwent surgery compared with those who continued conservative management. Women with 5+ findings have a significantly increased risk of infertility. Adenomyosis on ultrasound should be considered in the management decisions regarding these patients.

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