جستجوی مقالات مرتبط با کلیدواژه « Conservative Treatment » در نشریات گروه « پزشکی »

Radial head and neck fractures are one of the common fractures of the elbow in adult patients. There are controversial in treatment of nondisplaced head and neck fracture. However, nonoperative treatment remain as a choice treatment of nondisplaced radial head fracture without motion block.

Case Report: 

we presented a 23 years-old patient who had bilateral nondisplaced radial head fracture. The Patients was managed with conservative treatment and early elbow range of motion. Finally, the patient had full range of motion without any pain in his both elbows.

Nonoperative treatment with early range of motion remain as a treatment for bilateral nondisplaced radial head fracture with acceptable outcome.

 Neonatal benign pneumoperitoneum (NBPP) is an uncommon condition often characterized by abdominal distension. It necessitates differential diagnosis to distinguish it from pneumoperitoneum caused by perforation and peritonitis, which may lead to an exploratory laparotomy with negative outcomes. In this document, we summarize the cases of NBPP treated at our hospital over the past decade and review relevant literature to offer insights into the diagnosis and treatment of this disease.

 We report on three cases of NBPP, all of which presented with abdominal distension. Two of the cases were managed conservatively, while one underwent exploratory laparotomy. No evidence of perforation or other significant findings was observed during the surgery. All three patients survived.

 In cases of suspected neonatal pneumoperitoneum, it is essential to consider NBPP as a differential diagnosis and closely monitor disease progression to prevent misdiagnosis. NBPP can often be managed conservatively, although it is crucial to vigilantly observe any changes in vital signs throughout the treatment. Further research is needed to elucidate the etiology and pathogenesis of this disease.

Primary idiopathic frozen shoulder (FS) causes pain and stiffness in the shoulder joint. Over time, this disease causes restriction of shoulder motion. We undertook this study to evaluate possible correlation of MRI findings with outcome of conservative management in FS. A total of 65 cases participated in prospective cohort study. The correlation of MRI findings obtained before commencing the treatment with outcome of non-operative management (Mean of ROM, VAS, SST and OSS) was evaluated. Anterior extracapsular edema significantly correlated with FF, EXR, VAS (a) and OSS. The effusion in humeral side of axillary recess significantly correlated with ROM restriction in ABD, EXR. Capsular thickness of glenoid portion showed good significance with FF, ABD, VAS (a) and OSS. Increased thickness of CHL showed negative correlation with improvement of EXR (P=0.049) (r=-0.617). Thickening of IGHL showed negative correlation with improvement of ABD (p=0.005 r=-0.862) and FF (p=0.007 r=-0.831). Mean Height of Axillary recess (HAR) was 7.2mm (3.5-11mm). HAR showed negative correlation with VAS pain scale (P=0.036) (r=-0.682) and OSS (P=0.038) (r=-0.668) Thickness of the joint capsule and effusion at the axillary fold are important factors for refractory frozen shoulder. We can recommend MRI for refractive cases and low threshold of expectation can be set for conservative management in patients with above findings. Level of evidence: III

Conservative treatment of placenta accreta spectrum (PAS) become increasingly performed, especially due to acceptance of many obstetricians to preserve the uterus. To evaluate cesarean scar integrity following PAS conservative surgery using Shehata's technique and other conservative techniques because more than one level of pelvic devascularization was used. This cross-sectional study was conducted at Tanta University in the period from June 1, 2019 to October 31, 2022.

All patients underwent conservative uterine sparing technique (Shehata's technique) were assessed by 2 D ultrasound at 6-18 months later to detect the integrity of the CS scar. Fifty women with a history of other conservative treatment of PAS used as control.

Women who were operated with Shehata’s technique showed less incidence of scar dehiscence with less size of scar defects and more thickness of the myometrium over the scar site and more vascularity of these scars.

Shehata's technique resulted in a more integrated scar with less incidence of   dehiscence and more vascularity of the compared to other conservative methods of treatment of PAS. Therefore, it is an effective and safe method in treatment of PAS.

Rathke cleft cyst apoplexy is exceedingly rare, particularly in infants. The most prevalent clinical manifestations include headaches, visual field defects, and endocrine dysfunction. Treatment options range from surgery to conservative methods, taking into consideration the balance of benefits and risks, especially during critical life stages such as childhood.

We present the case of a 12-year-old boy admitted due to the recent onset of headaches and diabetes insipidus. Magnetic resonance imaging revealed Rathke cleft cyst apoplexy. Given the absence of compressive symptoms in a child at the early stages of puberty and without abnormalities in basic endocrine tests, a conservative strategy was employed, involving regular clinical, biological, and radiological follow-ups. The child experienced normal puberty without any endocrine deficiencies except for a partial growth hormone deficiency.

For clinically asymptomatic children diagnosed with Rathke's cleft cyst apoplexy, adopting a conservative management approach is recommended, provided there is thorough clinical, biological, and radiological surveillance.

The most common cause of heel pain is plantar fasciitis (PF). Although conservative treatments relieve pain in more than 90% of patients, it may remain painful in some cases. This study aimed to compare High-intensity Laser Therapy (HILT) with Extracorporeal Shock Wave Therapy (ESWT) in patients with PF.

In this double-blinded randomized clinical trial (conducted in Yazd, Iran, from May 2020 to March 2021), patients were classified into two groups, including the ESWT and HILT, using online randomization. Nine sessions, three times a week for 3 weeks, were the treatment period in both groups. Visual Analogue Score (VAS), Heel Tenderness Index (HTI), and the SF36 questionnaire were compared and analyzed statistically at the beginning and 9 months after treatment. 

38 patients (19 in each group) completed the study. Results showed that pain and patient satisfaction improved significantly 3 months after treatment. The VAS and HTI decreased 3 months after treatment in both groups, which was statistically significant (P<0.001). The SF36 score in both groups increased 3 months after treatment, and this increase was statistically significant (P<0.001). Although the two modalities were effective based on VAS, HTI, and SF36, a significant statistical difference was observed between them (P=0.03, P=0.006, P=0.002, respectively), and the HILT was more effective.

ESWT and HILT decrease pain and increase patient satisfaction in PF. Besides, both methods are non-invasive and safe. However, there is a significant difference between them, and HILT is more effective.Trial registration number: IRCT20210913052465N1.

Proper and conservative endodontic access cavity preparation is a crucial step in performing a successful root canal treatment that ensures a long-term prognosis. This study aimed to evaluate the intercuspal and interorifice length of maxillary first and second molars using cone beam computed tomography (CBCT).

The CBCT scans of 400 mature and intact maxillary first and second molars (16, 17, 26, and 27) were evaluated. The measured variables included the distances between the buccal cusps (intercuspal distance) and buccal orifices (interorifice distance), the interorifice/intercuspal ratio, and the angle at the intersection of interorifice and intercuspal lines. The variables were compared between different teeth and between male and female patients.

The interorifice and intercuspal distances were significantly greater in males compared to females (P<0.05), except for the intercuspal distance in the left maxillary second molar (P=0.056). There was a statistically significant difference concerning the angle formed between the interorifice and intercuspal lines among tooth numbers 26 and 27 (P=0.044). The interorifice/intercuspal ratio was significantly different between the maxillary first and second molars on the right (P=0.006) and left sides (P<0.001).

The angle formed between the intercuspal and interorifice distances and the interorifice/ intercuspal ratio was greater in the maxillary first molars compared to the second molars. Moreover, males generally had larger internal and external anatomical features than females. Hence, when preparing a conservative access cavity in maxillary molars, clinicians are advised to consider both the external tooth anatomy and the patient's gender as important factors

The present study aimed to compare knee function, as well as physical and psychological health, of athletes who underwent conservative treatment with those who underwent anterior cruciate ligament (ACL) reconstruction.

This cross-sectional study was conducted on 31 athletes with a history of unilateral ACL tear who were placed in two groups: ACL reconstruction (18 people) and conservative treatment (13 people). Single and triple hop tests for distance and knee injury and osteoarthritis outcome score (KOOS) were used for objective and subjective evaluation of knee function, respectively. The physical and psychological health of the athletes was also evaluated by the Patient-Reported Outcomes Measurement Information System 29 (PROMIS-29) questionnaire. Multivariate analysis of covariance was used to analyze the data at a significance level of P≤0.05.

Based on the result, the ACL treatment strategy (reconstruction or conservative treatment) had a significant effect on physical performance, ability to participate in social activities, anxiety, and depression of athletes (P<0.05). Regarding the knee function, the obtained results pinpointed that the ACL treatment strategy had a significant effect on knee symptoms and stiffness, activities of daily living, sports performance, quality of life, and limb symmetry index in hop distance (P<0.05).

It can be stated that selective treatment after an ACL injury can affect athletes' knee function, sports performance, as well as physical and psychological health. Nonetheless, it is necessary to know that the current study is retrospective and has many limitations that should be considered.

Restoring severely damaged teeth has always been challenging when the remaining crown structure is limited, and retention might be necessary from the root canal using intracanal posts. However, the real challenge is when the root canal walls are also weak, and there is a high risk of vertical root fracture due to the wedging forces of a rigid post. This case report presents a tooth with flared root canal walls successfully restored with a newly introduced polymer made of polyether ether ketone (PEEK) (BioHPPfor2press,Bredent,UK) with one-year follow-up. Regarding its close elastic modulus to dentin, the ability to bond to tooth structure, shock-absorbing ability, and therefore favorable stress distribution, using this material for an intracanal post may minimize the risk of fractures commonly observed with cast metal posts. It combines good fitness of cast posts with low modulus of elasticity and optical properties of prefabricated fiber posts.

This study aimed to evaluate the outcome and risk factors in operative and non-operativemanagement of splenic injury. This cross-sectional study was conducted on patients with traumatic splenic injuries who werehospitalized in Kashani Hospital (Isfahan, Iran) from 2017 to 2019. The studied variables were extracted fromthe medical records of the enrolled participants. The outcomes such as mortality complications and risk factorswere compared based on treatment methods. A total of 240 patients were investigated. The mean age of the patients was 29.8±12.2, with 180(77.5%) patients being men. 154 (64.2%) patients underwent operative treatment. The mortality rate was 18.9%and 4.6% among operative and non-operative groups (p<0.001). Complications were observed in 11.5% and46.1% of non-operative and operative groups, respectively (p<0.001). Operative treatment inversely correlatedwith mortality (p<0.001) and complications (p<0.05). Splenic injury severity was correlated positivelywith mortality (p<0.001) and negatively with complications (p<0.001). Unstable hemodynamic status waspositively correlated with complications (p<0.001). Age had a positive correlation with mortality (p<0.001)and complications (p<0.001). Male sex had a negative correlation with complications (p<0.001). GCS score andadmission were positively correlated with mortality (p<0.001). There was no statistically significant correlationbetween correlated injuries and outcomes (p≥0.05). Patients who received surgery had higher rates of mortality and complications. However, aftercontrolling for confounders, operative treatment was found to be inversely correlated with mortality andcomplications.

Thoracolumbar fractures are common traumatic injuries that can be treated conservatively or by surgery, depending on the type and severity of the injury. This study aimed to determine the efficiency of various orthoses used for these fractures based on the available literature.  

Between 1950 and 2023, a search was conducted in some databases, including PubMed Central and MEDLINE, ISI Web of Knowledge, Cochrane-centered Register of Controlled Trial (CCTR), Embase, and Scopus. Some keywords—such as conservative treatment, orthoses, brace, and cast—were used in combination with thoracolumbar fracture, burst fracture, and compressive fracture. The quality of the studies was evaluated using the PEDro scale. Two researchers independently reviewed the studies.   

Based on the results of the included studies, orthosis is not necessary for stable burst and compression fractures. Based on the inclusion criteria, 20 papers were selected for the final analysis, 12 of which were on the use of spinal braces and casting (with quality between 1 and 6), 2 on the no-treatment approach, and 6 on comparing the outputs of treatment with spinal braces with no braces.   

Although the use of orthosis and cast is one of the conservative treatments recommended for patients with thoracolumbar fractures, it seems that for stable burst fractures and compression fractures, the use of a brace does not provide any benefits. However, the use of a brace or cast is recommended for burst fractures with more than 1 column fracture.

The access cavity preparation technique might influence the fracture resistance of endodontically treated teeth. This study evaluated the impact of preserving the enamel-dentin bridge on fracture resistance of endodontically treated mandibular molars. A total of 42 mandibular molars were randomly divided into three groups according to the access cavity design: Traditional endodontic access cavity (TEC), truss endodontic access cavity (TREC), and control (CON) (n=14). The teeth in each group were divided into two equal subgroups (with and without thermocycling). The control group was stored in saline over the experiment, whereas class II mesio-occlusal access cavities were prepared in the two experimental groups. In the TEC design, a conventional access cavity was prepared. In the TREC design, the occlusal enamel and dentin between the mesial and distal root canal orifices were not removed. Endodontic treatment, and composite resin restoration were performed similarly in the experimental groups. The teeth were subjected to fracture resistance testing in an Instron machine and the load at fracture was compared among the groups. The CON group had significantly superior fracture resistance than the two experimental groups (P<0.05), which showed comparable fracture load values at both conditions (P>0.05). Thermal cycling reduced fracture resistance in both TEC and TREC groups (P<0.05), but had no significant effect in the control group (P=0.624). Considering the similar fracture resistance of the TEC and TREC groups, the study suggested that preserving the enamel-dentin bridge does not enhance fracture resistance in endodontically treated teeth with mesio-occlusal cavities.

We evaluated the optimal duration of pelvic floor muscle training (PFMT) in stress urinary incontinence (SUI) patients.

This cross-sectional study was conducted at Cipto Mangunkusumo Hospital from November 2018 to June 2019. We recruited 55 subjects diagnosed with SUI based on the questionnaire for urinary incontinence diagnosis (QUID) score >4 and more than 2 grams of 1-hour pad test. Considering the inclusion and exclusion criteria, we taught and supervised them for PFMT and evaluated them every four weeks to observe the urogenital distress inventory-6 (UDI-6), incontinence impact questionnaire-7 (IIQ-7), 1-hour pad test, and perineometer score. We used the Wilcoxon test to evaluate the improvement at a significance level of P<0.05.

Our subjects were mostly obese (65%), 30-55 years old (60%), and had >2 children (90%). There were improvements in UDI-6 and IIQ-7 for every four weeks up to 12 weeks of PFMT (P<0.05, 95% CI). Pelvic floor muscle strength only improved significantly (P=0.001 and P=0.006, respectively) after eight weeks of PFMT. Also, the 1-hour pad test score decreased significantly after four weeks of training (P<0.001). 

SUI distress and symptoms decrease after four weeks of Kegel exercises and continue to improve until 12 weeks of therapy. However, the 1-hour pad test reaches clinical and statistical significance during the first month of exercise with no further improvement clinically. Pelvic floor muscle strength increased significantly after eight weeks of training.

Placenta accreta spectrum (PAS) is a major cause of obstetric bleeding in third trimester of pregnancy.

This study aimed to compare the outcomes of uterine preservation surgery vs. hysterectomy in women with PAS.

In this retrospective cross-sectional study, the records of 68 women with PAS referred to the Imam Khomeini hospital in Ahvaz, Iran, between March 2015 and February 2020 were included. The women divided into 2 groups according to surgical approach: hysterectomy vs. uterine preservation (including just removing the lower segment, removing the lower segment with uterine artery ligation or removing the lower segment with hypogastric artery ligation during cesarean section). The need for blood components transfusion (whole blood, packed cells, and fresh frozen plasma), maternal mortality, duration of surgery, and length of hospitalization was compared between groups.

In total, we investigated 68 women between the ages of 24-45 yr (mean age of 32.88 ± 5.08 yr). All participants were multiparous and underwent cesarean section. Furthermore, 28 women (41.2%) had a history of curettage. In total, 24 women (35.3%) underwent hysterectomy, and 44 (64.7%) underwent uterine preservative surgeries. There were no significant differences between groups of hysterectomy and uterine preservative surgeries in terms of need for blood components transfusion, maternal mortality, duration of surgery, and length of hospitalization.

The results of this study showed no significant difference between groups regarding the studied outcomes. Therefore, conservative surgeries could be used to preserve the uterus instead of hysterectomy in women with PAS.

Calcifying tendinitis (CT) is an enigmatic lesion with several obscure aspects and it is a common disorder of the upper extremity characterized by the presence of calcifications in rotator cuff tendons and synovial tissues. In this study, we aimed to review the demographic and clinical characteristics, as well as radiologic and treatment history in CT patients who were referred with shoulder pain.  

In this cross-sectional study, a total of 146 patients who were referred with a shoulder CT were included.  The definitive diagnosis was based on a combination of plain radiograph and magnetic resonance imaging (MRI). A predesigned independent t test was used to capture demographic and clinical data, as well as radiologic and treatment histories, and a chi-square test was utilized to assess the statistical correlation between qualitative variables.  

The median age of the patients was 42.5 years. The female to male ratio was 2.3 to 1. The complaint of restricted shoulder movement was recorded in 107 (73.3%) patients and more frequently in women (p = 0.042). Night pain was present in 109 (74.7%) patients. The current and previous diagnoses matched in 36.1% (13 out of 36) of patients who only had MRI and in 63.6% (35 out of 55) patients who had both MRI and plain radiograph with them. Supraspinatus tendon was the main site of calcified deposition 65% (95 out of 146).   

CT is frequent at the age of around 40 and in the female gender. The diagnosis should be based on a combination of radiography and MRI and not based on MRI alone. The efficacy of different conservative treatments remains to be unwrapped.

As a rare ectomesenchymal neoplasm, benign cementoblastoma comprises less than 6% of all odontogenic tumors. The typical treatment plan involves surgical excision and extraction of the affected tooth. Limited evidence, however, suggests the conservative management of this condition as the best treatment. This article discusses the case of a 32-year-old man who had benign cementoblastoma and underwent conservative treatment. The diagnosis was established based on clinical and radiological features analyses. Root canal therapy was performed on the tooth, followed by enucleation, curettage, apicoectomy, and guided bone regeneration (GBR) 30 days later. After a year of follow-up, there was no recurrence, and the tooth was in healthy conditions. These findings demonstrated that the tooth affected by cementoblastoma can be saved. It was treated conservatively to preserve the patient’s oral health and masticatory function.

Distal radius fractures (DRFs) are the most common orthopedic injuries in emergency depart- ment. This study aimed to compare the outcomes of conservative and surgical managements of DRFs in the aged population.

In this retrospective cohort study, ninety patients with unilateral DRFs were treated using either surgical or conservative (casting) approach and the management outcomes as well as complica- tions were compared between the two groups at 3 and 6-month follow-ups.

A total of 90 patients over 70 years old were included (45 treated with cast immobilization, and 45 using the surgical method). The mean age (p = 0.56) and gender (p = 0.85) was similar in the two groups. Except for quality of life in both follow-up times, patients treated with surgical methods showed better outcomes in other aspects, including 3-month (p = 0.042) and 6-month (p = 0.022) mean Disability of the Arm Shoulder Hand (DASH) score, 3-month (p = 0.013) and 6-month (p = 0.006) mean range of motion (ROM), and 3-month (p = 0.003) and 6-month (p = 0.033) pain in- tensity based on Visual Analogue Scale (VAS). A total of 70 (77.77%) adverse events were registered (33 (36.6%) in the casting group and 37 (41.1%) in the surgical group; p = 0.05). The rate of mal-union (p = 0.021) and superficial radial nerve injury (p = 0.026) were significantly lower in the surgical group.

The findings suggest that surgical approach for management of DRFs in elder cases has better clinical and functional outcomes than cast immobilization.