scholarly journals VP63.05: Transvaginal ultrasound‐guided alcohol sclerotherapy:a novel conservative treatment for the management of accessory cavitated uterine malformations

2020 ◽  
Vol 56 (S1) ◽  
pp. 350-350
Author(s):  
J. Naftalin ◽  
T. Setty ◽  
P. Chaggar ◽  
D. Jurkovic
Keyword(s):  
Conservative Treatment ◽  
Transvaginal Ultrasound ◽  
Ultrasound Guided ◽  
Uterine Malformations

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

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.

Endometriosis of the perianal region – epidemiology, diagnosis and treatment

Nowa Medycyna ◽  
2018 ◽  
Vol 25 (4) ◽  
Author(s):  
Małgorzata Kołodziejczak ◽  
Iwona Sudoł-Szopińska ◽  
Małgorzata Siergiej
Keyword(s):  
Conservative Treatment ◽  
Histopathological Examination ◽  
Transvaginal Ultrasound ◽  
Young Patients ◽  
Pain Syndrome ◽  
Cervix Uteri ◽  
Pelvic Pain Syndrome ◽  
Hormonal Activity ◽  
Childbearing Age ◽  
Extensive Resection

Endometriosis is the presence of the uterine endometrium beyond the uterus. The disease usually affects women of childbearing age. Foci of endometriosis are mostly (in 95% of cases) located in the peritoneal cavity (cervix uteri, vaginal vault, vulva, urinary bladder, inguinofemoral region) and only rarely found beyond it. Occasionally, endometriosis is found in the perineal tissues, usually in the episiotomy scar, and, exceptionally rarely, in the anorectal region. Endometriosis usually develops in the period of hormonal activity. The disease may be asymptomatic or manifest with dyspareunia, pelvic pain syndrome, fertility problems, menstrual disorders and heavy menstruation. The diagnosis of anorectal endometriosis is established through a thorough interview and additional tests, including transrectal and transvaginal ultrasound or optionally magnetic resonance imaging. The final diagnosis is determined in a histopathological examination, usually of samples collected intraoperatively. Also, an endoscopic examination should be performed (at least rectoscopy) to rule out other pathological lesions. Treatment includes pharmacotherapy and surgery. In young patients, in the period of hormonal activity, extensive resection with primary sphincter reconstruction seems to be the most optimal option. In older patients, nearing menopause, conservative treatment is a better solution as endometriosis regresses and disease symptoms subside after menopause. In these cases, conservative treatment helps avoid iatrogenic sphincter injury and faecal incontinence.

scholarly journals Retrospective analysis of transvaginal ultrasound-guided aspiration of simple ovarian cysts

2019 ◽  
Vol 28 (11) ◽  
pp. 1531-1535
Author(s):  
Marta Kostrzewa ◽  
Agnieszka Zając ◽  
Jacek Wilczyński ◽  
Grzegorz Stachowiak
Keyword(s):  
Retrospective Analysis ◽  
Transvaginal Ultrasound ◽  
Ovarian Cysts ◽  
Ultrasound Guided
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