scholarly journals A chylothorax modern kezelésének bizonyítékalapú áttekintése

2016 ◽  
Vol 157 (2) ◽  
pp. 43-51
Author(s):  
Zsolt Sziklavári ◽  
Péter Zsoldos ◽  
F. Tamás Molnár
Keyword(s):  
Conservative Treatment ◽  
Success Rate ◽  
Best Practice ◽  
Keyword Search ◽  
Treatment Options ◽  
Chest Drain ◽  
Ductus Thoracicus ◽  
Mortality Index ◽  
Practice Method ◽  
Morbidity Index

Chylothorax is a multi-factorial complication, frequently of an operation or an accident, but rarely of a tumour. In the absence of prospective or randomised studies evidence-based treatment is normally based on personal experience, ideally in the possession of retrospective analyses using the “best practice” method. The aim of the authors was the review the up-to-date chylothorax treatments. They performed the PubMed database’s “chylothorax” keyword search of the publications reported in the last ten years. They put emphasis on articles that included a comparative analysis of the various treatment options. During the critical analysis of the methods and recommendations, the authors relied on their own joint experience amounting to 39 years. The results showed that the success of the initial conservative treatment indicates a significant deviation depending on the etiology (3–90%). The success rate of non-invasive or semi-invasive interventions is between 50–100%, again depending on the etiology. The standard surgical treatment following an unsuccessful conservative treatment of an operable patient includes the fitting of a (thoracoscopic) knot to the ductus thoracicus, pleurodesis, insertion of a permanent chest drain or a pleuroperitoneal shunt. The success rate of these interventions is between 64–100%, with a morbidity index and mortality index exceeding 25%. Conservative treatment should be the first step, which should then be followed by a gradually increased aggressive therapy, during which the decisions should be made according to the patient’s condition and the drain volume. Interventional radiology procedures are safe, successful and they can be offered concurrently with a conservative treatment or operational solutions, although they are available only in a few centres. Orv. Hetil., 2016, 157(2), 43–51.

scholarly journals Study of treatment options in stricture urethra management and success rate in different types and sites of stricture

2020 ◽  
Vol 7 (3) ◽  
pp. 676
Author(s):  
Krishna Rao S. V. ◽  
Preetam Penumatcha
Keyword(s):  
Success Rate ◽  
Best Practice ◽  
Treatment Options ◽  
Corpus Spongiosum ◽  
Voiding Symptoms ◽  
External Meatus ◽  
Stricture Urethra ◽  
Individualized Approach ◽  
Average Success Rate ◽  
American Urological Association

Background: A urethral stricture is a scar of the subepithelial tissue of the corpus spongiosum that constricts the urethral lumen. As the constriction progresses, obstruction develops and leads to symptoms either directly related to the obstruction or as a secondary consequence.Methods: All the cases of stricture urethra presented to our institute between June 2017 to June 2019 (n=60) in whom treatment was required were studied in a prospective manner. All cases of obstructive voiding symptoms are evaluated by conducting uroflowmetry studies (ESPON, gravimetric type). Obstructive voiding symptoms are evaluated by using the American Urological Association questionnaire.Results: The data collected was divided into 3 groups: infective causes of stricture (n=22), traumatic causes of stricture (n=14) and idiopathic causes of stricture (n=24). The mean age of presentation was 34.4 years (range of 20 to 50 years). 18 (30.00%) patients had stricture in the bulbo-urethra, 12 (20.00%) at the external meatus, 4 patients had stricture at the bulbo-membranous region. Procedures undertaken during the study were visual internal urethrotomy in 20, anastomotic urethroplasty in 17 patients and Augmented urethroplasty in 23 patients. In our series of 60 patients, 48 patients had a Qmax of >15 ml/sec.  Average success rate was 80.1%, 12 patients had a Qmax of <15 ml/sec.Conclusions: It is unwise to make sweeping recommendations for best practice for reconstructive urethral surgery based on the literature because each patient clearly requires an individualized approach based on individual circumstances. Buccal mucosa is the most widely used graft has excellent results in all types of urethroplasty.

scholarly journals A systematic review on conservative treatment options for OSGOOD-Schlatter disease

2021 ◽  
Vol 49 ◽  
pp. 178-187
Author(s):  
Cornelia Neuhaus ◽  
Christian Appenzeller-Herzog ◽  
Oliver Faude
Keyword(s):  
Systematic Review ◽  
Conservative Treatment ◽  
Treatment Options

Multistage Openhole Completion Using Integrated Dynamic Diversion Frac Technique in Highly Depleted Well: First Successful Application in West Kuwait Field

2021 ◽  
Author(s):  
Abdullah Abu-Eida ◽  
Salem Al-Sabea ◽  
Milan Patra ◽  
Bader Akbar ◽  
Kutbuddin Bhatia ◽  
...  
Keyword(s):  
Best Practice ◽  
Treatment Options ◽  
High Energy ◽  
Lessons Learned ◽  
High Potential ◽  
Fracture Plane ◽  
Fluid Loss ◽  
Field Development ◽  
Two Fluids

Abstract The Minagish field in West Kuwait is a high potential field which poses several challenges in terms of hydrocarbon flow assurance through highly depleted tight carbonate intervals with uneven reservoir quality and curtailed mobility. These conditions have shifted the field development from vertical to horizontal wellbore completions. Achieving complete wellbore coverage is a challenge for any frac treatment performed in a long openhole lateral with disparities in reservoir characteristics. The fluid will flow into the path of least resistance leaving large portions of the formation untreated. As a result, economic fracturing treatment options dwindle significantly, thus reservoir stimulation results are not always optimum. A multistage fracturing technique using Integrated Dynamic Diversion (IDD) has been performed first time in West Kuwait field well. The process uses active fluid energy to divert flow into a specific fracture point in the lateral, which can initiate and precisely place a fracture. The process uses two self-directed fluid streams: one inside the pipe and one in the annulus. The process mixes the two fluids downhole with high energy to form a consistent controllable mixture. The technique includes pinpoint fluid jetting at the point of interest, followed by in-situ HCL based crosslinked systems employed for improving individual stage targets. The IDD diversion shifts the fracture to unstimulated areas to create complex fractures which increases reservoir contact volume and improved overall conductivity in the lateral. The kinetic and chemical diversion of the IDD methodology is highly critical to control fluid loss in depleted intervals and results in enhanced stimulation. Pumping a frac treatment in openhole without control would tend to initiate a longitudinal fracture along the wellbore and may restrict productivity. By using specialized completion tools with nozzles at the end of the treating string, a new pinpoint process has been employed to initiate a transverse fracture plane in IDD applications. Proper candidate selection and fluid combination with in-situ crosslink acid effectively plug the fracture generated previously and generate pressure high enough to initiate another fracture for further ramification. By combining these processes into one continuous operation, the use of wireline/coiled tubing for jetting, plug setting and milling is eliminated, making the new multistage completion technology economical for these depleted wells. The application of the IDD methodology is a fit-for-purpose solution to address the unique challenges of openhole operations, formation technical difficulties, high-stakes economics, and untapped high potential from intermittent reservoirs. The paper will present post-operation results of this completion from all fractured zones along the lateral and will describe the lessons learned in implementation of this methodology which can be considered as best practice for application in similar challenges in other fields.

Comparing plaque brachytherapy and proton therapy for choroidal melanoma: a review of the literature

2010 ◽  
Vol 9 (1) ◽  
pp. 53-61
Author(s):  
Jeremy P. Appleton ◽  
Peter Bridge
Keyword(s):  
Conservative Treatment ◽  
Proton Therapy ◽  
Normal Tissue ◽  
Treatment Options ◽  
Choroidal Melanoma ◽  
Review Of The Literature ◽  
Tumour Control ◽  
Local Tumour Control ◽  
Local Tumour ◽  
Plaque Brachytherapy

AbstractThe aims of conservative treatment in patients with ocular melanoma are globe retention, good visual acuity (VA) and local control. Two well-established radiation conservative treatment options are proton beam radiotherapy and episcleral plaque brachytherapy (EPB). Patients who receive treatment with either of these options will experience some degree of radiation-related ocular complications and poor VA. The purpose of this review of the literature is to establish whether there is a significant clinical difference in normal tissue morbidity and local tumour control between proton therapy and EPB, and whether this difference can justify the purchase and implementation of additional proton therapy facilities. Based on this review, evidence suggested that both treatment options are comparable, and that neither proton therapy nor EPB is clinically superior than the other regarding normal tissue morbidity and local tumour control. This review highlighted the need for further research on a larger scale in order to bridge the gap that is apparent within the literature.

scholarly journals Thrombosis of persistent median artery as a cause of carpal tunnel syndrome : case report

2021 ◽  
Vol 87 (3) ◽  
pp. 529-532
Author(s):  
S Arnauw ◽  
G De Wachter
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Carpal Tunnel ◽  
Treatment Options ◽  
Surgical Excision ◽  
Acute Onset ◽  
Complete Relief ◽  
Anatomical Variant ◽  
Tunnel Syndrome ◽  
Median Artery

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, caused by compression of the median nerve. Symptoms usually are present for months and aggravate over time. Acute onset of complaints and symptoms, like coldness of the hand, should raise awareness of a possible vascular cause of CTS.Persistent median artery (PMA) is a very rare anatomical variant of the blood supply of the upper limb. The presence of a thrombosed PMA is an extremely rare cause of CTS. In this article a case is presented in which the patient has carpal tunnel syndrome of his left hand, caused by a thrombosed persistent median artery. Conservative treatment, consisting of rest, ice applica- tion and non-steroidal anti-inflammatory drugs, failed. Surgical excision of the thrombosis and open exploration of the carpal tunnel was performed, with complete relief of symptoms. In literature different treatment options, like conservative treatment with antiplatelet therapy or surgical excision of the throm- bosis and decompression of the nerve, are described with good results. However up until now, no consensus exists about the golden standard in treatment of a thrombosed persistent median artery.

scholarly journals Conservative treatment of a scoliosis patient after two heart surgeries in early childhood – A case report

2021 ◽  
Vol 77 (2) ◽  
Author(s):  
Hans-Rudolf Weiss ◽  
Manuel Lay ◽  
Tamisha Best-Gittens ◽  
Marc Moramarco ◽  
Mario Jimeranez
Keyword(s):  
Case Report ◽  
Conservative Treatment ◽  
Best Practice ◽  
Tanner Stage ◽  
Growth Spurt ◽  
Brace Treatment ◽  
Pubertal Growth Spurt ◽  
Patient Presentation ◽  
Main Curve

Introduction: This is a case report of a juvenile female patient with scoliosis following two heart surgeries for congenital heart disease (CHD).Patient presentation, management and outcome: Initially, the premenarchial female was 9 years old and had a Tanner stage 2–3 with a single thoracic curve of 65° Cobb. Because of the high risk for progression, immediate brace treatment was proposed as the father declined surgery. The patient received intensive treatment according to the Schroth Best Practice® programme and a Gensingen Brace® designed for large thoracic curves. Over the 18 months following the initial visit, she received two additional braces. As a result, the progression of the main curve was prevented. The patient continues to maintain an improved cosmetic result and is currently at a Risser 2.Conclusion: Surgery performed for CHD in rare cases may lead to stiff spinal deformity as a consequence of that surgery. Progression of a severe and stiff curve was prevented during the most vulnerable phase of the pubertal growth spurt with an improved clinical result. Therefore, we assume that the patient may have a normal life in adulthood with minor restrictions only. Supported by pattern-specific high correction exercises and braces, these typical single thoracic curves can be re-compensated to a more balanced appearance, less prone to progression in adulthood.Clinical implications: Because of the relative high risks of spinal fusion and the long-term unknowns of such an intervention, high-impact conservative treatment should be implemented first before surgical correction is considered.

scholarly journals Improvement of Medical Treatment Options of Proximal Deep Vein Thrombosis of Low Extremities Associated with Phlegmasia Alba Dolens

2021 ◽  
Vol 14 (3) ◽  
pp. 193-198
Author(s):  
Boris Sukovatykh ◽  
Aleksey Viktorovich Sereditsky ◽  
Andrey Mikhailovich Azarov ◽  
Vadim Feliksovich Muradyan ◽  
Mikhail Borisovich Sukovatykh ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Conservative Treatment ◽  
Treatment Options ◽  
Proximal Deep Vein Thrombosis ◽  
Venous Outflow ◽  
Partial Restoration ◽  
Vein Thrombosis ◽  
Phlegmasia Alba ◽  
Anti Inflammatory ◽  
Deep Vein

The aim of the study was to improve the conservative treatment options for proximal deep vein thrombosis of low extremities associated with phlegmasia alba dolens optimization of anticoagulant therapy and paravascular injection of the anti-inflammatory medical mixture in areas of the most intense inflammatory process.Materials and methods. The results of treatment of two statistically homogeneous groups of patients with proximal deep vein thrombosis of the lower extremities associated with white phlegmasia were compared. In the first group (n = 30), standard conservative treatment was carried out using rivaroxaban as an anticoagulant; in the second group (n = 30), initial heparin therapy was first performed and, additionally, the following mixture was administered in the places of the greatest severity of inflammatory process under ultrasound control: dexamethasone 16 mg, heparin 5 thousand units, 0.25% novocaine solution 20.0 ml. During treatment the incidence of hemorrhagic syndrome was recorded. The results were assessed after one year according to the degree of deep vein lumen restoration and the severity of venous outflow impairment according to the Villalta scale. Results. In patients of both groups, every tenth patient developed some minor manifestations of hemorrhagic syndrome during treatment with rivaroxaban that was corrected by a decrease in the dose of anticoagulant.Complete restoration of the lumen of the veins occurred in 20.0%, patients of the first group and in 40.0%, patients of the second group; partial, in 63.3% and 56.7% of patients, respectively, minimal - in 16.7% and 3.3% of patients, respectively.In the first group, clinical disorders of venous outflow were absent in 20.0% of patients, a weak degree of severity was registered in 23.3%, an average - in 40.0%, and a strong one in 16.7% of patients, and in the second group, in 40 %, 26.7%, 30% and 3.3% of patients, respectively.Different minor hemorrhagic complications after Rivaroxaban intake occurred equally in both groups in each of ten patients. These complications were treated by the reduction of the anticoagulants dose.Complete restoration of the vein lumen occurred in the first group in 20.0%, and in the second group in 40.0% of patients, partial restoration, in 63.3% and 56.7% of patients, minimal - in 16.7% and 3.3% of patients respectively.In patients of the first group clinical venous congestion was absent in 20,0% of patients, mild congestion was manifested in 23,3% of patients, moderate - in 40,0% of patients, and severe was in 16,7% of cases. In the second group, the obtained data was 40%, 26,7%, 30%, and 3,3% of patients, respectively. Conclusion. Starting therapy with heparin and paravascular injection of anti-inflammatory mixture helps improve treatment outcomes.

scholarly journals Diagnosis and treatment of calcific tendinitis of the shoulder

2020 ◽  
Vol 23 (4) ◽  
pp. 203-209
Author(s):  
Min-Su Kim ◽  
In-Woo Kim ◽  
Sanghyeon Lee ◽  
Sang-Jin Shin
Keyword(s):  
Conservative Treatment ◽  
Shoulder Pain ◽  
Treatment Options ◽  
Review Article ◽  
Calcific Tendinitis ◽  
Diagnosis And Treatment ◽  
Appropriate Treatment ◽  
Acute Calcific Tendinitis ◽  
Calcific Deposits ◽  
Pain Patients

Calcific tendinitis is the leading cause of shoulder pain. Among patients with calcific tendinitis, 2.7%–20% are asymptomatic, and 35%–45% of patients whose calcific deposits are inadvertently discovered develop shoulder pain. If symptoms are present, complications such as decreased range of motion of the shoulder joint should be minimized while managing pain. Patients with acute calcific tendinitis respond well to conservative treatment and rarely require surgery. In contrast, patients with chronic calcific tendinitis often do not respond to conservative treatment and do require surgery. Clinical improvement takes time, even after surgical treatment. This review article summarizes the processes related to the diagnosis and treatment of calcific tendinitis with the aim of helping clinicians choose appropriate treatment options for their patients.

scholarly journals Complications of laparoscopic cholecystectomy: an analysis of 1,695 laparoscopic operations

2017 ◽  
Vol 4 (9) ◽  
pp. 3049
Author(s):  
Dasharadha Jatothu ◽  
Rajkumar Sade ◽  
Kirthana Sade ◽  
. Taruni ◽  
Nagababu Pyadala
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Conservative Treatment ◽  
Minimally Invasive ◽  
Treatment Options ◽  
Gallstone Disease ◽  
Minimally Invasive Treatment ◽  
Medical Sciences ◽  
Invasive Treatment ◽  
Gold Standard Method ◽  
Operative Complication

Background: Laparoscopic cholecystectomy (LCs) is the gold standard method to treat gallstone disease. But there are some complications which occur frequently as compared to open cholecystectomy.Methods: The prospective study was conducted in the Department of Surgery, Kamineni Institute of Medical Sciences, Telengana during the period of 2 years; March 2015 to February 2017. A total of 1,695 laparoscopic cholecystectomy cases were included in this study. Several treatment options such as, conservative treatment, minimally invasive treatment and open surgery was performed based on the severity of the disease.Results: Majority of patients were female (83.9%) and most common age group affected was above 40 years. Intra-operative and post-operative complication occurred in 4.5% and 1.9% patients respectively. Majority complications were treated by conservative treatment and minimally invasive treatment. So, in conclusion, we can use conservative and minimally invasive treatment to manage the complications from laparoscopic cholecystectomy.Conclusions: Conservative treatment options and minimally invasive treatment was more efficient to overcome the post-operative complication of laparoscopic cholecystectomy.

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