RESUMEN
OBJECTIVE: To compare the short and long-term benefits (the length of hospital stay, surgical complications, and early clinical improvement) of adding early ultrasound-guided drainage to broad-spectrum antibiotic treatment. METHODOLOGY: Patients undergoing tubo-ovarian abscess treatment between January 2017 and June 2022 in a tertiary hospital were retrospectively evaluated. Of the patients studied, 50 subjects were treated with antibiotics alone and 63 underwent guided drainage. Twenty-one individuals underwent early drainage within 72 hours of admission, and 42 underwent guided drainage after this period. RESULTS: There was no statistical difference in the length of hospital stay between the groups simultaneously, averaging 6.4 days for the controls, 5.1 days for the early drainage group, and 9.6 days for the late drainage group (p = 0.290). In the multiple linear regression with the length of hospital stay outcome and adjusting for potential confounding factors, there was an average reduction of 2.9 days in the hospital stay (p = 0.04) for the early drainage group (< 72 hours) compared to the controls. Early clinical improvement and an expected drop in CRP were more frequent in patients who underwent drainage. Length of hospital stay increases with abscess diameter: 0.4 [(95% CI 0.1 - 0.7) (p = 0.05)] days per centimeter, regardless of other variables. CONCLUSIONS: Ultrasound-guided drainage of tubo-ovarian abscesses associated with antibiotic therapy is an effective treatment, with few complications, and may lead to clinical improvement especially when performed early.
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Absceso , Antibacterianos , Drenaje , Tiempo de Internación , Enfermedades del Ovario , Humanos , Femenino , Estudios Retrospectivos , Drenaje/métodos , Adulto , Estudios Transversales , Absceso/terapia , Absceso/diagnóstico por imagen , Absceso/cirugía , Absceso/tratamiento farmacológico , Antibacterianos/uso terapéutico , Enfermedades del Ovario/terapia , Enfermedades del Ovario/diagnóstico por imagen , Enfermedades del Ovario/tratamiento farmacológico , Enfermedades del Ovario/cirugía , Persona de Mediana Edad , Tratamiento Conservador/métodos , Enfermedades de las Trompas Uterinas/terapia , Enfermedades de las Trompas Uterinas/diagnóstico por imagen , Enfermedades de las Trompas Uterinas/cirugía , Ultrasonografía Intervencional/métodos , Resultado del Tratamiento , UltrasonografíaRESUMEN
BACKGROUND: Pituitary apoplexy (PA) is characterized by acute hemorrhage or infarction of the pituitary gland. Management can be either conservative or surgical. Evidence favoring either is still limited to observational studies. This meta-analysis evaluates the effectiveness of both approaches on patient outcomes. METHODS: A systematic search was performed until February 2024. We included cohort studies of patients with PA. Patients were divided into 2 groups: a conservative management group and a surgery group, including early and late surgery. Outcomes of interest were assessed categorically using risk ratio (RR) and Mantel-Haenszel's random effects model. RESULTS: Of the 273 published articles, 15 cohort studies comprising 908 patients were included. There was no statistically significant difference between groups in recovery of ophthalmoplegia (RR=1.09, confidence interval [CI]=1.00-1.18, P=0.05), visual field (RR=1.09, CI=0.91-1.3, P=0.35), visual acuity (RR=1.05, CI=0.87-1.26, P=0.61), hypopituitarism (RR=1.37, CI=0.81-2.32, P=0.25), and tumor recurrence (RR=0.74, CI=0.34-1.61, P=0.45). This was similar for conservative management versus early surgery in recovery of visual field (RR=0.92, CI=0.62-1.37, P=0.68), visual acuity (RR=1.01, CI=0.81-1.26, P=0.93), and ophthalmoplegia (RR=0.92, CI=0.53-1.61, P=0.77). CONCLUSIONS: Both interventions provide comparable outcomes. These findings, though, are drawn from observational studies, and more severe cases typically undergo surgery. Larger studies are necessary to provide conclusive evidence.
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Apoplejia Hipofisaria , Humanos , Tratamiento Conservador/métodos , Hipopituitarismo/etiología , Procedimientos Neuroquirúrgicos/métodos , Oftalmoplejía/etiología , Apoplejia Hipofisaria/complicaciones , Apoplejia Hipofisaria/cirugía , Apoplejia Hipofisaria/terapia , Resultado del TratamientoRESUMEN
INTRODUCTION: pelvic fracture in children is considered one of the most important injuries due to its high mortality. They are rare, but have a major impact on patients' functional outcomes. OBJECTIVE: to evaluate the clinical evolution and functional grade in pediatric patients with pelvic fractures who have already been treated, either conservatively or surgically. MATERIAL AND METHODS: descriptive-cross-sectional-retrospective study. Sample of 24 patients, aged five to 16 years with pelvic fracture, treated from 2016 to 2021. Clinical and functional outcome was assessed using the Barthel index and hip range of motion, as well as surgical or conservative treatment, accompanying lesions and injury mechanism. RESULTS: to find out if there is an association between the Torode and Zieg classifications with the Barthel index and hip range of motion, an association analysis was performed with the 2 statistic, obtaining a 2 value = 19.213. with p = 0.004 for the Barthel index and a 2= 14.253 with p = 0.0026 for hip ranges of motion; these results indicate that there is statistically significant association. CONCLUSION: the most frequent type of pelvic fracture in pediatric patients treated is type III on the Torode and Zieg scale, which according to the Barthel index is associated with a degree of independence and complete hip mobility arches, so the clinical and functional outcome in these patients is high in severe injuries.
INTRODUCCIÓN: la fractura de pelvis en edad pediátrica es considerada de las lesiones más importantes debido a su alta mortalidad; son poco frecuentes, pero tienen gran impacto en el resultado funcional de los pacientes. OBJETIVO: evaluar la evolución clínica y grado funcional en niños con fracturas de pelvis tratados de forma conservadora o quirúrgica. MATERIAL Y MÉTODOS: estudio descriptivo-transversal-retrospectivo. Muestra de 24 pacientes, de cinco a 16 años de edad, con fractura de pelvis, tratados del 2016 al 2021. Se valoró el resultado clínico y funcional mediante el índice de Barthel y arcos de movilidad de cadera, tratamiento quirúrgico o conservador, lesiones acompañantes y mecanismo de lesión. El análisis estadístico se realizó con el software IBM SPSS Statistics®. RESULTADOS: se realizó un análisis de asociación mediante 2 entre las clasificaciones de Torode y Zieg con el índice de Barthel y arcos de movilidad de cadera, obteniendo un valor de 2 = 19.213 con p = 0.004 para índice de Barthel y un valor de 2= 14.253 con p = 0.0026 para arcos de movilidad de cadera; estos resultados indican que hay una asociación estadísticamente significativa. CONCLUSIÓN: el tipo de fractura de pelvis más frecuente en pacientes tratados es el tipo III en la escala de Torode y Zieg, la cual, según el índice de Barthel, se asocia con un grado de independencia y arcos de movilidad de cadera completos, por lo que el resultado clínico y funcional en estos pacientes es alto en lesiones severas.
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Fracturas Óseas , Huesos Pélvicos , Humanos , Niño , Huesos Pélvicos/lesiones , Adolescente , Masculino , Femenino , Fracturas Óseas/cirugía , Fracturas Óseas/terapia , Fracturas Óseas/clasificación , Estudios Transversales , Preescolar , Estudios Retrospectivos , Centros de Atención Terciaria , Rango del Movimiento Articular , Tratamiento Conservador/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: We sought to determine the effect of secondary management strategies in addition to urotherapy on bowel bladder dysfunction outcomes. STUDY DESIGN: The review protocol was prospectively registered (CRD42023422168). MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Scopus (database initiation until June 2023) were searched. Comparative studies of secondary management strategies vs conventional urotherapy alone were included. Two authors independently screened titles, abstracts, and reviewed full-text articles. Two authors extracted data related to study characteristics, methodology, subjects, and results. RESULTS: In this systematic review and meta-analysis of 18 studies and 1228 children, secondary management strategies (home-based education, biofeedback, and physical therapy) were associated with reduced symptom burden, fewer recurrent urinary tract infections, and improved uroflowmetry findings than children treated solely with urotherapy for conservative management. CONCLUSIONS: Although there is significant reporting heterogeneity, secondary conservative management strategies such as home education, biofeedback or cognitive behavioral therapy, and physiotherapy-based education are associated with less urinary incontinence, fewer infections, and fewer abnormal uroflowmetry findings.
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Tratamiento Conservador , Humanos , Tratamiento Conservador/métodos , Niño , Biorretroalimentación Psicológica/métodos , Modalidades de FisioterapiaRESUMEN
OBJETIVO Comparar los resultados funcionales obtenidos en dos cohortes de pacientes ancianos tratados de forma quirúrgica (artroplastia reversa de hombro) versus tratamiento conservador. MATERIAL Y METODOS Estudio ambispectivo, no aleatorizado. Se incluyeron pacientes de 75 años o más, 15 tratados de forma quirúrgica y 16 siguieron tratamiento conservador. Seguimiento mínimo de 12 meses. A los 3, 6 y 12 meses de la fractura evaluamos las escalas ASES, Constant-Murley and Disabilities of the Arm, Shoulder and Hand score (DASH) y EVA. Además evaluamos los resultados radiológicos y las complicaciones. RESULTADOS No encontramos diferencias significativas para las escalas ASES, DASH, ni EVA .El grupo tratado de forma quirúrgica obtuvo a los 12 meses una puntuación media en la escala Constant mayor, diferencia estadísticamente significativa(75.1 þ/-10.3 vs. 51.9 þ/-12.4 p » 0.001). Además presentaban mayor rango de movilidad para flexión y rotación externa (128.9 þ/-17 versus 99.3 þ/-20.1 p » 0.001, and 35.7 þ/-13.9 vs. 23.4 þ/-15.5 p » 0.032). El 43% de los pacientes tratados mediante artroplastia reversa presentaban tuberosidades normoposicionadas y mejores resultados en las escalas versus pacientes con tuberosidades ausentes o malposicionadas. El grupo sometido a cirugía no presentó mayor tasa de complicaciones.CONCLUSIONES El tratamiento conservador en las fracturas de EPH en tres y cuatro fragmentos en pacientes ancianos ofrece buenos resultados en cuanto a dolor y funcionalidad en la mayoría de pacientes. Falta por definir qué pacientes por tener alta demanda funcional serían candidatos a tratamiento quirúrgico de entrada
OBJECTIVE This study compared functional results in two cohorts of older adults with three- and four-part proximal humeral fractures (PHFs) per Neer's classification treated with reverse shoulder arthroplasty (RSA) or nonoperative management. MATERIALS AND METHODS Ambispective, non-randomized study with two cohorts of patients aged 75 or older treated with RSA (n » 15) or nonoperative management (n » 16) with a minimum follow-up period of 12 months. We analyzed the American Shoulder and Elbow Surgeons (ASES), Constant-Murley, and Disabilities of the Arm, Shoulder, and Hand (DASH) scores and the visual analog scale (VAS) for pain at 3, 6, and 12 months. In addition, we recorded radiological findings and surgical complications. RESULTS The mean Constant-Murley score at 12 months was significantly higher for the RSA group (75.1 þ/- 10.3 vs. 51.9 þ/- 12.4, p » 0.001). There were no differences in ASES, DASH, and VAS scores. Statistically significant differences for flexion and external rotation in abduction favored the RSA group (128.9 þ/- 17.0 versus 99.3 þ/- 20.1, p » 0.001, and 35.7 þ/- 13.9 vs. 23.4 þ/- 15.5, p » 0.032, respectively). For the RSA group, tuberosity positioning was correct in 43% of subjects. These patients presented better scores than those with malpositioned or absent tuberosities but with no statistical significance. Complications in the surgical group were not higher. CONCLUSIONS Nonoperative treatment is a valid option regarding pain and functionality in elderly patients with three- and four-part PHFs. Characteristics of patients with high demands who may be candidates for the initial surgical treatment remain to be defined
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Fracturas del Hombro/cirugía , Fracturas del Hombro/terapia , Fracturas del Hombro/diagnóstico por imagen , Resultado del Tratamiento , Cuidados Posteriores , Tratamiento Conservador/métodos , Artroplastía de Reemplazo de Hombro/métodosRESUMEN
Introducción: el control de cavidades sin restauración (NRCC, por sus siglas en inglés), es una opción de tratamiento conservador y no invasivo para dentina cariosa, sobre todo en dentición temporal. Una de las estrategias del NRCC es la remineralización. El fluoruro de estaño (FDE) puede considerarse, como una opción viable ya que existe evidencia de su eficacia cariostática. Objetivo: valorar al FDE como remineralizante alternativo en dentina de molares temporales, asociado al NRCC. Material y métodos: se efectuó un estudio clínico, epidemiológico, y descriptivo con preescolares voluntarios de 3 a 5 años de edad con consentimiento firmado de participación en el estudio, y que presentaron molares con ICDAS 5 y 6. La aplicación del FDE a 0.8%, la evaluación de la dureza de la dentina con los criterios de Nyvad, y el diagnóstico del estado pulpar, la efectuó un operador entrenado para esta finalidad. Se aplicó un análisis estadístico descriptivo y uno no paramétrico. Resultados: el efecto cariostático producido por el FDE a 0.8%, sobre dentina afectada de molares temporales de niños mexicanos fue estadísticamente significativo durante cinco meses. Conclusiones: la aplicación de fluoruro de estaño puede considerarse como una alternativa de tratamiento cariostático asociado al NRCC para niños de 3 a 5 años de edad (AU)
Introduction: nonrestorative cavity control (NRCC), is a conservative and non-invasive treatment option for carious dentin, especially in primary dentition. One of the NRCC strategies is remineralization. Stannous Fluoride (SDF) can be considered as a viable option since there is evidence of its cariostatic efficacy. Objective: to evaluate FDE as an alternative remineralizing agent in the dentin of primary molars, associated with NRCC. Material and methods: a clinical, epidemiological, and descriptive study was carried out with preschool volunteers aged 3 to 5 years with signed consent to participate in the study, and who presented molars with ICDAS 5 and 6. The application of FDE at 0.8%, the evaluation of dentin hardness with the Nyvad criteria, and the diagnosis of pulp status, was carried out by an operator trained for this purpose. A descriptive and non-parametric statistical analysis was applied. Results: the cariostatic effect produced by 0.8% FDE on affected dentin of primary molars of Mexican children was statistically significant for five months. Conclusions: the application of stannous fluoride can be considered as an alternative cariostatic treatment associated with NRCC for children 3 to 5 years of age (AU)
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Humanos , Masculino , Femenino , Preescolar , Fluoruros de Estaño/uso terapéutico , Diente Primario/efectos de los fármacos , Caries Dental/terapia , Cariostáticos/uso terapéutico , Epidemiología Descriptiva , Estudios Longitudinales , Esmalte Dental/efectos de los fármacos , Dentina/efectos de los fármacos , Tratamiento Conservador/métodosRESUMEN
Objetivo: Apresentar as modalidades de tratamentos conservadoras e minimamente invasivas mais usadas disponíveis no arsenal terapêutico das desordens temporomandibulares (DTM). Revisão da literatura: Os objetivos do tratamento invariavelmente incluem redução da dor, diminuição das atividades parafuncionais e restauração da função. Dentre as alternativas conservadoras e minimamente invasivas, podemos citar os dispositivos interoclusais, exercícios terapêuticos, eletrofototermoterapia, agulhamento seco e infiltração de anestésicos locais em pontos gatilho, injeção de sangue autógeno para controle da luxação mandibular, terapia cognitivo comportamental, toxina botulínica, viscossuplementação, controle farmacológico da dor aguda e crônica. As DTMs afetam uma proporção significativa da população. Somente após o fracasso das opções não invasivas é que devem ser iniciados tratamentos mais invasivos e irreversíveis. No entanto, algumas condições, como a anquilose e neoplasias, por exemplo, são essencialmente tratadas cirurgicamente e tentativas de tratamentos conservadores podem trazer piora na qualidade de vida ou risco de morte. Considerações finais: Uma abordagem de equipe multidisciplinar para o manejo é essencial no cuidado fundamental de todos os pacientes com DTM, para que o tratamento possa ser especificamente adaptado às necessidades individuais do paciente.
Aim: To present the most widely used conservative and minimally invasive treatment modalities available in the therapeutic arsenal for temporomandibular disorders (TMD). Literature review: Treatment goals invariably include pain reduction, reduction of parafunctional activities and restoration of function. Among the conservative and minimally invasive alternatives, we can mention interocclusal devices, therapeutic exercises, electrophototherapy, dry needling and infiltration of local anesthetics in trigger points, autogenous blood injection to control mandibular dislocation, cognitive behavioral therapy, botulinum toxin, viscosupplementation, pharmacological control of acute and chronic pain. TMD affects a considerable proportion of the population. Only after non-invasive options have failed should more invasive and irreversible treatments be initiated. However, some conditions, such as ankylosis and neoplasms, for example, are treated surgically and attempts at conservative treatments can lead to worsening quality of life or risk of death. Conclusions: A multidisciplinary team approach to management is essential in the fundamental care of all TMD patients, so that treatment can be specifically tailored to the patient's individual needs.
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Humanos , Dolor Facial/terapia , Trastornos de la Articulación Temporomandibular/terapia , Trastornos de la Articulación Temporomandibular/fisiopatología , Ferulas Oclusales , Viscosuplementación/métodos , Tratamiento Conservador/métodos , Punción Seca/métodosRESUMEN
En 1827 el médico James William Cusack describió una lesión tumoral expansiva con características clínicas similares al ameloblastoma. Para el 2017 la Organización Mundial de la Salud lo clasificó como un tumor odontogénico benigno de origen epitelial. En la actualidad hemos aceptado la teoría de su etiología asociada con una mutación en el biomarcador BRAF-V600E, donde se presentan claras heterogeneidades extra/intratumorales en el metabolismo de la tumorogénesis; la mutación en BRAF genera cambios en la regulación de la odontogénesis, en conjunto con el gen CDC73 presente en el cromosoma 1 q25-q32, lo que produce un cambio en la proteína parafibromina que inhibe la proliferación celular durante el crecimiento y la división celular, esto afecta en conjunto al gen p53 y su homólogo p63 presentes en el cromosoma 17, por lo que se tiene como resultado la expresión de quistes y tumores dentales como el ameloblastoma. La presente obra muestra el caso clínico de un paciente femenino de 11 años de edad con aumento de volumen en la región submandibular izquierda de 7 × 4 cm, con seis años de evolución; de tal manera que fue diagnosticado con ameloblastoma uniquístico y tratado de forma conservadora mediante enucleación, posteriormente fue valorada anualmente hasta que la paciente cumplió los 18 años de edad (AU)
In 1827, physician James William Cusack described an expansive tumor lesion with clinical characteristics similar to ameloblastoma. For 2017, the World Health Organization classified it as a benign odontogenic tumor of epithelial origin. Currently, we have accepted the theory of its etiology associated with a mutation in the BRAF-V600E biomarker, where there are clear extra/intratumoral heterogeneities in the metabolism of tumorigenesis; the BRAF mutation generates changes in the regulation of odontogenesis, together with the CDC73 gene present on chromosome 1 q25-q32, producing a change in the parafibromin protein that inhibits cell proliferation during cell growth and division, which together it affects the p53 gene and its p63 homolog is present on chromosome 17, resulting in the expression of dental cysts and tumors such as ameloblastoma. This work provides the clinical case of an 11-year-old patient with an increase in volume in the left submandibular region of 7 × 4 cm of 6 years of evolution. Being diagnosed as a unicistic ameloblastoma and treated conservatively by enucleation, it is subsequently evaluated annually until the patient reaches 18 years of age (AU)
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Humanos , Masculino , Niño , Ameloblastoma/cirugía , Tumores Odontogénicos/clasificación , Recurrencia , Inmunohistoquímica , Ameloblastoma/diagnóstico , Ameloblastoma/genética , Tratamiento Conservador/métodosRESUMEN
INTRODUCTION: in Brazil, trauma is responsible for 40% of deaths in the age group between 5 and 9 years old, and 18% between 1 and 4 years, and bleeding is the leading cause of preventable death in the traumatized child. Conservative management of blunt abdominal trauma with solid organs injury - started in the 60s - is the current world trend, with studies showing survival rates above 90%. The objective was to assess the efficacy and safety of conservative treatment in children with blunt abdominal trauma treated at the Clinical Hospital of the University of Campinas, in the last five years. METHODS: retrospective analysis of medical records of patients classified by levels of injury severity, in 27 children. RESULTS: only one child underwent surgery for initial failure of conservative treatment (persistent hemodynamic instability), resulting in a 96% overall success rate of the conservative treatment. Five other children (22%) developed late complications that required elective surgery: a bladder injury, two cases of infected perirenal collections (secondary to injury of renal collecting system), a pancreatic pseudocyst and a splenic cyst. Resolution of the complications was attained in all children, with anatomical and functional preservation of the affected organ. There were no deaths in this series. CONCLUSION: the conservative initial approach in the treatment of blunt abdominal trauma was effective and safe with high resolution and low rate of complications leading to a high preservation rate of the affected organs. Level of evidence III - prognostic and therapeutic study.
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Traumatismos Abdominales , Heridas no Penetrantes , Humanos , Niño , Preescolar , Estudios Retrospectivos , Tratamiento Conservador/métodos , Heridas no Penetrantes/complicaciones , Traumatismos Abdominales/cirugía , PronósticoRESUMEN
CONTEXTO CLÍNICO O câncer ginecológico afeta diretamente a fertilidade, pois o tratamento consiste na remoção cirúrgica do sistema reprodutor e/ou na sua exposição a agentes gonadotóxicos. Entretanto, pacientes em estádios iniciais e que estejam dentro de critérios estabelecidos podem ser tratadas com cirurgias conservadoras da fertilidade, com resultados oncológicos equivalentes aos dos tratamentos tradicionais. As técnicas de preservação da fertilidade, como criopreservação de oócitos, embriões e tecido ovariano, também podem ser oferecidas em algumas situações. A American Society of Clinical Oncology (ASCO) publicou recomendações sobre a preservação de fertilidade, com o objetivo de aumentar a conscientização sobre o tema, e, juntamente com a American Society for Reproductive Medicine (ASRM), recomenda que pacientes em idade fértil com câncer passem por aconselhamento reprodutivo. Essas pacientes apresentam menores taxas de arrependimento, mesmo quando optam por desistir do tratamento conservador. O interesse na preservação da fertilidade aumentou nas últimas décadas, tanto pelo fato de as mulheres postergarem a gestação como pelo aumento da incidência de câncer em jovens. A taxa de incidência de todos os cânceres aumentou 29% entre 1973 e 2015 em adolescentes e adultos jovens de ambos os sexos. O câncer de colo uterino, em mulheres de 20-29 anos, aumentou anualmente em uma média de 10,3% entre 2000 e 2009. A omissão em orientar pacientes com câncer sobre as possibilidades de preservação da fertilidade pode gerar questionamentos futuros; em alguns países. isso já se configura má prática médica.
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Humanos , Femenino , Preservación de la Fertilidad/métodos , Neoplasias de los Genitales Femeninos , Trimestres del Embarazo , Técnicas Reproductivas Asistidas , Derechos Sexuales y Reproductivos/ética , Tratamiento Conservador/métodos , Neoplasias de los Genitales Femeninos/diagnóstico por imagen , Hormonas/uso terapéuticoRESUMEN
Introdução: As fraturas do tornozelo são lesões comuns, apesar de ocorrer em todas as idades, são mais comuns entre homens jovens e mulheres idosas, constituem cerca de 9% de todas as fraturas, com uma incidência de 107 a 187 por 100.000 pessoas por ano. A abordagem de tratamento selecionada ocorrerá de acordo com as condições do paciente e a opção do médico de acordo com cada situação em específico. Objetivo: Avaliar o desfecho do tratamento não cirúrgico e funcional de pacientes com fraturas estáveis e sem desvio do maléolo lateral tipo Weber B, com carga e mobilização articular imediatas. Método: estudo retrospectivo de uma série de pacientes com fratura estável e sem desvio do maléolo lateral tipo Weber B, que foram tratados de forma não cirúrgica com carga e mobilização articular imediatas, de janeiro 2016 a julho 2022. Os pacientes dessa pesquisa foram provenientes do Hospital do Servidor Público Municipal de São Paulo e da Clínica de Ortopedia e Traumatologia Ortocity. Resultados: Os pacientes tinham idade média de 54,7 anos, diagnosticados após eventos traumáticos (quedas, acidentes, etc.) por meio de exames radiográficos, 50% da amostra com comorbidades, especialmente HAS, 73,3% com desvio de 1mm, mais de 50% com consolidação em até 8 semanas, mais de 60% retornaram às atividades normais em até 16 semanas, as complicações ocorreram em aproximadamente 70% da amostra, porém todas leves e sem necessidade de nova abordagem de tratamento posterior. Conclusão: Nesse sentido, pode-se afirmar que a abordagem conservadora associado à mobilização e carga imediatas formam uma alternativa viável de tratamento, com bons resultados de recuperação funcional, semelhantes aos pacientes tratados por abordagens cirúrgicas, conforme a literatura levantada para este estudo. Palavras-chave: Fratura de tornozelo. Abordagem conservadora. Weber B. Resultados funcionais.
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Ortopedia/métodos , Heridas y Lesiones/rehabilitación , Traumatología/métodos , Accidentes/estadística & datos numéricos , Curación de Fractura/fisiología , Procedimientos Ortopédicos/métodos , Fracturas Óseas/rehabilitación , Ortesis del Pié , Fracturas de Tobillo/diagnóstico , Fracturas de Tobillo/rehabilitación , Tratamiento Conservador/métodos , Tobillo/cirugíaRESUMEN
BACKGROUND: Clinical complete responders after chemoradiation for rectal cancer are increasingly being managed by a watch-and-wait strategy. Nonetheless, a significant proportion will experience a local regrowth, and the long-term oncological outcomes of these patients is not totally known. OBJECTIVE: The purpose of this study was to analyze the outcomes of patients who submitted to a watch-and-wait strategy and developed a local regrowth, and to compare these results with sustained complete clinical responders. DESIGN: This was a retrospective study. SETTING: Single institution, tertiary cancer center involved in alternatives to organ preservation. PATIENTS: Patients with a biopsy-proven rectal adenocarcinoma (stage II/III or low lying cT2N0M0 at risk for an abdominoperineal resection) treated with chemoradiation who were found at restage to have a clinical complete response. INTERVENTIONS: Rectal cancer patients treated with chemoradiation who underwent a watch-and-wait strategy (without a full thickness local excision) and developed a local regrowth were compared to the remaining patients of the watch-and-wait strategy. MAIN OUTCOME MEASURES: Overall survival between groups, incidence of regrowth' and results of salvage surgery. RESULTS: There were 67 patients. Local regrowth occurred in 20 (29.9%) patients treated with a watch-and-wait strategy. Mean follow-up was 62.7 months. Regrowth occurred at mean 14.2 months after chemoradiation, half of them within the first 12 months. Patients presented with comparable initial staging, lateral pelvic lymph-node metastasis, and extramural venous invasion. The regrowth group had a statistically nonsignificant higher incidence of mesorectal fascia involvement (35.0% vs 13.3%, p = 0.089). All regrowths underwent salvage surgery, mostly (75%) a sphincter-sparing procedure. 5-year overall survival was 71.1% in patients with regrowth and 91.1% in patients with a sustained complete clinical response (p = 0.027). LIMITATIONS: This study was limited by its retrospective evaluation of patient selection for a watch-and-wait strategy and outcomes, as well as its small sample size. CONCLUSIONS: Local regrowth is a frequent event when following a watch-and-wait policy (29.9%); however, patients could undergo salvage surgical treatment with adequate pelvic control. In this series, overall survival showed a statistically significant difference from patients managed with a watch-and-wait strategy who experienced a local regrowth compared to those who did not. See Video Abstract at http://links.lww.com/DCR/B773.RESULTADOS DE LOS PACIENTES CON REBROTE LOCAL, DESPUÉS DEL MANEJO NO QUIRÚRGICO DEL CÁNCER DE RECTO, DESPUÉS DE LA QUIMIORRADIOTERAPIA NEOADYUVANTEANTECEDENTES:Los respondedores clínicos completos, después de la quimiorradiación para el cáncer de recto, se tratan cada vez más mediante una estrategia de observación y espera. No obstante, una proporción significativa experimentará un rebrote local y los resultados oncológicos a largo plazo de estos pacientes, no se conocen por completo.OBJETIVO:El propósito de este estudio, fue analizar los resultados de los pacientes sometidos a una estrategia de observación y espera, que desarrollaron un rebrote local, y comparar estos resultados con respondedores clínicos completos sostenidos.DISEÑO:Este fue un estudio retrospectivo.ENTORNO CLINICO.Institución única, centro oncológico terciario involucrado en alternativas a la preservación de órganos.PACIENTES:Pacientes con un adenocarcinoma de recto comprobado por biopsia (estadio II / III o posición baja cT2N0M0, en riesgo de resección abdominoperineal), tratados con quimiorradiación, y que durante un reestadiaje, presentaron una respuesta clínica completa.INTERVENCIONES:Los pacientes con cáncer de recto tratados con quimiorradiación, sometidos a una estrategia de observación y espera (sin una escisión local de espesor total) y que desarrollaron un rebrote local, se compararon con los pacientes restantes de la estrategia de observación y espera.PRINCIPALES MEDIDAS DE VALORACION:Supervivencia global entre los grupos, incidencia de rebrote y resultados de la cirugía de rescate.RESULTADOS:Fueron 67 pacientes. El rebrote local ocurrió en 20 (29,9%) pacientes tratados con una estrategia de observación y espera. El seguimiento medio fue de 62,7 meses. El rebrote se produjo a la media de 14,2 meses después de la quimiorradiación, la mitad de ellos dentro de los primeros 12 meses. Los pacientes se presentaron con una estadificación inicial comparable, metástasis en los ganglios linfáticos pélvicos laterales e invasión venosa extramural. El grupo de rebrote tuvo una mayor incidencia estadísticamente no significativa de afectación de la fascia mesorrectal (35,0 vs 13,3%, p = 0,089). Todos los rebrotes se sometieron a cirugía de rescate, en su mayoría (75%) con procedimiento de preservación del esfínter. La supervivencia global a 5 años fue del 71,1% en pacientes con rebrote y del 91,1% en pacientes con una respuesta clínica completa sostenida (p = 0,027).LIMITACIONES:Evaluación retrospectiva de la selección de pacientes para una estrategia y resultados de observar y esperar, tamaño de muestra pequeño.CONCLUSIONES:El rebrote local es un evento frecuente después de la política de observación y espera (29,9%), sin embargo los pacientes podrían someterse a un tratamiento quirúrgico de rescate con un adecuado control pélvico. En esta serie, la supervivencia global mostró una diferencia estadísticamente significativa de los pacientes manejados con una estrategia de observación y espera que experimentaron un rebrote local, en comparación con los que no lo hicieron. Consulte Video Resumen en http://links.lww.com/DCR/B773. (Traducción-Dr. Fidel Ruiz Healy).
Asunto(s)
Adenocarcinoma , Terapia Neoadyuvante , Recurrencia Local de Neoplasia , Tratamientos Conservadores del Órgano , Neoplasias del Recto , Espera Vigilante/métodos , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/patología , Adenocarcinoma/radioterapia , Brasil/epidemiología , Tratamiento Conservador/efectos adversos , Tratamiento Conservador/métodos , Tratamiento Conservador/estadística & datos numéricos , Femenino , Humanos , Incidencia , Metástasis Linfática/patología , Metástasis Linfática/terapia , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Terapia Neoadyuvante/estadística & datos numéricos , Invasividad Neoplásica/patología , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Tratamientos Conservadores del Órgano/efectos adversos , Tratamientos Conservadores del Órgano/métodos , Tratamientos Conservadores del Órgano/estadística & datos numéricos , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/patología , Neoplasias del Recto/radioterapia , Terapia Recuperativa , Resultado del TratamientoRESUMEN
Introducción: La isquemia anal aguda con gangrena es una entidad infrecuente, con escasa literatura publicada al respecto, cuyas cifras de mortalidad descritas se sitúan en un 20 por ciento - 40 por ciento de los casos. Debe considerarse en ancianos con enfermedad aterosclerótica que presenten síntomas gastrointestinales inferiores y shock hipotensivo. Puede ser causada por oclusión vascular aguda, enfermedad vascular grave o un estado de bajo flujo, aunque en algunos casos se presenta sin enfermedad vascular preexistente. Objetivo: Presentar la literatura existente acerca del manejo diagnóstico y terapéutico de la isquemia de canal anal en base a un caso clínico diagnosticado y tratado de urgencia en el hospital "Marina Baixa". Caso clínico: Se presenta un caso de isquemia espontánea de canal anal en paciente de 76 años de edad con morbilidad cardiovascular asociada. Debuta como cuadro séptico sin evidencia de causa desencadenante. Conclusiones: Las pruebas endoscópicas y radiológicas deben realizarse con urgencia y la valoración quirúrgica está siempre justificada en estos pacientes debido a la alta tasa de mortalidad descrita en el manejo conservador del cuadro. En casos graves, la reanimación preoperatoria y cirugía urgente para resecar el segmento gangrenoso es necesaria. Sin embargo, el tratamiento de la proctitis isquémica aguda es controvertido y depende, en parte, del estado basal del paciente y los hallazgos clínicos, siendo importante examinar otras posibles etiologías de proctitis isquémica y así determinar qué pacientes necesitan intervención quirúrgica temprana en comparación con una actitud más conservadora(AU)
Introduction: Acute ischemic gangrene of the anus is an infrequent entity, with little published literature, whose reported mortality figures are 20-40 percent of cases. It should be considered in elderlies with atherosclerotic disease who present lower gastrointestinal symptoms and hypotensive shock. It can be caused by acute vascular occlusion, severe vascular disease, or a low-flow state, although in some cases it presents without pre-existing vascular disease. Objective: To present the existing literature on diagnostic and therapeutic management of ischemia of the anal canal upon the base of a clinical case diagnosed and treated as an urgency at Marina Baixa hospital. Clinical case: The case is presented of a 76-year-old patient with spontaneous ischemia of the anal canal and associated cardiovascular morbidity. It debuts as a septic condition without evidence of a triggering cause. Conclusions: Endoscopic and radiological tests should be performed urgently. Surgical assessment is always justified in these patients, due to the high mortality rate described in the conservative management of the condition. In severe cases, preoperative resuscitation and urgent surgery to resect the gangrenous segment is necessary. However, managment of acute ischemic proctitis is controversial and depends, in part, on the patient's baseline status and clinical findings, while it is important to examine other possible etiologies of ischemic proctitis and thus determine which patients need early surgical intervention compared to a more conservative attitude(AU)
Asunto(s)
Humanos , Femenino , Anciano , Canal Anal/lesiones , Procedimientos Quirúrgicos Operativos/métodos , Enfermedades Vasculares/etiología , Isquemia/diagnóstico por imagen , Literatura de Revisión como Asunto , Tratamiento Conservador/métodosRESUMEN
Resumen Objetivo: Reportamos un caso clínico con presentación atípica de una úlcera duodenal benigna que simula el cuadro clínico y radiológico de una neoplasia de páncreas. Materiales y Método: Presentamos el caso de un varón de 83 años que debuta con un cuadro clínico de astenia e ictericia mucocutánea. En estudio de imagen se identifica una masa en cabeza pancreática. En estudio endoscópico se observa úlcera duodenal benigna penetrada a cabeza de páncreas que condiciona obstrucción de vía biliar. Discusión y Conclusiones: El manejo de estos pacientes suele ser quirúrgico porque desarrollan un deterioro asociado a sepsis o perforación. Si la situación clínica lo permite se puede intentar un tratamiento conservador. En nuestro caso el paciente precisó un mes de hospitalización con antibioticoterapia intravenosa de amplio espectro, reposo alimentario, nutrición parenteral y tratamiento con inhibidores de la bomba de protones (IBP) para la resolución del cuadro. La penetración o fistulización a la cabeza del páncreas es una complicación grave e infrecuente de la enfermedad ulcerosa péptica. Su manejo puede ser conservador en casos seleccionados donde no exista perforación de la úlcera a la cavidad peritoneal, ni exista deterioro séptico ni hemodinámico.
Aim: To report an atypical presentation of a benign duodenal ulcer that simulates pancreatic neoplasia. Materials and Method: A case of a 83 years old male patient with astenia and jaundice due to a benign duodenal ulcer penetrating into the pancreas with obstruction of common bile duct. Imagining study identified a pancreatic head mass. The patient required one month admission, receiving broad-spectrum antibiotics, parenteral nutrition and intravenous proton pump inhibitors. Discussion and Conclusion: Due to frequent complications associated to this condition, such as haemodynamic failure, sepsis or free peritoneal perforation, surgery is the main treatment. However, in mild cases, as in our patient, conservative management can be considered. Penetration or fistulization to the head of the pancreas is a rare and serious complication of peptic ulcer disease. Its management can be conservative in selected cases where there is no perforation of the ulcer into the peritoneal cavity, nor septic or hemodynamic deterioration.
Asunto(s)
Humanos , Masculino , Anciano de 80 o más Años , Páncreas/patología , Úlcera Duodenal/complicaciones , Úlcera Duodenal/tratamiento farmacológico , Conductos Biliares/patología , Úlcera Duodenal/diagnóstico por imagen , Tratamiento Conservador/métodosAsunto(s)
Tratamiento Conservador , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , Intervención Coronaria Percutánea , Medición de Riesgo/métodos , Infarto del Miocardio con Elevación del ST , Anciano , Tratamiento Conservador/métodos , Tratamiento Conservador/estadística & datos numéricos , Cuba/epidemiología , Países en Desarrollo , Femenino , Humanos , Masculino , Selección de Paciente , Intervención Coronaria Percutánea/métodos , Intervención Coronaria Percutánea/estadística & datos numéricos , Valor Predictivo de las Pruebas , Pronóstico , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/etiología , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/terapiaRESUMEN
OBJECTIVES: The risks of adenocarcinoma in situ (AIS) recurrence or progression after conservative treatment are uncertain. The aim of this study was to examine the role of high-risk human papillomavirus (hrHPV) and cytology in the posttreatment surveillance of AIS patients. MATERIALS AND METHODS: Follow-up results of hrHPV status, cytology results, and clinicopathological features of 207 patients were retrospectively analyzed, in whom AIS was initially treated by loop electrosurgical excision procedure (LEEP)/cone biopsy between September 2009 and June 2018. RESULTS: Among 207 patients diagnosed AIS on LEEP/cone biopsy, 30.9% (64/207) had positive margins. Persistent/recurrent AIS rate was substantially higher in the patients with positive margins than in those with negative margins (47.2% vs 9.3%, p < .001). Of 74 patients with hrHPV surveillance, 17 (17/74, 23.0%) were found to have positive hrHPV and 4 (4/17, 23.5%) had the persistent/recurrent AIS regardless of margin status. On the contrast, no AIS were found in negative surveillant hrHPV patients (23.5% vs 0%, p < .001). Lastly, 27.8% patients (22/79) were reported atypical glandular cells on surveillant cytology, and 9 persistent/recurrent AIS cases were further identified on second biopsy or hysterectomy with a positive detection rate of 40.9%. CONCLUSIONS: In this study, we concluded the positive margin on LEEP/cone biopsy in AIS patients was associated with a significantly greater risk of disease persistence or recurrence. The posttreatment surveillance by cytology and adjunct hrHPV would be an ideal strategy in predicting AIS persistence and recurrence, which will warrant further treatments.
Asunto(s)
Adenocarcinoma in Situ , Recurrencia Local de Neoplasia/patología , Neoplasias del Cuello Uterino/patología , Adenocarcinoma in Situ/patología , Adulto , Anciano , Tratamiento Conservador/métodos , Femenino , Humanos , Márgenes de Escisión , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Papillomaviridae , Infecciones por Papillomavirus , Pennsylvania/epidemiología , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Ante un escenario clínico de coxalgia por artrosis de cadera se planteó la necesidad de conocer los tratamientos con-servadores más seguros y efectivos para el manejo del dolor. El tratamiento de la artrosis requiere un enfoque integral e individualizado en función de las preferencias del paciente para lograr el máximo beneficio clínico. Existen numerosas estrategias útiles para el manejo del dolor en pacientes con artrosis de cadera siendo fuertemente recomendados de inicio la actividad física, los antiinflamatorios no esteroideos (AINE) orales y en ciertos casos los corticoides intraarticulares, tramadol o duloxetina, siempre asociado con la actividad física. Los ejercicios más recomendados son los aeróbicos y el Tai Chi o yoga. (AU)
Faced with a clinical scenario of coxalgia due to hip osteoarthritis, the need to know the safest and most effective conservative treatments for pain management arose. The treatment of osteoarthritis requires a comprehensive and individualised approach based on the patient's preferences to achieve maximum clinical benefit. There are numerous useful strategies for pain management in patients with hip osteoarthritis being strongly recommended from the beginning such as physical activity, oral non-steroidal anti-inflammatory drugs (NSAID) and in certain cases intra-articular corticosteroids, tramadol or duloxetine, always associated with physical activity. The most recommended exercises are aerobics and Tai Chi or yoga. (AU)
Asunto(s)
Humanos , Femenino , Anciano de 80 o más Años , Osteoartritis de la Cadera/tratamiento farmacológico , Osteoartritis de la Cadera/terapia , Tratamiento Conservador/métodos , Dolor , Tramadol/uso terapéutico , Yoga , Ejercicio Físico , Osteoartritis de la Cadera/diagnóstico por imagen , Antiinflamatorios no Esteroideos/uso terapéutico , Corticoesteroides/uso terapéutico , Taichi Chuan , Manejo del Dolor/métodos , Clorhidrato de Duloxetina/uso terapéutico , Rigidez MuscularRESUMEN
La uroflujometría es un estudio no invasivo del tracto urinario inferior que entrega información objetiva del flujo urinario y es ampliamente recomendado por las guías europeas en el estudio de pacientes con sintomatología urinaria baja. Se realizó un estudio descriptivo transversal cuyo propósito fue describir el uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos que acudieron a la consulta de Servicio de Urología del Hospital Central Universitario Dr. Antonio María Pineda de la ciudad de Barquisimeto, estado Lara durante el lapso 2018- 2019. La muestra estuvo conformada por 150 pacientes. Los resultados indican que el 62% de la muestra corresponde a pacientes entre 60 y 70 años de edad de los cuales 52% manifestaron síntomas urinarios leves. La uroflujometría evidenció que 56% de los pacientes tienen un flujo máximo entre 10 y 20 ml/seg lo cual sugiere una probable obstrucción al flujo de salida; 78% de los pacientes presentan un flujo promedio entre 0 a 10 ml/seg. El 53% de los pacientes mostró un volumen de vaciado < 300 ml y 49% un tiempo de flujo máximo entre 30 y 50 segundos. En conclusión, la uroflujometría es un examen simple y rápido que proporciona información útil sobre la salud de las vías urinarias inferiores(AU)
Uroflowmetry is a non-invasive study of the lower urinary tract that provides objective information on urinary flow and is widely recommended by European guidelines for the study of patients with lower urinary tract symptoms. We performed a cross-sectional descriptive study to describe the use of uroflowmetry for the study of lower urinary tract symptoms in males who attended the Servicio de Urología of the Hospital Central Universitario Dr. Antonio María Pineda (Barquisimeto, Lara state) during the 2018- 2019 period. The sample was made up of 150 males. The results show that 62% of the sample included males between 60 and 70 years old and 52% complained of mild urinary symptoms. Uroflowmetry results showed that 56% of patients had a maximum flow between 10 and 20 ml/sec suggestive of urinary tract obstruction; 78% had an average flow between 0 and 10 ml/sec while 53% had a micturition volume < 300 ml and 49% had a maximum flow time between 30 and 50 seconds. Uroflowmetry is a simple and fast test which provides useful information about the health of lower urinary tract(AU)
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Anciano , Obstrucción Uretral , Sistema Urinario , Prostatismo/diagnóstico por imagen , Tratamiento Conservador/métodos , Micción , Enfermedades Urológicas , UltrasonografíaRESUMEN
INTRODUCTION: Haemophilic pseudotumour (HP) is an encapsulated haematoma in patients with haemophilia (PWH) which has a tendency to progress and produce clinical symptoms related to its anatomical location. AIM: To show the experience of one surgeon who has been using mini-invasive technique to treat pseudotumours of limbs in PWH with and without inhibitors at one centre for 28 years. MATERIALS AND METHODS: Thirty-three patients with 39 HP were treated. All patients had haemophilia A. Twenty-four patients had no inhibitors (72.8%), and 9 had inhibitors (27.2%). The mean follow-up was 16 years (1-25). All patients had x-rays and MRIs. All of them received Buenos Aires protocol as conservative treatment for 6 weeks. MRIs were repeated after 6 weeks' treatment to assess response to treatment. Surgery was performed in patients who did not respond to conservative treatment. RESULTS: After Buenos Aires protocol, four pseudotumours did not shrink (10.24%), 33 (84.61%) shrank, and two (5.12%) healed. Thirty-seven pseudotumours had surgery, 35 pseudotumours (94.59%) healed with minimally invasive treatment, and two did not heal (5.41%). No infection was observed with this treatment. The mortality rate for the series was 0%. CONCLUSION: The minimally invasive treatment of pseudotumours was effective in 95% of the cases and resulted in no mortality in this series after 28 years.