Conservative treatment of clavicular fractures

The outcome of 99 clavicular fractures was examined retrospectively through a questionnaire and, in 20 cases, clinical examination. Primary treatment was in all cases a simple sling or a figure of eight bandage. The aim of the study was to examine prognostic factors in relation to the end-result. The fractures were classified, according to the roentgenograms, and the primary dislocation, primary shortening and secondary shortening of the shoulder were recorded. The end-result was expressed as the degree of pain. Statistically significantly more patients with group two type two fractures had a poor result. No other prognostic factors were found.     

Conservative medical treatment of chronic pancreatitis

The conservative medical treatment of chronic pancreatitis entails dealing prevalently with exocrine and endocrine insufficiency, diet and pain. As steatorrhoea can cause malabsorption, it is advisable to reduce first the fat content of the diet and secondly to prescribe, where necessary, pancreatic enzymes. Several factors can lead to a poor therapeutic enzyme effect. Attention should be given to the pharmacological properties of the enzyme-preparation and to the secretion of acid in the stomach. An endocrine insufficiency is more difficult to treat compared to a classical diabetes mellitus, for lack of endocrine regulatory mechanisms. Pain is the consequence of several pathophysiological processes. Before initiating analgetic treatment, a minimal diagnostic program should be completed allowing the exclusion of those primary causes of pain which require an alternative approach such as interventional endoscopy or surgery.     

Conservative treatment of favorable rectal carcinomas

Conservative treatment of rectal cancer with either full thickness en bloc local excision or endocavitary irradiation provides excellent local control for highly selected early rectal carcinomas. For either approach the selection criteria are similar. An ideal lesion should be: 1) freely mobile; 2) less than 3 cm in diameter; 3) no evidence of extension into the perirectal fat either on digital examination or on transrectal US; 4) no clinical evidence of involved nodes on physical examination of diagnostic studies; 5) the surgical alternative would be an abdominal perineal resection; 6) well or moderately differentiated. External beam radiation therapy can contribute to the results of conservative treatment by improving the chances of controlling subclinical nodal disease in the pelvis as well as by improving the control of disease in the rectum at the margins of the local procedure. For highly selected patients, the local control and disease-free interval is on the order of 90% with either endocavitary radiation or local excision.     

Conservative treatment of uterine arteriovenous fistula

A case of a uterine arteriovenous aneurysm in a 20-year-old woman is described. The patients's main symptom was copious uterine bleeding. The diagnostic difficulties are described and the importance of arteriography is emphasized. The aneurysm was occluded at laparotomy by introducing gel-foam into the uterine artery. The patient subsequently became pregnant and after an uneventful pregnancy was delivered of a healthy child. Thus, this type of conservative treatment seems to offer a possible means of avoiding hysterectomy in young patients with this rare condition who wish to retain their fertility.     

Conservative treatment of dysplastic multicystic kidney

BACKGROUND: Recent developments regarding the conservative management of multicystic dysplastic kidney disease (MDKD) have shown a reduction in the well-established practice of elective surgical treatment. It has been seen that in the majority of cases the evolution of MDKD is either partial or complete atrophy. The incidence of complications due to MDKD is very low. The aim was to study the ultrasound changes of MDKD in a group of patients from 1990, since this date the elective surgical procedure had been eliminated. MATERIALS AND METHODS: This group consisted of 16 patients. The diagnosis in each patient was confirmed by ultrasound and isotopic examinations. Other investigations were performed where there was a suspect of associated contralateral renal abnormalities or when a urinary tract infection occurred. RESULTS: Ultrasound follow-up revealed: no enlargement whatsoever in the kidney size in any patient; in 10 patients a reduction in the size of the MDK; in 3 patients a complete atrophy of MDK; in 3 patients there was no change at all. Five patients were found to have contralateral renal abnormalities. Compensatory hypertrophy of the contralateral kidney was present in all patients. No complications occurred. A nephrectomy was performed only in one patient aged 6 due to the express wishes of his parents. CONCLUSIONS: The results agree with recently published literature that routine surgical removal of the MDK is unnecessary.     

Conservative treatment in major kidney trauma

The kidney is frequently involved in penetrating abdominal injuries, and less so in closed abdominal traumatism. This paper presents one case of major renal trauma with total renal fracture and development of urinoma that separated both segments that, after a minimally invasive manoeuvre (percutaneous drainage), evolved favourably thus avoiding a surgical procedure which, quite reasonably, would have led to nephrectomy.     

Conservative treatment of phimosis in childhood]

Inborn or acquired stenosis of the prepuce is usually relieved by surgery. From the beginning of the nineties work was published where for treatment a steroid cream applied locally is used. The authors describe the method and achieved results of local non-surgical treatment using a corticoid cream made in the Czech Republic. The authors treated phimosis in a total of 44 boys. In 26 the phimosis was congenital, in 18 it was acquired. In the group of inborn phimoses cure was achieved in 100% and in the group of acquired affections in 72%. The final effect of treatment is according to the authors experience influenced by the interest and co-operation of the parents.     

Conservative treatment for early breast cancer]

68 Cases of early breast cancer were divided into local resection group (33 cases) and local resection plus axillary dissection group (35 cases). The 3-, 5- and 10-year survival rate of the two groups were 97.0%, 78.8%, 72.7% and 94.3%, 80.0%, 77.1% respectively; The metastasis rate of the two groups were 6.1%, 12.1%, 3.0% and 8.6%, 17.1%, 8.6% respectively; and the local recurrence rate of the two groups were 6.1%, 6.1%, 3.0%, and 5.7%, 5.7%, 2.9% respectively ( P > 0.05). The cosmetic satisfaction rate of the two groups were 60.6% and 65.7% respectively ( P > 0.05). Factors relating to cosmetic results were type of breast, operative incision, age and postoperative radiotherapy. Conservative operation for early breast cancer was safe, provided incision margin was 2 cm approximately 3 cm. In all patients mammplasty was performed after tumor resection, and contralateral breast were treated by mammominification when it was necessary.     

Intraarterial vs intravenous administration of antivenin for the treatment of Crotalidae atrox envenomation: a pilot study

OBJECTIVE: Standard therapy for significant snake envenomation includes antivenin. i.v. administration is currently the only recommended route. Intraarterial (i.a.) administration has potential advantages over i.v. that could improve outcome. To study this, the authors compared i.v. and i.a. antivenin administrations for the treatment of experimental snake envenomations. METHODS: 14 adult female swine were anesthetized and prepared with femoral artery and ear vein catheters, and baseline hoof, forearm, and thigh circumference and volume displacement measurements were taken. Crotalidae atrox venom was injected into the subcutaneous tissue of the hoof. The doses of venom were 4.75, 9.50, 19.00, 37.90, 47.30, 56.90, and 66.40 mg. Immediately following injection of venom, polyvalent antivenin (Crotalidae) (0.285 mg/10 mL saline) was infused over 30 minutes into the femoral artery (i.a. group) or ear vein (i.v. group). As a control, 10 mL of saline was infused into the ear vein (i.a. group) or femoral artery (i.v. group). Measurements were recorded up to 48 hours. Linear mixed-effect regression models were used for each measurement and to compare the i.a. and i.v. groups. RESULTS: Venom dose and time after administrations were associated with increased circumferences and increased volumes (p < 0.05). i.v. administration was associated with larger hoof (1.26 cm) and forearm (0.42 cm) sizes and volume displacement (21.71 mL) when compared with i.a. administration ( p < 0.05). CONCLUSION: i.a. antivenin results in a modest but significant decrease in tissue edema when compared with i.v..     

Conservative treatment of hemarthrosis for prevention of hemophilic synovitis

Acute hemarthroses are probably the most frequent type of bleeding in the patient with hemophilia. Delayed and/or inadequate treatment can trigger a series of pathologic changes within the joint leading to a painful and disabling arthropathy. Despite the advent of prophylactic treatment with factor concentrates, the majority of patients in the world have no access to even on demand factor replacement. Care for all patients involves a team approach led by the hematologist but including input from orthopaedic surgeons and physiotherapists. Optimal treatment involves a combination of factor replacement, rest, ice, and supervised rehabilitation. In certain cases, joint aspiration may be considered. In developing countries, where factor concentrates are in short supply, such bleeding episodes usually are treated by physical means alone or with the addition of cryoprecipitate or fresh frozen plasma. After successful resolution of such episodes by whatever means, the events leading to the bleeding episode and its subsequent management should be considered within the setting of the treating unit. Such debriefings should aim to provide counsel regarding any appropriate lifestyle modifications and, where necessary, treatment should be arranged to minimize the risk of additional episodes.     

Conservative initial treatment for liver abscesses in children

A total of 124 children aged less than 14 years with a liver abscess were seen in a 16-year period (1974-1990) and treated by non-operative initial management. Of the abscesses 98 occurred in the right liver and 26 in the left. The abscesses were solitary in 93 patients. Overall, 77 of the solitary and 21 of the multiple abscesses were confined to the right liver. In 78 of the right-sided and 20 of the left-sided abscesses the infection was primarily pyogenic in nature with Staphylococcus aureus being the usual organism cultured. The remainder were of amoebic origin. Clinical features were similar in patients with amoebic and pyogenic abscesses. Clinical and ultrasonographic follow-up demonstrated successful non-operative management and healing in 37 per cent of all patients submitted to an initial protocol of medical supportive care and antibiotic therapy. Of the multiple abscesses 60 per cent responded to non-operative management. Fourteen of the 16 solitary left-sided liver abscesses required drainage and three left-sided abscesses ruptured before drainage. Patients with a solitary left-sided abscess warrant early operative intervention.     

Conservative treatment of plantar fasciitis. A prospective study

A randomized, prospective study was conducted to compare the individual effectiveness of three types of conservative therapy in the treatment of plantar fasciitis. One hundred three subjects were randomly assigned to one of three treatment categories: anti-inflammatory, accommodative, or mechanical. Subjects were treated for 3 months, with follow-up visits at 2, 4, 6, and 12 weeks. For the 85 patients who completed the study, a statistically significant difference was noted between groups, with mechanical treatment with taping and orthoses proving to be more effective than either anti-inflammatory or accommodative modalities.     

Conservative treatment of fresh subcutaneous rupture of the Achilles tendon

Primary malignant melanoma of the uterine cervix in a 70-year-old Negro female is reported. Only 9 other cases have been reported in the literature. The diagnosis, prognosis, and modern trends in therapy for this lesion are discussed.