Patients In Conservative Group Research Articles

Conservative versus conventional oxygen therapy in type I acute respiratory failure patients in respiratory intensive care unit, Zagazig University.

The present study aimed to assess the effect of a conservative (permissive hypoxemia) versus conventional (normoxia) protocol for oxygen supplementation on the outcome of type I respiratory failure patients admitted to respiratory intensive care unit (ICU). This randomized controlled clinical trial was carried out at the Respiratory ICU, Chest Department of Zagazig University Hospital, for 18 months, starting in July 2018. On admission, 56 enrolled patients with acute respiratory failure were randomized in a 1:1 ratio into the conventional group [oxygen therapy was supplied to maintain oxygen saturation (SpO2) between 94% and 97%] and the conservative group (oxygen therapy was administered to maintain SpO2 values between 88% and 92%). Different outcomes were assessed, including ICU mortality, the need for mechanical ventilation (MV) (invasive or non-invasive), and ICU length of stay. In the current study, the partial pressure of oxygen was significantly higher among the conventional group at all times after the baseline reading, and bicarbonate was significantly higher among the conventional group at the first two readings. There was no significant difference in serum lactate level in follow-up readings. The mean duration of MV and ICU length of stay was 6.17±2.05 and 9.25±2.22 days in the conventional group versus 6.46±2.0 and 9.53±2.16 days in the conservative group, respectively, without significant differences between both groups. About 21.4% of conventional group patients died, while 35.7% of conservative group patients died without a significant difference between both groups. We concluded that conservative oxygen therapy may be applied safely to patients with type I acute respiratory failure.

Concomitant tricuspid repair in mitral regurgitation surgery: a systematic review and meta-analysis

Abstract Background Tricuspid Regurgitation (TR) is common in patients with severe mitral disease. However, the evidence is insufficient to inform a decision about whether to perform prophylactic tricuspid-valve repair during mitral-valve surgery in patients who have moderate TR or less-than-moderate regurgitation. Purpose To compare the outcomes of concomitant tricuspid repair in mitral valve surgery versus no concomitant tricuspid repair in less-than-severe TR patients. Methods We systematically searched PubMed, Embase and Cochrane databases, in December 2021, for interventional studies comparing concomitant tricuspid repair in mitral valve surgery versus no tricuspid intervention. Random-effects meta-analysis was performed. Results Four randomised trials were included, providing a total of 651 patients (323 in prophylactic tricuspid intervention group and 328 patients in conservative group). Our meta-analysis showed a similar all-cause mortality for concomitant prophylactic tricuspid repair compared with no tricuspid intervention (pooled OR, 0.54; 95% CI [0.25, 1.15], P=0.11; I2=0%). Additionally, there is a similar New York Heart Association (NYHA) III–IV classes in both groups, despite a lower trend in the tricuspid intervention group (pooled OR, 0.63; 95% CI [0.38, 1.06], P=0.08; I2=0%) (Figure 3). However, there was a significant lower progression of TR (pooled OR, 0.06; 95% CI [0.02, 0.24], P<0.01; I2=0%) and moderate-severe TR (pooled OR, 0.23; 95% CI [0.11, 0.46], P<0.01; I2=27%). Conclusions Our pooled analysis suggests that a tricuspid-valve repair at the time of mitral-valve surgery in patients with moderate or less-than-moderate TR does not impact perioperative or postoperative all-cause mortality, despite reducing TR severity and progression of TR following intervention. Funding Acknowledgement Type of funding sources: None.

Paper 49: Demographic and Clinical characteristics of patellar instability patients from prospective JUPITER (Justifying Patellar Instability Treatment by Early Results) cohort.

Objectives:The purpose of this study is to provide an objective analysis of patient demographics and clinical features for the young patients with patellar instability. JUPITER (Justifying Patellar Instability Treatment by Early Results) is a hypothesis-driven, multi-center, multi-armed, prospective cohort study developed to better describe demographic and clinical characteristics and predictors of clinical outcomes in the young patellar instability population.Methods:21 surgeons from 12 institutions enrolled patients between 10-30 years of age who presented with at least one documented patellar dislocation episode. Radiographs and MRI were evaluated for all patients at baseline to confirm patellar dislocation and skeletal maturity status. Patient demographics, dislocation history, physical exam characteristics and baseline validated patient reported outcome (PRO) scores were collected and analyzed. Conservative versus operative treatment was based on treating physician’s preference following standard of care guidelines. The cohort was divided between first-time vs recurrent dislocators and between conservative vs operative treatment.Results:At the end of enrollment in December 2020, a total of 1722 knees with patellar instability were enrolled. The mean age of the cohort was 17.7 years, 62.4% were female. 306 were skeletally immature. 59% of knees reported that they had more than 1 dislocation. ). 71% knees were enrolled in the operative group and 29% in the conservative group. For patients with recurrent dislocation, 89.7% were treated operatively and 10.2% were treated conservative (p<0.001). Operative treatment was indicated in 42.9% of first-time dislocators; 50% were due to presence of an osteochondral fracture. The recurrent and operative group patients were noted to have a higher percent of positive physical exam findings than first-time and conservative group patients on the affected knee (J-sign [p<0.001], apprehension [p<0.001], crepitus [p=0.041]) and the contralateral knee (except for the crepitus test [p=0.648]). The recurrent group was nearly twice as likely to be ligamentously lax (Beighton score of 5 or greater) compared to first-time dislocators (p<0.001). Baseline PROs varied with the recurrent group having lower Pedi-FABS (p=0.001) and KOOS-QoL (0.008) scores and higher Kujala (0.009), KOOS ADL (0.008), KOOS Sports (<0.001), and Pedi-IKDC (0.014) scores than the first-time dislocator group.Conclusions:Based on large prospective cohort of JUPITER group, operative management was indicated in 42.9% of first-time dislocators and 89.7% of recurrent dislocators. Besides osteochondral fracture, recognition of risk factors (young age, contralateral dislocation, anatomic risk factors) may account for higher rates of operative treatment after first-time dislocation. Recurrent dislocators were more likely to have positive physical exam findings on both knees and lower activity scores. However, the knee specific outcome scores were higher in patients with recurrent dislocations which may reflect adaptive mechanisms to improve function. This prospective study provides insights related to demographic information, clinical presentation and baselines PROs of patients with patellar instability. These baseline characteristics would help to identify the at-risk population and compare outcomes in a longitudinal fashion.

Comparison of Conservative versus Surgical Management of Acute Appendicitis in Terms of Hospital Stay

Aim: To compare the hospital stay of patients of appendicitis with conservative or surgical management in context of age and gender. Study design: Randomize Controlled Trial Methods: Purposive sampling technique was used. G power calculator was used to compute the total number of participants. Diagnosed appendix patients (n=100) with equal distribution of treatment conservative (n=50) and appendectomy (n=50) with age ranges of 16 years to 45 years (conservative group=31.26±9.13 and appendectomy group=29.32±7.96) were included. Patients with a final diagnosis of appendicitis presenting within 24 hours of onset were included in the study. While appendicular mass, perforated appendix, gangrenous appendix with signs of peritonitis, patients with chronic co-morbid conditions e.g. DM and patients with bleeding disorders, renal insufficiency, and liver problems were excluded from the study. Demographic form and MANTRELS Score (Alvarado, 1986) were used to collect data of Lahore General Hospital, Lahore by considering all the ethical issues. Total duration of this study was six months. Results: Significant difference (t =10.61: p&lt;0.05) was found in term of hospital stay of patients in conservative group (3.02±0.82 days) and appendectomy group (1.58±0.50 days). Results were also significant on the scores of Alvarado and age. Conclusion: This study showed significant differences in both groups (appendicitis and conservative) in terms of hospital stay, age and gender. Keywords: Appendectomy, conservative treatment, hospital stay

Comparative Study of Conservative Vs Surgical Management of Clavicle Fractures

Background: Clavicle Fractures is one of the common fractures of upper limb accounting for approximately 40 % of all shoulder fractures. Till recently all clavicle fracture were treated conservatively, but now interest in surgical management is rising. This study was carried out to see if Surgical management outweighs the conservative treatment of Fractures Of Clavicle. Methods: A total of 40 cases satisfying inclusion and exclusion criteria were included in the study. Alternate patients were allocated to operative and conservation groups. In total 20 patients were operated operatively and 20 patients were treated conservatively. Outcome was analysed in terms of radiological union and functional outcome of the patient. Constant and Murley score was used as a score to evaluate final outcome. Results: In this study, the 20 patients who were operated upon had an average union time of 7.8 weeks; 1 patient had delayed fracture union by 12 wks. 20 patients in conservative group had normal union of fractures with 1 patient going into non-union. Average union time in the conservative group was 9.4 weeks, which was more than the 7.8 weeks seen in the group treated operatively. Mal-union was present in 7 of the 20 patients treated conservatively, and 5 of these 7 had a visible deformity. Out of these patients with mal-union 1 had poor functional outcome, 3 had good to excellent outcome and 3 had satisfactory functional outcome. 4 of these had restricted movements terminally and 2 had pain on movement. Conclusions: From our study based on patients of clavicle fractures, it can be concluded that the operative group had significantly higher excellent outcomes as compared to the conservatively- managed group, based on the Constant and Murley score. Keywords: Clavicle Fractures, Constant and Murley Score, Operative Clavicle Fracture Management, Clavicle Fracture Functional Outcome.

Aggressive versus conservative fluid resuscitation in septic hemodialysis patients.

Sepsis and bacterial infections are common in patients with end-stage renal disease (ESRD). We aimed to compare patients with ESRD on hemodialysis presenting to hospital with severe sepsis or septic shock who received <20ml/kg of intravenous fluid to those who received ≥20ml/kg during initial resuscitation. We conducted a retrospective chart review of adult patients with ICD codes for discharge diagnosis of sepsis, severe sepsis, septic shock, ESRD, and hemodialysis admitted to our institution between 2015 and 2018. We present outcomes for a total of 104 patients - 51 patients in conservative group and 53 in aggressive group. The mean age was 69.5±11.2years and 71±11.5years in the conservative group and aggressive group, respectively. There was no significant difference in the rate of ICU admission, and ICU or hospital length of stay between the two groups. Complications such as volume overload, rate of intubation, and urgent dialysis were not found to be significantly different. We found that aggressive fluid resuscitation with ≥20ml/kg may not be detrimental in the initial resuscitation of ESRD patients with SeS or SS. However, a clinical decision of volume responsiveness should be made on a case-by-case basis rather than a universal approach for fluid resuscitation in ESRD patients.

Conservative versus Surgical Treatment for the Fifth Metatarsal Diaphyseal Fractures: A Retrospective Comparative Study

Category:Midfoot/Forefoot; TraumaIntroduction/Purpose:The fifth metatarsal fracture is the most common metatarsal fracture accounting for 56-68% of all metatarsals. Most of the previous studies have focused on fractures of the proximal fifth metatarsal. Whereas the current evidence has still remained controversial regarding appropriate treatment for the fifth metatarsal diaphyseal fracture. To date, there has been no comparative study between nonsurgical and surgical management in such fractures. The purpose of this study was to compare the outcomes and complications following conservative versus surgical treatment for displaced diaphyseal fractures of the fifth metatarsal bone. The primary outcome was time to union. Secondary outcomes were functional outcome scores (SF-36 and FAAM), VAS, time to return to activities of daily living (ADL), sports activities as well as complications.Methods:A retrospective study with prospective outcomes measurement was performed by reviewing charts and collecting data between January 2016 and December 2018. We included patients aged 18 or over, diagnosed with closed isolated fracture of the fifth metatarsal diaphyseal bone, all fractures had more than 2 mm of displacement in any planes of radiographs (AP, oblique, lateral), treated within 3 weeks after injury, minimal follow-up time of 6 months. Exclusion criteria were previous history of ipsilateral fifth metatarsal diaphyseal bone, pathological or stress fracture, proximal fifth metatarsal fracture, underlying diabetes, neuropathy, inability to walk such as cerebrovascular disease. All patients in surgical group were treated with ORIF with plate and screws. Postoperatively, early ROM exercise and heel weight bearing in walking boot were instructed. Whereas, patients in conservative group were immobilized with short leg cast in first six weeks and subsequently changed to walking boot or hard- soled shoes.Results:There were forty-five patients enrolled in the study, twenty patients treated with ORIF and twenty-five patients treated with casting. No significant differences were demonstrated with regard to demographic data. The mean union time of ORIF group was 8.7+-1.8 weeks, which was significantly shorter than the casting group (16.0 +- 4.18 weeks) (p<0.001). There was a significant improvement of functional outcomes (SF-36, FAAM) in both groups (p<0.001) but no statistically significant difference between two groups (p>0.05). An average time to return to ADL was significantly faster in ORIF group (8.6+-3.1 weeks) (p<0.001). The overall complications in casting group were significantly higher (28%,p<0.05) including painful malunion (3 patients, 12%), delayed union (2 patients, 8%) and persistent pain from CRPS (2 patients, 8%).Conclusion:Both casting and ORIF demonstrated significant improvement of functional outcomes compared to pre-operative status as measured with VAS, SF-36, and FAAM. Even though there was no significant difference of functional outcomes between two groups. ORIF group had significantly faster union time, time to return to ADL, and lesser in overall complications. The authors prefer early surgical treatment in fractures with more than 2 mm displacement, active, high-demand patients. However, randomized controlled trials with longer follow-up would be required.

Comparison of temporomandibular joint function and morphology after surgical and non-surgical treatment in adult condylar head fractures

PurposeThe aim of this study was to evaluate whether surgical treatment can distinctly improve temporomandibular joint (TMJ) function and morphology in adult patients with condylar head fractures (CHFs) when compared with conservative treatment. Patients and methodsA retrospective study was performed to evaluate surgical and conservative outcomes in all patients who had suffered CHFs. In this study, all patients were divided into a surgical group and a conservative group. In the surgical group patients were treated by open reduction and internal fixation (ORIF) combined disc anchorage, while in the conservative group patients were treated by a removable splint combined with intermaxillary elastics. Clinical and radiological outcomes were evaluated and functional outcomes were assessed using the Helkimo index score. Paired t-tests, Wilcoxon signed rank tests, independent t-tests and χ2 tests were used to assess inter-group differences. Results75 TMJs in 56 patients were included in this study and were divided into a surgical group (56 TMJs in 40 patients) and a conservative group (19 TMJs in 16 patients). The results showed that the Helkimo index score for TMJ in the surgical group was better than in the conservative group (pAi = 0.032, pDi = 0.001, respectively). Ramus height in the surgical group (61.08 ± 4.04 mm) recovered more than in the conservative group (54.82 ± 3.06 mm) (p = 0.012). Discs became shorter, moved further forward, and became severely distorted in the conservative group (disc length = 7.32 ± 1.35 mm). In contrast, discs became longer, retained a normal disc–condyle relationship, and formed a normal shape in the surgical group (disc length = 11.05 ± 2.07 mm) (p = 0.003). According to the MRI images, joint effusion, retrodiscal tear, and lateral capsular tear were better cured in the surgical group (p = 0.001, p < 0.001, p = 0.012, respectively). ConclusionBased on these results, it seems that surgical treatment of condylar head fractures should be the preferred approach if there are no contraindications for general anesthesia.

Conservative versus conventional oxygen therapy for cardiac surgical patients: A before-and-after study.

Avoiding hypoxaemia is considered crucial in cardiac surgery patients admitted to the intensive care unit (ICU). However, avoiding hyperoxaemia may also be important. A conservative approach to oxygen therapy may reduce exposure to hyperoxaemia without increasing the risk of hypoxaemia. Using a before-and-after design, we evaluated the introduction of conservative oxygen therapy (target SpO2 88%-92% using the lowest FiO2) for cardiac surgical patients admitted to the ICU. We studied 9041 arterial blood gas (ABG) datasets: 4298 ABGs from 245 'conventional' and 4743 ABGs from 298 'conservative' oxygen therapy patients. During mechanical ventilation (MV) and while in the ICU, compared to the conventional group, conservative group patients had significantly lower FiO2 exposure and PaO2 values ( P < 0.001 for each). Accordingly, using the mean PaO2 during MV, more conservative group patients were classified as normoxaemic (226 versus 62 patients, P < 0.01), fewer as hyperoxaemic (66 versus 178 patients, P < 0.01) and no patient in either group as hypoxaemic or severely hypoxaemic. Moreover, more ABG samples were hyperoxaemic or severely hyperoxaemic during conventional treatment ( P < 0.001). Finally, there was no difference in ICU or hospital length of stay, ICU or hospital mortality or 30-day mortality between the groups. Our findings support the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU after cardiac surgery.

Spontaneous Spondylodiscitis: Conservative Versus Surgical Management

AbstractBackground: The incidence of spontaneous spondylodis-citis is increasing per year and this attributed to an aging population, increasing prevalence of immunodeficiency and improving radiological technique.Aim of Study: To evaluate the results of conservative versus surgical treatment of spondylodiscitis as regard efficacy, complications and functional outcomes.Patients and Methods: This is a prospective randomized clinical trial study included 16 patients with spontaneous spondylodiscitis presented only with axial spinal pain. They were divided into 2 groups: One managed conservatively and the other surgically.Results: 9 patients were managed conservatively and 7 were managed surgically. After complete course of treatment; only 3 patients of conservative group and 4 patients of surgical group showed fusion assessed by imaging. There was no significant statistically difference between two groups in final clinical outcome using visual analogue scale and MacNab's outcome criteria.Conclusion: Both conservative and surgical methods are sufficient for achieving the goals of treatment of spontaneous spondylodiscitis as both are safe, feasible, and effective procedure in relieving pain.

Clinical profile of patients with unstable distal radius fracture

There are increasing reports of distal radius fractures suggesting that they are frequently articular injuries resulting in disruption of both radio carpal and radio ulnar joints and profoundly affecting the wrist of greater population. Preliminary information about age, sex, dominant hand, mechanism of injury, date of reporting to hospital, cause of delay and treatment received so far was noted and screening for associated injury after receiving of patient in emergency and vital parameters were checked. Out of 32 patients of Conservative group, 17(53.00%) were males and 15(47.000%) were females, while a total of 18 patients of operative (VLCP) group, 13 (72.00%) were males and 5(28.00%) were females. In Conservative group, majority was observed that in Operative group of patient i.e.16 (89.00%) and 22(68.76%) were lying in the age group < 50 years respectively.

Percutaneous kyphoplasty combined with zoledronic acid for the treatment of single segment osteoporotic lumbar vertebralcompression fractures

Objective To evaluate the clinical efficacy of percutaneous kyphoplasty combined with zoledronic acid for the treatment of single segment osteoporotic vertebral compression fractures(OVCF). Methods Clinical datas of 90 cases patients with postmenopausal suffered single segment vertebral compression fracture who were treated in Beijing ShiJingshan Hospital of Capital Medical University from March 2010 to March 2013 were retrospectively analyzed.The patienrs were randomly divided into three groups according to the different treatment methods, 20 patients received bed rest treatment as conservative group, 40 patients were undergone percutaneous kyphoplasty as operation group, 30 patients were given percutaneous kyphoplasty combined with zoledronic acid as combination group.Visual analogue score(VAS) were recorded before treatment and 1 week, 6 months after treatment, and lumbar vertebrae bone mineral density(BMD) was measured before treatment and 2 years after treatment.The subsequent fracture of the vertebrae was analyzed after 2 years of treatment. Results There were 4 patients were not followed up.Three patients in conservative group suffered complications, but no complications were observed in operation group and combination group.The VAS score of the combination group and operation group at 1 week after treatment was significantly different compared with conservative group((3.0±1.4) points vs.(3.2±1.2) points vs.(8.0±1.1) points, P 0.05). Lumbar vertebrae BMD of combination group increased at 2 years after treatment, compared with conservative group and operation group the difference were significantly((-1.8±0.6) vs.(-3.1±0.5) vs.(-2.7±0.3), P<0.05). The incidence of the subsequent fracture of the vertebrae reduced of combination group, compared with conservative group and operation group the difference were significantly(3.3%(1/30) vs.27.8%(5/18) vs.21.1%(8/38), P<0.05). Conclusion Percutaneous kyphoplasty combined with zoledronic acid for the treatment of OVCF-patients with postmenopausal and single segment fracture is not only safe, effective, but also can obviously relive pain and reduce the risk of subsequent fracture of the vertebrae. Key words: Osteoproticvertebral compression fractures; Osteoporosis; Percutaneous kyphoplasty; Zoledronic acid; Female; Postmenopause

Conservative oxygen therapy in mechanically ventilated patients following cardiac arrest: A retrospective nested cohort study

BackgroundIn mechanically ventilated (MV) cardiac arrest (CA) survivors admitted to the intensive care unit (ICU) avoidance of hypoxia is considered crucial. However, avoidance of hyperoxia may also be important. A conservative approach to oxygen therapy may reduce exposure to both. MethodsWe evaluated the introduction of conservative oxygen therapy (target SpO2 88–92% using the lowest FiO2) during MV for resuscitated CA patients admitted to the ICU. ResultsWe studied 912 arterial blood gas (ABG) datasets: 448 ABGs from 50 ‘conventional’ and 464 ABGs from 50 ‘conservative’ oxygen therapy patients. Compared to the conventional group, conservative group patients had significantly lower PaO2 values and FiO2 exposure (p<0.001, respectively); more received MV in a spontaneous ventilation mode (18% vs 2%; p=0.001) and more were exposed to a FiO2 of 0.21 (19 vs 0 patients, p=0.001). Additionally, according to mean PaO2, more conservative group patients were classified as normoxaemic (36 vs 16 patients, p<0.01) and fewer as hyperoxaemic (14 vs 33 patients, p<0.01). Finally, ICU length of stay was significantly shorter for conservative group patients (p=0.04). There was no difference in the proportion of survivors discharged from hospital with good neurological outcome (14/23 vs 12/22 patients, p=0.67). ConclusionsOur findings provide preliminary support for the feasibility and physiological safety of conservative oxygen therapy in patients admitted to ICU for MV support after cardiac arrest (Trial registration, NCT01684124).

Clinical and morphological pattern of brain arteriovenous malformations (BAVMs) in a tertiary care hospital in Bangladesh.

BackgroundWe have conducted this study to examine the clinical and morphological pattern of brain arteriovenous malformations (BAVMs) along with their treatment and short term outcome in a tertiary care hospital in Bangladesh. This retrospective chart review was carried out from the records of neuro-endovascular division at Department of Neurology, Dhaka Medical College Hospital (DMCH) from January 2010 to June 2013. A total 60 patients were evaluated. All the necessary information regarding the demographic, clinical, morphologic and treatment profile was gathered through a predesigned questionnaire. To our knowledge, we have the largest cohort of BAVM patients in Bangladesh and this is the first of this kind of study done in Bangladesh.ResultsThe mean age at diagnosis was 30.3 years with a standard deviation of ±14.3 and the majority was teenagers (30 %). Intracerebral hemorrhage was the commonest (70 %) type of presentation at diagnosis, followed by headache (50 %), altered consciousness (50 %), vomiting (40 %) and seizure (40 %). Majority of the AVMs had feeders from anterior circulation (50 %) and most of the AVMs (73.3 %) were supplied from the main feeders, whereas the rest from distal vessels. Regarding venous drainage, AVMs drained mostly either to superficial (43.3 %) or deep (40 %) venous system. AVMs frequently had larger (40 %) nidus size and a slow to medium flow (60 %), through the nidus. An eloquent AVM location was found in 50 % of the patients. Intranidal aneurysm was found in 10 % AVM and angiopathic AVM in 13.3 %. Patients were treated by endovascular embolization (31) or surgical excision (11) or conservative approach. There was one event of death, both in embolization group and surgically treated group before discharge. The patients were followed up for 1.3 ± 0.8 years. The rate of rebleed was 6.6, 30 and 60 % during follow up in endovascular, surgical and conservatively treated group. Though five patients in conservative group died during this time, no deaths reported in intervention group (endovascular or surgery).ConclusionIntracerebral hemorrhages, headache, altered consciousness and seizure are common clinical presentations of AVM at diagnosis. The remarkable morphologic features are larger AVM size at eloquent location, medium to slow flow with frequent feeders from main vessels of anterior circulation and drainage to superficial venous systems. Endovascular embolization or surgical excision of AVM are relatively safe and effective and provides better short term outcome than conservative approach.

Paediatric acute retropharyngeal abscesses: An experience

To describe our experience of paediatric patients with acute retropharyngeal abscess in terms of clinical presentation, diagnosis, management and complications. A prospective study was done for a period of 4 years (Jan 2009 to Jan 2013) on paediatric patients (< 15 years) with acute retropharyngeal abscess at two tertiary hospitals in Srinagar. Diagnosis was made on the basis of X-ray, CECT scan findings and confirmed on incision and drainage. Pus was aspirated from all patients and sent for culture and sensitivity. Data for clinical presentation, X-ray, CECT scan findings, causes, complications, bacteriology and management were collected. Thirty-five abscesses were drained while 5 with small abscesses on CECT were managed conservatively. A total of 40 patients were diagnosed as acute retropharyngeal abscesses. Males were commonly affected, and most of the patients were less than 6 years of age. Most common symptom at presentation was fever (35) followed by neck pain (30) Dysphagia/odynophagia (22), swelling in neck (19). Most common clinical sign observed was oropharyngeal swelling and limitation of neck movements (30), cervical swelling/lymphadenopathy in 22 patients. Torticollosis and drooling were seen in 15 patients. Complications were seen in 8 patients. Most common X-ray finding was pre-vertebral thickening. Success rate with primary surgical drainage was 95% while 3 patients in conservative group failed. Children with RPA most commonly present with restricted neck movements, fever and cervical lymphadenopathy, and rarely with respiratory distress or stridor. Surgical intervention is necessary for most of these patients.

Blunt Trauma Liver-Conservative or Surgical Management: A Retrospective Study

Background: The liver is one of the most frequently damaged organs and remains the most common cause of death following blunt abdominal trauma. Currently, a conservative management constitutes the treatment of choice in patients with hemodynamic stability. The aim of this study is to evaluate the results of an operative and conservative management of 55 patients with liver injury treated in a single institution. Methods: A retrospective study of the patients presented with blunt liver trauma was performed from 2008-2012. The patients were categorised according to the mode of treatment received. Group I: Conservative management; Group II: Operative management. Variables analyzed included demographic data, cause of injury, grade of injury, associated injuries, vitals, haemoglobin values, mode of treatment and complications. Results: A total of 55 patients were analyzed. 16 patients had sustained severe injuries. Mean pulse rate in conservative and operative group was 92 and 102 beats/min respectively. Mean blood pressure in conservative and operative group was 110/70 and 90/60 mmHg respectively. Conservative treatment was followed in 28 patients with surgery undertaken in 6 of the patients from this group due to failure of conservative treatment. Immediate surgery was carried out in 27 patients. Mortality occurred in 8 patients. Morbidity occurred among 5 patients in conservative group and among 8 patients in operative group. Mean duration of hospital stay in conservative and operative groups are respectively 17 and 19 days. P value is significant (0.04). Conclusions: Conservative treatment is an adequate treatment in mild to moderate liver injury patients. Failure of conservative treatment did not show a higher incidence of complications or mortality but it should be performed in centres with experienced surgeons.

Role of invasive ICP monitoring in patients with traumatic brain injury: An experience of 98 cases

The outcome of patients with head injury depends upon several factors, and most important among them is the raised intracranial pressure. ICP monitoring using subdural Richmond bolt system was used in 98 cases of TBI. The age range was 9–75 years; there were 78 adults and 20 children. This included 52 cases of severe HI and 46 cases with moderate HI.The GCS range was 4–10(mean: 5.6). Mortality was 64% in severe HI (34/52) and 9.5% in moderate HI patients (4/42). ICP ranged from 6–28mm Hg in moderate HI (mean 11.6 mm) and 8–42mm Hg in severe HI (mean 19.6 mmHg). Of 98 cases of HI, 41(41.8%) patients were operated (26 had moderate HI and 15 cases had severe HI. Seventy-three (74.5%) cases had single/multiple contusions in frontal/temporal regions while 25/73(25.5%) patients had diffuse axonal injury (10 cases) and thin subdural hematoma (15 cases). Fifty-seven patients were managed conservatively with decongestants, elective ventilation and continuous ICP monitoring for 3 days. Of these, 16(43%) had moderate HI and 41(71%) cases had severe HI. In the absence of intracranial hypertension (ICP <10 mm Hg), good recovery (Glasgow outcome scale: 4–5) was noted in 8/57(14%) cases in conservative group and in 4/41(9.7%)cases in operative group. In patients with ICP in 11–20 mm range, good recovery was noted in 6/41(14.6%) patients in operative group and in 9/ 57(15.8%) patients managed conservatively. When the ICP was >20 mm Hg, 10/41(24.3%) operated patients expired while only 6/57(10.5%) patients in conservative group expired. ICP malfunction after day 1 was noted in 27 cases ((27.5%) while ICP site infection/CSF leak was noted in 8 cases (8.2%). Outcome was related to severity of head injury and intracranial hypertension. Outcome was better in patients of moderate HI after surgery than in severe HI patients. Mortality was higher in patients operated in the presence of intracranial hypertension than in those managed conservatively. ICP monitoring was associated with a high blockage (27.5%) and infection rate (8.2%). ICP monitoring improved overall outcome in moderate head injury patients.

7142 Endoscopic hemoclipping for upper gastrointestinal bleeding due to mallory-weiss syndrome.

Aim: Endoscopic treatment with sclerotherapy or thermal methods has been widely used for upper gastrointestinal (UGI ) bleeding due to Mallory-Weiss syndrome (MWS). However, the potential drawback of thermal methods and the injection of sclerosing agents is that these may cause excessive tissue injury leading to necrosis and perforation. Recently, endoscopic hemoclipping was shown to be highly effective for as a hemostatic treatment for UGI bleeding. Hemoclipping causes less damage to the surrounding area than sclerotherapy or thermal methods. However, the efficacy and safety of hemoclipping for MWS bleeding has not been reported. The aim of the present study was to assess prospectively the usefulness of endoscopic hemoclipping for MWS bleeding. Methods: This prospective study was performed over a 5 year period beginning in January 1994. When patients were diagnosed with MWS by endoscopy , hemoclipping was performed for patients with active bleeding , visible vessel and/or red clots (Group H). The remaining patients with old clots and linear tears in the Esophagogastric junctional (EGJ) mucosa as the only possible origin of bleeding were conservatively treated (Group C). The clinical data and outcome of endoscopic treatment were compared between these two groups. Results: A total of 58 patients underwent emergency endoscopy for UGI bleeding due to MWS from January 1994 to August 1999. During endoscopic examination, active bleeding was found in 17 patients (29%), a visible vessel in one patient (2%) and red clots in 8 patients (14%); Hemoclipping was performed on all 26 patients. Of the remaining 32 patients, 12 patients (21%) had old clots, and 20 (34%) had linear tears without stigmata of recent hemorrhage in the EGJ; these patients did not receive hemoclipping. Significantly more patients in Group H had shock and trasfusional requirements over 800ml than in Group C [the former 4 (17%) vs 0, the latter 4 (17%) vs 0]. The mean hemoglobin level on admission was significantly lower in Group H (10.6±2.9g/dl)than in Group C (12.2±3.0g/dl). Significantly more patients in Group H had critical concomitant diseases than in Group C [14 (54%) vs 8 (25%)]. However, all patients in Group H successfully underwent endoscopic hemostasis with no rebleeding. No patients in Conservative group had rebleeding. No complications related to the endoscopic procedures and no hospital deaths were found in either group. Conclusion : Endoscopic hemoclipping provided an effective and safe modality for securing hemostasis for MWS bleeding.