Conservative Treatment Measures Research Articles

Sternoclavicular Joint Reconstruction Using the Sternal Docking Technique

Background: Sternoclavicular joint (SCJ) dislocations may occur as the result of traumatic injury, ligamentous laxity, or chronic arthropathy. While initial management of anterior sternoclavicular dislocations is typically nonoperative treatment, patients with symptomatic chronic dislocation may benefit from reconstruction. In this video, we describe the sternal docking technique for SCJ reconstruction using a semitendinosus allograft augmented with a biologic collagen scaffold. Indications: Current indications for SCJ reconstruction include acute posterior dislocations, symptomatic chronic anterior dislocations, and cases of symptomatic arthropathies of the SCJ. Technique Description: In a lazy beach-chair position, a curvilinear incision is made over the anterior SCJ centered over the inferior portion of the joint. After exposure of the joint, the intra-articular disc and 5 mm of medial clavicle are resected. A 4-mm bur is used to open the intramedullary canal on the articular facet of the manubrium and the medial clavicle. Additional perforations to act as tunnels are made on the anterior aspects of the manubrium and medial clavicle both superiorly and inferiorly, and a small curved curette is used to widen the tunnels and connect them to their respective intramedullary canals to allow for graft passage. The semitendinosus graft is whipstitched to a biologic collagen shoestring scaffold and passed through the tunnels. The joint is reduced, and the graft is sutured together over the top of the medial clavicle with appropriate tension. Results: The sternal docking technique was successfully implemented for the reconstruction of a chronic anterior SCJ dislocation and allowed the patient to return to full pain-free activity by 16 weeks. Discussion: Chronic anterior SCJ dislocations may fail to respond to conservative treatment measures necessitating operative reconstruction. The sternal docking technique using semitendinosus allograft augmented with a biologic shoestring scaffold described here is a safe and effective reconstructive technique. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Autoimmune intestinal leiomyositis as a rare cause of chronic intestinal pseudo-obstruction in children: Case report with literature review

Introduction. Chronic intestinal pseudo-obstruction represents a group of rare disorders characterized by impaired gastrointestinal motility in the absence of mechanical bowel obstruction. These disorders can be primary or secondary, with autoimmune intestinal leiomyositis falling into the latter category. This condition is observed in adolescence and adulthood but is very rarely seen in children, especially in infancy. Case outline. A nine-month-old male infant was hospitalized due to persistent vomiting, abdominal bloating, and distension. After diagnostic evaluations and failure of conservative treatment measures, surgical formation of an ileostomy was performed. During the procedure, intestinal samples were obtained, revealing T lymphocyte infiltration of the intestine. Immunological blood analyses showed elevated serum immunoglobulins and smooth muscle auto antibodies. Combined with histological findings and elevated inflammatory markers, a diagnosis of autoimmune intestinal leiomyositis was established. Immunosuppressive therapy was initiated, leading to normalization of inflammatory markers and resolution of clinical symptoms. After four years of immunomodulatory therapy, the ileostomy was closed, and intestinal biopsies showed no inflammatory infiltrates. Five years later, the boy remains free of gastrointestinal symptoms, with normal growth and development. Conclusion. Although a rare condition, autoimmune intestinal leiomyositis is an important differential diagnostic entity in chronic intestinal pseudo-obstruction. Early disease recognition with intestinal biopsies, coupled with prompt and aggressive immunosuppressive therapy, enables favorable therapeutic outcomes.

Lumbar disc herniation

The most common cause of disc herniation is the degeneration of the intervertebral disc. Consequently, lumbar disc herniations are amongst the most common pathologies of the lumbar spine. Factors that can increase the risk of disc herniation include genetics, weight, occupational risk factors, smoking, as well as apredominantly sedentary profession. Pathognomonic symptoms of aherniated disc include sciatica, caused by the compression of one or more spinal nerve roots. The clinical sequelae of lumbar disc herniations range from mild low back and buttock pain to severe, immobilising cases of sciatica to cauda equina compression syndromes. In 1-1.5% of cases, acauda equina syndrome may occur. This cauda equina syndrome may be considered an emergency situation that requires immediate attention and surgical decompression. The same applies to significant and rapidly deteriorating neurological deficits (< 24 h). In all other cases, which represents the majority of all patients,substantial pain relief can be achieved with nonsurgical measures. If an adequate and intolerable pain relief cannot be achieved despite intense conservative treatment measures after an extended period of 6-12weeks, surgical removal of the disc herniation may be indicated. Lumbar disc herniations may be addressed surgically with minimally invasive techniques. The goal of the surgery is full and sufficient safe removal of the herniated disc fragments in order to decompress the spinal nerves as well as the cauda equina. The two most commonly used surgical techniques (endoscopic/microsurgical) entail fivedifferent approaches (endoscopic: interlaminar, transforaminal; microsurgical: interlaminar, translaminar, extraforaminal). Patients are generally fully mobilized within hours after the surgery without any further restrictions. Postoperative rehabilitation measures are often carried out, but have no scientifically proven influence on the outcome of the operation. This article sheds light on the diagnostic and therapeutic procedures, techniques and special features of this socio-medically very important clinical picture.

Risk factors of delayed upper gastrointestinal transit in capsule endoscopy

Objective The purpose was to investigate the risk factors for delayed upper gastrointestinal transit (DUGT) in small bowel capsule endoscopy (SBCE) and to improve the efficacy of SBCE. Methods The medical records of patients who underwent SBCE in Renji hospital between January 2015 and January 2023 were retrospectively reviewed. Data collection included patient demographics and potential risk factors for DUGT such as indications for the examination, underlying diseases, hospitalization status, anemia, inflammation. Risk factors were analyzed using univariable and multivariable logistic regression models. DUGT was defined as failure of a capsule to pass through the pylorus within 1 h. Results A total of 1459 patients who underwent SBCE were included in the study. 306 Cases (21%) experienced DUGT and all received conservative observation, medication treatment, endoscopic intervention, and other measures based on specific circumstances. The overall completion rate (CR) of the examination was 95.5% (1394/1459). Logistic regression analysis showed that hospitalization status (p = 0.030), diarrhea (p = 0.017), diabetes (p = 0.027) and cerebrovascular disease (p = 0.038) were significant risk factors for DUGT. Conclusions In our study, DUGT of SBCE was associated with hospitalization status, diarrhea, diabetes and cerebrovascular disease. Therefore, for the patients with the above risk factors, we should closely check the capsule status during the examination process, in order to take appropriate intervention measures as soon as possible.

Early Functional Outcomes and Complications of Tibial and/or Peroneal Sesamoidectomy Utilizing a Burr Through a Medial Approach.

Sesamoid pathology can lead to significant pain and disability both with activities of daily living and high-impact athletic movements. Sesamoidectomy is a widely used procedure for patients who fail conservative treatment measures. Traditional dorsal or plantar approaches for sesamoidectomy have shown to successfully alleviate pain, but complications were reported. A proposed alternative medial approach using a burr may provide many advantages compared with traditional approaches. This study presents patient outcomes and complications for this technique. This was a retrospective chart review of patients undergoing sesamoidectomy (tibial, peroneal, or both) using a burr through a medial approach to the sesamoid metatarsal articulation. Data collected included patient demographics, radiographic analysis, and outcomes: Veterans Rand 12 Item Health Survey (VR-12), Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), patient satisfaction, and complications. Twenty-seven patients (29 feet) were included. The mean age was 38.4 years followed up for a mean of 30.9 months. VR-12 physical component improved from 35.98 ± 7.86 to 51.34 ± 8.01 (P < .001), FAAM ADL and sport improved from 58.33 ± 16.61 to 83.27 ± 18.28 (P < .001) and 26.37 ± 20.31 to 63.75 ± 29.74 (P < .001), respectively. Patient satisfaction with the treatment was 80.59% ± 27.06%. The overall complication rate was 11 (37.9%) whereas the overall reoperation rate was 4 (13.7%) of 29 feet. Complications included 1 arthrofibrosis, 1 flexor hallucis longus subacute rupture, and 1 asymptomatic hallux valgus. There were no sesamoid excision revisions. Sesamoidectomy using a medial approach with a burr provided significantly improved short-term functional outcomes, 80% patient satisfaction rate, with a relatively acceptable complications rate including 20% persistent pain. The medial approach is familiar to orthopaedic foot and ankle surgeons, provides adequate exposure, and eliminates the possibility of a painful plantar scar while avoiding disruption of the plantar plate, flexor hallucis brevis tendon, and ligamentous structures attached to the sesamoids. Larger studies with long-term follow-up from other centers are needed.

Narrative review of radiofrequency ablation applications in peripheral nerves.

Chronic pain is a pervasive and often-complex condition that can severely detract from an individual's quality of life. When conservative measures of treatment fail, radiofrequency ablation (RFA) has emerged as a potential alternative. This narrative review subsequently explores recent advancements in the use of RFA on peripheral nerves as a means of attenuating chronic pain and providing relief to patients. A comprehensive literature search was conducted on the PubMed database using the keywords "Radiofrequency", "Ablation", "Pain", "Chronic", "Peripheral", and "Nerve". The search focused on articles published between 2018 to 2023 that discussed an application of RFA in a peripheral nerve. In total, 30 articles were selected for inclusion in this review. Results indicate the successful use of RFA in an array of chronic pain conditions and anatomical sites. Applications include the treatment of trigeminal neuralgia (TN), occipital neuralgia, cluster headaches, knee pain derived from osteoarthritis (OA), hip pain, abdominal pain associated with pancreatic cancer, and several other chronic pain conditions. These findings suggest RFA is a viable option for reducing patient's pain scores and improving quality of life. Future research should build off extensive case reports/series with double-blind, randomized controlled studies to further investigate anecdotal successes.

Reconstructive Options for Pressure Ulcers in Pediatric Patients.

Pressure ulcers pose significant challenges in terms of treatment, often exhibiting a low success rate and a propensity for recurrence. Children with neurological impairments such as myelomeningocele and those with spinal injuries are particularly vulnerable to developing pressure ulcers. Despite advancements, achieving successful reconstruction remains a formidable task. Common sites prone to pressure ulcer formation include the sacral and ischial regions, as well as areas over bony prominences. Additionally, pressure ulcers attributable to medical devices facilitating ambulation are observed. While many pressure sores resolve spontaneously, conservative management may prove ineffective for some, especially in cases of stage 3 and 4 ulcers, necessitating surgical intervention. Various surgical techniques are employed for the treatment of decubitus ulcers, yet there exists no universally accepted gold standard for their management. This paper presents our institutional experience in this domain, highlighting differences in surgical approaches, treatment outcomes, complication rates, and long-term follow-up. This study involved a retrospective analysis of medical records from 11 children, ranging in age from 10 to 17 years, who presented with extensive pressure ulcers that were unresponsive to conservative treatment measures. Data collection spanned from February 2017 to June 2022. The pressure ulcers affected various anatomical regions, including the ischial area (5/11 patients), sacral region (3/11 patients), lower limb (1/11 patients), elbow (1/11 patients), and perineal area (1/11 patients). Surgical intervention was the chosen approach for all cases, employing techniques such as reconstructive surgery utilizing perforator, pediculated flaps, and locoregional flaps. Eleven patients with sore ulcers (stage 3 and 4) were treated surgically. We present our experience of using surgical methods, including pedicled anterolateral flaps, pedicled gracilis musculocutaneous flaps, propeller flaps and locoregional flaps. In some cases, surgery was performed after 60 days of hospitalization or ten years after ulcer occurrence. We reviewed the length of hospital stay, surgical management and patient satisfaction. Patients were followed up to 5 years post-surgery. All flaps survived except for one flap where partial necrosis was observed. The recurrence rate was 9.01% (1/11). One patient underwent another surgery. The general outcome was satisfactory. Conclusions: Our findings underscore the efficacy of flap reconstruction surgical techniques in the management of pressure ulcers among pediatric patients. Based on our experience and the outcomes observed, we advocate for considering reconstructive surgery as a viable therapeutic option early in the treatment course, particularly for stage 3 and 4 ulcers. This approach not only addresses the immediate needs of patients but also holds promise for long-term wound healing and prevention of recurrence.

Complex knee injuries in football : Management from injury to return to competition

Knee joint injuries are aregular and serious injury in football, often resulting in along period of absence for players and are, therefore, asignificant disadvantage for clubs. The various structures of the knee joint, such as ligaments, meniscus or cartilage, are exposed to the risk of injury due to different sport-specific situations in football and require different and specific therapeutic approaches for their adequate healing. Both surgical and conservative treatment measures have been well investigated scientifically, especially for knee joint injuries in football, so that asuccessful and sustainable return to play on field is highly possible. Only in professional football is there adeviation from the usual standard of treatment in special situations in order to meet the demands and goals of professional footballers. In order to do address different subpopulations in football in the various injury types, both in treatment and in the return to play decision and, thus, sustainable secondary prevention, in addition to knowledge of scientific evidence on knee joint injuries, basic experience in the sport in which the patients with knee joint injuries are active is also useful.

The urological case reports of the Hippocratic Corpus : Medical practice in classical Greece

Which theoretical and practical competences do the urologic case histories of the Hippocratic Corpus convey? The 431Hippocratic case histories have been studied for reports and communication on diagnostic methods, treatment, and prognosis related to urologic diseases. Within the seven books of the Hippocratic Epidemics, atotal of 69patients with urologic symptoms are described; in 21 cases the urologic disease is dominant. The leading clinical signs were urine discoloration and urinary sediment, polyuria, testicular swelling and pain, hematuria, stranguria, anuria, and renal pain, the most frequent diseases were nephritis and urolithiasis. Most patients were men in juvenile and adult age; 33 sick persons are named. The statements of patients regarding the course of their illness were often sparse. Diagnostic tests were restricted to inspection and palpation. Otherwise, treatment was confined to conservative measures. The dietary decisions for treatment of nephritis were differentiated but nonuniform. The Hippocratic physician diagnosed and treated diseases of the urinary tract. Inflammatory conditions and traumatic lesions are described in detail. Highest priority was awarded to uroscopy. Nephritis was awidespread disorder und usually associated with other symptoms, above all fever. The urinary tract was often regarded as an indicator of physical and mental health. Conservative treatment measures dominate in the case reports.

A rare case of intervertebral disc calcification combined with ossification of the posterior longitudinal ligament in a child: a case report and literature review

BackgroundIntervertebral disc calcification (IDC) combined with calcification in children has been sporadically reported, while ossification of the posterior longitudinal ligament (OPLL) in the cervical spine in pediatric patients is exceedingly rare. The aim of this study is to investigate the potential prognosis and outcomes associated with this condition.Case presentationWe present an unusual case involving a 10-year-old Chinese child diagnosed with calcified cervical disc herniation and ossification of the posterior longitudinal ligament. Conservative treatment measures were implemented, and at the 1-month and 6-month follow-up, the patient's pain exhibited significant improvement. Subsequent cervical MRI and CT scans revealed the complete disappearance of OPLL and substantial absorption of the calcified disc. During the three-month follow-up, CT demonstrated slight residual disc calcification, however, the patient remained asymptomatic with no discernible limitation in cervical motion.ConclusionsWe conducted a comprehensive review of several cases presenting with the same diagnosis. It is noteworthy that IDC combined with OPLL in children constitutes a rare clinical entity. Despite imaging indications of potential spinal canal occupation, the majority of such cases demonstrate complete absorption following conservative treatment, with OPLL exhibiting a faster absorption rate than calcified discs.

Infrapatellar Branch of the Saphenous Nerve: Therapeutic Approaches to Chronic Knee Pain.

The infrapatellar branch of the saphenous nerve (IPS) is an under-investigated nerve that can be a source of chronic knee pain. This literature review aims to deliver an up-to-date review of chronic pain transmitted via the IPS along with therapeutic approaches available for pain refractory to conservative measures. Knee pain transmitted via the IPS can arise from several etiologies. Damage to the IPS is often iatrogenic and develops following total knee arthroplasty, anterior cruciate ligament reconstruction, and other knee surgical procedures. Other causes of IPS-derived pain include entrapment of the nerve, neuromas, Schwannomas, and pain from knee osteoarthritis transmitted through the IPS.This article investigated therapeutic approaches to pain derived from the IPS. Common approaches included radiofrequency ablation, neuroma excisions, Schwannoma excision, nerve blocks, surgical exploration, surgical release of an entrapped nerve, cryoablation, and peripheral nerve stimulation. Pain scores, duration of pain relief, adverse events, and secondary outcomes were all included in this review. A subset of the patient population experiences chronic pain deriving from the IPS that is refractory to conservative treatment measures. This review aims to evaluate the etiologies and therapeutic approaches for chronic pain arising from the IPS refractory to conservative treatments.

Meniscus Allograft Transplantation Augmented With Autologous Bone Marrow Aspirate Concentrate

Meniscus allograft transplantation (MAT) has been shown to be a feasible surgical option for younger patients, below 50 years of age who have meniscal insufficiency and have failed conservative treatment measures. In this technical note, we describe a procedure of harvesting and injecting bone marrow aspirate concentrate in a meniscus allograft during a MAT procedure, which may allow for longer lasting transplants and improve patient outcomes. In this technical note, bone marrow aspirate concentrate is harvested arthroscopically from the intercondylar notch at the surgical site, which prevents additional donor site morbidity, as seen with harvesting from other locations, such as the iliac crest. This also reduces operating time, since harvesting from the iliac crest requires different patient positioning and usually additional anesthesia. The authors of this surgical technique believe that biological augmentation during MATs will assist surgeons in maximizing graft survivorship and, ultimately, lead to better patient outcomes.

Does Single Intra-Articular Plasma-Rich Plasma (PRP) Injection for Temporomandibular Joint (TMJ) Internal Derangement Relieve Joint Pain?

Introduction: The temporomandibular disorder (TMD) is a common pathological entity and is found in 31% of the adult population. Different minimally invasive techniques, such as the injection of diverse substances into the joint, arthrocentesis have exhibited good clinical results and such modalities would be considered either for severe TMDs or after the failure of conservative treatments. Several studies endorsed intra-articular injections of platelet- rich plasma (PRP) as an effective procedure to decrease TMD tenderness. The primary aim of this study is to assess the effectiveness of a single PRP injection in terms of reducing pain, and improving mandibular motion in patients affected by internal derangement of the TMJ. Materials &amp; Methods: The study consisted of 10 patients who reported to the oral and maxillofacial surgery clinic with painful dysfunction of the temporomandibular joint who received a single injection of PRP in the TMJ. Variables measured including pain score and mouth opening were assessed preoperatively and postoperativel. SPSS 24.0 was used for data management and statistical analysis. The level of significance was set at 0.05 for all statistical tests using chi-square. Results:The group of 10 patients consisted of 9 women and 1 man. The age of the participants ranged from 27 to 75 years, and a median age of 45.5. Upon the follow up visit within 1-3 months: 7/10 patients showed a significant reduction of the pain intensity (more than 50% reduction of pain intensity), 2/10 patients showed a partial resolution of the symptoms with minimal reduction of pain and one patient showed no improvement in either pain or mouth opening and subsequently underwent arthrocentesis. The PRP injections were successful in decreasing pain intensity scores to below 5 in most cases. A Chi-squared test was performed to test for an association between the PRP injections and pain intensity score and the outcome supports the conclusion that there is a strong correlation between the PRP injection and pain and that it is statistically significant. Conclusions:TMD symptoms and movement limitations disrupt everyday life and in cases with severe illness, studies showed that the conservative treatment measures lead to insignificant or low improvement in quality of life. For this reason, a fast acting and effective method of reducing pain and movement limitations is essential and our study findings support the role of PRP injections. It exhibited a very strong negative relationship, which indicates that the PRP injection and pain scores are inversely related.

Teduglutide therapy in a child with short bowel syndrome

Introduction. Short bowel syndrome (SBS) in children is a rare disease. One of the most common etiological factors for the development of SBS in children is atresia of the small intestine. After surgical correction of the congenital anomaly, the remaining intestine attempts to increase absorption to restore homeostasis, and the process of intestinal adaptation begins. This process of adaptation can be assisted with analogues of endogenous growth factors of the intestine, such as teduglutide. Case outline. This report presents ? girl, aged two years and eight months, who had an estimated 20 cm of small intestine after surgical correction of congenital small bowel atresia and clinical signs of SBS. She was repeatedly hospitalized due to frequent need for parenteral correction of fluid, electrolyte, and nutrient imbalances. Stagnation in body weight and slow growth in body height were accompanied by weakened gross motor strength and slowed psychophysical development. After exploit conservative treatment measures, stimulation of intestinal adaptation was initiated with the drug teduglutide. After six months of drug therapy, progress was observed in body parameters, as well as an increase in intelligence quotient and motor abilities. Conclusion. SBS is a challenging entity for every clinician, and its previous therapy has mainly consisted of parenteral substitution of nutrients, fluids, and electrolytes. Surgical treatment carries the risk of loss of the remaining bowel and lifelong immunosuppression. The pharmacological possibilities of promoting intestinal adaptation using drugs such as teduglutide represent a light at the end of the tunnel for patients with SBS.

Vascularized pedicled fibula flap with split periosteal overlay for ankle arthrodesis: Modification of technique and case report

Defects of the distal tibia, ranging from infectious to neoplastic origins, are difficult lesions to repair given their proximity to the ankle joint. Surgical repair options have often been limited, as ankle replacements and ankle arthrodesis generally require more tibial bone stock to achieve positive outcomes and avoid loss of function in the affected joint. Here we present a case of a distal tibial defect being reconstructed using a pedicled fibula flap and ankle arthrodesis technique that allowed for a sufficient range of mobility of the joint post-operatively. Our patient was a 52-year-old female with a history of myelodysplastic syndrome treated with a stem-cell transplant; fifteen months following the transplant, she was diagnosed with osteonecrosis of the distal tibia and calcaneus after developing severe swelling and pain in her left ankle. Despite conservative treatment measures, her symptoms continued to worsen, and ankle reconstruction was chosen as the only viable option for recovery. She underwent distal tibial reconstruction and tibiotalar arthrodesis using an ipsilateral vascularized pedicled fibular flap. The patient was ambulating well eight weeks post-op; she reported being able to painlessly bear full weight on the left ankle 14 weeks post-op. One-year post-op the patient was able to demonstrate an adequate range of motion of the affected joint, reduced relative to the unaffected limb but still allowing for suitable and comfortable ambulation. A 21-month post-op X-ray showed complete radiographic union of the distal tibia to the fibula flap and tibiotalar arthrodesis. As evidenced in our patient, an extremely positive postoperative outcome can be achieved with the utilization of this technique. • Split periosteal overlay in the setting of fibula flap can potentiate bony fusion. • Pedicled fibula flap can be used as viable treatment for distal tibial defects. • Pedicled fibula flap for distal tibial defects maintains the tibiotalar joint.

Epidural Steroid Injection Versus Conservative Measures in Treatment of Chronic Axial Low Back Pain, A Prospective Randomized Controlled Study

Chronic low back pain (CLBP) is a very common disorder with various management strategies. There is still debate regarding treatment alternatives for axial CLBP. This study aimed to compare the effect of epidural steroid injection (ESI), interferential current (IFC) therapy and core strengthening exercises in a prospective randomized controlled manner. Hence, sixty patients complaining of axial CLBP were included and randomly assigned into either a group of ESI and exercises (group A) or IFC and exercises (group B) or exercises only (group C); each group was of 20 patients. Outcomes were visual analogue scale (VAS) for pain, Oswestry disability index (ODI) for function and Beck's depression inventory (BDI) for depression, assessed at baseline and 3-, 6- and 12-week follow-ups. At the start of the study, there were no significant differences between the three groups in age, gender, cause and duration of CLBP, body mass index, abdominal muscle power, muscle spasm or tenderness (p &gt; 0.05). Significant improvement in VAS and ODI at 3-, 6- and 12-weeks was observed compared to baseline assessment in the three studied groups. The improvement was higher for group A compared to B and C. BDI was significantly improved in group A and C at 3 weeks, and in all groups at 6- and 12-weeks compared to baseline. However, at the end of the study, there was no significant difference in the BDI between the three groups. From this study and over a period of 3 months, all studied groups showed improvement in pain, function, and depression but the group who received epidural steroid injection with core strengthening exercises was statistically better than the other two groups, with significant improvement in pain and function, but not in depression. Early effective assessment and dealing with depression, even prophylactic treatment and cognitive behavioral therapy should be addressed. Trial registration: The Pan African Clinical Trial Registry (www.pactr.org) identification number is PACTR201901523042787 on 16 January 2019.

Neck swelling 19 days after thyroidectomy: A case report of a rare chyle leak patient.

The occurrence of chyle leak after neck dissection for thyroid carcinoma is uncommon, but it usually occurs within 1-10days after surgery. We encountered a 30-year-old patient with chyle leak 19days after the operation for thyroid carcinoma. The initial symptom was swelling of the neck, which was quickly diagnosed as chyle leak by puncture. This report describes the patient's presentation and discusses the conservative management of this complication. We highlight that more attention should be given to chyle leak in high-risk patients, and stricter dietary management for these patients after surgery may avoid this complication. In addition, timely diagnosis and rapid implementation of various conservative treatment measures play an important role in patient recovery.

Concomitant hypertrophic lichen planus and squamous cell carcinoma: Clinical features and treatment outcomes.

Patients with hypertrophic lichen planus (HLP) and squamous cell carcinoma (SCC) diagnoses present clinicians with diagnostic and disease management challenges. To better define the clinical and treatment outcomes of patients with concomitant diagnoses of HLP and SCC. A retrospective review was performed from January 1, 2008, to July 31, 2015, at Mayo Clinic. Patients with a histologic diagnosis of HLP and SCC were included. Patient demographics, associated comorbidities, histopathologic characteristics, treatment, and outcomes were evaluated. Thirty-three patients were identified; 79% were female, and mostly the lower extremities were involved. Most of the SCCs were well-differentiated and in situ with the majority treated with destruction or excision. There were no cases of local recurrence, metastasis, or disease-specific death during the follow-up period (mean 55.8 months). Patients with diagnoses of both HLP and SCC appear to be a distinct population that is predominantly female with lesion predilection for the lower extremities. However, regardless of treatment modality or tumor size, there were no adverse outcomes. An initial trial of more conservative treatment measures with close follow-up may be reasonable with biopsy of lesions unresponsive to conventional treatment.

The role of mobile applications in the conservative management of stress urinary incontinence in women

Urinary incontinence (UI) affecting over 300 million women worldwide, regardless of race and age, is considered one of the most important health issues in the 21st century. Due to the scale of the problem, the priority should be to provide therapy to as many patients as possible. Although effective conservative treatment measures for UI are available, they may not cater to all individuals who seek help. Sometimes a sense of embarrassment or a fear of stigmatization causes patients’ reluctance to report UI symptoms to their health provider and to join therapy. That forces to search for the new approach. In this field, use of mHealth technologies seems very promising. They became even more valuable during the Covid-19 pandemic, when the interest in telemedicine, as a means of providing care, while not being exposed to the risk of virus infection, further increased.&lt;br /&gt; The purpose of this work is a narrative review showing possibilities of using conservative measures of stress urinary incontinence (SUI) in women, with particular emphasis on the use of mHealth technologies, as recent studies have shown that mobile application seem to be an effective tool in terms of improving SUI symptoms, satisfaction and adherence to therapy.

Meniscal Root Tears: A Decade of Research on their Relevant Anatomy, Biomechanics, Diagnosis, and Treatment.

A foundational knowledge of the anatomy and biomechanics of meniscal root tears is warranted for proper repair of meniscal root tears and for preventing some of their commonly described iatrogenic causes. Meniscal root tears are defined as either a radial tear occurring within one cm of the root attachment site of the meniscus or a complete bony or soft tissue avulsion of the root attachment altogether. Meniscal root tears disrupt the protective biomechanical function of the native meniscus. Biomechanical analyses of the current techniques for meniscal root repair highlight the importance of restoring menisci to their correct anatomic orientation, thereby restoring their biomechanical function. A comprehensive understanding of the clinical and radiographic presentations of these injuries is critical to preventing their underdiagnosis. The poor long-term outcomes associated with conservative treatment measures, namely, ipsilateral compartment osteoarthritis, warrants the surgical repair of meniscal root tears whenever possible. While excellent patient-reported outcomes exist for the various surgical repair techniques, adherence to stringent post-operative rehabilitation protocols is critical for patients to avoid damaging the integrity of a repaired root. This review will focus on current concepts pertaining to the anatomy, biomechanics, diagnosis, treatment, and postoperative rehabilitation for meniscal root tears.