Conservative Treatment In Children Research Articles

Bracing of children with pectus carinatum: A literature review

BACKGROUND: Conservative treatment of children with carinatum is currently an urgent and unresolved problem despite the wide range of techniques available. Conservative treatment stops the progression of deformation and reduces the degree of deformation or eliminates it. Methods of evaluating treatment results include clinical (photo–video assessment, questionnaire survey, and chest measurements) and instrumental diagnostics (radiography, computed tomography [CT], and 3D scanning); however, no method of correction and orthosis that would consider all the tasks of conservative treatment, method of evaluating conservative treatment, and uniform protocol have been established. AIM: This study aimed to analyze the literature containing information on the conservative treatment of patients with pectus carinatum. MATERIALS AND METHODS: The study presents the results of a search in PubMed, Cochrane, and eLibrary using combinations of operators and keywords. A total of 54 foreign and domestic sources were extracted, and the search was not limited retrospectively. RESULTS: Orthosis is effective and positively perceived by doctors and patients. The most modern designs in the treatment of carinatum included dynamic orthoses FMF-DCS and Braceworks (Calgary). Recent studies have reported a strong correlation between 3D scanning and CT to assess treatment outcomes. However, no single option for conservative correction of deformity allowed for achieving all treatment goals. The assessment of the effectiveness of orthosis using photos, videos, and questionnaire, and chest measurement is subjective. CONCLUSIONS: The disadvantages of prosthetics determine the need to develop a clear treatment algorithm, methodology, and objective assessment of treatment outcomes, requiring further research.

Analysis of the efficacy and safety of conservative treatment of blunt abdominal trauma in children: retrospective study. Conservative treatment of blunt abdominal trauma in children.

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. retrospective analysis of medical records of patients classified by levels of injury severity, in 27 children. 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. 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.

Technologies for stimulation of the reparative processes in children with knee osteochondritis dissecans: A review

Dissecting osteochondritis of the knee joint, Koenigs disease is a disease of the knee joint that result in articular surface and osteoarthritis congruence. The disease incidence reaches 15% in the pathological knee joint structure in children. The comparative effectiveness of various treatment methods for children with Koenigs disease, from conservative therapy to orthobiological technologies, is a topical subject of discussion among specialists.
 The effectiveness of modern treatment methods for children with Koenigs disease has been evaluated and is the leading trend in the use of biotechnology for further experimental and clinical studies.
 The literature search was conducted in the electronic databases of PubMed, Web of Science, Scopus, MEDLINE, eLibrary, RSCI, and Cyberleninka, whereas 2300 references were analyzed, 283 articles were viewed, and 90 publications on orthopedics and biotechnology were selected for the review.
 Indications for conservative treatment in children with Koenigs disease are currently limited to stages III of the process. Surgical methods occupy a dominant position when pain relief and pathological focus regeneration stimulation are necessary. However, the long-term results of therapy indicate the replacement of the necrosis zone with coarse fibrous connective tissue, which is significantly inferior to hyaline cartilage in terms of biomechanical characteristics, which determines a high risk of developing osteoarthritis. The actively developing direction of orthobiology allows the use of a patients tissues to activate the processes of reparative regeneration with the relief of clinical manifestations and favorable immediate results.
 The focus of attention of researchers has shifted to the plane of orthobiological technologies following the established trends in regenerative medicine development, which provide a high proportion of favorable immediate interventional results. However, the limited number of publications and the lack of long-term results of therapy do not meet the criteria for demonstrative effectiveness of technologies.

Застосування методів консервативної терапії в дітей з післяопіковими рубцевими деформаціями та їх вплив на метаболізм сполучної тканини

One of the factors of scarring is changes in the connective tissue (CT). Defeat of CT is accompanied by changes in the content of glycosaminoglycans (GAG), activity of lysosomal enzymes, levels of mineral metabolism. To eliminate the influence of inflammatory phenomena and disorders of CT metabolism on the formation of scar tissue, it is urgent to use conservative rehabilitation measures. Purpose - to determine the effectiveness of measures of conservative therapy of post-burn scars in children for the clinical course and metabolism of connective tissue. Material and methods. 27 children aged 5 to 18 were supervised. The group of healthy children without clinical manifestations of inflammatory reactions consisted of 17 people. Conservative treatment of children with scarring included local, drug, physiotherapy, balneological and efferent therapy methods. The impact of treatment measures was assessed on a modified scar score scale, which consisted of a patient (parent) scale and a researcher scale. Laboratory criteria of effectiveness were the amount of ceruloplasmin (CP), lactic (MC) and sialic (SC) acids, GAG content, lysosomal enzyme activity (bone and alkaline phosphatase), mineral metabolism (total calcium). Laboratory parameters in patients were studied in the period from 150 to 170 and 310 to 340 days after injury. SPSS v was used for statistical analysis. 17.0. Results. Improvements in clinical signs of scar tissue were 1.7-fold according to objective estimates and 1.6-fold according to patient estimates. Laboratory monitoring showed the effectiveness of conservative treatment of convalescents, which was manifested in a reduction in GAG levels 1.6 times after 6 months and 2.0 times after a year. There was a decrease in the activity of acid phosphatase in 1.6 times, alkaline phosphatase and its bone fraction in 1.4 times. In addition, after treatment, there was an increase in ceruloplasmin activity by 1.5 times at all times. A 1.5-fold increase in the number of MCs was determined at all observation times. After treatment, the amount of MC decreased by 1.2 times (P<0.05). Significant confirmation of an increase in the level of SC in 1.4 times (P<0.05) was observed only on the 160th day of the study. At other times, the increase in the IC was unreliable. Conclusions. Long-term studies have shown that in children after thermal trauma in the process of productive scarring there are deviations in the metabolism of CT in the direction of increasing its synthetic function, metabolic disorders and inflammation continue. The use of complex conservative therapy in children with post-burn scars during convalescence allowed to reduce the severity of inflammatory reactions, improve CT metabolism and reduce scarring. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: post-burn scarring in children, connective tissue, metabolism, inflammation, conservative therapy.

Surgery for Flatfoot Unresponsive to Conservative Treatment in Children and Adolescents

Surgery for Flatfoot Unresponsive to Conservative Treatment in Children and Adolescents

Dental caries in primary teeth during early childhood in the Warsaw agglomeration

Introduction. The high incidence and level of Early Childhood Caries (ECC) in children aged 3 in Poland indicate a high risk of developing this disease in younger children. There are no data describing the scale of the problem in Poland. Aim. Determining the prevalence and level of severe early childhood caries (S-ECC), the needs of conservative treatment in children in the second and third year of life from the Warsaw agglomeration. Material and methods. A cross-sectional study of children aged 12-36 months was carried out after obtaining the consent of the Bioethics Committee of the Medical University of Warsaw. The presence of non-cavitated (d1) and cavitated caries (d2), fillings (f), and missing teeth (t) and surfaces (s) caused by caries (m), periodontal abscesses and fistulas was assessed. The frequency of ECC and its intensity (d1d2mft and d1d2mfs), conservative treatment index (f/f + d) were determined. In the statistical analysis, the chi-square test was used to compare the fractions. Results. 496 children were examined, including 262 (52.8%) boys. S-ECC was recorded in 44.8% of the respondents, d1d2mft and d1d2mfs reached the values of 2.62 ± 3.88 and 4.46 ± 8.42. The incidence and level of S-ECC increased with age. The greatest increase was seen in the subgroup > 18 to 24 months. The main components of d1d2mft were the teeth with caries (d). Abscesses and fistulas were diagnosed in 15 (3%) patients. The treatment indexes increased from 0 in the youngest to 0.08 in the oldest age group. Conclusions. Caries of primary teeth in the early childhood period is characterized by a rapid transformation of non-cavitated lesions into cavitated ones and subsequent eruption of teeth. With medical negligence, complications result in tooth loss. The greatest increase in the frequency and level of caries is observed in the second half of the second year of life, therefore, early home and professional prevention is essential.

Visual outcomes of surgical and conservative treatment in children with small posterior polar cataracts and posterior lenticonus.

To compare the visual outcomes of children with small (≤3 mm) posterior polar cataracts (PPC) and posterior lenticonus who had cataract extraction surgery with the visual outcomes of those who were managed conservatively. Children who initially had small PPC and posterior lenticonus who were followed up over 1-year period were retrospective reviewed in the study. Patients receiving surgery were compared with those receiving conservative therapy. The axial length, keratometry, refraction, best-corrected visual acuity (BCVA), and strabismus measurements were recorded. Lens morphology, i.e., the location, size, and depth of the cataract lesion, was measured with a Scheimpflug imaging system. To help control for baseline differences in the groups, patients were matched with controls by propensity score methodology. The study evaluated 60 patients (30 in the surgery group and 30 in the conservative therapy group) after matching by propensity score. Patients who underwent cataract surgery showed greater BCVA improvements (0.36±0.24 logMAR) than patients who were treated without surgery (0.22±0.26 logMAR; P=0.036). Surgery was effective in patients with a rear projection length (RPL) less than 1.0 mm and a pretreatment BCVA worse than 0.52 logMAR. Children with small PPC and posterior lenticonus who undergo cataract surgery experience greater BCVA improvements than those managed conservatively. Certain patients presenting with a RPL less than 1.0 mm and a pretreatment BCVA of 0.52 logMAR or worse may benefit from surgery.

Wyniki leczenia zachowawczego dzieci z chorobą Legg-Calve-Perthes do 7 roku życia

Introduction. Legg-Calve-Perthes disease is one of the most common avascular necroses in children and adolescents. Aims. Assessment of hip joint development and of the quality of life in conservatively treated patients. Establishing indications for conservative treatment in children with Perthes disease. Materials and methods. The inclusion criterion was the age of affected patients: under 7 years at the time of diagnosis The study population included 50 children (10 girls and 40 boys) in the mean age of 5 years and 1 month. All the children participated in follow up appointments, arranged every 3 months, during which clinical examinations (the range of hip joint motion, limb length) were carried out and radiological parameters (Salter extrusion index, ATD, Wiberg angle) were assessed. All the patients were assessed in the IPSG Modified HOOS-16 Hip Survey. Results. The patients, qualified to group A by the Herring classification, demonstrated less limits in hip joint inward rotation and no length reduction of the affected limb (p<0.05). In the patients with Wiberg angle and Salter extrusion index in the affected joint being similar to their corresponding values on the healthy side, the intensity of pain was lower, assessed in the IPSG Modified HOOS-16 Hip Survey, as well as their functioning in everyday life and in sport and recreation activities was better, thus their general quality of life was higher (p <0.05). Conclusions. Children with Perthes disease, diagnosed before the age of 7, do not usually require surgical intervention. In our study, the radiological evaluation of hip joint development showed complete healing of the proximal femoral epiphysis, while preserving femoral head sphericity and good hip functionality. In general, the quality of life of affected patients does not differ from the quality of life of healthy children. The indication for conservative treatment of children with Perthes disease is their age below 7 years. Then a regular monitoring of the course of physiotherapeutic therapy is required, combined with regular radiological controls and clinical assessments of hip joint motion range.

Nonunion of the bone fragments during total hip replacement with T. Paavilainen osteotomy — causes of failure

Background. Conservative treatment options for hip dysplasia and hip dislocation in early childhood allow for good results in cases of a timely diagnosis. The preferred treatment option for patients with hip dislocation in adulthood is total hip joint replacement. The shortening osteotomy, proposed by T. Paavilainen, allows the surgeon to restore the difference in the lengths of the lower extremities during arthroplasty of the hip joint. However, according to the results of the Paavilainen technique, as presented by Russian orthopedic surgeons, the problem of nonunion of the greater trochanter fragment with the diaphysis of the femur remains unresolved, as evidenced by a massive group of clinical cases.
 Aim. The aim of this study was to identify factors affecting the consolidation of bone fragments after osteotomy of the greater trochanter, according to T. Paavilainen, during total hip arthroplasty and evaluate their significance after fixation with cerclage screws in comparison with a special trochanteric fork-plate.
 Materials and methods. The present study includes 208 cases that were treated at the Russian Scientific Research Institute of Traumatology and Orthopedics named after R.R. Vreden from 2003 to 2019 using various fixation techniques of the greater trochanter fragment. Patients were divided into two groups depending on their type of fixation. The quality of consolidation of a greater trochanter fragment with the femur was assessed during a follow-up period of six months or longer. The fragment of the greater trochanter was divided into the part that was not in contact with the diaphysis, or A, and the part that was in contact with the diaphysis, or B. We assessed the effect of the absolute value of the contact between fragments, the B/A ratio, the distance between the points of insertion of the screws into the diaphyseal part of the femur, the quality of the bone by the modified Barnet-Nordin index, and the history of previous surgical interventions on this joint on the consolidation.
 Results. When the part of the greater trochanter was in contact with the diaphysis of the femur (B) was less than 3.5 cm, the risk ratio of nonunion of the greater trochanter fragment with the diaphysis of the femur increased. Also, a significant factor is the index of the contact of the greater trochanter fragment (B/A less than 1) with the diaphysis of the femur using the T. Paavilainen technique. In addition, the presence of surgical intervention in the hip joint history significantly increases the relative risk (RR) of nonunion of the greater trochanter fragment with the diaphysis of the femur with this method of shortening osteotomy of the femur.
 Conclusion. In the absence of timely diagnosis and conservative treatment of children with hip dislocation, reconstructive-plastic techniques on the hip joint do not allow the achievement of proper results and increase the complexity of total hip arthroplasty. According to the results of this study, the absolute value of the contact between fragments (B), the index of the greater trochanter contact with the diaphysis of the femur, and the history of previous surgical intervention on this joint are objective tools for the prognostic assessment of the probability of fragment unions during total hip arthroplasty with the T. Paavilainen technique.

Conservative treatment of children with chronic diffuse sclerosing osteomyelitis/tendoperiostitis of the mandible

Chronic diffuse sclerosing osteomyelitis (DSO) of the mandible is a rare disease of unknown aetiology. It has been suggested that overuse of the masticatory muscles, tendoperiostitis (TP), is a contributing factor for DSO. Therefore, we tested this hypothesis by treating consecutive children with conservative therapy.All patients were treated with conservative therapy, comprising occlusal splint therapy, physiotherapy, and/or disease counselling. Pain intensity on a visual analogue scale (VAS) and pain frequency in number of days per 3 months were recorded before the start of treatment, and at 3, 6, and 12 months after treatment initiation.Eleven children (seven girls, four boys, mean age: 11.55 ± 1.97 years) were included in this study. Six patients showed a decrease in pain intensity and pain frequency over time and they continued with conservative therapy. For the remaining five patients, bisphosphonate administration was initiated because of persistent severe pain – one after 3 months of conservative therapy, and the other four after 1 year of conservative therapy.The pain complaints of patients with DSO/TP decreased with conservative therapy, and 55% did not require additional therapy. This suggests that DSO/TP of the mandible is precipitated by muscle overuse.

Errors of diagnosis and the initiation of conservative treatment in children with congenital hip dislocation

Background. Dysplasia of hip joints and congenital hip dislocation are common impaired developments in newborns. Currently, there are common cases of late detection of the disease, failure in treatment, and development of complications, which is not adequately reflected in the modern literature.
 Aim of the study. This study aimed to identify the most common errors during diagnosis and treatment onset in children with congenital hip dislocation during the first year of life.
 Materials and methods. This study is based on a retrospective analysis of the anamnesis history, which is the history of diagnosis and previous treatment, as well as on clinical, sonographic, radiation, and magnetic resonance examinations of 250 patients aged 5 months to 2 years. The patients were admitted to the specialized Department of Hip Joint Pathology of the Turner Scientific and Research Institute for Children’s Orthopedics with a diagnosis of congenital hip dislocation between 2005 and 2015.
 Results and Conclusion. The most common causes of errors during diagnosis of congenital hip dislocation in children are the lack of examination of the newborn by an orthopedist in the maternity hospital and sonographic screening as well as an error in its implementation. At the onset of treatment, the use of structures that did not provide the optimal position for repositioning the femoral head was noted as well as late indications for primary surgical treatment in cases of unreducible hips.

Risk factors of cubitus varus in humeral condylar fracture after conservative treatment in child

To further investigate the risk factors of cubitus varus in humeral condylar fracture after conservative treatment in children through Logistic regression analysis, so as to guide the clinical treatment. Children with humeral condylar fracture who were treated by manipulative reduction and plaster fixation in our hospital from March 2008 to December 2014 were studied. The clinical data including age, gender, BMI, time from injury to reduction, direction of displacement, rotation displacement, fixed position, and epiphyseal injury were collected. First, preliminary screen the risk factors through univariate analysis of the above data, then determine the risk factors of cubitus varus through multivariate Logistic regression analysis of the significant factors from univariate analysis. Univariate analysis showed that time from injury to reduction, direction of displacement, rotation displacement and epiphyseal injury were significantly correlated with the cubitus varus. Multivariate Logistic regression analysis showed that time from injury to reduction which was longer than 8 h [P=0.017, OR=3.303(1.243-8.774)], ulnar displacement [P=0.001, OR=11.951(2.895-49.335)], rotation displacement [P=0.003, OR=4.190(1.643-10.685)]and epiphyseal injury [P=0.000, OR=7.092(2.557-19.671)] were independent risk factors of cubitus varus. Time from injury to reduction, ulnar displacement, rotation displacement and epiphyseal injury are independent risk factors of cubitus varus. So it need corresponding treatment according to different risk factors.

Predicting long-term renal damage in children with vesicoureteral reflux under conservative initial management: 205 cases in a tertiary referral center.

IntroductionVesicoureteral reflux (VUR) is one of the most common ailments in children. Evidence-based guidelines recommend conservative treatment in children with VUR, followed by endoscopic surgery in those with breakthrough febrile urinary tract infections (UTIs). Despite this fact, the management of VUR is still controversial. Our objective is to evaluate the conservative strategy in children with primary VUR in terms of renal function and scarring, and identify factors associated with poor prognosis in those children.Material and methodsA retrospective study was carried out in a tertiary center in children with primary VUR under conservative strategy treatment from 1989 to 2015. Data extracted included age of presentation, family and prenatal backgrounds, radiographic evaluation including ultrasound (US), dimercaptosuccinic acid (DMSA) scans and voiding cystourethrogram (VCUG). The SPSS program was used for statistical analysis.ResultsTwo-hundred and five patients were diagnosed and followed a conservative therapy scheme (49.8% males, 50.2% females) after febrile UTI (73.17%) or prenatal diagnosis (26.83%). VCUG showed 53.20% of low-moderate VUR grade, 46.80% high VUR grade. Renal damage was present at diagnosis in 40.89%. Mean follow-up reakthrough recurrent febrile UTIs and underwent surgery. Conservative therapy was followed in 189 patients. Renal scarring or decreased kidney function were shown in 15.12% respectively. Renal damage was identified as a risk factor for poor prognosis (p-value <0.005) only for renal function deterioration. Patients with high-grade VUR required surgery in a significantly greater proportion (p <0.005) due to recurrent febrile UTIs.ConclusionsConservative strategy is a feasible treatment for primary VUR in children. The majority of cases could be managed conservatively with good outcomes after long-term follow-up. Decreased renal function is more frequent in patients with high-grade VUR. Renal damage at diagnosis increases the risk for surgical treatment.

Rehbein procedure for secondary megacolon in children

To evaluate the results of Rehbein procedure with extraperitoneal colorectal anastomosis combined with complex conservative treatment in children with secondary megacolon due to chronic constipation. We carried out surgical interventions in 78 children aged 7-12 years with chronic colostasis resistant to conservative treatment. All patients underwent clinical, laboratory and instrumental examination. All patients were divided into 3 groups depending on type of surgery: group I - colon resection followed by intraperitoneal colorectal anastomosis (28 patients), group II - open Rehbein procedure (29 patients), group III - laparoscopic Rehbein procedure (21 patients). Absence of dyspeptic disorders and enterocolitis in remote postoperative period in patients receiving comprehensive treatment enhanced with new additions is the cause of improved outcomes. Type of surgery should be individualized in view of anatomical colon changes and secondary pathological conditions. Some pathological symptoms observed at preoperative period may be recurrent in long-term postoperative period due to wrong selection of surgery. The risk of recurrent chronic constipation is high after colon resection followed by intraperitoneal colorectal anastomosis. Rehbein procedure may be preferred for management of secondary megarectum and megasigma. Laparoscopic technique reduces surgical trauma and requires less postoperative analgesia.

Conservative treatment of children with vertebral compression fractures of the thoracic and lumbar spine in the Russian Federation: a literature review

Various options for medical treatment of children with compression fractures of the thoracic and lumbar spine include unloading of damaged segments by simultaneous or gradual reclination (e.g., functional traction and reclination of the spine); measures aimed at building and strengthening the muscular “corset” of the back; and the use of orthotic devices of various designs (e.g., fixating-discharging, fixating-correcting corsets, orthoses on a modular basis). Questions regarding the early and late use of orthotics in patients with compression fractures of the vertebral bodies are discussed. Literature analysis, considering different methods used in the treatment of these patients in terms of their effectiveness to restore the height and shape of the damaged spinal segment revealed the absence of a differentiated approach for choosing treatment and selection criteria for orthopedic management.

Treatment of proximal humerus fractures in children and young adolescents.

Fractures of the proximal humerus in children are rare and represent approximately 0.45% of all paediatric fractures. These injuries are common in patients up to an age of 16 years. The treatment of displaced subcapital fractures is still controversially discussed in literature. Therefore the aim of this study was to evaluate the short-term outcome and to provide guidelines for surgical treatment of these fractures in children and adolescents. Clinical and radiological results of 231 patients between 0 and 17 years with subcapital humerus fractures were evaluated. Patients were devided according to their treatment as followed (1) conservative treatment group (2) operative treatment group. A total of 191 patients (82.7%) underwent conservative treatment and 40 (17.3%) underwent operative treatment. Surgical treatment consisted of open reduction and internal fixation (ORIF) (35.0%) or closed reduction and internal fixation (CRIF) (52.5%). In all operated patients an axial deviation of more than 20° was observed preoperatively. According to our groups; the surgical group presented in 90% (N = 36) of the patients with an excellent result, in 5% (N = 2) an average result was observed and in 5% (N = 2) a poor result according to Constant Murley Score was achieved. In the conservative treatment group in 185 patients (96.9%) excellent results were achieved and in 6 patients (3.1%) an average result in the Constant Murley Score was achieved. Conservative treatment in children < 10 years and an angulation angle < 20°, as well as surgical treatment with ORIF or CRIF in patients > 10 years and with an angulation angle > 20° leads to excellent short-term outcome. However, studies with longer observation time are needed to evaluate long-term complications like limb length discrepancy.

Adolescent femoral diaphyseal fracture nonunion

Femoral diaphyseal fractures comprise approximately 1.4-1.7% of all pediatric fractures and are the most common pediatric orthopaedic injury requiring hospitalization. Over the last 2 decades there has been a shift from conservative treatment in children to options of external fixation, submuscular plating, rigid locked intramedullary nailing, and flexible elastic nailing, the latter of which has emerged as a treatment of choice. Titanium elastic intramedullary nailing is minimally invasive, provides adequate stability, has good reported outcomes, and low rates of complications. However, nonunion, although rare, can occur. This paper examines the complication of the rare nonunion after titanium elastic intramedullary nailing of a femoral diaphyseal fracture, using a case illustration.

Ameloblastic fibroma conservative treatment in children

Objetives: Achieve nasal squamous cell carcinoma implants in experimental animals and evaluating the effectiveness of an antiangiogenic drug called Acriflavine (ACF) to inhibit tumour progression in animal model check antiangiogenic effect of other kinds of antiangiogenic drugs like Fenol Derivatives comparing with ACF in vitro. Assessing ACF in vivo by tumour histology. Materials and methods: We assess the effect of ACF and phenol derivates, in vitro, on the proliferation of tumor cells. We studied the effect of ACF in experimental animals, 19 rats. Results: ACF inhibits the proliferation of the squamous cell carcinoma in vitro if we compare with fenol derivatives by the absorbance at 595 nm tecnic and decreases the tumour progression in rats by inhibition the angiogenesis. Also, this antiangiogenic drug shows histologically a decrease in the number of blood vessels and increase in apoptosis compared with those who were not treated. Conclusions: Antiangiogenic drugs likeACFcould be an alternative treatment for head and neck squamous cell carcinoma.

Surgical treatment of complex spinal cord lipomas

This paper shows the long-term benefits of total/near-total resection of complex spinal cord lipomas and meticulous reconstruction of the neural placode, and specifically, its advantage over partial resection, and over non-surgical treatment for the subset of children with asymptomatic virgin lipomas. The technique of total resection and placode reconstruction, together with technical nuances, are described in detail. We added 77 patients with complex lipomas to our original lipoma series published in 2009 and 2010, to a total of 315 patients who had had total or near-total resection and followed for a span of 20 years. Long-term outcome is measured by overall progression-free survival (PFS) with the Kaplan-Meier analysis, and by subgroup Cox proportional recurrence hazard analysis for the influence on outcome of 4 predictor variables of lipoma type, presence of symptoms, prior surgery, and post-operative cord-sac ratio. These results are compared to an age-matched, lesion-matched series of 116 patients who underwent partial lipoma resection over 11 years. The results for total resection is also compared to two large published series of asymptomatic lipomas followed without surgery over 9 to 10 years, to determine whether prophylactic total resection confers better long-term protection over conservative treatment for children with asymptomatic lipomas.. The PFS after total resection for all lipoma types and clinical subgroups is 88.1 % over 20 years versus 34.6 % for partial resection at 10.5 years (p < 0.0001). Culling only the asymptomatic patients with virgin (previously unoperated) lipomas, the PFS for prophylactic total resection for this subgroup rose to 98.8 % over 20 years, versus 67 % at 9 years for one group of non-surgical treatment and 60 % at 10 years for another group of conservative treatment. Our own as well as other published results of partial resection also compare poorly to non-surgical treatment for the subset of asymptomatic virgin lipomas. Multivariate subgroup analyses show that cord-sac ratio is the only independent variable that predicts outcome, with a 96.9 % PFS for ratio < 30 % (loosest sac), 86.2 % for ratio between 30 and 50 %, and 78.3 % for ratio > 50 % (tightest sac), and a threefold increase in recurrence hazard for high ratios (p = 0.0009). Pre-operative patient profiling using multiple correspondence analysis shows the ideal patient for total resection is a child less than 2 years old with a virgin asymptomatic lipoma, who, with a PFS of 99.2 %, is virtually cured by total resection. Total/near-total resection of complex lipomas and complete reconstruction of the neural placode achieves far better long-term protection against symptomatic recurrence than partial resection for all lesions; and for the subset of asymptomatic virgin lipomas, also better than non-surgical treatment. Partial resection in many cases produces worse outcome than conservative treatment for asymptomatic lesions.

Laparoscopic Appendectomy Following Conservative Treatment in Children with Appendiceal Mass

Introduction: In this study, we hypothesized that performing laparoscopic appendectomy following conservative treatment is a safe and feasible procedure in children with appendiceal mass. Patients and Methods: Ten children diagnosed with appendiceal mass were treated by conservative therapy in our clinic between August 2009 and August 2012. Among these, 6 children received only medical treatment, and 4 of them received medical treatment following percutaneous abscess drainage under US guidance. Patients underwent laparoscopic appendectomy 2 to 3 months later. Age and gender of the patients, sizes of abscess, treatment modalities, length of hospital stay, complications, and pathologic examination results were evaluated retrospectively. All information was collected from computer records. Results: Six of the patients were male, and 4 of them were female, and their ages ranged between 4 and 15 (9.1 on average). The size of the abscess was between 3 and 8.5 cm (5.2 cm on average). Conservative treatment proved to be successful for all patients. After laparoscopic appendectomy, all patients, excluding one who required being hospitalized for 3 days, were discharged within a period of time shorter than 24 hours. No early or late complications were observed in any of our patients. Conclusions: We can assert that laparoscopic interval appendectomy to be performed after conservative treatment is a good option in the treatment of appendiceal mass.