Conservative Treatment Regimen Research Articles

The prognosis of idiopathic choroidal neovascularization in persons younger than 50 years of age

Objective To examine the prognosis of idiopathic choroidal neovascular membranes in patients younger than 50 years of age at the time of diagnosis. Design Retrospective noncomparative case series. Participants Eighteen consecutive patients from a university clinic (20 eyes) with idiopathic choroidal neovascularization in the macular area. All patients diagnosed between 1979 and 1996 were included; follow-up time varied from 5 to 187 months (mean, 55 months). Intervention Treatment was conservative. All patients were informed about argon laser photocoagulation, but in the majority of cases, patients were not encouraged to undergo such treatment. Treatment was given on patient’s request. Main outcome measures The dimensions of the choroidal neovascular membrane and its distance to the foveola were determined by computerized image analysis and their correlation with final visual acuity determined. Results Fifteen (75%) of the 20 eyes retained a visual acuity of 20/60 or better. In ten eyes (50%), acuity was 20/25 or better. Six eyes had been treated with laser photocoagulation; only one had a membrane located 200 μm or more from the foveola at the time of treatment. The outcome for treated eyes was no better than for untreated eyes, although the two groups were not directly comparable. In no eye did an initially juxtafoveal or extrafoveal membrane continue to grow under the foveola. Conclusions The prognosis of idiopathic choroidal neovascularization was much better than reported previously for eyes with choroidal membranes associated with age-related macular degeneration. A conservative treatment regimen should be considered. The authors have no reason to believe that laser photocoagulation would have improved the outcome in the nontreated eyes.

MEDIAL SHIN PAIN - RUNNER

245 HISTORY - A 17 year old runner presented with a 4 year history of bilateral medial shin pain of insidious onset The pain, a constant ache, was initially felt only following activity, but progressed to become marked during running, walking and finally standing. There was associated lower back pain, the onset of which did not occur until [Illegible Text] after the prescription of orthotics 3 years following the initial onset of shin pain. She had been seen by a number of specialists including: Physicians, Orthopaedic surgeons and Rehabilitation physicians. The diagnosis had ranged from back related, to shin splints and compartment syndrome. She had undergone a number of conservative treatment regimes directed at both her shins and back, all for no improvement. PHYSICAL EXAMINATION - BACK-Full range of motion, Palpation revealed mild stiffness of her L4/5 and L5/S1 facet joints. There was no increased neuromeningeal tightness. LOWER LIMBS-Unstable forefoot valgus, Tight soleus apponeuroses, but no tightness of the deep posterior compartment. Pedal pulses were present in both plantarflexion and dorsiflexion. Examination post exercise, again revealed no tightness of the deep posterior compartments, presence of pedal pulses with the addition of bruits over the SFA. DIFFERENTIAL DIAGNOSIS: Vascular: Entrapment of the Popliteal or Superficial Arteries. Shin Splints(Tenoperiostitis) Deep Posterior Compartment Syndrome. Back: Spondylolisthesis at L5 on S1, resulting in a secondary spinal claudication. TESTS AND RESULTS: ANKLE BRACHIAL Index Test:RT Post. Tibial Artery Rest: 1.06 Post: 0.89LT Dorsalis Pedis Artery: Rest: 1.14 Post: 0.77Arterial Doppler US:Arterial compression with plantarflexion.Angiogram:High takeoff of the anterior tibial artery bilaterally;Occlusion of the popliteal arteries with plantarflexion. MRI of LumbosacralSpine.Gradel-2 Spondylolisthesis of L5 on S1, loss of disc space at L5/S1, Bilateral L5 nerve root entrapment. TREATMENT AND RESULTS: Bilateral Popliteal Artery Entrapment Release.-No Improvement.Neurosurgeon - Two Level Lumbar Fusion-L4/5 & L5/S1.-One month post surgery-A marked improvement.

Riga‐Fedes syndrome: Natal or neonatal teeth associated with tongue ulceration. Case report

A case of natal teeth associated with traumatic ulceration to the ventral surface of the tongue (Riga-Fedes syndrome) in a four week old boy is presented. On radiographic examination, two teeth, present at birth, were found to be early erupted deciduous lower central incisors. A family history of natal teeth, all involving both lower deciduous central incisors associated with trauma to the tongue during suckling, was elicited. The ulceration healed over a period of four weeks using an innovative conservative treatment regime, involving the use of Stomahesive Wafer. Four months later the only sign of any previous pathosis was a fibrous scar on the ventral surface of the tongue.

Plantar Fasciitis: Diagnosis and Conservative Management.

Plantar fasciitis is a common cause of heel pain, which frustrates patients and practitioners alike because of its resistance to treatment. It has been associated with obesity, middle age, and biomechanical abnormalities in the foot, such as tight Achilles tendon, pes cavus, and pes planus. It is considered to be most often the result of a degenerative process at the origin of the plantar fascia at the calcaneus. However, neurogenic and other causes of subcalcaneal pain are frequently cited. A combination of causative factors may be present, or the true cause may remain obscure. Although normally managed with conservative treatment, plantar fasciitis is frequently resistant to the wide variety of treatments commonly used, such as nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics, corticosteroid injections, casts, physical therapy, ice, and heat. Although there is no consensus on the efficacy of any particular conservative treatment regimen, there is agreement that nonsurgical treatment is ultimately effective in approximately 90% of patients. Since the natural history of plantar fasciitis has not been established, it is unclear how much of symptom resolution is in fact due to the wide variety of commonly used treatments.

Skier's thumb: a literature review

Skier's thumb is defined as an acute injury to the ulnar collateral ligament of the metacarpophalangeal joint of the thumb. This review details the history, aetiology, epidemiology, anatomy, diagnosis, surgical and conservative treatment regimes, rehabilitation and current advances in the prevention of skier's thumb. It emphasises the importance of accurate diagnosis of skier's thumb, and appropriate referral of grade three ruptures for surgery. The need for research by physiotherapists which examines this common soft tissue injury is highlighted throughout the review.

Differentiated thyroid carcinoma in children and adolescents

From 1936 to 1990, 89 children and adolescents (72 girls and 17 boys) were treated for differentiated thyroid carcinoma at the University of Michigan Medical Center; 58 of these patients were first reported in 1971. Thirty (34%) patients had previously received external irradiation to the head and neck, although only 1 (3%) patient of the last 33 patients seen had this history. Patients first presenting from 1971 to 1990 had less advanced disease than those seen earlier. Also, during this time period, the rate of initial palpable cervical adenopathy fell from 63% to 36%, local infiltration of primary cancer from 31% to 6%, and initial pulmonary metastases from 19% to 6%. The incidence of cervical nodal metastases has remained 88% for 54 years. Papillary or the follicular variant of papillary carcinoma was found in 93% of all patients. Seventy-nine (89%) patients had total or completion total thyroidectomy. Surgical management of lymphatic metastases varied from regional excision of nodes to radical neck dissection. The overall rate of permanent accidental recurrent laryngeal nerve palsy and hypoparathyroidism was 4.5%, although neither has occurred in a child or adolescent undergoing surgery at the center in the past 25 years. The most recent 33 patients had a low rate of local/regional persistence or recurrence. Cervical nodal persistence occurred in 21%; there were no thyroid recurrences. Eighty-two percent of patients received 131I. The long-term mortality rate was 2.2%. We continue to advocate total thyroidectomy, cervical lymph node dissection, and postoperative 131I therapy as the most conservative treatment regimen for children with differentiated thyroid carcinoma.

Dutch oral anticoagulation trial

A prospective randomized placebo-controlled study with 300 patients was performed in order to evaluate the potentially beneficial effects of long-term treatment with oral anticoagulants (Fenprocoumon, Marcoumar) in patients with chronic peripheral arterial obstructive disease. Both conservatively and surgically treated patients were included. The difference in progression of peripheral vascular disease, cardiovascular disease and cerebrovascular disease is statistically highly significant (p<0.0001, log-rank test) in favour of oral anticoagulants. Bleeding complications were relatively infrequent in both groups. Conclusion: the long-term use of oral anticoagulants is recommended for the treatment of patients with chronic peripheral atherosclerotic obstructive disease, both after surgical vascular reconstructions and as an adjunct to conservative treatment regimens.

Improved seminal characteristics in infertile men after a conservative treatment regimen based on the avoidance of testicular hyperthermia

Evidence to support the contention that avoidance of testicular hyperthermia (due to hot baths and/or tight clothing) will improve fertility is, in the main, anecdotal. Semen samples derived from 128 infertile men were analyzed before and after a 3-month conservative treatment regimen. Six seminal characteristics were studied. Clinical evaluation included normal bath temperature, types of underwear worn, and past history of hernia repair, orchiopexy, or varicocelectomy. The patients were divided into three groups (A to C) according to sperm density and then subclassified on the basis of progressive motility status. The results show that a significant, or approaching significant, improvement in seminal characteristics occurs in certain groups of oligospermic individuals with pretreatment progressive motility of less than 40%. In clinical trials, it should be recognized that any improvement in seminal quality following pharmacologic or surgical intervention may include a contribution from conservative treatment.

Conservative treatment of gastroesophageal reflux and hiatus hernia.

Gastroesophageal reflux is a frequent occurrence in infancy. Most frequently, gastroesophageal reflux (GER) is due to a functional disturbance and lack of coordination of esophageal motility and lower esophageal sphincter incompetence. Vomiting is the sole symptom in the great majority of infants and responds readily to postural and dietary therapy. A malposition and defective fixation of the cardia and abdominal esophagus is the pathophysiologic substrate of hiatus hernia. Although most patients with hiatus hernia have GER, hiatus hernia is only symptomatic with concomitant GER. Differentiation between hiatus hernia and GER should therefore be dispelled. Treatment of hiatus hernia with GER is directed towards placing the patient in an upright position, even 24 h a day if necessary in a patient severe symptoms. The duration of therapy can be weeks to months. Small, frequent feedings are of additional importance, while thickening of formula with cereals were found unnecessary. Over the last few years, we have been able to observe 22 infants under 1 year of age with GER and hiatus hernia. In 19 of these patients-among them also patients with reflux esophagitis-this conservative treatment regimen has been successful. Drugs like antacids or cimetidine to lower gastric were considered unnecessary. Bethanechol was considered contra-indicated due to its discomforting side effects in infants. Three patients have been treated surgically during this period of time. In contrast, hiatus hernia in older children-mainly mentally retarded children-with GER has to be treated surgically; conservative therapy is usually without effect. The rare clinical condition of brachyesophagus is considered a malformation and requires surgical therapy in every instance.

Stability of the cervical spine after conservative treatment.

175 patients with cervical spine and spinal cord injuries were admitted to the Spinal Injuries Unit, Austin Hospital, in the five-year period from the 1 July 1968, to the 30 June 1973. Only 4-2 per cent of the patients required delayed spinal fusion for instability after a conservative treatment regime.

Functional rehabilitation of the knee: A preliminary study

Functional rehabilitation of the knee in cludes a program designed to restore agility to patients with unstable or incom pletely rehabilitated knees. The program was created at the United States Military Academy, West Point. It proved success ful with the highly motivated cadets who were required to participate in athletic activities, and it has been useful as a therapeutic regimen for a more hetero geneous population at a medical center. The program is used to evaluate knees diagnostically, to provide a conservative treatment regimen, and to ensure maxi mum functional return after surgery. With this composite facsimile of agility drills, confidence can be bolstered and re- injuries decreased.