Long-term Results Of Conservative Treatment Research Articles

Long-term results of conservative treatment of pacemaker pocket site infections.

The increasing frequency of cardiac device use has led to an increase in complication rates. The standard treatment for cardiac device-related infections is removal of the entire pacemaker system and reimplantation from the contralateral side after systemic antibiotherapy. The efficacy of various conservative treatments has been established for many years, but there is conflicting information in the literature regarding long-term efficacy. Our study investigated the long-term efficacy of conservative treatment in patients with pacemaker pocket site infection. In this retrospective study, according to the exclusion criteria, 132 patients were included. Patients were divided into conservative and standard treatment groups. Conservative treatment was considered to be opening the pacemaker pocket capsule, removing all infected and necrotic tissue, cleaning the capsule, and embedding the battery in the prepectoral region in the subpectoral muscle region. The follow-up time was 36 ±12.96 months in the conservative treatment group and 39.6 ±10.8 months in the standard treatment group. During this period, no re-infection at the pacemaker pocket site was observed in either group. Examination of the swab cultures of the patients' pacemaker wounds revealed negative culture results in 15 patients (15 out of 60) in the conservative treatment group. In the standard treatment group, 60 patients (60 out of 72) were culture-negative. This difference was statistically significant (p = 0.04). After a rigorous evaluation, conservative treatment is considered effective and safe in the long term in patients with device pocket site infection.

Factors Affecting the Results of Treatment of Plantar Fasciitis and Their Prognostic Value

Summary. Objective: to determine the prognostic value of the factors influencing the outcome of treatment of plantar fasciitis, to develop a system for predicting the results of treatment of plantar fasciitis.
 Materials and Methods. Analysis of long-term results of conservative treatment of 145 patients with plantar fasciitis. Clinical, instrumental and statistical (correlation-regression analysis) research methods were used. The factors that influenced the end result of treatment were identified.
 Results. The statistically significant influence of age, gender, disease duration up to 6 months, BMI up to 25, the presence of “functional” equinus, pronated foot and history of treatment on the prevalence of positive treatment results were determined. The estimation of the informative nature of the presented factors for the probability of achieving positive results of treatment, the calculation of the prognostic coefficients and their sum were determined. A high prognostic evaluation of a successful treatment outcome should be expected with a total prognosis of +5 to +25; a total estimate of prognostic coefficients from -15 to +5 determines the average probability of positive treatment results; the sum of the prognostic coefficients from -34 to -15 determines the low probability of achieving positive treatment results.
 Conclusions. The result of treatment of plantar fasciitis depends on age, sex, duration of the disease up to 6 months, BMI, "functional" equinus, pronated foot, and medical history. The system for predicting treatment outcomes involves the possibility of obtaining high, medium and low probability of a positive result when applying conservative treatment.

Prediction of Long-term Results of Conservative Treatment of Acute Deep Vein Thrombosis of Lower Limbs

Introduction: The development of the concept of a personalized approach to patients with deep vein thrombosis of the lower limbs(DVT),based on the choice of tactics for patients,depending on the characteristics of phenotype,characteristics of disease,is a new,unexplored and promising direction of research. Methods: We studied the results of treatment of 102 patients with DVT receiving conservative therapy by the prospective randomized study.The patients were divided into 3 groups.The first group consisted of 23 patients taking warfarin (22.5%),39 patients(38.2%)receiving dabigatran,40 patients receiving rivaroxaban (39.21%).Patients of all groups received anticoagulant therapy from the first day of the diagnosed disease for 6 months.The observation period was one year.In addition to anticoagulant therapy,patients received compression therapy with a 2nd compression class and venotonic drugs.The mean age of the patients was 57±3 years and there was no statistically significant difference in the groups.The average period from the onset of the disease to the start of the treatment was 5.6±4.8 days and also did not have a statistically significant difference in the compared groups.Patients were examined on 44 grounds.All the changing parameters were measured in dynamics and evaluated on the 1st, 4th and 7th days,and also at1,6 and 12 months from the start of treatment.The statistical programming language R [RCoreTeam (2017) was used for data processing.In the work,nonparametric statistics methods were used:Kraskel-Wallis test when comparing several groups,the Mann-Whitney-Wilcoxon test for comparison of two groups(with the Benjamin-Yekutil correction in the case of multiple comparisons).We also used the Friedman test,and the Fisher test was used to analyze the conjugacy tables.As additional analysis methods we used the solution trees,the RPART algorithm,cluster analysis and the fuzzy C algorithm. Results: After 1 year,72 patients were examined(16,31 and 25 patients taking warfarin,dabigatran and rivaroxaban respectively).Postthrombotic disease in the warfarin group was observed in 8 patients (50%),in the dabigatran group in 16 patients(51.6%),in the rivaroxaban group in 10 patients(38.5%).Factors directly influencing the unsatisfactory outcome of conservative treatment of DVT were:dynamics of venous insufficiency during 7 days of treatment(venous insufficiency rates on the scale of Villalta are more than 2.5 points for the 7th day of treatment,OR=6.9, 95% CI[1.63 42.51],Fisherexacttestp=.004),the age of the patient(the threshold was less than 47 years old(OR=5,95% CI [0.9 53.29],Fisherexacttestp = .049),type of drug used (bad results for Warfarin group),and patients with a high BMI(more than 30 kg/m2). Conclusion: 1.Using of rivaroxaban in contrast to the use of warfarin or dabigatran in the treatment of DVT leads to less probability of postthrombotic disease in 1 year of follow-up.2.Factors leading to unsatisfactory results of conservative treatment of DVT are: unsatisfactory response to conservative therapy for 7 days,BMI over 30 kg/m2,age less than 47 years,choosing of warfarin instead of new oral anticoagulants (dabigatran or rivaroxaban).3.The conducted studies have created the possibility of creating a mathematical algorithm for predicting the outcome of conservative treatment of DVT with a probability of 75%,which may allow us to further outline ways to improve the results of treatment of such patients on the basis of an individual approach to their treatment(see the figure).

Conservative treatment of traumatic injuries of the rotatory-bicepital complex

The effectiveness of the developed approaches to the conservative treatment of traumatic injuries of the rotatory-bicepital complex is assessed. The long-term results of conservative treatment of 29 patients for the period from 2004 to 2017 and treated in the Mogilyov regional hospital and the SCTC of the 6th Minsk city clinical hospital were studied. The conservative treatment indications were considered to be the cases with traumatic partial local or extensive injuries of the rotator-bicepital complex in the presence of clinical manifestations in the form of pain syndrome and limitation of limb movements and in the absence of a decrease in limb strength in the sectoral testing of elements. The proposed tactical approaches implied immobilization, physiotherapy, local injection therapy.The developed conservative approaches to treating patients with damage to the rotary element of RBC allowed one to achieve a favorable outcome in the absolute majority of cases with long periods of patient follow-up, which improved the performance evaluation indicators according to the Oxford questionnaire for Me shoulder from 56 [48–58] to 12 [12–32] (Me [Q25–Q75]). The applied conservative approaches to treating patients with damage to the rotary element of RBC are a promising way to improve the clinical treatment results of patients with partial injuries of the rotator-bicepital complex.

Evaluation of the dynamics of the main indicators of treatment care and the long-term results of conservative treatment of ulcerative gastroduodenal bleeding


 Relevance. Improvement of medical and diagnostic care for ulcerous gastroduodenal bleeding is a complex problem of modern medicine, the solution of which is connected both with the search for and introduction of modern medical technologies into clinical practice, and with the necessity to conduct in-depth analysis of the effectiveness of medical care in this pathology at various stages of its delivery.
 Purpose .To study the dynamics of the main indicators of the provision of medical and diagnostic care to patients with ulcerative gastroduodenal bleeding in a large multidisciplinary hospital and to evaluate the long-term results of conservative treatment of this group of patients.
 Materials and methods. An assessment of the dynamics of the main indicators of the provision of medical and diagnostic care for ulcerative gastrointestinal bleeding in the Voronezh Regional Clinical Hospital for the period from 1989 to 2010, during which 1831 patients were hospitalized. Long-term results of 106 patients were analyzed. Among the patients, males predominated (70.7%), the average age was 50.2 ± 4.7 years (median - 18 - 79 years). In 62 patients (58.5%) bleeding ulcer was located in the duodenum.
 Results. During the analyzed period there was a general tendency to reduce the number of hospitalizations by 57.8%. Surgical activity in this pathology in 1989-1993 was 56.0%; in the period from 2009 to 2013, this indicator decreased to 33.8% against the background of an increase in the postoperative mortality to 8.7%. In the evaluation of long-term results, favorable outcomes of treatment were noted - in 74.5% of patients. In 17.9% of patients with peptic ulcer with predominant localization of ulcers in the DPC, the development of various complications and recurrences of bleeding was noted, which gives grounds for recommending in the current situation the implementation of planned surgical interventions.
 Conclusions. Conservative treatment of ulcerative gastroduodenal bleedings with the use of endoscopic technologies creates conditions for optimization of immediate and long-term outcomes of treatment. The polyethiologic nature of the disease and the significant specific gravity of severe combined pathology makes it urgent to introduce a multidisciplinary brigade principle for the treatment of ulcerative gastroduodenal bleeding.
 Key words: ulcerative gastroduodenal bleeding.

Long-term results of conservative treatment with calcium orthophosphates of apical periodontitis with large lesions

Long-term results of conservative treatment with calcium orthophosphates of apical periodontitis with large lesions

Conservative treatment of upper urinary tract carcinoma: Long-term results.

We sought to assess the long-term results of conservative treatment for upper urinary tract carcinoma (UUTC) with regard to tumour recurrence and preservation of renal unit. From October 1987 to January 2014, 65 patients (median age 68 years) were diagnosed with UUTC and underwent endoscopic and open surgical techniques. Thirteen patients had bilateral disease and one had a single kidney. The primary approach was endoscopic in 37 reno-ureteral units (20 percutaneous resections, 17 ureteroscopies ). Open surgery was performed in 19 cases. A total of 20 patients received mitomycin C. Superficial stage pTa or T1 was noted in 37 patients, infiltrating stage pT2 and pT3 in seven and inverted papilloma in one. The stage of the tumour was impossible to classify in 20. With a median followup of 75.12 months (interquartile range [IQR] 144.71-17.41), the kidney preservation, recurrence, specific survival, and global survival rates were 78.5% (51/65), 40.0% (26/65), 92.3% (60/65), and 69.2% (45/65), respectively. From the patients who had recurrence, 15 were salvaged with radical nephroureterectomy (RNU). The bladder tumour recurrence rate after the surgery was 30.76% (20/65). At the end of the followup, five patients had died of UUTC progression and 16 from other causes. Postoperative complications included one case of fistula, one case of stricture, and one case of nephrectomy due to bleeding. In selected cases, conservative management is a safe and feasible alternative to RNU, with the advantage of renal unit preservation.

Отдаленные результаты консервативного лечения остеомиелита позвоночника

The purpose of this study was to analyze long-term results of conservative treatment of patients with osteomyelitis of the spine. The authors examined 135 patients with osteomyelitis of the spine. Conservative treatment was made in 67 (50%) patients, other patients was carried out surgical treatment. Indications for treatment included: early diagnosis of the disease, the absence of sig-nificant lesions destruction of vertebral bodies, neurological complications, the presence of comorbidity and organ failure. The complex conservative treatment consisted of: antibacterial and detoxification therapies, orthopedic immobilization, immune-corrective and tonic medicines. In the preoperative and long-term period (time from 1 year to 15 years after surgery) the clinical, paraclinical, radiation methods and classification developed by Frankel H.L.et al (1969) were used for evaluation of neurological disorders. Long-term results included assessment of pain on VAS and quality of life questionnaire developed by Oswestry and SF-36. For statistical analysis of the material was used the software package Statistica 6.1 (license agreement BXXR006B092218FAN11). Long-term clinical, laboratory and x-ray methods didn’t shown recurrence of the disease. In 16 patients with neurological complications after treatment, regression of neurological symptoms was revealed. Pains in the spine, associated with symptoms of degenerative disc disease without neurological deficit, were established in some patients. At most patients the presence of spontaneous fibrous or bone block is marked at the level of former inflammatory process with symptoms of degenerative disc disease in the lower divisions. All patients returned to their previous jobs in terms from 6 to 12 months after the treatment. Thus, the authors concluded that conservative treatment of the patients with osteomyelitis of the spine is defensible, harmless and effective method in particular indicated cases.

Psychosocial Status and Mental Health in Adolescents before and after Bariatric Surgery: A Systematic Literature Review

Objective: As long-term results of conservative treatment for obesity are discouraging, bariatric surgery is becoming a treatment option for extremely obese adolescents. However, mental and behavioral problems need to be respected when treating this vulnerable target group. Methods: A detailed systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, PubMed and Medline electronic databases. Results: Twelve studies met the inclusion criteria. Although strength of evidence was limited, results suggested that pre-operatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while a substantial number showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Original articles on outcomes of eating and anxiety disorder symptoms after weight loss surgery were not found. Conclusions: Further attention is needed on consistent clinical assessment of mental health disturbances and their consecutive treatment in adolescents. Future research should also focus on psychological and psychosocial predictors of weight loss after bariatric surgery.

Long-term results and complications after treatment of bilateral fractures of the mandibular condyle

The purpose of this study was to investigate the long-term results of conservative treatment of bilateral condylar fractures and to study the influence of possible functional impairment on intensity of pain and associated disability. We studied 71 patients (mean (SD) age 33 (14) years) with conservatively treated bilateral condylar fractures. Traffic crashes (n=42, 59%) and falls (n=20, 28%) were the main cause of the fractures. Forty-one patients (58%) were re-examined after about 90 months (mean 86, range 3–193). Five of the 41 (12%) had developed malocclusion, but did not experience any pain in the temporomandibular joint according to the Research Diagnostic Criteria for Temporomandibular Disorders. There was a significant negative relation between the presence of pain and the duration of follow up (p=0.02). Increasing age was significantly related to reduction in the intensity of pain (p=0.03). Of the remaining 30 patients who were not followed up, 2 had had bilateral sagittal split osteotomy and 1 a Le Fort I osteotomy. One patient had had orthodontic correction for a malocclusion. Including the five malocclusion patients, at least 9 of the total of 71 (13%) developed a malocclusion after conservative treatment. Functional impairment had no influence on the intensity of pain or pain-related disability in the patients with malocclusion after conservatively treated bilateral condylar fractures. This report may therefore be of value in the debate about whether open or closed treatment is better for bilateral mandibular condylar fractures.

Long-term follow-up of cases of rotator cuff tear treated conservatively

This study clarified the long-term results of conservative treatment of rotator cuff tears. This study focused on 103 shoulders diagnosed with rotator cuff tears by magnetic resonance imaging or arthrography at our institution from 1996 to 1999. Sixty-five shoulders were followed up by telephone survey and 43 of these shoulders were evaluated; 11 shoulders were excluded because the patient had died, 10 shoulders because of severe dementia, and 1 shoulder that had undergone trauma. The mean patient age for these 43 shoulders at the time of diagnosis was 62 years, and the mean follow-up period was 13 years. The pain score (30 points) and the activities-of-daily-life score (10 points) of the Japanese Orthopaedic Association shoulder scoring system were determined. The mean pain score was 25.4 points, and the proportion of patients with no pain or with only slight pain was 88%. The mean score for activities of daily life was 9.4 points, and the proportion of patients with no disturbance in daily life was 72%. The patients with fewer than 20 points out of the possible 40 points (30 points for pain score plus 10 points for activities-of-daily-life score) were significantly younger than the other patients. In cases of rotator cuff tears treated conservatively, at 13 years after diagnosis, about 90% of patients had no or only slight pain and about 70% had no disturbance in activities of daily life. However, the younger patients tended to have more significant pain or disorder in daily life more than 10 years after diagnosis.

Long-term results of conservative treatment of Sanders type 4 fractures of the calcaneum

A high rate of complications is associated with open reduction and internal fixation of Sanders type 4 fractures of the calcaneum. We assessed the long-term outcome of 83 Sanders type 4 comminuted intra-articular fractures of the calcaneum in 64 patients who underwent non-operative treatment between 1999 and 2005. Each fracture was treated by closed reduction and immobilisation in a long leg cast. Patients were reviewed every three months in the first year, and every six months thereafter. At each visit, the involved ankles were assessed by the American Orthopaedic Foot and Ankle Society (AOFAS) criteria. The degree of fracture healing and the presence of osteoarthritis were assessed. At a mean follow-up of 51 months (24 to 70) the mean AOFAS score was 72 (52 to 92). Osteoarthritis was scored radiologically using Graves’ classification and was evident in the subtalar joints of 75 ankles (90%) on x-ray and in all ankles on CT scans, of which 20 were grade 0 or 1, 39 grade 2, and 24 grade 3. A non-operative approach to treating these fractures may be simpler, less expensive, easier to administer with fewer complications, and may be better tolerated than surgery, by many patients.

Conservative Treatment of Thoracolumbar Burst Fractures

A retrospective study to review patients with acute thoracolumbar burst fractures who were conservatively treated. The purpose of this study was to analyze the efficacy of conservative treatment of thoracolumbar burst fractures in terms of long-term results, and to determine whether the long-term results of conservative treatment would be predicted by the Load Sharing Classification. The optimal management of thoracolumbar burst fractures remains controversial, with advocates for nonoperative or operative approaches. Different criteria for treatment options have been advocated for classifying the fractures, guiding treatment decision-making, and predicting the prognosis. A total of 127 patients with an acute thoracolumbar burst fracture (Denis type B) were treated conservatively. Their Load Sharing score ranged from 3 to 9 (average, 5.3). Twenty-two (17.3%) of these patients presented with a neurologic deficit. They were followed up for at least 3 years (range, 3-12 years; average, 7.2 years) and assessed for clinical and radiologic outcomes. The motor score of the American Spinal Injury Association, and Denis pain and work scales were used for clinical evaluation, whereas the loss of kyphosis correction (LKC) for the local kyphosis angle was examined for radiologic outcome. None of the patients had neurologic deterioration during the reduction. All 22 patients with neurologic deficit experienced improvement with average recovery rate of 93%. Significant correlation (P < 0.05) was found between the Load Sharing score on admission and the LKC for local kyphosis angle at final follow-up. Most patients reported acceptable results regarding pain (111/127, 87.4%) and work (110/127, 86.6%). A positive correlation was found between the LKC and the severity of pain (r = 0.194, P < 0.05). Seven patients (5.5%) required or had undergone late surgery for correction of loss-related back pain and/or poor functional outcome. Conservative treatment is safe and effective for selected patients with thoracolumbar burst fractures, even in some cases with neurologic deficit. The Load Sharing Classification could be used for guiding the treatment of thoracolumbar burst fractures not only in surgical approach choice but also in surgical decision-making.

Palliative operation for the treatment of alveolar echinococcosis

The World Health Organization guidelines recommend radical hepatic resection for definite treatment of alveolar echinococcosis (AE), because it can cure the patient. However, parasitic masses are not entirely removable in about 70% of patients. Even so, palliative resections are carried out, although cure cannot be achieved. As conservative treatment has improved, the role of palliative surgical procedures has to be redefined. Critical appraisal of published reports on palliative resections for AE and estimation of the level of evidence and grade of recommendation. Prospective randomized trials comparing palliative resections, radical resections, and conservative treatment are lacking. Most papers analyzed case series retrospectively. The number of palliative operations is significant. In the past, palliative resections were recommended in order to enhance anthelminthic drug efficacy but advances in conservative and interventional treatment improved the prognosis of AE. Prolonged survival by systematic palliative resections is not evident. However, palliative surgery is an option to treat persistent bacterial infection, fistulas, and obstructing or compressing masses. The indication is based on individual considerations and decisions. Curative surgery for AE is feasible if parasitic tissue is entirely removable. The benefit of palliative resections is uncertain because long-term results of conservative treatment are favorable. Palliative surgery is an option for complications not being manageable otherwise.

Long-term results of conservative treatment for the thoracolumbar compression fractures

We evaluated the radiologic and clinical outcomes of conservative treatment for thoracolumbar compression fractures. Forty-three patients (28 males, 15 females; mean age 39 years; range 24 to 54 years) were treated conservatively for 47 thoracolumbar compression fractures. All the patients were assessed by plain radiograms and computed tomography. According to the Denis classification, there were eight type A, 20 type B, 12 type C, and seven type D fractures. Involvement was at L1 in 30, L2 in five, and T12 in 12 fractures. There were no neurological deficits. Treatment involved use of a body cast for two months, followed by a thoracolumbosacral orthosis for four months. Radiographically, local kyphosis angle and sagittal index were measured before treatment, after casting, and at the final follow-ups. Pain and functional scales proposed by Denis et al. were also utilized. The mean follow-up was 7.5 years (range 6 to 11 years). The mean local kyphosis angle and sagittal index were measured as 12.6 and 13.7 degrees before treatment, and 5.9 and 7.0 degrees after casting, respectively (p<0.05). However, both did not differ significantly from the baseline at the final measurements (12.7 and 13.9, respectively; p>0.05). The mean pain and functional scores were 1.4 and 1.6, respectively. Four patients had moderate to severe back pain despite mean kyphosis angles of 12 (baseline), 13.5 (after casting), and 14.8 (final). Two patients required substitution of the body cast for orthosis due to excessive sweating, and three patients received local treatment for skin problems secondary to the use of orthosis. If the kyphosis angle is less than 30 degrees, compression fractures are supposed to be stable to be treated conservatively with satisfactory clinical results. Functional results seem to be unaffected from the fact that casting does not improve radiographic parameters in the long-term.

Beschwerden im Verlauf nach konservativ behandelten distalen Radiusfrakturen - Prädiktoren aus der initialen Röntgenaufnahme

Radius fractures are frequent in adults, and the long-term results of conservative treatment remain disappointing. This study examines predictors for the clinical outcome in the initial radiograph. This will help to identify patients who will benefit from surgical treatment. A cohort study including a standardized telephone interview (Cooney score) was used to identify all conservatively treated patients with a distal radius fracture over a five-year period. The additional selection criteria were: over 15 years old, initial X-ray available, patient reachable by phone for the follow-up interview. The following measurements were taken from the initial radiograph: radius-base angle, radial shortening, radiopalmar angle and intraarticular displacement. Correlations and a simple test to predict negative outcome were computed. Of the initially identified 2211 patients with distal radius fracture, 179 also fulfilled the other criteria. The patients were 56.2 years old on average (standard deviation SD = +/- 22.45 years) and 72 % were female. 60 % of the fractures were on the right side. The average follow-up was 4.3 years (SD +/- 1.66). The Cooney score results averaged 85 points (with 100 being the optimal and maximum score), indicating good or very good functional results in the long term follow-up for 61 % of patients. However, 31 % received a rating of fair or poor and therefore had an unfavorable outcome. With respect to the correlations, age and shortening of the radius (but not gender) had a significant influence on the functional result. Using an age of 75 years or above and a radial shortening of at least 4 mm to predict an unfavorable outcome, the sensitivity is only 16 %, but the positive predictive value is 73 % and the specificity is 96 %. In the analysis of the initial radiographs after distal radius fracture, age and radial shortening primarily correlate with functional results after four years after conservative treatment. Using the values age > or = 75 and radial shortening > or = 4 mm, it is possible to predict an unfavorable functional outcome with a positive predictive value of 73 %. This could aid in the indication of operative treatment.

Long-term outcome of conservative treatment in patients with diverticulitis of the sigmoid colon

The indication for surgery after conservative treatment of acute diverticulitis is still under debate. This is partly as a result of limited data on the outcome of conservative management in the long run. We therefore aimed to determine the long-term results of conservative treatment for acute diverticulitis. The records of all patients treated at our institution for diverticulitis between 1985 and 1991 were reviewed (n=363, median age 64 years, range 29-93). Patients who received conservative treatment were interviewed in 1996 and 2002 [follow-up time 7 years 2 months (range 58-127 months) and 13 years 4 months (range 130-196 months). A total of 252 patients (69%) were treated conservatively, whereas 111 (31%) were operated on. At the first follow-up, 85 patients treated conservatively had died, one of them from bleeding diverticula. A recurrence of symptoms was reported by 78 of the remaining 167 patients, and 13 underwent surgery. At the second follow-up, one patient had died from sepsis after perforation during another episode of diverticulitis. Thirty-one of the 85 patients interviewed reported symptoms and 12 had been operated on. In summary, at the second follow-up interview, 34% of patients treated initially had had a recurrence and 10% had undergone surgery. No predictive factors for the recurrence of symptoms or later surgery could be determined. Despite a high rate of recurrences after conservative treatment of acute diverticulitis, lethal complications are rare. Surgery should thus mainly be undertaken to achieve relief of symptoms rather than to prevent death from complications.

Conservative treatment of children with congenital hip dislocation

Long-term results of conservative treatment of 612 children (710 joints) with congenital hip dislocation showed that the highest complication rate was detected in Lorenz procedure. Authors suggest the device to reduce hip dislocation without traumatization but with preservation of joint movement during treatment. Movements rotating the hip inside promote epiphysis centration into acetabulum that decreases the risk of dystrophic process development. In 91.4% of cases excellent and good results were achieved in children over 4 months who were treated using that device in combination with physiotherapy. Rational tactics for conservative treatment of congenital hip dislocation was elaborated. Authors believe that the suggested treatment complex allows to delay by 10-15 years the early coxarthrosis development in children and adolescents.

THE OVERACTIVE BLADDER IN CHILDHOOD: LONG-TERM RESULTS WITH CONSERVATIVE MANAGEMENT

Idiopathic detrusor overactivity has not been thoroughly investigated and its natural history remains largely anecdotal. Bladder overactivity resulting from a neurogenic, anatomical or medical condition has been well described. Therefore, we assessed the long-term results of conservative treatment of children with idiopathic symptomatic refractory detrusor instability. We reviewed the records of 58 patients who had an isolated finding of uninhibited contractions on urodynamics performed for refractory enuresis and daytime wetting between 1988 and 1994. Study exclusion criteria were chronic urinary tract infection, neurological lesion, anatomical abnormality of the lower urinary tract and less than 12 months of followup. Of the 30 children who met our study inclusion criteria 26 (87%) had complete (21) or significant (5) symptom resolution. Average time to resolution was 2.7 years (range 0.2 to 6.6). Patients with a 50% to 90% bladder capacity expected for age were more likely to benefit from therapy than those with a bladder capacity outside of this range. Age and gender were not significant predictors of resolution although girls were more likely to have resolution than boys. Idiopathic detrusor instability is amenable to conservative management in the majority of patients during a prolonged period. We advocate thorough urological and urodynamic evaluation to identify idiopathic detrusor instability as an etiology of enuresis and daytime wetting in complicated cases.

Acute DVT: Long-Term Results of Conservative Treatment

Acute DVT: Long-Term Results of Conservative Treatment