Conservative Treatment Methods Research Articles

Intra-Abdominal Hypertension and Abdominal Compartment Syndrome. Literature Review

Intra-abdominal hypertension and abdominal compartment syndrome remain a challenging problem in abdominal surgery. Due to various etiological factors leading to increased intra-abdominal pressure (inflammatory, destructive processes, trauma, sepsis, postoperative complications, etc.), and the negative impact of increased IBP on the functions of the gastrointestinal, respiratory, cardiovascular systems, kidneys, central nervous system, timely diagnosis and treatment play an important role. Gradually elevated intra-abdominal pressure can cause persistent organ dysfunction and be potentially fatal. To date, the pathophysiological mechanisms, methods for determining intra-abdominal pressure, the frequency of its measurement, and methods of conservative and surgical treatment have been studied in sufficient detail. The paper presents a literature review on the problem of intra-abdominal hypertension and abdominal compartment syndrome. The study considers issues of epidemiology, mortality rates, methods for measuring intra-abdominal pressure, including advanced innovative technologies. The authors present the basics of clinical diagnosis, the significance and informativity of additional biochemical blood tests, radiation methods, mainly computed tomography, and ultrasound examination. Advanced methods of conservative treatment are considered, which, when used early, significantly minimize target organ damage, organ dysfunction, and indications for emergency decompressive laparotomy. Finally, recommendations are given for the postoperative management of patients with an “open” abdomen, and for the optimal timing of laparostoma closure.

Pathogenesis and modern methods for treatment of hip infectious arthritis: a review

Background. One of the little-studied but long-known problems is determining the optimal treatment regimen for patients with infectious arthritis of the hip joint. Existing studies offer various methods of conservative and surgical treatment, which, however, do not have a fundamental evidence base. The polyetiology and variability of the clinical manifestations of infectious arthritis of the hip joint and the severity of the consequences in case of incorrectly chosen tactics require a differentiated approach to treatment and development of certain diagnostic and treatment algorithms. The aim of the review – to identify pathogenesis factors that are significant for the choice of treatment tactics and to analyze modern methods of treating infectious arthritis of the hip joint based on the data from available medical literature. Methods. For analysis, we selected 90 foreign and domestic sources published between 1997 and 2003. Inclusion criteria were: clinical studies, analytical reviews and meta-analyses of the literature. The search was performed in eLIBRARY, PubMed and Google Scholar databases. Results. The analysis showed that, despite the comparable effectiveness and advantages of individual treatment methods, their use is limited to certain indications, and the choice of the optimal one for a particular patient should take into account many etiopathogenetic factors, clinical, laboratory and instrumental data, the role of which is still insufficiently studied. Currently, throughout the world the “gold standard” for radical surgical treatment remains the technique of two-stage hip arthroplasty using an antibacterial spacer. However, encouraging results of alternative treatment methods require continued search for ways to optimize diagnostic and therapeutic tactics.

Possibilities of surgical correction of complicated forms of chronic venous insufficiency in patients after coronavirus infection

Introduction. COVID-19 causes generalized endothelitis and impaired arthriolo-venular circulation leading to a slowdown in blood flow and venous hypervolemia. This leads to decompensation of the drainage function of perforated veins and the occurrence of horizontal venous reflux. Aim. To determine the possibilities of surgical correction of decompensated forms of chronic venous insufficiency (CVI) in patients after COVID-19, when determining the localization of pathological venous reflux by ultrasound duplex scanning of the lower extremity veins. To determine the character of microcirculatorydisorders in the examined patients. Material and methods. Ultrasound duplex scanning with a 7.5-10 MHz linear sensor was performed in 59 patients aged 40-78 years, 34 women and 25 men who had suffered from COVID-19 in a moderate form that did not require hospitalization. Patients had not previously noted manifestations of CVI and did not use diosmin drugs. The reason for treatment was the manifestation of complicated forms of CVI, which first appeared after COVID-19. 39 patients of group I underwent surgical correction of horizontal venous reflux, 20 patients of group II received conservative treatment. The microcirculatory bed was examined using a high-frequency ultrasound Dopplerograph on the nail bed of the 1st finger of the upper limb with a 25 MHz sensor. Results. The revealed microcirculatory disorders were characterized by a depletion of the Doppler spectrum, which corresponds to parietal stasis. Isolated horizontal venous reflux was recorded in the area of trophic disorders: pigmentation, induration and trophic ulcers (TU) of the shin. In group I patients, as compared to group II, pain syndrome, edema, induration and inflammation significantly decreased after treatment when assessed by the VCSS scale. More rapid and complete healing of TU was observed. Conclusions. COVID-19 provokes accelerated progression of isolated horizontal venous reflux, due to generalized microcirculatory disorders reported in patients in the post-COVID period. The surgical intervention for its elimination in the nearest future after applying undoubtedly surpasses conservative methods of treatment and allows achieving a good cosmetic and clinical result.

Some aspects of biomechanics of the operated thoracolumbar junction following two-level corpectomy

Traumatic spinal injuries pose a significant medico-social challenge, with about 60% of all spine fractures occurring at the thoracolumbar junction. Optimizing care for these patients remains a critical issue, despite the development of numerous surgical and conservative treatment methods, with outcomes still far from ideal. A key factor contributing to the consistently high rate of unsuccessful surgical interventions, which lead to stabilization failures in both the early and late postoperative periods, is the disregard of the biomechanical characteristics of the thoracolumbar junction area. Clinical protocols often regulate intervention methods based on the degree and nature of damage to the thoracolumbar spine as a whole. Enhancing the reliability of fixation, while maintaining the number of transpedicular screws, can be significantly achieved by using cross-links and adjusting screw length. The purpose of our study was to investigate the distribution of loads on the metal construct elements and bone structures in the thoracolumbar junction after extensive decompressive-stabilizing interventions. The load was modeled with a backward tilt. A mathematical finite element model of the human thoracolumbar spine segment was developed, incorporating vertebrae Th9-Th11, L2-L5, with Th12-L1 vertebrae removed, as well as elements of the metal construct—interbody support and a transpedicular system. We modeled four variants of transpedicular fixation using both short and long screws that penetrate the anterior surface of the vertebral body, with and without the use of two cross-links. Stress parameters were monitored at 20 control points in the models. Comparative analysis of the results revealed that models including long bicortical screws and two cross-links demonstrated the best biomechanical performance when the torso was tilted backward, effectively reducing stress in critical areas and enhancing the durability and effectiveness of the fixation.

Instrumental Tracheal Rupture

Abstract Tracheal rupture is an urgent life-threatening complication that relates to complex and poorly understood areas of trauma surgery. The article presents a review of modern world and domestic literature on instrumental tracheal ruptures, the Relevance of early diagnosis and various treatment methods. Based on an analysis of modern literature data, the article describes the issues of conservative and surgical treatment methods, as well as an assessment of their results. The problem of the diagnostic algorithm and the choice of conservative, surgical treatment has not been solved and remains relevant. The issues of treating patients with a defect in the membranous wall of the trachea in intensive care and in need of artificial ventilation in clinical practice remain unresolved. All of the above indicates the Relevance of the study.Aim of the study To present data from domestic and foreign literature on the diagnosis and treatment of instrumental tracheal ruptures.Material and methods A review of the literature was carried out for the period from 1993 to 2024 in Russian and English, available on the databases Pubmed, Medline, UpTodate, Scopus, E-library, on topics such as post-intubation tracheal rupture, iatrogenic tracheal rupture, diagnosis and treatment of instrumental tracheal ruptures, closed tracheal injury.Results The concept of the classification system, risk factors, etiopathogenesis is outlined. Information is provided on the diagnostic significance of computed tomography and tracheobronchoscopy. Close attention is paid to the methods and choice of treatment tactics, the principles of intraoperative tactics, and the strategy of conservative treatment. A comparative assessment of treatment Results and their complications with a conservative or surgical treatment approach is given.Conclusion Thus, an analysis of domestic and foreign literature indicates that the issues of diagnosis and treatment of iatrogenic tracheal injuries remain largely unresolved. There is no generally accepted algorithm for instrumental diagnosis of tracheal ruptures. There are no uniform approaches to determining indications and contraindications for conservative and surgical treatment of tracheal injuries. There are diametrically opposed opinions regarding the choice of treatment tactics. These contradictions create significant difficulties in assessing the Results of treatment of this complex category of patients.

Rehabilitation of cancer patients: the use of pneumatic compression in secondary lymphedema treatment

Complex decongestive therapy is a cornerstone of conservative chronic lymphedema treatment. There are other conservative treatment options that include intermittent pneumatic compression. Its mechanism of action is based on pressure applying on the underlying tissues and promoting the lymph flow through the lymphatic structures. Pneumatic compression was invented in 1972; nevertheless it has not found widespread support of professional community as a self-sufficient method of conservative lymphedema treatment, though it’s used a lot in many rehab clinics worldwide.Aim. To determine the indications and effectiveness of pneumatic compression, as well as to identify the possibility of using this method in the practice of treating lymphatic edema.

MEDICAL CARE OF NEWBORNS WITH MECONIUM ILEUS. DATA ANALYSIS OF WORLD EXPERIENCE AND OWN OBSERVATIONS

According to various scientists, 10-20 percent of newborns with cystic fi brosis have meconium ileus (MI).MI is an obstruction of the small intestine that occurs in fetuses during the 20th-24th week of gestation due to a violation of the processes of the formation of meconium. The latter has an increased viscosity and cannot pass through the intestines causing their obturation. About 50 percent of the cases of MI are complicated by intestinal volvulus, intestinal atresia, malrotation, perforation with the development of meconium peritonitis and ascites, the formation of a meconium pseudocyst etc. The goal of the research is to conduct a systematic overview of the literature on the issue of MI in neonatal patients and to off er optimal tactics of medical support of newborns with MI on the basis of the analysis of relevant literary sources and our own observations related to this topic.The results. The overview of the literature in the historical aspect covering the last 20 years has demonstrated the following: due to the development and improvement of the methods of conservative surgical treatment of newborns with MI the mortality of the newborns with MI has decreased. The analysis of the data based on the global experience as well as on our own observations indicates the possibility of conservative therapy and surgical treatment of infants with MI and testifi es to the fact that in 50 percent of cases of uncomplicated MI the conservative treatment can be an eff ective option.The research contains the description of the step-by-step measures of conservative treatment. The indications for surgical interventions have also been specifi ed in the research.Conclusion. In treatment of newborns with MI resections and stomata should be avoided. Instead, preference should be given to gastric lavage.

Comparison of different surgical approaches for treating aortic graft infections.

There is still no guideline or consensus on the treatment of aortic graft infection. This study reported and compared conservative and surgical treatment and different surgical methods for aortic graft infection. Data from aortic graft infections treated at our institution between February 2017 and June 2022 were retrospectively analyzed. Clinical data and surgical approaches were evaluated. This article retrospectively analyzed the treatment and prognosis of 48 patients (43 males) with aortic graft infection. The patients were divided into conservative treatment group (n = 15) and surgical treatment group (n = 33). During follow-up, the mortality rate of the conservative treatment group was significantly higher than that of the surgical treatment group (P<0.05). The survival curve also showed that the survival time of the surgical treatment group was longer than that of the conservative treatment group (P<0.05). The surgical treatment group included local treatment (n=5), in situ replacement (n=8) and bypass surgery (n=20) groups. There was no significant difference in the mortality rate at 1 month or final follow-up among the local treatment, in situ replacement and bypass surgery groups. Surgical treatment is the optimal option for treating aortic graft infections compared to conservative treatment.

Kidney Transplantation as a Treatment Option of Chronic Renal Failure Among Lung Transplant Recipients: A Single-Center Experience

Chronic renal failure is one of the most common complications after solid organ transplantation. It is associated with multiple pre-, peri-, and post-transplant factors. In some patients, the available methods of conservative treatment are insufficient and kidney transplantation (KTx) is necessary. The aim of this study was to present our experience in the treatment of renal failure by KTx after lung transplantation (LTx). Our study is a single-center retrospective review of clinical data of all 7 LTx recipients who underwent a KTx between the years 2013 and 2021. Patients' clinical condition, pulmonary function, renal function, and survival were examined. There were a total of 7 patients with medium age 36 years (±15). In 3 patients, the period of time from LTx to KTx was less than 3 years, and in 4 of them less than 13 years. Dialysis therapy was required in 4 patients. One patient had pre-LTx renal disease, while 6 patients had renal dysfunction related to post-transplant factors, including the use of calcineurin inhibitors. Renal protection is a very important aspect among LTx recipients; therefore, physicians must show a holistic and individual approach to patients and minimize exposure to nephrotoxic medication. Patients at high risk of developing chronic renal failure should be identified and, if required, renal replacement therapy should be initiated, including KTx.

Minimally Invasive Interventions on Ganglion Impar in Treatment of Patients with Coccygodynia

Chronic pelvic pain (CPP) is usually treated conservatively, but in patients who do not respond to treatment, ganglion impar (GI) interventions are used as an alternative way to reduce pain. Objective ‒ to study the course of pain syndrome and functional status in patients with coccygodynia (CD) and CPP during the application of minimally invasive interventions on GI. Materials and methods. The analysis of the results of 56 interventions on GI in 50 patients was performed. Inclusion criteria were patients with coccyx pain for ≥3 months aged 23 to 71 years (mean age 47.9±14.8years) who did not respond to conservative treatment methods. 15 (35.7%) of the study participants were male and 27 (64.3%) were female. Interventions were performed on the patients according to five different methods, which were divided into two groups: the first group (n=34) ‒ GI block (GIB) with a local anesthetic and a steroid (patients with CD in whom medical conservative methods of treatment were not effective). The second group (n=14) consisted of persons with recurrent pain syndrome, resistant forms of CD and CPP, including after previously performed steroid injections: n=2 – neurolysis of GI with ethyl alcohol; n=2 – neurolysis of GI by phenol; n=3 – radio frequency modulation of GI; n=7 – radiofrequency ablation of GI. Results. 14.0% of all study participants had post-traumatic CD (history of falling on the coccyx), the vast majority of 86.0% ‒ idiopathic CD. Pain intensity was significantly lower post-intervention compared to baseline VAS mean of 7.6±1.5 cm: 2.5±0.9 cm one-week post-procedure, 1.5±1.9 cm one month, 1.3±1.5 cm three months, 2.1±1.2 cm six months. The average score according to the Karnovsky Scale (KS) before and after the procedure was 73.3±6.3% and 83.9±4.9%, respectively. Conclusions. Interventions on ganglion impar are an effective method of treating patients with coccygodynia of various etiology, which significantly reduce pain according to the VAS scale (p&lt;0.001) and improve the quality of life according to the KS (p&lt;0.001) in dynamics after 1, 3, 6 months. Minimally invasive interventions on ganglion impar make it possible to reduce tissue trauma, to quickly recover for patients after the procedure, and to minimize any complications. In the first and second groups of the study, there was a decrease in the pain on the VAS from 8.0 cm to 2.0 cm (p&lt;0.0001) and from 7.0 cm to 2,7 cm (p&lt;0.001) before and after the procedure, respectively. In the first and second groups of the study, there was an improvement in the indicator of functional status according to the KS from 70% (95% сonfidence interval (CI) 60‒90%) to 90% (95% CI 70‒100%, p&lt;0.0001) and from 70% (95% CI 70‒90%) to 90% (95% CI 80‒100%, p=0.001) before and after the procedure, respectively.

EXPERIENCE OF RESORPTION OF LUMBAR SPINE HERNIAS

Background. In most cases, the reduction in pain and clinical manifestations is associated with a decrease in the size of the hernia or its resorption, which is the natural process of reduction or complete disappearance of the hernia without the need for surgical intervention. Currently, there are several intensive physical therapy methods that influence the process of hernia resorption, making conservative treatment preferable. Materials and methods. At the «Expert Neuro» clinic, as part of a prospective observational study from 2023 to 2024, 30 patients with a confirmed diagnosis of “herniated intervertebral discs of the lumbar spine” were analyzed based on the results of magnetic resonance imaging. The main group of patients received conservative treatment using modern high-intensity physiotherapy methods, the control group received classical methods of conservative treatment. Results. According to magnetic resonance of the spine, 3 patients developed resorption of a herniated intervertebral disc. In all patients, radiculopathy symptoms improved after 1 month and lower back pain symptoms improved after 2 to 3 months. Conclusion. According to our clinical experience and relevant literature, sequestered disc herniations have a high rate of resorption. Pathophysiological processes of inflammation and regeneration are the main mechanisms of this phenomenon. Conservative management of such patients in the absence of definitive surgical indications should not be underestimated.

The effect of complex treatment including osteopathic correction on pain intensity and quality of life in patients with chronic tonsillitis

Introduction. The relevance of the problem of chronic tonsillitis is due to the wide spread of the disease and the occurrence of complications associated with it, which, in turn, contributes to the appearance of pain and a decrease in the quality of life. Available information about the role of the palatine tonsils as an important organ of the immune system makes conservative treatment methods more preferable. Conventional conservative treatment is reduced to episodic implementation of individual techniques and remains insufficiently effective. Obtaining in-depth knowledge about the mechanisms of development of chronic tonsillitis necessitates the search for an integrated approach to treatment including non-drug methods. Often, questions about the severity of pain in patients that affect the level of quality of life are not given due attention.The aim is to study the effect of complex treatment including osteopathic correction on the quality of life and intensity of pain in patients with chronic tonsillitis.Materials and methods. In a prospective controlled randomized study conducted at the Department of Osteopathy and the Department of Otorhinolaryngology of the North-Western State Medical University named after I. I. Mechnikov of the Ministry of Health of Russia in the period from 06.2022 to 06.2023, 60 patients with a diagnosis of chronic tonsillitis were included. All patients, depending on the treatment, were divided using the randomization envelope method into two groups — main (n=30) and control (n=30). Patients in both groupsreceived otorhinolaryngological treatment in the form of lavage of the palatine tonsils (five rinsing procedures using an antiseptic solution, the interval between procedures was 2 days). Patients in the main group additionally received osteopathic correction (three procedures with an interval of 14 days). In all patients, before and after completion of treatment, the intensity of pain was assessed using a visual analogue scale (VAS) and quality of life using the SF-36 questionnaire.Results. In patients of both the main and control groups, there was a statistically significant decrease in the intensity of sore throat (p&lt;0,05) after treatment. The increase in the level of quality of life in terms of both physical and psychological components of health was statistically significant (p&lt;0,001) in patients of the main group. The level of quality of life in patients in the control group increased only due to the psychological component (p&lt;0,001) of health, and the indicators of the physical component did not change (p=0,092).Conclusion. The inclusion of osteopathic correction in the complex therapy of patients with chronic tonsillitis in the inter-relapse period helps to reduce the pain and improve the physical component of quality of life compared to traditional conservative treatment alone. The study should be continued with a larger sample.

Minimally invasive interventions on celiac plexus in patients with persistent abdominal pain caused by pancreatic cancer

Background. Chronic abdominal pain is common in 50 % of patients with intra-abdominal malignancies and has a huge impact on quality of their lives. As the number and doses of systemic analgesics increase, so does the frequency of side effects that can further worsen functional status, which is important for this cohort of patients who have a five-year survival rate of only 8 %. The purpose of the study: to assess the efficacy and safety of computed tomography-guided celiac plexus neurolysis as a method of reducing persistent, severe pain in patients with pancreatic cancer that affects their functional status. Materials and methods. The analysis of the results of 17 interventional procedures on the celiac plexus in 16 participants was conducted, sympatholysis was performed twice in one patient. Inclusion criteria: pancreatic cancer with persistent pharmacoresistant neuropathic abdominal pain for ≥ 3 months, which did not respond to medications, including opioids, anti-inflammatory drugs, and other conservative methods of treatment. Age of patients was 39 to 72 years (mean of 62.6 ± 8.2 years), 10 (62.5 %) research participants were male and 6 (37.5 %) were female. Results. Interventions were successfully performed for all patients on the first attempt. There were no cases of perforations of hollow organs, damage to blood vessels, pleural sinuses, or other structures of the abdominal and thoracic cavities. No neurological complications were recorded, and no one required blood transfusion. All study patients had a significant reduction in pain on the visual analogue scale compared to baseline, both one week after the procedure, from 9.7 ± 0.6 to 4.7 ± 1.4 (P &lt; 0.001), and in six months, from 9.7 ± 0.6 to 4.1 ± 1.4 (P &lt; 0.001). The average Karnofsky Performance Status Scale score compared to the data before the procedure, one week after increased from 64.7 ± 7.9 to 78.2 ± 6.4 (P &lt; 0.001). A significant improvement in functional status was maintained up to three months — 71.2 ± 6.9 (P &lt; 0.001). However, in six months, this indicator was 63.5 ± 6.0 (Р = 0.668), which may be related not only to the intensity of the pain syndrome, but also to other complications of the underlying disease (ascites, cachexia, tumor growth, palliative surgical interventions, etc.). Conclusions. Computed tomography-guided celiac plexus neurolysis is a safe and effective procedure for patients with abdominal pain caused by inoperable pancreatic cancer. Sympatholysis provides a long-term significant reduction in pain syndrome according to the visual analogue scale after 1, 3, 6 months (Р &lt; 0.001) and increases the functional status of patients according to the Karnofsky Performance Status Scale in 1 (Р &lt; 0.001), 3 months (Р = 0.023). Celiac plexus neurolysis should be considered as part of a multidisciplinary approach to the comprehensive treatment of upper abdominal pain associated with cancer in the early stages of the disease.

FEATURES OF THE TREATMENT OF HYPERMOBILITY OF THE ARTICULAR HEADS AND DISLOCATIONS OF THE LOWER JAW ON THE BACKGROUND OF FRACTURES OF THE CONDYGAL PROCESSES OF THE MANDIBLE, AS A PREVENTION OF ALLOPLASTIC REPLACEMENTS OF THE TEMPOMANDIBULAR JOINT

Acute, chronic, and recurrent dislocations are currently defined as conditions in which the mandibular process becomes dislocated from its joints and requires manipulation by another person to return to its normal position. Such conditions are usually preceded by either iatrogenic factors, including fractures of the mandibular branch, or joint instability and hypermobility of its heads. This pathology requires a personalized treatment algorithm: in each case, the clinical and radiological signs of this pathology should be clearly taken into account and the method of conservative or surgical treatment should be determined. Each of them has its advantages and disadvantages, and their combined use is also possible, which is the key to preventing more significant complications that can lead to allostatic replacements, joint components, or joint replacement as a whole.&#x0D; The purpose of the study is to conduct a comparative analysis of the data of clinical examinations, conservative and surgical treatment, complications and postoperative results, taking into account the prevalence of chronic dislocations of the mandible against the background of condylar fractures.&#x0D; Clinical cases of chronic dislocations of the mandible lasting from one to three months after osteosynthesis were analyzed by the authors. Attempts at manual reduction did not bring a positive result, so it was decided to treat the patients conservatively, using bite blocks made of self-hardening plastic and the use of elastic methods of fixation of the mandible, which gave a positive result already in the third week of treatment. Also, these patients were observed in the clinic for 6 months without visualization of complications of both mechanical and inflammatory nature.&#x0D; The analysis of clinical case data allows us to state that the goal of treatment should be to return the condyles to their original physiological position, and conservative methods should be in the first place when creating an algorithm. Early manual reduction of the joint heads is the best method of treatment, if it is possible to carry it out in a timely manner. As the duration of the dislocation increases, the joint cavity is filled with connective tissue, cartilaginous changes occur, adhesions between the articular surfaces are formed, the masticatory muscles shorten with possible fibrosis of the temporalis muscle. We have confirmed the fact that one of the best conservative treatments is the use of an elastic chin-parietal bandage, which acts as a fulcrum to move the heads back under the anterior slope of the articular tubercle, with the simultaneous use of arches and posterior occlusal rollers. If this treatment does not bring a positive result, we use intraoral splints with a fulcrum in the area of the second molar in combination with extraoral traction to move the heads in the posterior direction with simultaneous stretching of the capsule of the temporomandibular joint and its intracapsular ligaments.&#x0D; It should be noted that in each case, all the features of the pathogenesis of this disease should be taken into account and a personalized treatment algorithm should be developed, consisting of conservative methods, and, if ineffective, surgical treatment.

Ultrasound-guided platelet-rich plasma vs. radiofrequency nerve ablation for refractory plantar fasciitis

Objectives: Plantar fasciitis (PF), which accounts for approximately 80% of heel pain, is a common condition affecting adults' quality of life. There are many different treatment modalities used in the treatment of PF. In this study, we compared the clinical and functional outcomes of patients diagnosed with chronic PF in our clinic who underwent USG-guided PRP (platelet-rich plasma) injection and patients who underwent RFNA (radiofrequency nerve ablation) treatment. Methods: Ultrasound-guided PRP injection or RFNA was performed on 95 patients who were diagnosed with chronic PF and met the inclusion criteria. This group of patients was followed for at least one year (October 2021-October 2023), and the clinical and functional results of the patients were compared. Results: The mean pre-treatment Visual Analog Scale (VAS), Foot Function Index (FFI), and American Orthopaedic Foot and Ankle Society (AOFAS) posterior-ankle scores were similar, and no significant difference was found (P&amp;gt;0.05). A significant improvement was observed in the groups' FFI, VAS, and AFOAS scores after treatment (P&amp;lt;0.05). However, no significant difference was found in treatment modalities (P&amp;gt;0.05). Conclusions: As a result of the study, it was concluded that PRP injection and RFNA are effective treatment methods in patients diagnosed with chronic plantar fasciitis without response to other conservative treatment methods, but these two methods are not superior to each other.

Revolutionizing Back Pain Management: Is Epidural Platelet-Rich Plasma the Superior Choice Over Steroids?

Background and objective Low back discomfort is one of the main factors that restrict physical activity, and it is becoming more and more common. Surgery is the best option when all other conservative treatment methods have failed, but it is not a panacea. While local anesthetic-free and combined epidural steroid injections have been used for many years, their usefulness is limited to shorter periods. In the field of orthopedics, platelet-rich plasma (PRP) has gained widespread recognition as an adjuvant component. PRPhas been applied to improve tissue repair, both soft and hard.This comparative study aimed to evaluate the potential of PRP as atherapy for low back pain (LBP). Methods We included 64 adult individuals with complaints ofLBP. They were classified into two groups: group A underwent a single injection in the afflicted lumbar intervertebral disc (IVD) level with 1.5 ml of methylprednisolone, 1.5 ml 2% lidocaine, and 0.5 ml of saline under rigorous aseptic precautions; in contrast, group B was administered a single injection of 3 milliliters of autologous PRP. Patients' scores on the visual analog scale (VAS), the Modified Oswestry Disability Questionnaire (MODQ), and the Straight Leg Raising Test (SLRT) were assessed before and during therapy. Results The datagathered were subjected to statistical analysis. Statistically significant differences were found in the VAS scores between group A (methylprednisolone group) and group B (PRP group) post-one hour (6.0 ±0.74 vs. 6.92 ±0.57) and after three months (5.2 ±0.65 vs. 3.26 ±0.79). Conclusions Our study revealed gradual progressive improvement in the symptoms of patients in the PRP group as indicated by scores onSLRT, VAS, and MODQ. The results were comparable to those who received methylprednisolone injections. There was a statistically significant difference in VAS scores between the two groups, with the PRP group reporting a higher degree of pain reduction, showing that PRP is an effective alternative to epidural steroid infiltration in managing chronic LBP.

Hip dysplasia: pathogenesis, diagnosis, treatment, analysis of the activities of a nurse in caring for sick children

Hip dysplasia is a very common disease and the main type of congenital anomalies of the musculoskeletal system in young children. Timely detection and targeted treatment of the disease can improve the quality of life of patients and prevent complications that can lead to the development of disability. The article discusses the causes of the disease, pathogenesis, clinical picture, diagnosis and principles of treatment of hip dysplasia, and the tactics of a nurse working with this category of sick children. Modern principles of rehabilitation associated with treatment regimens depending on the severity of the pathology are considered, the characteristics and content of the functional conservative method of treatment are given. The place of physical rehabilitation methods is determined, the main methods and techniques are characterized, including new organizational solutions: complex impact and multidisciplinary approach. The role of close contact with parents, constructive interaction between doctors, nurses and rehabilitation specialists is noted.

Current Approaches for the Diagnosis and Conservative Treatment of Stress Urinary Incontinence - A Guideline of Guidelines

Urologists utilize evidence-based guidelines organized by urological organizations in the management of stress urinary incontinence (SUI). The objective of this study is to provide guidance in the clinical management of stress urinary incontinence (SUI) by reviewing key guidelines. We conducted a medical literature analysis in the following databases: PubMed, Medline, Embase, National Guideline Clearinghouse, the National Institute for Health and Care Excellence, and Cochrane Library. We also manually searched the websites of the following international and national societies to identify relevant guidelines for inclusion in this review: the International Consultation on Incontinence, American College of Obstetrics and Gynecology, American Urogynecologic Society, American Urological Association/Society of Urodynamic, Female Pelvic Medicine and Urogenital Reconstruction, National Institute for Health and Care Excellence, European Association of Urology, and Canadian Urological Association. The recommendations in the guidelines are summarized in different areas, including the diagnostic standards of SUI, examination and evaluation methods, and conservative treatment methods. This ‘guideline of guidelines’ presents the similarities and differences between prominent authorities in the management of SUI.

Functional Outcome of Lower Limb Long Bone Trauma Management in Pregnant Mothers: A Prospective Study of 30 Cases From a Tertiary Care Centre in North India.

The occurrence of orthopedic injuriesduring pregnancy carries considerable morbidity and mortality for both the mother and fetus. Successful care of lower limb fractures during pregnancy requires a multidisciplinary approach. Both operative and non-operative treatments must be taken into account by the treating orthopedic physician. There is limited literature available on the management of these lower limb fractures in pregnancy, and peri-operative management of this obstetric and orthopedic trauma is largely unclear. Trauma during pregnancy is a common cause of non-obstetrical maternal death, having a significant public health burden to both the mother and child. The aims and objectives of this study were to review the common causes of lower limb long bone trauma during pregnancy and their functional outcome in terms of morbidity and mortality. This study evaluates various operative and conservative methods of treatment to provide a comprehensive management approach to pregnant patients with lower limb trauma. A prospective study on functional outcomes of 30 pregnant females who were admitted with lower limb long bone fractures from 2017 to 2021 was done. The patients were randomly selected intra-operatively for various procedures based on the surgeon's preference. All patients were followed for two years or till union occurred, and the radiographic union score for tibial (RUST) and modified radiographic union score for tibial (mRUST) fracture criteria were used to assess bony union clinico-radiologically. Results: During this study, the mean age of patients was 27 years (range 19-38), having right-side (53.33%) predominance with road traffic accidents (n=22) and falls (n=6) as the most common causes of injury. Two cases of domestic violence were also reported. In our study, the maximum number of cases was 17-25 weeks of their gestation; 12 (40%) patients had tibial fractures, and 18 (60%) had femoral fractures. Six tibial fractures were handled conservatively, while all femoral fractures required surgical intervention. Out of 18 femoral fractures, which were treated surgically, dynamic compression plating was done in 15 (83.33%) patients, while interlock nailing was done in three patients. Six tibial fractures have been operated upon, two (66.66%) with dynamic compression plating and four (33.33%) with an interlocking nail. A multidisciplinary approach in terms of both operative and non-operative methods must be taken into account for treating pregnant mothers by the orthopedic physician while carefully weighing the benefits and risks of both procedures. Based on the pattern and displacement of the fracture, many prenatal fractures can be treated conservatively. Another alternative that is frequently safe is to postpone the surgical procedure until childbirth. The physiologic changes associated with pregnancy and any potential dangers to the fetus must be taken into account by the orthopedic surgeon when fractures necessitate surgical intervention. The surgeon is responsible for the patient's correct placement, the C-arm's use, the radiation dose, and the intra-operative fetal monitoring, as well as the danger brought on by anesthetics, antibiotics, analgesics, and anticoagulants.

Изменение ИК-спектров метаболитов энергетического обмена в крови крыс с гепатоцеллюлярной карциномой при воздействии гипертермии и апитоксина

There is a need to develop and improve conservative treatment methods for malignant liver tumours, since only in a small percentage of cases (10–30 %) radical treatments can be applied. Therefore, of relevance are studies into the effect of hyperthermia on the absorption of antitumour drugs and the effect of bee venom as a physiological therapeutic agent on the energy metabolism of tumour cells. Infrared spectroscopy could potentially be used to study changes in energy metabolism parameters in the blood plasma. The purpose of this article is to assess changes in the concentrations of energy metabolism metabolites in the blood of tumour-bearing animals during hyperthermia under the action of apitoxin using infrared spectroscopy. Materials and methods. The research involved 50 white non-linear female rats, divided into an intact, control and three experimental groups. The control and experimental groups were inoculated with hepatocellular carcinoma. The experimental groups were injected intraperitoneally with honey bee venom followed by hyperthermia sessions at different temperatures (42.5; 43.5 and 44.5 °С). Blood plasma was studied using a spectrophotometer in the wavenumber range of 1170–1025 cm–1. Results. We found a statistically significant increase in adenosine triphosphate concentrations (by 54 %) and a decrease in adenosine monophosphate (by 54 %), adenosine diphosphate (by 18 %) and glucose (by 87 %) levels compared to the control at 42.5 °C hyperthermia under the action of bee venom by the 7th day; however, on the 28th day the opposite effect was observed: an increase in adenosine monophosphate, adenosine diphosphate and glucose concentrations and a decrease in adenosine triphosphate levels. No positive dynamic was detected at other hyperthermia regimens. It is concluded that infrared spectroscopy can be used to assess energy changes in animals with hepatocellular carcinoma at different hyperthermia regimens under the therapeutic effect of bee venom. The optimal conditions for bee venom effects on the body are achieved at 42.5 °C.