Conservative Treatment Methods Research Articles

Scapholunate advanced collapse of the wrist: a review

Background. Scapholunate advanced collapse (SLAC) is a common type of the wrist osteoarthritis. It is characterized by progressive deformity, instability and arthritis due to chronic dissociation of the scaphoid and lunate bones with chronic scapholunate interosseous ligament (SLIL) injuries. Quite often, in this pathology, it is difficult to alleviate the pain syndrome and preserve the range of motion. The aim of the review — based on the modern literature data, to analyse the concept and pathogenesis of scapholunate advanced collapse, current methods of radiological diagnosis and treatment modalities of the pathology. Methods. The search was performed in eLIBRARY and PubMed databases using the following keywords: scapholunate advanced collapse, SLAC, scapholunate instability, proximal row carpectomy. We selected 86 original articles and reviews out of 110 papers found. The selected ones reveal the issues of pathogenesis, radiological diagnosis and treatment of the pathology. Results. Scapholunate carpal collapse is secondary arthritis of the carpal bones resulting from rupture of the SLIL, which can be traumatic or non-traumatic. Conservative methods of the SLAC treatment can be used in the early stage of arthritis, but there is no data on their effectiveness in the world literature. Surgical treatment methods are varied, the choice depends on the clinical stage of the disease. Conclusions. The efficiency of conservative treatment modalities of the SLAC syndrome has not been proved yet. There is a plenty of surgical treatment methods and their modifications developed to alleviate the pain syndrome and preserve the motion and strength of the wrist grip as far as it is possible. However, the choice of the treatment method depending on the clinical stage of the disease is still problematic. For young active patients especially important is the development of adjuvant techniques aimed to increase the treatment efficiency. To date, there is accumulating evidence of successful use of pyrocarbon implants and arthroscopy techniques in the wrist surgery.

Study on duration of symptoms of anal fissure and its impact on response to conservative treatment – A systemic review

Conservative treatment is the main course of action for anal fissure. The goal of this review was to see how symptom duration affected the anal fissure's responsiveness to conservative treatment.In this systematic review, We evaluated the duration of symptoms related to anal fissure as well as their effect on the response to conservative treatment. The study was done by referring journals and articles from PUBMED, Scopus, web of science and Elsevier for a systemic review and references for additional studies. All the articles and literature other than in English language are excluded. Atypical fissures which occur due to conditions like cancer, anal infection and inflammatory bowel disease are excluded. The key search words used are Anal fissure , Fissure in anal and conservative treatment, symptoms of anal fissure , Anal fissure and Glycery l Tri Nitrate (GTN), Anal fissure and Botox, Anal fissure and pathophysiology, Anal fissure and calcium channel Blockers, classification of anal fissure. A total yielded 1048 articles on initial search; first 614 duplicate publications were removed. After screening additional 467 articles were excluded and 147 full articles were assessed for the study. After performing complete screening data analysis of total 14 literature were involved in this present systematic review.This Systemic review can be concluded by the above mentioned finding that if symptom duration is less or in other words in acute anal fissures conservative treatment methods can work very effectively especially with GTN. However, as the duration of symptoms exceed the healing rate decreases attributing to the chronicity of the anal fissures. This renders the conservative treatment modalities less effective and making surgical treatment alternatives like Lateral internal sphincterotomy (LIS) the mainstay for chronic anal fissure.

Endoscopic Iliopsoas Fractional Lengthening as a Treatment for Refractory Iliopsoas Impingement After Total Hip Arthroplasty Shows Favorable Functional Outcomes With No Impact In Range of Motion

To report the minimum 2-year clinical outcomes of endoscopic iliopsoas fractional lengthening (IFL) in patients with recalcitrant iliopsoas tendonitis after Total hip arthroplasty (THA). Data was prospectively collected from 2014 to 2020 for patients who underwent IFL following primary THA as part of the institutional hip outcomes registry. Patients were included if they had completed preoperative and minimum 2-year follow-up the following patients reported outcomes (PROs): modified Harris Hip Score (mHHS) and, visual analog scale (VAS). Preoperative and postoperative data was available for the International Hip Outcomes Tool (iHOT-12), and patient satisfaction was also analyzed. Patients included in the study reported irritation of the iliopsoas tendon following cementless THA, refractory to conservative treatment methods. IFL was recommended after workup which included ruling out infection and aseptic loosening, and a positive iliopsoas diagnostic injection. Seventeen patients were included in the study . The mean age at IFL was 56.42 (30.17-81.29). The mean interval between THA and IFL was 2.72 (0.25-8.34) years. There was a significant improvement in all evaluated PROs, and a high percentage of patients meeting MCID (14 (82.35%) for mHHS, 11 (92.00%) for iHOT-12, and 16 (94.12%) for VAS (p < 0.05). Furthermore 15 (88.2%) of patients reported a positive response to the PASS anchor question. No impact was observed from pre-to postoperative active range of motion and no patient reported weakness at the latest follow up (p > 0.05). Preoperative flexion was 106.33° (85.0°-120.0°) and post-operative flexion was 106° (900°-120.00). Endoscopic IFL yielded significant improvements in functional outcomes with a high patient satisfaction at minimum 2-year follow-up, with no reported complications. This procedure did not have a significant negative impact on hip range of motion. Retrospective Case Series; Level IV.

Conservative therapy for lumbar disc herniation

Herniated discs are acommon cause of neurological symptoms that often lead to reduced quality of life. They affect around 20% of 45-56-year olds and, therefore, represent acorrespondingly major challenge for healthcare. Conservative therapy methods are usually used as the first treatment option; surgical interventions should only be considered in special symptom constellations. This study aims to evaluate the effectiveness of conservative therapy methods in the treatment of lumbar disc herniation and to demonstrate their influence on pain reduction and functional improvement. The current valid AWMF guideline was analyzed, and asystematic literature search was conducted to identify relevant information on the conservative treatment of herniated discs. The therapeutic approaches analyzed included physiotherapy, drug treatment, manual therapy and injection therapies. Inclusion criteria covered reviews and meta-analyses from 2019 to 2024. The analysis showed that conservative treatment methods led to asignificant reduction in pain and improvement in functional abilities in the majority of patients. Not all frequently clinical used forms of therapy have been well proven. The results of this study underline the importance of conservative treatment methods as an effective treatment option for herniated discs. In particular, the combination of different treatment approaches can improve treatment outcomes. However, further long-term studies are needed to determine the long-term effects and optimal treatment protocols.

Modern methods of treatment of complicated forms of pilonidal cyst

There are several theories of the origin of diseases of the epithelial coccygeal tract: empirical, neurogenic, ectodermal and acquired. Most Russian scientists consider this pathology to be congenital, while foreign colleagues believe that it is a consequence of sacrococcygeal area injuries. This pathology is quite common, affecting more than 5 % of the adult population, it also occurs in children and adolescents. This disease decreases the quality of patients` life significantly, affecting all aspects of their life. Conservative methods of treatment do not provide a complete cure, since they do not eliminate the causes of the disease. These include sclerotherapy and obliteration of the cavity with silver nitrate or hydrochloric acid. These methods are not used nowadays. Surgical treatment is the most effective one for this pathology. Surgical intervention, despite its apparent simplicity, turns out to be quite complex, which makes it inaccessible to any general surgeon. Treatment results are often disappointing due to the high incidence of complications after surgery, as well as the long period of activity limitation. Therefore, the resulting rough scar is a cosmetic defect, and the risk of recurrence remains quite high. Studying the literature data, one can see that the authors` opinions concerning surgical tactics for this disease differ. At the moment, there is no single approach and surgical tactic for the treatment of epithelial pilonidal cyst. The problem of creating and introducing new methods of treatment of pilonidal disease remains relevant nowadays.

COMPARISON OF THE EFFECTIVENESS OF CONSERVATIVE AND SURGIRAL TREATMENT OF GENERALIZED PERIODONTITIS

In the complex treatment of generalized periodontitis, special attention is paid to the correct combination of conservative and surgical methods of treatment, which reduce the activity of destructive processes in periodontal tissues and restore the lost anatomy [1-9]. However, despite various additions and modifications, conservative and surgical interventions on the periodontal itself do not create sufficient conditions for effective relief of pathological processes and restoration of periodontal tissues [10-18]. In some cases, the use of new technologies, including the use of occupational hygiene, dental splints and other conservative methods of treatment, does not lead to the stabilization of destructive processes in the alveolar process, and in some cases contributes to the further destruction of periodontal tissues and surrounding bone tissue with the formation of defects of various sizes. The problem of dental preservation in patients with generalized periodontitis of II-III severity is still relevant. The organizational inconsistency of dentists of different specialties, the lack of a real medical examination of patients with periodontal disease create prerequisites for the interruption of treatment at the level of conservative therapeutic agents and the active course of destruction of bone tissue of alveolar processes.

СОВРЕМЕННОЕ ЛЕЧЕНИЕ РУБЦОВОЙ ДЕФОРМАЦИИ ТКАНЕЙ

The problem of scar treatment is one of the most widespread in modern medicine. Treatment of scar formations is one of the most difficult tasks, as there is no single standard that is favorable in terms of efficacy and safety despite the active development in this area of research. Currently, conservative methods of treatment of scar tissue deformities such as corticosteroid administration, botulinum therapy, cryotherapy, microneedling, as well as surgical excision in combination with therapeutic methods are widely used, due to which the most favorable result is achieved. This study is devoted to the study of various modern methods of correction of hypertrophic and keloid scars that are becoming widespread in medicine, their comparison and identification of important advantages and disadvantages in order to choose the most effective treatment technique. Currently used conservative methods of treatment allow to cope with the problem of scar formations, but due to the high incidence of side effects, there is a tendency to search for the combined use of each of them, including with surgical excision to prevent the development of recurrences and to achieve a pronounced cosmetic effect and satisfaction among patients. Thanks to the constant development of medicine and the improvement of various methods, each patient can receive a personalized treatment approach that is guaranteed to reduce aesthetic discomfort due to the existing pathology, which is the main and important aspect of scar correction.

Treating Chronic Tendinopathy: Physical Therapy, Surgery and Other Form of Therapy

Introduction: The term "tendinopathy" refers to pathological changes in tendons. The previously used term "tendonitis" does not fully capture the nature of the condition, as inflammatory changes, when present, are secondary to degenerative damage. Tendinopathies are quite common in the general population. Aim: The aim of this review is to characterize various types of tendinopathies, with a focus on both conservative and surgical treatment methods, in order to organize available information that may be helpful for clinicians in their practice. State of Knowledge: Chronic tendinopathies develop as a result of multiple factors. The most significant include improper exercise techniques, excessive strain, and musculoskeletal system abnormalities. Summary (Conclusions): The approach to tendinopathy treatment should vary depending on the patient's clinical condition and provoking factors. Physiotherapy plays the most important role, along with supportive methods such as analgesic pharmacotherapy and cryotherapy. Surgical intervention may be necessary in cases where conservative treatment fails.

Treatment Options for Plantar Fasciitis: Surgical Release vs. Conservative Therapy

Introduction Plantar fasciitis is one of the most common reasons for visits to orthopedic clinics. This tendinopathy can cause medial heel pain, stiffness, and tenderness on the plantar surface of the foot. Both conservative and surgical methods are employed in its treatment. Aim The aim of this study is to evaluate selected conservative treatment methods, such as stretching, the use of orthotic insoles, splints, injections, extracorporeal shockwave therapy, and taping, as well as surgical treatment options. The study presents a comparison of these methods in terms of their effectiveness, advantages, and disadvantages. State of Knowledge The plantar fascia is a stiff, connective tissue structure extending along the plantar surface of the foot. Biomechanical load on the fascia, which supports the medial longitudinal arch, can lead to degenerative changes that underlie plantar fasciitis. Symptoms include pain, particularly in the mornings and late evenings, which intensifies with palpation of the heel area. Summary (Conclusions) Conservative treatments for plantar fasciitis are effective in 90% of patients. There are no studies that conclusively demonstrate the superiority of one treatment method over another. Thus, the choice of therapy should be tailored to the patient's lifestyle, activity level, and financial capability. Surgical intervention is necessary in cases of chronic plantar fasciitis which remains resistant to conservative treatments.

Effectiveness of extracorporeal shock wave therapy in comparison with other methods of treatment of patients with plantar fasciitis: literature review

Plantar fasciitis (PF) is one of the most common causes of pain in the heel area, which is associated with the presence of inflammation in the plantar fascia and is most often localized in the medial part of the heel area. Extracorporeal shock wave therapy (ESWT) is a method of hardware treatment that has been used in orthopedics and traumatology for the past decades. One of the main diseases successfully treated with this method is plantar fasciitis. The aim of the work was to determine the effectiveness of extracorporeal shock wave therapy in the treatment of plantar fasciitis compared to other methods of conservative treatment based on the literature review. Research literary sources from scientific electronic databases PubMed, Medline and other sources of scientific and medical information were analyzed. A literature search was performed using search queries specifying the method under study and plantar fasciitis, namely: «Extracorporeal Shockwave Therapy», «Plantar Fasciitis», «Conservative Treatment», «Physiotherapy». During the search, 473 scien­tific articles devoted to the treatment of plantar fasciitis were selected. Given the large number of articles and the desire to present up-to-date data, the query was limited to the last 9 years (from 2015 to 2023) and 417 articles were selected. Articles devoted to other methods of treatment of PF (conservative and surgical) and articles devoted to the use of ESWT in orthopedic and traumatological diseases of other localizations were excluded from the search results. At the second stage of the search, articles devoted exclusively to the treatment of PF by the ESWT method were excluded, and sources comparing the effectiveness of ESWT treatment with other methods of conservative treatment were selected (31 articles). The main results – it was determined that extracorporeal shock wave therapy continues to remain one of the main methods of conservative treatment of PF, which has been used for the last decades. It has proven its high efficiency and safety in the treatment of PF. Compared with other methods of conservative treatment of PF, extracorporeal shock wave therapy remains one of the most effective, it is successfully used in the treatment of PF.

Role of Non-Mesh Grafts in Surgical Treatment of Stress Urinary Incontinence

Stress urinary incontinence refers to a multifactorial disease characterized by involuntary urination associated with a sudden increase in intra­abdominal pressure. Millions of females around the world suffer from stress incontinence each year. Conservative methods of treatment and physical rehabilitation are considered to be ineffective, thereby driving the need for surgical treatment. Sling surgeries comprise a widely used surgical technique for the treatment of stress urinary incontinence due to their affordability and minimal time investment. Introduction of synthetic polypropylene mesh prostheses in the treatment of stress incontinence made them the most common material. However, the accumulated experience and complications associated with the use of mesh grafts contribute to the recent decline in the popularity of synthetic slings and give rise to the search for and development of alternative materials for the surgical treatment of stress urinary incontinence. Since the need for treatment of urinary incontinence remains high, fascia autograft surgeries have been proposed, even though they require an additional surgical procedure and expose the patient to complications at the donor site of the graft. In addition, surgeons use allografts and xenografts, and regenerative technology is developing in this field. Considering high social significance of this problem, the present paper is aimed at reviewing the scientific literature concerning grafts for the treatment of stress incontinence.

THE INFLUENCE OF THE CULTURE OF FIBROBLASTIC CELL ELEMENTS ON THE INDICATORS OF THE METABOLISM OF CONNECTIVE TISSUE IN EXPERIMENTAL ANIMALS

The number of patients with degenerative tendon disease affects millions of people both among athletes and the general population, causing significant socio-economic consequences. Despite the availability of various methods of conservative and surgical treatment, more than a third of patients experience constant pain. Objective. To study the indicators of the metabolism of connective tissue in animals with a model of degenerative damage to tendons against the background of the introduction of a culture of fibroblastic cell elements. Methods. Therefore, the development of methods for restoring the structure of tendons using cell cultures, in particular fibroblasts, will allow to optimize the course of reparative processes, reduce the risk of complications during surgical intervention and accelerate healing, and at the molecular level — to improve the structure of collagen fibers. Laboratory studies of biochemical markers of a tendon with a degenerative-dystrophic lesion and against the background of the introduction of cell culture can help in the differential diagnosis of its extracellular matrix. Results. The experimental data obtained by us indicate the presence of differences in the biochemical markers of tendons with degenerative-dystrophic lesions in rats 7, 21, and 45 days after the introduction of culture of fibroblastic cell elements. However, 45 days after the introduction of the culture of fibroblast cell elements, the normalization of metabolic processes in the extracellular matrix of connective tissue occurs, namely, the activity of collagenase and the concentration of protein-bound hydroxyproline approaches normal values. This indicates the predominance of the synthetic phase over the catabolic one in collagen metabolism. Conclusions. In this context, the introduction of culture of fibroblastic cell elements, as an alternative anti-inflammatory method, may provide another potential opportunity in the treatment of chronic degenerative-dystrophic lesions of the Achilles tendon.

Хвороба Байлера: консервативні і хірургічні стратегії лікування

Byler's disease (BD) is rare and difficult for diagnosing hereditary cholestatic liver disease. Proper diagnosis, early correction and treatment (including liver transplantation (LT)) improves the quality of life (QoL), prevents irreversible liver changes, multiple organ failure and death. Aim - to study the features of differential diagnostics, feasibility, terms, strategies, methods of conservative treatment, surgical correction (palliative surgery (PS), LT) in five children with BD. Materials and methods. Five clinical episodes of chronic disease with data on hematological indicators during treatment, physical development (PD) (harmony, body mass index - BMI), neuropsychiatric development (NPD), QoL before treatment, after PS, after LT. Results. Five clinical episodes of chronic disease were analyzed, one of which was fatal. All indicators (hematological, FD, NPD, QoL) improved after PS, but completely normalized after LT. Conclusions. Differential diagnosis of severe hereditary rare disease progressive familial intrahepatic cholestasis (BD) is possible using genetic research methods as a marker of this disease among all cholestatic diseases in young children. The first clinical signs of the disease appear in the neonatal period and progress in the first months of life. Early modern diagnosis and diversion of bile prevent liver damage and death. Palliative surgical intervention is performed in the case of rapid progression of cirrhosis and the threat of liver failure as a temporary measure to better prepare the patient for transplantation and obtain the results of genetic analysis, carry out the necessary vaccinations and correct concomitant congenital and acquired diseases, improve PD, NPD, QoL, biochemical indicators, ultrasound data. LT is an effective method of radical treatment of BD, normalization of FD, NPD, QoL, biochemical and sonographic indicators. The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research. The author declares no conflict of interest.

Хірургічне лікування мегадуоденум у дітей, які перенесли корекцію атрезії дванадцятипалої кишки в неонатальному періоді

Aim - to determine the tactics of diagnosis and surgical correction of megaduodenum and its complications in children operated on in the neonatal period for duodenal atresia. Materials and methods. A retrospective analysis of the medical records of 5 patients with megaduodenum who were treated at the SI «Institute of Pediatrics, Obstetrics and Gynecology named after academician O.M. Lukyanova of the NAMS of Ukraine» was performed for the period from 2018 to 2023. In the neonatal period, these children were operated on for duodenal atresia at their place of residence (n=3) or at the Institute (n=2). Results. The diagnosis of megaduodenum was confirmed in 100% of cases. All patients underwent surgery. Stapled longitudinal constrictive duodenoplasty was performed. Intraoperatively, the anatomy of the megaduodenum was examined in detail: its diameter ranged from 42 mm to 90 mm, on average 63.4±21.16 mm, length from 50 mm to 140 mm, on average 98±37.01 mm. In all cases, the patency of the previous duodeno-duodenal anastomosis was monitored. Its diameter ranged from 18 mm to 30 mm. The effect of the surgical treatment in all patients was good. Conclusions. The developed diagnostic algorithm includes: radiography of the abdominal cavity, X-ray contrast study of the gastrointestinal tract, ultrasound of the ENT organs, EGD, and others if necessary. Surgical correction of megaduodenum and its complications consists of stapled longitudinal narrowing duodenoplasty, which, in combination with conservative treatment methods, leads to good functional results. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of all institutions mentioned in the work. Informed consent of the women was obtained for the research. The authors declare no conflict of interest.

Evaluation of the efficacy of low-level laser therapy in the treatment of ulnar neuropathy at the elbow in terms of symptoms and clinical and electrophysiological findings: a randomized, prospective, double-blind clinical trial.

Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy and presents with symptoms such as pain, paresthesia, and weakness in the elbow. Provocative tests and electrophysiological examinations are helpful in the diagnosis of UNE. Low-level laser therapy is one of the conservative treatments of UNE however, limited results were reported on the effectiveness of low-level laser therapy (LLLT) in the treatment of UNE. In our study, we aimed to the efficacy of LLLT in reducing symptoms and providing clinical and electrophysiological improvement in patients with UNE. This study with a randomized-sham controlled, and double-blind design included 68 patients aged 18-60 years who were diagnosed with UNE. LLLT was applied to the first group, and sham laser was applied to the second group. The VAS pain, paresthesia, and weakness scores, grip strength, and provocative test positivity were evaluated in clinical examination. The QuickDASH questionnaire was administered to assess functional status. Electrophysiologically, motor distal latency (MDL) differences, sensory distal latency (SDL), motor and sensory nerve conduction velocity (NCV) were examined. Evaluations were performed before treatment and on the 15th day and at the third month after treatment. The LLLT group showed improvement in symptoms, clinical findings, motor NCV, and MDL at both post-treatment evaluations and sensory NCV on the post-treatment 15th day (p < 0.05). The comparison of post-treatment changes between the two groups revealed that the LLLT group had greater improvement in VAS day and night pain scores at both post-treatment evaluation times, QuickDASH scores at the third month, and sensory NCV on the 15th day (p < 0.05) compared to the SL group. There were no significant differences between the groups in terms of the post-treatment changes in VAS weakness scores, grip strength and electrophysiological findings (p > 0.05). It was observed that splinting alone was effective in UNE, but the addition of LLLT, one of the conservative treatment methods, enhanced treatment outcomes.

Mural infectious endocarditis in a patient with tetralogy of Fallot: a clinical case

The article presents a clinical case of development of mural infective endocarditis (IE) with formation of vegetations in the region of the upper third of the interventricular septum in patient A., 51 years old, with uncorrected tetralogy of Fallot. The patient was admitted with complaints of increased heart rate, interruptions in the heart work, feet swelling, shins up to the upper third, dyspnea at rest, general weakness, fever up to 39 оC, sweating, headache. During transthoracic echocardiography on the upper third of the interventricular septum (IVS) from the side of the RV, an additional echo-positive linear mobile formation 0.9 cm long is visualized, similar to the chords of the tricuspid valve. Thus, based on the identification of 1 major Duke criterion (imaging criterion — the presence of parietal vegetation) and 3 minor criteria (predisposing factors — congenital heart disease of the blue type; fever &gt;38 оC; positive blood culture not meeting the requirements for the major criterion), laboratory and instrumental diagnostic data and anamnesis, the following diagnosis was established: "Secondary infective endocarditis with damage to the upper third of the interventricular septum". Taking into account the sensitivity of the identified microflora, polymyxin and moxifloxacin were prescribed. During therapy, a dry cough and dry wheezing in the projection of the middle lobe on the right appeared. To exclude septic embologenic pneumonia, computed tomography of the chest organs was performed, on which no focal/infiltrative changes were detected. However, a shunt connecting the brachiocephalic trunk with the right pulmonary artery was visualized, which may explain the cause of compensation of hypoxemia that arose due to pathological hemodynamics as a result of high pulmonary stenosis. Given the incomplete effectiveness of therapy, as well as the sensitivity of the infectious agents isolated, a decision was made to change antibacterial therapy to vancomycin in combination with imipenem. Conservative treatment methods allowed not only to compensate for the existing clinical symptoms, but also to achieve reference values of laboratory parameters, despite the impossibility of surgical intervention.

Analysis of assisted reproductive outcomes in patients with atypical endometrial hyperplasia and early-stage endometrial cancer after fertility-sparing treatment.

To explore the assisted reproductive outcomes of patients with atypical endometrial hyperplasia (AEH) and early-stage endometrial cancer (EEC) who achieved complete remission after conservative treatment and to provide reference for clinical selection of appropriate conservative treatment. This retrospective cohort study included seven patients with EEC and 62 patients with AEH who underwent invitro fertilization or intracytoplasmic sperm injection at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University between August 2015 and October 2023. The authors divided the participants into two groups based on the type of fertility-sparing treatment received: the oral medication group and the levonorgestrel-releasing intrauterine system (LNG-IUS) group. The primary outcome was the cumulative clinical pregnancy rate. Secondary outcomes included clinical pregnancy rate per transfer cycle, embryo utilization rate, and high-quality embryo rate. The LNG-IUS group had a significantly higher rate of usable embryos compared with the oral medication group (80.8% vs 91.1%, P = 0.005) and also had a thinner endometrial thickness on the day of embryo transfer. The cumulative clinical pregnancy rate was higher in the LNG-IUS group compared with the medication group (46.7% vs 78.9%, P = 0.037), and the difference was statistically significant. For patients with AEH and EEC with fertility needs, the conservative treatment method of LNG-IUS can achieve better assisted reproductive outcomes.

Overview of Leech Therapy as an Alternative Treatment for Varicose Ulcers: Mechanisms and Efficacy

Varicose ulcer, the most severe and debilitating complication of chronic venous insufficiency in the lower limbs, impart substantial obstacles in medical management because of their chronicity and propensity for recurrence. About 80 percent of ulcerations on the lower extremities are triggered by varicose ulcer. Despite advances in diagnosis and treatment, varicose ulceration remains a major healthcare concern due to its potential for life-threatening complications. The morbidity has a detrimental effect on life expectancy. Venous ulceration results from persistent venous pressure brought on by venous insufficiency. Although the diagnosis is primarily clinical, it must be distinguished from other lower limb ulcer causes. Reduction of edema, enhancement of ulcer healing, and avoidance of recurrence are the objectives of treatment. Although conservative care, mechanical treatment, pharmaceutical, and surgical methods are available for the treatment of venous ulcers, but Hirudotherapy, also known as leech therapy, has grown into a prominent complementary treatment option. It has the potential to promote wound healing and alleviate varicose ulcer symptoms. The objective of this review is to accord a thorough overview of the application of leech therapy to the management of varicose ulcers. The present study emphasizes on the mechanisms of action, efficacy and safety profile of leech therapy in the context of managing varicose ulcers by synthesizing a collection of available literature, clinical investigations, and case reports.

Значение видео-уродинамического исследования в выборе метода лечения детей с нейрогенными дисфункциями мочевого пузыря

Video urodynamics is the standard for assessment of the lower urinary tract in children with neurogenic urinary disorders aiming to provide more information about the condition of the lower urinary tract v. retrograde urethrocystography. Video urodynamics parameters are used as possible indicators for choosing various surgical treatment options, however, all work is focused on adult patients, and data for the pediatric cohort were not available as yet. The purpose of this research was the evaluation of the role of video urodynamics and retrograde urethrocystography in the selection of effective conservative and surgical treatment of neurogenic urinary disorders in children. Materials and methods used: 112 patients aged 1,8 to 18 y/o with neurogenic urinary disorders were included in the study, of whom 101 were those who had been proven effectively treated with conservative M-cholinoblockers or had successfully undergone minimally invasive surgery as follows: intradetrusor injection of botulinum toxin (n=21), transurethral correction of VUR (n=17), simultaneous execution of two of these interventions (n=22). Based on the results of video urodynamic and cystographic examination of these patients with the CHAID technique, the classification trees were built in order to evaluate the effective treatment (conservative/surgical). Results: the median age of patients was 9,0 years [7,8-12,0]. The first classification tree containing the parameter “presence of VUR according to the results of retrograde cystography.” The sensitivity of the obtained model for the effectiveness of surgical treatment was 83,3% v. 73,2% for conservative treatment. The accuracy was 79,2%. The ROC-AUC value was 0,783. The second classification tree contained the maximum Pves value according to the results of the video urodynamics, presence of hyperactivity, presence of VUR. The sensitivity of the obtained model for the effectiveness of surgical treatment was 93,3% v. 97,6% for conservative treatment. The accuracy was 95,0%. The ROC-AUC value was 0,972. Comparison of ROC-AUC values by the Delong test revealed statistically significant differences between these binary classification metrics (p&lt;0.001). Conclusion: the parameters of video urodynamics have greater diagnostic accuracy in effective prediction of both conservative and surgical treatment methods compared to the retrograde urethrocystography.

The role of thymectomy in the treatment of myasthenia

A systematic review of the data of domestic and foreign literature on the treatment of myasthenia was carried out. Special attention was paid to indications for thymectomy and its effect depending on various prognostic factors. Pubmed, Elibrary, UpToDate databases were used to search for sources. Based on the analysis of literary sources, data on the treatment of myasthenia in tumor and non-tumor pathology of the thymus gland was presented; indications for surgical treatment were clarified. A brief historical review of the use of the surgical method in patients with myasthenia was carried out. The methods of conservative treatment were described. Attention was paid to current trends in surgical approaches for myasthenia as well as repeated operations for refractory course of myasthenia.Minimally invasive thymectomy is a pathogenetically justified, modern, safe and reproducible treatment option for patients with thymic and non-thymic myasthenia.