Nonsurgical Treatment Methods Research Articles

The Role of Retinopathy Anemia in the Pathogenesis of Retinopathy of Prematurity and the Effect of Erythropoietin Treatment on the Frequency and Severity of the Disease

Premature infants with extremely low birth weight are at high risk of developing severe disabling forms of retinopathy of prematurity. Nonsurgical therapy methods of treatment of retinopathy in prematurity are ineffective. Taking into consideration the multifactoriality of retinopathy in prematurity, studies aimed at analyzing accessory risk factors aiding the progression of active retinopathy of prematurity and the development in their pharmacological therapy are relevant for practical healthcare. Effective prevention of retinopathy of prematurity and prevention of severe disabling stages in premature infants at risk require timely diagnosis of the form and severity of anemia. This is the neonatologist’s task. The ophthalmologist should inform the neonatologist about the possibility of developing retinopathy of prematurity in a baby’s eye and about the necessity for diagnostic and remedial measure to treat anemia. The purpose of this study was to assess the impact of early anemia of prematurity on the frequency and severity of retinopathy of prematurity in infants at risk and the effectiveness of its treatment with erythropoietin. The frequency of anemia in preterm risk group (total 1603 children) and its treatment with the degree of prematurity were analyzed. Anemia was manifested in 99–100 % of children with retinopathy of prematurity. The comparative frequency and severity of retinopathy of prematurity was observed in three groups of infants: with extremely low birth weight and gestational age up to 28 weeks of pregnancy (245 children) group I, with gestational age 29–31 weeks of pregnancy (471 children) group II, and more than 31 weeks (581 children) group III. It was found that without treatment in group I retinopathy of prematurity developed in 100 % of cases and ended with adverse outcomes (IV–V degree of retinopathy of prematurity) in 13.64 %, which is significantly higher ( p < 0.01) than after treatment (1.78 %). Similar index was found in groups II and III. Conclusion. We traced the importance of early premature anemia in the pathogenesis of retinopathy of prematurity. It helped us to conclude that the lower the gestational age of the child at the time of birth stronger linked with the dependence of anemia and retinopathy of prematurity. Both of them are associated with the imperfection of the protective mechanisms of preterm infants. Early prescription of erythropoietin significantly improves the clinical course of retinopathy of prematurity and its prognosis.

The Effect of Body Mass Index on the Outcome of Lumbar Epidural Steroid Injections: Six-Month Follow-up

Obesity is a risk factor for severe, radicular, and debilitating lumbosacral pain. The use of non-surgical treatment methods in obese patients is important. Epidural steroid injection (ESI) is a common procedure that helps patients with low back pain and radicular symptoms. So far, using ESI in patients with lumbar herniated discs remains to be controversial among physicians. Thus, the current study was carried out to compare the therapeutic effects of ESI's in obese and non-obese patients with spinal disc herniation. This prospective, clinical trial study was conducted among 124 patients (58=non-obese, 66=obese) with low back pain caused by a lumbar herniated disc, who referred to our Pain Clinic from 2017 to 2018. The ESI was done using the parasagittal inter-laminar approach. The severity of pain was measured by the patients’ self-report of pain and using the visual analog scale (VAS) before the treatment and two and six weeks after the treatment. The Oswestry Disability Index (ODI) was also measured in the treatment groups. Patients were followed for 6 weeks (IRCT20131124015515N3). Overall, 58 (46.8%) patients had a BMI of 20-25 kg/m2, 38 (30.6%) had a BMI of 25-30 kg/m2, and 28 (22.6%) patients had a BMI of >30 kg/m2. The changes in the pain scores and ODI at different time periods showed no statistically significant differences in the two groups (P=0.685, P=0.995), respectively. The ESI is an effective, safe, minimally invasive, and cost-effective method that can result in pain relief and improvements in patients' function after a short period of time. Hence, we suggested that this treatment be considered for all patients with acute/chronic low back pain as well as radiculopathy.

Huge Post-traumatic Cystic Hygroma, Combination of Surgical and Nonsurgical Treatment Methods: A Case Report

Background: Cystic hygroma (cystic lymphangioma) is a malformation of the lymphatic system. It is rare in adults and trauma may be the cause in some cases. Surgical and non-surgical treatment methods have been described in the management of cystic hygroma. Case Report: A 38-year-old woman, known case of systemic lupus erythematosus (SLE), presented a huge cystic formation in the posterior aspect of her thigh following trauma. We treated the patient using a combination of three treatment methods including surgical excision, intra-cavity bleomycin injection, and post-operative use of compression pants. Conclusion: Huge post-traumatic cystic hygroma in adults is rare. By the combination of the above three therapeutic regimens, there was no cystic lesion recurrence after eight months.

Non-surgical treatment of uterine cancer

Under the non-surgical method of treatment of uterine cancer, the author means scraping with a spoon with sequential cauterization. Without sometimes denying the need for a radical operation, that is, excision of the cervix or the entire uterus, the author believes that in many cases this dangerous operation, which gives a significant percentage of mortality, can be successfully replaced with curettage, especially in cases where the patient resists the operation, or this the latter is dangerous due to the age and emaciation of the patient.

Role of Endoscopic Vacuum Therapy as a Treatment for Anastomosis Leak after Esophageal Cancer Surgery

Esophageal anastomotic leak is the most common and serious complication following esophagectomy. However, the standard treatment for anastomotic leaks remains unclear. Recently, endoscopic vacuum therapy has become an important non-surgical alternative treatment method for patients with esophageal anastomotic leak. This treatment involves the endoscopic placement of a sponge connected to a nasogastric tube into the defect cavity or lumen. Subsequently, continuous negative pressure is delivered to the cavity through the tube. Several studies have reported a treatment success rate of 80% to 100%. In this study, we review the mechanism of action, the method of performing the procedure, its safety and efficacy, and prognostic factors for failure of endoscopic vacuum therapy in the management of patients with anastomotic leak, and on this basis attempted to confirm the possibility of establishing a standardized treatment protocol using endoscopic vacuum therapy.

Immobilization in External Rotation Reduces the Risk of Recurrence After Primary Anterior Shoulder Dislocation: A Meta-analysis.

Background:The best method for nonsurgical treatment after primary dislocation of the shoulder is not clear. The efficacy of immobilization with the arm in external rotation (ER) compared with internal rotation (IR) remains controversial.Purpose:To determine the efficacy of ER immobilization versus IR immobilization on recurrence rate after primary dislocation of the shoulder from the evidence of randomized controlled trials.Study Design:Systematic review; Level of evidence, 2.Methods:Electronic databases (MEDLINE [Ovid SP], PubMed, Web of Science, EBM reviews, and CINAHL) and available proceedings according to the abstracts of major international meetings related to or including shoulder injuries and trauma were used to search for randomized controlled trials. Two independent investigators determined eligibility and carried out data extraction from the selected studies.Results:A total of 9 studies (817 patients) were selected for this meta-analysis. They included 668 male and 149 female patients, with a mean age ranging from 20.3 to 37.5 years. In the 9 pooled studies, the recurrence rate of shoulder dislocation was 21.5% (84/390) in the ER group versus 34.9% (130/373) in the IR group. ER immobilization significantly reduced the recurrence rate compared with IR immobilization (risk ratio, 0.56; P = .007). In the subgroup analysis of those immobilized full-time, ER immobilization was significantly more effective than IR immobilization in reducing the recurrence rate (risk ratio, 0.57; P = .01). In the subgroup analysis of age, ER immobilization was significantly more effective than IR immobilization in those aged 20 to 40 years but not in those younger than 20 years.Conclusion:This meta-analysis demonstrates that ER immobilization reduces the recurrence rate after primary shoulder dislocation compared with IR immobilization in patients older than 20 years. When treating a patient with primary shoulder dislocation, the clinician should provide this information to the patient before a treatment method is selected.

Magnetic Compression Anastomosis for the Treatment of Post-Transplant Biliary Stricture.

A number of different conditions can lead to a bile duct stricture. These strictures are particularly common after biliary operations, including living-donor liver transplantation. Endoscopic and percutaneous methods have high success rates in treating benign biliary strictures. However, these conventional methods are difficult to manage when a guidewire cannot be passed through areas of severe stenosis or complete obstruction. Magnetic compression anastomosis has emerged as an alternative nonsurgical treatment method to avoid the mortality and morbidity risks of reoperation. The feasibility and safety of magnetic compression anastomosis have been reported in several experimental and clinical studies in patients with biliobiliary and bilioenteric strictures. Magnetic compression anastomosis is a minimally traumatic and highly effective procedure, and represents a new paradigm for benign biliary strictures that are difficult to treat with conventional methods.

Mayer–Rokitansky–Küster–Hauser syndrome as an interdisciplinary problem

The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome, also known as Müllerian agenesis or aplasia, is a congenital disease manifested by the aplasia of the uterus and the upper 2/3 of the vagina; its incidence is 1 in 4,000-5,000 female live births. We can distinguish 2 types of the MRKH syndrome: type I, which is characterized by an isolated absence of 2/3 of the vagina and uterus; and type II or MURCS (Müllerian duct aplasia, unilateral renal agenesis and cervicothoracic somite anomalies), which is also associated with other symptoms. The treatment of the MRKH syndrome patients aims at creating a neovagina and enabling sexual intercourse. Non-surgical techniques are the first-choice methods, and more than 90% of patients notice an anatomical and functional improvement if they are well-prepared emotionally. If non-surgical treatment does not bring about the expected results, a surgical procedure remains an option. The surgical method is mainly determined by the surgeon's experience. There are a few types of operations, though none of them seems superior to others. The next challenge is to provide these patients with a chance to become parents. Nowadays, a uterine transplant, a surrogate or adoption are the available solutions. An interdisciplinary approach is required, and the treatment should consist of medical and psychological support. This review presents the current knowledge about the MRKH syndrome with regard to the current methods of non-surgical and surgical treatment as well as a summary of the associated psychological problems.

A Comparative Assessment of Autologous Conditioned Serum and Ozone for Knee Osteoarthritis Treatment: Mid-Term Follow up

Background: Knee osteoarthritis is a common disease associated with knee pain, physical disability, and joint stiffness. The use of non-surgical treatment methods in patients with knee osteoarthritis is important. Autologous conditioned serum (ACS) is a new regenerative therapeutic method that was investigated by a limited number of clinical trials. So far, using ACS in patients with Knee osteoarthritis remains to be controversial among physicians. Thus, the current study was carried out to compare the therapeutic effects of intra-articular ACS and ozone injections in patients with knee osteoarthritis.Materials and Methods: This prospective, double-blind randomized clinical trial was conducted among 60 patients (30= interleukin-1 receptor antagonist (IL-1Ra) group, 30= ozone group) with knee osteoarthritis, who referred to the Pain Management Clinic of Akhtar Educational Hospital during 2018 to 2019. In the IL-1Ra group, 2 ml of IL-1Ra was injected into the knee joint. The regimen protocol consisted of 4 injections, performed on the first, seventh, fourteenth, and twenty-first days of the treatment and ozone group, 10 ml of ozone (30 μg/ml) + 5 ml of lidocaine 1% were injected into the knee joint. The regimen protocol consisted of 3 injections, performed on the first day of the treatment, one month after the first injection, and two months after the first injection. The severity of pain was assessed by the patients’ self-report of pain and using the visual analog scale (VAS), before the treatment and 1, 3 and 6 months after the treatment. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaires were also measured at before and 6 months following treatment.Results: The changes in the VAS pain at different time periods showed statistically significant differences in the two groups, (P=0.0001). There was no significant difference between the two groups before the treatment and one month and three months after the initiation of the treatment; however, there was a significant difference between the two groups six months after the initiation of the treatment (P=0.0001). KOOS scores of symptoms, daily activities, and athletic and recreational functions were significantly higher in the IL-1Ra group, and the WOMAC scores of physical function and joint stiffness and the overall scores were significantly higher in the IL-1Ra group, (p<0.05).Conclusion: The intra-articular injection of IL-1Ra is a low-invasive, safe, effective, and long-acting method. In patients with knee osteoarthritis, clinical improvements and responses to the intra-articular IL-1Ra injection are better and longer compared to ozone injection. Therefore, it can be considered as a suitable choice in treating patients with chronic knee pain.

Comparative effectiveness of complex physiotherapeutic treatment of patients in the early stages of avascular necrosis of the femoral head

In the late stages of avascular necrosis of the femoral head (ANFH), total hip arthroplasty (THA) is a non-alternative treatment method. In the early stages, methods of conservative treatment show some effectiveness. Among them, most often there is evidence of the effectiveness of physiotherapy options. Of this study is the development and study of a method of complex non-surgical treatment of ANFH based on a combination of physiotherapy and phytotherapy methods. We examined 60 patients with early stages of ANFH, who underwent courses of complex treatment. Patients of the primary group received a complex, including: exposure to acupuncture points in the area of hip joint (HJ) with low-frequency currents using the Osteon-1 apparatus in combination with phytoapplications, HJ massage, special physiotherapy exercises. Unloading the HJ (walking on crutches) was mandatory component. Patients in the control group were treated using a complex including: manual massage of HJ, the use of sinusoidally modulated currents and ultraphonophoresis of hydrocortisone on the affected joint. In order to assess the dynamics of the clinical and functional state of HJ before and after the treatment, Harris questionnaire, radiography, ultrasound densitometry, and laser Doppler imaging were used. Quality of life was assessed using the SF36 questionnaire. The full course of treatment was 1 month. Long-term results were studied after 1 year by the questionnaire method. In patients of both groups, a positive dynamics of the clinical and functional state of the joints was registered, but higher statistically significant indicators were obtained in the primary group. Moreover, in a significant number of patients (in 95% of cases), positive clinical results persisted throughout the year. The use of a complex of treatment based on physiotherapy and a combination of physiotherapy and phytotherapy makes it possible for us to obtain positive clinical and functional dynamics of the state of the joints and an increase in the quality of life in patients with ANFH.

MODERN ENDOVASCULAR TREATMENT METHODS FOR ERECTILE DYSFUNCTION: A CRITICAL ANALYSIS

75% of men with coronary artery disease confirmed by coronarography have erectile dysfunction in history, while 75% of patients with a vascular etiology of ED have significant stenoses in penile arterial vascularization. Patients with coronary artery disease have shown a relationship between the range of the lesions in the coronary vessels and erectile dysfunction intensity. This paper aims at attempting to systematize the knowledge of the benefits and drawbacks of nonsurgical endovascular treatment methods for erectile dysfunction with confirmed vascular causes. It analyzes seven studies which assess the results of erectile dysfunction treatment with percutaneous angioplasty. It also mentions the limitations of the cited works and formulates relevant conclusions. Conclusions: The analysis shows that endovascular procedures in erection-related arteries are safe in a specially selected group of men. It is necessary to conduct further studies to define an appropriate group of patients who have a chance of benefiting optimally from the endovascular treatment of erectile dysfunction in a long-term follow-up.

Transcatheter pulmonary valve implantation in 100 patients: a 10-year single-center experience.

IntroductionTranscatheter pulmonary valve implantation (TPVI) is a non-surgical method of treatment for patients with right ventricular outflow tract (RVOT) dysfunction after surgical repair of congenital heart defects (CHD).AimTo evaluate the long-term results of TPVI performed in a single center.Material and methods: Over 10 years, TPVI was performed in 100 patients (mean age: 26.4 ±8.1 years), using Melody Medtronic or Sapien Edwards valves.ResultsThe initial success rate of TPVI was 93%. In 7 cases (5 urgent), a switch to surgical intervention was necessary due to periprocedural complications (all patients survived). Following TPVI, none of the 93 patients had severe pulmonary regurgitation. The pulmonary gradient decreased from 49.0 ±37.8 before to 27.6 ±14.9 mm Hg directly after TPVI (p < 0.0001). Right ventricular end-diastolic volume decreased, while NYHA class and pVO2 uptake significantly improved in 1 year after TPVI. Freedom from reintervention was 100% in 1 year. Freedom from serious adverse events was 86% in mean 5.5 years of observation. The main reason for reintervention was infective endocarditis (IE) (1.6% patients/year). Increased risk of IE was associated with severe PS before valve implantation and the suboptimal result of TPVI. The incidence of IE seems to be lower in patients treated permanently with antiplatelet therapy (1.8% vs. 0.9% patients/year, NS).ConclusionsTPVI is a safe and effective method of treatment in patients with RVOT dysfunction after surgical correction of CHD. To achieve a good outcome, precise patient selection and rigorous IE prevention are necessary.

Ledderhose Disease With Concomitant Presence of Dupuytren Contracture: A Case Report and Review of the Literature

Ledderhose disease, or plantar fibromatosis, is a rare benign disorder of fibrous proliferation in the plantar aponeurosis. It is known to be highly associated with Dupuytren disease of the hand by sharing similar symptomatology and treatment methods. This case study explores a presentation of Ledderhose disease in a 56-year-old male with concomitant Dupuytren contracture. The patient underwent surgical excision resulting in symptomatic relief with regained function. This case highlights diagnostic measures, association with Dupuytren disease, and both surgical and nonsurgical treatment methods of Ledderhose disease.

Результаты нехирургического лечения витреомакулярной тракции с применением бактериальной коллагеназы

Purpose. To study the efficacy of a developed method of non-surgical treatment of vitreomacular traction (VMT) using the bacterial collagenase. Material and methods. The study group included 65 cases of VMT with a length from 20 to 3100 μm. The VMT was isolated in 22 cases, and it was complicated in 43 cases: by macular hole (29 eyes) or epiretinal fibrosis (14 eyes). Results. In 3 cases (4.6%) within three months after the diagnosis there was a spontaneous resolution of traction with the restoration of the macular profile. In 48 cases (73.9%) an elimination of VMT after the treatment was achieved. In 14 cases (21.5%) VMT could not be eliminated. In 15 cases it was possible to achieve not only the elimination of VMT, but also the closure of macular hole. In 9 cases, it was possible to achieve the resolution of VMT and epiretinal fibrosis with the improved visual acuity. Conclusion. The obtained results showed that the developed method of non-surgical treatment of VMT can be the method of choice in the treatment of both isolated and complicated VMT of any length.

Treatment of relapsed, residual and neglected clubfoot: adjunctive surgery.

Over the past two decades, the Ponseti ‘conservative’ (non-surgical) method of clubfoot treatment has been almost universally adopted worldwide. As a result, the need for operative treatment for clubfoot has decreased dramatically. However, even Ponseti himself routinely used surgery for certain patients: at least 90% of feet need percutaneous tenotomy, and 15% to 40% may require tibialis anterior tendon transfer. Additionally, relapses are common, sometimes necessitating further surgical intervention. Relapses are recurrent deformities in previously well corrected feet. Residual deformities may be defined as persistent deformities in incompletely corrected feet. In addition, in many parts of the developing world, neglected clubfoot is still a major challenge. Many neglected feet can be treated with Ponseti principles, particularly in younger children. However, in older children and adults, surgical approaches are more likely to be needed. Major reasons for relapsed/residual clubfoot include incomplete application of the Ponseti principles, inability to adhere to the foot abduction brace protocol, failure to recommend a complete course of bracing and inadequate follow-up. Sometimes, despite excellent treatment, and perfect adherence to the bracing protocols, there are still relapses, related to intrinsic muscle imbalance. We describe several solutions that include reinstitution of Ponseti casting and ‘á la carte’ operative treatment. As an alternative for particularly stubborn cases, application of a hexapod external fixator can be a powerful tool. In order to be a full-service clubfoot specialist, and not only a Ponseti practitioner, one must have in their toolbox the full gamut of adjunctive surgical options.Level of Evidence:V

Post-operative bleeding complications in laparoscopic sleeve gastrectomy: sources, solutions and lessons learnt from a single cohort of patients

Post-operative bleeding is a major but infrequent complication in laparoscopic sleeve gastrectomy (LSG). There is paucity in the literature on management of this complication. This paper seeks to review the presentation of post-operative bleeding complications after LSG in a single cohort of patients and highlight the surgical and non-surgical methods of treatment. A retrospective study of 409 LSG patients performed in a tertiary hospital, Singapore General Hospital (SGH) since 2008. Patients who encountered post-operative bleeding complications, defined as requiring blood transfusion or re-laparoscopy for haemostasis, were identified from a prospectively recorded database. The presentation, source of bleeding and management were recorded and presented. Five out of 409 (1.2%) patients were diagnosed with post-operative bleeding. Two patients were treated conservatively requiring only blood transfusion and 3 patients were surgically explored with laparoscopy, 2 were from staple line bleeding (SLB) and suture haemostasis performed. In 1 patient, the source of bleeding was not identified intraoperatively and CT angiography performed post-operatively showed active contrast bleeding near short gastric arteries and gastroepiploic artery. Gel foam and coil embolization was performed and the bleeding was controlled. Average hospitalization stay due to post-operative bleeding was 7.3 days compared to 2.3 days for those without. Post-operative bleeding after LSG occurred at the staple line and branches of the right gastro-epiploic artery and short gastric arteries. Bleeding may stop spontaneously or require haemostasis by operative or endovascular means. CT angiogram is proposed to locate the source of bleed and subsequent embolization of bleeding arteries maybe possible, avoiding the need for re-operation. Bleeding from the staple line requires surgical haemostasis.

Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis

Lumbar spinal stenosis (LSS) is the most common reason for spine surgery in older US adults. There is an evidence gap about nonsurgical LSS treatment options. To explore the comparative clinical effectiveness of 3 nonsurgical interventions for patients with LSS. Three-arm randomized clinical trial of 3 years' duration (November 2013 to June 2016). Analysis began in August 2016. All interventions were delivered during 6 weeks with follow-up at 2 months and 6 months at an outpatient research clinic. Patients older than 60 years with LSS were recruited from the general public. Eligibility required anatomical evidence of central canal and/or lateral recess stenosis (magnetic resonance imaging/computed tomography) and clinical symptoms associated with LSS (neurogenic claudication; less symptoms with flexion). Analysis was intention to treat. Medical care, group exercise, and manual therapy/individualized exercise. Medical care consisted of medications and/or epidural injections provided by a physiatrist. Group exercise classes were supervised by fitness instructors in senior community centers. Manual therapy/individualized exercise consisted of spinal mobilization, stretches, and strength training provided by chiropractors and physical therapists. Primary outcomes were between-group differences at 2 months in self-reported symptoms and physical function measured by the Swiss Spinal Stenosis questionnaire (score range, 12-55) and a measure of walking capacity using the self-paced walking test (meters walked for 0 to 30 minutes). A total of 259 participants (mean [SD] age, 72.4 [7.8] years; 137 women [52.9%]) were allocated to medical care (88 [34.0%]), group exercise (84 [32.4%]), or manual therapy/individualized exercise (87 [33.6%]). Adjusted between-group analyses at 2 months showed manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care (-2.0; 95% CI, -3.6 to -0.4) or group exercise (-2.4; 95% CI, -4.1 to -0.8). Manual therapy/individualized exercise had a greater proportion of responders (≥30% improvement) in symptoms and physical function (20%) and walking capacity (65.3%) at 2 months compared with medical care (7.6% and 48.7%, respectively) or group exercise (3.0% and 46.2%, respectively). At 6 months, there were no between-group differences in mean outcome scores or responder rates. A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity. ClinicalTrials.gov Identifier: NCT01943435.

Огляд сучасних методів лікування раннього раку гортані

Aim. To review and analyze the basic methods of treating early laryngeal cancer used in clinical practice. Material and Methods. Scientific articles on the subject listed in the international science-computer bases were selected for analysis. The basic indications and contraindications for application of various surgical and non-surgical methods of treatment of early laryngeal cancer were determined. Results and Discussion. The goal of treatment of early laryngeal cancer at the present stage is not only ablastic elimination of the tumor, but also preservation of the organ and its linguistic function. The development of endoscopic and robotic surgical techniques as well as of radiation therapy equipment has greatly expanded the arsenal of procedures for a physician over the last decade. At the same time, the accumulated experience of large medical centers allowed to separate indications for each of the methods. Analysis and systematization of their results will allow changing the existing treatment principles, identifying groups of patients for the optimal surgical or radiotherapy treatment, which will preserve voice and reduce the frequency of relapse. Conclusions. In early laryngeal cancer patients have two main methods of treatment: radiotherapy or surgery. For the final choice, it is necessary to take into account a number of circumstances: the location and prevalence of the process; the duration of treatment; the cost and effectiveness of treatment; the experience and skills of ENT-surgeon.

Analysis of clinical and microbiological results of photodynamic therapy as support in non-surgical treatment of periodontitis – preliminary study

Introduction. Photodynamic therapy is supportive method of non-surgical treatment of periodontitis. The aim of the study was the assessment of photodynamic therapy impact on periodontal disease clinical parameters with a particular emphasis on microbiological aspects during periodontal treatment. Material and methods. The research was conducted on seven healthy patients aged 26- 55 years. All the patients were treated with a non-surgical (SRP) periodontal treatment. Then, the assisted photodynamic therapy was applied in selected pockets. Samples of the material obtained from periodontal pockets before and after the treatment were cultured in a microbiological laboratory. Results. After the introduced therapy the clinical improvement of periodontal disease was observed in the majority (6/7) of patients taking part in the study. There obtained the elimination of inflammation to 85.7% of the patients. Periodontal pocket depths have deteriorated from 0.5 to 3.0 mm in comparison to the pre-treatment values. The overall number of bacteria compared to the pre-treatment value was reduced. In addition, there was noticed a decrease in the number of periopathogens. Control samples showed a vivid dominance of the physiological flora. Conclusions. The non-surgical treatment of periodontitis in combination with the supportive action of photodynamic therapy has promising therapeutic effects by reducing the inflammation and decreasing the depth of periodontal pockets. The change in the ratio of periopathogens to physiological flora may indicate the restoration and maintenance of the state balance in periodontal pockets for patients with periodontitis.

Use of local corticosteroid injection in the treatment of plantar fasciitis

Background and Objectives: Plantar fasciitis is a common pathological condition that affects the hind foot. Management of plantar fasciitis employs use of various non-surgical and surgical treatment methods. The aim of this study was to evaluate the efficacy of steroid injection in the treatment of plantar fasciitis in adults.&#x0D; Materials and Methods: From January 2016 to June 2017, fifty patients aged &gt;18 years with plantar fasciitis symptomatic for three months or more were injected with a single dose of methylprednisolone acetate with 2% lignocaine. Assessment was done using visual analogue scale (VAS) and foot function index (pain sub-scale). Patients were followed-up for a period of 6 months.&#x0D; Results:There was significant reduction in VAS score and improvement in foot function index at 1 and 3 month follow-up (p&lt;0.001) as compared to pre-injection score but this VAS reduction or improvement in foot function index was not significant at 6 month follow-up (p=0.057 and 0.729 respectively). There were no major adverse effects of the steroid injection.&#x0D; Conclusion: A single dose of corticosteroid injection provides only a short term benefit in plantar fasciitis.