Nonsurgical Treatment Research Articles

Comparison of two treatment modalities in the management of gingival enlargement during orthodontic treatment: a randomized clinical trial.

This clinical trial aimed to evaluate and compare the effectiveness of diode laser gingivectomy, conventional gingivectomy, and nonsurgical periodontal treatment (NSPT) in the management of gingival enlargement (GE) during orthodontic treatment. forty-five healthy, orthodontic patients with labial gingival enlargement on the 6 anterior teeth were selected and randomly assigned to one of the groups (Conventional, Laser, and NSPT). Clinical parameters including clinical crown length (CCL) , periodontal pocket depth (PPD), and vertical gingival overgrowth index (vGOi) were recorded at baseline, 1 month, 3 months, and 6 months. Postoperative pain was evaluated at 1,3, and 7 days. Esthetic satisfaction and acceptance of the procedure were recorded on day 10 and repeated after 6 months. Statistically significant results were obtained for mean reduction in PPD for conventional, laser, and NSPT groups (-1.43, -.1.75, and -0.9 mm, respectively; P < 0.001), CCL gain (1.45, 1.7, and 0.38 mm, respectively; P<0.001) and mean vGOi score (-1.14, -1.29 and -0.76, respectively; P<0.001) over 6 months. Both test groups showed greater statistically significant changes in clinical parameters over 6 months compared to NSPT (P<0.001). There was a gradual decrease in postoperative pain for all three groups over 7 days, with conventional group showing statistical difference in mean pain score on days 1 and 3 compared to other groups. Both conventional and laser gingivectomies were more effective in controlling enlargement over non-surgical periodontal treatment alone at 1, 3, and 6 months. laser and conventional gingivectomies as adjunctive treatments achieved superior results when compared to NSPT alone in the treatment of GE and gingival inflammation during orthodontic treatment, with no significant clinical differences between the two treatments.

What is the incidence and non-union rate of radiation-associated fractures? – A systematic review of the literature

BackgroundRadiation-associated fractures (RAFs) are a challenging complication in oncologic patients, yet their incidence remains unknown and optimal management lacks consensus. AimThis review aimed to evaluate the incidence of RAFs in the trunk, pelvis, and extremities as well as non-union rates of surgical and non-surgical treatment. Materials and methodsA systematic review of PubMed and Embase databases was conducted. The study was registered on PROSPERO (ID: CRD42024513017). Studies were included if they reported RAFs in oncologic populations, had a sample size of at least five patients, and provided extractable data on RAF incidence or number. The STROBE checklist was utilized for evaluation of study quality. For eligible studies, quantitative analyses were conducted to determine weighted incidence of RAF and fracture non-union. ResultsThirty-five studies comprising 9,980 patients treated with radiation therapy were included. The weighted incidence of RAFs was calculated to be 6.5% across 8,061 patients. The weighted incidence of femoral RAF was 5.2%, while pelvic RAF incidence was 17.1%. Non-union rates after initial treatment varied from 4% to 100%, with an overall weighted incidence of 48%. Treatments included intramedullary nailing, fixation with screws/plate, prosthetic replacement, conservative treatment, and amputation, with varying success rates. ConclusionThis review highlights RAFs as a significant complication of radiation therapy, with a weighted incidence of 6.5% and a non-union rate of 48%. Advanced radiation techniques have reduced RAF occurrences, but non-union remains a challenge, necessitating tailored treatment strategies. Further research is needed to optimize RAF management and improve patient outcomes.

Non-surgical treatment for tandem spinal stenosis: a systematic review protocol

BackgroundTandem Spinal Stenosis (TSS) is a disease characterised by the narrowing of the spinal canal in two or more non-adjacent areas of the spine, often affecting both the cervical and lumbar vertebrae. Doctors and patients increasingly favour non-surgical treatments that have the function of relieving symptoms and improving outcomes. This systematic review aims to evaluate the effectiveness and safety of non-surgical therapies for TSS and comprehensively summarise existing evidence.Methods and analysisWe will conduct comprehensive searches, both manual and electronic, of literature published up to 30 September 2024; database searches will commence after the publication of this agreement, with an estimated commencement date of 1 December 2024, and the end date is 31 May 2025, without language restrictions. Key databases such as MEDLINE, PubMed, EMBASE, Web of Science, Cochrane Library, WHO International Clinical Trial Registration Platform, China National Knowledge Infrastructure, China Biomedical Literature Database, China Scientific Journal Database and Wan-Fang Database will be explored. In addition, we will include resources such as library journals and conference abstracts. Following the identification and screening of all randomised controlled trials focusing on non-surgical treatments for TSS, two investigators will perform a meta-analysis of the included studies. The findings will be summarised as the risk ratio for binary data and the standardised or weighted mean difference for continuous data.Ethics and disseminationEthical approval is not required, as the review does not involve individual patient data. The review’s findings will provide clinicians with evidence on using non-surgical treatments for TSS, disseminated through peer-reviewed publications or conferences.PROSPERO registration numberCRD42024496634.

Diagnosis and endodontic treatment of odontogenic cutaneous sinus tracts: A report of two cases

Introduction: The odontogenic cutaneous sinus tract (OCST), caused by pulp necrosis, creates connections between pathological spaces and anatomical structures. Extraoral manifestations pose diagnostic challenges leading to inappropriate treatments such as multiple surgery and antibiotic therapies. Effective management requires the treatment of dental pathology through endodontic therapy or extraction. This paper presents two cases of OCST and emphasizes the importance of accurate diagnosis and successful non-surgical endodontic treatment. Observations: Case report 1: A 23-year-old male patient referred by his dermatologist with a cutaneous sinus tract on his chin that had appeared five years ago. During this period, he reported spontaneous pain and pus discharge from the chin area. The examination revealed a periapical lesion associated with tooth number 31. Cone beam computed tomography (CBCT) revealed the existence of a localized perforation on the buccal alveolar table and a second root canal of the tooth. After six months of follow-up, the cutaneous sinus tract was significantly improved by the appropriate endodontic treatment. Case report 2: A 36-year-old female patient was referred by her dentist to examine a chin lesion that had appeared a month ago. In clinical examination and radiographic assessment, periapical lesion associated with two mandibular central incisor teeth #41 and #31 was observed. After identifying the source of infection, endodontic treatment was carried out, and a good improvement in fistula was observed after one month. Conclusions: The correct diagnosis and treatment of OCST are important for healing. CBCT aids to identify odontogenic origin of the sinus tract through the detection of apical periodontitis and bone lesion. Root canal therapy is the treatment of choice for these cases and should always be attempted first. Monitoring the patients is necessary until complete healing of the disease.

The immune landscape in apical periodontitis: From mechanism to therapy.

Apical periodontitis (AP) is featured by a persistent inflammatory response and alveolar bone resorption initiated by microorganisms, posing risks to both dental and systemic health. Nonsurgical endodontic treatment is the recommended treatment plan for AP with a high success rate, but in some cases, periapical lesions may persist despite standard endodontic treatment. Better comprehension of the AP inflammatory microenvironment can help develop adjunct therapies to improve the outcome of endodontic treatment. This review presents an overview of the immune landscape in AP, elucidating how microbial invasion triggers host immune activation and shapes the inflammatory microenvironment, ultimately impacting bone homeostasis. The destructive effect of excessive immune activation on periapical tissues is emphasized. This review aimed to systematically discuss the immunological basis of AP, the inflammatory bone resorption and the immune cell network in AP, thereby providing insights into potential immunotherapeutic strategies such as targeted therapy, antioxidant therapy, adoptive cell therapy and cytokine therapy to mitigate AP-associated tissue destruction.

Beyond The Usual Suspects: A Challenging Case Of Radix Entomolaris With Endodontic-Periodontal Lesion: A Case Report

The purpose of this case report is to present an unusual endodontic periodontal lesion along with radix entomolaris in tooth 46 in a 31-year-old female patient with intermittent pain and sensitivity to hot and cold stimuli. Clinical examination revealed deep dentinal caries and periodontal pocket depth of 5mm in tooth #46.The radiographic examination revealed an extra distal root with a periapical radiolucency in tooth #46. patient was diagnosed with irreversible pulpitis and chronic apical periodontitis, with secondary periodontal involvement due to an endodontic-periodontal lesion. Non-surgical root canal treatment was performed, followed by canal obturation with resin-based sealer and final restoration with a porcelain fused to metal crown. After a 3-month follow-up, the patient remained asymptomatic, radiographs showed bone reposition, and periodontal probing depth decreased, indicating successful treatment.

Cause of death following conservative, non-surgical treatment for seasoned patients with early-stage, low-grade endometrial cancer

Cause of death following conservative, non-surgical treatment for seasoned patients with early-stage, low-grade endometrial cancer

Danning tablets for the treatment of multiple gallbladder polyps: Study protocol of multicentre, randomised, open-labelled, controlled trial

IntroductionGallbladder polyps (GPs) are protrusions of the gallbladder wall into the lumen, and are commonly detected during ultrasound examinations. Traditional management of multiple GPs (MGPs) has been conservative, including lifestyle interventions, regular monitoring, and surgical intervention in certain cases, but this approach poses risks of polyps enlargement and increase of number, as well as patients’ psychological burdens. Danning Tablets, a traditional Chinese medicine, have emerged as a potential non-surgical treatment for GPs, showing promise in reducing polyp size and alleviating symptoms, backed by their anti-inflammatory and antitumor properties demonstrated in preclinical studies. This suggests the need for further research into Danning Tablets as an alternative treatment for MGPs. Methods and analysisThe study is designed as a prospective, randomized, controlled, open-label trial. The study will be conducted across multiple centres specializing in gastroenterology and hepatology. Participants will be recruited from these centres, ensuring a diverse patient demographic. Adult patients diagnosed with MGPs, based on ultrasound findings, will be included. Exclusion criteria include patients with a history of gallbladder cancer, previous gallbladder surgery, or serious comorbid conditions. The control group will receive standard care, including dietary and lifestyle advice, while the intervention group will receive Danning Tablets and standard care. The dosage and administration of Danning Tablets will follow established clinical guidelines. The primary outcome will be the change in size of the largest gallbladder polyps on week 24 ​± ​1, measured by ultrasound. The secondary outcomes will include symptom improvement and recording of any adverse events. The study will span over a period of 6 months, with periodic assessments at baseline, 4, 8, 12, and 24 weeks.

Conservative, non-surgical treatment for young patients with early-stage, low-grade endometrial cancer: Population-level trends and oncologic outcomes

Conservative, non-surgical treatment for young patients with early-stage, low-grade endometrial cancer: Population-level trends and oncologic outcomes

Ultrasound-Guided Needling Combined With High- or Low-Energy Extracorporeal Shock Wave Therapy Versus Needling Alone for Calcified Rotator Cuff: A Retrospective Study.

Rotator cuff calcific tendinitis is a common shoulder joint disorder. Nonsurgical treatment methods, including multiple needling and extracorporeal shock wave therapy (ESWT), can effectively treat calcific tendinitis. To evaluate the clinical results and radiological outcomes of treatment with ultrasound-guided needling (UGN) alone versus UGN with high-energy ESWT (UGN-H) or UGN with low-energy ESWT (UGN-L) in patients with calcific tendinitis of the rotator cuff. Cohort study; Level of evidence, 3. Outpatient records for patients with calcific tendinitis of the rotator cuff were evaluated retrospectively. Patients were grouped into those treated with UGN-H, UGN-L, or controls with UGN alone. The visual analog scale (VAS) for pain, American Shoulder and Elbow Surgeons (ASES) scores, Constant-Murley scores, and radiographic evaluation to assess calcification size were available before treatment and at 3, 6, and 12 months after the first treatment. Post event pairwise analysis to analyze score differences between treatment groups was used. Overall, 130 patients were included for analysis (42 UGN-H, 44 UGN-L, and 44 with UGN alone). At 3 months, the VAS scores were UGN-H (4.13 ± 0.84; P < .001) and UGN-L (4.47 ± 1.01; P < .001) which were significantly better than UGN alone (5.35 ± 1.00) in terms of the VAS score; however, the difference was not significant between UGN-H and UGN-L. These differences persisted at months 6 and 12 (6 months: UGN-H, 2.66 ± 1.00; P < .001; UGN-L, 3.16 ± 1.05; P = .033; 12 months: UGN-H, 1.93 ± 0.43; P < .001; UGN-L, 2.04 ± 0.46; P < .001). The results of the ASES and Constant-Murley scores were similar to those of the VAS score. In terms of radiographic outcome, follow-up at months 3, 6, and 12 revealed that UGN-H and UGN-L were superior to UGN alone at removing calcification (median 95% CI; 3 months: UGN-H, 1.4 mm2 [1.08, 7.25 mm2); P = .002; UGN-L, 5.79 mm2 (1.17, 7.85 mm2]; P = .041; 6 months: UGN-H, 0.91 mm2 [0, 1.15 mm2); P < .001; UGN-L, 1.13 mm2 [0.84, 5.10 mm2]; P < .001; 12 months: UGN-H, 0 mm2 [0, 0 mm2]; P < .001; UGN-L, 0 mm2 (0, 4.33 mm2]; P = .023). There was no significant difference between UGN-H and UGN-L at the month 3 follow-up, but the month 6 and 12 follow-ups revealed that UGN-H was more effective at removing calcification compared with UGN-L. The study demonstrated that, for pain relief and recovery of shoulder joint function, UGN + ESWT was significantly superior to UGN alone. No significant difference was observed between different energy levels of ESWT. UGN + ESWT was significantly superior to UGN alone on radiographic evaluation. Furthermore, UGN-H performed better radiographically with reducing calcifications compared with UGN-L at 12 months.

Nonsurgical root canal treatment of an Oehlers type IIIa maxillary central incisor with dens invaginatus: a case report

Dens invaginatus has a complex anatomy, making endodontic treatment challenging. We report the case of a 11-year-old girl who presented with radiolucency at the apex of the maxillary central incisor; she was diagnosed with symptomatic apical periodontitis. Cone-beam computed tomography (CBCT) revealed dens invaginatus. The invagination and root canal were observed using a dental operating microscope, and nonsurgical root canal treatment was performed. The invagination was connected to the periodontal tissue, and the tooth was classified as Oehlers type IIIa. Root canal preparations were performed using NiTi files and an ultrasonic device. A calcium hydroxide paste was used as an intracanal dressing. The root canal was filled using a single-cone hydraulic condensation technique with a highly fluid calcium silicate-based sealer. At the 2-year follow-up, no clinical symptoms were observed, and CBCT images revealed no radiographic lesions. Nonsurgical endodontic treatment using CBCT imaging, dental microscope, effective cleaning systems, and a highly fluid sealer facilitated the successful treatment of apical periodontitis attributed to dens invaginatus. The single-cone hydraulic condensation technique using a bio-ceramic sealer is considered effective even in cases with a complex morphology and open apex.

Nonsurgical endodontic treatment of Type II dens invaginatus by removal of the internal structure of the tooth : a case report

Dens invaginatus is a developmental anomaly that occurs when the enamel organ is invaginated into the dental papilla before the process of calcification during tooth development. Dens invaginatus exhibits various anatomical variations, and these structural changes can complicate treatment. For effective management of dens invaginatus, it is crucial to accurately understand the internal structure of the tooth and to establish an appropriate treatment plan. Cone-beam computed tomography (CBCT) has proven to be a valuable tool for three-dimensional reconstruction of the tooth. This case report presents a maxillary lateral incisor with pulpal necrosis and periapical periodontitis. The case involves dens invaginatus characterized by a separate tooth structure, diagnosed using CBCT, and a treatment plan was established accordingly. For treatment, a dental microscope was used to remove the internal structure of the tooth, followed by filling with mineral trioxide aggregate (MTA).

Total Hip Replacement or Resistance Training for Severe Hip Osteoarthritis

BackgroundTotal hip replacement is routinely recommended for severe hip osteoarthritis, but data from randomized trials are lacking regarding comparison of the effectiveness of this procedure with that of nonsurgical treatment such as resistance training.MethodsWe conducted a multicenter, randomized, controlled trial to compare total hip replacement with resistance training in patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery. The primary outcome was the change in patient-reported hip pain and function from baseline to 6 months after the initiation of treatment, assessed with the use of the Oxford Hip Score (range, 0 to 48, with higher scores indicating less pain and better function). Safety was also assessed.ResultsA total of 109 patients (mean age, 67.6 years) were randomly assigned to total hip replacement (53 patients) or resistance training (56 patients). In an intention-to-treat analysis, the mean increase (indicating improvement) in the Oxford Hip Score was 15.9 points in patients assigned to total hip replacement and 4.5 points in patients assigned to resistance training (difference, 11.4 points; 95% confidence interval, 8.9 to 14.0; P<0.001). At 6 months, 5 patients (9%) who had been assigned to total hip replacement had not undergone surgery, and 12 patients (21%) who had been assigned to resistance training had undergone total hip replacement. The incidence of serious adverse events at 6 months was similar in the two groups; the majority of such events were known complications of total hip replacement.ConclusionsIn patients 50 years of age or older who had severe hip osteoarthritis and an indication for surgery, total hip replacement resulted in a clinically important, superior reduction in hip pain and improved hip function, as reported by patients, at 6 months as compared with resistance training. (Funded by the Danish Rheumatism Association and others; PROHIP ClinicalTrials.gov number, NCT04070027.)

Enhancing Acromioclavicular Rehabilitation and Functional Capacity With Blood Flow Restriction Training: A Case Report

BACKGROUND: Type V Acromioclavicular joint (ACJ) separations often require surgical stabilization to restore functional capacity of the shoulder. However, the purpose of this case study is to demonstrate non-surgical management of this condition. CASE PRESENTATION: A 32-year-old female with a radiographic Type V ACJ separation underwent non-surgical management. This case used a novel criteria-based protocol which utilized 6 weeks of upper extremity blood flow restriction (BFR) to restore the functional capacity of a radiographic type V ACJ separation. OUTCOME AND FOLLOW UP: Following non-surgical management, there was a 2.47 fold increase in external rotation strength, 97% limb symmetry on upper quarter Y-Balance, a score of 91 on American Shoulder and Elbow Surgeons assessment, and 9 mm radiographic reduction of the coracoclavicular interval. DISCUSSION: The case illustrates how clinical findings did match the radiographical findings, but the non-surgical treatment using upper extremity BFR provided a desired functional outcome.

Current Status of Immunotherapy in Management of Small Bowel Neuroendocrine Tumors.

This study aims to present the current landscape of immunotherapy in the management of small bowel neuroendocrine tumors and identify ongoing and future targets for improved response. Somatostatin analogs and mTOR inhibitors remain cornerstones of non-surgical treatment, and applications of PRRT in SBNET are promising. Several efforts to replicate the success of immunotherapies in other solid tumors have been attempted in SBNET, with limited responses observed with current immune targets, such as PD-1/PD-L1 and CTLA-4. Epigenetic analyses have suggested a potential role for methylation and histone acetylation in SBNET tumorigenesis that warrant greater exploration. While the incidence of SBNET continues to increase, the number of effective therapies is few. Further elucidation of targetable components of the SBNET immune microenvironment with greater modulatory effects is necessary to improve outcomes in this growing patient population.

The worn knee

Early osteoarthritis in patients between 35 and 65 years of age is mostly observed following previous cartilage, meniscus, and bone or ligament injuries. The expectations individuals have regarding their physical abilities have increased over the past few decades. Patients who despite relevant non-surgical treatment still experience knee pain are often a challenge for primary care. The purpose of this review is to provide non-orthopaedic surgical colleagues with an overview of the surgical assessment and treatment for young patients (less-than 65 years) with early signs of osteoarthritis of the knee.

Long noncoding RNA Sngh20 promotes vascular smooth muscle cell senescence and abdominal aortic aneurysm growth by interacting with dead-box helicase 5

Abstract Background Development of non-surgical treatment of human abdominal aortic aneurysm (AAA) has clinical significance. Long noncoding RNAs (lncRNAs) are emerging as powerful mediators participated in cellular senescence process that a critical pathological alteration prompting AAA development. Purpose To investigate the role and underlying mechanism of lncRNA Small nucleolar RNA host gene-20 (Snhg20) in AAA formation. Methods Experimental AAA mice models were produced by peri-aortic CaPO4 injury in C57bl/6J mice or Subcutaneousangiotensin-II (Ang-II) infusion in Apoe–/– mice and gapmeR was used to knockdown Snhg20 expression. Adeno-associated virus and anti-IL-6 monoclonal antibody was used to knockdown dead-box helicase 5 (DDX5) and neutralize IL-6, respectively.Immunohistochemical and immunofluorescent staining, ELISA and real-time PCR were performed to determine the vascular structure and inflammation, cellular senescence and senescence-associated secretory phenotype (SASP) content in human and mouse AAA lesions. Human aortic SMC cell line was used to investigate the effect of Snhg20 knockdown on senescence and SASP in vitro. LncRNA pulldown and mass spectrometry were used to identify potential targets that interact with Snhg20. p53 DNA binding affinity was examined by EMSA. Results The expression of Snhg20 was downregulated in both human and mice AAA lesion. Snhg20 knockdown promoted SMC senescence and loss, vascular inflammation and AAA growth in both experimental AAA mice models. Mechanistically, Snhg20 interacted with DDX5, an important transcriptional coactivator of p53. The absence of snhg20 increased DDX5 and p53 interaction and thereby promoted p53 DNA binding affinity to transcriptionally initiate p21expression, resulting in increased cellular senescence and senescence-associated secretory phenotype (SASP) secretion, including IL-6. Moreover, DDX5 silencing or anti-IL-6 therapy rescued the SMC senescence and loss, vascular inflammation and AAA growth mediated by Snhg20 knockdown. Furthermore, human AAA lesions showed increased DDX5 co-localization with p53 and abundant senescent vascular SMC. Conclusion These findings identify an important role of Snhg20 in controlling vascular SMC senescence and SPAP expression and suggest that Snhg20 is a potential target for AAA treatment aimed at reducing VSMCs senescence.Schematic summary

Spatial immunogenomic patterns associated with lymph node metastasis in lung adenocarcinoma

BackgroundLung adenocarcinoma (LUAD) with lymph node (LN) metastasis is linked to poor prognosis, yet the underlying mechanisms remain largely undefined. This study aimed to elucidate the immunogenomic landscape associated with LN metastasis in LUAD.MethodsWe employed broad-panel next-generation sequencing (NGS) on a cohort of 257 surgically treated LUAD patients to delineate the molecular landscape of primary tumors and identify actionable driver-gene alterations. Additionally, we used multiplex immunohistochemistry (mIHC) on a propensity score-matched cohort, which enabled us to profile the immune microenvironment of primary tumors in detail while preserving cellular metaclusters, interactions, and neighborhood functional units. By integrating data from NGS and mIHC, we successfully identified spatial immunogenomic patterns and developed a predictive model for LN metastasis, which was subsequently validated independently.ResultsOur analysis revealed distinct immunogenomic alteration patterns associated with LN metastasis stages. Specifically, we observed increased mutation frequencies in genes such as PIK3CG and ATM in LN metastatic primary tumors. Moreover, LN positive primary tumors exhibited a higher presence of macrophage and regulatory T cell metaclusters, along with their enriched neighborhood units (p < 0.05), compared to LN negative tumors. Furthermore, we developed a novel predictive model for LN metastasis likelihood, designed to inform non-surgical treatment strategies, optimize personalized therapy plans, and potentially improve outcomes for patients who are ineligible for surgery.ConclusionsThis study offers a comprehensive analysis of the genetic and immune profiles in LUAD primary tumors with LN metastasis, identifying key immunogenomic patterns linked to metastatic progression. The predictive model derived from these insights marks a substantial advancement in personalized treatment, underscoring its potential to improve patient management.

Cesarean scar pregnancy: should surgery be the preferred treatment approach?

To compare the characteristics and outcomes of non-surgical and surgical treatments for Cesarean scar pregnancy (CSP). A retrospective study conducted at a tertiary university affiliated medical center, including all women diagnosed with Cesarean scar pregnancy between 2019 and 2023. Women treated non-surgically (including: methotrexate, uterine artery embolization and balloon catheter) were compared to women treated surgically (including: hysterectomy, hysteroscopy and excision of the pregnancy with or without uterine niche repair). Demographic information, medical history, obstetric and gynecological characteristics, presenting symptoms, imaging findings, management details, surgical characteristics, and follow-up data were collected from the women's electronic medical records. Primary outcome was defined as the β-hCG levels on follow-up visit at 2weeks following treatment. 42 women were diagnosed with Cesarean scar pregnancy during the study period, of them 9 (21%) were treated non-surgically and 33 (79%) were treated surgically. Median age was 33 (30-36) year old and median BMI was 31 (27-35) kg/m2, with no statistical differences in-between the groups. Most of the women had previous two Cesarean sections (n = 12, 28%). 63% of the women were asymptomatic at the time of diagnosis. On transvaginal ultrasound examination, embryo was demonstrated in 66.7% and cardiac activity was observed in 75%. The median gestational age at diagnosis and β-hCG levels were comparable between the non-surgical and surgical treatment groups (p = 0.22, p = 0.61, respectively). In the surgical arm, the most common surgical procedure was excision of the pregnancy with uterine niche repair, that was performed in 14/42 (33%) of the women. Median hospitalization length was 3 (1-4) and 2 (1-3) days, for the non-surgical and surgical treatment groups, respectively (p = 0.51). The hemoglobin level before discharge was similar between the groups (p = 0.20). Only one woman in each group visited the emergency room before the follow-up visit (p = 0.31). β-hCG levels on follow-up were significantly lower in the surgical group compared to the non-surgical (p = 0.02). Cesarean scar pregnancy can be asymptomatic and should be suspected to enable early diagnosis. Both non-surgical and surgical treatments are viable options, with comparable hospitalization lengths; however, the surgical intervention group is expected to show a significantly faster decrease in β-hCG levels.

Approaches to Managing Herniated Disc Surgical vs. Conservative Treatment

Introduction Disc herniation is a displacement of an intervertebral disc, most often caused by degeneration of its outer layer, the annulus fibrosus. This condition can cause various symptoms such as numbness, pain, muscle weakness or lose of sensation. While many patients can be successfully treated with non-surgical methods, some of them some require surgical intervention. Aim of study The objective of this study is to evaluate both surgical and non-surgical treatment methods for herniated disc and seeks to introduce doctors and patients to the advantages and disadvantages associated with them. State of Knowledge Disk herniation occurs when disk material prolapses beyond intervertebral disk’s space. The symptoms may arise when displaced material start to compress major structures located nearby, such as spinal nerves. The most common causes include age-related degeneration, repetitive movements, obesity, trauma or genetic predisposition. Summary (Conclusion) Disk herniation can be managed with various non-surgical and surgical methods. Conservative treatment should be considered as first line treatment showing high success rate for mild to moderate cases in long term relief and preventing recurrence of symptoms. Surgical options offer better short-term relief for sever and more advanced cases but carry greater risks of side effects and involve longer recovery time. Best approach should be carefully selected based on the severity of symptoms and patient needs.