Conservative Management Options Research Articles

Biology of fish associated with moored fish aggregation devices (FADs): implications for the development of a FAD fishery in New South Wales, Australia

Abstract The number of pelagic fish were counted around fish aggregation devices (FADs) moored 3 (inshore) or 10 km (offshore) from the coast on the continental shelf off Sydney, Australia. Visual counts were made on 81 separate days periodically from April 1999 to April 2002 to estimate abundance and size of dolphinfish (Coryphaena hippurus) and kingfish (Seriola lalandi). Dolphinfish were also collected from around FADs off Sydney and Port Stephens for analysis of sex ratio, stomach contents, age and spawning period. Occurrence of both species at FADs was seasonal. Abundance of dolphinfish was 2–8 times higher at offshore than inshore FADs in summer and autumn, respectively. Attraction of kingfish was the greatest in summer but was not affected by cross-shelf position. Size and age data indicated most FAD-associated dolphinfish and kingfish were immature juveniles. Sex ratios of dolphinfish captured at FADs were significantly skewed; over two females were captured for every male, probably due to behavioral differences in attraction to FADs. Based on the biological data, the most effective FAD deployment strategy to enhance the fishery for dolphinfish would be to place FADs offshore in summer and autumn. As large catches of dolphinfish are frequently made at FADs, two females are caught for every male, and limited information exists to estimate dolphinfish stocks, establishment of a bag limit would be a conservative management option. Moreover, management strategies to minimize by-catch of juvenile kingfish that aggregate at FADs should be considered.

Images in vascular medicine

A 33-year-old woman presented with a painless swelling in the left supraclavicular groove extending to the side of the neck. She reported that the swelling had occurred several times previously over the course of 3 years in the same location and had always regressed spontaneously within 5 days. An inciting event preceding the episodes was not apparent. The swelling was accompanied by diffuse abdominal and flank tenderness, fullness, and flatulence. The patient noted an increase in waist circumference and a weight gain of 1 2 kg. Other symptoms were absent, such as constitutional complaints, dyspnea, loss of appetite, nausea and vomiting, change in bowel habits, or peripheral edema. The medical history was otherwise unremarkable, except for allergic reactions against usual substances (house dust, pollen). The physical examination revealed a marked diffuse swelling, as shown in Panel A, without skin erythema or urticaria. A firm, painless nodule of approximately 3 cm was palpable dorsal to the sternocleidomastoid muscle. Diffuse abdominal tenderness could be elicited by palpation, but there were normal peristaltic sounds and no rigidity of the abdominal wall. Using duplex ultrasound, a cystic tubular lesion of 30 14 17 mm could be demonstrated in the subcutaneous tissue of the left supraclavicular groove, extending medially from the internal jugular vein to the subclavian vein and the clavicle laterally (Panels B and C). There was some solid material adherent to the cyst walls with low echogenicity, and no flow was detected in the fluid-filled areas. Sonographic examination of the abdomen revealed no pathological findings; in particular, ascites, pleural effusions, and lymphadenopathy could be ruled out. Contrastenhanced magnetic resonance tomography was performed as an additional imaging modality (Panel C; T2 and haste sequence). The cervical soft tissue surrounding the cyst appeared infiltrated with edematous fluid. The thoracic duct could be identified as a tubular structure in the mediastinum with a diameter of no more than 3 mm and draining into the cyst. To establish the diagnosis, the cyst was punctured under sonographic guidance. The aspirated fluid had a cloudy, milky appearance and contained 20 400 cells per ml with almost 100% mature lymphocytes. The triglycerides were 1579 mg=dl, cholesterol 80 mg=dl, total protein 4.5 g=dl, and albumin 3.6 g=dl. This composition is unique for chylous fluid and proves the diagnoses of a thoracic duct cyst in this case. A control sonographic examination the next day revealed that the cystic lesion was no longer visible. Cystic dilatations of the thoracic duct have been described in abdominal, mediastinal, and cervical locations, with almost half of the patients being asymptomatic. Most of the cysts are related to surgical or traumatic lesions, for example during radical neck dissection or thoracic surgery. Spontaneous supraclavicular thoracic duct cysts are very rare and should be included in the differential diagnosis of lateral cervical masses because inadvertent damage to the thoracic duct can result in chylous fistula or chylothorax. Regarding pathogenesis, hypotheses include congenital weakness of the vessel wall as well as acquired degenerative and inflammatory processes. Surgical excision of cervical thoracic duct cysts is only indicated if the cyst is causing symptoms, is cosmetically unpleasant, or if rupture may be anticipated leading to chylothorax. Resection can be performed with good results if care is taken to ligate all lymphatic vessels connected to the cyst based on knowledge of the highly variable thoracic duct anatomy. Options for conservative management include repeated percutaneous aspiration and a low-fat diet supplemented with mediumchain triglycerides. Departments of Angiology and Radiology, Medical Center of the University of Munich, Germany

Chylous ascites following para-aortic lymphadenectomy: a case report

Background. Chylous ascites is an uncommon complication following para-aortic lymph node dissection in the management of gynecologic malignancies. Treatment options are serial paracentesis, medium-chain triglyceride diet, total parenteral nutrition and somatostatin as conservative management and peritoneovenous shunting, and surgical exploration for refractory cases. Case. A 31-year-old female patient developed chylous ascites following para-aortic lymph node dissection for borderline mucinous tumor of the ovary. Conservative management options failed with recurrence of chylous ascites. Chylous ascites resolved after surgical closure of the lymphatic fistula on the cisterna chyli. There was no evidence of ascites at 10 months follow-up. Conclusion. If the patient is a good surgical candidate, surgical exploration should be considered earlier in the treatment of refractory chylous ascites.

Bleeding in early pregnancy

Bleeding in early pregnancy is a common occurrence. Some form of bleeding complicates at least a quarter of clinically diagnosed pregnancies. The different types of miscarriage and early pregnancy failure, along with ectopic pregnancies and gestational trophoblastic disease account for the bulk of early pregnancy bleeding problems. The management of early pregnancy bleeding has been overhauled, moving away from in-patient care and out of hours surgical treatment, to out-patient care with same or next day elective surgical treatment or alternatively, medical and conservative management options. This change has been principally brought about through the establishment of early pregnancy assessment clinics run on a daily basis, in combination with the more widespread availability and use of quantitative serum beta human chorionic gonadotrophin (bHCG) measurements and transvaginal ultrasound scanning.

Expectant management of a cornual pregnancy followed up by serial transvaginal color power Doppler angiography and serum beta human chorionic gonadotropin levels

Expectant management of a cornual pregnancy followed up by serial transvaginal color power Doppler angiography and serum beta human chorionic gonadotropin levels

THE IMPACT OF MARINE RESERVES: DO RESERVES WORK AND DOES RESERVE SIZE MATTER?

Marine reserves are quickly gaining popularity as a management option for marine conservation, fisheries, and other human uses of the oceans. Despite the popularity of marine reserves as a management tool, few reserves appear to have been created or designed with an understanding of how reserves affect biological factors or how reserves can be designed to meet biological goals more effectively (e.g., attaining sustainable fish populations). This shortcoming occurs in part because the many studies that have examined the impacts of reserves on marine organisms remain isolated examples or anecdotes; the results of these many studies have not yet been synthesized. Here, I review the empirical work and discuss the theoretical literature to assess the impacts of marine reserves on several biological measures (density, biomass, size of organisms, and diversity), paying particular attention to the role reserve size has in determining those impacts. The results of 89 separate studies show that, on average, with the exception of invertebrate biomass and size, values for all four biological measures are significantly higher inside reserves compared to outside (or after reserve establishment vs. before) when evaluated for both the overall communities and by each functional group within these communities (carniv- orous fishes, herbivorous fishes, planktivorous fishes/invertebrate eaters, and invertebrates). Surprisingly, results also show that the relative impacts of reserves, such as the proportional differences in density or biomass, are independent of reserve size, suggesting that the effects of marine reserves increase directly rather than proportionally with the size of a reserve. However, equal relative differences in biological measures between small and large reserves nearly always translate into greater absolute differences for larger reserves, and so larger reserves may be necessary to meet the goals set for marine reserves. The quality of the data in the reviewed studies varied greatly. To improve data quality in the future, whenever possible, studies should take measurements before and after the creation of a reserve, replicate sampling, and include a suite of representative species. Despite the variable quality of the data, the results from this review suggest that nearly any marine habitat can benefit from the implementation of a reserve. Success of a marine reserve, however, will always be judged against the expectations for that reserve, and so we must keep in mind the goals of a reserve in its design, management, and evaluation.

An expandable nailing system for the management of pathological humerus fractures.

People with metastatic fracture of the humerus are of poor general health. Often they are not able to compensate the handicap of an impaired extremity. Standard osteosynthetic techniques are not always applicable. To reduce the trauma of the operation, we used the Fixion expandable nail system. At two centers, 23 metastatic fractures of the humerus (in 22 patients) were stabilized with a new nailing system. The nail expands under hydraulic pressure up to 150% of its uninflated diameter, gaining long frictional contact to the bone. All patients were followed up until osseous healing occurred or until they died. The operative time was approximately 32 min, including 1.4 min fluoroscopy time. Nail insertion is brief and therefore not very stressful to the group of debilitated patients who require this intervention. Immediately postoperatively, the upper extremity is stable to permit physiotherapy. In these few patients, we saw no complications. The advantages of the surgical approach appear to outweigh those of conservative management options if a simple and safe surgical technique makes the humerus stable enough to resist normal daily loads.

Hand Therapy for Carpal Tunnel Syndrome Part I: Overview of Disease and Non-surgical Management

Carpal tunnel syndrome is the commonest peripheral nerve compression neuropathy and as such is frequently seen by hand therapists. Patients presenting with carpal tunnel syndrome are seen both in the primary and tertiary (hospital) settings and are referred for treatment at various stages of the disease process.The provision of splintage alone is viewed by some healthcare providers as conservative management for this condition. The purpose of this paper is to give a broad overview of conservative management options including posture and exercise, task modifications, splints, nerve and tendon-gliding exercises and ultrasound. It is the view of the authors that early and comprehensive treatment may relieve symptoms and potentially decrease the need for operative intervention, in the short to middle term at least, for patients with mild to moderate symptoms.

5. Preserving wellness and independence of the aging patient with spinal cord injury: A primary care approach for the rehabilitation medicine specialist

This self-directed learning module highlights consideration and treatment of individuals with long-term spinal cord injury (SCI). It is part of the chapter on SCI medicine in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on the challenges of chronic disease prevention, diagnosis, therapeutic options, and the resultant impact on the person with long-term SCI. With cardiovascular disease becoming a leading cause of mortality in this population, risk factor modification through weight, lipid, and glucose control becomes more important. Likewise, bowel dysfunction increases with duration and severity of SCI. Conservative and surgical management options are discussed. Musculoskeletal repetitive trauma injuries occur commonly in long-term SCI but can be prevented with appropriate lifestyle or equipment modifications. These and other conditions occurring in the person with long-term SCI are closely related to psychosocial function with resultant social isolation, depression, and substance abuse. Thus, identification and surveillance of these comorbidities are addressed, with an emphasis on prevention. Overall Article Objective:To summarize the unique medical, psychosocial, and functional needs of the individual with long-term SCI.

The use, of pressure garments on hypertrophic scars

Hypertrophic scars are unsightly and can cause much distress to the sufferer. Pressure garments have been the preferred conservative management option for these scars for the last three decades. This paper reviews the history, underpinning theory and use of compression therapy in the management of hypertrophic scars particularly following burn injury. It is particularly aimed at clinicians who do not come into contact with this type of scarring frequently and are not familiar with its treatment. Other methods for managing hypertrophic scarring are also described briefly. Overall, there is a fair body of evidence to support the use of pressure garments, but it is not definitive research and further work is needed. However, the selection of any treatment must follow negotiation and agreement with the patient who will be required to continue treating their scars at home.

Fetal parvovirus B19 infection

Parvovirus B19 infection during pregnancy causes up to 27% cases of non-immune hydrops in anatomically normal fetuses. The virus is believed to cause arrest of maturation of red blood cell precursors at the late normoblast stage and also causes a decrease in the number of platelets. Fetal anemia is presently thought to be responsible for the development of skin edema and effusions. Myocarditis leading to heart failure may contribute to the development of fetal hydrops. We reviewed the literature regarding prevalence, transmission rates, clinical presentation, diagnostic techniques, current invasive vs. conservative management options, outcome and postmortem findings in a total of 82 studies involving 230 invasively and 435 conservatively managed pregnancies. In this non-selected population, the proportion of seronegative susceptible mothers ranged from 19 to 65%, seroconversion with an incubation time of up to 20 days occurred in 5.7-12.1%, and 188/230 (82%) who were transfused infected fetuses had a normal outcome as opposed to only 239/435 (55%) in the conservatively managed group. The average time from diagnosis to resolution in both groups was 6 weeks (range, 3-12 and 2-12 weeks, respectively). The most promising diagnostic techniques were PCR of amniotic fluid or fetal blood and electron microscopy. There are some reports of fetal abnormalities occurring (probably coincidentally) in cases of parvovirus, but the majority of postmortem findings were infection-related, in particular myocarditis and hepatic abnormalities. Although management guidelines cannot be derived from this study due to the variable degree of hydrops in the analyzed studies, the present data suggest a benefit of transfusion therapy over conservative management in infected fetuses. The only study which was corrected for severity of hydrops using ultrasound criteria showed a clear benefit of intrauterine transfusion.

Development options of natural habitats in a post-mining landscape

Rehabilitation of the post-mining landscape of Lower Lusatia (Brandenburg, Germany) represents a complex problem: 85 per cent of this area is currently being recultivated for forests or agriculture and 15 per cent is reserved for nature development. After mining, soil conditions are dry, acidic and nutrient poor. The ‘LENAB’ project aimed at conservation strategies and management options for natural habitats. Two competing basic motives of nature conservation on a small or medium scale were defined: (1) close-to-naturalness (allowing natural dynamics to take place without human interference) and (2) biodiversity (selective species and habitat protection). An overall strategy for sustainability of a cultural landscape can only be applied to the entire post-mining landscape. The application of the two basic motives leads to different management options; this is illustrated by two important vegetation types. Copyright © 2000 John Wiley & Sons, Ltd.

Transpedicular instrumentation as an adjunct in the treatment of thoracolumbar and lumbar spine tuberculosis with early stage bone destruction.

Because modern imaging techniques now allow for early diagnosis of spinal tuberculosis, more conservative management options are possible. The authors evaluated the effectiveness of transpedicular instrumentation for treatment of thoracolumbar and lumbar spinal tuberculosis in patients with mild bone destruction and the main symptom of "instability catch" (a sudden painful "snap" that occurs when one extends from a forward bent to an upright position). Eighteen patients (nine men and nine women, age range 49-71 years) with spinal tuberculosis were treated with transpedicular instrumentation that was supplemented with posterolateral fusion and chemotherapy. All patients were wheelchair dependent or bed-ridden due to severe instability catch, with a mean symptom duration of 2.5 months (range 1-6 months). Two contiguous vertebrae were involved in 17 patients, and a single vertebrae was involved in one. In five patients mild neurological deficits (Frankel Grade D) were present. During surgery, the screws were implanted into the two nonaffected pedicles nearest the lesion to stabilize the involved segments. No attempt at radical debridement or neural decompression was undertaken. The follow-up period ranged from 21 to 40 months. Postoperatively the instability catch was relieved within 10 days (excellent outcome) and within 1 month (good outcome) in seven and eight patients, respectively, and within 3 months (fair outcome) in two; in the remaining patient, the symptom did not resolve (poor outcome). A short duration of symptoms (generally < 3 months) and bone destruction of less than 50% in the involved vertebral bodies were observed in patients who made a good or excellent outcome. During the follow-up period, good maintenance of spinal alignment, stabilization of the involved segment, and resolution of the inflammatory process were shown; however, there was no strong evidence that fusion had occurred at the bony defect. Patients in whom a fair outcome was achieved experienced a longer duration of symptoms, and in each, one vertebral body with greater than 50% bone destruction was demonstrated. However, good maintenance of spinal alignment was also shown during the follow-up period. The patient whose outcome was poor had the longest history (6 months) of symptoms and the most extensive involvement of the spine (> 50% destruction of two adjacent lumbar vertebral bodies). Postoperatively, implant failure occurred and the patient developed a wound infection. Transpedicular instrumentation provides rapid relief of instability catch and prevents late angular deformity in patients with thoracolumbar and lumbar spinal tuberculosis in whom limited (< 50%) bone destruction of the involved vertebral bodies has been shown and whose main symptom is instability catch.

Paediatric trauma and resuscitation

Severe paediatric trauma differs from adult trauma in that blunt trauma, and especially head trauma, represents 98% of cases. In these instances, early control of the airways, prompt haemodynamic stabilization, emergency explorations and further conservative management of bleeding abdominal lesions are the most challenging issues. On-scene resuscitation, primary stabilization before transportation and transfer to a specialized centre are mandatory. The pre-hospital management of injured children, however, is frequently neglected. The need for emergency intubation and rapid intravenous access insertion is difficult to meet, in spite of many attempts to ameliorate this situation. The option of conservative surgical management of spleen and liver lesions has been extensively developed, and is now applied in many paediatric institutions with a high rate of success. A better application of on-scene resuscitation and of the selective management of bleeding lesions is the key to the prevention of secondary lesions, representing a major source of avoidable death and long-term sequelae.

A Study of 530 Patients Referred for Rigid Gas Permeable Scleral Contact Lens Assessment

The purpose of this study was to analyse the current application of scleral contact lenses in two specialist centres. The case notes of 530 patients assessed for fitting or refitting with rigid gas permeable (RGP) scleral lenses were retrospectively analysed to determine the indication for contact lenses and the outcome. Scleral lenses had been offered as a conservative management option in suitable cases for a variety of visual and medical indications. Various types of primary corneal ectasia, ranging from low grade to advanced, including keratoconus, keratoglobus, and pellucid marginal degeneration, formed 53.0% of the total referred for assessment. The other principal indications for contact lenses were corneal transplant (15.8%), aphakia (10.3%), high myopia (8.9%), and various ocular surface disorders (8.2%). Sixty percent continued to use scleral lenses, 42.9% RGP, and 17.1% polymethylmethacrylate lenses. Twenty-two percent discontinued scleral lens wear or failed a trial of scleral lenses, with 9.3% in progress at the time of assessment and 8.7% lost to follow-up. In the authors' opinion, scleral lenses have retained their traditional role in the management of complex ametropia and ocular surface disease. That role has been further enhanced by the application of gas permeable materials.

Ranking Conservation and Timber Management Options for Leadbeater’s Possum in Southeastern Australia Using Population Viability Analysis

The conservation of the endangered Leadbeater’s Possum, Gymnobelideus leadbeateri, is one of the most contentious forestry issues in Australia. The challenge is to identify strategies to conserve the species in the significant portion of its range in the central highlands of Victoria (southeastern Australia) where timber harvesting occurs. We used ALEX, a simulation program for population viability analysis, to explore the effectiveness of potential forest management strategies to enhance the persistence of G. leadbeateri in areas of wood production. Our study focused on the relationship between the risk of metapopulation extinction and (1) the number and spatial arrangement of 50‐ha logging areas that could be reserved from timber harvesting and (2) the impacts of post‐fire salvage logging in reserved areas. We modeled complex patch structures within two forest blocks (Murrindindi and Steavenson) that were based on maps of both existing patches of suitable habitat for G. leadbeateri and the location of potential logging areas. We recorded high values for the probability of extinction of metapopulations of G. leadbeateri when existing strategies for the conservation of the species within the Murrindindi and Steavenson Forest Blocks were modeled. Exclusion of salvage logging operations from burned, old‐growth forests significantly improved the species’ prospects of survival in both the short and long term. Withdrawal of timber harvesting from some proposed logging coupes made a significant, positive long‐term contribution to metapopulation persistence. But there will be a delay of at least 150 years until areas set aside now make a significant contribution to metapopulation persistence. This is the time required for existing stands of regrowth to develop old‐growth characteristics that are an essential habitat component for G. leadbeateri. We examined the effectiveness of different designs for setting aside a total reserved area of 300 ha. These ranged from a single 300‐ha reserve to 12, 25‐ha reserves. Populations in smaller reserves were vulnerable to extinction from demographic stochasticity and environmental variability. Conversely, a small number of larger reserves were susceptible to destruction in a single, catastrophic wildfire, highlighting the need for several dispersed reserves. Analyses of the sensitivity of various management options to variations in fire frequency and extent, movement capability, and a wide range of other factors indicated that the conservation strategy that gave the best relative outcome for G. leadbeateri was both to set aside several 50 to 100‐ha reserves in every forest block and to preclude post‐fire salvage logging operations from these areas if they burned in a wildfire.

An integrated approach to management of coastal aquatic resources—a case study from Jervis Bay, Australia

AbstractThe types of pressures evident in coastal regions are typified by the Jervis Bay region in south‐eastern Australia which, despite a long history of human occupation, remains largely undisturbed. How much longer those values and the ecological processes which sustain them will remain viable is questionable.This paper describes the development of a conservation management strategy which sought an integrated approach to management of the terrestrial and marine resources of the Bay region. A geographical information system (GIS) was developed for the region, using the raster‐based E‐RMS GIS software system.A continuum of conservation management options for the region was defined, ranging from no change to the presently limited protected area system (which covers only 7.5% of the region), to almost complete reservation. The preferred option, known as the Jervis Bay Conservation Zone, was derived using a landscape ecology approach. This involves a coordinated approach to conservation management by private and public agencies and individuals, with variable levels of control on the use of core habitat and adjacent land/sea areas.Three specific findings of relevance to the management of coastal aquatic resources elsewhere were that (1) traditional ‘reservation‐based’ approaches to conservation management in isolation are not likely to be effective in conserving biodiversity over time; (2) the planning process should be open for review by non‐technical audiences to facilitate community understanding and support; and (3) GIS can be a very useful tool for data organization and analysis.

Conservative Management of Interstitial Pregnancy

Earlier detection of ectopic pregnancies allows the patient and physician the option of conservative management. Conservative surgical management of ampullary ectopic pregnancies has been well described. Traditional management of interstitial or cornual gestation has been by salpingectomy with or without cornual resection or by hysterectomy. In this paper we present a case report of alternative, less radical surgical management and review the literature on conservative surgical and medical management of interstitial pregnancies.

Conservative Alternatives in the Management of Early Adenocarcinoma of the Rectum

The majority of patients with adenocarcinoma of the rectum are treated with radical surgical procedures. Lesions located in the distal third of the rectum are usually treated by abdominoperineal resection, and those situated in the proximal portion of the rectum are treated by low-anterior resection. Relatively small, moderately or well differentiated lesions have a low risk of lymph node metastasis, and are therefore amenable to conservative (ie, rectum-sparing) procedures. Conservative management options consist of transrectal excision, transrectal excision and preoperative or postoperative radiotherapy, endocavitary contact radiotherapy, and interstitial therapy. Discussion of these options, the experience at the University of Florida with two of these options, and review of the literature follow.

Second Trimester Detection of Unilateral Hydrothorax: A Case Report of Successful Pregnancy Outcome with Passive Management

EDITORIAL COMMENT: This case illustrates the important option of conservative management of abnormalities detected using ultrasound antenatally. The number of investigative and therapeutic techniques available for use on the fetus antenatally is increasing rapidly. All of these techniques however carry some degree of risk to the fetus. In some instances such as amniocentesis this risk is well defined but in others less well so. After the initial enthusiasm for operative intervention antenatally for treatment of such conditions as hydrocephalus and hydronephrosis most experts now recognize such procedures have a very limited role to play in the antenatal period. The natural history of many ultrasound detected abnormalities is poorly characterized. It is increasingly evident as more publications appear in the literature that many conditions such as that illustrated in this report will disappear spontaneously without any intervention being necessary.There is still a place for masterly inactivity in obstetrics. With the sophistication of modern technology, observation of fetal condition can indeed be masterly, but the need for clinical judgement is probably greater now that spectacular beneficial intervention is technically possible in some conditions.Our librarian traced for us the likely origin of the aphorism that ‘in obstetric practice an error of omission is better than an error of commission’—‘In medicine the sin of commission is mortal, the sin of omission venial.“1. Bulletin of the New York Academy of Medicine, 1929: 5.