Traditional Conservative Therapy Research Articles

Genetic markers of the risk of coronary heart disease and coronary artery thrombosis developing in the Kazakh population.

Surgical methods such as coronary artery bypass grafting and percutaneous coronary interventions (PCI) are widely used along with traditional conservative therapy in the treatment of coronary artery disease. The disease outcome directly depends on timely diagnosis and treatment. A significant role in predicting the effectiveness of treatment is given to personification of treatment and management of the patient. In this case, the determining component is its individual genetic status. The study groups included persons of Kazakh nationality which identify themselves, their biological parents, and biological grandparents on the maternal and paternal side as Kazakh. Research groups included 108 people at the age from 45 to 65 years of both sexes. Blood samples genotyping was carried out by PCR using highly specific TaqMan samples. Thermo Fisher cloud applicationwas used for genotypes determining on the base of an automatic algorithm. The article presents the results of the evaluation of gene polymorphisms associated with coronary artery restenosis in a population of Kazakh nationality. 3 SNPs were determined when searching for an association with stenting due to coronary artery thrombosis: rs7543130 (p=0.009324), rs6785930 (p=0.016858), rs7819412 (p=0.061325). Four polymorphisms associated with the risk of developing coronary heart disease were revealed during the study of polymorphisms among the people of the Kazakh population. Three SNPs were determined when searching for an association with stenting due to coronary artery thrombosis. It should be noted that the Bonferonni correction for multiple comparisons did not reveal significant polymorphisms associated with coronary artery disease, which requires further research with more quantity of samples.

Advances in Non-Invasive Neuromodulation.

Pain medicine is rapidly expanding. The gap in treatment for patients with chronic pain in between traditional conservative therapy and major invasive surgery is closing. Neuromodulation is one therapeutic area that has continued to show promise for treatment of chronic pain. Our aim is to review updates in non-invasive neuromodulation (NIN) techniques as an adjunct for various chronic pain conditions. Overall, the literature suggests that NIN techniques such as tCDS, TMS, TENS, tVNS, and HIFUS/LIFUS have utility in treating various types of chronic pain and have a promising future. There is a better understanding of the mechanistic basis for pain relief from NIN, as well as refinement in technology improving NIN therapy success. Future studies will need to focus on continuing to refine protocols for optimal benefit from NIN as well as implementing larger RCTs to improve the quality of data being generated in the field.

Use of Teriparatide for the Treatment of MRONJ in Non-Cancer Patients Refractory to the Traditional Conservative Therapy: A Systematic Review

Use of Teriparatide for the Treatment of MRONJ in Non-Cancer Patients Refractory to the Traditional Conservative Therapy: A Systematic Review

TREATMENT OF UNDESIRABLE CONSEQUENCES AFTER AESTHETIC BLEPHAROPLASTY

The purpose of the work is to improve the results of postoperative complications of the lower eyelid after blepharoplasty.
 Materials and methods. A retrospective study of 14 patients in the postoperative period after blepharoplasty was conducted. All patients had a diagnosis: Age-related changes in the skin of the upper and lower eyelids (ptosis of the skin of the eyelids) before surgery and after surgery, patients had complications with the diagnosis: Dislocation of the lower eyelid, in the postoperative period. In the early postoperative period (up to 6 months), all patients with complications underwent non-surgical correction. Patients were divided into two groups: 1 group - traditional conservative therapy was used, including massage and administration of a glucocorticosteroid solution, 2 group - author's treatment scheme using an erbium laser (Er: YAG, 20940 nm).
 Results. A retrospective study was conducted and it was proved that the author's scheme using an erbium laser (Er: YAG, 20940 nm) gives positive treatment results. Errors in the diagnosis and planning of the volume of surgery, surgical errors, in our opinion, are the main causes of formidable complications that affect the function of the vision organ. Despite the fact that aesthetic blepharoplasty by many surgeons is considered as the simplest surgical intervention and mastered by novice surgeons in the first place, one should not forget about "pitfalls" and possible dramatic consequences, which are caused by neglect of the nuances and precision of surgical equipment, as well as errors in the diagnosis and planning of the volume of surgery.
 Conclusion. Aesthetic blepharoplasty is an operation that requires the individual approach of highly qualified specialists. To avoid the development of complications, not only the degree of atrophy of the skin of the eyelids, but also the peculiarities of the structure of the eyelids and the periorbital region should be taken into account.

74 The Effectiveness of Serial Casting in Obtaining Maximum Range in Burn Scar Contracted Joints

Abstract Introduction Recovery from burn scar contracture demands significant time and resources from patients and healthcare providers. Few studies have explored how serial casting improves recovery. The aim is to present preliminary data illustrating the benefits of serial casting in burn scar contracture rehabilitation. Methods Six burn patients (8 joints) that did not respond to traditional conservative therapy were included. Joints were x-rayed to rule out heterotopic ossification/joint abnormality before casting. Patients were casted 5x, 3x or 1x/week. Initial session consisted of measuring baseline range of motion (ROM) prior to physiotherapy intervention (PTI) (heat, active ROM with end range overpressure, joint glides, and progressive resistive exercises) and plaster cast application by Occupational Therapy. Following sessions involved measuring ROM post cast removal, and before PTI and new cast application. Scar contractures were photographed weekly and assessed using the Modified Vancouver Scar Scale (MVSS). Results On average, casting started 93.67±20.31 days post burn injury and lasted 8.90±1.23 days. Mean time between cast changes was 2.30±0.25 days; on average, each joint was casted 4.30±0.65 times. MVSS score (pre/post serial casting:9.70±0.47 / 4.70±0.42, p< 0.0001) and ROM as a percentage of total (pre/post serial casting:56.30±5.12% / 96.40±0.90%, p< 0.0001) showed improvements from pre to post casting. Post casting, average ROM gained was 43.70±6.60 degrees and average percentage of ROM regained was 96.38±0.87%. Each joint consumed a mean of 6.56±1.22 therapy hours and $45.13±12.15 in materials. Conclusions Serial casting produced rapid gains in ROM to near full ROM in burn scar contracted joints. Correspondingly scar pliability, height, and pigmentation improved. Serial casting can be effective and initiated early in scar maturation. Applicability of Research to Practice Serial casting can be a standard technique in rehabilitation of burn scar contracture. It is easy to adopt due to low material cost, easy therapist training, and low time demands from patients and therapists. It can delay or prevent the need for contracture release surgery (in the case of 3 patients). Based on therapist observations, it can lead to increased treatment compliance due to rapid effectiveness.

The effectiveness of combined laser therapy in patients with trophic leg ulcer and chronic venous insufficiency

Development and scientific justification for the low-intensity laser radiation of different wavelengths combined use in patients with trophic leg ulcers and chronic venous insufficiency (CVI). 102 patients with trophic leg ulcers and CVI were examined. They were divided into 3 equal groups using simple randomization. Patients in the control group received only traditional conservative therapy; comparison group - traditional conservative therapy and an intravenous laser blood irradiation (ILBI) (λ - 635 nm); the main group - traditional conservative therapy and different wavelengths laser therapy (LT) course. A more significant improvement in the clinical condition occurred under the influence of the course application of combined different wavelengths laser therapy in patients with trophic venous leg ulcers. Compared to patients who received traditional conservative therapy and in combination with ILBI 635 nm, the speed of reparative regeneration of trophic ulcers increased, the time for cleansing trophic ulcers from devitalized tissues was reduced. Computer capillaroscopy data showed that the positive effect of laser exposure on all parts of the microcirculation underlies its therapeutic efficacy.

Management of Patulous Eustachian Tube

Patients with patulous Eustachian tubes (PET) suffer from annoying aural symptoms, such as voice or breath autophony, and aural fullness due to the ET’s abnormal patency. It may lead to an enormous reduction in quality of life. Various treatment methods, including conservative and surgical therapy, have been reported. In most cases, conservative treatment is sufficient to relieve patients of aural symptoms. However, some chronic and severe cases are resistant to traditional conservative therapy. Recently performed prospective and multicenter trials revealed the efficacy and safety of a silicone plug (Kobayashi plug) insertion for patients with severe PET. Patulous Eustachian tube handicap inventory-10 (PHI-10), tubal obstruction procedures, sitting computed tomography (CT), and ET function tests (tubo-tympano-aerodynamic graphy (TTAG) and sonotubometry) are useful for diagnosis as well as selecting candidates for surgery in severe cases.

Migraine Surgery: An All or Nothing Phenomenon? Prospective Evaluation of Surgical Outcomes.

A detailed analysis of outcomes after migraine surgery suggests an anatomic etiology of pain, such as peripheral nerve compression, in select patients. Historically, surgeons have not played a role in the treatment of migraine. However, a subgroup of patients with extracranial anatomic triggers appear to benefit from surgical intervention. Traditionally, the determination of success or failure of migraine surgery is based on whether there is greater or less than 50% improvement of the migraine headache index (MHI) after surgery. However, in this study, patients either did not respond to treatment (≤5%) or improved completely (≥80%). Detailed analysis is provided of this surprising finding. Subjects completed a prospective migraine questionnaire preoperatively as well as at 3 and 12 months postoperatively. All variables improved significantly from baseline. Interestingly, in 83% of patients, the MHI improved either ≥80% or ≤5%, suggesting a more binary distribution. Only 17% of indices fell in the intermediate (5% to 80%) range. Moreover, 69% of patients had ≥80% improvement resulting in a mean improvement of 96% in this group. The remaining 14% had ≤5% improvement, with an average improvement of 0%. Migraine surgery remains controversial. Traditional conservative therapy targets the central theory of migraine propagation. This study again prospectively demonstrates the efficacy of surgical trigger site deactivation in migraine patients. Patients either failed to improve or improved after surgery, with few intermediate outcomes. The binary distribution of data lends further support to an anatomic etiology of pain, that is, peripheral nerve compression, in select patients.

Results of rest, soft sole slippers, contrast bath and plantar stretches physiotherapy in case of plantar fasciitis

Almost 10 lakh patients are affected by plantar fasciitis (PF), which is the commonest cause of chronic heel pain. This condition is often managed conservatively, and many rehabilitation protocols, some with the aid of orthoses, have been adopted, with good-to-excellent clinical results. Although most cases of chronic PF can be successfully managed with a conservative approach, alternative treatments, including high-energy shock wave therapy and corticosteroid injections, are commonly accepted as second-line treatment when traditional conservative therapy fails.The literature suggests that, initially, traditional conservative treatments consisting of rest, oral nonsteroidal anti-inflammatory drugs, foot orthotics, and stretching exercises can be tried for several weeks. In patients with chronic recalcitrant PF, extracorporeal shock wave therapy or corticosteroid injection can be considered. Surgery (Minimally invasive techniques) should be considered only after failure of the conservative treatments. Objectives: To study the effectiveness of Rest, exercises (Plantar fascia stretching technique), soft sole slippers and contrast bath with in patients with plantar fasciitis in fresh as well as recurrent cases. Materials and Methods: In the prospective study totally 30 subjects was taken, between the age group of 20 to 70 years in our Patients department Orthopedics at Tertiary care Hospital Surat with short follow-up of 2 weeks. Results: On comparing the Pre and post -test mean values of group nova’s score and foot functional index shows significant reduction in posttest mean in both the group. No patient in our study was non compliant to conservative treatment in 2 weeks follow-up.Conclusions: The Present study concluded that 2-weeks treatment program performed on subjects with plantar fasciitis demonstrated that both contrast bath and plantar fascia stretching exercises combined with rest & soft sole slippers were effective in reducing pain intensity and improving functional activities.

INFLUENCE OF LASER TREATMENT ON INDICATORS OF FREE-RADICAL OXIDATION AND ANTIOXIDANT PROTECTION IN SECONDARY PYELONEPHRITIS

Relevance. Optimization of the conservative tactics of acute inflammation of the kidney in nephrolithiasis makes it advisable to use non-traditional methods of detoxification low-intensity laser radiation (LILR) in particular. Aim. To evaluate the effectiveness of laser therapy (LT) in the complex correction of acute secondary pyelonephritis (ASP) in patients with single kidney stones according to the basic adaptation criteria of oxidative-antioxidant clinical medicine КЛИНИЧЕСКАЯ МЕДИЦИНА homeostasis of the organism. Materials and methods. Indices of endogenous intoxication (EI), characterizing the oxidative-antioxidant homeostasis of the body in ASP, were studied in 96 patients with nephrolithiasis aged 19 to 40 years. Patients of the comparison group (48 people) underwent basic (according to the standards) treatment aimed at controlling of calculous pyelonephritis. Patients of the main group (48 people) in the traditional conservative therapy from the second day of hospitalization daily received additional LT sessions with apparatus LTA “Uzor-3KS” with a frequency of 0.6 kHz, a power of 1.5 watts within 4 minutes (total for treatment course is eight procedures). The effectiveness of therapy was assessed on the 5th and 9th day of the inpatient stay. Results. It was found that endotoxicosis in non-destructive forms of ASP is caused by the increase in the concentration of malonic dialdehyde of plasma (by 20.3%) and erythrocytes (by 35.5%), decrease in catalase activity (by 14.2%) and the amount of total (by 11.8%) and free (21.1%) thiol groups with a decrease in the detoxification index (DI) by 24,1%. Compared with the baseline therapy (BT), the effectiveness of LT in the complex treatment of ASP in the analyzed parameters of metabolic homeostasis against the background of the increase in catalase capacity from 6.9 to 10.2%, the detoxification index from 5 to 12.5% was 7.5% (on the 5th day) and 17.5% (on the 9th day of treatment). Conclusions. ASP leads to activation of ROS, suppression of antioxidant and catalase activity of blood, reduction of DI, indicating a subcompensated syndrome of EI. Standard therapy contributes to the normalization of ROS and SLA values of body protection and reduces the level of endotoxicosis caused by ASP. Additional inclusion in the complex treatment of LT sessions more significantly normalizes redox metabolic homeostasis and EI parameters, improving the effectiveness of basic therapy.

СОВРЕМЕННЫЕ ПОДХОДЫ К ДИАГНОСТИКЕ И ЛЕЧЕНИЮ ПЕЧЁНОЧНОЙ НЕДОСТАТОЧНОСТИ (ОБЗОР ЛИТЕРАТУРЫ)

Currently, the world is marked rise in the number of patients with liver disease. Approximately 100,000 patients hepatitis complicated by acute liver failure, with mortality in this disease reaches 70-90% despite the use of modern methods of treatment Currently, there are more than 20 concepts of this disease. In 15-20% of cases the cause of acute liver failure can not be established. Most clinicians believe that the pathogenesis of liver failure is a strong humoral and hyperimmune response, resulting in massive necrosis of liver cells. Diagnosis of liver failure based on anamnesis, clinical, biochemical and electroencephalographic changes. Traditional conservative therapy of acute liver failure in the first place based on the measures taken to address the etiological factor. Transplantation is an effective measure in acute liver failure. In the world there are a sufficient number of prognostic scales, criteria and risk factors of acute liver failure. Each of them has its own characteristics, but a unified system of prognostic estimation of arrester.

Effect of transplantation of cord blood total nucleated cells on the manifestation and prognosis of refractory congestive heart failure

The results of a prospective non-randomized observation study without control group to assess the course of heart failure in patients who underwent of cord blood total nucleated cells (CB TNCs) transplantation combined with traditional drug therapy have been presented.
 Materials. The study included 20 patients with congestive heart failure (CHF) IIA-IIB stage, functional class III-IV by the NYHA. CB TNCs transplantation was performed by a single intravenous dose of cell product "Cryopreserved human cord blood". Before and 1, 3, 6 and 9 months after CB TNC transplantation patients underwent echocardiographic study, the results of tests with the 6-minute walk determined exercise tolerance. The concentration of brain natriuretic peptide precursor (NT-proBNP) in blood was determined. The cardiovascular death risk was calculated using the scale MAGGIC.
 Results. Initial patients’ status was characterized by the presence of severe heart failure with reduced contractility of the myocardium and increased risk of 1- and 3-year death. Traditional conservative therapy (beta blockers, ACE inhibitors, diuretics) was not effective. After CB TNC transplantation there was registered a significant improvement of general condition of patients, an increase in exercise tolerance and, therefore, reduce of HF functional class by NYHA (before transplantation average FC was 3.2, in the post-transplant period – from 2.1 to 2, 8). Also after TNCs transplantation levels of biochemical markers of HF significantly decreased (before CB TNCs transplantation the level of NT-proBNP was 2370.3 ± 448.9 pg/mL, after CB TNCs transplantation – from 1198,6 ± 396,3 to 2300,7 ± 403,0 pg/mL ) and the same was estimated death risk from HF (1-year – 10.1-37.4 %, 3 years - 9.1-42.3 % relative to the data of the initial state). Reduced HF manifestations after CB TNCs transplantation allowed to reduce significantly the diuretics dose.
 Conclusion. Thus, transplantation of cord blood total nucleated cells in complex treatment of congestive heart failure has led to a greater efficiency of therapy and a significant reduce of CHF manifestations in patients.

The use of the enzymes for the enhancement of the effectiveness of antimicrobial photodynamic treatment of the patients presenting with chronic tonsillitis

The objective of the present study was to enhance the effectiveness of the treatment of the patients presenting with various forms of chronic tonsillitis (CT) by means of antimicrobial photodynamic therapy (APDT). The study included 48 patients at the age from 18 to 55 years divided into three groups; all of them suffered from various forms of CT. Group 1 was comprised of 12 patients given a course of traditional conservative therapy. Group 2 consisted of 17 patients treated by APDT while group 3 included 19 patients in whom a course of antimicrobial photodynamic therapy was preceded by the treatment of the mucous membrane of the palatine amygdalae with a lidase solution. The microbiological testing was performed on days 5, 12, and 24 after APDT and also within the next 6-9 months. The results of the microbiological and clinical studies give evidence of the possibility to improve the effectiveness of the treatment of chronic tonsillitis by means of antimicrobial photodynamic therapy with the use of the preventive treatment of palatine tonsillar mucosa with a lidase solution. Such treatment was found to facilitate degradation of theintercellular matrix of the biofilm and reduced its resistance to the photodynamic impact.

Changes of intracardiac hemodynamics in patients with decreased myocardial contractility at transplantation of cord blood stem cells

Experiments on animals have shown an effectiveness of cord blood stem cells (SCs) in restoration of myocardial contractility. But there is not enough information about the use of this SCs type at heart lesion in people. Therefore, the aim of this study was to analyze the effect of cord blood SCs transplantation on impaired myocardial contractility of patients with chronic heart failure.Materials and methods. According to the data echocardiography we analyzed the changes of intracardiac hemodynamics in patients with decreased myocardial contractility, who underwent intravenous transplantation of cord blood stem cells in case of ineffective traditional conservative therapy schemes of heart failure (HF).Results. Left ventricular ejection fraction before cord blood stem cells transplantation was 22.0 ± 5.0 %, 1 month after SC transplantation – 22.3 ± 6.5%, and in 3 months – 28.5 ± 7.8 % (p < 0.05). The average stroke index increased from 21.3 ± 3.5 ml/m2 before transplantation up to 29.0 ± 8.5 ml/m2 3 months after transplantation SC (p < 0.05). Statistically significant changes of diastolic function parameters (index e’, E/A, E/e’) and venous stasis have not been established. Before transplantation local cell contractility index (LCI) of basal and middle segments was 2.43 points; 1 month after transplantation LCI decreased to 2.38, and after 3 months – up to 2.18 points (p <0.05).Conclusion. In a short term (1-3 months) after transplantation of cord blood cells there was demonstrated a partial restoration of parameters that characterize left ventricular systolic function, and a significant improvement of impaired heart rate mechanics. No negative effects, complications and side effects have been recorded in short periods of observation after transplantation of cord blood cells.

Current therapeutic approaches for plantar fasciitis

Current therapeutic approaches for plantar fasciitis Nicolò Martinelli, Carlo Bonifacini, Giovanni RomeoDepartment of Ankle and Foot Surgery, IRCCS Galeazzi Orthopaedic Institute, Milan, ItalyAbstract: Almost 1 million Americans are affected by plantar fasciitis (PF), which is the commonest cause of chronic heel pain. This condition is often managed conservatively, and many rehabilitation protocols, some with the aid of orthoses, have been adopted, with good-to-excellent clinical results. Although most cases of chronic PF can be successfully managed with a conservative approach, alternative treatments, including high-energy shock wave therapy and corticosteroid injections, are commonly accepted as second-line treatment when traditional conservative therapy fails. However, surgery is still an important mode of treatment. Recently, new minimally invasive surgical techniques that offer numerous advantages (faster recovery time, early weight-bearing, lower postoperative pain) over standard surgical approaches have been proposed, with good results and low complication rates. The purpose of this review is to report new conservative and surgical techniques for the treatment of PF. A literature search for articles about plantar fasciitis was conducted on the PubMed database in order to identify publications addressing the treatments of PF. The literature suggests that, initially, traditional conservative treatments consisting of rest, oral nonsteroidal anti-inflammatory drugs, foot orthotics, and stretching exercises can be tried for several weeks. In patients with chronic recalcitrant PF, extracorporeal shock wave therapy or corticosteroid injection can be considered. Surgery (minimally invasive techniques) should be considered only after failure of the conservative treatments.Keywords: heel pain, surgery, plantar fasciosis

SIGNIFICANCE OF OCTAPEPTIDE CHOLECYSTOKININ IN DEVELOPMENT OF ODDI’S SPHINCTER DYSFUNCTION OF INORGANIC ETIOLOGY AFTER CHOLECYSTECTOMY IN PATIENTS OPERATED FOR CALCULOUS CHOLECYSTITIS

Aim. To improve the results of treatment of patients with cholelithiasis, calculous cholecystitis and Oddi’s sphincter dysfunction of inorganic etiology. Materials and methods. 214 patients of both sex (aged 25–80) with acute calculous cholecystitis (ACC) and postcholecystectomy syndrome (PCES) were examined. All patients were divided into 4 groups depending on the scheme of treatment carried out. Results. Cholecystokinin level determined in patients with cholelithiasis makes it possible to assess the severity of functional biliary disorders. Cholecystokinin concentration <0,5 ng/ml with absence of organic pathology from the side of the organs of hepatopancreatoduodenal zone indicates Oddi’s sphincter dysfunction of functional nature. In case of a two-fold decrease in cholecystokinin level on the day 9 th after cholecytectomy, the probability of development of Oddi’s sphincter dysfunction of functional nature is increased by 22,6% that requires administration of selective spasmolytic drugs. Conclusion. The developed scheme of complex therapy allows to eliminate manifestations of postcholecystectomy syndrome of functional etiology at earlier terms compared to patients cured with traditional conservative therapy.

Approaches to the development of individualized schemes for treatment of otitis media with effusion in patients with low efficiency of traditional conservative therapy

Management of otitis media with effusion is a challenging problem in view of its high prevalence and frequent complications in the form of stable hearing loss. High frequency of secondary immunodeficiencies in ENT diseases dictates the necessity of immunocorrection in combined treatment. Dinamic pure tone audiometry, tympanometry and subjective response demonstrated higher treatment efficiency in the «Gepon» groups.

Current Perspectives on Percutaneous Vertebroplasty: Current Evidence/Controversies, Patient Selection and Assessment, and Technique and Complications

Osteoporotic-associated vertebral compression fractures are a major public health concern, dwarfing even hip fractures in incidence in the United States. These fractures carry a significant morbidity and mortality burden and also represent a major growing source of consumption of scarce heath resources. Percutaneous vertebroplasty remains a commonly used and safe technique for the symptomatic treatment of vertebral compression fractures, both osteoporotic- and neoplastic-induced. By carefully selecting appropriate patients who are referred promptly, vertebroplasty can provide significant and durable pain relief over traditional conservative therapy. Recent controversies surrounding the evidence for vertebroplasty in osteoporotic-associated vertebral compression fractures are reviewed. A comprehensive step-by-step practical guide to performing vertebroplasty is then described. A brief description of patient selection, workup, as well as complications is also provided.

Cost analysis model of outpatient management of ovarian hyperstimulation syndrome with paracentesis: “Tap early and often” versus hospitalization

To compare the cost of two treatment regimens for moderate to severe ovarian hyperstimulation syndrome (OHSS): conservative inpatient versus outpatient management with paracentesis. A decision-tree mathematical model comparing conservative inpatient versus outpatient management of moderate to severe OHSS was created. The common final pathway of either management was resolution of OHSS. Sensitivity analyses were performed over the range of variables. Total management cost of OHSS. The cost of conservative therapy including first-tier complications was $10,099 (range $9,655-$15,044). The cost of outpatient management with paracentesis was $1954 (range $788-$12,041). This resulted in an estimated cost savings of $8145 with outpatient management with paracentesis. One-way sensitivity analyses were performed. Varying the probability of admission after outpatient treatment still indicated that outpatient treatment was the most cost-effective (probability = 1.0, cost = $6110). Varying the duration of hospitalization with primary inpatient treatment was equal to outpatient treatment costs only at a stay of 0.71 days or shorter. Our model suggests early outpatient paracentesis for moderate to severe OHSS is the most cost-effective management plan when compared with traditional conservative inpatient therapy. The cost savings for outpatient management persisted throughout a variety of outcome probabilities.

Bronchobiliary Fistula Successfully Treated with n-Butyl Cyanoacrylate via a Bronchial Approach

A bronchobiliary fistula is an abnormal communication between the biliary tree and the airway that can result in debilitating amounts of bilioptysis, or bile-stained sputum. The authors present an approach for the conservative management of a bronchobiliary fistula in a patient who failed traditional conservative therapy and refused surgical intervention.