Base de dados : MEDLINE
Pesquisa : E02.197 [Categoria DeCS]
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[PMID]:29480864
[Au] Autor:Khan S; Su S; Jiang K; Wang BM
[Ad] Endereço:Department of Gastroenterology and Hepatology, Tianjin Medical University General Hospital, Tianjin, PR China.
[Ti] Título:Retrograde gastroesophageal intussusception after peroral endoscopic myotomy in a patient with achalasia cardia: A case report.
[So] Source:Medicine (Baltimore);97(2):e9609, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Retrograde gastroesophageal intussusception (RGEI) is a relatively rare gastrointestinal (GI) disorder in which a portion of the stomach wall invaginates into the esophagus. More recently, peroral endoscopic myotomy (POEM) has emerged as an endoscopic alternative to surgical myotomy for achalasia, and, to the best of our knowledge, our case is the first RGEI after POEM to be reported. PATIENT CONCERNS: A 22-year-old male was presented with a history of vomiting, intractable retching and hematemesis for 3 days. He had a history of achalasia and underwent POEM 3 years ago caused by symptoms of severe dysphagia to solid and liquid. DIAGNOSES: Initially, the patient was diagnosed with a blood-filled esophagus, and the mid esophagus was occluded with a ball-like mass, however, the final diagnosis of RGEI was made by thoracotomy. INTERVENTIONS: A therapeutic strategy of conservative treatment and left transthoracic surgery were applied. OUTCOMES: The surgery and post operative course were uneventful, and he remained asymptomatic 1 year after operation. LESSONS: POEM is a reliable and minimally invasive endoscopic method for esophageal achalasia. Early recognition and severity of RGEI are essential to decrease the unwanted complications. Upper GI series, esophagogastroduodenoscopy and computed tomography scan are helpful for diagnostic purposes of RGEI. Conservative treatment, endoscopic intervention, and surgery are the mainstay of treatments for RGEI.
[Mh] Termos MeSH primário: Endoscopia Gastrointestinal
Acalasia Esofágica/cirurgia
Intussuscepção/etiologia
Miotomia
Complicações Pós-Operatórias
Gastropatias/etiologia
[Mh] Termos MeSH secundário: Tratamento Conservador
Endoscopia Gastrointestinal/métodos
Acalasia Esofágica/diagnóstico por imagem
Acalasia Esofágica/patologia
Junção Esofagogástrica
Seres Humanos
Intussuscepção/diagnóstico por imagem
Intussuscepção/patologia
Intussuscepção/terapia
Masculino
Miotomia/métodos
Complicações Pós-Operatórias/terapia
Gastropatias/diagnóstico por imagem
Gastropatias/patologia
Gastropatias/terapia
Procedimentos Cirúrgicos Torácicos
Adulto Jovem
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009609


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[PMID]:29480862
[Au] Autor:Yao BZ; Li L; Jiang M; Wang J; Zhang J
[Ti] Título:Refractory chyle leakage after laparoscopic cholecystectomy for gallstone disease: A case report and literature review.
[So] Source:Medicine (Baltimore);97(2):e9604, 2018 Jan.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Gallstone disease is commonly worldwide and safely treated by laparoscopic cholecystectomy. Chylous ascites is a rare but serious complication of many abdominal operations. PATIENT CONCERNS: We present a rare case of refractory chyle leakage post-LC for acute cholecystitis that is successfully treated in a 40-year-old man, and review current literature on the prevalence, diagnosis, and management of this complication. DIAGNOSES: Refractory chyle leakage post-LC, a rare but serious complication after laparoscopic cholecystectomy. INTERVENTIONS: Conservative treatment was given initially; however, the outcome was frustrating. Surgical intervention was given without further delay. OUTCOMES: After the reoperation, conservative treatment was still maintained. After nearly 8 months of treatment, the patient recovered and then was discharged. LESSONS: This case represents a previously unreported complication of refractory and high flow chyle leakage after laparoscopic cholecystectomy, which did not improve alter conservative management with dietary changes and other measures. So we suggest that surgical intervention should be given for refractory cases without further delay. It can not only shorten the disease progression, but also alleviate the sufferings of the patient.
[Mh] Termos MeSH primário: Colecistectomia Laparoscópica/efeitos adversos
Colecistite Aguda/cirurgia
Quilo
Complicações Pós-Operatórias
[Mh] Termos MeSH secundário: Adulto
Tratamento Conservador
Drenagem
Cálculos Biliares/cirurgia
Seres Humanos
Masculino
Reoperação
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180227
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009604


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[PMID]:29390332
[Au] Autor:Zhang H; Zhuang G; Sun D; Deng T; Zhang J
[Ad] Endereço:Department of Urology, The 107th Hospital of the People's Liberation Army, Yantai, Shandong.
[Ti] Título:Spontaneous rupture of the renal pelvis caused by upper urinary tract obstruction: A case report and review of the literature.
[So] Source:Medicine (Baltimore);96(50):e9190, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Spontaneous renal rupture is rupture of the renal parenchyma, collecting system, or renal blood vessel, which often occurs in pathological kidney and is clinically less common. Postoperative long-term renal rupture is rarely reported in flexible ureteroscopy treatment of calculus in the upper urinary tract. PATIENT CONCERNS: A 58-year-old man complained of right lower abdominal pain with hematuria for 3 hours after flexible ureteroscopy, combined with holmium laser lithotripsy of right renal calculi was performed 1 month ago. The urinary B-mode ultrasonogram suggested calculi and dilatation at the end of the right ureter, and moderate hydronephrosis of the right kidney. On the second day, the urinary system computed tomography (CT) examination suggested right renal rupture. DIAGNOSIS: Spontaneous rupture of the right renal pelvis. INTERVENTION: The patient underwent conservative treatment after the optimal treatment strategy was reviewed and discussed. OUTCOMES: Urinary system CT re-examination suggested complete absorption of the hematoma and urinary extravasation 3 months later. LESSONS: Calculi obstruction is the most important cause of spontaneous renal rupture. CT is a valuable diagnostic modality, and spontaneous renal rupture should receive tailored treatment.
[Mh] Termos MeSH primário: Nefropatias/etiologia
Pelve Renal
Urolitíase/complicações
[Mh] Termos MeSH secundário: Tratamento Conservador
Seres Humanos
Nefropatias/diagnóstico por imagem
Nefropatias/terapia
Masculino
Meia-Idade
Ruptura Espontânea
Urolitíase/diagnóstico por imagem
Urolitíase/terapia
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009190


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[PMID]:28463154
[Au] Autor:Chargari C; Haie-Meder C; Guérin F; Minard-Colin V; de Lambert G; Mazeron R; Escande A; Marsolat F; Dumas I; Deutsch E; Valteau-Couanet D; Audry G; Oberlin O; Martelli H
[Ad] Endereço:Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif, France; Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France. Electronic address: cyrus.chargari@gustaveroussy.fr.
[Ti] Título:Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma.
[So] Source:Int J Radiat Oncol Biol Phys;98(2):352-359, 2017 06 01.
[Is] ISSN:1879-355X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: To report the results of a conservative strategy based on partial surgery combined with brachytherapy in a prospective cohort of children with bladder-prostate rhabdomyosarcoma (BP RMS). METHODS AND MATERIALS: We prospectively documented the outcome of children treated in our department between 1991 and 2015 for BP RMS and undergoing a multimodal approach combining conservative surgery (partial cystectomy and/or partial prostatectomy) and perioperative interstitial low-dose-rate or pulse-dose-rate brachytherapy. Before brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment. RESULTS: A total of 100 patients were identified, with a median age of 28 months (range, 5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) group, 84 were IRS-III, and 12 were IRS-IV tumors. Four patients were treated at relapse. The median number of chemotherapy cycles before local therapy was 6 (range, 4-13). After surgery, 63 patients had a macroscopic tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiation therapy because of nodal involvement, and 95 had exclusive brachytherapy. Median follow-up was 64 months (range, 6 months-24.5 years). Five-year disease-free and overall survival rates were 84% (95% confidence interval 80%-88%) and 91% (95% confidence interval 87%-95%), respectively. At last follow-up most survivors presented with only mild to moderate genitourinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse. CONCLUSION: Brachytherapy is effective as part of a conservative strategy for BP RMS, with a relatively low delayed toxicity as compared with previously published studies using external beam radiation therapy. Longer follow-up is required to ensure that the functional results are maintained over time.
[Mh] Termos MeSH primário: Braquiterapia/métodos
Tratamento Conservador/métodos
Neoplasias da Próstata/radioterapia
Neoplasias da Próstata/cirurgia
Rabdomiossarcoma/radioterapia
Rabdomiossarcoma/cirurgia
Neoplasias da Bexiga Urinária/radioterapia
Neoplasias da Bexiga Urinária/cirurgia
[Mh] Termos MeSH secundário: Adolescente
Antineoplásicos/uso terapêutico
Braquiterapia/efeitos adversos
Criança
Pré-Escolar
Terapia Combinada/métodos
Intervalos de Confiança
Tratamento Conservador/efeitos adversos
Cistectomia/efeitos adversos
Cistectomia/métodos
Cistectomia/estatística & dados numéricos
Intervalo Livre de Doença
Feminino
Seguimentos
Seres Humanos
Lactente
Masculino
Neoplasia Residual
Estudos Prospectivos
Prostatectomia/efeitos adversos
Prostatectomia/métodos
Prostatectomia/estatística & dados numéricos
Neoplasias da Próstata/tratamento farmacológico
Neoplasias da Próstata/mortalidade
Rabdomiossarcoma/tratamento farmacológico
Rabdomiossarcoma/mortalidade
Fatores de Tempo
Resultado do Tratamento
Neoplasias da Bexiga Urinária/tratamento farmacológico
Neoplasias da Bexiga Urinária/mortalidade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Antineoplastic Agents)
[Em] Mês de entrada:1707
[Cu] Atualização por classe:180228
[Lr] Data última revisão:
180228
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:29298507
[Au] Autor:Gavriel H; Jabarin B; Israel O; Eviatar E
[Ad] Endereço:1 Department of Otolaryngology Head and Neck Surgery, Assaf Harofeh Medical Center, Zerifin, Israel.
[Ti] Título:Conservative Management for Subperiosteal Orbital Abscess in Adults: A 20-Year Experience.
[So] Source:Ann Otol Rhinol Laryngol;127(3):162-166, 2018 Mar.
[Is] ISSN:1943-572X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: Orbital complications (OC) secondary to acute rhinosinusitis (ARS) in adults are less common than in children, with assumed worse outcome. MATERIALS AND METHODS: Adults with OC secondary to ARS between 1994 and 2014 were reviewed retrospectively. Parameters recorded included age, gender, clinical symptoms and signs, computed tomography (CT) scan findings, duration of hospitalization, treatment before and during admission, cultures, and outcome. RESULTS: Thirty-seven adults with a mean age of 34.6 years, 27 males and 10 females, were diagnosed with OC, 19 (51.3%) with subperiosteal orbital abscess (SPOA), and none with orbital abscess/cellulitis or cavernous sinus thrombosis. Twelve patients with SPOA were managed conservatively with Amoxicillin-Clavulanate in most cases, and only 7 (36.8%) underwent surgery. A CT scan was performed in 27 cases revealing rhinosinusitis in all patients, including frontal involvement in 19 (51.3%) patients and sphenoid sinus in 16 (43.2%). CONCLUSIONS: A shift toward conservative treatment in cases of SPOA has long been integrated in the management protocols, mainly in children under 9 years old. The presumed worse prognosis in adults is not supported in our study, and a conservative treatment is urged to be considered in this group of patients albeit the more extensive radiologic involvement of their sinuses.
[Mh] Termos MeSH primário: Abscesso
Combinação Amoxicilina e Clavulanato de Potássio/administração & dosagem
Celulite Orbitária
Rinite/complicações
Sinusite/complicações
[Mh] Termos MeSH secundário: Abscesso/diagnóstico
Abscesso/etiologia
Abscesso/terapia
Doença Aguda
Adulto
Tratamento Conservador/métodos
Drenagem/métodos
Feminino
Seres Humanos
Israel/epidemiologia
Masculino
Órbita/diagnóstico por imagem
Celulite Orbitária/diagnóstico
Celulite Orbitária/etiologia
Celulite Orbitária/terapia
Prognóstico
Estudos Retrospectivos
Tomografia Computadorizada por Raios X/métodos
Resultado do Tratamento
Inibidores de beta-Lactamases/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (beta-Lactamase Inhibitors); 74469-00-4 (Amoxicillin-Potassium Clavulanate Combination)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180105
[St] Status:MEDLINE
[do] DOI:10.1177/0003489417751155


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[PMID]:29384849
[Au] Autor:Kim B; Lee BS; Kwak HK; Kang H; Ahn JH
[Ad] Endereço:Department of Radiology.
[Ti] Título:Natural course and outcomes of spontaneous isolated celiac artery dissection according to morphological findings on computed tomography angiography: STROBE compliant article.
[So] Source:Medicine (Baltimore);97(5):e9705, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We aimed to identify natural course and optimal management of spontaneous isolated celiac artery dissection (SICAD) according to morphologic classification determined on computed tomography angiography (CTA), and to investigate the association between symptoms and morphological classification of SICAD.This retrospective observational study included 21 consecutive patients with SICAD from January 2012 to April 2017. Demographic data, clinical features, treatment modalities, follow-up results, and CTA findings including morphologic classification, dissection length, and relative diameter of the true lumen (TLRD) were reviewed. Changes in follow-up CTA were recorded and compared to prior studies to reveal natural course of the disease.The serial changes of SICAD on follow-up CTA according to morphologic classifications were as follows; type I (5/5, no interval change), type IIa (1/1, no interval change), type IIb (1/1, partial remodeling), type IIIa (1/4, complete remodeling; 1/4, partial remodeling; 1/4, no interval change; 1/4, deterioration), type IIIb (4/6, no interval change; 2/6, partial remodeling), and type IV (2/2, no interval change). Thirteen (61.9%) symptomatic and 8 (38.1%) asymptomatic patients were all treated with conservative management with or without antiplatelet and/or anticoagulation therapies. Symptomatic group (SG) more commonly had type IIb, IIIa, IIIb, and IV than asymptomatic group (AG) (SG; 11 patients, AG; 1 patient, P = .002). TLRD in AG was larger than that in SG (SG: 40.5 ±â€Š24.1%, AG: 61.7 ±â€Š7.0%, P = .045).SICAD might be treated by conservative management in stable patients irrespective of the morphologic classification except for with type IV (dissecting aneurysm) and extension of celiac branch who may need an early intervention. Types IIb, IIIa, IIIb, and IV are TLRD are associated with patients' symptoms. Further studies on extended natural course of SICAD with a larger number of subjects are needed to draw a strong conclusion.
[Mh] Termos MeSH primário: Aneurisma Dissecante/diagnóstico por imagem
Artéria Celíaca/diagnóstico por imagem
Angiografia por Tomografia Computadorizada
[Mh] Termos MeSH secundário: Adulto
Idoso
Idoso de 80 Anos ou mais
Aneurisma Dissecante/classificação
Aneurisma Dissecante/terapia
Comorbidade
Tratamento Conservador
Progressão da Doença
Feminino
Seguimentos
Seres Humanos
Masculino
Meia-Idade
Estudos Retrospectivos
Fatores de Risco
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180221
[Lr] Data última revisão:
180221
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009705


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[PMID]:29185324
[Au] Autor:Winter S
[Ti] Título:Treating Post-Orthodontic White Spots: A Conservative Resin Infiltration Technique.
[So] Source:Dent Today;35(10):122-3, 2016 Oct.
[Is] ISSN:8750-2186
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Cárie Dentária/etiologia
Cárie Dentária/terapia
Braquetes Ortodônticos/efeitos adversos
Resinas Sintéticas/administração & dosagem
[Mh] Termos MeSH secundário: Adulto
Tratamento Conservador
Feminino
Seres Humanos
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Resins, Synthetic); 0 (icon infiltrant)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:D
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE


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[PMID]:29390530
[Au] Autor:Raasck K; Khoury J; Aoude A; Abduljabbar F; Jarzem P
[Ti] Título:Nonsurgical management of an extensive spontaneous spinal epidural hematoma causing quadriplegia and respiratory distress in a choledocholithiasis patient: A case report.
[So] Source:Medicine (Baltimore);96(51):e9368, 2017 Dec.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:RATIONALE: Spontaneous spinal epidural hematoma (SSEH) manifests from blood accumulating in the epidural space, compressing the spinal cord, and leading to acute neurological deficits. The disease's cloudy etiology and rarity contribute to dangerously suboptimal therapeutic principles. These neural deficits can be permanent, even fatal, if the SSEH is not treated in a timely and appropriate manner. Standard therapy is decompressive laminectomy, though nonsurgical management is a viable course of action for patients who meet a criterion that is continuously being refined. PATIENT CONCERNS: A 76-year-old woman on warfarin for a past pulmonary embolism presented to the emergency room with jaundice, myalgia, hematuria, neck pain, and an International Normalized Ratio (INR) of 14. Upon admission, she rapidly developed quadriplegia and respiratory distress that necessitated intubation. DIAGNOSES: T2-weighted magnetic resonance imaging (MRI) revealed an epidural space-occupying hyperintensity from C2 to S5 consistent with a spinal epidural hematoma. An incidental finding of dilated intrahepatic and common bile ducts prompted an endoscopic retrograde cholangiopancreatography, which demonstrated choledocholithiasis. INTERVENTIONS: The patient's INR was normalized with Vitamin K and Beriplex. Upon transfer to the surgical spine team for assessment of a possible intervention, the patient began to demonstrate recovery of neural functions. The ensuing sustained motor improvement motivated the team's preference for close neurologic monitoring and continued medical therapy over surgery. Thirteen hours after the onset of her symptoms, the patient was extubated. A sphincterotomy was later performed, removing 81 common bile duct stones. OUTCOMES: MRI demonstrated complete resorption of the SSEH and the patient maintained full neurological function at final follow-up. LESSONS: Nonsurgical management of SSEH should be considered in the context of early and sustained recovery. Severe initial neural deficit does not necessitate surgical decompression. Choledocholithiasis and subsequent Vitamin K deficiency, particularly when coupled with anticoagulant use, can increase INR and is a novel proposed risk factor for SSEH. Furthermore, coagulopathies should be medically corrected before surgical intervention within a given timeframe, as spontaneous recovery may manifest. This should be favored over surgery in patients demonstrating early and sustained recovery, as nonsurgical management is 25% more effective in achieving full recovery.
[Mh] Termos MeSH primário: Coledocolitíase/cirurgia
Hematoma Epidural Espinal/diagnóstico por imagem
Quadriplegia/reabilitação
Insuficiência Respiratória/terapia
Varfarina/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Colangiopancreatografia Retrógrada Endoscópica/métodos
Coledocolitíase/complicações
Coledocolitíase/diagnóstico por imagem
Tratamento Conservador
Serviço Hospitalar de Emergência
Feminino
Seguimentos
Hematoma Epidural Espinal/complicações
Hematoma Epidural Espinal/etiologia
Seres Humanos
Coeficiente Internacional Normatizado
Intubação Intratraqueal
Embolia Pulmonar/diagnóstico
Embolia Pulmonar/tratamento farmacológico
Quadriplegia/diagnóstico
Quadriplegia/etiologia
Recuperação de Função Fisiológica
Insuficiência Respiratória/diagnóstico
Medição de Risco
Índice de Gravidade de Doença
Varfarina/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
5Q7ZVV76EI (Warfarin)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180219
[Lr] Data última revisão:
180219
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180203
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009368


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[PMID]:29351748
[Au] Autor:Oka H; Matsudaira K; Takano Y; Kasuya D; Niiya M; Tonosu J; Fukushima M; Oshima Y; Fujii T; Tanaka S; Inanami H
[Ad] Endereço:Department of Medical Research and Management for Musculoskeletal Pain, 22nd Century Medical & Research Center, Faculty of Medicine, University of Tokyo, Hongo 7-3-1, Bunkyo, Tokyo, 113-8655, Japan. okah-tky@umin.ac.jp.
[Ti] Título:A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture and physical therapy study (LAP study).
[So] Source:BMC Complement Altern Med;18(1):19, 2018 Jan 19.
[Is] ISSN:1472-6882
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Although the efficiency of conservative management for lumbar spinal stenosis (LSS) has been examined, different conservative management approaches have not been compared. We have performed the first comparative trial of three types of conservative management (medication with acetaminophen, exercise, and acupuncture) in Japanese patients with LSS. METHODS: Patients with L5 root radiculopathy associated with LSS who visited our hospital for surgical treatment were enrolled between December 2011 and January 2014. In this open-label study, patients were assigned to three treatment groups (medication, exercise, acupuncture) according to the visit time. The primary outcomes were Zurich claudication questionnaire (ZCQ) scores before and after 4 weeks of treatment. Least square mean analysis was used to assess the following dependent variables in the treatment groups: changes in symptom severity and physical function scores of the ZCQ and the ZCQ score of patient's satisfaction after treatment. RESULTS: Thirty-eight, 40, and 41 patients were allocated to the medication, exercise, and acupuncture groups, respectively. No patient underwent surgical treatment during the study period. The symptom severity scores of the ZCQ improved significantly after treatment in the medication (p = 0.048), exercise (p = 0.003), and acupuncture (p = 0.04) groups. The physical function score improved significantly in the acupuncture group (p = 0.045) but not in the medication (p = 0.20) and exercise (p = 0.29) groups. The mean reduction in the ZCQ score for physical function was significantly greater for acupuncture than for exercise. The mean ZCQ score for treatment satisfaction was significantly greater for acupuncture than for medication. CONCLUSIONS: Acupuncture was significantly more effective than physical exercise according to the physical function score of the ZCQ and than medication according to the satisfaction score. The present study provides new important information that will aid decision making in LSS treatment. TRIAL REGISTRATION: This study was registered with the UMIN Clinical Trials Registry ( UMIN000006957 ).
[Mh] Termos MeSH primário: Terapia por Acupuntura
Vértebras Lombares/fisiopatologia
Modalidades de Fisioterapia
Estenose Espinal/fisiopatologia
Estenose Espinal/terapia
[Mh] Termos MeSH secundário: Idoso
Tratamento Conservador
Feminino
Seres Humanos
Masculino
Satisfação do Paciente
[Pt] Tipo de publicação:CLINICAL TRIAL; COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180216
[Lr] Data última revisão:
180216
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180121
[St] Status:MEDLINE
[do] DOI:10.1186/s12906-018-2087-y


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[PMID]:29419692
[Au] Autor:Mohamadi A; Googanian A; Ahmadi A; Kamali A
[Ad] Endereço:Department of Neurosurgery.
[Ti] Título:Comparison of surgical or nonsurgical treatment outcomes in patients with thoracolumbar fracture with Score 4 of TLICS: A randomized, single-blind, and single-central clinical trial.
[So] Source:Medicine (Baltimore);97(6):e9842, 2018 Feb.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Thoracolumbar fractures are among the most common types of damages caused to the spinal cord .Therefore, the aim of this study was the comparison of surgical or nonsurgical treatment outcomes in patients with thoracolumbar fracture with score 4 of the thoracolumbar injury classification and severity (TLICS) METHODS:: This study was clinical trial and double blind. Patients with thoracolumbar fracture with score 4 of TLICS entered at this research. We divided patients in 2 groups randomly (each group 25 patients) and then we followed patients for 1 year after start of treatment. We checked duration of bedridden and absence work, pain every 3 months for 1 year and radiography every 3 months for 1 year. RESULTS: Pain in operative group was lower than nonoperative group (P = .02). Regional sagittal angles (RSA) in operative group was lower than nonoperative group in all time (P = .0001). Mean of time of return to work in operative group was lower than nonoperative group (P = .001). CONCLUSIONS: Pain and mean of time of return to work and RSA in operative group was lower than nonoperative group. The present data suggest the use of operative method in patients with thoracolumbar fracture with score 4 of TLICS.
[Mh] Termos MeSH primário: Tratamento Conservador
Vértebras Lombares
Traumatismos da Medula Espinal/cirurgia
Fraturas da Coluna Vertebral/cirurgia
Procedimentos Cirúrgicos Operatórios
Vértebras Torácicas
[Mh] Termos MeSH secundário: Adulto
Tratamento Conservador/efeitos adversos
Tratamento Conservador/métodos
Feminino
Seres Humanos
Vértebras Lombares/lesões
Vértebras Lombares/cirurgia
Masculino
Doenças do Sistema Nervoso/diagnóstico
Doenças do Sistema Nervoso/etiologia
Avaliação de Resultados da Assistência ao Paciente
Procedimentos Cirúrgicos Operatórios/efeitos adversos
Procedimentos Cirúrgicos Operatórios/métodos
Vértebras Torácicas/lesões
Vértebras Torácicas/cirurgia
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180209
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000009842



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