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Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
All patients should receive supportive resuscitation irrespective of cause. This includes: Provide the patient with appropriate analgesic and antiemetics.Place the patient nil by mouth to rest the bowel and relieve future vomiting.Consider insertion of a nasogastric tube to decompress the bowel and relieve future vomiting.Gain intravenous access and begin fluid resuscitation matched to the patient’s hydration status.Fluid input and output charts are helpful alongside urinary catheterisation to aid fluid management.Patients who are being prepared for surgery may benefit from prophylactic antibiotics.Conservative treatment must often be trialled for at least 3 days for effect.
Benign Prostatic Hyperplasia and Lower Urinary Tract Symptoms in Men with Neurogenic Bladder
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Jeffrey Thavaseelan, Akhlil Hamid
Diagnosis and management of LUTS and BPH in the older man with underlying neurologic disease is complex. The potential for an adverse outcome following surgical intervention in these patients with BPH reinforces the importance of a detailed clinical history and knowledge of how neurologic conditions present themselves with respect to LUTSs. VCUG with/without EMG is an essential part of the diagnostic process, but it must be recognized that it is not always possible to discriminate between LUTS secondary to BPH and LUTS secondary to neurologic disease. As a consequence, in many circumstances, conservative treatment is preferable to irreversible surgical intervention.
Orthopaedics
Published in Roy Palmer, Diana Wetherill, Medicine for Lawyers, 2020
Degenerative disease of a joint is destruction of the lining articular cartilage. It occurs as a result of old age or secondary to any process which destroys this cartilage, namely trauma, infection or inflammatory disease (such as rheumatoid arthritis). The treatment is conservative or operative. Conservative treatment is pain relief, physiotherapy, walking aids for lower limb problems and splints for upper limb problems. Operative treatment is used for patients with severe pain, particularly when it disturbs sleep. The procedures include osteotomy, arthrodesis, and arthroplasty. In an osteotomy the bone near the joint is divided and the angle of the joint altered so that a less damaged portion of cartilage bears the weight. It relieves pain in about 60% of patients. An arthrodesis stiffens the joint so no movement occurs. It relieves pain most successfully but, of course, puts an extra strain on the joints above and below it. It should only be undertaken if these joints are normal.
Comparative outcomes between surgical treatment and orthosis splint for mallet finger: a systematic review and meta-analysis
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Chi Peng, Ren-Wen Huang, Shih-Heng Chen, Chung-Chen Hsu, Cheng-Hung Lin, Yu-Te Lin, Che-Hsiung Lee
With regards to the complications rate, no significant difference was found in our meta-analysis between surgical and conservative treatment. The complications of conservative treatment are frequent and most often benign and transient. Skin lesions, including ulceration, local irritation, maceration, superficial infection and dorsal bump, are especially common. The complications of surgical intervention are usually serious and long-term, including nail dystrophy or deformity, pin tract infection, osteomyelitis and skin necrosis [58]. Stern and Kastrup reported complication rates of surgery and splint of 53% and 45%, respectively. They also found that only one finger (4%) with splint had a long-term complication, a minor nail deformity. However, 76% of the surgical complications were long-term [45].
Is conservative management of partial zone II flexor tendon laceration possible? A systematic literature review and meta-analysis
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Young Woong Mo, Da Hye Ryu, Gyo-Young Cho, Jong Won Hong
In order to assert that surgery, which has been originally actively and invasively performed in medical studies, especially clinical studies, is not really necessary, conservative treatment should be gradually adopted as long as it does not harm the patient. The fact that it already has been performed under a low threshold of indication is a very burdensome aspect. Conservative treatment was used in anticipation that it would be okay after seeing a few cases. In conclusion, if the results and prognosis are poor, this is because conservative treatment after exploration is an act that ultimately harms the patient. These reasons explain why the number of patients in the group that underwent conservative treatment was small in all of the papers we analyzed in accordance with the inclusion criteria.
Platelet rich plasma for hallux sesamoid injuries: a case series
Published in The Physician and Sportsmedicine, 2022
Hung M. Le, Andrea Stracciolini, Cynthia J. Stein, Bridget J. Quinn, Sarah S. Jackson
Given the potential risks associated with surgery, some patients may consider other conservative treatment options. Our case series is the first to report the potential role of PRP in the treatment of refractory sesamoid injuries in humans. Leukocyte-rich PRP has been used for sesamoiditis in thoroughbreds [10]. Although the evidence of PRP use in sesamoid injuries is limited, the use of orthobiologics in treating foot and ankle disease has been described. For example, there has been emerging evidence showing an improved function and pain with the use of adipose-derived mesenchymal stem cells for treating hallux rigidus [11], improved bone healing in foot and ankle surgery with the use of bone marrow aspirate concentrate (BMAC) [12], and benefits of PRP for treating Achilles pathology, chronic plantar fasciitis, ankle osteoarthritis, and talar osteochondral lesions [13].