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1.
Evid. actual. práct. ambul ; 24(2): e002071, 2021. tab
Article in Spanish | LILACS | ID: biblio-1254939

ABSTRACT

Ante un escenario clínico de coxalgia por artrosis de cadera se planteó la necesidad de conocer los tratamientos con-servadores más seguros y efectivos para el manejo del dolor. El tratamiento de la artrosis requiere un enfoque integral e individualizado en función de las preferencias del paciente para lograr el máximo beneficio clínico. Existen numerosas estrategias útiles para el manejo del dolor en pacientes con artrosis de cadera siendo fuertemente recomendados de inicio la actividad física, los antiinflamatorios no esteroideos (AINE) orales y en ciertos casos los corticoides intraarticulares, tramadol o duloxetina, siempre asociado con la actividad física. Los ejercicios más recomendados son los aeróbicos y el Tai Chi o yoga. (AU)


Faced with a clinical scenario of coxalgia due to hip osteoarthritis, the need to know the safest and most effective conservative treatments for pain management arose. The treatment of osteoarthritis requires a comprehensive and individualised approach based on the patient's preferences to achieve maximum clinical benefit. There are numerous useful strategies for pain management in patients with hip osteoarthritis being strongly recommended from the beginning such as physical activity, oral non-steroidal anti-inflammatory drugs (NSAID) and in certain cases intra-articular corticosteroids, tramadol or duloxetine, always associated with physical activity. The most recommended exercises are aerobics and Tai Chi or yoga. (AU)


Subject(s)
Humans , Female , Aged, 80 and over , Osteoarthritis, Hip/drug therapy , Osteoarthritis, Hip/therapy , Conservative Treatment/methods , Pain , Tramadol/therapeutic use , Yoga , Exercise , Osteoarthritis, Hip/diagnostic imaging , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Tai Ji , Pain Management/methods , Duloxetine Hydrochloride/therapeutic use , Muscle Rigidity
2.
Bol. méd. postgrado ; 36(2): 43-47, dic.2020. tab, graf
Article in Spanish | LILACS, LIVECS | ID: biblio-1117899

ABSTRACT

La uroflujometría es un estudio no invasivo del tracto urinario inferior que entrega información objetiva del flujo urinario y es ampliamente recomendado por las guías europeas en el estudio de pacientes con sintomatología urinaria baja. Se realizó un estudio descriptivo transversal cuyo propósito fue describir el uso de la uroflujometría en el estudio de síntomas del tracto urinario bajo en pacientes masculinos que acudieron a la consulta de Servicio de Urología del Hospital Central Universitario Dr. Antonio María Pineda de la ciudad de Barquisimeto, estado Lara durante el lapso 2018- 2019. La muestra estuvo conformada por 150 pacientes. Los resultados indican que el 62% de la muestra corresponde a pacientes entre 60 y 70 años de edad de los cuales 52% manifestaron síntomas urinarios leves. La uroflujometría evidenció que 56% de los pacientes tienen un flujo máximo entre 10 y 20 ml/seg lo cual sugiere una probable obstrucción al flujo de salida; 78% de los pacientes presentan un flujo promedio entre 0 a 10 ml/seg. El 53% de los pacientes mostró un volumen de vaciado < 300 ml y 49% un tiempo de flujo máximo entre 30 y 50 segundos. En conclusión, la uroflujometría es un examen simple y rápido que proporciona información útil sobre la salud de las vías urinarias inferiores(AU)


Uroflowmetry is a non-invasive study of the lower urinary tract that provides objective information on urinary flow and is widely recommended by European guidelines for the study of patients with lower urinary tract symptoms. We performed a cross-sectional descriptive study to describe the use of uroflowmetry for the study of lower urinary tract symptoms in males who attended the Servicio de Urología of the Hospital Central Universitario Dr. Antonio María Pineda (Barquisimeto, Lara state) during the 2018- 2019 period. The sample was made up of 150 males. The results show that 62% of the sample included males between 60 and 70 years old and 52% complained of mild urinary symptoms. Uroflowmetry results showed that 56% of patients had a maximum flow between 10 and 20 ml/sec suggestive of urinary tract obstruction; 78% had an average flow between 0 and 10 ml/sec while 53% had a micturition volume < 300 ml and 49% had a maximum flow time between 30 and 50 seconds. Uroflowmetry is a simple and fast test which provides useful information about the health of lower urinary tract(AU)


Subject(s)
Humans , Male , Middle Aged , Aged , Urethral Obstruction , Urinary Tract , Prostatism/diagnostic imaging , Conservative Treatment/methods , Urination , Urologic Diseases , Ultrasonography
3.
Rev. bras. oftalmol ; 79(2): 131-133, Mar.-Apr. 2020. graf
Article in Portuguese | LILACS | ID: biblio-1137949

ABSTRACT

Resumo Ectrópio palpebral congênito é o termo utilizado para descrever a ocorrência da eversão das pálpebras, seja ela superior ou inferior, presente ao nascimento. Trata-se de uma afecção rara com reduzido número de casos publicados no meio científico desde 1896, ano em que o primeiro relato foi documentado. O objetivo desse trabalho é descrever um caso de abordagem conservadora do Ectrópio Palpebral Congênito, evidenciando as suas principais características, importância do diagnóstico precoce e conduta adequada para o seu tratamento. Este é um estudo transversal, retrospectivo e documental baseado na metodologia de relato de caso que envolve um recém-nascido do sexo feminino que apresentou eversão palpebral unilateral e foi tratada de maneira conservadora, obtendo melhora do quadro com satisfatório resultado estético e funcional.


Abstract Congenital eyelid ectropion is the term used to describe the eversion of the eyelids, be it in the upper or lower lid, present at birth. It is a rare condition with a reduced number of cases published in scientific world since 1896, the year it was first reported. The objective of this work is to describe a case of Congenital Ectropion treated conservatively, emphasizing its main characteristics, importance of early diagnosis and appropriate treatment. This is a cross-sectional, retrospective and documentary study based on the methodology of case report involving a female newborn who presented unilateral palpebral eversion at birth and was treated conservatively, showing a satisfactory and functional improvement of the condition.


Subject(s)
Humans , Female , Infant, Newborn , Ointments , Ophthalmic Solutions , Ectropion/congenital , Ectropion/drug therapy , Eyelids/abnormalities , Conservative Treatment/methods , Cross-Sectional Studies , Retrospective Studies
4.
Medwave ; 20(1): e7758, 2020.
Article in English, Spanish | LILACS | ID: biblio-1096477

ABSTRACT

INTRODUCCIÓN La caries dental ha sido convencionalmente manejada mediante la remoción no selectiva del tejido carioso (remoción total), sin embargo, los efectos adversos de este procedimiento han promovido la utilización de técnicas de remoción de caries conservadoras (remoción selectiva), pero aún existe controversia respecto a su efectividad. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metaanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos siete revisiones sistemáticas que en conjunto incluyeron siete estudios primarios, todos ellos correspondientes a ensayos aleatorizados. Concluimos que la remoción selectiva de caries podría disminuir la necesidad de tratamiento de endodoncia y el riesgo de exposición pulpar en dientes con caries profundas, pero la certeza de la evidencia es baja. No existe claridad de que la remoción selectiva de caries disminuya el riesgo de aparición de signos y síntomas de patología pulpar y el riesgo de fracaso de las restauraciones ya que la certeza de la evidencia es muy baja.


INTRODUCTION Dental caries have been conventionally managed by non-selective removal of carious tissue (total complete removal); however, the adverse effects of this procedure have promoted the use of conservative caries removal techniques (selective removal), but there is still controversy regarding its effectiveness. METHODS We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS We identified seven systematic reviews including seven studies overall, of which all were randomized trials. We concluded that selective caries removal may decrease the need for root canal treatment and the risk of pulp exposure in teeth with deep caries, but the certainty of the evidence is low. It is not clear whether the selective removal of caries reduces the risk of appearance of signs and symptoms of pulp disease and the risk of restorations failure, as the certainty of the evidence is very low.


Subject(s)
Humans , Dental Caries/therapy , Conservative Treatment/methods , Systematic Reviews as Topic , Randomized Controlled Trials as Topic , Treatment Outcome , Risk Assessment , Dental Caries/pathology , Regenerative Endodontics
5.
Rev. ANACEM (Impresa) ; 14(1): 74-80, 2020.
Article in Spanish | LILACS | ID: biblio-1123589

ABSTRACT

INTRODUCCIÓN: La artrosis rodilla es una enfermedad crónica, degenerativa, inflamatoria y multifactorial que afecta el cartílago articular, provocando dolor y pérdida de funcionalidad. Actualmente, existen una variedad de nuevos fármacos y protocolos terapéuticos, generando dudas al momento del tratamiento. Por lo anterior, el objetivo de este trabajo es entregar una revisión de la literatura con información reciente, con el fin de brindar una recomendación actualizada para el manejo de la artrosis de rodilla. MATERIALES Y MÉTODOS: Se realizó una revisión no sistemática de estudios publicados entre enero del 2000 y agosto del 2020, utilizando los términos MeSH "knee", "osteoarthritis" y "therapeutics". Se usaron como motores de búsqueda PubMed, The Cochrane Library y Trip Data base, excluyendo estudios en animales y población pediátrica. DISCUSIÓN: Es importante destacar que independientemente de la modalidad de tratamiento, este debe ser escalonado e individualizado, pues cada paciente va a responder de forma diferente. Se recomienda en primer lugar los cambios de estilo de vida, autocuidado y educación. En segundo lugar, la kinesioterapia, seguido de la farmacología tópica y oral (AINES y paracetamol) y como última opción, el tratamiento intraarticular en base a corticoides. CONCLUSIÓN: El tratamiento de la artrosis de rodilla debe ser integral y centrado tanto en el manejo farmacológico como no farmacológico. Actualmente, no existe un único fármaco seguro, altamente útil y costo-efectivo para el tratamiento crónico


INTRODUCTION: Knee osteoarthritis is a chronic, degenerative, inflammatory, and multifactorial disease that affects joint cartilage, causing pain and loss of functionality. Currently, there are a variety of new drugs and therapeutic protocols, raising doubts at the time of treatment. Therefore, the objective of this work is to provide a review of the literature with recent information, to provide an updated recommendation for the management of knee osteoarthritis. MATERIALS AND METHODS: A non-systematic review of studies published between January 2000 and August 2020 were performed, using the MeSH terms "knee", "osteoarthritis" and "therapeutics". PubMed, The Cochrane Library, and Trip Database were used as search engines, excluding studies in animals and the pediatric population. ABSTRACT: It is important to highlight that regardless of the treatment modality, it must be stepped and individualized, since each patient will respond differently. Lifestyle changes, self-care, and education are recommended first. Secondly, kinesiotherapy, followed by topical and oral pharmacology (NSAIDs and paracetamol) and as a last option, intra-articular treatment based on corticosteroids. CONCLUSION: Treatment of osteoarthritis of the knee should be comprehensive and focused on both pharmacological and non-pharmacological management. Currently, there is no single safe, highly useful, and cost-effective drug for chronic treatment


Subject(s)
Humans , Male , Female , Osteoarthritis, Knee/therapy , Conservative Treatment/methods , Self Care , Osteoarthritis, Knee/drug therapy
6.
Rev. ANACEM (Impresa) ; 14(1): 88-92, 2020. graf
Article in Spanish | LILACS | ID: biblio-1123599

ABSTRACT

Introducción: El síndrome de dolor patelofemoral, se define como aquel dolor retro o peripatelar agravado por al menos 1 actividad que cargue la articulación en flexión. Su diagnóstico, se basa en una correcta anamnesis, examen físico y pruebas de evocación de dolor e inestabilidad. El tratamiento puede ser quirúrgico o conservador, este último, tiene como objetivo disminuir el dolor e inflamación. Sin embargo, a pesar de su alta prevalencia, existen escasos protocolos sobre su manejo, por lo que el objetivo de este trabajo es entregar una revisión de la literatura con información reciente, a modo de dar una recomendación actualizada para su tratamiento. Materiales Y Métodos: Se realizó una revisión no sistemática de estudios publicados entre enero del 2005 y agosto del 2020, utilizando los términos MeSH "Anterior knee pain", "Patellofemoral pain syndrome" y "Treatment". Se usaron como motores de búsqueda PubMed, The Cochrane Library y Trip Data base, excluyendo estudios en animales y población pediátrica. Desarrollo: El tratamiento conservador del síndrome de dolor anterior de rodilla, puede dividirse en intervenciones proximales, locales y distales, todas centradas en una correcta pauta de fortalecimientos y estiramientos de los elementos comprometidos. Se recomienda esquemas asociados de fortalecimientos de core, cadera y rodilla, sin embargo, la literatura no es consistente en pautas de tratamiento protocolizados. Conclusión: El tratamiento conservador del síndrome del dolor patelofemoral depende exclusivamente de los resultados de un correcto examen físico y de las pruebas terapéuticas correspondientes.


Introduction: Patellofemoral pain syndrome is defined as that retro or peripatellar pain aggravated by at least one activity that loads the joint in flexion. Its diagnostic is based on the correct anamnesis, physical exam, pain evocation tests and instability. The treatment can be surgical or conservative, and the last one aims to reduce pain and inflammation. However, despite its high prevalence, there are few protocols concerning its handling, so the main objective of this research is to offer a literature review with updated information, in order to give an updated recommendation for its treatment. Materials And Methods: A non-systematic review of studies published between January 2005 and August 2020 were performed, using the MeSH "Anterior knee pain", "Patellofemoral pain syndrome" and "Treatment". PubMed, The Cochrane Library, and Trip Database were used as search engines, excluding studies in animals and the pediatric population. Development: The conservative treatment of anterior knee pain syndrome, can be divided into proximal, local and distal interventions, all of them focused on a correct guide of strengthening and stretching of the elements involved. Associated schemes of core, hip and knee strengthening are recommended, nevertheless, the literature is not consistent in terms of protocolized treatment guidelines. Conclusion: The conservative treatment of patellofemoral pain syndrome depends exclusively on the results of a correct physical examination, and the corresponding therapeutic tests.


Subject(s)
Humans , Patellofemoral Pain Syndrome/therapy , Exercise Therapy/methods , Knee Injuries/therapy , Patellofemoral Pain Syndrome/physiopathology , Conservative Treatment/methods
7.
Säo Paulo med. j ; 137(6): 543-549, Nov.-Dec. 2019. tab
Article in English | LILACS | ID: biblio-1094517

ABSTRACT

ABSTRACT BACKGROUND: Shoulder pain is considered to be the third largest cause of musculoskeletal functional alterations in individuals presenting pain during movement. OBJECTIVE: The purpose of this synthesis of evidence was to identify the clinical effectiveness of conservative and surgical treatments reported in Cochrane systematic reviews among individuals diagnosed with rotator cuff disease. DESIGNAND SETTING: Review of systematic reviews, conducted in the Federal University of São Paulo (Universidade Federal de São Paulo, UNIFESP). METHODS: This synthesis of evidence included systematic reviews that had been published in the Cochrane database. The inclusion criteria were that these systematic reviews should involve individuals aged ≥ 16 years with rotator cuff disease, comparing surgical procedures with or without associated nonsurgical procedures versus placebo, no treatment or other nonsurgical interventions. RESULTS: Thirty-one systematic reviews were included, involving comparisons between surgical procedures and conservative treatment; procedures either combined or not combined with drugs, versus other procedures; and procedures involving exercises, manual therapy and electrothermal or phototherapeutic resources. CONCLUSIONS: The findings suggest that strengthening exercises, with or without associated manual therapy techniques and other resources, were the interventions with greatest power of treatment over the medium and long terms, for individuals with shoulder pain. These had greater therapeutic power than surgical procedures, electrotherapy or photobiomodulation. Protocol registration number in the PROSPERO database: ID - CRD42018096578.


Subject(s)
Humans , Evidence-Based Medicine , Rotator Cuff Injuries/therapy , Phototherapy/methods , Exercise , Treatment Outcome , Shoulder Pain/therapy , Pain Management/methods , Rotator Cuff Injuries/surgery , Rotator Cuff Injuries/drug therapy , Conservative Treatment/methods , Systematic Reviews as Topic
8.
Rev. cuba. endocrinol ; 30(3): e190, sept.-dic. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126447

ABSTRACT

RESUMEN Introducción: El manejo conservador en el tratamiento de la obesidad, tiene una eficacia limitada, lo que ha hecho posible el desarrollo y empleo de otros métodos como la cirugía bariátrica y los procedimientos endoluminales para el tratamiento de la obesidad. En este sentido, recientemente ha sido aprobado para su uso un método que se conoce como baipás externo, al cual debemos prestar atención por constituir una posible opción en el tratamiento de la obesidad. Objetivo: Describir el papel del baipás externo en el tratamiento de la obesidad, a través de algunas preguntas y respuestas. Métodos: Se utilizó como buscador de información científica a Google Académico. Las palabras clave empleadas fueron: obesidad, baipás externo, pérdida de peso, tratamiento. Se evaluaron artículos de revisión y de investigación, provenientes de diferentes bases de datos y páginas Web, que en general, tenían 10 años o menos de publicados, en idioma español, portugués o inglés. Esto permitió el estudio de 36 artículos, de los cuales 23 fueron referenciados por su calidad científica. Conclusiones: El baipás externo debe jugar un destacado papel en el tratamiento de la obesidad, por ser un procedimiento simple, eficaz y con un índice de complicaciones muy bajo, donde no se modifica o altera la anatomía gastrointestinal del paciente, como sucede con la cirugía bariátrica. Tiene como inconveniente la incomodidad de vivir con una sonda abdominal y la necesidad de vaciarla varias veces en el día(AU)


ABSTRACT Introduction: Conservative management in the treatment of obesity has a limited efficiency, which has made possible the development and use of other methods such as bariatric surgery and endoluminal procedures for the treatment of this condition. In this regard, it has been recently approved for its use a method that is known as external bypass, to which we must pay attention as a possible option in the treatment of obesity. Objective: To describe the role of the external bypass in the treatment of obesity through some questions and answers. Methods: It was used Google Scholar as searcher of scientific information. The keywords used were: obesity, external bypass, weight loss, treatment. There were assessed review and research articles from different databases and web pages, which in general had 10 years or less of being published in Spanish, Portuguese or English languages. This allowed the study of 36 articles from which 23 were referenced due to their scientific quality. Conclusions: The external bypass should play a prominent role in the treatment of obesity, for being a simple, effective and with a very low complications rate procedure that does not change or alter the gastrointestinal anatomy of the patient, as in the case of bariatric surgery. It has as inconvenience the discomfort of living with an abdominal probe and the need to empty it several times a day(AU)


Subject(s)
Humans , Bariatric Surgery/methods , Conservative Treatment/methods , Obesity/therapy , Review Literature as Topic , Databases, Bibliographic
9.
Rev. cuba. obstet. ginecol ; 45(3): e489, jul.-set. 2019. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1093663

ABSTRACT

RESUMEN Introducción: La insuficiencia cervical se concibe hoy día como un proceso biológico continuo con grados progresivos de insuficiencia. La expresión más extrema de la insuficiencia cervical se conoce como "bolsa en reloj de arena". La mayoría de los autores están de acuerdo en recomendar el reposo en cama y realizar cerclaje cervical de emergencia. Objetivo: Presentar el caso de una gestante en la que se logró la reversión del prolapso de las membranas amnióticas en "reloj de arena" con buenos resultados perinatales. Presentación de caso: Paciente de 31 años con antecedentes de parto anterior a las 36,5 semanas, que en los momentos actuales cursa una gestación de 20,6 semanas. Acude a la consulta por dolor en hipogastrio y al examen físico se comprueba que la bolsa amniótica protruye por el orificio cervical externo y presenta una dilatación cervical de 2 cm. Se aplica tratamiento medicamentoso y se reduce el prolapso de la bolsa. Conclusiones: Con el tratamiento conservador se logró una buena evolución de la gestación, con parto eutócico y buenos resultados perinatales(AU)


ABSTRACT Introduction: Cervical insufficiency is conceived today as a continuous biological process with progressive degrees of insufficiency. The most extreme expression of cervical insufficiency is known as "hourglass bag". Most authors agree to recommend bed rest and perform emergency cervical cerclage. Objective: To report the case of a pregnant woman in whom the prolapse reversal of the amniotic membranes in hourglass was achieved with good perinatal results. Case report: A 31-year-old patient who is currently pregnant at 20.6 weeks and has history of childbirth prior to 36.5 weeks. She comes to the consultation complaining of pain in hypogastrium. The physical examination shows that the amniotic sac protrudes through the external cervical orifice and there is 2cm cervical dilation. Drug treatment is applied and the prolapse of the sac is reduced. Conclusions: The conservative treatment achieved good evolution of the gestation, with eutócico childbirth and good perinatal results(AU)


Subject(s)
Humans , Female , Adult , Pain/etiology , Prolapse , Cerclage, Cervical/methods , Conservative Treatment/methods , Physical Examination/adverse effects , Bed Rest/methods
10.
Rev. cuba. reumatol ; 21(2): e91, mayo.-ago. 2019.
Article in Spanish | LILACS, CUMED | ID: biblio-1093817

ABSTRACT

Introducción: la osteoartrosis es la más frecuente de las enfermedades articulares. Objetivo: exponer los referentes bibliográficos que actualmente se refieren a la osteoartrosis en el marco de la revisión de literatura realizada. Desarrollo: como síndrome anatomoclínico se identifica por dolor mecánico que usualmente se relaciona con rigidez y que provoca poco a poco una pérdida o mengua de la función articular. Diversos factores de riesgo se relacionan con el progreso de esta enfermedad entre los que destacan, además de la edad y el sexo femenino, la obesidad, los microtraumas repetitivos en la práctica de determinados deportes y el cumplimiento de actividades profesionales específicas. Conclusiones: el tratamiento de la osteoartrosis debería ejecutarse a nivel de medicina familiar, tanto en el componente preventivo, como en el del control y manejo conservador, instruyendo al paciente en sus cuidados y acciones diarias y operando esquemas de medicamentos, ejercicios, apoyos funcionales como rodilleras, bastones y andadores. La educación médica debe asumir este paradigma, y no solicitar acto seguido la interconsulta a la especialidad cuando el paciente no responde, sin tener en cuenta que el manejo del paciente con artrosis se encuentra distante de la prescripción farmacológica(AU)


Introduction: osteoarthrosis is the most frequent joint disease. Objective: to expose the bibliographic references that currently refer to osteoarthrosis in the framework of the literature review carried out. Development: as anatomoclinic syndrome is identified by mechanical pain that is usually related to stiffness and that gradually causes a loss or decline of joint function. Several risk factors are related to the progress of this disease, among which stand out, in addition to age and female sex, obesity, repetitive microtrauma in the practice of certain sports and compliance with specific professional activities. Conclusions: treatment of osteoarthrosis should be carried out at the level of family medicine, both in the preventive component, as well as in the control and conservative management, instructing the patient in his daily care and actions and operating medication schemes, exercises, functional supports such as knee pads, canes and walkers. The medical education must assume this paradigm, and not immediately request the interconsultation to the specialty when the patient does not respond, without taking into account that the management of the patient with osteoarthritis is distant from the pharmacological prescription(AU)


Subject(s)
Humans , Osteoarthritis/prevention & control , Exercise , Osteoarthritis/therapy , Education, Medical , Conservative Treatment/methods
11.
Int. j. odontostomatol. (Print) ; 13(2): 198-202, jun. 2019. graf
Article in English | LILACS | ID: biblio-1002306

ABSTRACT

ABSTRACT: Florid osseous dysplasia (FOD) is an extensive form of osseous dysplasia where normal trabecular bone is substituted by fibrous connective tissue and amorphous mineralized tissue. Usually, the lesions are mainly asymptomatic and the patients should be followed with clinical and imaging examination, requiring no intervention. Nevertheless, due to the poor vascularization of the lesion and to local trauma, secondary infections and osteomyelitis may occur. Patients may present with pain, mucosal ulceration, lesion exposure in the oral cavity, fistula and swelling. In such cases, the correct diagnosis and management of the lesion is decisive to reestablish patient's health and quality of life. The aim of this article is to present a case of complicating secondary chronic osteomyelitis treated successfully with conservative intervention. A 68-year-old black female patient reported a "swelling of the gums" that was present for eleven years, with episodes of periodic pain and swelling. On physical examination, a papule with suppuration in the alveolar mucosa in the right side of the mandible was observed. Panoramic radiography and CBCT showed a mixed lesion surrounded by sclerotic bone. The patient was diagnosed with chronic osteomyelitis in association with FOD and treated with antibiotic therapy together with surgical curettage. The incidence, etiophatology, differential diagnosis, treatment and prevention of secondary osteomyelitis associated with FOD are discussed in the light of literature. This information might assist the dentists while choosing the best treatment options for similar cases.


RESUMEN: La displasia ósea florida (DOF) es una forma de displasia ósea donde el hueso trabecular normal es sustituido por tejido conectivo fibroso y tejido mineralizado amorfo. En general, las lesiones son de origen asintomático y los pacientes deben ser seguidos con el examen clínico. Sin embargo, debido a la pobre vascularización de la lesión y al trauma local, pueden producirse lesiones secundarias y osteomielitis. Los pacientes pueden presentarse con dolor, ulceración mucosa, lesión de exposición en la cavidad oral, fístula y edema. En estos casos, el correcto diagnóstico y tratamiento de la lesión es decisivo para reestabilizar la salud y la calidad de la vida. El objetivo de este artículo consistió en presentar un caso de complicación secundaria crónica de osteomielitis tratados con tratamiento conservador. El paciente, negro, de 68 años de edad, consulta por "hinchazón de las encías" que se presentó durante once años, con episodios de dolor. En el examen intraoral, se observó una pápula con supuración en la mucosa alveolar en el lado derecho de la mandíbula. La radiografía panorámica y CBCT mostraron una lesión mixta rodeada de hueso esclerótico. El paciente fue diagnosticado con osteomielitis crónica en asociación con DOF y fue tratado con tratamiento antibiótico junto con curetaje quirúrgico. La incidencia, la etiopatología, el diagnóstico diferencial, el tratamiento y la prevención de la osteomielitis secundaria asociada con DOF se discuten a la luz de la literatura. Esta información puede ayudar a los dentistas a elegir las mejores opciones de tratamiento para casos similares.


Subject(s)
Humans , Aged , Osteomyelitis/therapy , Osteomyelitis/diagnostic imaging , Mandibular Diseases/therapy , Conservative Treatment/methods , Radiography, Panoramic , Mandibular Diseases/diagnostic imaging , Fibrous Dysplasia of Bone/therapy , Fibrous Dysplasia of Bone/diagnostic imaging
12.
J. bras. nefrol ; 41(1): 95-102, Jan.-Mar. 2019. graf
Article in English | LILACS | ID: biblio-1002415

ABSTRACT

ABSTRACT Estimates suggest that 20-30% of the deaths of patients with chronic kidney disease with indication to undergo dialysis occur after refusal to continue dialysis, discontinuation of dialysis or inability to offer dialysis on account of local conditions. Contributing factors include aging, increased comorbidity associated with chronic kidney disease, and socioeconomic status. In several occasions nephrologists will intervene, but at times general practitioners or family physicians are on their own. Knowledge of the main etiologies of chronic kidney disease and the metabolic alterations and symptoms associated to end-stage renal disease is an important element in providing patients with good palliative care. This review aimed to familiarize members of multidisciplinary care teams with the metabolic alterations and symptoms arising from chronic kidney disease treated clinically without the aid of dialysis.


RESUMO Estimativas sugerem que em torno de 20% a 30% dos óbitos de pacientes com doença renal crônica em estágio dialítico decorrem de renúncia à diálise, da interrupção do tratamento dialítico ou da incapacidade de oferecer tratamento dialítico em função das condições locais. O envelhecimento populacional, o aumento das comorbidades associadas à doença renal crônica e o nível socioeconômico do país contribuem para esse cenário. Em diversas ocasiões o nefrologista estará presente para intervir ativamente, mas em outras o médico generalista ou o médico de família estarão sós. O conhecimento das principais etiologias da doença renal crônica e das alterações metabólicas e dos sintomas associados à fase terminal da doença renal são condições importantes para a evolução do paciente sem sofrimento para uma boa morte. O objetivo desta revisão é familiarizar os membros da equipe multiprofissional para o reconhecimento e conduta quanto às alterações metabólicas e aos sintomas decorrentes da doença renal crônica tratada clinicamente sem suporte dialítico.


Subject(s)
Humans , Aged , Aged, 80 and over , Palliative Care/methods , Treatment Refusal , Renal Insufficiency, Chronic/therapy , Conservative Treatment/methods , Renal Dialysis , Diet, Protein-Restricted , Dietary Supplements , Diet, Sodium-Restricted , Renal Insufficiency, Chronic/etiology , Pain Management , Nephrologists
13.
J. vasc. bras ; 17(3)jul.-set. 2018. graf
Article in Portuguese | LILACS | ID: biblio-916209

ABSTRACT

A síndrome de quebra-nozes é caracterizada por um grupo de manifestações clínicas que ocorrem por conta da compressão da veia renal esquerda. Seus principais sintomas são macro e micro-hematúria, proteinúria e dor no flanco. O diagnóstico é geralmente realizado após a exclusão de outras causas mais comuns, por conta da ausência de critérios clínicos para diagnóstico. Sua confirmação é feita por exames de imagem, com uso da ultrassonografia Doppler e tomografia computadorizada. O tratamento pode variar com as características do paciente e com a gravidade dos sintomas, e inclui o tratamento conservador, a cirurgia aberta e a cirurgia endovascular. Atualmente, a cirurgia aberta continua sendo a linha de frente, mas abordagens menos invasivas vêm ganhando cada vez mais espaço


The nutcracker syndrome is characterized by a group of clinical manifestations caused by compression of the Left Renal Vein. The main symptoms are: macro and micro hematuria, proteinuria, and flank pain. Diagnosis is usually made after excluding other causes, because there are no clinical criteria for diagnosis. Confirmation is by Doppler ultrasonography or computed tomography. Treatment can vary, depending on patient characteristics and the severity of the symptoms, while conservative treatment, open surgery, and endovascular surgery may be employed. Currently, open surgery is still the first-line treatment, but some less invasive approaches are gaining acceptance


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Diagnosis , Renal Nutcracker Syndrome/diagnosis , Renal Nutcracker Syndrome/therapy , Therapeutics , Aorta, Abdominal/diagnostic imaging , Conservative Treatment/methods , Endovascular Procedures/methods , Hematuria/diagnosis , Mesenteric Veins , Nephrectomy/methods , Pelvic Pain/etiology , Renal Veins , Review , Stents , Surgical Procedures, Operative/methods , Tomography/methods , Ultrasonography, Doppler/methods
14.
Rev. cuba. pediatr ; 90(2): 299-305, abr.-jun. 2018. ilus
Article in Spanish | LILACS | ID: biblio-901489

ABSTRACT

Introducción: las perforaciones duodenales son consideradas lesiones de extrema gravedad a cualquier edad. Su etiología puede ser por traumatismos, o después de la realización de un procedimiento endoscópico digestivo. Debido a la elevada morbilidad y mortalidad de estas lesiones, su tratamiento quirúrgico ha sido el método de elección durante años en la mayoría de los casos. Más recientemente se ha reportado con éxito el tratamiento no quirúrgico en pacientes seleccionados. Presentación del caso: se presenta el caso de tratamiento exitoso no quirúrgico en un adolescente de 13 años con una perforación duodenal intraperitoneal después de una colangiopancreatografía retrógrada endoscópica. Las medidas terapéuticas en este caso fueron: la suspensión de la vía oral, el uso de nutrición parenteral total, la administración de análogo de la somatostatina y los antibióticos sistémicos. Conclusiones: la perforación duodenal intraperitoneal después de una colangiopancreatografía retrógrada endoscópica en niños puede ser diagnosticada precozmente. El tratamiento médico basado en la observación estricta del enfermo, la nutrición parenteral total, la suspensión de la alimentación oral, la aspiración nasogástrica octeotride y la administración de antibióticos sistémicos, es eficaz en enfermos selectos(AU)


Introduction: duodenal perforations are considered extremely serious lesions at any age. Its etiology may be due to trauma, or after performing a digestive endoscopic procedure. Due to the high morbidity and mortality of these injuries, surgical treatment has been the method of choice for years in most cases. More recently, non-surgical treatment has been reported successfully in selected patients. Case presentation: it is presented a case of successful non-surgical treatment in a 13-year-old adolescent with intra-peritoneal duodenal perforation after endoscopic retrograde cholangiopancreatography. Therapeutic measures in this case were: the suspension of the oral route, the use of total parenteral nutrition, the administration of the somatostatin analog and systemic antibiotics. Conclusions: intra-peritoneal duodenal perforation after endoscopic retrograde cholangiopancreatography in children can be diagnosed early. Medical treatment based on strict observation of the patient, total parenteral nutrition, suspension of oral feeding, nasogastric octeotride aspiration; and administration of systemic antibiotics is effective in selected patients(AU)


Subject(s)
Humans , Male , Adolescent , Cholangiopancreatography, Endoscopic Retrograde/adverse effects , Intestinal Perforation/complications , Conservative Treatment/methods , Intestinal Perforation/drug therapy , Parenteral Nutrition/methods
15.
Medwave ; 18(7): e7344, 2018.
Article in English, Spanish | LILACS | ID: biblio-966468

ABSTRACT

INTRODUCCIÓN: Las fracturas maxilofaciales se asocian a importante morbilidad, pérdida de función y secuelas estéticas, entre otros. Dentro de las fracturas mandibulares, las fracturas de cóndilo mandibular son las más frecuentes. Estas pueden ser tratadas mediante un tratamiento quirúrgico (reducción abierta más estabilización con miniplacas de titanio) o un tratamiento conservador (ortopédico). MÉTODOS: Realizamos una búsqueda en Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante el cribado de múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, analizamos los datos de los estudios primarios, realizamos un metanálisis y preparamos una tabla de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES: Identificamos ocho revisiones sistemáticas que en conjunto incluyen 66 estudios primarios, de los cuales, seis corresponden a ensayos aleatorizados. Concluimos que, en comparación con el tratamiento conservador, el tratamiento quirúrgico en fracturas de cóndilo mandibular probablemente se asocia a menor dolor articular, menor maloclusión y menor desviación lateral en apertura bucal.


INTRODUCTION: Maxillofacial fractures are associated with significant morbidity, loss of function and aesthetic sequelae, among others. Within mandibular fractures, mandibular condylar fractures are the most frequent. These can be treated by surgical treatment or conservative treatment (orthopedic). METHODS: We searched in Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. RESULTS AND CONCLUSIONS: We identified eight systematic reviews including 66 primary studies overall, of which six were randomized trials. We concluded surgical treatment of mandibular condyle fractures, compared to conservative treatment, is probably associated with less joint pain, less malocclusion and less lateral deviation in buccal opening.


Subject(s)
Humans , Orthopedic Procedures/methods , Mandibular Condyle/injuries , Mandibular Fractures/therapy , Randomized Controlled Trials as Topic , Databases, Factual , Conservative Treatment/methods , Mandibular Fractures/pathology
16.
Rev. bras. enferm ; 71(supl.6): 2792-2799, 2018. tab
Article in English | LILACS, BDENF | ID: biblio-977679

ABSTRACT

ABSTRACT Objective: To evaluate the effectiveness of vitamin D supplementation as protection factor against infection of patients with chronic kidney disease on conservative treatment. Method: Retrospective cohort study carried out between 2013 and 2016 in the Conservative Treatment Outpatient Clinics (Ambulatório de Tratamento Conservador) of the Hypertension and Kidney Hospital (Hospital do Rim e Hipertensão) of the Universidade Federal de São Paulo. Data on sociodemographic factors, comorbidity, infection episodes and use or nonuse of vitamin D supplementation for at least 6 months were collected from medical records. The primary outcomes considered in both groups were: presence or absence of infection anywhere on the body (bloodstream, urinary, respiratory and surgical sites). Results: A total of 263 patients were included and those who received (n=43) vitamin D had 59% less chance of developing infections (OR=0.41; 95%CI; 0.15-0.99), when compared to those who did not receive. Conclusion: Vitamin D supplementation was a protective factor against infections of all causes.


RESUMEN Objetivo: evaluar la efectividad de la suplementación de vitamina D en pacientes con enfermedad renal crónica en tratamiento conservador como factor de protección contra infecciones. Método: Estudio de Cohorte retrospectiva realizado entre 2013 y 2016 en el Ambulatorio de Tratamiento Conservador del Hospital do Rim e Hipertensão da Universidade Federal São Paulo. Se recogieron de los prontuarios los datos sociodemográficos, de comorbilidad, episodios de infección, en uso o no de suplementación de vitamina D por lo menos 6 meses. Los resultados primarios considerados en los dos grupos fueron: la presencia o no de infección en cualquier sitio: urinario, respiratorio, corriente sanguínea y sitio quirúrgico. Resultados: Se incluyeron 263 pacientes y los que recibieron (n = 43) vitamina D tenían un 59% menos de posibilidades de desarrollar infección (OR = 0,41, IC95% 0,15-0,99), en comparación con los que no recibieron. Conclusión: La suplementación de vitamina D fue factor de protección contra infecciones de todas las causas.


RESUMO Objetivo: avaliar a efetividade da suplementação de vitamina D em pacientes com doença renal crônica em tratamento conservador como fator de proteção contra infecções. Método: Estudo de Coorte retrospectiva realizado entre 2013 e 2016 no Ambulatório de Tratamento Conservador do Hospital do Rim e Hipertensão da Universidade Federal de São Paulo. Foram coletados dos prontuários os dados sociodemográficos, de comorbidade, episódios de infecção, em uso ou não de suplementação de vitamina D por no mínimo 6 meses. Os desfechos primários considerados nos dois grupos foram: a presença ou não de infecção em qualquer sítio: urinário, respiratório, corrente sanguínea e sítio cirúrgico. Resultados: Foram incluídos 263 pacientes e os que receberam (n=43) vitamina D tiveram 59% menos chance de desenvolver infecção (OR=0,41; IC95% 0,15-0,99), quando comparados aos que não receberam. Conclusão: A suplementação de vitamina D foi fator de proteção contra infecções de todas as causas.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Vitamin D/pharmacology , Renal Insufficiency, Chronic/drug therapy , Infections/drug therapy , Vitamin D/therapeutic use , Brazil , Retrospective Studies , Cohort Studies , Dietary Supplements/standards , Renal Insufficiency, Chronic/complications , Conservative Treatment/methods , Middle Aged
17.
Rev. cuba. cir ; 56(1): 37-49, ene.-mar. 2017.
Article in Spanish | LILACS | ID: biblio-900963

ABSTRACT

Introducción: la principal regla en el manejo del cáncer del recto es la cura oncológica y el mantenimiento de la calidad de vida. El advenimiento de la cirugía laparoscópica ha tenido un impacto en la cirugía gastrointestinal en los últimos 20 años. Tres décadas después de su original descripción por Heald, la escisión total del mesorrecto se ha convertido en la regla de oro para la resección curativa del cáncer del recto. Objetivos: revisar las diferentes opciones técnicas de las que se dispone en la actualidad para el tratamiento laparoscópico del cáncer del recto, mediante la descripción de sus resultados, ventajas y desventajas. Métodos: se realizó una revisión en las bases de datos bibliográficas accesibles por Infomed, que incluyó artículos que trataran el tema en español e inglés, mediante los descriptores de DeCS y MeSH. Resultados: el cáncer del último tercio del recto plantea un cambio significativo para el cirujano. La resección abdominoperineal ha sido considerada como la regla de oro para el tratamiento de los adenocarcinomas situados en el tercio medio y bajo del recto. Sin embargo, con el incremento del conocimiento de la enfermedad, el desarrollo de las técnicas quirúrgicas, la mejor instrumentación, y el uso de la radioquimioterapia preoperatoria, se ha llegado a un cambio en el tratamiento del cáncer de recto que va de la resección abdominoperineal con colostomía permanente a la cirugía preservadora del esfínter mediante las técnicas mínimamente invasivas. Conclusiones: la cirugía conservadora de esfínteres para el cáncer del recto mediante las técnicas mínimamente invasivas es posible en la mayoría de los pacientes con unos resultados a largo plazo iguales a los de la resección abdominoperineal(AU)


Introduction: the main rule for the management of rectal cancer is oncologic cure and the maintenance of quality of life. The advent of laparoscopic surgery has had an impact on gastrointestinal surgery over the last 20 years. Three decades following its original description by Heald, total mesorectal excision has become the gold standard for the curative resection of rectal cancer. Objectives: To review the different technical options currently available for the laparoscopic treatment of rectal cancer, by describing their outcomes, advantages and disadvantages. Methods: A review was performed in the bibliographical databases accessible from Infomed, including articles on the topic written in Spanish and English, using DeCS and MeSH descriptors. Results: Cancer of the lower third of the rectum signifies a fundamental change for the surgeon. Abdominoperineal resection has been considered as the gold standard for the treatment of adenocarcinomas located in the middle and lower rectum. However, with increased knowledge of the disease, the development of surgical techniques, better instrumentation, and the use of preoperative radiochemotherapy, a change has been achieved in treating rectal cancer, which goes from abdominoperineal resection with permanent colostomy to conservative surgery of the sphincter using minimal invasive techniques. Conclusions: The conservative surgery of the sphincters for rectal cancer by minimal invasive techniques is possible to be performed in most patients, with long-term results similar to those of the abdominoperineal resection(AU)


Subject(s)
Humans , Conservative Treatment/methods , Laparoscopy/methods , Rectal Neoplasms/diagnosis , Databases, Bibliographic/statistics & numerical data , Review Literature as Topic , Surgical Stomas/statistics & numerical data
18.
Rev. cuba. cir ; 42(4)oct.-dic. 2003. tab
Article in Spanish | LILACS, CUMED | ID: lil-388375

ABSTRACT

Sesenta pacientes a los que se les realizó esplenectomía total por ruptura traumática del bazo, sin lesiones asociadas, ni enfermedades concurrentes, fueron comparados con 60 a los que se les efectuó una esplenectomía segmentaria reglada, pero no gozaron de los criterios de selección antes mencionados; aunque ambas muestras tienen características similares en cuanto a edad, sexo, seguimiento mayor de 5 años y estar operado en el Servicio de Urgencias Provincial de Pinar del Río a partir de 1985. El objetivo fue conocer las ventajas y desventajas de aplicar la cirugía conservadora y los resultados demostraron que la segmentectomía es seguida de menos complicaciones, menor mortalidad intrahospitalaria y durante el seguimiento estadísticamente significativos con p<0,05; además se observó que estos resultados disminuyen la estadía y reducen el costo hospitalario, por lo que se deduce que la aplicación de la esplenectomía segmentaria reglada es mejor para los pacientes a corto y a largo plazo y beneficia al Sistema de Salud


60 patients who underwent total splenectomy due to traumatic spleen rupture without associated lesions or concurrent diseases, were compared with 60 cases that underwent ruled segmentary splenectomy without the above-mentioned selection criteria, eventhough both samples had similar characteristics as regards age, sex, follow-up for more than 5 years and they had been operated on at the Provincial Emergency Service of Pinar del Río, from 1985 on. The objective was to know the advantages and disadvantages of performing conservative surgery. The results showed that segmentectomy present less complications and intrahospital mortality and statistically significant results with p < 0.05 during the follow-up. It was also observed that these results reduce the hospital stay and cost and that's why is it is considered that the application of ruled segmentary splenectomy is better for patients on the short and long term and that it benefits the health system(AU)


Subject(s)
Humans , Splenectomy/methods , Splenic Rupture/surgery , Conservative Treatment/methods
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