ObjectiveTo investigate etiology of granulomatous mastitis and it,s conservative treatment method. MethodThe clinical data of 120 patients with granulomatous mastitis given drugs for closed treatment plus massage dredge and ductal lavage from January 2011 to December 2012 in this hospital were analyzed retrospectively. ResultsOne hundred and one cases were cured following conservative treatment for 2 to 8 weeks,19 cases were underwent surgical treatment because of poor outcome.Nine of 101(8.9%) cured patients were relapsed for following-up of 30 to 42 months. ConclusionClosed treatment with drugs,which is effective,could keep patient with granulomatous mastitis from having mastectomy and reduce recurrence.
ObjectiveTo assess the effect of surgical treatment or conservative treatment on the clinical outcomes for displaced 3-part or 4-part proximal humeral fractures in elderly patients. MethodsWe searched CNKI (between January 1979 and April 2014), Wanfang Data (between January 1982 and April 2014), Medline (between January 1946 and April 2014), PubMed (between January 1966 and April 2014), Embase (between January 1974 and April 2014) and Cochrane Database of Systematic Reviews (between January 2005 and April 2014) for randomized controlled trials comparing surgical treatment and conservative treatment for displaced 3-part or 4-part proximal humeral fractures in elderly patients. The data were extracted and a Meta-analysis was made using RevMan 5.2. ResultsFive randomized controlled trials with a total of 226 patients were accepted in this Meta-analysis. The differences of Constant scores[WMD=0.48, 95%CI (-4.39, 5.35), P=0.85], incidences of avascular necrosisr of the humeral head[RR=0.66, 95%CI (0.37, 1.16), P=0.15], incidences of nonunion[RR=0.56, 95%CI (0.20, 1.58), P=0.27], incidences of osteoarthritis[RR=0.35, 95%CI (0.10, 1.22), P=0.10] between the two groups were not statistically different. The difference of incidences of additional surgery after primary treatment was statistically significant[RR=3.52, 95%CI (1.18, 10.45), P=0.02]. ConclusionThe results does not support the surgical treatment to improve the shoulder function when compared with conservative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures. But surgical treatment increases the incidence of additional surgery after primary treatment. Considering surgery can increase the trauma and economic burden of patients, so the conservative treatment is suggested.
Osteoporotic vertebral compression fractures (OVCFs) are common in elderly patients with reduced bone density. Pain and loss of function after fractures have a serious impact on the patient's activities of daily living and quality of life. Management of patients with early OVCFs who choose non-surgical treatment is necessary to prevent complications, relieve pain, and improve functional status. This paper focuses on the development of OVCFs non-surgical management in many aspects, which may provide reference for the rapid recovery of OVCFs patients in the process of non-surgical management.
ObjectiveTo review the clinical research progress of spinal epidural lipomatosis (SEL). Methods The clinical studies on SEL at home and abroad in recent years were extensively reviewed, and the pathogenesis, clinical and imaging manifestations, and treatment status of SEL were summarized and analyzed. ResultsSEL is a disease characterized by compression of the spinal cord and nerve roots due to abnormal accumulation of epidural adipose tissue in the spinal canal. Its prevalence and diagnosis rate are low and the pathogenesis is not fully understood. MRI is the most sensitive and specific diagnostic test for SEL. Surgical decompression and removal of excess adipose tissue are the only options for patients with acute SEL or those who have failed conservative management, and conservative management should be considered for other patients. ConclusionSEL is a rare disease and related research still needs to be improved. In the future, high-quality, multi-center and large-sample studies will be of great significance for evaluating the choice of treatment methods and effectiveness of SEL patients.
Objective To investigate the effectiveness of kyphoplasty in treating osteoporotic vertebral fracture according to comparative study. Methods Between March 2006 and August 2007, 60 patients with osteoporotic vertebral fractures were treated. Kyphoplasty was performed in 40 patients (test group) and conservative treatment was performed in 20patients as control (control group). In test group, there were 6 males and 34 females with an average age of 68.7 years (range, 56-78 years). The disease duration was 10-18 months (mean, 12 months). A total of 73 vertebral bodies fractured. In control group, there were 5 males and 15 females with an average age of 70.1 years (range, 57-80 years). The disease duration was 9-16 months (mean, 13 months). A total of 41 vertebral bodies fractured. There was no significant difference in the general data between 2 groups (P gt; 0.05). Results All incisions healed by first intention in test group, and no leakage of bone cement occurred. The patients of 2 groups were followed up 36-38 months. The visual analogue scale (VAS) scores, European Vertebral Osteoporosis Study (EVOS) questionnaire scores, anterior and middle vertebral column heights, and Cobb angles of test group at 1-3 days, 12 and 36 months after treatment were significantly improved when compared with those before operation (P lt; 0.05); but there was no significant difference between before treatment and after treatment in control group (P gt; 0.05). After 12 and 36 months, the VAS scores, EVOS scores, anterior and middle vertebral column heights, and Cobb angles of test group were better than those of control group (P lt; 0.05). The incidence of vertebral re-fractures was higher in control group than in test group after 36 months (χ2=16.347, P=0.015). Conclusion Kyphoplasty can effectively rel ieve pain and restore the function after the procedure. The risk of vertebral re-fractures after kyphoplasty can be reduced in comparison with conservative treatment.
In order to find out the causes, diagnosis, and the prevention and treatment of vascular crisis following anastomosis of small vessels, 314 cases vascular crisis from 1985 to 1997, were analyzed, in which 152 cases, suffered from tissue necrosis either total or partial, making up 48.4%. One hundred and forty-four cases underwent conservative treatment occupying 45.8% and 104 cases had tissue necrosis, occupying 68.4%. Operative exploration was done on 170 cases, occupying 54.1% and 48 cases of them suffered from necrosis, which made up 31.6% of all necrotic cases. Eighty-six cases were followed up by regular visits, ranging from 40 days to 7 years, with the finding that those who had regained normal circulation after vascular crisis recovered as well as those without crisis, and among those who did not regain normal circulation but survived with the help of collateral circulation after vascular crisis, they were usually cases of bad union, healing of wound, persistent swelling, different degree of tissue atrophy, poor recovery of sensation. It was concluded that proper use of vascular anastomosis technique and prophylactic measures preventing postoperative vascular spasm were extremely important, in the prevention of development of vascular crisis following anastomosis of small vessels. If vascular crisis did not respond well to conservative treatment, prompt surgical exploration should be undertaken.
Objective To compare the effects of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures. Methods All randomized controlled trials (RCTs) of operative versus nonoperative treatment for displaced intra-articular calcaneal fractures were identified. Quality assessment and data extraction were performed by two reviewers independently. Results Four published trials involving 530 patients were included. All studies compared operative with nonoperative treatment. It was clear that operative treatment was superior to nonoperative treatment in terms of helping patients back to work, reducing problems wearing shoes, expanding the range of motion of subtalar joint, and improving the recovery of Bohler’s angle. As for foot pain, there was no difference between the two methods. Because the outcome measures varied across the trials, a meta-analysis could not be performed. Conclusions Both operative and nonoperative treatments produce comparable long-term outcomes in the treatment of displaced intra-articular calcaneal fractures. Because of the poor reporting of outcomes, it is not possible to determine if there is any significant difference in outcome measures apart from those listed above. More trials with high methodological quality are needed.
Objective To assess the long-term results and relevant influencing factors of extended thymectomy and medicine-alone treatment of non-thymomatous myasthenia gravis (MG) patients. Methods We retrospectively analyzed the clinical data of 174 patients with non-thymomatous MG diagnosed and treated in our department from December 2009 to April 2017, including 81 males and 93 females, aged 13-88 (47.1±17.8) years. According to the different treatment methods, the patients were divided into two groups: an operation group (91 patients receiving extended thymectomy) and a medicine-alone group (83 patients receiving medical therapy alone). The efficacy was evaluated according to the Myasthenia Gravis Foundation of America (MGFA). Survival curves of the patients were plotted using the Kaplan-Meier method to evaluate the remission rate and survival rate. Cox regression analysis was used to assess the influencing factors of the outcomes. Results The patients were followed up for 3 to 94 (39.1±26.9) months. As a result, 29 patients (31.9%) achieved complete remission in the surgery group and 13 patients (15.7%) were completely relieved in the medicine-alone group (P=0.014). Further analysis showed that treatment pattern (P=0.018) and MG type (P=0.021) were the main factors related to the efficacy. Conclusion For patients with non-thymomatous MG, extended thymectomy is superior to the medicine-alone in terms of complete remission rate and the postoperative immunosuppression ratio.