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Background/Objectives: Bowel endometriosis (BE) is characterized by the presence of endometrial-like tissue within the muscular layer of the bowel wall. When BE does not result in the severe obstruction to fecal transit and in the absence of (sub)occlusive symptoms, the decision to perform surgery can be challenging, as intestinal procedures are associated with higher complication rates and long-term bowel dysfunction. This cross-sectional study aims to evaluate the quality of life (QoL) in patients with BE who avoided surgery, as well as to investigate the impact of the characteristics of BE nodules on the QoL and intestinal function. Methods: A retrospective cross-sectional analysis was conducted involving 580 patients with BE who did not undergo surgery but were treated conservatively with medical therapy or expectant management between January 2017 and August 2022. The diagnosis of BE was established through transvaginal ultrasound and confirmed via double contrast barium enema. After at least one year of follow-up, the QoL and intestinal function were assessed using the Endometriosis Health Profile-5 (EHP-5) questionnaire and the Bowel Endometriosis Symptom (BENS) score, while pain symptoms were quantified with the Visual Analog Scale (VAS 0–10). Statistical analyses were performed to explore potential associations between the QoL and the characteristics of BE nodules (size, location, and evidence of stenosis), as well as the type and duration of medical therapy. Results: Patients with BE reported a satisfactory overall QoL, with a mean EHP-5 score of 105.42 ± 99.98 points and a VAS score below three across all pain domains. They did not demonstrate significant impairment in bowel function, as indicated by a mean BENS score of 4.89 ± 5.28 points. Notably, patients receiving medical therapy exhibited a better QoL compared to those not receiving treatment (p < 0.05), with the exception of postmenopausal patients, who reported the highest QoL overall (p < 0.05). Among the characteristics of BE, nodule location significantly impacted the QoL and symptom intensity, with low (rectal or rectosigmoid) nodules less tolerated compared to sigmoid nodules, particularly regarding non-menstrual pelvic pain (NMPP), dyschezia, and psychological impact on daily life (p < 0.05). Conclusions: Women can effectively manage BE conservatively in the absence of (sub)occlusive symptoms, even when large nodules are present, causing significant radiological stenosis. The characteristics of BE nodules do not significantly affect the QoL or symptom intensity; however, the location of BE nodules is a crucial factor negatively influencing these outcomes. Medical therapy may confer a beneficial impact on patients of reproductive age with BE, but its use should be carefully considered for those approaching menopause, weighing the risks and benefits. [ABSTRACT FROM AUTHOR]

Introduction: Increasing evidence shows that conservative management of ovarian tumors classified as benign, based on ultrasound assessment, is safe. Therefore, conservative management has been adopted as the preferred strategy for certain ovarian tumors assessed as benign in the Dutch national guideline on enlarged ovaries in 2013. The aim of this study was to examine whether implementation of this guideline has led to changes in the number of women/100 000 women undergoing surgery for an ovarian tumor in the Netherlands. Material and Methods: Histopathology reports were requested for all examinations of ovarian and fallopian tube specimens (including cyst enucleations) registered in Palga, the Dutch nationwide pathology databank, from 2011 (before guideline adaptation) and 2019 (after guideline adaptation). Reports on prophylactically removed adnexa, removal for other primary tumors (eg endometrial carcinoma), and for patients under 18 years of age, were excluded from the analysis. Interobserver agreement for the inclusion and classification of reports was assessed using Cohen's Kappa analysis. Results: A total of 34 932 reports were retrieved, 13 917 of which were included in the analysis. In 2011 and 2019, respectively, 96.3/100 000 vs 68.8/100 000 women aged ≥18 underwent surgery for benign ovarian tumors, and 19.6/100 000 vs 18.3/100 000 for borderline and malignant tumors combined. The number of women/100 000 who had surgery for a benign ovarian tumor per 100 000 women declined by 28.5% (p < 0.001) between 2011 and 2019. The largest difference between 2011 and 2019 was observed in the number of women per 100 000 women who underwent surgery for a serous cystadenoma (−40.7%; 20.8/100 000 vs. 12.3/100 000), followed by endometrioma (−33.2%; 14.7/100 000 vs. 9.8/100 000), simple epithelial cyst (−57.3%; 8.4/100 000 vs. 3.6/100 000), and corpus luteum cyst (−57.0%; 4.0/100 000 vs. 1.7/100 000). Cohen's Kappa for the interobserver agreement was 0.96. Conclusions: The number of women/100 000 undergoing surgery for a benign ovarian tumor has substantially decreased in the Netherlands when comparing data before and after implementation of the national guideline in 2013, while the number of women/100 000 undergoing surgery for a malignant or borderline tumor remained the same. These findings suggest successful implementation of the updated guideline, and a measurable effect on increased adoption of conservative management for benign‐looking ovarian tumors. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to illustrate the outcomes of abnormally invasive placenta (AIP) cases managed in three leading centers in Lebanon. Methods: We conducted a retrospective multicenter cohort study. Patients managed conservatively (cesarean delivery with successful placental separation) or radically (cesarean hysterectomy) were included in the study. Data included patient characteristics, surgical outcomes (blood loss, operative time, transfusion, partial bladder resection), maternal outcomes (death, length of stay, ICU admission, postoperative hemoglobin level) and neonatal outcomes (Apgar score, neonatal weight, admission to neonatal intensive care unit, neonatal death). Results: The study included 189 patients. In the radical treatment subgroup (141/189), patients were para 3 and delivered at 34 4/7 weeks in average, bled 1.5 L and were transfused with three packed red blood cells, with operative time averaging 160 min. A total of 36% were admitted to the ICU and patients stayed on average for 1 week despite partial bladder resection in 19% of cases. Unscheduled radical delivery occurred at a lower gestational age, was associated with more blood loss, higher rate and volume of transfusion, and risk of maternal and neonatal death. In addition, patients delivered in an unscheduled fashion experienced higher rates of partial bladder resection and longer interventions. In the conservative treatment subgroup, on average patients were para 2 and delivered at 36 weeks, bled 800 mL on average with low rates of transfusion (35%) and ICU admission (22.9%). With regard to neonatal outcomes, the average neonatal birth weight was 2.4 kg in the radical subgroup and 2.5 kg in the conservative subgroup. Neonatal death occurred in 5.4% of cases requiring radical management while it occurred in 2% of patients treated conservatively. Conclusion: Through their multidisciplinary approach, the three centers demonstrated that management of AIP in Lebanon has led to excellent outcomes with no maternal mortality occurring in scheduled radical treatment. By comparison of the three leading centers, pitfalls in each center were identified and addressed. Synopsis: Delivering patients with abnormally invasive placenta should occur in tertiary centers, scheduled when possible. Referral pathways should be designed to guarantee access to appropriate care. [ABSTRACT FROM AUTHOR]

Proximal rectus femoris avulsion is an uncommon injury that is usually seen in athletes, particularly in the Western population. While the existing literature largely focuses on surgical treatment as the main approach, growing evidence suggests that conservative management for these injuries can also be effective. Such injuries are rarely associated with non-sport activities and have not been documented in the Indian population to date. In this report, we present a case of partial proximal avulsion of the rectus femoris that was managed conservatively with a structured rehabilitation programme, leading to good functional outcome. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To compare conservative management and appendectomy for acute appendicitis during pregnancy by trimester.This retrospective cohort study used data from a national inpatient database from July 2010 to March 2022. Pregnant women diagnosed with acute appendicitis were included. Multivariable analysis using generalized estimating equations was performed to compare outcomes between conservative management and appendectomy across trimesters. The main outcomes were preterm labor, preterm delivery, or abortion; antepartum hemorrhage; duration of hospitalization; and duration of antibiotic use.A total of 3158 individuals from 632 acute‐care hospitals were eligible. The proportion of conservative management versus appendectomy by trimester were 507 (49.1%) versus 525 (50.9%) in the first, 690 (44.6%) versus 856 (55.4%) in the second, and 337 (58.1%) versus 243 (41.9%) in the third. In the second trimester, appendectomy was associated with a higher rate of preterm delivery, preterm labor, or abortion (odds ratio [OR], 2.91 [95% confidence interval (CI), 1.62–5.25]). Antepartum hemorrhage occurred more frequently for appendectomy in the first (OR, 2.12 [95% CI, 1.31–3.43]) and third (OR, 2.43 [95% CI, 1.79–3.31]) trimesters. Appendectomy was associated with a longer duration of hospitalization in the second (2.15 days; 95% CI, 1.14–3.17 days) and third (3.97 days; 95% CI, 2.22–5.71 days) trimesters. Antibiotic use duration was shorter for appendectomy in the first (−1.20 days [95% CI −1.51 to −0.90 days]) and second (−0.61 days [95% CI −0.90 to −0.32 days]) trimesters.Clinical outcomes of acute appendicitis during pregnancy vary by trimester. Considering the appendectomy risks, conservative management may be viable depending on the clinical context and trimester. [ABSTRACT FROM AUTHOR]

Background: Acute incarcerated paraesophageal hernias (PEH) have historically been considered a surgical emergency. Emergent operations have a higher rate of morbidity and mortality compared to elective surgery. Our institution has adopted a strategy of initial conservative management in patients presenting with acute obstruction from an incarcerated PEH who are clinically stable. Patients are given at least 24 h for their symptoms to improve (selective nasogastric decompression). If symptoms resolve, contrast on an upper GI study passes to the small bowel, and liquids are tolerated, patients are discharged with planned interval repair. We sought to characterize the outcomes of this interval surgical strategy for incarcerated PEH. Methods: A retrospective chart review was performed to identify patients admitted to a single institution between October 2019 and September 2023 with an incarcerated PEH. Patients taken directly to surgery within 24 h were excluded. Results: A total of 45 patients admitted with obstruction from an incarcerated PEH were identified. Ten patients (22%) were taken urgently to surgery due to clinical instability and were excluded. Of the remaining 35 patients, 23 (66%) resolved their obstruction with conservative non-operative management and were offered planned interval PEH repair (successful conservative management). In the successful conservative management cohort, there was one unplanned readmission before interval PEH repair. Average time between discharge and repair was 25 days. Complication rates did not differ in those who failed and in those who had a successful conservative management result. The cumulative length of stay for those who succeeded in conservative management (including days for the interval surgery) was equivalent with those who underwent PEH repair during the index admission. Conclusion: A trial of conservative management in clinically stable patients with symptomatic incarcerated PEH appears to be safe and often avoids emergent repair without increasing perioperative complications or total days in the hospital. [ABSTRACT FROM AUTHOR]

Background: Cesarean hysterectomy is a dominant and effective approach during delivery in patients with placenta accreta spectrum (PAS). However, as hysterectomy results in a loss of fertility, conservative management is an alternative approach. However, management selection may be affected by a country's overall economic level. Thus the preferred treatment for PAS generates controversy in middle‐income countries. Objectives: We aimed to compare conservative management and cesarean hysterectomy for managing PAS in middle‐income countries. Search Strategy: China National Knowledge Infrastructure, Wanfang Med Online Databases, Cochrane Library, Ovid MEDLINE, PubMed, Web of Science, EMBASE, clinicaltrials.gov, and Scopus were searched from inception through to October 1, 2022. Selection Criteria: We included studies that evaluated at least one complication comparing conservative management and hysterectomy. All cases were diagnosed with PAS prenatally and intraoperatively. Data Collection and Analysis: The primary outcomes were blood loss, adjacent organ damage, and the incidence of hysterectomy. Descriptive analyses were conducted for studies that did not meet the meta‐analysis criteria. A fixed‐effects model was used for studies without heterogeneity and a random‐effects model was used for studies with statistical heterogeneity. Main Results: In all, 11 observational studies were included, with 975 and 625 patients who underwent conservative management and cesarean hysterectomy, respectively. Conservative management was significantly associated with decreased blood loss and lower risks of adjacent organ injury and hysterectomy. Conservative management significantly reduced blood transfusions, hospitalization duration, operative time, intensive care unit admission rates, and infections. There were no significant differences in the risks of coagulopathy, thromboembolism, or reoperation. Conclusion: Given short‐term complications and future fertility preferences for patients, conservative management appears to effectively manage PAS in middle‐income countries. Owing to low levels of evidence, high heterogeneity and insufficient long‐term follow‐up data, further detailed studies are warranted. Synopsis: In middle‐income countries, conservative treatment of placenta accreta spectrum seems to be a viable option for managing PAS in the short term. [ABSTRACT FROM AUTHOR]

Objective: To systematically investigate and analyse the aggregated data from recent studies to provide a quantitative synthesis for a conservative approach to the management of high‐grade kidney trauma, as accumulating evidence supports the favourable outcomes of a conservative approach. Methods: A comprehensive search was performed using databases, including PubMed, EBSCO, ProQuest, Google Scholar, and Cochrane Library, to identify studies relevant to high‐grade renal trauma in both adult and paediatric populations. The compare review focused on comparing conservative management interventions, such as observation, rest, resuscitation, transfusion, symptomatic management, and angioembolisation, with operative management interventions. Search strategies incorporated specific medical subject headings and keywords related to conservative management, kidney trauma, mortality, and renal preservation. Random and fixed‐effect meta‐analyses were conducted to estimate the rates of nephrectomy and mortality, respectively. Results: A total of 36 and 29 studies were included for qualitative and quantitative synthesis, respectively. The aggregated data showed a cumulative risk difference of 0.52 (95% confidence interval [CI] 0.38–0.66, P < 0.001), indicating a higher likelihood of nephrectomy in cases where operative management was used instead of conservative management. In terms of mortality, conservative management demonstrated a lower risk difference of 0.09 (95% CI 0.05–0.13, P < 0.001). Conclusion: The results indicate that opting for conservative management in cases of high‐grade renal trauma, particularly for haemodynamically stable patients, presents a lower risk of mortality and reduced probability of requiring nephrectomy when compared to operative management. These findings provide strong evidence in favour of considering conservative management as a viable and effective treatment option for high‐grade renal trauma. [ABSTRACT FROM AUTHOR]

Study Design This study was a retrospective study conducted from October 2020 to October 2022 on 106 posttraumatic patients with acute extradural hematomas (EDHs) who were initially planned for conservative treatment. 74 patients had spontaneous EDH regression (EDHR), while 32 patients developed EDH progression (EDHP) and were shifted for surgery. The two groups were statistically compared regarding the different demographic, clinical, and radiographic factors to identify the significant predictors for regression versus progression of acute posttraumatic EDH. Objectives Conventionally, urgent evacuation is the accepted management for EDH. However, several recent reports have described successful conservative management in selected patients. There are no adequate clues to verify patients who will have spontaneous EDHR from those at risk for EDHP and delayed surgery. The main objective of this study was to identify the significant predictors for possible regression versus progression of acute posttraumatic EDH initially planned for nonsurgical treatment. Materials and Methods A retrospective study conducted over 2 years, included 106 head trauma patients with acute EDH, who were admitted to our department and were initially planned for conservative treatment. Various demographic, clinical, and radiographic factors were analyzed to verify the significant predictors for spontaneous EDHR (EDHR group) versus EDHP and subsequent surgical evacuation (EDHP group). Results The mean age was 20.37 ± 12.712 years and the mean Glasgow Coma Scale score (GCS) was 12.83 ± 2.113. Total 69.8% of patients showed spontaneous EDHR, while 30.2% developed EDHP and were shifted for surgical evacuation. Statistical comparison showed that higher GCS (p = 0.002), frontal location (p = 0.022), and concomitant fissure fracture (p = 0.014) were the significant predictors for EDHR, while younger age (p = 0.006), persistent nausea/vomiting (p = 0.046), early computed tomography (CT) after trauma (p = 0.021), temporal location (p < 0.001), and coagulopathy (p = 0.001) were significantly associated with EDHP. Conclusion Patients with traumatic EDH fitting the criteria of initial nonsurgical treatment necessitates 48 hours of close observation and serial CT scans at 6, 12, 24, and 48 hours to confirm the regression or early detect the EDHP. Patients with high GCS, frontal hematomas, and associated fissure fracture are at low risk for EDHP. Increased alertness is mandatory for young age and patients with persistent nausea/vomiting, early CT scan, temporal hematomas, or coagulopathy. [ABSTRACT FROM AUTHOR]

Study Design. Retrospective chart review. Objective. To determine the effect of conservative measures on radiographic outcomes in those with isolated spondylolysis. Summary of Background Data. Spondylolysis is a common cause of low back pain in pediatric patients, affecting between 4.4% and 4.7% of all pediatric patients. This rate is even higher in high-level athletes, with recent studies suggesting a rate of 47% in this population. Conservative measures are recommended for treating symptomatic spondylolysis and are effective in controlling symptoms, but there is little evidence regarding their effect on radiographic outcomes. Methods. A retrospective review was conducted of patients diagnosed with spondylolysis who were treated at a single academic institution between January 1, 2012, and January 1, 2022. Data collected included demographics, presentation characteristics, pretreatment and post-treatment radiologic findings, types of treatments employed, and final symptomatic status at follow-up. The Student t test and the Wilcoxon rank sum test were used to compare continuous variables. The χ² test was used to compare categorical variables. Results. A total of 119 patients were included in the study. There was an 81.5% rate of healing on advanced imaging for those treated with conservative measures. When comparing those with healing on advanced imaging to those without, those with healing were more likely to have an acute fracture (P= 0.04), have symptomatic improvement (P<0.01), and return-to-play (P= 0.02) compared with those without. Those with healing also had an odds ratio of 6.9 (P< 0.01) and 4.5 (P=0.02) to achieve symptomatic improvement and return to their sport, respectively, compared with those who did not. Conclusion. Our study found those with isolated spondylolysis who were treated with conservative measures had a high healing rate on advanced imaging and those with healing had significantly higher odds of having symptomatic improvement and returning to play compared with those without. [ABSTRACT FROM AUTHOR]

Background: Sternoclavicular joint arthritis is a rare condition that poses considerable diagnostic and therapeutic challenges, leading to severe complications and a high mortality rate. Although surgical interventions are often considered necessary for advanced cases, some reports have suggested that conservative management with antibiotic therapy can be effective in certain cases. However, to our knowledge, there are no reports of successful conservative treatment in cases exhibiting aggressive spread. This report highlights a case of advanced sternoclavicular joint arthritis with bone destruction and pulmonary infiltration, successfully treated conservatively with outpatient antibiotic therapy. Case presentation: A 58-year-old Japanese male presented with a 1-month history of left-sided shoulder pain. Contrast-enhanced computed tomography showed abscess formation and clavicular bone destruction, with infiltrative shadows suggesting lung involvement. The diagnosis of sternoclavicular joint arthritis was made, and outpatient oral antibiotic therapy was initiated. The patient exhibited a marked reduction in inflammatory marker levels and symptoms, and antibiotic therapy was discontinued after 3 weeks, with no recurrence observed at a 4-month follow-up. Conclusions: This case highlights that conservative management with antibiotics can be effective for treating advanced sternoclavicular joint arthritis, emphasizing the need for individualized management and further research into non-surgical treatment options. [ABSTRACT FROM AUTHOR]

Background: Patients with pilonidal disease (PD) can present with concurrent draining secondary sinus at the superior gluteal cleft. The natural disease course in the setting of this severe phenotype is poorly characterized. We present the largest cohort of patients with PD and concurrent secondary sinus. Methods: Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed. Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded. Recurrent drainage from previous secondary sinus site was defined as isolated painless serous drainage after the wound had closed for > 3 weeks; recurrent PD was characterized as recurrent pain and bloody drainage after excision. Results: One hundred and five patients (seventy-one males) with a median age of 17.2 years [interquartile range (IQR):15.4–19.0] underwent excision of their disease and were followed for a median of 367.0 days (IQR: 173.2–658.8). Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD. Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage. Median time to recurrent drainage was 75.5 days (IQR: 65.2–216.2) after excision and for recurrent drainage to resolve was 72 days (IQR: 49–81). Recurrent secondary sinus site drainage was treated with antibiotics, silver nitrate, debridement, or no treatment. Conclusion: Patients who present with PD in the setting of concurrent secondary sinus have a unique, more severe disease phenotype. Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision. [ABSTRACT FROM AUTHOR]

Background: Retained products of conception after childbirth or miscarriage are associated with an increased rate of maternal complications, such as abnormal vaginal bleeding and infections. Late complications may also include intrauterine adhesions, causing infertility. Surgical interventions carry a certain risk. Thus, conservative management is often discussed as an alternative. The aim of this study was to assess the clinical outcomes of patients with retained products of conception, comparing a primary surgical approach to conservative management. Methods: We conducted a retrospective cohort study of 88 patients diagnosed with retained products of conception after 23+0 weeks of gestation at the Medical University Vienna between 2014 and 2022. Results: Forty-seven (53.4%) patients underwent primary surgical management and 41 (46.6%) primary conservative management. After primary conservative treatment, a complication could be observed in 10 (24.4%) women. In contrast, complications occurred in 32 (68.1%) women in the group with primary surgical treatment (p < 0.001). The most common complication in both groups was the ongoing suspicion of retained products of conception. Patients after primary surgical treatment were significantly more likely to require a secondary change in treatment (p < 0.001). Ultimately, secondary conservative management was applied in 30 (63.8%) patients. In contrast, only nine (21.95%) patients with primary conservative management required secondary surgical management. Conclusions: Due to the high risk of complications and persistent retained products of conception, primary surgical management should only be prioritized in hemodynamically instable or septic patients. [ABSTRACT FROM AUTHOR]

Background: Cesarean hysterectomy as a traditional therapeutic maneuver for placenta accreta spectrum (PAS) has been associated with serious morbidity, conservative management has been used in many institutions to treat women with PAS. This systematic review aims to compare maternal outcomes according to conservative management or cesarean hysterectomy in women with placenta accreta spectrum disorders. Methods: A systematic literature search was performed in MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Web of Science, and four Chinese databases (Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Wanfang database and VIP database) to May 2024. Included studies were to be retrospective or prospective in design and compare and report relevant maternal outcomes according to conservative management (the placenta left partially or totally in situ) or cesarean hysterectomy in women with PAS. A risk ratio (RR) with 95% confidence interval (95% CI) was calculated for categorical outcomes and weighted mean difference (WMD) with 95% CI for continuous outcomes. The Newcastle-Ottawa Quality Assessment Scale was used to assess the observational studies. All analyses were performed using STATA version 18.0. Results: Eight studies were included in the meta-analysis. Compared with cesarean hysterectomy, PAS women undergoing conservative management showed lower estimated blood loss [WMD − 1623.83; 95% CI: -2337.87, -909.79], required fewer units of packed red blood cells [WMD − 2.37; 95% CI: -3.70, -1.04] and units of fresh frozen plasma transfused [WMD − 0.40; 95% CI: -0.62, -0.19], needed a shorter mean operating time [WMD − 73.69; 95% CI: -90.52, -56.86], and presented decreased risks of bladder injury [RR 0.24; 95% CI: 0.11, 0.50], ICU admission [RR 0.24; 95% CI: 0.11, 0.52] and coagulopathy [RR 0.20; 95% CI: 0.06, 0.74], but increased risk for endometritis [RR 10.91; 95% CI: 1.36, 87.59] and readmission [RR 8.99; 95% CI: 4.00, 12.21]. The incidence of primary or delayed hysterectomy rate was 25% (95% CI: 19–32, I2 = 40.88%) and the use of uterine arterial embolization rate was 78% (95% CI: 65–87, I2 = 48.79%) in conservative management. Conclusion: Conservative management could be an effective alternative to cesarean hysterectomy when women with PAS desire to preserve the uterus and are informed about the limitations of conservative management. Prospero ID: CRD42023484578. [ABSTRACT FROM AUTHOR]

Background: The most significant accidental head injury complication is extradural hematoma (EDH), requiring to be diagnosed immediately and treated either conservative or surgically. Objective: The current study intended to assess the effectiveness, prognosis, and results of conservative EDH management. Patients and methods: This prospective study included 30 patients with EDH who were admitted to Zagazig University Hospitals. The conservative management was performed, only four of the 26 cases that underwent conservative care of EDH during follow-up required surgical intervention. Results: Patients with Glasgow coma scale score (GCS) 13/15 were 2 cases (6.7%), both cases went for delayed surgical intervention due to increase size of hematoma to surgical volume and deterioration of conscious level. Patients with GCS 14/15 were 7 cases (23.3%); 2 cases went for delayed surgical intervention due to deterioration and the other 5 cases completed their conservative management. Patients with GCS 15/15 were 21 cases (70%). All cases who went for surgical intervention at time when they deteriorate, had improvement for their GCS to be 15/15 with in the first 6 hours postoperatively. Conclusion: Patients who meet the criteria (volume<30 mm, thickness 9) may benefit from conservative surgical therapy of their EDH. Successful outcomes are produced by the conservative management, and the advantages of the conservative management of EDH have increased. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the functional outcomes and direct costs of Stack splints and aluminum finger splints when used in the conservative management of patients with acute Doyle type IVb bony mallet finger. We retrospectively analyzed demographic and clinical characteristics, functional outcomes (using the Crawford classification, DIP flexion angles, and extension lag measurements), time to confirmation of union, and splint costs of 24 patients treated with aluminum finger splints (Group 1) and 20 patients treated with Stack splints (Group 2). Of 44 patients, the median age was 38 (range, 20–59) years, 14 (32%) were smokers, 23 (52%) had fourth digit injuries, 32 (70%) had injuries to the dominant hand, 30 (68%) had a mechanism of injury of a fall, and median follow-up was 15 (range, 12–18) months; none of these differed significantly between Group 1 and Group 2 (all p > 0.05). In Group 1, functional outcomes were excellent and good in 14 (58%) and 10 (42%) patients, respectively; in Group 2 functional outcomes were excellent and good in 13 (62%) and 7 (35%) patients, respectively; and there was no significant difference between the groups. Median extension lag was 3.2° (range, 3.0°–3.5°) in group 1 and 3.4° (range, 3.2°–3.8°) in group 2, indicating no significant difference between groups. Complete union was confirmed radiographically in all patients. Per-patient cost was significantly lower for aluminum finger splints (0.208 TRY [US $0.03]) than for Stack splints (25 TRY [US $3.60]). Good functional outcomes are possible with the use of either Stack or aluminum finger splints in patients with acute Doyle type IVb mallet finger, confirming that conservative management may be appropriate for these injuries. Direct costs of Stack splints are many times greater than those of aluminum splints, though the costs for both are relatively low. Therapeutic, Level III. [ABSTRACT FROM AUTHOR]

Summary: An 8‐year‐old Warmblood cross mare was presented for further investigation of an acute‐onset lameness of the right hindlimb. Three weeks prior to presentation, the horse was found markedly lame at walk following a fall during exercise. The horse was initially managed with field rest, but the lameness persisted. A marked right hindlimb lameness at trot graded 5/10 was confirmed. Atrophy of the right gluteal musculature was evident, and palpation over the region of the right coxofemoral joint provoked a pain reaction. Nuclear scintigraphy revealed a diffuse area of increased radiopharmaceutical uptake in the right femoral head, neck and greater trochanter. Radiographs identified a complete, slightly displaced fracture of the base of the greater trochanter of the right femur. Ultrasound examination of the proximal femur demonstrated an irregularity of the caudolateral bone surface of the greater trochanter, extending along its attachment to the femur; this was consistent with the radiological findings. On re‐examination, after 9 months of stable rest, the horse was found to be sound when trotted in a straight line on the hard surface. Follow‐up two and a half years after the initial incident reported the horse to be nonlame and at its previous level of work. [ABSTRACT FROM AUTHOR]

Introduction: Most of the elderly individuals with cervical spondylotic myelopathy (CSM) suffer from a progressive, and irreversible spinal cord dysfunction and pain. The incidence is rising in tandem with the ageing population. Due to its debilitating effects on a person's physical, mental, and social aspects, it is quickly becoming a public health issue. Therefore, the primary objective is to diagnose the condition in its milder form, prevent its progression, and treat the symptoms aggressively. This article discusses the management of mild CSM, including our experiences, difficulties, current state of knowledge, and potential future developments. Material and Methods: From the patients presenting with neck pain in the OPD, those with mild CSM according to modified Japanese Orthopedic Association (mJOA) scoring system were selected. Their disabilities were studies with commonly used scoring systems like Nurick grading, Neck Disability Index (NDI), and quality of life with SF-36v2. Only the degenerative cases were included, and other pathologies were excluded. Classical cervical disc prolapse with radiculopathy was also not included. Conservative management was initiated in all these patients and followed up for the improvement or deterioration. Results: With the above selection criteria, 235 patients with mild CSM were included in the studies. There were 186 males and 49 females with ages ranging from 42 to 78 years. The clinical profiles were studied. The major signs and symptoms were neck pain, disturbed dexterity of hands, imbalance on walking and exaggerated reflexes. The impairments were stratified and found that the average mJOA score was 16.2, Nurick score was 2.8 and NDI was 33.6. The quality of life was judged using SF-36v2 and was 39.7. The patients were monitored for three, six, twelve, and twenty-four months with conservative care. The follow up was very poor and only 46 out of the total 235 patients could be followed up to two years. Thus the result obtained could not derive any significant information. The symptoms like pain significantly reduced and there was improvement in overall scores including the quality of life. There were no case of deterioration during the conservative treatment. Thus, there was no discernible advancement that called for surgery. Conclusion: Mild CSM is a common, under diagnosed and usually ignored entity which affects big portion of elderly population. It specifically impacts the mental and social aspects that impairs one's quality of life, as well as the functional and emotional aspects. They are initially being treated conservatively and closely monitored for signs of worsening and advancement. Most of the patients respond to conservative treatment but those having risk factors for progression and bad prognosis, should remain vigilant of any features of deterioration. The treatment plan must be timely modified if a patient's clinical condition deteriorates preventing life-long sufferings. [ABSTRACT FROM AUTHOR]

To comprehensively understand the manifestation, treatments, and resultant consequences of temporal bone fractures, given their substantial impact on auditory and balance systems and the overall quality of life. A prospective study, adhering to the STROBE guidelines, spanning five years (2011–2015) was conducted on 83 male patients aged between 20 and 54 years, diagnosed with temporal bone fractures primarily caused by road traffic accidents. Evaluations comprised symptom presentation, otologic manifestations, radiological classifications, and management strategies, including both conservative and surgical interventions. Our study found that patients commonly presented with symptoms such as Oto-haematorrhoea, hearing impairment, and vertigo. Specifically, longitudinal fractures were the most frequent radiological finding, occurring in 63 cases (p < 0.001 for road traffic accidents). In terms of treatment outcomes, there was a notable improvement in the average hearing threshold, decreasing from 50 dB to 25 dB post-treatment (p < 0.001), and the air-bone gap reduced from 30 dB to 10 dB (p < 0.001). Audiometric outcomes varied significantly with fracture type, showing severe hearing loss was more common in transverse fractures (50%, p < 0.001) compared to longitudinal and mixed fractures. Additionally, the study revealed a significant reduction in the incidence of post-trauma vertigo over eight weeks (p < 0.001), underscoring the importance of early and appropriate intervention in managing temporal bone fractures. Efficient early detection and tailored interventions for temporal bone fractures lead to optimistic results. This research underscores the imperative for healthcare practitioners to adopt a comprehensive approach, from initial diagnosis to ongoing monitoring, to achieve optimal patient care. [ABSTRACT FROM AUTHOR]

Plantar fasciitis (PF) is the most common cause of heel pain in adults. There are numerous non-operative treatments available including platelet rich plasma (PRP) injections. PPR has demonstrated effectiveness for a range of musculoskeletal conditions including plantar fasciitis. To compare the effectiveness of PRP to other conservative treatment options for the management of PF. A systematic search of PubMed and Google Scholar was performed for randomized control trials (RCT) comparing PRP to other treatment modalities. Studies met inclusion criteria if mean and standard deviations for visual analog scale (VAS) pain scores, plantar fascia thickness (PFT), Foot Function Index (FFI), or American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were reported. Mean differences (MD) were used to compare VAS pain, PFT, FFI, and AOFAS between PRP and other treatments. Twenty-one RCTs which altogether included 1356 patients were included in the meta-analysis. PRP demonstrated significantly greater improvements in VAS pain scores compared to extracorporeal shock wave therapy (ESWT) (SMD: 0.86; CI: [0.30, 1.41]; p = 0.002), corticosteroid injections (CSI) (SMD: 1.08; CI: [0.05, 2.11]; p = 0.04), and placebo (SMD: 3.42; CI: [2.53, 4.31]; p < 0.00001). In terms of FFI, no significant differences existed among PRP, ESWT, CSI, dextrose prolotherapy (DPT), and meridian trigger points (MTP) in enhancing foot functionality. However, PRP demonstrated a marked advantage over phonophoresis, showing a substantial improvement in FFI scores (SMD: 3.07, 95% CI: 2.34–3.81). PRP did not demonstrate superiority over ESWT, CSI, or MTP for improving PFT, but it was notably more effective than phonophoresis (SMD: 3.18, 95% CI: 2.43–3.94). PRP demonstrated significantly greater improvements in AOFAS scores over CSI (SMD: 3.31, CI: [1.35, 5.27], p = 0.0009) and placebo (SMD: 3.75; CI: [2.81, 4.70]; p < 0.00001). PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement. Level I Meta-Analysis [ABSTRACT FROM AUTHOR]

Objective: Management of placenta accreta spectrum (PAS) with the placenta kept in situ aims to preserve fertility and minimize blood loss. However, this method is associated with a risk of coagulopathy and subsequent bleeding. The aim of this study was to evaluate the occurrence and pathophysiology of coagulopathy in cases of PAS managed conservatively. Methods: We reviewed our database for cases of PAS in which the placenta was kept in situ. In addition, we performed a systematic review of articles on PAS in which the placenta was left in situ and was complicated by coagulopathy. PubMed was searched for publications between 1980 and 2023. Our eligibility criteria included studies in which no additional interventions were performed other than keeping the placenta entirely in situ, and in which coagulopathy was reported. Results: After screening and selection of full‐text articles, 10 studies were included in the review. A review of our databases yielded a case series of PAS managed conservatively with the placenta kept in situ. When adding our case series to the results of our systematic review, a total of 87 cases were found to have been managed conservatively, with 28 cases of coagulopathy. Of these, the time at which coagulopathy developed was known in 11 cases. The median time at development of coagulopathy was 58 (interquartile range, 50–67) days postpartum. Conclusions: Our findings highlight that conservative management of PAS with the placenta in situ poses a risk of coagulopathy. Keeping the placenta in situ after delivery prolongs the risk factors that are integral to PAS. The pathophysiology behind coagulopathy is comparable with that of concealed placental abruption, due to the disrupted uteroplacental interface and the collection of blood in the placenta. Therefore, the presence of large placental lakes could be an indicator of developing coagulopathy. © 2023 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by hemorrhage and/or infarction of the pituitary gland. It is clinically characterized by the sudden onset of headache. Depending on the severity, it may also be accompanied by nausea, vomiting, visual disturbances, varying degrees of adenohypophyseal hormone deficiency, and decreased level of consciousness. Corticotropic axis involvement may result in severe hypotension and contribute to impaired level of consciousness. Precipitating factors are present in up to 30% of cases. PA may occur at any age and sometimes develops during pregnancy or the immediate postpartum period. PA occurs more frequently in men aged 50–60, being rare in children and adolescents. It can develop in healthy pituitary glands or those affected by inflammation, infection, or tumor. The main cause of PA is usually spontaneous hemorrhage or infarction of a pituitary adenoma (pituitary neuroendocrine tumor, PitNET). It is a medical emergency requiring immediate attention and, in many cases, urgent surgical intervention and long-term follow-up. Although the majority of patients (70%) require surgery, about one-third can be treated conservatively, mainly by monitoring fluid and electrolyte levels and using intravenous glucocorticoids. There are scoring systems for PA with implications for management and therapeutic outcomes that can help guide therapeutic decisions. Management of PA requires proper evaluation and long-term follow-up by a multidisciplinary team with expertise in pituitary pathology. The aim of the review is to summarize and update the most relevant aspects of the epidemiology, etiopathogenesis, pathophysiology, clinical presentation and clinical forms, diagnosis, therapeutic strategies, and prognosis of PA. [ABSTRACT FROM AUTHOR]

Aim: Living‐donor liver transplantation (LDLT) is a highly effective life‐saving procedure; however, it requires substantial medical resources, and the cost‐effectiveness of LDLT versus conservative management (CM) for adult patients with end‐stage liver disease (ESLD) remains unclear in Japan. Methods: We performed a cost‐effectiveness analysis using the Diagnostic Procedure Combination (DPC) data from the nationwide database of the DPC research group. We selected adult patients (18 years or older) who were admitted or discharged between 2010 and 2021 with a diagnosis of ESLD with Child–Pugh class C or B. A decision tree and Markov model were constructed, and all event probabilities were computed in 3‐month cycles over a 10‐year period. The willingness‐to‐pay per quality‐adjusted life‐year (QALY) was set at 5 million Japanese yen (JPY) (49,801 US dollars [USD]) from the perspective of the public health‐care payer. Results: After propensity score matching, we identified 1297 and 111,849 patients in the LDLT and CM groups, respectively. The incremental cost‐effectiveness ratio for LDLT versus CM for Child–Pugh classes C and B was 2.08 million JPY/QALY (20,708 USD/QALY) and 5.24 million JPY/QALY (52,153 USD/QALY), respectively. The cost‐effectiveness acceptability curves showed the probabilities of being below the willingness‐to‐pay of 49,801 USD/QALY as 95.4% in class C and 48.5% in class B. Tornado diagrams revealed all variables in class C were below 49,801 USD/QALY while their ranges included or exceeded 49,801 USD/QALY in class B. Conclusions: Living‐donor liver transplantation for adult patients with Child–Pugh class C was cost‐effective compared with CM, whereas LDLT versus CM for class B patients was not cost‐effective in Japan. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Placenta previa, accompanied by placenta percreta, which involves invasion of the bladder, presents a significant risk of excessive bleeding during and after delivery. This case highlights that prophylactic embolization, conservative surgery, and careful monitoring offer an effective approach to avoid hysterectomy in cases of placenta percreta with adjacent organ involvement. Placenta previa complicated by placenta percreta is associated with a high risk of massive intra and post‐partum hemorrhage. We present a case of a 35‐year‐old woman (G2 P1) who was referred to the Akbar‐Abadi hospital at 13 weeks of gestation. Color Doppler ultrasound indicated complete placenta previa‐percreta with bladder invasion. After induction of fetal demise, bilateral uterine and bladder artery endovascular embolization was conducted for the patient. After 48 h, under ultrasound guidance, surgical resection of residual percreta tissue was conducted as much as possible. Eight weeks later, a follow‐up sonography showed the minimum residual placenta tissue and she regained menstrual cycles after 2 months. This case indicated that the combination of prophylactic embolization, conservative surgical management with placenta left in situ, and follow‐up with serial color Doppler monitoring, is an optimum method to avoid hysterectomy in placenta percreta patient with adjacent organ invasion. [ABSTRACT FROM AUTHOR]

Up to 25% of prostate cancer (PCa) patients managed conservatively experienced hospitalization and emergency department visits within 12 mo after diagnosis; 6% experienced PCa-related symptomatic progression. The probabilities of receiving therapies for PCa decreased according to the time elapsed after the diagnosis. Conservative management is an option for prostate cancer (PCa) patients either with the objective of delaying or even avoiding curative therapy, or to wait until palliative treatment is needed. PIONEER, funded by the European Commission Innovative Medicines Initiative, aims at improving PCa care across Europe through the application of big data analytics. To describe the clinical characteristics and long-term outcomes of PCa patients on conservative management by using an international large network of real-world data. From an initial cohort of >100 000 000 adult individuals included in eight databases evaluated during a virtual study-a-thon hosted by PIONEER, we identified newly diagnosed PCa cases (n = 527 311). Among those, we selected patients who did not receive curative or palliative treatment within 6 mo from diagnosis (n = 123 146). Patient and disease characteristics were reported. The number of patients who experienced the main study outcomes was quantified for each stratum and the overall cohort. Kaplan-Meier analyses were used to estimate the distribution of time to event data. The most common comorbidities were hypertension (35–73%), obesity (9.2–54%), and type 2 diabetes (11–28%). The rate of PCa-related symptomatic progression ranged between 2.6% and 6.2%. Hospitalization (12–25%) and emergency department visits (10–14%) were common events during the 1st year of follow-up. The probability of being free from both palliative and curative treatments decreased during follow-up. Limitations include a lack of information on patients and disease characteristics and on treatment intent. Our results allow us to better understand the current landscape of patients with PCa managed with conservative treatment. PIONEER offers a unique opportunity to characterize the baseline features and outcomes of PCa patients managed conservatively using real-world data. Up to 25% of men with prostate cancer (PCa) managed conservatively experienced hospitalization and emergency department visits within the 1st year after diagnosis; 6% experienced PCa-related symptoms. The probability of receiving therapies for PCa decreased according to time elapsed after the diagnosis. [ABSTRACT FROM AUTHOR]

Background: Non-operative management is typically indicated for extra-articular distal radius fractures. Conservative treatments such as Sugar tong splints (STs) and Muenster splints (MUs) are commonly used. However, there is limited research and outcome data comparing the two splint types. Therefore, this study aimed to investigate and compare the radiographic and clinical outcomes of treatment using STs and MUs. Methods: In this retrospective comparative study, we aimed to evaluate and compare the radiographic and clinical outcomes of STs and MUs for the treatment of distal radius fractures. The study included 64 patients who underwent closed reduction (CR) in the emergency room and were treated with either STs or MUs splints (STs group: n = 38, MUs group: n = 26). Initial X-rays, post-CR X-rays, and last outpatient follow-up X-rays were evaluated. Radial height (RH), ulnar variance (UV), radial inclination (RI), and volar tilt (VT) were measured by a blinded investigator. The Quick DASH form was applied to measure patients' satisfaction after treatments. Results: There were no significant differences in baseline characteristics, initial radiographic measurements, or radiographic measurements immediately after CR between the two groups. However, the overall radiological values deteriorated to some degree in both groups compared to the post-CR images. Furthermore, using a paired test, the STs group showed significant differences in RH and RI, and the MUs group showed significant differences in RH and UV between the last follow-up and post-CR images. Conclusions: The study concluded that there was no difference in clinical outcomes between the two splint types. However, both STs and MUs groups showed reduced radiographic parameters, and the MUs group showed a significant reduction of RH and UV in the treatment of distal radius fractures. Level of evidence: Level IV; Retrospective Comparison; Treatment Study. [ABSTRACT FROM AUTHOR]

Corticosteroids are crucial for treating inflammatory ocular conditions. The development of dexamethasone revolutionized targeted ocular therapy. Ozurdex, a dexamethasone implant, effectively treats various eye conditions but carries risks such as implant migration. This is a case of anterior segment migration of intravitreal dexamethasone implant, Ozurdex, in a patient with scleral fixation intraocular lens implant in whom conservative management with supine positioning and pharmacologic pupil dilation can help retain the implant back in the vitreous. Patients at high risk of Ozurdex migration should avoid its use. Educate patients on the risk of implant migration and signs of migration to present immediately to an ophthalmology emergency department to avoid corneal damage. It is essential to identify high-risk patients before considering Ozurdex migration. In some cases, conservative management can be initiated while preparing for surgical removal. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the diagnostic accuracy of single and multiple fluorescence in situ hybridization (FISH) tests for upper urinary tract cancer (UTUC), we analyzed the diagnostic efficacy of FISH in patients with UTUC and the difference between it and the Tumor Node Metastasis (TNM) stage and grade of the tumor. Materials and Methods: Patients treated for UTUC at our institution between 2011 and 2021 who had not been previously diagnosed with UTUC were included. Patients were divided into single, two, and multiple (three times or four times) FISH groups based on the number of FISH tests performed on different samples from the same patient, and the diagnostic efficiency of single, two, and multiple FISH tests for muscle-invasive tumors and highgrade tumors were assessed. Results: We included a total of 207 patients with UTUC, and when compared to single FISH, the sensitivity of multiple and double FISH for the diagnosis of UTUC increased from 62% to 76% and 78%, respectively. It went from 67% to 78% and 80% for muscle-invasive UTUC (> = pT2) and from 71% to 79% and 81% for the highest-grade UTUC. Conclusion: Multiple FISH improves the diagnostic efficacy of UTUC and helps to differentiate aggressive tumors. [ABSTRACT FROM AUTHOR]

Cystic adenomyomas (CA) are rare. They primarily affect adolescents and young women in their fertile years. Therefore, fertility and pregnancy outcome are of pivotal relevance in this patient collective. Apart from the guidelines of the European Society of Human Reproduction and Embryology (ESHRE) on the management of endometriosis in general, there are no specific treatment recommendations for CA and, as far as our research shows, no data illustrating the behavior of a CA over the course of pregnancy. Thus, we report the case of a 32-year-old 1-gravida, 1-para, preconceptionally diagnosed with a CA by ultrasound. After thoroughly discussing further treatment options, the decision was made to opt for a more conservative approach and not perform surgery before attempting a next pregnancy. The patient conceived spontaneously and sonographic monitoring of the CA throughout pregnancy showed complete regression of the cystic component during the second trimester. A healthy baby was delivered at term by an uncomplicated elective cesarean section. Following a review of the literature and taking into account the course of our case, we propose the feasibility of a conservative, non-surgical approach in women with a CA and the desire to conceive. [ABSTRACT FROM AUTHOR]

Endoscopic retrograde cholangiopancreatography (ERCP) is invasive for pancreaticobiliary diseases. Perforation is a rare but severe complication among its associated risks. A 45-year-old female with biliary colic and multiple gallbladder calculi was diagnosed with choledocholithiasis based on imaging showing CBD dilation and gallstones. ERCP was planned for stone removal. Sphincterotomy was performed, but stone retrieval attempts failed, leading to severe pneumo-peritoneum and respiratory compromise. Immediate CBD stenting was done, avoiding surgical intervention. The patient recovered uneventfully, later undergoing laparoscopic cholecystectomy with CBD exploration and stone removal. ERCP-related perforations, rare but severe, involve retroperitoneal air collection. Clinical signs include abdominal discomfort, and imaging confirms diagnosis. Management varies by type, with some requiring surgical repair. Conservative management sufficed in this case, with successful patient recovery. ERCP-related complications like pneumo-peritoneum require prompt diagnosis and conservative management if no perforation is evident. [ABSTRACT FROM AUTHOR]

Lumbar disc herniation associated with radiculopathy (LDHR) is among the most frequent causes of spine-related disorders. This condition is triggered by irritation of the nerve root caused by a herniated disc. Many non-surgical and surgical approaches are available for managing this prevalent disorder. Non-surgical treatment approaches are considered the preferred initial management methods as they are proven to be efficient in reducing both pain and disability in the absence of any red flags. The methodology employed in this review involves an extensive exploration of recent clinical research, focusing on various non-surgical approaches for LDHR. By exploring the effectiveness and patient-related outcomes of various conservative approaches, including physical therapy modalities and alternative therapies, therapists gain valuable insights that can inform clinical decision-making, ultimately contributing to enhanced patient care and improved outcomes in the treatment of LDHR. The objective of this article is to introduce advanced and new treatment techniques, supplementing existing knowledge on various conservative treatments. It provides a comprehensive overview of the current therapeutic landscape, thereby suggesting pathways for future research to fill the gaps in knowledge. Specific to our detailed review, we identified the following interventions to yield moderate evidence (Level B) of effectiveness for the conservative treatment of LDHR: patient education and self-management, McKenzie method, mobilization and manipulation, exercise therapy, traction (short-term outcomes), neural mobilization, and epidural injections. Two interventions were identified to have weak evidence of effectiveness (Level C): traction for long-term outcomes and dry needling. Three interventions were identified to have conflicting or no evidence (Level D) of effectiveness: electro-diagnostic-based management, laser and ultrasound, and electrotherapy. [ABSTRACT FROM AUTHOR]

Aims: To present a case series of 11 rare uterine tumors resembling ovarian sex cord tumors (UTROSCTs), and review the literature on this topic to offer up-to-date treatment management for UTROSCTs. Method: Eight cases from Fujian Cancer Hospital between January 2017 and May 2023 and three patients from Fujian Union Hospital between October 2012 and October 2020 were retrospectively reviewed. All cases were pathologically confirmed as UTROSCTs by two senior and experienced pathologists. Clinical behaviors, medical data, histopathological features, therapy approaches, and survival outcomes were discussed. Results: The median age at initial diagnosis was 53 years (29–70 years). 3 (27.3%) patients were under 40. Seven cases presented with abnormal vaginal bleeding, one with menstrual disorder, one with abnormal vaginal secretion, and two patients were accidentally found by physical examination without any symptoms. Three patients were initially misdiagnosed with endometrial cancer by MRI. Curettage was performed in all cases. Nine of them were well diagnosed by routine curettage, except for two samples, which were identified after surgery. Immunohistochemical biomarkers, such as CD99, Desmin, WT-1, CK, Vimentin, SMA, α-Inhibin, Ki67, CD56, ER, PR, and CR, tend to be positive in UTRO SCs patients. Six patients underwent hysterectomy with bilateral salpingo-oophorectomy. Two cases received a radical hysterectomy with bilateral salpingo-oophorectomy, retroperitoneal lymph node dissection, and omentum dissection. Three UTROSCTs were under observation after mass resection. The median PFS was 24 months (range 1–125 months). Conclusion: UTROSCT is a rare mesenchymal tumor with low malignant potential. Treatment modalities should be carefully considered to balance the therapy outcomes and patient needs. Surgery conservative management might be suitable for young women with fertility desires. [ABSTRACT FROM AUTHOR]

To compare delivery outcomes of pregnancies diagnosed with placenta-accreta-syndrome (PAS) who underwent conservative treatment to patients who underwent cesarean hysterectomy. A retrospective study of all women diagnosed with PAS treated in one tertiary medical center between 03/2011 and 11/2020 was performed. Comparison was made between conservative management during cesarean delivery and cesarean hysterectomy. Conservative management included leaving uterus in situ with/without placenta and with/without myometrial resection. A total of 249 pregnancies (0.25 % of all deliveries) were diagnosed with PAS, 208 underwent conservative cesarean delivery and 41 had cesarean hysterectomy, 31 of them were unplanned (75.6 %). The median number of previous cesarean deliveries was significantly higher in the cesarean hysterectomy group. There was no difference in the duration from the last cesarean delivery, the presence of placenta previa, pre-operative hemoglobin or platelets levels between the pregnancies with conservative management and the cesarean hysterectomy. Significantly more pregnancies with sonographic suspicion of placenta percreta and bladder invasion had cesarean hysterectomy. Cesarean hysterectomy was significantly associated with earlier delivery, with bleeding and required significantly more blood products. There was no statistically significant difference in the rate of relaparotomy following cesarean delivery or the rate of infections. Multivariable-regression-analysis revealed a significant odds ratio of 3.38 of blood loss of >3,000 mL following cesarean hysterectomy. Conservative management in delivery of PAS pregnancies is associated with less bleeding complications during surgery compared to cesarean hysterectomy. [ABSTRACT FROM AUTHOR]

In the last few decades, the aging of the general population has significantly increased the number of elderly patients with end-stage kidney disease (ESKD) who require renal replacement therapy. ESKD elders are often frail and highly comorbid with social issues and seem to not benefit from dialysis in terms of survival and quality of life. Conservative management (CM) could represent a valid treatment option, allowing them to live for months to years with a modest impact on their habits. Despite these possible advantages, CM remains underused due to the myth of dialysis as the only effective treatment option for all ESKD patients regardless of its impact on quality of life and survival. Both CM and dialysis remain valid alternatives in the management of ESKD. However, assessing comorbidities, disabilities, and social context should drive the choice of the best possible treatment for ESKD, while in elderly patients with short life expectancies, referring them to palliative care seems the most reasonable choice. [ABSTRACT FROM AUTHOR]

Purpose. To determine whether surgical management is more effective than conservative management in reducing the incidence of re rupture in adult patients with Achilles' tendon rupture. Materials and methods. A systematic review and meta-analysis was conducted, including ten clinical trials that compared surgical management versus conservative management. Data were extracted and analyzed to compare the efficacy of both approaches in the incidence of re-rupture of the Achilles tendon and secondary outcomes: short- and long-term functional outcome, presence of chronic pain, and adverse effects (deep vein thrombosis and pulmonary embolism). Results. The incidence of re rupture in the surgical management group was 65% lower than in the conservative management group (RR 0.35; 95%CI 0.20-0.62). As for short-term functional outcome, there were no statistically significant results (MD 1.22; 95%CI -1.62 to 4.05). The mean long-term functional outcome in the surgical management group was 0.72 standard deviations higher (MD 0.72; 95%CI 0.37-1.08). The probability of developing chronic pain in the surgical management group is 68% higher than in the conservative management group (RR 1.68; 95%CI 1.09-2.59). The probability of developing pulmonary embolism and developing deep vein thrombosis did not have statistically significant results (RR 2.75; 95%CI 0.31-24.75) (RR 0.71; 95%CI 0.23-2.23). Conclusions. Surgical management is more effective in reducing the incidence of Achilles tendon re-rupture, presents a lower long-term functional result. However, increase the probability of presenting chronic pain compared with conservative management. [ABSTRACT FROM AUTHOR]

Background Most patients with end-stage renal disease (ESRD) are managed with dialysis and less commonly kidney transplantation. However, not all are suitable for or desire either of these renal replacement therapies. Conservative management (CM) is an option. However, the selection of CM is often not easy for patients and clinicians. The aim of this systematic review is to identify the key factors that influence the selection of CM for ESRD. Methods Medline, Embase, PsychINFO, and CINAHL Plus were systematically searched from inception to 10 September 2021. Titles/abstracts and full texts were independently screened by two reviewers. Reference lists of included articles were searched. An update search via PubMed was conducted on 10 August 2023. A narrative synthesis of review findings was conducted. Results At the end of the screening process, 15 qualitative and 8 survey articles were selected. Reference checking yielded no additional relevant studies. Main themes were: (i) Patient-specific factors; (ii) Clinician-specific factors; (iii) Organisational factors; and (iv) National and international factors. Patient-specific factors were awareness and perceptions of CM and dialysis, beliefs about survival, preferred treatment outcomes and influence of family/caregivers and clinicians. Clinician-specific factors included perceptions of CM as 'non-intervention', perceptions of clinician role in the decision-making process, and confidence and ability to initiate sensitive treatment discussions. Relationships with and involvement of other healthcare professionals, time constraints, and limited clinical guidance were also important factors. Conclusions An improvement in the provision of education regarding CM for patients, caregivers, and clinicians is essential. Robust studies are required to generate crucial evidence for the development of stronger recommendations and guidance for clinicians. [ABSTRACT FROM AUTHOR]

Cervical spine surgery is rapidly increasing, and our knowledge of the natural history of degenerative cervical myelopathy (DCM) is limited. To synthesize accurate time-based estimates of meaningful neurologic decline in patients with DCM managed conservatively and to provide formulae to help communicate survivorship estimates to patients. Systematic review and meta-analysis. A systematic review and meta-analysis was conducted using Cochrane and PRISMA guidelines. A librarian-assisted search strategy using multiple databases with broad search terms and validated filter functions was used. All articles were reviewed in duplicate. A total of 9570 studies were captured in the initial search, which after deletion of duplicates and manual review of abstracts and full texts revealed 6 studies for analyses. All studies were prospective cohorts or randomized controlled trials. The pooled survival estimates for neurologic stability (95% CrI) for mild DCM patients are: 91% (83%–97%) at one year; 85% (72%–94%) at 2 years; 84% (70%–94%) at 3 years; 75% (54%–90%) at 5 years; 66% (40%–86%) at 15 years; and 65% (39%–86%) at 20 years. The pooled survival estimates for neurologic stability (95% CrI) for moderate/severe DCM patients are: 83% (76%–89%) at 1 year; 72% (62%–81%) at 2 years; 71% (60%–80%) at 3 years; 55% (41%–68%) at 5 years; 44% (27%–59%) at 15 years; and 43% (25%–58%) at 20 years. This is the first quantitative synthesis of the totality of published data on DCM natural history. Our review confirms a slow decline in neurologic function. We developed formulae which can be easily used by surgeons to communicate to patients their risk of neurologic deterioration. These formulae can be used to facilitate the shared decision-making process. [ABSTRACT FROM AUTHOR]

Simple Summary: Medial coronoid disease of the elbow is a common lesion of the elbow in young and middle-aged dogs, which can cause pain and lameness. Various treatment options are available for this disease, all aimed at providing a pain-free life for the patient and minimizing potential consequential damage, such as osteoarthritis and cartilage damage. This study investigates the use of both conservative and surgical (arthroscopic) therapies for single dogs, with a focus on clinical outcomes (owner-based dog lifestyle and mobility evaluation), radiological changes, and gait patterns. The study has shown that arthroscopic treatment can improve gait patterns and enhance the overall quality of life for affected dogs, despite worsening radiological findings. Notably, diagnostic imaging often does not correlate with clinical outcomes. Computed tomographic findings, such as fragment size and the presence of dislocation, may influence the treatment outcomes. This was indicated in the group of conservatively treated limbs. However, further studies are needed to establish this relationship more precisely. In summary, a patient-specific evaluation, considering all available diagnostic options, should guide the appropriate treatment. The purpose of this study was to assess the outcome of dogs with bilateral medial coronoid disease (MCD) treated with arthroscopic intervention for the clinically more severely affected side and conservative management for the contralateral side. The medical records of dogs with bilateral medial coronoid disease diagnosed using computed tomography (CT) and treated using arthroscopic intervention on one elbow and conservative management on the other elbow were retrospectively reviewed. The outcome evaluation included clinical re-examination; follow-up radiographic-visible osteophytic lesions; as well as sclerotic changes and Liverpool osteoarthritis in a dogs questionnaire. Data from 48 clinically affected elbow joints (24 dogs) with bilateral MCD diagnosed using CT were included. Every dog underwent arthroscopic intervention on the elbow joint, which was clinically more severely affected, and the other side was treated with conservative management. A fragment of the medial coronoid was diagnosed using CT in all elbows, whereas 19 elbows (39.4%) showed a dislocation of the fragment and the other 29 elbows (60.4%) did not. There are no findings regarding the radioulnar Incongruence. Initially, 86% of all radiographs had the same degree of osteophytes. At the time of follow-up, the arthroscopic-treated limbs had more severe radiological changes in comparison to the conservatively treated limbs. Lameness improved after arthroscopic therapy in walking. The conservative group showed a largely unchanged gait pattern. Radiological changes do not necessarily reflect the severity of clinical signs. Arthroscopic intervention showed an improvement of the clinical gait pattern, even though the radiographic changes worsened. [ABSTRACT FROM AUTHOR]

Background and objectives: One of the common osteoporotic fractures being the proximal humerus fractures accounts for nearly 4% of all fractures. Undisplaced fractures are usually managed conservatively. But here we study the outcome of 3part and 4part proximal humerus fractures managed conservatively. Materials and methods: This is a observational study of 30 patients with 3 part and 4 part proximal humerus fractures above the age 50years, who are managed conservatively with U-slab. Functional outcome was evaluated with constant scoring system. Results: In our study among the 30 patients, most common age group was 50-60years, with female preponderance (60%). Most common mode of injury was slip and fall with 76.7%. mean constant score at the end of 6months follow up was found to be 77.9. Conclusion: significant improvement was seen in the functional outcome compared from 1month follow up to final follow up at 6months. [ABSTRACT FROM AUTHOR]

Background: An estimated 40% of all traumatic brain injury (TBI) occurs in ≥70-year-olds with a high prevalence of traumatic subdural haematoma (tSDH). It is anticipated that an expanding elderly population will lead to a proportional increase in the incidence of patients with tSDH presenting to UK trauma centres, but the long-term clinical outcomes and factors influencing functional outcomes in this patient group remain poorly understood. Aim: To examine the management and clinical outcomes for elderly (≥70 years) patients diagnosed with tSDH. Methods: Patient data for this single-centre, retrospective cohort study were analysed from a Major Trauma Centre (MTC) electronic patient records between January 2013 and December 2019. Results: Two hundred and eighty patients were included, 43% aged 70-79, 42% aged 80-89 and 15% >90. In total, 37% underwent a surgical intervention. The 6-month survival in the severe, moderate, and mild TBI groups was 14%, 43%, and 67%, respectively. The 6-month survival in the surgical group was 58%, vs. 60% in the conservatively managed group. Surgical intervention did not significantly impact Extended Glasgow Coma Score (GOS-E) at 6 months, regardless of injury severity. Advanced age (p = 0.04), mixed intracranial injuries (p < 0.0001), craniotomies (p = 0.03), and poor premorbid performance status (p = 0.02) were associated with worse survival and functional outcomes. Conclusions: Our study demonstrated that increasing age, increasing severity of TBI and poorer premor-bid performance status were associated with significantly poorer 6-month survival and functional outcomes in elderly patients with tSDH. Burr hole evacuation was associated with better functional outcomes compared to craniotomy, but overall, there was no significant difference in the outcomes of the surgical and non-surgical groups. We identified strong risk factors for death and poor functional outcomes at 6-months which are important to consider when counselling patients and families about the long-term prognosis of elderly patients with tSDH and can help guide clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: Decompression of the intestine with a long tube or nasogastric tube is the first-choice treatment for adhesive small bowel obstruction (ASBO). Scheduling surgery while weighing the risks of surgery against conservative care is a crucial factor in clinical decision-making. Whenever feasible, unnecessary surgeries should be avoided, and it is essential to provide clinical markers for this. This study aimed to obtain evidence regarding the optimal timing of ASBO and when conservative treatment options are not successful. Methods: The data of patients diagnosed with ASBO and receiving long tube insertion for more than 7 days were reviewed. We investigated transit ileal drainage volume and recurrence. The primary outcomes were the change in the drainage volume from the long tube over time and the percentage of patients who required surgery. We evaluated some cutoff values to determine the indication for surgery based on the insertion duration and volume of long tube drainage. Results: Ninety-nine patients were enrolled in this study. Fifty-one patients showed improvement with conservative treatment, whereas 48 ultimately required surgery. When a daily drainage volume of ≥500 mL was considered an indication for surgery, 13-37 cases (25%-72%) would be judged unnecessary within 6 days of long tube insertion, while 5 cases (9.8%) would be judged unnecessary on day 7. Discussion: Unnecessary surgical interventions for ASBO might be avoided by assessing the drainage volume on day 7 after inserting a long tube. [ABSTRACT FROM AUTHOR]

Dysphonia in children represents broad-spectrum voice problems. Global prevalence of hoarseness in school-aged children is 6–23%. It impairs communication of child, thus affects social life. This study shows importance of appropriate preventive measures for paediatric dysphonia and diagnosis of voice problems in early stages. Continuous voice abuse in children can cause recurrent voice disorders as well as speech problems. This prospective study included 104 patients(78 males and 26 females) of 6–15 years, with voice problems, in a tertiary care centre, North Kerala, during June 2022-March 2023. Chief complaints and risk factors evaluated. Voice analysis using maximum phonation time (MPT), Child Voice Handicap Index for Parents (CVHI-10-P), Reflux Symptom Index (RSI) and clinical examination including indirect laryngoscopy (IDL) and 70degree scopy were done. Treatment given for a maximum of 2 weeks. Advised voice rest and voice therapy throughout. All patients followed up after 2 weeks and up to 3 months. Voice abuse was the commonest risk factor and voice change, the commonest symptom. MPT reduced in 23% males and 14% females. According to CVHI-10-P, screaming was present in 52% children and symptoms present mostly in afternoon. RSI identified the role of LPRD in dysphonia. IDL and 70 scopy identified most common diagnosis as vocal nodule. Treatment given and follow-up period noted. All except vocal polyp had complete relief. Most common diagnosis was vocal nodule which resulted from chronic voice abuse. Appropriate preventive measures, early diagnosis and adequate treatment of voice problems should be considered. Conservative management in early stages is recommended. [ABSTRACT FROM AUTHOR]

Introduction: Pregnancy-related back pain is one of the most common musculoskeletal disorders during pregnancy. In some women, pregnancy-related back pain can be the beginning of chronic back pain for the rest of life and the cause of subsequent problems and disabilities. This study was performed with aim to systematically review the effectiveness of conservative management and physical therapy modalities in pregnancy-related low back pain and pelvic girdle pain. Methods: A search was done in Persian language databases, including the Scientific Information Database (SID), MagIran, Iran Medex and the English-language EMBASE, including Web of Science, ClinicalTrials.gov, Scopus, Physiotherapy Evidence Database (PEDro), Allied and Complementary Medicine Database (AMED) and MEDLINE (Pubmed) without time limitation until September 2022 using the keywords‬ included‬ (“Pregnancy”‬ OR‬ “Postnatal‬ Care”)‬ AND‬ (“Pelvic‬ Girdle‬ Pain”‬ OR‬ “low‬ back‬ pain”‬ OR‬ “Lower‬ Back‬ Pain”‬ OR‬ “Low‬ Back‬ Ache”) AND (“Conservative‬ Management”‬ OR‬ “Self-management”‬ OR‬ “Complementary‬ Medicine”‬ OR‬ “Alternative‬ Medicine”‬ OR‬ “Alternative‬ Therapy”‬ OR‬ “Physical‬ Therapy”‬OR‬“Kinesio‬Tape”‬OR‬“Acupuncture”‬OR‬“Manual‬Therapy”‬OR‬“Muscle‬ Training”‬OR‬“Cupping‬Treatment”‬OR “Cupping‬Therapy”‬OR‬“Cupping‬Treatment”‬ OR‬ “Acupressure”‬ OR‬ “Massage‬ Therapy”‬ OR‬ “Belt”‬ OR‬ “Physical‬ Activity”‬ OR “Aquatic‬Therapy”‬OR‬“Hydrotherapy”‬OR‬“Exercise‬Therapy”‬).‬The‬Cochrane‬Risk‬ of Bias tool was applied to evaluate the quality of the studies. Results: Eighty-six articles entered the final results. Ergonomic training and low and moderate-intensity exercises lead to pain relief and functional improvement in pregnancy-related back or pelvic girdle pain sufferers. Local and auricular acupuncture, Kinesio taping, and modified belts separately or in combination with other methods lead to pain relief and improved performance. Conclusion: Clinicians can recommend conservative multidisciplinary management combining ergonomic training and exercise with acupuncture, Kinesio taping, and belts to manage pregnancy-related back and pelvic girdle pain. Care should be taken in choosing other interventions due to the lack of evidence. [ABSTRACT FROM AUTHOR]

Conservative management of lumbar radiculopathy (LR) is the first treatment option. To date, systematic reviews and clinical practice guidelines have not considered the most appropriate timing of management. This study aimed to establish consensus on effective conservative treatment modalities across different stages (i.e., acute, sub-acute, or chronic) of LR. Through an iterative multistage Delphi process, experts rated agreement with proposed treatment modalities across stages of LR and could suggest additional treatment modalities. The agreement was measured using a 5-point Likert scale. Descriptive statistics were used to measure agreement (median, interquartile ranges, and percentage of agreement). Consensus criteria were defined a priori for each round. Fourteen panelists produced a consensus list of effective treatment modalities across stages of LR. Acute stage management should focus on providing patients with information about the condition including pain education, individualized physical activity, and directional preference exercises, supported with NSAIDs. In the sub-acute stage, strength training and neurodynamic mobilization could be added and transforaminal/epidural injections considered. In the chronic stage, spinal manipulative therapy, specific exercise, and function-specific physical training should be combined with individualized vocational, ergonomic and postural advice. Experts agree effectiveness of interventions differs through the evolution of LR. To date clinical guideline for conservative management of lumbar radiculopathy do not consider the evolution of the condition. Acute stage management of lumbar radiculopathy should focus on providing information about the condition and support individualized physical activity with pain medication. Sub-acute management should add neurodynamic mobilization to strength training, while transforaminal and/or epidural injections could be considered. Chronic stage management should consider spinal manipulative therapy and focus on restoring personalized functional capacity. [ABSTRACT FROM AUTHOR]

Simple Summary: Cervical cancer remains a major public health concern despite available screening and vaccination. Early-stage disease is frequently treated with radical surgery that has greater operative complications and results in a loss of fertility. Cervical cancer is most frequently diagnosed in pre-menopausal women, making fertility preservation a frequent concern. Additionally, in early-stage disease, there is mounting evidence that radical surgery is not necessary to achieve optimal oncologic outcomes. Using less radical surgical techniques improves patient surgical recovery, avoids long-term complications of surgery, and allows women to retain their fertility if they desire. This editorial presents the data for conservative management of early-stage cervical cancer. Cervical cancer remains a significant public health concern within the United States and across the world. Cervical cancer is most frequently diagnosed in women between the ages of 35 and 44 and therefore affects a younger patient population than many other cancers. The management of early-stage disease has frequently utilized radical hysterectomy with the associated increased surgical morbidity, without clear evidence of any benefits. In stage IA disease, there are retrospective pathologic data supporting the safety of conservative surgery and lymphadenectomy over radical hysterectomy. There are also emerging prospective studies supporting conservative management. This editorial presents the evidence for conservative management of stage IA cervical cancer by reviewing the existing retrospective studies as well as the ongoing prospective studies. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of the study was to evaluate the effect of second-look ureteroscopy (SU) in the endoscopic operative work-up of patients with upper tract urothelial carcinoma (UTUC). Materials and methods: Patients with UTUC who underwent SU between 2016 and 2021 were included. Cancer detection rate (CDR) at SU was defined as endoscopic visualization of tumor. The effect of SU on recurrence-free survival (RFS), radical nephroureterectomy-free survival (RNU-FS), bladder cancer-free survival (BC-FS), and cancer-specific survival (CSS) was estimated using the Kaplan–Meier method. Multivariate logistic regression analysis (MLR) assessed predictors of negative SU. Finally, we evaluated the effect of SU timing on oncological outcomes, classifying SUs as "early" (≤ 8 weeks) and "late" (> 8 weeks). Results: Overall, 85 patients underwent SU. The CDR at SU was 44.7%. After a median follow-up was 35 (IQR: 15–56) months, patients with positive SU had a higher rate of UTUC recurrence (47.4% vs 19.1%, p = 0.01) and were more frequently radically treated (34.2% vs 8.5%, p = 0.007). Patients with high-grade disease (hazard ratio [HR]: 3.14, 95% CI 1.18–8.31; p = 0.02) had a higher risk of UTUC recurrence, while high-grade tumor (HR: 3.87, 95%CI 1.08–13.77; p = 0.04) and positive SU (HR: 4.56, 95%CI 1.05–22.81; p = 0.04) were both predictors of RNU. Low-grade tumors [odds ratio (OR): 5.26, 95%CI 1.81–17.07, p = 0.003] and tumor dimension < 20 mm (OR: 5.69, 95%CI 1.48–28.31, p = 0.01) were predictors of negative SU. Finally, no significant difference emerged regarding UTUC recurrence, RNU, BC-FS, and CSM between early vs. late SUs (all p > 0.05). Conclusions: SU may help in identifying patients with UTUC experiencing an early recurrence after conservative treatment. Patients with low-grade and small tumors are those in which SU could be safely postponed after 8 weeks. [ABSTRACT FROM AUTHOR]

This report presents a unique finding of an incidental right internal carotid artery dissection in an asymptomatic 69-year-old man. The report highlights the possible trigger and long-term outcomes of this condition. The patient had participated in Japanese archery competitions for many years. His medical history included hypertension and a prior ischemic stroke in the left lateral medulla, resulting in Wallenberg syndrome. During a routine visit, head magnetic resonance angiography revealed right internal carotid artery dissection. He was managed conservatively with antiplatelet therapy and close monitoring. Follow-up imaging after 10 years showed no changes, and the patient remained asymptomatic. Therefore, routine screening for incidental findings is important even in asymptomatic patients. Archery competitions may be a possible trigger for internal carotid artery dissection. The presence of re-entry in the lesion at the time of onset can be a predictor of a good long-term prognosis. [ABSTRACT FROM AUTHOR]

Background: Occult pneumothorax (OPTX) is found in up to 15% of chest injuries. There is a history of conservative management of this pathology (only observation), although its practice continues to be discussed, especially in penetrating trauma. The objective of this paper is to describe our experience in the conservative management of OPTX. Materials and Method: Retrospective cohort study conducted over a 3-year period at a level I Trauma Center. Patients with thoracic trauma (blunt or penetrating) with OPTX were included. They were divided into two groups (preserved or drained) comparing their evolution. Results: Over a 3-year period 679 patients were admitted with chest trauma. From 93 patients with OPTX, 74 (80%) were initially preserved and 19 (20%) drained. Two patients (3%) presented pneumothorax progression in the follow-up imaging. There were no complications related to the absence of pleural drainage. Complications and hospital stay were lower in the conservative management group. Conclusion: Patients with OPTX due to chest trauma (blunt or penetrating), without requiring assisted ventilation and hemodynamically stable, can be safely conservative managed with close monitoring for 24 hours, with a lower rate of complications and hospital stay. [ABSTRACT FROM AUTHOR]

Chilaiditi sign represents a rare condition marked by the interposition of the bowel between the diaphragm and liver, mimicking pneumoperitoneum on radiological imaging. The syndrome manifests with gastrointestinal symptoms and is often confused with more serious conditions. This case report presents a rare instance of Chilaiditi syndrome, initially misdiagnosed as pneumoperitoneum based on chest X-ray findings. The patient, a 61-year-old woman, arrived at the emergency department complaining of acute epigastric pain. Initial tests, including a chest X-ray, suggested pneumoperitoneum, but a subsequent contrast-enhanced abdominal CT-scan revealed the interposition of the right colon between the liver and diaphragm, characteristic of Chilaiditi sign. The patient's symptoms, including abdominal pain and diarrhea, were consistent with Chilaiditi syndrome. The patient was treated successfully with intravenous antibiotics and fluids, showing significant improvement within 48 hours. The report highlights the importance of differentiating Chilaiditi syndrome from other acute abdominal conditions to avoid unnecessary surgical intervention. [ABSTRACT FROM AUTHOR]