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Key Clinical Message: Complications of uterine perforation and herniation of intra‐abdominal organs into the perforated area may occur after gynecological operations. They can be treated with a conservative approach, especially in cases whose vital signs are stable, laboratory values are within normal limits and their general condition is suitable. We aim to present the conservative treatment without using surgical and medical methods as it is the first case in the literature. Uterine perforation is a rare but potentially serious complication of curettage for gynecologic or obstetric reasons especially during and after operative procedures and the application of intrauterine contraceptive devices. The incidence of uterine perforation during gynecological operations is between 0.002–1.7. A 30‐year‐old multiparous case with a 7‐week 4‐day pregnancy was diagnosed with incomplete abortion at an external center due to vaginal bleeding. The case underwent suction curettage. After 24 h, revision suction curettage was performed due to the finding of rest in the endometrium during the ultrasonographic control, and the case was diagnosed with uterine perforation and omental herniation due to this. We highlighted the importance of a thorough gynecological assessment following a dilated suction curettage (D&C) procedure that includes a careful clinical examination and a detailed ultrasound evaluation. [ABSTRACT FROM AUTHOR]

Key Clinical Message Complications of uterine perforation and herniation of intra‐abdominal organs into the perforated area may occur after gynecological operations. They can be treated with a conservative approach, especially in cases whose vital signs are stable, laboratory values are within normal limits and their general condition is suitable. We aim to present the conservative treatment without using surgical and medical methods as it is the first case in the literature. Abstract Uterine perforation is a rare but potentially serious complication of curettage for gynecologic or obstetric reasons especially during and after operative procedures and the application of intrauterine contraceptive devices. The incidence of uterine perforation during gynecological operations is between 0.002–1.7. A 30‐year‐old multiparous case with a 7‐week 4‐day pregnancy was diagnosed with incomplete abortion at an external center due to vaginal bleeding. The case underwent suction curettage. After 24 h, revision suction curettage was performed due to the finding of rest in the endometrium during the ultrasonographic control, and the case was diagnosed with uterine perforation and omental herniation due to this. We highlighted the importance of a thorough gynecological assessment following a dilated suction curettage (D&C) procedure that includes a careful clinical examination and a detailed ultrasound evaluation.

Abstract Background Retrieval of cement-retained implant-supported restorations is intriguing in cases of screw loosening. Detecting the estimated size of the screw access hole (SAH) could decrease destruction to the prosthesis and preserve the crown. Objectives To precisely localize loose implant screws through cemented crowns to reduce crown damage after screw loosening. Materials and methods In this in vitro study, 60 cement-retained implants supported 30 zirconia-based, and 30 ceramics fused to metal (CFM) lower molar crowns were invented, and each was subdivided into three subgroups (10 each). In group I (AI/BI) (control), SAH was created with the aid of orthopantomography (OPG). In contrast, in group II (zirconia-crown), SAH was created with the aid of CBCT + 3D printed surgical guide with a 2 mm metal sleeve in subgroups IIA/IIIA and CBCT + MAR was used to develop SAH in subgroups IIB/IIIB. SEM and Micro-CT scanned the SAH openings to determine the diameter of the hole, cracking, chipping, and chipping volume. Results Regarding the effect of plane CBCT and CBCT + MAR on prepared crowns, a highly significant association between group I with group II (p = 0.001) and group III (p = 0.002) was detected. Regarding the cracking of SAH, significant differences between the zirconium crown and CFM restoration (p = 0.009) were found, while for the chipping, no significant association was seen between groups (p = 0.19). Conclusions CBCT, either as a plane CBCT or with MAR, significantly improved the accuracy of drilling the screw channel and decreased injury to the existing restoration and abutment, aiding in better localization of SAH in loosened implant abutment screws.

Background: Retrieval of cement-retained implant-supported restorations is intriguing in cases of screw loosening. Detecting the estimated size of the screw access hole (SAH) could decrease destruction to the prosthesis and preserve the crown. Objectives: To precisely localize loose implant screws through cemented crowns to reduce crown damage after screw loosening. Materials and methods: In this in vitro study, 60 cement-retained implants supported 30 zirconia-based, and 30 ceramics fused to metal (CFM) lower molar crowns were invented, and each was subdivided into three subgroups (10 each). In group I (AI/BI) (control), SAH was created with the aid of orthopantomography (OPG). In contrast, in group II (zirconia-crown), SAH was created with the aid of CBCT + 3D printed surgical guide with a 2 mm metal sleeve in subgroups IIA/IIIA and CBCT + MAR was used to develop SAH in subgroups IIB/IIIB. SEM and Micro-CT scanned the SAH openings to determine the diameter of the hole, cracking, chipping, and chipping volume. Results: Regarding the effect of plane CBCT and CBCT + MAR on prepared crowns, a highly significant association between group I with group II (p = 0.001) and group III (p = 0.002) was detected. Regarding the cracking of SAH, significant differences between the zirconium crown and CFM restoration (p = 0.009) were found, while for the chipping, no significant association was seen between groups (p = 0.19). Conclusions: CBCT, either as a plane CBCT or with MAR, significantly improved the accuracy of drilling the screw channel and decreased injury to the existing restoration and abutment, aiding in better localization of SAH in loosened implant abutment screws. [ABSTRACT FROM AUTHOR]

Objective: To report an alternative combined gingivobuccal and endoscopic endonasal approach to treating ossifying fibroma of the left maxilla. Methods: Design: Case Report Setting: Tertiary Private University Hospital Patient: A 19-year-old girl with a progressively enlarging left cheek mass for 3 years. Results: Our patient underwent left medial maxillectomy via a combined gingivobuccal and endoscopic endonasal approach with complete resection and significant improvement of symptoms, with good functional outcome. Conclusion: Large ossifying fibromas of the maxilla can be completely and successfully excised via a combined gingivobuccal and endoscopic endonasal approach.

As a treaty obligation and customary international law, universal jurisdiction is crucial in the global fight against impunity. While Western countries have been at the forefront, actively expanding and developing universal jurisdiction, East Asian countries have adopted a more conservative approach, emphasizing state sovereignty. This article begins by exploring the theoretical construction, legal frameworks, and state practices of East Asian countries (China, Korea, and Japan) when exercising universal jurisdiction, highlighting the typical differences between these countries and Western countries. It is then observed that the passive universal jurisdiction system in East Asia is deficient in defending state interests or counteracting other countries' inappropriate extraterritorial jurisdiction. Accordingly, this article advocates a more proactive approach to the application of universal jurisdiction in East Asian countries. By doing so, while assuming responsibility to prevent impunity, the state can use universal jurisdiction as a legitimate countermeasure and reprisal in reciprocal international relations. [ABSTRACT FROM AUTHOR]

BACKGROUND: Sickle cell disease (SCD) patients may develop multiple alloantibodies that pose problem in finding compatible blood for transfusion and require crossmatching with large number of blood. AIM: The aim of the present study was to find compatible blood with reduced cost by adopting a conservative approach. MATERIALS AND METHODS: A step-by-step approach using tube technique, antibodies in original serum, and the saved test supernatant (TS) in search of compatible blood for transfusion purposes. RESULTS: 32 years SCD patient grouped A with multiple antibodies required transfusion. A total of 641 red blood cell (RBC) units of groups A and O were crossmatched using serum and the TS by tube method. Of 138 units tested using the serum at 4°C, 124 units showed direct agglutination in the saline phase and the remaining 14 units were processed through low ionic strength solution (LISS)-IAT, of which 2 units were compatible even by the gel-IgG-card method. The TS, saved from the tests on serum, was used in an identical manner as that of the serum to screen additional 503 units by saline tube method at 4°C units showed direct agglutination of the RBCs of 428 units, hence were removed from inventory for this patient. The remaining 75 units were tested by the LISS-IAT-tube method at 37°C, of which 8 units were found compatible but only 2 units were clear compatible by the gel-IgG-card method. As such, 4 units compatible by the sensitive gel-IgG-card method were issued for transfusion purposes. CONCLUSION: The new approach on using the saved TS consumed less of the patient's blood specimen, and the use of the tube method in screening and eliminating a large chunk of incompatible blood units has proved economical if compared with the use of the only gel-IgG-cards device in the entire maneuvering.

Background: Retroperitoneal panniculitis is a rare, benign, and nonspecific inflammatory disease that affects the retroperitoneal adipose tissue. The specific cause of the disease is unknown. The diagnosis is evoked by computed tomography (CT) and is rarely confirmed by biopsies. Surgical resection is sometimes attempted for complicated forms. A case of a 22-year-old man was presented who was diagnosed with retroperitoneal panniculitis, further, a literature review was also conducted to compare various presentations, etiologies, and potential treatment modalities. Case presentation: A 22-year-old man presented to the emergency department with acute abdominal pain and episodes of postprandial vomiting. A physical examination revealed marked epigastric tenderness accompanied by abdominal distension. The blood examination revealed normal lipase and amylase levels. An abdominal contrast-enhanced CT showed retroperitoneal panniculitis complicated by a paralytic ileus. A self-limiting course of the disease was obtained by adopting a conservative approach. After 20 days, there were no abnormal findings on CT and the patient was referred to internal medicine consultation for additional care. Conclusion: Diagnosis of retroperitoneal panniculitis is a real challenge to surgeons, gastroenterologists, radiologists, and pathologists. Consequently, it is imperative that all hospital practitioners should distinguish between this benign lesion and malignant diseases. [SJEMed 2023; 4(1.000): 073-075]

BACKGROUND: Sickle cell disease (SCD) patients may develop multiple alloantibodies that pose problem in finding compatible blood for transfusion and require crossmatching with large number of blood. AIM: The aim of the present study was to find compatible blood with reduced cost by adopting a conservative approach. MATERIALS AND METHODS: A step-by-step approach using tube technique, antibodies in original serum, and the saved test supernatant (TS) in search of compatible blood for transfusion purposes. RESULTS: 32 years SCD patient grouped A with multiple antibodies required transfusion. A total of 641 red blood cell (RBC) units of groups A and O were crossmatched using serum and the TS by tube method. Of 138 units tested using the serum at 4°C, 124 units showed direct agglutination in the saline phase and the remaining 14 units were processed through low ionic strength solution (LISS)-IAT, of which 2 units were compatible even by the gel-IgG-card method. The TS, saved from the tests on serum, was used in an identical manner as that of the serum to screen additional 503 units by saline tube method at 4°C units showed direct agglutination of the RBCs of 428 units, hence were removed from inventory for this patient. The remaining 75 units were tested by the LISS-IAT-tube method at 37°C, of which 8 units were found compatible but only 2 units were clear compatible by the gel-IgG-card method. As such, 4 units compatible by the sensitive gel-IgG-card method were issued for transfusion purposes. CONCLUSION: The new approach on using the saved TS consumed less of the patient's blood specimen, and the use of the tube method in screening and eliminating a large chunk of incompatible blood units has proved economical if compared with the use of the only gel-IgG-cards device in the entire maneuvering. [ABSTRACT FROM AUTHOR]

To gain insight in the availability of guidelines, diagnostic criteria, and treatment strategies and whether clinical equipoise regarding optimal treatment for patent ductus arteriosus (PDA) in prematurity is present. We hypothesized that (co-)authors of PDA-related papers were more likely to screen for a PDA and would treat earlier and more aggressively. An international internet-based survey between September 2019 and March 2020 in which we collected (1) baseline characteristics; (2) availability of guidelines; (3) screening strategy for PDA; (4) diagnostic criteria for hemodynamic significance; (5) treatment strategy; and (6) metrics of treatment efficacy. Finally, ten clinical equipoise statements were posed on a Likert scale. In total, 144 surveys were sent, of which 71/144 (49%) surveys could be analyzed with 56/71 (79%) fully completed surveys. The respondents, mainly neonatologists in a level III neonatal intensive care unit, of whom 36/71 (51%) had (co-)authored a publication on the PDA, highlighted a lack of national guidelines, heterogeneous approach to screening strategies, and marked variability in diagnostic criteria to assess hemodynamic significance, treatment strategies and effect measurement. No major significant differences were observed between respondents who did or did not (co-)author a publication on the PDA. Respondents who screened for PDA scored significantly higher on the need for screening, early and aggressive treatment. Remarkably, the scores of all statements regarding clinical equipoise varied widely. Conclusions: Our survey highlights the lack of guidelines and enormous heterogeneity in current practice. Current evidence is not robust enough to harmonize current treatment strategies into (inter)national guidelines. What is Known: • Patent ductus arteriosus (PDA) incidence is inversely related to gestational age. • Although early pharmacological treatment induces PDA closure, optimal treatment is debated due to the lack of beneficial effects on outcome. What is New: • In the absence of (inter)national guidelines, diagnostic and treatment strategies are heterogeneous and contradictory, even in a selected hemodynamically- interested group. • Different PDA screening strategies did, while PDA publication status did not, show significant differences in treatment strategy and responses to equipoise statements. [ABSTRACT FROM AUTHOR]

Conservation of mandibular molar teeth exhibiting furcation involvement and perforation of the pulp floor have always been a challenge. Section of the affected tooth at the furcation zone, and preservation of the mesial and distal roots individually with its crown portion, helps to preserve the tooth structure, alveolar bone and avoids sacrificing a strategic tooth. Therapeutic planning is multidisciplinary. It contains surgical, endodontic and prosthetic phase. Long-term success depends on thorough diagnosis and careful selection of cases. This article describes a simple procedure for bisection in mandibular molar. This is illustrated by a clinical case while detailing the entire operative sequences of bisection procedure. [ABSTRACT FROM AUTHOR]

Corynebacterium striatum is an emerging Gram-positive bacillus associated with invasive infection in both immunocompetent and immunocompromised patients, especially associated with medical devices. Its ability to form biofilms has been demonstrated and it has been occasionally associated with cardiac device-related infective endocarditis with few cases described in literature. We report a case of C. striatum cardiac device-related infective endocarditis of complex management.

Introduction: Patent ductus arteriosus (PDA) is a commonly encountered morbidity that occurs inversely with gestational age. In response to the growing trend of avoiding PDA ligation and prophylactic interventions, our center adopted a conservative approach starting in September 2020. This approach involves more precise fluid restriction for hemodynamically significant (hs) PDA. This study aimed to evaluate whether a conservative approach to hsPDA has led to a reduction in adverse clinical outcomes for very low birth weight infants (VLBWIs) during the period of conservative treatment., Methods: Since more conservative approach to hsPDA was adopted since September 2020, the two periods were divided into period 1 (January 2015 to August 2020) and period 2 (September 2020 to June 2023). Fluid therapy was carefully monitored and advanced from day 1 in all VLBWI, and a more conservative approach as fluid restriction was attempted in hsPDA during period 2., Results: Of the 540 VLBWI with hsPDA, 348 infants were born and diagnosed with hsPDA. Period 2 demonstrated a significantly higher rate of medical treatment (79.17% vs. 19.51%) and lower PDA ligation (54.17% vs. 78.05%). Period 2 showed a greater adherence to conservative fluid restriction compared to period 1. Bronchopulmonary dysplasia (BPD) and BPD ≥ moderate, sepsis, necrotizing enterocolitis (≥ grade 2), IVH (grade ≥3) were notably lower in period 2 with lower mortality. In regard to PDA-related treatment, primary PDA ligation was significantly higher in period 1. The secondary PDA ligation after medical failure and more conservative fluid restriction were significantly higher in period 2. At corrected age of 18-24 months, cognitive score was significantly lower in VLBWI born in period 1 compared to those born in period 2., Conclusion: Our study demonstrated that a conservative approach to hsPDA led to better clinical outcomes and improved cognitive scores at a corrected age of 18-24 months compared to the period of active PDA ligation. This conservative strategy, involving more precise fluid restriction and the judicious use of appropriate diuretics, has shown to improve clinical outcomes with minimal intervention., (© 2024 The Author(s). Published by S. Karger AG, Basel.)

Radicular cysts are among the most common odontogenic cystic lesions in the maxillofacial region. This case report details the management of a large radicular cyst in the anterior maxillary region of a 32-year-old female patient and includes a literature review on such cysts. The patient underwent cyst decompression, surgical enucleation, tooth extractions, root canal treatments, periapical curettage, and prosthetic rehabilitation. This study underscores the effectiveness of conservative approaches, such as decompression, in reducing cyst size and highlights the importance of individualized treatment plans for achieving optimal outcomes and preventing recurrence. Collaborative efforts between clinicians and multidisciplinary teams are crucial for managing radicular cysts and ensuring long-term oral health for patients., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Vijayashree et al.)

Objective We aimed to report the treatment approaches we administered to the patients admitted to our clinic for odontoid fracture, accompanied by literature. Material and Methods Eighteen patients with odontoid fracture who admitted to our clinic were evaluated retrospectively. Six patients were female, twelve patients were male and the mean age was 45,5 (16-87). Type 1 fracture in 7 patients, Type 2 fracture in 4 patients and Type 3 fractures in 7 patients were determined. As 86% of the patients with type 1 fracture, and 57% of the patients with type 3 fracture were treated conservatively, all patients with type 2 fracture treated with anterior odontoid screw and in 1 patient with type 3 fracture posterior arthrodesis was performed. Six of the conservatively treated patients used Halo-Vest, 3 of them used Philadelphia cervical collar, and 2 of them used sterno-occipito-mandibular immobilizer (SOMI). Results Fusion was occurred in 7 patients (64%) of 11 patients, who treated conservatively, and in the 4 patients (36%) surgery was planned as non-fusion was occurred. Two of these patients with no symptoms did not accept surgery. In one patient, with anterior surgery, posterior occipitocervical fusion was done as screw malposition was seen. Conclusion In decision making of the odontoid fractures, type of the fracture and age of the patient should be considered. As deciding the surgical technique beside clinical improvement, fusion rate is also important. In the elder patients anterior screwing should be preferred to conserve mobility; in the older patients posterior fusion should be preferred not to have mechanical deficiency and to minimize the other complications. However appropriate treatment strategy is still not clear. [ABSTRACT FROM AUTHOR]

Acromion fractures, particularly isolated cases, are uncommon but significant in shoulder injuries. There is no universally accepted treatment protocol, but the classification of the fracture helps to guide clinical decisions. We present a case report aiming to contribute to the understanding of treatment options for acromion fractures. A 22-year-old male sustained a left shoulder injury during a wrestling match, resulting in a type 2 acromion fracture. Conservative treatment was initiated with regular follow-ups. Serial imaging showed no further displacement. Gradual rehabilitation exercises were introduced based on healing progress. The rarity of isolated acromion fractures complicates their management. Conservative management, coupled with rehabilitation exercises, yielded positive outcomes in our case, suggesting its efficacy as a primary treatment option for isolated displaced acromion fractures. Further research is needed to establish standardized protocols for managing such fractures, but until then, conservative care remains a viable approach, potentially preferred over surgical intervention., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Deshmukh et al.)

In endodontic and restorative procedures, an accidental perforation of the pulp chamber floor or roots presents a considerable risk, potentially leading to persistent inflammatory responses and ultimately tooth loss. Accidental root canal perforations are primary complications encountered by clinicians, requiring either surgical or non-surgical intervention, depending on the severity of the perforation. Over the years, various materials have been utilized for the treatment of such complications, but mineral trioxide aggregate (MTA) stands out prominently due to its exceptional biocompatibility, remarkable sealing capacity, and potent antibacterial properties. The unique ability of MTA to set in the presence of moisture facilitates the formation of a robust seal, thereby making it highly effective in managing root perforations and fostering tissue regeneration within the affected area. Its versatility and effectiveness have made MTA a cornerstone material in modern endodontic therapy, offering clinicians a reliable solution for enhancing the long-term prognosis of teeth affected by perforations., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Panchal et al.)

Objective: Small bowel obstruction (SBO) is a common and important surgical emergency. Our aim in this study is to describe the clinical, laboratory, and computed tomography (CT) findings to facilitate the objective identification of SBO patients in need of operative treatment in this patient population., Methods: This retrospective study included 340 patients hospitalized due to a preliminary diagnosis of ileus. Retrieved data of patients included age, gender, comorbidities, previous hospitalization due to ileus, surgical history, physical examination findings, complete blood count and biochemistry test results, and CT findings at admission., Results: The study included 180 (52.9%) male and 160 (47.1%) female patients. Treatment was conservative in 216 patients and surgery in 124 patients. Of the patients included in the study, 36.4% needed surgery. Of the female patients, 38.90% received conservative treatment and 61.30% underwent surgery. Adhesions were the most common cause of obstruction in operated patients (43.50%)., Conclusion: We have found that female gender, vomiting, guarding, rebound, C-reactive protein levels above 75 mg/L, increased bowel diameter, and a transition zone on CT images indicate a strong need for surgery, but a history of previous hospitalization for ileus may show that surgery may not be the best option., (Copyright: © 2024 Permanyer.)

The aim of this review is to evaluate the current evidence regarding the best management in terms of active surveillance of angiomyolipoma (AML) cases less than 4 cm, particularly the optimal timing of active surveillance. In addition, we aimed to describe their initial size, clinical presentation, and growth rates. The present systematic review included prospective and retrospective studies that evaluated and followed up patients with AML through active surveillance. Studies were retrieved through an online bibliographic search of the Medline database via PubMed, SCOPUS, Web of Science, and Cochrane Library from their inception to January 2022. Seven studies were included in the present systematic review. Concerning the active surveillance protocol, only four studies describe the frequency of active surveillance and the utilized imaging modality. Some studies followed up lesions by ultrasound annually for two to five years, while other studies followed-up patients twice for the first year, then annually for a median follow-up period of 49 (9-89) months. The used modalities were ultrasound, CT, and magnetic resonance imaging (MRI). Notably, the incidence of spontaneous bleeding was consistent across the included studies (ranging from 2.3 - 3.1%), except for one study which showed an incidence rate of 15.3%. In terms of the need for active treatment, the rate of active treatment was slightly higher in some studies than the others. However, this variation could not be considered clinically relevant to favor one surveillance strategy over the other. We concluded that active surveillance is the first line of management in all small asymptomatic ALMs. ALMs less than 2 cm do not require active surveillance. The current published literature suggested that active surveillance for two years may provide the same benefits as a five-year surveillance strategy, with fewer radiation hazards and less socioeconomic burden., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Zeid et al.)