Advances in diagnosis and non-surgical treatment of Bell's palsy

Bell’s palsy is a commonly seen cranial nerve disease and can result in compromised facial appearance and functions. Its etiology, prognosis and treatment are still being debated. This paper is a review of recent development in the understanding of etiology, diagnosis and non-surgical treatment of Bell’s palsy.

Multidisciplinary non-surgical treatment of advanced periodontitis:A case report

BACKGROUND Patients with severe periodontitis often require multidisciplinary treatment to achieve healthy periodontal tissue,normal occlusion,and optimal aesthetics.In the present study,we aimed to evaluate the efficacy of multidisciplinary non-surgical treatment in a patient with stage IV/grade C periodontitis,malocclusion,and dentition defects.CASE SUMMARY A 47-year-old woman visited our periodontology department due to teeth mobility problems and difficulties chewing food.The patient had no history of drug allergies or systemic disease.Initial therapy involved scaling and root planning with a Gracey scaler and periodontal ultrasonic therapeutic apparatus using a periodontal endoscope(Perioscopy,Zest Dental Solutions,United States)to control the periodontal inflammation prior to treatment.Five months later,orthodontic treatment was then performed to treat occlusion and overall aesthetics.After completion,a Maryland bridge was used to restore Nos.22,31,and 41 teeth.Florida probing(Florida probe,United States)was performed every 2-3 mo to evaluate the periodontal condition throughout treatment.Overall,multidisciplinary non-surgical treatment resulted in satisfactory aesthetic results with healthy periodontal tissue and stable occlusion.CONCLUSION In some patients with stage IV/grade C periodontitis,systematic and sequential non-surgical treatment can provide excellent therapeutic results.

How to manage isolated tension non-surgical pneumoperitonium during bronchoscopy?A case report

BACKGROUND Tension pneumoperitonium is a rare complication during bronchoscopy that can cause acute respiratory and hemodynamic failure,with fatal consequences.Isolated pneumoperitonium during bronchoscopy usually results from ruptures of the abdominal viscera that need surgical repair.Non-surgical pneumoperitoneum(NSP)refers to some pneumoperitoneum that could be relieved without surgery and only by conservative therapy.However,the clinical experience of managing tension pneumoperitonium during bronchoscopy is limited and controversial.CASE SUMMARY A 51-year-old female was admitted to our hospital for cough with bloody sputum of seven days.On the 8th day of her admission,a bronchoscopy was arranged for bronchial-alveolar lavage to detect possible pathogens in the lower respiratory tract,as oxygen was delivered via a 12 F nasopharyngeal cannula,approximately 5-6 cm from the tip of the catheter,with a flow rate of 5-10 L/min.After four minutes of bronchoscopy,the patient suddenly vomited 20 mL of water,followed by severe abdominal pain,while physical examination revealed obvious abdominal distension,as well as hardness and tenderness of the whole abdomen,which was considered pneumoperitonium,and the bronchoscopy was terminated immediately.A computer tomography scan indicated isolated tension pneumoperitonium,and abdominal decompression was performed with a drainage tube,after which her symptoms were relieved.A multidisciplinary expert consultation discussed her situation and a laparotomy was suggested,but finally refused by her family.She had no signs of peritonitis and was finally discharged 5 d after bronchoscopy with a good recovery.CONCLUSION The possibility of tension pneumoperitonium during bronchoscopy should be guarded against,and given its serious clinical consequences,cardiopulmonary instability should be treated immediately.Varied strategies could be adopted according to whether it is complicated with pneumothorax or pneumomediastinum,and the presence of peritonitis.When considering NSP,conservative therapy maybe a reasonable option with good recovery.An algorithm for the management of pneumoperitonium during bronchoscopy is proposed,based on the features of the case series reviewed and our case reported.

Non-Surgical Orthodontic Treatment of Class III Adult with Posterior Crossbite, Anterior Open Bite and Asymmetric Occlusion, Using TADs and Auxiliary Wires: A Case Report

Class III malocclusion associated with posterior crossbite, anterior open bite pattern with asymmetric occlusion in adults can be a challenging orthodontic problem, especially for the nonsurgical treatment. Skeletal Class III anteroposterior discrepancies in adult patients are generally managed either by surgical-orthodontic treatment or by orthodontic camouflage through dentoalveolar compensation. Although correction with surgery may be the most effective and stable way, many patients refuse surgical treatment plan because of the costs and traumas it may bring. This case report describes the successful use of TADs with expansion auxiliary wire to treat a 24-year-old man with skeletal class III malocclusion, posterior crossbite, anterior open-bite and asymmetric occlusion, mild upper and lower dental spacing and a chief manifestation of anterior crossbite. The patient refused surgery. A treatment plan was formulated consisting of using auxiliary expansion wire to expand the maxillary arch, 8 mm mini-screws between the roots of the mandibular canines and first premolars, preadjusted edgewise brackets to align the teeth, Class III and asymmetric elastics to correct the canines, premolars, and molars relationship and midline deviation, reverse curve of the nickel-titanium wire combined with anterior vertical elastics to intrude molars and correct the anterior open-bite. In this case, without going through surgery, the posterior cross-bite was corrected, and ideal overjet and overbite relationships, midline coincidence and functional occlusion were all achieved. Satisfactory occlusal, functional, esthetic and stable results were obtained.

The Effectiveness of Non-Surgical Weight Management Interventions for Obesity in the UK: A Review and Meta-Regression Analysis

Background: Obesity is regarded as one of the most serious challenges public health faces in the 21st century for adults and children alike. Accordingly weight management interventions remain a public health priority aiming to reduce the burden of obesity and co-morbidities. Therefore this review aims to assess the effectiveness of non-surgical weight management interventions for obesity in the UK. Method: Thirty one databases were searched that identified 20 articles for inclusion. Articles were screened and quality scored using the “Effective Public Health Practice Project Quality Assessment Tool”. Meta-regression analysis (MRA) was undertaken on seven studies that allowed for effect size calculations. Results: In adult populations, lifestyle interventions that targeted both diet and physical activity, delivered in the private sector were most effective in reducing weight and/or BMI, and were more cost-effective. In children the most successful interventions mirrored adult interventions, but were family-orientated. MRA supported these findings. Most frequent intervention duration was 12 weeks. Discussion: The results provide evidence to support policy makers for the effective delivery of weight management interventions. Findings suggest that weight management interventions in the UK are effective in reducing weight and/or BMI for both children and adults. Interventions delivered in the private sector (e.g. Weight Watchers), targeting diet and physical activity levels, demonstrated the highest levels of effectiveness. However, compared to these models, NHS programmes are less well defined in the research literature and may not have been optimised. For children, effectiveness is improved by family-level programmes incorporating children and their parents.

The Benefits of Non-Surgical Periodontal Treatment in Association with Gastric Eradication

Periodontitis is a chronic degenerative disease which is inflammatory and whose bacteriological aetiology interests the hard and soft tissues supporting the dental elements. A typical characteristic of periodontitis is its correlation with other branches of medicine since periodontal disease is often associated with several other illnesses or systemic conditions which exacerbate or predispose the course of the disease. Amongst the most frequent gastroduodenal diseases are those associated with Helicobacter pylori (Hp) infections such as acute gastritis, chronic atrophic gastritis, gastric atrophy, gastritis ulcers, dysplasia, duodenal ulcer, gastric cancer, gastric MALT-lymphoma. Transmission of the microorganism occurs through iatrogenic pathways (faecal-oral, oral-oral) and through food and water ingestion. From this the possible role of the oral cavity becomes evident as a means of transmitting the microorganism and as an extra-gastric reservoir of Hp which develops inside the oral plaque, the main aetiological agent of periodontal disease. Considering that in a patient affected with periodontal disease the oral cavity presents elevated indices of bacterial plaque in association with infrabony pockets one is brought to ask if it might represent a favourable habitat for Hp colonisation. Furthermore, another query that one might pose is whether the presence of Hp in the oral cavity might be the cause of relapse in gastric infections caused by Hp. Consequently, might non-surgical periodontal treatment, in association with an eradicating gastric therapy, foster decontamination of the microorganism in the oral cavity leading to a better prevention of relapse and re-infection of the gastric cavity? Could non-surgical periodontal treatment thus mean prevention of gastric diseases brought on by Helicobacter pylori? The objective of this study is therefore to evaluate the incidence of periodontal disease and oral Hp infection in patients affected by gastric Hpinfection and to determine the possible benefits of the association of non-surgical periodontal therapy with eradicating gastric therapy compared with treatment that involves just the eradicating gastric therapy in patients who are affected by periodontal disease and Hp infection.

Assessment and management of immature facial scars by non-surgical methods

Background:Scar quality is affected by patients’wound healing conditions,trauma type,and skin features that differ due to ethnicity.Despite tremendous improvements in scar remodeling techniques,conspicuous scars can still remain postoperatively.Non-surgical methods used for handling scars include the use of topical corticosteroids,pressure therapy,lasers,and platelet-rich plasma(PRP).This study aimed to assess and evaluate different non-surgical modalities for treating immature facial scars.Methods:Fifteen patients with scars were included for non-surgical management.They received one or more of 5 treatments:corticosteroid injection,topical silicone gel application with or without bandage,pressure therapy,lasers,or PRP injection.Scars were assessed using the Patient and Observer Scar Assessment Scale(POSAS)and serial photographs.Results:There were no significant differences in the results obtained using POSAS.None of the patients required a secondary intervention or sought a second opinion.The rate of complications associated with the treatments were very minor.Conclusion:Good assessment of patient characteristics,proper planning,and appropriate treatment lead to favorable outcomes.

Non-Surgical Treatment with Chemical Peeling and Subsequent Vitamin C Iontophoresis for Rolling Scars in Acne Vulgaris

A 19-year-old man had atrophic scars on bilateral temple for several years. The atrophic scars were composed of rolling scars (three depressions, 8 × 4 mm in diameter), ice pick scars and boxcar scar. The patient was treated with chemical peeling (CP) using 20% glycolic acid (GA) (pH 3.2) and subsequent iontophoresis with vitamin C derivative at one month’s interval twice. Remarkable improvement was observed;the rolling scars almost disappeared with traces of hypopigmented macule. However, the ice pick scars and boxcar scar did not improve. CP and subsequent vitamin C iontophoresis can be an alternative non-surgical and non-invasive treatment for rolling scar in acne.

Modern blepharoplasty:From bench to bedside

The demand for procedures aiming to rejuvenate the upper third part of the face and the periocular region has increased in the past several years.Blepharoplasty is one of the most frequently performed procedures worldwide to date.Surgery is currently the first choice in order to achieve permanent and effective results;however,it is burdened by potential surgical complications feared by patients.There is an increasing trend in individuals to request less invasive,non-surgical,effective,and safe procedures for eyelid treatment.The aim of this minireview is to present a brief overview of non-surgical blepharoplasty techniques that have been reported in the literature in the past 10 years.Numerous modern techniques that provide a rejuvenation of the entire area have been described.Numerous less invasive methods have been proposed in the current literature and in modern-day routine clinical settings.Dermal fillers are a commonly chosen option for providing enhanced aesthetic results,especially considering that volume loss can be one of the main underlying causes of facial and periorbital aging.Deoxycholic acid use may be considered when the problem is represented by periorbital excess fat deposits.The simultaneous excess and loss of elasticity of the skin can be assessed with techniques such as lasers and plasma exeresis.Furthermore,techniques such as platelet-rich plasma injections and the insertion of twisted polydioxanone threads are emerging as viable methods to rejuvenate the periorbital region.

Wingless/It/β-catenin signaling in liver metastasis from colorectal cancer:A focus on biological mechanisms and therapeutic opportunities

The liver is the most common site of metastases in patients with colorectal cancer.Colorectal liver metastases(CRLMs)are the result of molecular mechanisms that involve different cells of the liver microenvironment.The aberrant activation of Wingless/It(Wnt)/β-catenin signals downstream of Wnt ligands initially drives the oncogenic transformation of the colon epithelium,but also the progression of metastatization through the epithelial-mesenchymal transition/mesenchymalepithelial transition interactions.In liver microenvironment,metastatic cells can also survive and adapt through dormancy,which makes them less susceptible to pro-apoptotic signals and therapies.Treatment of CRLMs is challenging due to its variability and heterogeneity.Advances in surgery and oncology have been made in the last decade and a pivotal role for Wnt/β-catenin pathway has been recognized in chemoresistance.At the state of art,there is a lack of clear understanding of why and how this occurs and thus where exactly the opportunities for developing anti-CRLMs therapies may lie.In this review,current knowledge on the involvement of Wnt signaling in the development of CRLMs was considered.In addition,an overview of useful biomarkers with a revision of surgical and non-surgical therapies currently accepted in the clinical practice for colorectal liver metastasis patients were provided.

Thrombosis of the Transverse Sinus: About a Clinical Observation and Review of the Literature

Cerebral venous thrombosis has an unfavorable prognosis. It is a rather rare pathology concerning 3 to 5 cases per million inhabitants. The clinical symptomatology also varies according to the topography of the venous thrombosis and, in some cases, the CVT can have an unusual presentation. Progress and accessibility of non-invasive imaging currently allow early diagnosis of CVT. Brain MRI is the reference method for the diagnosis of CVT. We report a case of transverse sinus thrombosis in a 32-year-old male patient who consulted for headaches through which we want to study the etiological, clinical, paraclinical, therapeutic aspects as well as the evolutionary profile. The clinical history dates back to 2 weeks ago with frontal headaches radiating to the occipital region, throbbing of severe intensity, progressive onset and permanent evolution associated with right unilateral anterior purulent rhinorrhea. He had no nasal obstruction, epistaxis, hearing loss or other otological symptoms;no neurological deficit or notion of head trauma. Cerebral and maxillofacial computed tomography showed right maxillary sinusitis and right transverse sinus thrombosis. We carried out medical treatment based on antibiotics and analgesics without the use of anticoagulants. The evolution was favorable after four weeks of treatment. Conclusion: Transverse sinus thrombosis has a non-specific and heterogeneous clinical presentation. Headaches are the first sign. MRI and CT can help establish the diagnosis. The treatment is both etiological and symptomatic.

Conservative treatment of knee osteoarthritis:A review of the literature

Knee osteoarthritis(KOA)is a common chronic debilitating disease with an estimated prevalence of 23.9%in the general adult population.The condition is characterised by joint pain,functional impairment and significant reduction in quality of life.Management for KOA can generally be divided into conservative(non-operative)and surgical(operative)measures.Conservative management broadly compromises pharmacological and non-pharmacological options and is conventionally the first line treatment to avoid or delay the need for surgical management.The aim of this study is to provide an overview of the current recommendations,efficacy and safety profile of different conservative treatments through a review of the literature.

Treatment of bilateral granulomatous lobular mastitis during lactation with traditional Chinese medicine: A case report

BACKGROUND Granulomatous lobular mastitis(GLM)is a type of benign chronic inflammatory disease that poses therapeutic challenges to healthcare providers.The diagnosis of GLM relies on tissue biopsy,and incorrect treatment may lead to delayed diagnosis,considerable aesthetic damage,and even mastectomy.CASE SUMMARY We report the case of a 37-year-old Chinese woman who was lactating and had GLM in both breasts.At the time of treatment,the right breast had a mass of approximately 15 cm×11 cm,which was hard and had poor mobility.Multiple skin ulcerations and pus spills were also observed on the surface of the breast.The left breast had a mass of about 13 cm×9 cm,which was hard and had poor mobility.CONCLUSION Herein,we report a case of bilateral GLM in a lactating woman that was successfully treated with traditional Chinese medicine(TCM),without the requirement for surgery or other treatments.Therefore,TCM may have advantages in the nonsurgical treatment of GLM.

Comments on the article about the treatment of peripancreatic infection

We read with great interest the article by Tang et al published in issue 4 of World Journal of Gastroenterology 2010.The results of their study indicate that percutaneous catheter drainage in combination with choledochoscope-guided debridement is a simple,safe and reliable treatment procedure for peripancreatic infections secondary to severe acute pancreatitis.However,there are some points that need to be addressed,including data about the patients in the study and their clinical characteristics,data about infection and superinfection during the treatment and type of treatment of patients with acute necrotizing pancreatitis.

Impact of age on long term survival following transcatheter aortic valve implantation

Objective To compare the long-term survival following transcatheter aortic valve implantation (TAVI) in an octogenarian population with that in a younger population.Methods This retrospective study included 274 patients that underwent TAVI for severe symptomatic aortic stenosis.The study group was divided into two age groups,as those with an age ≥ 80 years (octogenarians,n = 132),and age < 80 (younger patients,n = 142).The two groups were compared in terms of clinical outcomes and survival.In addition,significant predictors of survival were estimated.Results Non-cardiac mortality (during follow-up)(21.9% vs.10.5%,P = 0.01) and in-hospital stroke (8.3% vs.2.8%,P = 0.01) were more common among octogenarians.The two groups did not differ in terms of mean survival (41.0 ± 2.1 vs.38.2 ± 2.2 months,respectively,P =0.18).Multivariate analysis identified left ventricular ejection fraction < 35%(OR: 2.17,95% CI: 1.17–4.03;P = 0.01),preoperative of moderate to severe mitral insufficiency (OR: 1.88,95% CI: 1.15–3.06;P = 0.01),postoperative major and life-threating bleeding (OR: 2.49,95% CI: 1.05–5.89;P =0.03),and in-hospital stroke (OR: 2.29,95% CI: 1.04–5.04;P = 0.03) as potential predictors of poor survival.Conclusions In this study,similarly favorable survival outcomes were achieved in the elderly population as in younger patients,despite the presence of comorbid conditions.A consideration should be given to non-surgical management of severe aortic stenosis with the TAVI procedure in elderly patients,in the absence of co-existent conditions associated with shortened life expectancy.

Improvement in Radicular Symptoms but Continued Facet Arthropathy and Axial Back Pain Following Rupture of a Facet Joint Synovial Cyst

Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.

Concurrent Multi-Modality Treatment of Keloids (CMTK) Not Manageable by Conventional Postoperative Radiotherapy

Objective: To design and test a treatment regimen which is clinically responsive, readily available, cost effective, and applicable especially to children and women of child bearing age. Design Setting: A prospective cohort study. Setting: Two major postgraduate teaching hospitals: one in Tripoli, Libya and the other in Jeddah, Saudi Arabia. Participants: Fifty-seven patients with 79 keloids, referred from Plastic Surgery Units between April 1996 and January 2005. Main Outcome Measure: Degree of flattening of the keloidal lesion and symptomatic recovery. Results: Result of treatment has been analyzed using unified set criteria. Seventy-seven percent of this cohort had complete response. 19% of cases had partial response, 50% acknowledged the treatment outcome had been “satisfactory” and 44% had an “acceptable” outcome. There was no significant acute or delayed reaction. Conclusion: The technique appears universally adaptable, cost effective, and can safely be prescribed for children and women of child-bearing age. In spite of prolonged treatment course, compliance was excellent.

Retrospective study on the efficacy and safety of quinacrine sterilization

Aim: To observe the efficacy and safety of quinacrine sterilization.Methods: This retrospective study was to evaluate the efficacy and safetyof quinacrine sterilization in 572 cases in Jiangsu and Guizhou Provincesfrom 1993 to 1997. A total of 588 cases of surgical sterilization performed atthe same time served as the controls. Results: Two groups had similardemographic and gynecological characteristics. The multiple decrement lifetable analysis showed that the 12th month gross cumulative failure rate forquinacrine sterilization was 3.13% . Serious side effects occurred in 2 cases(0.35%); one is ectopic pregnancy (20 months after treatment) and theother, allergy reaction (10 minutes after the second insertion). The liverand renal functions were all normal in both groups. No cance cells/suspect-ed cancer cells were found. In the quinacrine group, the acceptability was99.6% . Conclusions: The quinacrine method has a high acceptability,but the efficacy is relatively low. It is a safe method of contraception inshort-term study, while the long-term safety warrants further investigation.

Non-Invasive management of invasive cervical resorption associated with periodontal pocket: A case report

BACKGROUND Invasive cervical resorption(ICR), a commonly misdiagnosed condition, is an aggressive form of external tooth resorption that contributes to periodontal tissue inflammation and deepening of the periodontal pockets. Herein we report the case of a patient, exhibiting ICR and elaborate the effects of a non-surgical approach in the amelioration of this condition.CASE SUMMARY A 21-year-old female reporting intermittent pain at the upper left side, multiple restorations, no trauma history, and having received orthodontic treatment was studied. Localized erythematous swelling was noted at the buccal interdental papilla between the left maxillary first molar and second premolar. The diseased pulp and tissue in resorption were removed and the root canal system including the defect were sealed using gutta percha/AH Plus and mineral trioxide aggregate(MTA). At the one-year recall, the tooth showed no symptoms and responded normally to percussion and palpation. The surrounding periodontium exhibited a normal color and the probing depth was normal. Radiographic examination showed a restoration of crestal alveolar bone and good adaption to MTA.CONCLUSION Non-surgical root canal treatment in conjunction with resorption defect orthograde repair with MTA was found to be an effective treatment option in the elimination of ICR. Early diagnoses are recommended in order to employ nonsurgical approaches for management of ICR instead of surgical interventions.

Comparison of semilunar coronally repositioned flap with gingival massaging using an Ayurvedic product(irimedadi taila) in the treatment of class-Ⅰ gingival recession: A clinical study

AIM: To study the comparison in terms of root coverage the effect of gingival massaging using an ayurvedic product and semilunar coronally repositioned flap(SCRF) to assess the treatment outcomes in the management of Miller's class Ⅰ gingival recessions over a-6mo period. METHODS: The present study comprised of total of 90 sites of Miller's class-Ⅰ gingival recessions in the maxillary anteriors, the sites were divided into three groups each comprising 30 sites, Group Ⅰ-were treated by massaging using a Placebo(Ghee) Group Ⅱ-were treated by massaging using an ayurvedic product(irimedadi taila). Group Ⅲ-were treated by SCRF. Clinical parameters assessed included recession height, recession width, probing pocket depth, width of attached gingiva, clinical attachment level and thickness of keratinized tissue. Clinical recordings were performed at baseline and 6 mo later. The results were analyzed to determine improvements in the clinical parameters. The comparison was done using Wilcoxon signed rank test. The overall differences in the clinical improvements between the three groups was done using Kruskal-Wallis test. The probability value(P-value) of less than 0.01 was considered as statistically significant.RESULTS: Non-surgical periodontal therapy and gingival massaging improves facial gingival recessions and prevents further progression of mucogingival defects. Root coverage was achieved in both the experimental groups. The SCRF group proved to be superior in terms of all the clinical parameters.CONCLUSION: Root coverage is significantly better with semilunar coronally repositioned flap compared with the gingival massaging technique in the treatment of shallow maxillary Miller class Ⅰ gingival recession defects.