138 research outputs found
Interstitiaalisen virtsarakkotulehduksen eli virtsarakon kipuoireyhtymÀn hoito
KansainvĂ€linen urologityöryhmĂ€ on ehdottanut, ettĂ€ termi virtsarakon kipuoireyhtymĂ€ korvaisi aiemman interstitiaalinen kystiitti -termin laajan merkityksen. Interstitiaalinen kystiitti tarkoittaisi tĂ€llöin yhtĂ€ ÂkipuoireyhtymĂ€n alatyyppiĂ€, jossa on histologisesti varmennettu inflammaatio. Virtsarakon kipuoireyhtymĂ€n diagnoosi perustuu kliiniseen oirekuvaan ja muiden samantapaisia oireita Âaiheuttavien tunnettujen sairauksien poissulkemiseen. Koska sairauden etiologiaa ei tunnetta, kaikki virtsarakon kipuoireyhtymĂ€n hoitomenetelmĂ€tkin ovat ÂkokemusperĂ€isiĂ€. Virtsarakon kipuoireyhtymĂ€ on krooninen kiputila, jonka ei oleteta paranevan. OirelÀÀkkeistĂ€ ja kokeilevista hoidoista on kuitenkin hyötyĂ€.Peer reviewe
The comprehensive cohort model in a pilot trial in orthopaedic trauma
Background: The primary aim of this study was to provide an estimate of effect size for the functional outcome of
operative versus non-operative treatment for patients with an acute rupture of the Achilles tendon using
accelerated rehabilitation for both groups of patients. The secondary aim was to assess the use of a
comprehensive cohort research design (i.e. a parallel patient-preference group alongside a randomised group) in
improving the accuracy of this estimate within an orthopaedic trauma setting.
Methods: Pragmatic randomised controlled trial and comprehensive cohort study within a level 1 trauma centre.
Twenty randomised participants (10 operative and 10 non-operative) and 29 preference participants (3 operative
and 26 non-operative). The ge range was 22-72 years and 37 of the 52 patients were men. All participants had an
acute rupture of their Achilles tendon and no other injuries. All of the patients in the operative group had a simple
end-to-end repair of the tendon with no augmentation. Both groups then followed the same eight-week
immediate weight-bearing rehabilitation programme using an off-the-shelf orthotic. The disability rating index (DRI;
primary outcome), EQ-5D, Achilles Total Rupture Score and complications were assessed ed at two weeks, six
weeks, three months, six months and nine months after initial injury.
Results: At nine months, there was no significant difference in DRI between patients randomised to operative or
non-operative management. There was no difference in DRI between the randomised group and the parallel
patient preference group. The use of a comprehensive cohort of patients did not provide useful additional
information as to the treatment effect size because the majority of patients chose non-operative management.
Conclusions: Recruitment to clinical trials that compare operative and non-operative interventions is notoriously
difficult; especially within the trauma setting. Including a parallel patient preference group to create a
comprehensive cohort of patients has been suggested as a way of increasing the power of such trials. In our
study, the comprehensive cohort model doubled the number of patients involved in the study. However, a strong
preference for non-operative treatment meant that the increased number of patients did not significantly increase
the ability of the trial to detect a difference between the two interventions
Acute Achilles tendon rupture: minimally invasive surgery versus non operative treatment, with immediate full weight bearing. Design of a randomized controlled trial
<p>Abstract</p> <p>Background</p> <p>We present the design of an open randomized multi-centre study on surgical versus conservative treatment of acute Achilles tendon ruptures. The study is designed to evaluate the effectiveness of conservative treatment in reducing complications when treating acute Achilles tendon rupture.</p> <p>Methods/Design</p> <p>At least 72 patients with acute Achilles tendon rupture will be randomized to minimally invasive surgical repair followed by functional rehabilitation using tape bandage or conservative treatment followed by functional rehabilitation with use of a functional bracing system. Both treatment arms use a 7 weeks post-rupture rehabilitation protocol. Four hospitals in the Netherlands will participate. Primary end-point will be reduction in complications other than re-rupture. Secondary end-point will be re-rupturing, time off work, sporting activity post rupture, functional outcome by Leppilahti score and patient satisfaction. Patient follow-up will be 12 month.</p> <p>Discussion</p> <p>By making this design study we wish to contribute to more profound research on AT rupture treatment and prevent publication bias for this open-labelled randomized trial.</p> <p>Trial registration</p> <p>ISRCTN50141196</p
Percutaneous & Mini Invasive Achilles tendon repair
Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Recent studies have shown little difference in outcome between the techniques of open and non-operative treatment using an early active rehabilitation programme. Meta-analyses have shown that non-operative management has increased risk of re-rupture whereas surgical intervention has risks of complications related to the wound and iatrogenic nerve injury. Minimally invasive surgery has been adopted as a way of reducing infections rates and wound breakdown however avoiding iatrogenic nerve injury must be considered. We discuss the techniques and outcomes of percutaneous and minimally invasive repairs of the Achilles tendon
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