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Summary

Background/Aim: The management of horizontal root fracture is not straight forward. It depends upon the location of the fracture, mobility and vitality of fractured tooth segment. The goal of treatment is to restore the shape and function of affected tooth.

Case report: This following case report described the conservative management of horizontal root fracture which was also displaced but somehow maintained its vitality. The affected tooth was initially stabilized and followed up in the subsequent appointments for evaluation of vitality that turned out to be vital, thus, preventing any unnecessary intervention.

Conclusions: Horizontal root fractures in the vital teeth should be initially managed conservatively and every effort should be made to preserve the vitality of tooth.

;30:3-23. 46. Lerman MA, Xie W, Treister NS, Richardson PG, Weller EA, Woo SB. Conservative management of bisphosphonate-related osteonecrosis of the jaws: staging and treatment outcomes. Oral Oncol . 2013;49:977-983. 47. Melea PI, Melakopoulos I, Kastritis E, Tesseromatis C, Margaritis V, Dimopoulos MA. Conservative treatment of bisphosphonate-related osteonecrosis of the jaw in multiple myeloma patients. Int J Dent . 2014;2014:427273. 48. Vescovi P, Merigo E, Meleti M, Manfredi M, Fornaini C, Nammour S. Conservative surgical management of stage I bisphosphonate

References 1. Anderson B, Kaye S. Treatment of flexor tenosynovitis of the hand (“trigger finger”) with corticosteroids. A prospective study of the response to local injection. Arch Intern Med 1991;151:153-6. 2. Nimigan AS, Ross DC, Gan BS. Steroid injections in the management of trigger fingers. Am J Phys Med Rehabil 2006;85:36-43. 3. Quinnell RC. Conservative management of trigger finger. Practitioner 1980;224:187-90. 4. Saldana NJ. Trigger digits: Diagnosis and treatment. J Am Acad Orthop Surg 2001;9:246-52. 5. Bonnici AV, Spencer JD. A survey of ‘trigger

Abstract

Introduction. Vesicoureteral reflux (VUR) is the most common pediatric urologic abnormality and since it can predispose to urinary tract infection and resultant kidney scar it is an important issue in pediatric nephrourology. Methods. A retrospective chart review and follow-up of 958 patients with primary VUR was performed in the Children’s Medical Center, Tehran, Iran. Children with primary vesicoureteral reflux were included in the study and these parameters were studied: age, sex, clinical presentation, VUR grade, sonographic findings, DMSA changes, treatment modality (medical, surgical or endoscopic) and response to treatment, hypertension (presence/absence), urinary tract infection recurrence and development of new kidney scars in patients under medical treatment. Results. VUR was more prevalent in girls. Sonography was unable to detect VUR in many cases. Presence of renal scars was strongly associated with degree of reflux. Medical management was effective in a substantial percentage of patients and they experienced full resolution of reflux. This was especially true for lower degrees of VUR. 17.6% of patients developed new kidney scars on followup which was associated with higher degrees of VUR. Hypertension and breakthrough urinary tract infection was an uncommon finding in our patients. Conclusion. Medical management, which means using prophylactic antibiotics for prevention of urinary tract infection, is effective in many cases of VUR especially in cases with lower degrees of VUR. Surgical and endoscopic procedures must be reserved for patients with higher degrees of VUR unresponsive to conservative management or in whom new scars may develop.

Abstract

The incidence of chronic kidney disease (CKD) in patients with chronic heart failure (CHF) is high as CKD and CHF share underlying risk factors such as arterial hypertension, diabetes mellitus and atherosclerosis. Cardiac failure leads to renal hypoperfusion and dysfunction and then fluid overload and need for aggressive diuretic therapy. However, development of diuretic resistance represents a significant problem in the management of these patients.

The role of Renal Replacement Therapy (RRT) is important for patients who do not response to conservative management of fluid overload facilitating the failing heart to restore function. According to the guidelines, venovenous isolated Ultrafiltration (UF) is indicated for patients with refractory congestion not responding to medical therapy with loop diuretics and infusion of dopamine. A systematic review of randomized controlled trials on the effect of UF vs. IV furosemide for decompensated heart failure showed a benefit of UF on total body weight loss and on readmissions due to heart failure in patients with decompensated heart failure and CKD. Peritoneal dialysis (PD) can provide efficient ultrafiltration and sodium extraction in volume overloaded patients followed by decline of hospitalization days, decrease of body weight and improvement of LVEF in patients with refractory heart failure. The continuous draw of ultrafiltrate is followed by a lesser risk of abrupt hypotension and better preservation of the residual kidney function. This represents a significant advantage of PD over intermittent UF by dialysis.

In conclusion, application of UF by dialysis and PD is followed by significant total body weight loss, reduced need for hospital readmissions and better quality of life. PD has a higher probability of preservation of residual kidney function and can be used by patients at home.

, P., Toporcer, T., Vidinský, B., Hudák, R., Živčák, J., Sabo, J. (2009), Simple interrupted percutaneous suture versus intradermal running suture for wound tensile strength measurement in rats: A technical note , European Surgical Research., Vol. 43, No. 1, 61-65. 5. Hermus J., Hulsbosch M., Guldemond N., Rhijn L. V. (2009), Developing a new brace with pressure measurements, 6th International Conference on Conservative Management of Spinal Deformities, Lyon, France, 1-1. 6. Hermus J., Monteban P., Guldemond N., Rhijn L. V. (2008), Pressure measurements in a new

. Placental polyp: Power Doppler imaging and conservative resection. Ultrasound Obstet Gynecol. 1998;11:225-6. 10. Takeuchi K, Ichimura H, Masuda Y, Yamada T, Nakago S, Maruo T. Selective transarterial embolization and hysteroscopic removal of a placental polyp with preservation of reproductive capacity. J Reprod Med. 2002;47:608-10. 11. Yamamasu S, Nakai Y, Nishio J, Hyun Y, Honda KI, Hirai K, Ishiko O, Ogita S. Conservative management of placental polyp with oral administration of methotrexate. Oncol Rep. 2001;8:1031-3.

Malformations, Springer Verlag Italia 2009, 65-77. 15. Pandey A, Gangopadhyay AN, Sharma SP, Kumar V, Gopal SC, Gupta DK. - Conservative management of ulcerated haemangioma - twenty years experience. Int Wound J 2009; 6:59-62. 16. Poetke M, Philipp C, Berlien HP. Flashlamp pumped pulsed dye laser for hemangiomas in infancy. Arch Dermatol 2000;136:628-632. 17. Mulliken JB, Rogers GF, Marler JJ. Circular excision of hemangioma and purse-string closure: the smallest possible scar. Plast Reconstr Surg 2002;109:1544-1554.

of postoperative smoking on femoropopliteal bypass grafts. Ann Vasc Surg, 1989;3:20-25. 8. Radack K, Wyderski RJ. Conservative management of intermittent claudication. Ann Intern Med, 1990;113:135-146. 9. Lepantalo M, Lassila R. Smoking and occlusive peripheral arterial disease: clinical review. Eur J Surg, 1991;157:83-87. 10. Ingolfsson IO, Sigurdsson G, Sigvaldason H, Thorgeirsson G, Sigfusson N. A marked decline in the prevalence and incidence of intermittent claudication in Icelandic men 1968-1986: a strong relationship to smoking and serum cholesterol

References 1. Martineau, P., Shwed, J.A. & Denis, R. (1996). Is Octerotide a new hope for enterocutaneous and external pancreatic fistula closure? Am J Surg . 72, 386-395 2. Fischer, J.E. (1983). The pathophysiology of enterocutaneous fistulas. World J Surg . 7, 446-450 3. Sachdev, A., Agarwal, A. & Chowdhary, A. (1994). Management of enterocutaneous fistula . In: Chattopadhyay TK, editor. GISurgery Annual, 1, 65-84 4. Rubelowsky, J. & Machiedo, G.W. (1991). Reoperative versus conservative management for gastrointestinal fistulas. Surg Clin North Am. 71