An ankle dislocation without an accompanying fracture is extremely rare, and an open ankle dislocation is even rarer. Due to its rarity, there is no consensus on the optimal treatment strategy. A professional basketball player (a 28-year-old male) incurred an open ankle dislocation (with no accompanying fracture) during a basketball game due to plantar flexion and inversion of his ankle during the transition from dashing to stop motion. The same day, an emergency reduction under spinal anesthesia was performed with primary closure of the wound. Considering the complications of infection and decreased ankle range of motion (ROM), primary ligament repair was not performed. He was treated conservatively with cast immobilization for four weeks, and early weight-bearing and ROM exercises were initiated. At six weeks postoperatively, stress radiography did not reveal ankle instability. After three months of conservative treatment, the patient was able to play basketball at his previous performance level. Four weeks of cast immobilization without ligament repair plus early rehabilitation with weight-bearing and ROM exercises allowed for an early return without complications. Even in high-level athletes, open ankle dislocation without an accompanying fracture can be treated adequately with conservative therapy.

Introduction The preservation of tooth structure during cavity preparation is crucial for maintaining tooth strength and longevity of restorations. The biomechanical behavior of teeth, especially those with mesio-occlusal-distal (MOD) cavity preparations, is significantly affected by the extent of cavity preparation and the type of restorative treatment employed. The aim of the current study was to evaluate and analyze the stress distribution seen in the mandibular molar with MOD cavity when restored with transverse post, using finite element analysis (FEA). Materials and methodology FEA was utilized to evaluate stress distribution in an endodontically treated mandibular first molar with MOD cavity preparation, restored using a transverse post and composite restoration. Three-dimensional models incorporating the tooth and the surrounding structures, along with the transverse post and composite restoration, were constructed based on known biomechanical properties. After meshing the models, loads were defined on the buccal and lingual cusps with a constant value of 600N and at an angle of 45 degrees. Preprocessing involved model preparation followed by postprocessing to obtain results representing the degree and type of stress distribution. Results FEA simulations revealed the distribution of stress within the tooth structure under functional occlusal forces. The transverse post system effectively reinforced the tooth by deflecting incident forces and providing uniform stress distribution. von Mises stresses were analyzed to assess the likelihood of material failure. The distribution of the stress in the restored tooth model was comparable to that seen in the intact model. Conclusion Transverse post along with composite restoration provides a conservative and cost-effective alternative to full coverage crowns while providing a functional and aesthetic outcome. Further research and clinical studies are warranted to validate these findings and optimize the clinical application of transverse post systems in restorative dentistry.

UNASSIGNED: Spondylodiscitis (SD) is an inflammatory condition affecting the intervertebral discs and adjacent structures, often leading to serious complications, including epidural abscesses. This study aimed to differentiate postoperative SD from spontaneous cases caused by osteoporotic defects and associated pathologies, evaluating the frequency of SD in spinal diseases at a single center.
UNASSIGNED: A retrospective observational study involving 25 patients was conducted, analyzing variations between postoperative revisions in SD patients and spontaneous SD due to concurrent pathology and osteoporotic defects. The effects of postoperative wound healing following transforaminal lumbar interbody fusion and decompressive hemilaminectomy with pedicle screws were also investigated. Ethical guidelines were strictly followed during the study, conducted from January 2023 to September 2023 at Moscow City Clinical Hospital No. 68, Demikhova V.P.
UNASSIGNED: Among the 25 patients with spontaneous SD, 15 females and 10 males were included, with only two undergoing surgical revision. Predominant purulent inflammatory foci were observed at specific spinal levels, and demographics revealed prevalent comorbidities such as arterial hypertension (80%) and type 2 diabetes mellitus (60%). Postoperative complications included paravertebral abscesses and wound-related issues. Structural observations indicated vertebral destruction, joint gaps, and localized spinal canal narrowing, revealing complexities in SD cases.
UNASSIGNED: Surgical intervention remains crucial for addressing SD-related vertebral complications, while antimicrobial therapy tailored to specific pathogens is pivotal. Concurrent conditions necessitate comprehensive management, often involving cardiological interventions. Postoperatively, a combined approach of conservative therapy and calcium phosphate adjuncts is recommended, especially considering the observed low bone density, aiming to optimize patient recovery and spinal stability.

BACKGROUND: Patients with giant intracranial aneurysms (GIAs) are at a high risk of rupture, morbidity, and mortality even after surgical or endovascular treatment. We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA, continuously progressed aneurysmal thrombosis, complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery (RICA).
METHODS: A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital. She had been diagnosed with a GIA [30 mm (axial) × 38 mm (coronal) × 28 mm (sagittal)] containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging (MRI), enhanced MRI, and magnetic resonance angiography more than 14 years ago. Later, with slow growth of the cavernous carotid GIA, aneurysmal thrombosis progressed continuously, spontaneous occlusion of the RICA, complete aneurysmal calcification, and occlusion of the GIA occurred gradually. She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage. As a result, she was left with severe permanent sequelae from the injuries to the right cranial nerves II, III, IV, V1/V2, and VI.
CONCLUSIONS: The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery (ICA) induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification. However, nowadays, it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA, mainly caused by the mass effect of the cavernous carotid GIAs.

Low back pain is one of the most common ailments encountered by physicians and orthopedic surgeons. There are various modalities used to treat low back pain, including conservative management, and a few of them involve rest, medications, massage, bracing, acupuncture, and physical therapy. Though most of the patients improve with conservative management, the burden of this disease has been very high and caused a significant amount of economic loss. Therefore, in-depth knowledge of all conservative methods is essential for physicians managing low back pain. Furthermore, there can be many causes of low back pain. Some of the more common ones are mechanical back pain due to paraspinal muscles or facetal in origin, discogenic back pain, and sacroiliac joint dysfunction. Many patients, especially the older population, have the discogenic origin as the more common cause of back pain, and traction therapy has been used for its treatment for ages. In this review, we discuss non-surgical spinal decompression/traction therapy popularly known as interferential differential dynamics (IDD) therapy with its current standing and recent advancement.

BACKGROUND: Chylous ascites is a rare but morbid condition following removal of residual mass in non-seminomatous germ cell tumours following chemotherapy.
METHODS: We hereby present the case of a 20-year-old man who had undergone RPLND with complete surgical excision. A lesion of the Cisterna chyli complicated the operation. The post-operative course was marked by the appearance of chylous ascites. The conservative management strategy for this complication was successful, but only after a month.
UNASSIGNED: Chylous ascites is a rare but morbid condition following removal of residual mass in non-seminomatous germ cell tumours following chemotherapy. Conservative management based on a high-protein diet with fat restriction and medium-chain triglyceride supplementation, and somatostatine are usually successful. Surgery should be reserved for situations that are refractory to treatment.
CONCLUSIONS: We report our successful management and, we also analysed the different management protocols using our experience and review of the literature.

The atlas (C1) and occipital bone at the base of the skull fuse together in atlas occipitalization, an uncommon congenital abnormality. Because it can result in cervical spine instability, nerve impingement, and related symptoms including stiffness, pain, and neurological impairments, it poses a challenging therapeutic problem. We describe the case of a female patient, 27 years old, who had gradually deteriorating neck discomfort, stiffness, and limited cervical mobility for six years prior to presentation. Her symptoms worsened over time despite conservative treatment, so more testing was necessary. Atlas occipitalization, congenital fusion at the C7 and D1 vertebrae, and other related cervical spine pathologies were identified by imaging examinations. The intricacies of atlas occipitalization and related cervical spine pathologies are highlighted in this case study, along with the diagnostic difficulties and interdisciplinary therapeutic strategy needed to address them. To improve cervical range of motion (ROM), lessen discomfort, and improve functional results, the patient underwent a thorough musculoskeletal examination and was given a customized physiotherapeutic intervention.

BACKGROUND: Infective endocarditis represents a life-threatening disease with high mortality rates. A fraction of patients receives exclusively conservative antibiotic treatment due to their comorbidities and high operative risk, despite fulfilling criteria for surgical therapy. The aim of the present study is to compare outcomes in patients with infective endocarditis and indication for surgical therapy in those who underwent or did not undergo valve surgery.
RESULTS: Three databases were systematically assessed. A pooled analysis of Kaplan-Meier-derived reconstructed time-to-event data from studies with longer follow-up comparing conservative and surgical treatment was performed. A landmark analysis to further elucidate the effect of surgical intervention on mortality was carried out. Four studies with 3003 patients and median follow-up time of 7.6 months were included. Overall, patients with an indication for surgery who were surgically treated had a significantly lower risk of mortality compared with patients who received conservative treatment (hazard ratio [HR], 0.27 [95% CI, 0.24-0.31], P<0.001). The survival analysis in the first year showed superior survival for patients who underwent surgery when compared with those who did not at 1 month (87.6% versus 57.6%; HR, 0.31 [95% CI, 0.26-0.37], P<0.01), at 6 months (74.7% versus 34.6%) and at 12 months (73.3% versus 32.7%).
CONCLUSIONS: Based on the findings of this study-level meta-analysis, patients with infective endocarditis and formal indication for surgical intervention who underwent surgery are associated with a lower risk of short- and long-term mortality when compared with conservative treatment.

UNASSIGNED: To formulate the most current, evidence-based recommendations for the conservative management of lumbar disc herniations (LDH).
UNASSIGNED: A systematic literatüre search was performed 2012-2022 in PubMed/Medline and Cochrane using the keywords \'\'lumbar disc herniation\'\' and \'\'conservative treatment,\'\' yielding 342 total manuscripts. Screening criteria resulted in 12 final manuscripts which were summarized and presented at two international consensus meetings of the World Federation of Neurosurgical Societies (WFNS) Spine Committee. The Delphi method was utilized to arrive at three final consensus statements.
UNASSIGNED: s: In the absence of cauda equina syndrome, motor, or other serious neurologic deficits, conservative treatment should be the first line of treatment for LDH. NSAIDs may significantly improve acute low back and sciatic pain caused by LDH. A combination of activity modification, pharmacotherapy, and physical therapy provides good outcomes in most LDH patients.

BACKGROUND: Our objective was to conduct a systematic review and meta-analysis of studies evaluating the oncological and reproductive outcomes of patients with endometrial atypical hyperplasia (AH) and endometrioid endometrial cancer (EEC) undergoing conservative therapy with hysteroscopic resection (HR).
METHODS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for systematic reviews and meta-analyses. The study strictly followed the methodological framework proposed by the Cochrane Handbook and was retrospectively registered in PROSPERO (CRD42023469986). Searches were conducted in PubMed, Embase, and the Cochrane Library, from inception to October 10, 2023. A checklist based on items of the Newcastle-Ottawa Scale and the Methodological Index for Non-randomized Studies was used for quality assessment. The primary end points for this meta-analysis were complete response (CR), pregnancy, and live birth rates following HR-based therapy in patients with EEC or AH. The secondary end point was the recurrence rate (RR).
RESULTS: Twenty-one articles involving 407 patients with clinical stage IA, low or intermediate grade, EEC, and 444 patients with AH managed with HR-based conservative treatment were included for this systematic review. CR to HR-based conservative therapy was achieved in 88.6% of patients with EEC and 97.0% of patients with AH. Of these, 30.6% and 24.2%, respectively, had live births. The overall pooled disease RR was 18.3% and 10.8% in patients with EEC and AH, respectively. Further subset analyses revealed that EEC patients with body mass index (BMI) ≤28 kg/m2 had higher CR rates as well as higher chances of pregnancy and live birth (91.6% CR, 32.9% pregnancy, 31.1% live birth) compared with patients with BMI >28 kg/m2 (86.4% CR, 28.4% pregnancy, 23.0% live birth). The HR followed by oral progestogen subgroup had higher CR rates and higher chances of pregnancy and live birth (91.8% CR, 36.3% pregnancy, 28.2% live birth) than the HR followed by the levonorgestrel intrauterine system subgroup (82.5% CR, 25.3% pregnancy, 16.3% live birth).
CONCLUSIONS: Hysteroscopic resection followed by progestins appears to be a promising choice for fertility-sparing treatment in young patients with AH and EEC, with effective and safe responses. The live birth rate remains to be improved by providing medical guidance and encouragement.