INTRODUCTION: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous disorder causing a mutation in the tumor suppressor genes, TSC1 or TSC2. Loss of function of these genes leads to dysfunction of hamartin and tuberin, resulting in hamartoma formation. It usually manifests with cutaneous manifestations at childhood. However, it also affects other organ systems. Based on the Philippine Dermatological Society Health Information System census, there have been 104 cases of TSC from 2011-2018. Currently, limited data is available regarding the treatment options in the local setting.

CASE REPORT: The case involves a 4 year-old boy, with a two year history of flesh-colored to dusky red fi rm papules on the centrofacial areas and neck. Lesions have been increasing in number since first appearance. He had a normal birth history. Family history was insignificant. However, delay in expressive speech development was noted. Physical examination revealed multiple well-defined angiofibromas on centrofacial areas and neck; fibrous cephalic plaque on the left temporal area, and several ash-leaf spots on the trunk. Periungual and subungual fibromas, confetti macules, shagreen patch and dental pits were absent. Based on the clinical manifestations, he was diagnosed with TSC. Histopathology of a papule on the chin was consistent with angiofibroma. Parents were concerned with the appearance of the lesions and preferred conservative management. Hence, topical sirolimus 0.2% ointment was applied once daily on the angiofibromas for 4 months. Monthly follow-up showed marked improvement, manifested by the decrease in number and by flattening of the lesions.

CONCLUSION: To the best of our knowledge, this is the fi rst case report of successful treatment of topical sirolimus for TSC in the Philippines.

KEYWORDS: tuberous sclerosis complex, topical, treatment success, conservative management, hematoma

Tuberous Sclerosis ; Conservative Treatment ; Hematoma

OBJECTIVE: To systematically evaluate the safety and efficacy of laparoscopic surgery versus conservative treatment for appendiceal abscess. METHODS: The databases of CNKI, Wangfang, VIP, PubMed, EMBASE and Cochrane Library were searched to retrieve randomized controlled trials (RCT) or clinical controlled trials (CCT) comparing laparoscopic surgery with conservative treatment for appendiceal abscess published before June 2018. The search terms were Chinese or English. Chinese search terms included appendix, abscess, and laparoscopy; English search terms included appendix, abscess, and laparoscope. References of the resulted papers, related reviews or meta-analysis references were also induded. Literature inclusion criteria: (1)RCT or CCT, whether or not to assign concealment or blinding; (2) appendiceal abscess was diagnosed at admission; (3) laparoscopic group: laparoscopic appendectomy or laparoscopy surgical methods, such as irrigation and drainage, for appendiceal abscess; conservative treatment group: conservative methods, such as antibiotics or percutaneous abscess drainage were used to treat appendiceal abscess. EXCLUSION CRITERIA: (1) review, case report, single cohort study and other non-controlled studies literature; (2) single study sample size ≤ 20; (3) subjects with simple appendicitis or perforation of appendix to form diffuse peritonitis; (4) no valid data available for extraction; (5) repeated publication of the literature. Data were extracted from the included studies, and the Cochrane Collaboration RevMan 5.1.0 version software was used for this meta-analysis. RESULTS: Three RCTs and four CCTs with a total of 591 patients were included in this study. There were 312 patients in the laparoscopic group and 279 patients in the conservative group. Compared with the conservative group, the laparoscopic group had higher uneventful recovery rate (OR=11.91, 95%CI: 4.59 to 30.88, P<0.05), shorter hospital stay (WMD=-2.98, 95%CI: -5.96 to -0.01, P=0.05), lower incidence of recurrent or residual abscess (OR=0.07, 95%CI:0.03 to 0.20, P<0.05), and shorter time to recover to normal condition for body temperature and white blood cell respectively (SMD=-2.12, 95%CI:-2.49 to -1.75, P<0.05; SMD=-2.07, 95%CI: -3.84 to -0.29, P<0.05). However, no significant difference was found in hospital charge(P>0.05). CONCLUSIONS Laparoscopic surgery for appendiceal abscess is safe and feasible. It can improve the recovery with shorter postoperative hospital stay and less recurrent or residual abscess.
Abdominal Abscess ; surgery ; therapy ; Appendix ; surgery ; Cohort Studies ; Conservative Treatment ; Humans ; Laparoscopy ; Length of Stay ; Treatment Outcome

Objective: To compare the efficacy between percutaneous coronary intervention (PCI) and conservative medication treatment in chronic total occlusions (CTO) patients. Methods: It was a meta-analysis.Articles on drug therapy and PCI for complete coronary artery occlusion were retrieved from Pubmed, Embase and Web of Science databases. The search time was from the database construction to May 10, 2020, and the following search criteria were used for the search "chronic total occlusion" "percutaneous coronary intervention" and "medical therapy". References from searched literatures were also searched to identify more eligible studies. Randomized controlled trials (RCT) and cohort studies comparing efficacy of PCI versus oral medication as well as medication as initial therapy option for CTO patients with single or multiple lesions were included. The primary endpoints included all-cause death, cardiac death, recurrent myocardial infarction, re-revascularization, major adverse cardiac events (MACE) and stroke. Data were analyzed with ReviewManager5.3.0 software. Pooled effect size RR and 95%CI were calculated by randomization effect model. Heterogeneity was evaluated by I². Bege test was used to evaluate publication bias. Subgroup analyses were performed for RCT and cohort studies. Results: A total of 1 079 articles were retrieved and 16 studies (RCT=4, cohort study=12) were included with 12 223 patients. Fourteen publications (RCT=4, cohort study=10) reported all-cause death post PCI and/or drug therapy. Results showed that risk of all-cause death was significantly lower in PCI group than in drug therapy group (RR=0.45,95%CI 0.39-0.53,P<0.001);subgroup analysis showed that risk of all-cause death was significantly lower in PCI group than in drug therapy group from cohort studies (RR=0.44,95%CI 0.38-0.52,P<0.001),but comparable in RCT (P=0.27). Thirteen studies (RCT=3, cohort study=10) reported cardiac death post PCI and/or drug therapy. Results showed that risk of cardiac death was significantly lower in PCI group than in drug therapy group (RR=0.44,95%CI 0.35-0.55,P<0.001);subgroup analysis showed that risk of cardiac death was significantly lower in PCI group than in drug therapy group in cohort studies (RR=0.43,95%CI 0.34-0.54,P<0.001),but not in RCT (P=0.25). Fourteen publications (RCT=4, cohort study=10) reported recurrent myocardial infarction post PCI and/or drug therapy. Results showed that risk of recurrent myocardial infarction was significantly lower in PCI group than in drug therapy group (RR=0.62,95%CI 0.44-0.88,P=0.007);subgroup analysis showed that risk of recurrent myocardial infarction was significantly lower in PCI group than in drug therapy group from cohort studies (RR=0.56,95%CI 0.40-0.78,P=0.000 5),but comparable in RCT (P=0.17). Fourteen publications (RCT=4, cohort study=10) reported re-revascularization post PCI and/or drug therapy. Results showed that risk of re-revascularization was comparable between PCI group and drug therapy group (P=0.91);subgroup analysis showed that risk of re-revascularization was comparable between PCI group and drug therapy group both in cohort study and RCT (P=0.60 and 0.41, respectively). Eleven publications (RCT=3, cohort study=8) reported MACE post PCI and/or drug therapy. Results showed that risk of MACE was significantly lower in PCI group than in drug therapy group (RR=0.74,95%CI 0.59-0.93,P=0.03);subgroup analysis showed that risk of MACE was significantly lower in PCI group than in drug therapy group in cohort studies (RR=0.72,95%CI 0.56-0.93,P=0.01), but not in RCT (P=0.8). Six publications (RCT=2, cohort study=4) reported stroke post PCI and/or drug therapy. Results showed that risk of stroke was comparable between PCI and drug therapy groups (RR=0.62,95%CI 0.32-1.20, P=0.15);subgroup analysis showed that risk of stroke was comparable between PCI and drug therapy groups both in cohort studies and RCT (P=0.48 and 0.32, respectively). Conclusion: Compared with oral drug therapy, PCI may have better efficacy for CTO patients based on results from this cohort study.
Conservative Treatment/adverse effects* ; Death ; Humans ; Myocardial Infarction/complications* ; Percutaneous Coronary Intervention/methods* ; Stroke ; Treatment Outcome

Low malignant potential serous tumors are the most common subtypes of non-benign serous tumors in the young, usually confined to one or both ovaries. To preserve ovarian function and fertility conservative management can be performed. Although recurrence is higher than that after a completion surgery, the rate of recurrences continues to be debated. Most recurrent diseases are of the same histopathology as the initial tumor and adequate excision of the recurrent tumor can be done.

A 31-year old, primigravid underwent bilateral oophorocystectomy for serous borderline ovarian tumor stage IB. After 3 years she had tumor recurrence and another fertility-sparing surgery consisting of left salpingooophorectomy and contralateral cystectomy was done. Histopathology was a recurrent borderline ovarian tumor. Two years later, she had a spontaneous pregnancy and delivered to a live term baby. This is a reported case of a successful pregnancy after two fertility-sparing surgeries for borderline ovarian tumor.

Human ; Female ; Adult ; Pregnancy ; Cystectomy ; Conservative Treatment ; Ovarian Neoplasms ; Fertility ; Ovariectomy ; Neoplasms, Glandular And Epithelial

This study presents a series of patients with Hirschsprung's disease (HD) who underwent a one-stage endorectal pull-through procedure using a purely transanal approach. A total of11 patients, 7(64%) males and 4(36'10) females, with a mean age of 2.37 years underwent the procedure over an IS-month period. Mean operating time was 108 minutes. The average length of bowel resected was 17.32 ern, which correlated well with the barium enema transition zone. No patient required conversion to open procedure. The mean total hospital stay was 5 days. Postoperatively, two patients developed enterocolitis that responded to conservative management.Follow up ranged from 4 to 14 months. No deaths occurred in this series. This procedure can be performed successfully in patients with short segment HD. This technique is associated with good clinical results and no visible scars.

Human ; Male ; Female ; Barium Enema ; Conservative Treatment ; Cicatrix ; Hirschsprung Disease ; Enterocolitis ; Digestive System Surgical Procedures ; Rectum

Thoracic outlet syndrome(TOS) are constellation of symptoms caused by compression of the neurovascular bundle including the brachial plexus, the subclavian artery and the subclavian vein at the thoracic outlet region. It includes neurogenic TOS, venus TOS, arterial TOS, and neurogenic TOS is the most common type. TOS has varied manifestations and lack of confirmatory testing, therefore, the diagnosis should be conbination with thorough history, physical examination and associated supplementary examinations. Conservative and surgical treatment can be choosed for TOS and the outcomes are generally good. Conservative management is the initial treatment strategy for neurogenic TOS. In cases of symptomatic vascular TOS and neurovascular TOS, which has been failed by conservative treatment, surgery should be considered more promptly.
Brachial Plexus ; Conservative Treatment ; Humans ; Physical Examination ; Thoracic Outlet Syndrome ; diagnosis ; therapy

Objective: To investigate the diagnosis and treatment of Chiari malformation patients with hoarseness and other otorhinolaryngological symptoms. Methods: The clinical data of 18 patients of Chiari malformation with hoarseness were retrospectively collected, which was composed of 5 men and 13 women, aged 3-71 with median age of 52. All the patients were admitted to the Affiliated Hospital of Qingdao University from January 1989 to January 2020. All patients underwent brain MRI and laryngoscopy. The patient's symptoms and first diagnosis department, diagnosis time, total course of disease, hoarseness course, diagnosis and treatment, and postoperative recovery time were summarized. Follow-up time was 3-16 years, with median follow-up time of 6.5 years. Descriptive methods were used for analysis. Results: The first visit departments of 18 patients included neurology (9 cases), otorhinolaryngology head and neck surgery (5 cases), pediatrics (2 cases), orthopedics (1 case) and respiratory department (1 case). Except for the 7 cases in neurology department, the other 11 patients were not diagnosed in time. The disease duration of 18 patients with Chiari malformation ranged from 2 months to 5 years, and hoarseness was present from 20 days to 5 years. After diagnosis, 9 patients underwent posterior fossa decompression surgery, and 1 of them underwent syrinx drainage at the same time. The symptoms of 8 cases improved significantly after operation, with the improvement time from 1 to 30 days. In addition, 9 patients chose conservative treatment, among whom 8 had no improvement in symptoms and 6 progressed. Conclusions: Posterior fossa decompression is an effective treatment for Chiari malformation, and the prognosis is good. Timely diagnosis and treatment can improve the prognosis of patients.
Male ; Humans ; Female ; Child ; Hoarseness/etiology* ; Retrospective Studies ; Conservative Treatment ; Drainage ; Laryngoscopy

Conservative Treatment ; Dens in Dente/therapy* ; Humans ; Incisor ; Periapical Periodontitis/therapy* ; Root Canal Filling Materials

Premature ejaculation (PE) is a most common type of ejaculatory dysfunction, which has significant adverse effects on the life quality of the patients and their partners. Medication is currently the first choice for PE and psycho-behavior therapy is sometimes used as an adjuvant means. It is reported in a number of studies that medication alone or combined with psycho-behavior therapy has a great short-term efficacy and a very low risk of side effects. Conservative therapies for PE, however, have some obvious disadvantages such as easy recurrence after drug withdrawal, ineffectiveness in some cases, and so on. Thus, clinicians in China and abroad have developed and tried various surgical methods for the treatment of PE, most of which are reportedly safe and effective. However, International Society for Sexual Medicine guidelines for the diagnosis and treatment of PE recommended against surgical methods because of possible permanent loss of sexual function and insufficient reliable data, though without support from evidence or relevant literature. Although controversial, surgical treatment remains an effective and feasible strategy for refractory PE that does not respond to any conservative therapies. This review summarizes a variety of surgical techniques for PE, along with their basic principles, indications, effects and safety.
Behavior Therapy ; China ; Conservative Treatment ; Ejaculation ; Humans ; Male ; Premature Ejaculation ; drug therapy ; surgery ; Quality of Life ; Recurrence ; Sexual Partners

Prostate cancer (PCa) is the primary malignancy threatening men's health in the United States and its incidence is increasing in China year by year. Many PCa cases are found in the advanced stage or in the old age, treated with unstandardized options, with negligence of comprehensive assessment of the patient's physical status, which may frequently add to the physical, psychological and economic burdens of the patient and even result in death. On the other hand, some excessively conservative therapeutic options may cause the loss of the best time of management or lead to deterioration of the disease. Therefore, sufficient importance should be attached to the comprehensive assessment of the physical status of the elderly PCa patient before treatment and the choice of the best therapeutic protocol.
Aged ; China ; epidemiology ; Conservative Treatment ; Humans ; Incidence ; Male ; Physical Fitness ; Prostatic Neoplasms ; epidemiology ; pathology ; therapy ; United States ; epidemiology