level 3 studies, which meet none of the evidence criteria for that study type or are derived from expert opinion, commentary, or consensus. Study types and criteria are defined at http://smartmedicine.acponline.org/criteria.html Disclaimer: The information included herein should never be used as a substitute for clinical judgement and does not represent an official position of the American Coll...

Operative management of unstable burst vertebral fractures is challenging and debatable. This study of such cases was conducted at the Aga Khan Hospital, Karachi from January 1998 to April 2003. All surgically managed spine injuries were reviewed from case notes and operative records. Clinical outcome was assessed by Hanover spine score and correction of kyphosis was measured for radiological a...

HYPOTHESIS Chronic pancreatitis in childhood is a rare but potentially debilitating disorder, and failure of conservative therapy with chronic pain medication use is common. We hypothesize that aggressive surgical therapy may hold promise for long-term remission. DESIGN Retrospective analysis of data collected prospectively for 12 years. SETTING Tertiary care children's hospital. PATIENTS...

The risk of overwhelming postsplenectomy infection (OPSI) prompted the evolution toward preservation of the injured spleen. Nonoperative management (NOM) of blunt injury to the spleen in adults has become the standard of care in hemodynamically stable patients. This modality of treatment began in the 1970's in paediatric patients. It is highly successful with overall failures rates from 2% to 3...

Operative fixation of distal radius fractures is one of the most commonly performed orthopedic procedures. However, there remains little consensus on the indications for operative versus nonoperative treatment of these injuries. The American Academy of Orthopaedic Surgeons has recently published clinical practice guidelines to help guide management of these injuries. The purpose of this paper i...

INTRODUCTION The treatment of adhesive small bowel obstruction is controversial, with both operative and non-operative management practiced in different centers worldwide. Non-operative management is increasingly getting popular, though operative rates still remain high. A study to compare the efficacy of an oral water-soluble medium (Gastrografin®) with standard conservative management, both n...

It is very common to encounter patients on strong opioid medication. These patients present particularly challenging pain management difficulties in the peri-operative period due to behavioural, psychological and pharmacological consequences of opioid treatment. This article discusses the key concepts in the anaesthetic management of patients taking strong opioids and steps that can be taken to...

While most sternoclavicular joint (SCJ) dislocations can be managed non-operatively with closed reduction, persistent or recurrent instability associated with pain or inability to work necessitates operative management [1]. Non-operative management has further been shown to result in symptomatic degenerative changes in the SCJ [2]. Reconstruction is generally indicated in the setting of symptom...

background: the use of high-dose steroid therapy peri portoenterostomy may have a positive impact on the frequency of cholangitis and survival rate.   methods: a prospective study was conducted on two groups of patients (less than three months of age) suffering from biliary atresia from 1999 to 2005. the patients in group i (g i) were managed peri-operatively by high-dose methylprednisolone whi...