Review of published information on foam sclerotherapy.

BACKGROUND: New data on foam sclerotherapy of varicose veins has been recently published. OBJECTIVE: To identify the current treatment modalities and their effectiveness in use of foam sclerotherapy. MATERIALS AND METHODS: Review of the recent literature regarding clinical treatment of varicose veins using foam sclerotherapy, with emphasis on safety and efficacy. RESULTS Foam sclerotherapy of the great saphenous vein is more effective than liquid. Higher sclerosant concentrations tend to induce higher occlusion. Catheter-assisted sclerotherapy may further improve occlusion rates. To achieve adequate occlusion, vein diameter and volume of foam must be matched. If a critical foam volume is exceeded, the risk of deep venous thrombosis increases. Foam sclerotherapy offers the possibility of using lower sclerosant concentrations than with liquids. Foam sclerotherapy can also be used in venous malformations and periulcerous tributaries. Side effects are hyperpigmentation, skin necrosis, scotoma, and thromboembolic events. Thromboembolism prophylaxis is necessary only in patients with special risk factors. CONCLUSION: Foam sclerotherapy has significantly better efficacy than liquid. It is essential to select the correct concentration and the correct foam volume. In the hands of an experienced physician, foam sclerotherapy is a safe and effective option for treating varicose veins.

Ascending thrombophlebitis after foam sclerotherapy as first symptom of breast cancer.

Malignancy increases the risk of thromboembolic events. Vascular events such as venous thromboses can even precede the diagnosis of cancer. A 48-year-old woman presented with an extensive thrombophlebitis of the left small saphenous vein and a perforating vein of the right leg after foam sclerotherapy with Aethoxysklerol foam 0.5% for small varicose veins of both lower legs. A few days later an unknown advanced breast cancer was diagnosed. This case shows that not only venous thromboses but also thrombophlebitis can be a warning sign for malignancy.

Cell cycle regulation and proliferation in lichen sclerosus.

INTRODUCTION: Genital lichen sclerosus (LS) is considered a potential precursor lesion of squamous cell carcinoma. We aimed to investigate the expression pattern of cell cycle regulators, tumour suppressor proteins and proliferation markers in genital LS as compared to extragenital LS (ELS) and healthy controls (HC). METHODS: In order to assess the expression of minichromosome maintenance protein 3 (MCM3), MCM7, Ki-67, cyclin D1, cyclin E, p16, p21, and p53, immunohistochemistry and immunofluorescence were performed on skin specimens obtained from the genital region of LS patients (short-standing LS, n=19; long-standing LS, n=15), patients with ELS (n=10), and HC (n=8). RESULTS: Median protein expression of MCM3 and Ki-67 was significantly higher in LS when compared to ELS and HC. In patients with long-standing LS, the expression profiles of MCM3 and Ki-67 significantly correlated. Moreover, long-standing LS lesions showed significantly increased expression of p53 when compared to short-standing LS, ELS, and HS. Immunoreactivity of MCM7, p16, p21, cyclin D1 and cyclin E did not significantly differ between the groups. CONCLUSIONS: Tumour suppressor proteins such as p53 are significantly overexpressed in genital LS when compared to extragenital disease and healthy skin. The significant p53 overexpression, particularly in long-standing genital lesions, may reflect the increased risk of malignant transformation and/or oxidative stress associated with LS. Moreover, we have demonstrated that proliferation markers such as Ki-67 and MCM3 are significantly up-regulated in genital LS as compared to controls. With regard to cell cycle regulation and proliferation rates, ELS significantly differs from its genital counterpart.