Polidocanol Sclerotherapy in Pyogenic Granulomas.

BACKGROUND: Polidocanol is a safe sclerosing agent with anesthetic properties and minimal skin toxicity. OBJECTIVE: To evaluate the efficacy, safety, and recurrence rates with polidocanol sclerotherapy in the treatment of pyogenic granulomas (PGs). METHODS AND METHODS: Thirty-nine patients with PG were injected with polidocanol 1% solution. Repeat injections were given weekly in case of incomplete clinical/dermoscopic resolution, until a maximum of 3 sittings. A higher strength (3%) was used for subsequent sessions in those with a minimal response to 1% solution. A final assessment for relapses was performed at 3, 6, and 12 months. RESULTS: All 39 patients achieved complete resolution (100% clearance rate), with most (n = 26) lesions resolving after the first sitting. Side effects noted were postprocedure pain (22), erythema (2), superficial ulceration (2), paresthesias (1), prominent edema (4), thrombophlebitis (1), cyanotic discoloration (1), purpuric staining around injection site (4), and mild local pruritus (1). The procedure was well tolerated across the age spectrum (4-63 years) included. CONCLUSION: We report polidocanol to be a highly effective, safe, and cost-effective sclerosant for treatment of PGs with no recurrences or need for special postprocedure care.

Transparent cap-assisted endoscopic sclerotherapy in esophageal varices: a randomized-controlled trial.

BACKGROUND AND AIM: Endoscopic treatment is widely accepted as the first-line therapy selection for esophageal variceal bleeding. Nevertheless, endoscopic injection sclerotherapy requires experienced endoscopists and is associated with a high risk of bleeding. Our study evaluates the feasibility and efficacy of transparent cap-assisted endoscopic sclerotherapy in the management of esophageal varices. PATIENTS AND METHODS: A randomized-controlled trial was conducted in a tertiary referral center from April 2015 to May 2016. Patients who received endoscopic sclerotherapy were randomized in a blinded manner into two groups: the transparent cap-assisted group (n=59) and the control group (n=61). RESULTS: The average injection sites were reduced in the transparent cap-assisted group compared with the control group (1.2±0.4 vs. 1.4±0.05, P=0.000), whereas no difference was observed in the dosage of lauromacrogol (16.97±4.91 vs. 16.85±4.57, P=0.662) and the hemorrhage that occurred during injection made no difference (50.8 vs. 61.0%, P=0.276); yet, salvage hemostasis methods were used in only nine patients in the transparent cap-assisted group compared with 17 patients in the control group (25.0 vs. 38.7%, P=0.0936). The cost of each procedure in the cap-assisted group was ¥2578 (1878-4202), whereas it was ¥3691 for the control group (2506-5791) (P=0.023). Moreover, in both groups, no esophageal constriction was observed during the 6-month follow-up period, whereas the rebleeding rate between two groups showed no statistical significance in 6 months (89.8 vs. 93.4%, P=0.563). CONCLUSION: Transparent cap-assisted sclerotherapy provided a clear field of vision and helped to fix the targeted veins, thus significantly reducing the use of the salvage hemostasis method during sclerotherapy injection hemorrhage. It is also associated with reduced injection sites and endoscopic therapy cost.

Comparison of Ultrasound-Guided Percutaneous Polidocanol Injection Versus Percutaneous Ethanol Injection for Treatment of Benign Cystic Thyroid Nodules.

OBJECTIVES: We compared the efficacy, safety, and cost-effectiveness of ultrasound-guided percutaneous polidocanol injection and percutaneous ethanol injection for the treatment of benign cystic and predominantly cystic thyroid nodules. METHODS: A total of 135 cystic thyroid nodules treated by percutaneous ethanol injection and 136 cystic thyroid nodules treated by percutaneous polidocanol injection were enrolled retrospectively in this study from May 2010 to March 2016. The nodules were followed after 1, 3, 6, and 12 months. Nodule volumes, symptoms scores, and cosmetic scores were assessed before treatment and at follow-up. The therapeutic success rate, safety, and cost-effectiveness between the groups were also compared. RESULTS: No significant differences in the reduction of the nodule volume, volume reduction rate, and therapeutic success were observed between the groups with cystic and predominantly cystic thyroid nodules during follow-up (P > .05). Neither the cosmetic scores (P = .59; P = .42) nor the symptom scores (P = .32; P = .73) in the cystic and predominantly cystic nodules were significantly different between the groups at the last follow-up. The complication rates for ethanol were higher than those for polidocanol (P < .05). However, the cost of polidocanol injection was higher than that of ethanol injection for cystic thyroid nodules (mean ± SD, US$97.18 ± US$22.17 versus US$43.36 ± US$5.51; P < .01). CONCLUSIONS: Ultrasound-guided percutaneous polidocanol injection can be an alternative for sclerotherapy of cystic or predominantly cystic thyroid nodules. However, its cost was higher than that of percutaneous ethanol injection.

Prospective Randomized Study of Ultrasound-Guided Foam Sclerotherapy Combined with Great Saphenous Vein High Ligation in the Treatment of Severe Lower Extremity Varicosis.

BACKGROUND: To evaluate the effect of ultrasound-guided foam sclerotherapy (UGFS) in a single session combined with great saphenous vein (GSV) high ligation for severe lower extremity varicosis classified as C4-C6, compared with GSV stripping plus multistab avulsion or transilluminated powered phlebectomy (TIPP). METHODS: From January 2012 to December 2014, 177 patients with primary GSV insufficiency, classified as C4-C6, were randomized into the UGFS group or the control group. The UGFS group was managed by GSV high ligation and foam sclerotherapy in one session under the surveillance of ultrasonography, whereas the control group received GSV high ligation and stripping combined with multistab avulsion or TIPP. The patients were followed up at 1, 6, and 12 months after treatment. Outcome assessments included reflux recurrence rate, procedure-related adverse events, hemodynamic parameters, revised Venous Clinical Severity Score (VCSS), and Aberdeen Varicose Vein Questionnaire (AVVQ) score. The medical cost and operating time of the 2 groups were also compared. RESULTS: In total, 73 patients received UGFS, whereas 90 patients underwent traditional surgery. Sixty-five patients in the UGFS group (89.0%) and 74 patients in the control group (82.2%) completed the follow-up. At the end of 12 months, the cumulative reflux recurrence rate was 13.8% in the UGFS group and 13.5% in the control group (P = 0.955). In the UGFS and control groups, minor complications (27.7% vs. 21.6%, P = 0.406) and major complications (3.1% vs. 2.7%, P = 0.895) were not significantly different. Compared with baseline values, obvious improvements of the venous filling index, VCSS, and AVVQ scores after treatment were confirmed in both groups (P < 0.001). The average operating and recovery times were much shorter (38.3 vs. 81.2 min, 5.4 vs. 9.6 days, P < 0.001, respectively), and the average hospital cost was much lower ($853 vs. $1,575, P < 0.001) in the UGFS group than in the control group. The patient satisfaction rate reached 92.3% in the UGFS group and 89.2% in the control group 12 months after operation (P = 0.270). CONCLUSIONS: Our outcomes indicated that UGFS combined with GSV high ligation was safe and effective for severe lower extremity varicosis.

Esclerosis venosa eco-asistida con espuma para la insuficiencia venosa crónica / Ultrasound-guided sclerotherapy with foam in chronic vein insufficiency

CONTEXTO CLÍNICO: La insuficiencia venosa crónica de miembros inferiores se manifiesta a través de varices que son dilataciones permanentes de las venas superficiales de los miembros inferiores. Afectan ambos miembros, suelen aparecer antes de los 30 años y tienen un predominio marcado en el sexo femenino. Se calcula que el 44% de las mujeres y el 32% de los varones presentan algún grado de insuficiencia venosa crónica. Entre un 10 a 15 % evolucionan a formas sintomáticas con dolor, picazón, alteraciones cutáneas, flebitis y ulceras. La insuficiencia venosa crónica se clasifica según la etiología en varices primarias o esenciales (no existe una alteración del sistema venoso profundo) y varices secundarias, como las que siguen a una trombosis venosa profunda. Según a su morfología se clasifican en varices tronculares, reticulares, de venas perforantes y telangectasias.Las formas leves pueden ser tratadas con medidas de contención (posturales, lubricación, medias compresivas, etc.) y tratamiento farmacológico, mientras que las formas sintomáticas moderadas a graves pueden ser tratadas con diferentes técnicas de escleroterapia que utilizan distintos tipos de sustancias esclerosantes (hiperosmóticas, corrosivas y detergentes) y cuando son formas muy severas está indicada la resección o ligadura radical quirúrgica del paquete venoso comprometido. Otras técnicas usadas son la crio-esclerosis, eco-esclerosis, laser-esclerosis, radiofrecuencia. La escleroterapia es una técnica simple de tratamiento que se usa para el manejo de venas de pequeño o moderado tamaño, no siendo eficaz en vasos de mayores a 9 mm de diámetro debido a que los esclerosantes líquidos no cumplen los requerimientos básicos de la técnica. Se postula el uso del tratamiento del síndrome varicoso con Eco-doppler con espuma para venas varicosas esenciales de cualquier tipo y tamaño (desde las arañas vasculares, venas capilares subcutáneas hasta las varices de gran volumen). TECNOLOGÍA: La escleroterapia es una técnica percutánea mínimamente invasiva cuyo objetivo es cerrar las venas varicosas utilizando irritantes químicos. El uso de agentes esclerosantes con espuma provoca la desorganización de la membrana fosfolipídica de las células endoteliales con un poder esclerosante mayor. Los tipos de sustancia que se pueden usar son: polidocanol (hidroxipolietoxidodecano), tetradedilsulfato de sodio, cloruro de lapidio. OBJETIVO: Evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura de la Esclerosis venosa eco-asistida con espuma para la insuficiencia venosa crónica. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas (incluyendo Medline, Cochrane y CRD), en buscadores genéricos de Internet, agencias de evaluación de tecnologías sanitarias y financiadores de salud utilizando la siguiente estrategia: ((Sclerotherapy[MeSH] OR Sclerotherap*[tiab]) AND (Polidocanol[Supplementary Concept] OR Polidocanol[tiab] OR Varithena[tiab] OR Laureth[tiab] OR Lubrol[tiab])) AND (Venous Insufficiency[MeSH] OR Venous Insufficien*[tiab] OR Varicose Veins[Mesh] OR Varicose[tiab] OR Varix[tiab] OR Varices[tiab]) AND (ultrasound-guided[All Fields] AND foam[All Fields] AND elds])) Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias y económicas, guías de práctica clínica(GPC) y políticas de cobertura de otros sistemas de salud cuando estaban disponibles. RESULTADOS: Para el informe se incluyeron dos RS, un ECA, una evaluación de tecnología, tres GPC y seis políticas de cobertura. CONCLUSIONES: Evidencia de moderada calidad sugiere que la esclerosis venosa eco-asistida con espuma no demostró mayor efectividad que otros tratamientos como ablación con radiofrecuencia, láser o cirugía para la insuficiencia venosa crónica. Las distintas guías de práctica clínica recomiendan esta tecnología como una opción terapéutica para síndromes varicosos sintomáticos venas safenas incompetentes, venas varicosas reticulares, telangiectasias y venas varicosas residuales a otros tratamientos. Algunos financiadores estadounidenses y británicos dan cobertura a esta tecnología sólo para síndrome varicoso de venas safenas grandes, pequeñas y accesorias sintomáticas de más de 2,5 mm con presencia de insuficiencia venosa documentada por eco-doppler. Otros financiadores lo consideran un tratamiento cosmético o en fase experimental.

Cost-Effectiveness Analysis of Percutaneous Sclerotherapy for Venous Malformations.

PURPOSE: To assess cost-effectiveness of sclerotherapy for venous malformations (VMs) to improve patient quality of life (QOL). MATERIALS AND METHODS: This prospective study enrolled 28 patients with symptomatic VMs who underwent sclerotherapy. EuroQol-5 Dimension (EQ-5D) and Short-Form 36 (SF-36) Health Survey were used to measure health-related QOL. Questionnaires were collected before and 1, 3, 6, and 12 months after sclerotherapy. Quality-adjusted life years (QALYs) were calculated using EQ-5D score as a measure of health utility. Medical costs obtained from the hospital accounting system and other costs of staff, drugs, materials, and angiographic equipment were calculated for each procedure. Cost-effectiveness was analyzed using incremental cost-effectiveness ratio (ICER) as the medical cost/gain of QALYs. RESULTS: Median EQ-5D scores improved from 0.768 (range, 0.705-1) to 1 (range, 0.768-1) after 6 months (P = .023) and 1 (range, 0.768-1) after 12 months (P = .063). The gain of QALYs at 12 months was 0.043. The mean medical cost was ¥281,228 ($2,337). The pain group (baseline bodily pain scale of SF-36 score < 70) showed greater improvement in median EQ-5D score, from 0.705 (range, 0.661-0.768) to 0.768 (range, 0.705-1) after 6 months (P = .041) and 0.768 (range, 0.768-1) after 12 months (P = .049). ICER at 12 months was ¥6,600,483 ($54,840) in the overall group and decreased to ¥3,998,113 ($33,218) in the pain group, < ¥6,000,000 ($49,850), threshold for acceptance of a public health benefit in Japan, even accounting for 50% increase in costs. CONCLUSIONS: Sclerotherapy was cost-effective for improving QOL for symptomatic VMs, especially for patients with moderate to severe pain.

Venous leakage treatment revisited: pelvic venoablation using aethoxysclerol under air block technique and Valsalva maneuver.

OBJECTIVE: We evaluated the effectiveness of pelvic vein embolization with aethoxysclerol in aero-block technique for the treatment of impotence due to venous leakage in men using sildenafil for intercourse. The aim of the procedure was to reduce the use of sildenafil. METHODS: A total of 96 patients with veno-occlusive dysfunction, severe enough for the need of PDE5 inhibitors for vaginal penetration, underwent pelvic venoablation with aethoxysclerol. The mean patient age was 53.5 years. Venous leaks were identified by Color Doppler Ultrasound after intracavernous alprostadil injection. Under local anesthesia a 20-gauge needle was inserted into the deep dorsal penile vein. The pelvic venogram was obtained through deep dorsal venography. Aethoxysclerol 3% as sclerosing agent was injected after air-block under Valsalva manoeuver. Success was defined as the ability to achieve vaginal insertion without the aid of any drugs, vasoactive injections, penile prosthesis, or vacuum device. Additionally, a pre- and post- therapy IIEF score and a digital overnight spontaneous erections protocol (OSEP) with the NEVA™-system was performed. RESULTS: At 3 month follow-up 77 out of 96 patients (80.21%) reported to have erections sufficient for vaginal insertion without the use of any drug or additional device. Four (4.17%) patients did not report any improvement. Follow up with color Doppler ultrasound revealed a new or persistent venous leakage in 8 (8.33%) of the patients. No serious complications occurred. CONCLUSIONS: Our new pelvic venoablation technique using aethoxysclerol in air-block technique was effective, minimally invasive, and cost-effective. All patients were able to perform sexual intercourse without the previously used dosage of PDE5 inhibitor. This new method may help in patients with contra-indications against PDE5 inhibitors, in patients who cannot afford the frequent usage of expensive oral medication or those who do not fully respond to PDE5-inhibitors.

[The assessment of surgical treatment of patients with malignant pleural effusion].

An analysis of results of 498 patients with malignant pleural effusion was made. All patients were divided into three groups depending on methods of treatment: in the first group of patients the puncture of pleural cavity and the evacuation of liquid were made against the background of complex treatment; in the second group of patients the thoracocentesis and suspension induction were performed; in the third group the video thoracoscopy was carried out. In an assessment of each method of treatment, the researchers came to the conclusion that in case when the patient had the sufficient functional capabilities, the doctors should give preference to the thoracoscopy operations and in case of severe somatic status the doctors should give preference to the drainage of pleural cavity with release from exudates and with subsequent introduction of talc as the most effective sclerosing agent.

[Intracardiac echography in interventional cardiology]. / L'ecografia intracardiaca in cardiologia interventistica.

Since its early development, interventional cardiology relies on radiological imaging to show and describe vascular structures involved in percutaneous treatment. However, the development of the transcatheter approach to structural heart disease has highlighted the limits of X-rays in guiding interventions targeting soft heart tissues because of their low radiological resolution. Transesophageal echocardiography has thus gained an important role in many catheterization laboratories that perform percutaneous structural heart disease interventions. The endorsement of this technique necessarily requires expertise of echocardiographers and anesthesiologists for endotracheal intubation, thus increasing the logistic complexity of the procedure. Hence, the idea to apply ultrasonography directly into the heart, thus the introduction of intracardiac echography. At present, there are two different technological implementations of intracardiac echography related to the use of an electronic or mechanical ultrasonic transducer placed at the tip of a catheter inserted into the cardiac chambers, most frequently via femoral venous vascular access. In this review, we describe the potentials, advantages and limits of intracardiac echography, as well as its operative function, current use, and future developments.

Management of malignant pleural effusions: questions that need answers.

PURPOSE OF REVIEW: Malignant pleural effusion (MPE) is common. However, regardless of the differences between patients, their underlying cancer type, and pleural fluid characteristics, management options are often limited. These have not advanced significantly over the last 80 years since pleurodesis was first described. Correspondingly, patient-related outcome measures have been neglected. The evidence (or lack of) behind the current treatment recommendations is reviewed and key research questions are described. RECENT FINDINGS: Talc continues to be the most effective sclerosant available for pleurodesis in MPE. A recent randomized controlled trial comparing talc pleurodesis and indwelling pleural catheter insertion as first-line therapy suggests these approaches are equally effective, and utilized a patient-based symptom score as the primary outcome. The need to acknowledge the advances in translational medicine and oncological therapies to measure patient-related trial outcomes and to target pleural fluid formation in MPE is discussed. SUMMARY: Pulmonologists should be aware of the staggering lack of progress in the evidence that supports the current 'recommended' management of MPE. The need for a re-think about MPE management with a focus on alternative therapeutic targets and treatment objectives should be appreciated, in order to optimize future patient care.

Randomized clinical trial of ultrasound-guided foam sclerotherapy versus surgery for the incompetent great saphenous vein.

BACKGROUND: New minimally invasive treatment modalities, such as ultrasound-guided foam sclerotherapy (UGFS), are becoming more popular. In a multicentre randomized controlled non-inferiority trial, the effectiveness and costs of UGFS and surgery for treatment of the incompetent great saphenous vein (GSV) were compared. METHODS: Patients with primary great saphenous varicose veins were assigned randomly to either UGFS or surgical stripping with high ligation. Recurrence, defined as reflux combined with venous symptoms, was determined on colour duplex scans at baseline, 3 months, 1 year and 2 years after initial treatment. Secondary outcomes were presence of recurrent reflux (irrespective of symptoms), reduction of symptoms, health-related quality of life (EQ-5D(™)), adverse events and direct hospital costs. RESULTS: Two hundred and thirty patients were treated by UGFS and 200 underwent GSV stripping. The 2-year probability of recurrence was similar in the UGFS and surgery groups: 11·3 per cent (24 of 213) and 9·0 per cent (16 of 177) respectively (P = 0·407). At 2 years, reflux irrespective of venous symptoms was significantly more frequent in the UGFS group (35·0 per cent) than in the surgery group (21·0 per cent) (P = 0·003). Mean(s.d.) hospital costs per patient over 2 years were €774(344) per patient for UGFS and €1824(141) for stripping. CONCLUSION: At 2-year follow-up, UGFS was not inferior to surgery when reflux associated with venous symptoms was the clinical outcome of interest. UGFS has the potential to be a cost-effective approach to a common health problem. Registration numbers: NCT01103258 (http://www.clinicaltrials.gov) and NTR654 (http://www.trialregister.nl).

[Diagnostic performance of colonoscopy in lower gastrointestinal bleeding]. / Rendimiento de la colonoscopia en la hemorragia digestiva baja.

Lower gastrointestinal bleeding is a common medical emergency that usually has a favorable prognosis. However, these events generate high resource use. The procedure of choice is colonoscopy with prior colonic preparation due to its high diagnostic performance and safety and the possibility of endoscopic therapy. Emergency colonoscopy has advantages over elective colonoscopy, showing higher diagnostic yield and superior detection of stigmata of recent bleeding, increasing the probability of endoscopic treatment. Predictive models of bleeding severity and recurrence have been published, allowing resource use to be rationalized, mainly by reducing hospital stay in low-risk patients. Nevertheless, the optimal timing of emergency colonoscopy has not been established and the impact of endoscopic treatment on prognosis is controversial.

Volumetric assessment of results of treatment of vascular malformations of the head and neck regions treated with a minimally invasive surgical technique after embolization procedure.

Treatment of large soft tissue vascular lesions, one of the greatest challenges facing plastic surgeons, is patient specific in almost all cases, and preoperative angiographic evaluation and embolization of these lesions are standards of care. The aim of this study was to evaluate the usefulness of 3-dimensional demonstration and volumetric assessment of soft tissue vascular lesions both in the treatment of these lesions with curettage and in the participation of the patients to the decision-making process of the disease. Five patients with vascular malformation of the head and neck regions were included to this prospective trial. All patients were evaluated with preoperative angiography, and selective embolizations of the soft tissue vascular lesions were done in the same session by the same interventional radiologists. The amount of embolic agent injected was determined according to the size and vascularization of the lesions. Surgery was done by curettage of the embolized lesions 7 to 10 days after the embolization procedure. The raw data obtained from preoperative and postoperative high-resolution computed tomographic scans of the patients were processed with a Mimics 9.22 Software (Materialise's Interactive Medical Image Control System, Leuven, Belgium). Volume and surface area of the injected embolic agent were assessed. Statistical analysis was performed using the software package SPSS 10.0 for Windows (SPSS Inc, Chicago, IL). Wilcoxon signed rank test was used to compare the measurements of the volume and the surface area of injected sclerosing agent preoperatively and postoperatively. There were no complications related to either the preoperative angiography or embolization procedure. All the patients emphasized (assessed) that the 3-dimensional demonstration of the lesions and their relation with other anatomic structures helped them to understand the extent of their pathology and aim of the proposed treatment. The difference between the volumetric measurements before and after the treatment was found statistically significant. Treatment of large soft tissue vascular lesions with curettage after embolization has acceptable cosmetic results. Although it is not possible to remove all of the sclerosing agent from its injection site with this technique, a significant amount of it can be removed, and the 3-dimensional vascular architecture of the lesion is disturbed. Reactive chronic inflammation against the remaining sclerosing agent and the intralesional scarring caused by curettage lead to further improvement. Using 3-dimensional imaging modalities helps patients and/or their relatives to understand their disease and participate in the decision-making process.

Minimally invasive thoracic surgery for diagnostic assessment and palliative treatment in recurrent neoplastic pleural effusion.

BACKGROUND: We evaluated the effectiveness of VATS in the diagnosis and palliative treatment of recurrent neoplastic pleural effusions. METHODS: From 1987 to 2001, we performed 325 VATS chemical pleurodesis for malignant pleural effusions. We used talc in 253 subjects (78 %) and alcohol in 72 (22 %) as the sclerosant agent. In 226 patients (68 %) we performed biopsies because the histology was unknown. RESULTS: Mean operating time was 33.38 +/- 9.77 minutes (median: 32; range: 19 - 58), and the mean duration of chest intubation was 3.78 +/- 1.33 days (median: 4; range 2 - 8). Complications occurred in 2 % of patients. Thirty-day mortality was 2 %. Mean postoperative in hospital stay was 5.53 +/- 1.90 days (median 6; range: 2 - 11). We obtained 264 (81 %) therapeutic successes (no effusion recurrence within 4 months), and 55 relapses of which 32 had talc insufflation (13 % of talc group) and 23 alcohol instillation (32 % of alcohol group). CONCLUSIONS: VATS chemical pleurodesis is a safe, useful, versatile procedure for oncological pleural effusion management. The use of talc rather than alcohol significantly increased the therapeutic success rate. VATS should be considered the treatment of choice in patients with advanced neoplasm to obtain good palliation and a better quality of life.

Percutaneous treatment of simple renal cysts with sclerotherapy and extended drainage.

PURPOSE: To present the long-term results of sclerotherapy of symptomatic simple renal cysts with alcohol and aethoxysclerol followed by protracted seven-day drainage and to compare the efficacy of the two sclerosing agents used in the therapy. MATERIALS AND METHODS: Sixty-six symptomatic patients underwent percutaneous treatment with drainage and sclerotherapy of 72 simple renal cysts in a day hospital setting. The cysts were divided into two groups according to size (Group I and Group II with cyst volume smaller or larger than 600 ml respectively) for a better comparison of the results. The cysts were punctured directly under local anaesthesia with a 7 French Trocar catheter using the ''one-shot'' technique and ultrasound guidance; a pig tail catheter was then left in the cyst for the complete evacuation of the cyst fluid. Sclerotherapy was performed by injection of 95% alcohol or 3% aethoxysclerol for 40 minutes, followed by seven-day drainage. On the basis of dimensional criteria, response to treatment was defined as: recovery, partial recurrence or recurrence. RESULTS: The procedure was successful in 97.2% of the cases with regard to cyst drainage, with clinical recovery in 95.3% of the cases. Group I had 14 recoveries and no complete recurrence after either alcohol or aethoxysclerol, 2 partial recurrences with alcohol and 4 partial recurrences with aethoxysclerol; Group II had 15 recoveries, 14 partial recurrences and one complete recurrence with alcohol, and 5 recoveries, 8 partial recurrences and 2 complete recurrences with aethoxysclerol. CONCLUSIONS: The one-shot technique under ultrasound guidance prevents the risk of major complications, reduces the likelihood of failure and is inexpensive; furthermore, it significantly reduces procedure time and is better tolerated by patients. On the basis of the clinical and dimensional results obtained, percutaneous sclerotherapy of renal cysts can be recommended as the treatment of choice and as a valid alternative to laparoscopy. As for the comparison between the two sclerosing agents, alcohol has a higher cost and negative side effects, but is more effective for the treatment of larger cysts. Aethoxysclerol is less expensive and has no side effects, but tends to lead to septic complications. On the basis of our experience, we therefore recommend the use of aethoxysclerol for sclerotherapy of smaller cysts followed by a 4-day drainage. For larger cysts, we recommend repeated alcoholization and the removal of the drainage catheter after seven days.

Analysis of radiation doses in the percutaneous treatment of varicocele in adolescents.

PURPOSE: Varicocele is a common clinical condition that affects 15% of the male population and is an important cause of male infertility. Fluoroscopy-guided percutaneous treatment with retrograde sclerosis is a good alternative to surgery. We report our experience in calculating the total radiation dose to patient and the associated risk. MATERIALS AND METHODS: Our study was performed on 67 patients undergoing percutaneous treatment of varicocele with transbrachial approach and retrograde sclerosis. Thirteen dosimeters with two TLD detectors were positioned on the patients' skin. Calculation of the Entrance Surface Dose and application of appropriate transmission coefficients of the depth-dose allowed us to determine the Equivalent Doses for the single organs. Similar studies were conducted during plain abdominal x-ray and urography for comparative purposes. RESULTS: The mean effective dose during percutaneous treatment of varicocele was 18 mSv, whereas the dose for abdominal x-ray was 1.31 mSv and that for urography was 4.6 mSv. DISCUSSION AND CONCLUSIONS: Examinations involving the use of x-rays have been estimated to contribute to half of all the radiation absorbed by the population, and the number of both diagnostic examinations and interventional procedures is steadily rising. Radiation exposure, especially in children, requires special consideration. Percutaneous treatment of varicocele is a valuable alternative to surgery, not least because of reduced exposure. The use of specially-built lead coats and the creation of regional referral centres employing specialised staff are two possible measures that could further reduce radiation doses and dispel concerns about this procedure.

[Endoscopic hemostasis in bleeding gastroduodenal ulcer--a contribution to the cost aspect]. / Endoskopische Blutstillung bei der gastroduodenalen Ulkusblutung--Ein Beitrag zur Kostenproblematik.

Endoscopic injections of fibrin glue for the treatment of gastroduodenal ulcer hemorrhage have been increasingly used instead of sclerosing agents since 1987. Sclerosants have the drawback that they themselves have tissue-destroying or rather ulcerogenic effects. A difficult form of administration and a relatively high price are set against the good biological properties of the fibrin glue. In a randomized study comparing fibrin glue with polidocanol there was a statistically significant lower rebleeding rate in the fibrin group. The data of this study were analysed with regard to economic aspects. They showed an improved cost-benefit and cost-effectiveness ratio of the fibrin glue compared with polidocanol.