Chemical synovectomy with sodium morrhuate in the treatment of symptomatic recurrent knee joint effusion.

The aim of this study was to assess the efficacy and safety of intra-articular sodium morrhuate injections in the treatment of recurrent knee joint effusions. Ninety-eight knees of 92 patients (f = 59, m = 33) with knee arthritis of heterogeneous etiology were treated with chemical synovectomy (CSO). Of those, 39 patients suffered from rheumatoid arthritis (RA). The mean follow-up was 29.8 months. Clinical outcome was evaluated by analyzing subjective patient satisfaction, activity level, pain severity on the basis of the Visual Analogue Pain Scale (VAS), Lysholm and Gillquist score, and the Knee Injury and Osteoarthritis Outcome Score (KOOS). Fifty-seven percent of all patients and 67% of patients diagnosed with RA were satisfied with CSO. No significant effects on patient satisfaction by CSO were noted in patients older than 40 years. Overall, VAS, Lysholm and Gillquist score, and KOOS improved significantly at final review. The intra-articular application of sodium morrhuate is an effective and safe measure in the treatment of recurrent symptomatic knee joint effusions in young patients suffering from recurrent knee joint effusions.

Fluoroscopy-guided foam sclerotherapy with sodium morrhuate for peripheral venous malformations: Preliminary experience.

BACKGROUND: Ultrasound-guided foam sclerotherapy is a generally safe, cost-effective, and practical technique for the treatment of certain venous malformations; however, not all vascular malformation lesions are amenable to the ultrasound-guided method. Venous outflow of the sclerosing agent and extravasation are difficult to check when only ultrasound guidance is used. This study describes a new fluoroscopy-guided technique that uses standardized sclerosing foam for peripheral venous malformations. The short-term efficacy and safety of fluoroscopy-guided foam sclerotherapy for peripheral venous malformations was evaluated. METHODS: A retrospective review of a prospectively collected data was performed for 23 patients (9 males, 14 females) with limited (localized) venous malformations treated with foam sclerotherapy who were referred from January 2007 to December 2007. Median patient age was 21 years (range, 5 months-39 years). Lesion locations included extremities in 13, faces in eight, and trunks in two. The standardized sclerosing foam was prepared using Tessari's method to mix room air with 5% sodium morrhuate in a 4:1 ratio. Sclerotherapy was performed by the "filling-defects" technique under fluoroscopy. Postsclerotherapy surveillance was done at 6 months after the last session. Treatment response was assessed clinically and by means of lesion size measurement with magnetic resonance imaging. During the treatment and the follow-up period, adverse events and adverse drug reactions were recorded. Specific complications were classified as major or minor. RESULTS: A total of 58 treatment sessions were performed (mean, 3 sessions per patient; range, 1-6 sessions). At the 6-month follow-up, 15 patients (65.2%) showed a total disappearance of treated malformations, six (26.1%) showed a reduction in malformation size of >50%, and two (8.7%) showed a reduction in malformation size of

Evaluation of a rabbit model for osteomyelitis by high field, high resolution imaging using the chemical-shift-specific-slice-selection technique.

The rabbit model of osteomyelitis introduced by C.W. Norden, based on injection of an infecting solution (Staphylococcus aureus, sodium morrhuate) into the tibia, was studied at 4.7 Tesla with a time-efficient chemical shift selective imaging technique, Chemical Shift Specific Slice Selection (C4S). The evolution of the disease over several weeks was followed on water-selective, fat-selective, and sum images obtained simultaneously with this imaging sequence. Experiments were performed either on different groups of rabbits at different times after infection with subsequent sacrifice of the animal and microbiological analysis of the infected tibia or on the same group of animals imaged several times after infection. Associated analysis of the water and fat selective images revealed marrow modifications very early (Day 5 after inoculation) demonstrating the high sensitivity of the employed imaging technique. Later on, bone modifications were best identified on the sum images. Additional experiments performed on animals injected with a noninfecting solution containing only sodium morrhuate showed however that the sclerosing agent alone can yield images similar to those produced by infection at early stages after inoculation. Therefore, the Norden model would not be suitable for monitoring quantitatively outcome of therapy by magnetic resonance imaging. It is however well adapted for the evaluation and optimization of MRI techniques or protocols intended to detect early changes of bone marrow produced by septic or aseptic infarct.

Sclerotherapy of oral and facial venous malformations with use of pingyangmycin and/or sodium morrhuate.

Two hundred and sixty patients with oral and facial venous malformations received intralesional injections of either pingyangmycin, sodium morrhuate, or pingyangmycin alternating with sodium morrhuate. Results were rated excellent, good, fair, or poor, depending on clinical outcome. The prevalence of an "excellent" rating in the combined sclerotherapy group (82%) was higher than that in the pingyangmycin group (71%) and the sodium morrhuate group (61%). Swelling and pain following injection were commonly associated with the use of sodium morrhuate. Sclerotherapy with pingyangmycin or sodium morrhuate is an effective and safe treatment for oral and facial venous malformations. Alternate injection of pingyangmycin and sodium morrhuate appears to be more effective for venous malformations than using sclerosant alone.

[Conservative local therapy of inflammation of joints: local invasive forms of therapy]. / Die konservative Lokaltherapie des entzündeten Gelenks: Lokal-invasive Therapieformen.

Local invasive procedures represent possibilities for the treatment of arthritic swollen joints without surgical interventions, when general measures alone are not successful and intra-articular injections are of utmost importance in this context. The differences between degenerative and rheumatologic diseases must be considered as well as possible specific adverse reactions, side effects and contraindications. The technical intervention is performed according to the guidelines of scientific societies such as the Scientific Medical Profession Society (AWMF). Cortisone and radiosynoviorthesis/chemosynoviorthesis are suitable for activated rheumatic and degenerative joints, low-grade radiation therapy or infiltration of hyaluronic acid is recommended for relief in cases of arthritic inflammation. The combination of arthroscopic synovectomy and subsequent radiosynoviorthesis in the early stages of rheumatically swollen joints show the best results with respect to regression prophylaxis and slowing the process of rapidly progressing destruction of chondral surfaces and distension of the capsules and ligaments.

Scintigraphic detection of pulmonary embolization of esophageal variceal sclerosant.

Intravariceal injection of a sodium morrhuate sclerosant solution, an effective therapy for bleeding esophageal varices, is complicated occasionally by fever and pneumonia. To determine if embolization of sclerosant to or through the pulmonary circulation occurs, chest scintigrams were performed following intravariceal injection of 1-3 mCi 99m-Tc-MAA mixed with 5-20cc of sclerosant in 18 patients undergoing a total of 25 sclerotherapy sessions. Sclerosant embolization was documented in 15/25 procedures (60%). Tracer localization in esophageal veins cephalad to the injection site (gastroesophageal junction) occurred in 2 studies. Atelactasis, effusion, or infiltrate on chest x-ray occurred after 6/25 procedures. Post-sclerosis fever (greater than 99.5 degrees F) occurred in 5/15 (33%) with embolization and in 1/10 (10%) without. However, neither x-ray abnormalities nor fever were positively correlated with sclerosant embolization. We conclude that embolization of sclerosant to the pulmonary arterial circulation occurs frequently. Chest radiographs may be negative despite significant embolization. We conclude that embolization of sclerosant to the pulmonary arterial circulation occurs frequently. Chest radiographs may be negative despite significant embolization.

Prospective randomized comparison of esophageal variceal sclerotherapy agents: sodium tetradecyl sulfate versus sodium morrhuate.

We designed a prospective randomized study to evaluate differences in efficacy and complication rate between the two most commonly used sclerosing agents, sodium tetradecyl sulfate (STD) and sodium morrhuate (MOR). Of 41 patients with acute index variceal bleeding initially evaluated, 21 were randomized to receive 0.75% STD and 20 to receive 1.6% MOR diluted with 50% dextrose. Overall mortality for the STD group was 38% and that for the MOR group was 25% (NS). Control of acute bleeding was achieved in 86% of the STD patients and 90% of the MOR patients (NS). Overall, obliteration was achieved in only 33% of the STD group and 25% of the MOR group; but in those patients who remained in the study over 3 months, obliteration was achieved in 87 and 83%, respectively (NS). There was a trend toward higher rebleeding in the STD group compared with the MOR group (81% vs. 51%) (p = 0.078), but there was no significant difference between the STD and MOR patients with regard to transfusion requirements (8.4 units/patient vs. 8.7 units/patient), ulceration (53% vs. 40%), or stricture formation (9.5% vs. 0.0%). The results of this study suggest that STD and MOR are clinically equivalent sclerosing solutions, and that bias favoring use of one agent over the other may be unfounded.

Chronic esophageal ulceration after endoscopic sclerotherapy.

Ulceration at the site of injection is a common sequel of endoscopic sclerotherapy. Most postsclerotherapy ulcers heal spontaneously, usually within 3 weeks. We report a patient who developed a large esophageal ulcer after sclerotherapy, which did not heal despite 2 years of aggressive medical therapy. He bled twice from the ulcer. This is the first report in which such an ulcer has been followed sequentially for 2 years and has remained unhealed.

Varicose veins--primary treatment with sclerotherapy. A personal appraisal.

Varicose veins are a very common condition that presents in a variety of forms. Treatment modalities are variant and beneficial. The author reports on an experience of 25 years treating 20,000 patients using surgery and sclerotherapy with particular results using morrhuate sodium.

Experimentally induced ankylosis and facial asymmetry in the macaque monkey.

Six Macaca nemestrina were used for induction of ankylosis by different methods. One TMJ capsule was either (a) mechanically damaged, (b) injected with sodium morrhuate, or (c) injected with a strain of Staphylococcus aureus. The other capsule served as a control. Facial asymmetry of varying degrees was evident from dry-skull preparations and histologically. Sodium morrhuate caused the least degree of alteration; mechanical damage, the most. The effects of Staph. aureus injection into the TMJ seemed to depend upon the length of time elapsed since injection. In one animal there was no change at autopsy after two injections several weeks apart, once on each side; in the other, the capsule injected initially showed no change at autopsy, whereas that injected several weeks prior to autopsy was considerably altered. Induction of ankylosis was achieved with varying degrees of success, causing differing degrees of facial asymmetry.

Persistent bradyarrhythmia after sclerotherapy for esophageal varices.

Sclerotherapy for esophageal varices has recently gained wide acceptance in major medical centers for the control of bleeding esophageal varices. We have described two elderly patients with preexisting cardiac disease (right bundle branch block) in whom persistent bradyarrhythmia followed sclerotherapy using 5% sodium morrhuate. Both patients required insertion of a permanent pacemaker. This is the first report associating sclerotherapy with significant bradyarrhythmias.

Squamous cell carcinoma after endoscopic injection sclerotherapy for esophageal varices.

We report two cases of squamous cell carcinoma of the esophagus following endoscopic injection sclerotherapy for esophageal varices. The interval between sclerotherapy and the development of carcinoma was 24 months in case 1 and 21 months in case 2. The sclerosant was 5% sodium morrhuate in case 1 (total dose, 10 ml) and 5% ethanolamine oleate in case 2 (45.5 ml). Although no recurrent variceal bleeding occurred after sclerotherapy, we could not perform any curative surgical treatment for esophageal cancer because of the advanced stage of the cancer and the severity of the accompanying liver dysfunction. It is difficult to determine the relationship between sclerotherapy and carcinoma; however, long-term surveillance is essential to avoid overlooking a neoplasm in the esophagus after endoscopic injection sclerotherapy.

Bilateral perinephric abscesses: a complication of endoscopic injection sclerotherapy.

Ten years after right hepatic lobectomy for primary hepatocellular cancer, a 45-yr-old black woman presented with bleeding esophageal varices. After five endoscopic injection sclerotherapy procedures using sodium morrhuate, she developed fever and elevated white blood count. Reendoscopy, chest x-ray, and upper gastrointestinal contrast x-rays showed no local complication. Urine analysis was normal, but CT scans, renal sonograms, and white blood cell radionuclide scan demonstrated bilateral perinephric abscesses. Percutaneous abscess drainage grew Streptococcus pneumoniae, normally found in the nasopharyngeal flora, which was probably a result of hematogenous spread. The perinephric abscesses were successfully treated with percutaneous drainage and antibiotics. Renal infection should be considered as a possible locus of distant blood-borne infection in patients who develop fever after endoscopic injection sclerotherapy.

Treatment of postsclerotherapy esophageal ulcers with sucralfate.

Deep ulceration of the esophagus is the most common significant complication of endoscopic injection sclerosis of varices. Four patients with persistent bleeding from sclerotherapy-induced ulcers were treated with sucralfate. Adherence of sucralfate to the ulcerated areas was demonstrated endoscopically, and bleeding stopped in three patients. Sucralfate may be useful in the treatment of esophageal ulcers caused by sclerotherapy.

Esophageal ulceration and bleeding after flexible fiberoptic esophageal vein sclerosis.

Three patients with portal hypertension and variceal hemorrhage were treated with flexible fiberoptic esophageal vein sclerosis by injection of sodium morrhuate. Each of these patients bled after sclerotherapy, and deep esophageal ulcers were found at the previous injection sites. Postsclerotherapy pathologic features are presented in 2 patients. It is suggested that the sclerotherapy caused esophageal ulceration and bleeding. Careful evaluation of the sclerosing technique and its histopathologic consequences is needed.

Sodium morrhuate delivery to the lung during endoscopic variceal sclerotherapy.

We determined quantitatively the amount of sodium morrhuate that reaches the pulmonary vascular bed during endoscopic variceal sclerotherapy to ascertain whether this affects the diffusing capacity of the lung to carbon monoxide (DLCO). Eleven patients had measurements of DLCO and specific diffusing capacity (DLCO/VA) before and after sclerotherapy. In ten of these patients sclerotherapy was done using sodium morrhuate mixed with 99mTc-labeled albumin microspheres followed by quantitative radionuclide scanning. Most of the sodium morrhuate, 80 +/- 18% (SD) of the total dose, remained in the region of the esophagus. Only 20% of the injected dose reached the pulmonary circulation. There were no changes in DLCO or DLCO/VA. We conclude that most of the sclerosing solution injected during endoscopic variceal sclerotherapy remains at the site of injection. As a result, the pulmonary endothelium is exposed to small amounts of sodium morrhuate and no change in diffusing capacity occurs.