Sclerotherapy for Reticular Veins in the Lower Limbs: A Triple-Blind Randomized Clinical Trial.

Importance: Reticular veins are subdermal veins located in the lower limbs and are mainly associated with aesthetic complaints. Although sclerotherapy is the treatment of choice for reticular veins in the lower limbs, no consensus has been reached regarding to the optimal sclerosant. Objective: To compare the efficacy and safety of 2 sclerosants used to treat reticular veins: 0.2% polidocanol diluted in 70% hypertonic glucose (HG) (group 1) vs 75% HG alone (group 2). Design, Setting, and Participants: Prospective, randomized, triple-blind, controlled, parallel-group clinical trial with patients randomly assigned in a 1:1 ratio between the 2 treatment groups from March through December 2014, with 2 months' follow-up. The study was conducted in a single academic medical center. Eligible participants were all women, aged 18 to 69 years, who had at least 1 reticular vein with a minimum length of 10 cm in 1 of their lower limbs. Interventions: The patients underwent sclerotherapy in a single intervention with either 0.2% polidocanol plus 70% HG or 75% HG alone to eliminate reticular veins. Main Outcomes and Measures: The primary efficacy end point was the disappearance of the reticular veins within 60 days after treatment with sclerotherapy. The reticular veins were measured on images obtained before treatment and after treatment using ImageJ software. Safety outcomes were analyzed immediately after treatment and 7 days and 60 days after treatment and included serious adverse events (eg, deep vein thrombosis and systemic complications) and minor adverse events (eg, pigmentation, edema, telangiectatic matting, and hematomas). Results: Ninety-three women completed the study, median (interquartile range) age 43.0 (24.0-61.0) years for group 1 and 41.0 (27.0-62.0) years for group 2. Sclerotherapy with 0.2% polidocanol plus 70% HG was significantly more effective than with 75% HG alone in eliminating reticular veins from the treated area (95.17% vs 85.40%; P < .001). No serious adverse events occurred in either group. Pigmentation was the most common minor adverse event, with a 3.53% treated-vein pigmentation length for group 1 and 7.09% for group 2, with no significant difference between the groups (P = .09). Conclusions and Relevance: Sclerotherapy with 0.2% polidocanol diluted in 70% HG was superior to 75% HG alone in sclerosing reticular veins, with no statistical difference for complications. Pigmentation occurred in both groups, with no statistical difference between them. No serious adverse events occurred in either group. Trial Registration: clinicaltrials.gov Identifier: NCT02054325.

Polidocanol versus hypertonic glucose for sclerotherapy treatment of reticular veins of the lower limbs: study protocol for a randomized controlled trial.

BACKGROUND: The prevalence of chronic venous disease is high and occurs more frequently in females. According to the clinical, etiological, anatomical, and pathological classification (CEAP) definition, the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints. Several invasive techniques are used for treatment, including mini phlebectomy, laser ablation, and radiofrequency ablation. However, a wide range of sclerosing agents may serve as minimally invasive alternatives, promoting chemical sclerosis of the vein wall. Although this technique is routinely performed around the world, there is no consensus on the most efficacious and safe chemical agent to be used. METHODS/DESIGN: Inclusion criteria are women between 18 and 69 years old with at least 10 cm long reticular veins in the lower limbs, on the outer side of the leg/thigh. Patients with CEAP 2 to 6, or with allergies, pregnancy, performing breastfeeding, or with any dermatologic or clinical problems will be excluded. Patients with venous ultrasound mapping showing involvement of saphenous trunks and/or a deep venous system will also be excluded. Patients will be randomized into two groups, one receiving 75% pure glucose and the other group receiving 0.2% polidocanol diluted in 70% glucose. Just one limb and one session per patient will be performed. The sclerosing agent volume will not exceed 5 mL. Clinical follow-up will include visits on days 7 and 60, always with photographic documentation. DISCUSSION: This project aims to enroll 96 patients and subject them to a double-blind treatment after the randomization process. The design is intended to evaluate efficacy through a primary end point and safety through a secondary end point. Forty-eight patients have currently been enrolled. Preliminary results for these patients showed that 25 received treatment, 2 were excluded, and 22 returned after 7 days and showed no greater adverse events. To date, establishing efficacy criteria has not been possible, and no patients have reached the 60-day return point. These data may help doctors choose the best chemical agent for the treatment of reticular veins. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02054325, 3/02/2014.

Fluidoterapia transoperatoria / Transoperative fluid administration

Se llevó a cabo un estudio sobre la respuesta a 2 programas diferentes de administración de líquidos transoperatorios, en 40 pacientes del sexo masculino, sometidos a anestesia general balanceada o a intubación orotraqueal. Se formaron 2 grupos de 20 cada uno, de los cuales al primero únicamente se les administró solución de Ringer lactada y a los del segundo se les aplicó una combinación de soluciones glucosada y salina. No hubo diferencias de importancia en parámetros tales como presión arterial, gases en sangre arterial, osmolaridad plasmática y gasto renal. La única diferencia de importancia consistió en que en el segundo grupo se presentaron niveles de glucosa en sangre superiores a los límites normales.

Diferenciaçäo metabólica-hormonal de pacientes traumatizados, com e sem lesäo cranioencefálica, recebendo dieta enteral hiperprotéica - hiperenergética, suplementada ou näo com glicose hipertônica endovenosa / Metabolic-hormonal differentiation of traumatized patients with and without brain injury, receiving enteral hyperprotein diet supplemented or not by intravenous hypertonic glucose

O trauma resulta invariavelmente, em desnutriçäo pelo hipercatabolismo que impöe aos pacientes. Imagina-se que os mediadores hormonais desse hipercatabolismo possam ser diferentes no trauma com (TCE) ou sem (PT) lesäo cranioencefálica. A fim de evitar ou atenuar as conseqüências nutricionais do trauma, recomenda-se o suporte nutricional precoce desses pacientes. Assim, estudou-se a resposta metabólico-hormonal desses pacientes que receberam hiperalimentaçäo enteral suplementada ou näo com glicose hipertônica endovenosa. Foram estudados 12 pacientes, 6 com TCE (escala de Glasgow 4-6) e 6 com PT (ISS 30-42), adultos (21-39 anos), no período 4-11 dias pós-trauma. As avaliaçöes foram feitas em três momentos consecutivos (M1, M2, M3) coincidentes com três períodos dietéticos de três dias cada. M1 e M3 corresponderam à oferta de dieta enteral contendo 1,9g de proteína/kg/dia e 47 kcal/kg/dia e M2 a mesma dieta suplementada com glicose 50 por cento endovenosa (17,6 kcall/kg/dia). Amostras de sangue e urina (24 horas) foram colhidas no 3§ dia de cada regime dietético e utilizadas para dosagens de proteínas da fase aguda (proteína C reativa,alfa1-antitripsina, ceruloplasmina, transferrina, transtiretina e proteína ligadora do retinol), substratos energéticos (glicose, ácidos graxos livres e nitrogênio amínico) e triacilgliceróis, hormônios (insulina, peptídeo C, glucagon, cortisol, dopamina, epinefrina e norepinefrina) e uréia urinária. A partir da relaçäo entre proteínas positivas e negativas (da fase aguda) calculou-se o índice inflamatório e, da diferença entre N-ingerido e N-uréico excretado o índice catabólico. Em M1, o PT diferenciou-se do TCE por apresentar maiores níveis de glicemia e do índice inflamatório enquanto que o TCE houve maiores cortisolemias e índice catabólico. No transcorrer do estudo, ambos os grupos se assemelharam por apresentarem alto índice catabólico e elevados níveis de epinefrina e dopamina. Elevaçöes mais acentuadas da glicemia, insulinemia e peptídeo C foram mais característicos do PT denotando maior resistência insulínica, enquanto maiores elevaçöes do cortisol, glucagon, epinefrina e norepinefrina, sugestivos de maior descarga adrenérgica, foram observados no TCE. Esses padröes metabólicos dos grupos foram minimamente alterados pela suplementaçäo de glicose ou pelo curso da doença, demonstrando que essas individualidades dos tipos de trauma...

Influência da lavagem da cavidade peritoneal com glicose hipertônica 10 por cento na cicatrizaçäo por segunda intençäo do colo em vigência de peritonite fecal: estudo experimental em ratos / Influence of peritoneal cavity lavage with 10 percent hypertonic glucose on healing by secondary intention of the colon in presence of fecal peritonitis: experimental study in rats

O açúcar tem sido estudado clínica e experimentalmente nas feridas cutâneas e deiscências cirúrgicas com resultados satisfatórios. O objetivo deste estudo foi o de verificar a influência da lavagem da cavidade peritoneal com soluçäo glicosada a 10// diante de uma peritonte fecal e na cicatrizaçäo por segunda intençäo do cólo. 70 ratos Wistar foram randomizados em 2 grupos: CONTROLE (N=37) e GLICOSE (N=33). Após a realizaçäo de um ferimento cecal de 0.3 cm a cavidade foi lavada com soro fisiológico no primeiro e com soluçäo hipertônica de glicose a 10// no segundo grupo. Os animais foram sacrificados no 4§ e no 7§ dia do P.O. Näo houve diferença estatisticamente significante entre os grupos quanto à mortalidade, presença de peritonite e qualidade das aderências. No estudo da cicatrizaçäo do ferimento cólico através da pressäo máxima de rotura (PMR) e de tensäo na parede da alça (TRPA), observou-se na totalidade dos dados, uma diferença significante (p < 0.05) na resistência no local de cicatrizaçäo favorável aos animais do grupo glicose. Embora esse melhores resultados tenham sido observados nas duas datas de estudo, só ocorreu uma diferença significativa (p<0.01) no 7§ dia (PMR = 246.6 x 181.1 mm de Hg; TRPA = 233.5 x 164.8 dinas/cm x 10**3). Conclui-se que a lavagem da cavidade abdominal com glicose a 10// determina uma cicatrizaçäo por segunda intençäo mais rápida e mais resistente nos ferimentos cólicos

Estudio del vaciamiento gástrico de diferentes líquidos mediante ultrasonografía / Gastric emptying of different liquid test meals measured by real time ultrasonic imaging

Estudiamos el vaciamiento gástrico de líquidos en 80 sujetos voluntarios sanos del sexo masculino (edad promedio 19.9 ñ 1.6 años) mediante ultrasonografía de tiempo real. Realizamos múltiples cortes del antro a intervalos regulares (15-30 minutos) hasta completar el vaciamiento gástrico después de la ingestión a 500 ml de 8 diferentes dietas líquidas ensayadas: salina isotónica, glucosada al 50%, glucosada al 5%, proteínas 40 g, proteínas 20 g, grasas 40 g, 20 g y mixta (carbohidratos, proteínas y grasas). Cada dieta fue administrada a 10 sujetos e identificamos 3 tipos de vaciamiento gástrico: lento (117 ñ 12 minutos) en los que recibieron las dietas mixta, glucosada al 50%, proteinas 40 y 20 g; intermedio (83 ñ 9 minutos) con la glucosada al 5%, grasas 40 y 20 g; y rapido (40 ñ 6 minutos) con la salina isotónica. La dieta mixta tuvo el vaciamiento gástrico más lento (210 ñ 6 min). Nuestros resultados concuerdan con los conocimientos actuales de la fisiología motora del estómago y demuestran la utilidad de la ultrasonografía para el estudio del vaciamiento gástrico de líquidos

[Gastric emptying of different liquid test meals measured by ultrasonography]. / Estudio del vaciamiento gástrico de diferentes líquidos mediante ultrasonografía.

The rate of gastric emptying of different liquid solutions was measured in 80 voluntary normal young male subjects (mean age 19.9 +/- 1.6 years) by direct real-time ultrasonic imaging. Multiple US scans were repeated at regular intervals (15-30 minutes) until complete gastric emptying was established, after ingestion of 500 cc of 8 different liquid test meals: isotonic saline, 50% glucose, 5% glucose, 40 g of proteins, 20 g of protein, 40 g of fat, 20 g of fat and mixed (carbohydrates, proteins and fat). Eight groups of ten subjects were studied, each one with a different test meal. Three types of gastric emptying were identified: slow (177 +/- 12 minutes) in subjects receiving 50% glucose, 40 and 20 grs of proteins and mixed test meals; intermediate (83 +/- 9 minutes) with 5% glucose, 40 and 20 g of fat; rapid (40 +/- 6 minutes) with isotonic saline. The mixed diet had the slowest emptying time (210 +/- 6 min). Our results are in accordance with published data regarding gastric motor physiology and demonstrates the usefulness of ultrasound in the study of gastric emptying of fluids.

Hidratación oral o sin agua intermedia, en niños con diarrea aguda / Oral hydration with or without intermediate water in children with acute diarrhea

Se estudiaron 46 lactantes deshidratados por diarrea aguda, los cuales se dividieron en dos grupos: los niños del grupo A(23 casos) recibieron suero oral(SO) con la fórmula recomendada por OMS/UNICEF que contiene 90 mmol/l de sodio, durante un periodo de seis horas; los pacientes del grupo B(23 casos) recibieron dos tomas de SO por una toma de agua en tiempo semejante a los del primer grupo. Al corregir la deshidratación se observó incremento de la natremia y calemia en los pacientes del grupo A con descenso de estos parámetros en los niños del grupo B. Algunos pacientes del grupo B desarrollaron hiponatremia. Los resultados del estudio demuestran la eficacia y seguridad de la fórmula recomendada por la OMS/UNICEF sin tomas de agua intermedia, para la corrección de la deshidratación en niños con diarrea aguda

Influence of free fatty acids and glucose infusion on serum bilirubin and bilirubin binding to albumin: clinical implications.

We studied the risk of a large group of jaundiced neonates for bilirubin encephalopathy by serial assessment of their reserve serum albumin binding capacity as measured by the saturation index test. In 1271 infants with serum bilirubin concentration greater than 10 mg/dl, 12% had a saturation index (SI) of 7% or greater and therefore were clinically at or near risk for bilirubin encephalopathy. Treatment with glucose infusion (1 gm/kg over one hour) was highly effective in lowering the SI (delta = -3.7%. P less than 0.001). In none of the infants did SI rebound to 7% or greater within 24 hours after the infusion. In a detailed study of 19 infants who received glucose, the highly significant (P less than 0.001) fall in SI (delta = -3.7%) was accompanied by an equally significant rise in serum values for insulin (delta = +21.6 mcu/ml) and fall in serum free fatty acids (delta = -0.51 mEq/L). Many factors in the study, such as prematurity, hemolysis, acidosis, and hypoxemia, could have predisposed the infants to the risk of bilirubin encephalopathy. However, the facility by which most (93%) of the infants with high SI, including those who were premature or had evidence of hemolysis or respiratory insufficiency, responded to infusion of glucose indicates that serum free fatty acids may be the principal factor contributing to the high saturation index and therefore an underestimated factor in bilirubin binding to albumin.

Treatment of 242 neonates with dehydrating diarrhea with an oral glucose-electrolyte solution.

Two hundred thirty-four of 242 neonates (96.7%) with a mean dehydration of 5.1% body weight were rehydrated with a glucose-electrolyte solution given orally in an average time of 7 44 hours. Eight (3.3%) neonates required intravenous fluid therapy. Emesis was not an obstacle for complete oral rehydration. Hypernatremia, hyponatremia, and acidosis present on admission were corrected within a few hours. Oral rehydration is an entirely satisfactory choice for treatment of uncomplicated dehydration in neonates.

[Gastric emptying in children. II. Influence of the osmolarity of the hydration solution for oral use]. / Esvaziamento gástrico em crianças. II. Influência da osmolaridade da solução hidratante de uso oral.

The gastric retention of three oral rehydration solutions whose osmolality was changed by means of varying glucose concentration (mean values: 224, 312 and 422 mOsm/kg) was studied in 12 children (6 low birthweight infants and 6 infants). The children were fed by a nasogastric tube. The 422 mOsm/k solution caused slower gastric emptying than the 224 mOsm/kg solution. Thus, the use of an oral rehydration solution with osmolality varying between 200-300 mOsm/kg is recommended.

Comparison of sucrose with glucose in oral therapy of infant diarrhoea.

In a randomised double-blind trial, 51 5--10% dehydrated infants were rehydrated with oral electrolyte solutions containing sucrose or glucose. Most infants in both groups were successfully rehydrated, but the sucrose solution produced a slower correction of electrolyte abnormalities and a higher percentage of patients who needed more than 24 h of therapy. Where there is adequate knowledge of the oral therapy method sucrose can substitute for glucose in many cases; where there is a choice glucose is recommended.

PIP: 51 infants aged 3 to 12 months with dehydration due to acute watery diarrhea were randomly assigned to either the glucose or sucrose oral therapy group on admission to the hospital. Oral rehydration and maintenance without any intravenous fluids was successful in 100% and 92% of patients in the glucose and sucrose groups respectively, as evidenced by the subjects' weight gain, fall in plasma proteins and hematocrit, and disappearance of clinical signs of dehydration. There was a greater improvement in mean HC03 in the glucose group than in the sucrose group. Both groups exhibited decline in mean serum osmolarity. The 2 oral treatment failures in the sucrose group occurred in patients who could not absorb the solutions adequately. This study shows that oral therapy with sucrose is less efficient than oral therapy with glucose. However, in areas where only sucrose is available and where knowledge and means of using oral therapy exist, the oral sucrose solution can be used to treat most infants with diarrhea and 5 to 10% dehydration.