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1.
Nihon Shokakibyo Gakkai Zasshi ; 118(12): 1160-1166, 2021.
Artigo em Japonês | MEDLINE | ID: mdl-34897146

RESUMO

A 67-year-old man with a history of esophageal and gastric varices that were treated endoscopically was treated for Budd-Chiari syndrome and immunoglobulin G4-related sclerosing cholangitis in our facility. Varices in the second portion of the duodenum were revealed in follow-up upper endoscopy. The draining vein formed a venous plexus that was detected on computed tomography. Treatment with interventional radiology was difficult;therefore, endoscopic injection sclerotherapy (EIS) was performed instead. No recurrence has been observed to date. Thus, in this case, EIS for duodenal varices was effective.


Assuntos
Escleroterapia , Varizes , Idoso , Duodeno/diagnóstico por imagem , Gastroscopia , Humanos , Masculino , Soluções Esclerosantes/uso terapêutico , Escleroterapia/efeitos adversos , Varizes/diagnóstico por imagem , Varizes/terapia
2.
Stomatologiia (Mosk) ; 100(5): 30-37, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34752031

RESUMO

AIM: The article analyzes the results of treatment of children affected with lesions of blood vessels of the head and neck. The research is aimed at developing and implementing minimally invasive techniques to treat such children. MATERIAL AND METHODS: The study group comprised 4416 patients with hyperplasia of blood vessels (the so-called infantile and congenital hemangiomas) and 397 patients with blood vessel malformations, examined and treated from 1991 to 2020. RESULTS: The paper summarizes developed indications and the results of implementation of effective minimally invasive methods for the treatment of children with vascular lesions: radiofrequency thermal ablation and pulsed dye laser treatment of children with severe forms of arterio-venous malformation in their maxillofacial area and. The treatment is currently the golden standard that provides stable aesthetic results. CONCLUSION: The most optimal and preferred methods of vascular lesions treatment proved to be minimally invasive techniques that include: radiofrequency thermal ablation, interstitial laser coagulation, pulse phototherapy, sclerotherapy and systemic treatment of beta-blockers.


Assuntos
Hemangioma , Malformações Vasculares , Criança , Cabeça , Humanos , Pescoço , Escleroterapia
3.
Cochrane Database Syst Rev ; 10: CD012723, 2021 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-34637138

RESUMO

BACKGROUND: Telangiectasias (spider veins) and reticular veins on the lower limbs are very common, increase with age, and have been found in 41% of women. The cause is unknown and the patients may be asymptomatic or can report pain, burning or itching. Treatments include sclerotherapy, laser, intense pulsed light, microphlebectomy and thermoablation, but none is established as preferable. OBJECTIVES: To assess the effects of sclerotherapy, laser therapy, intensive pulsed light, thermocoagulation, and microphlebectomy treatments for telangiectasias and reticular veins. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, AMED and CINAHL databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 16 March 2021. We undertook additional searches in LILACS and IBECS databases, reference checking, and contacted specialists in the field, manufacturers and study authors to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that compared treatment methods such as sclerotherapy, laser therapy, intensive pulsed light, thermocoagulation, and microphlebectomy for telangiectasias and reticular veins in the lower limb. We included studies that compared individual treatment methods against placebo, or that compared different sclerosing agents, foam or laser treatment, or that used a combination of treatment methods. DATA COLLECTION AND ANALYSIS: Three review authors independently performed study selection, extracted data, assessed risks of bias and assessed the certainty of evidence using GRADE. The outcomes of interest were resolution or improvement (or both) of telangiectasias, adverse events (including hyperpigmentation, matting), pain, recurrence, time to resolution, and quality of life. MAIN RESULTS: We included 3632 participants from 35 RCTs. Studies compared a variety of sclerosing agents, laser treatment and compression. No studies investigated intensive pulsed light, thermocoagulation or microphlebectomy. None of the included studies assessed recurrence or time to resolution. Overall the risk of bias of the included studies was moderate. We downgraded the certainty of evidence to moderate or low because of clinical heterogeneity and imprecision due to the wide confidence intervals (CIs) and few participants for each comparison. Any sclerosing agent versus placebo There was moderate-certainty evidence that sclerosing agents showed more resolution or improvement of telangiectasias compared to placebo (standard mean difference (SMD) 3.08, 95% CI 2.68 to 3.48; 4 studies, 613 participants/procedures), and more frequent adverse events: hyperpigmentation (risk ratio (RR) 11.88, 95% CI 4.54 to 31.09; 3 studies, 528 participants/procedures); matting (RR 4.06, 95% CI 1.28 to 12.84; 3 studies, 528 participants/procedures). There may be more pain experienced in the sclerosing-agents group compared to placebo (SMD 0.70, 95% CI 0.06 to 1.34; 1 study, 40 participants; low-certainty evidence). Polidocanol versus any sclerosing agent There was no clear difference in resolution or improvement (or both) of telangiectasias (SMD 0.01, 95% CI -0.13 to 0.14; 7 studies, 852 participants/procedures), hyperpigmentation (RR 0.94, 95% CI 0.62 to 1.43; 6 studies, 819 participants/procedures), or matting (RR 0.82, 95% CI 0.52 to 1.27; 7 studies, 859 participants/procedures), but there were fewer cases of pain (SMD -0.26, 95% CI -0.44 to -0.08; 5 studies, 480 participants/procedures) in the polidocanol group. All moderate-certainty evidence. Sodium tetradecyl sulphate (STS) versus any sclerosing agent There was no clear difference in resolution or improvement (or both) of telangiectasias (SMD -0.07, 95% CI -0.25 to 0.11; 4 studies, 473 participants/procedures). There was more hyperpigmentation (RR 1.71, 95% CI 1.10 to 2.64; 4 studies, 478 participants/procedures), matting (RR 2.10, 95% CI 1.14 to 3.85; 2 studies, 323 participants/procedures) and probably more pain (RR 1.49, 95% CI 0.99 to 2.25; 4 studies, 409 participants/procedures). All moderate-certainty evidence. Foam versus any sclerosing agent There was no clear difference in resolution or improvement (or both) of telangiectasias (SMD 0.04, 95% CI -0.26 to 0.34; 2 studies, 187 participants/procedures); hyperpigmentation (RR 2.12, 95% CI 0.44 to 10.23; 2 studies, 187 participants/procedures) or pain (SMD -0.10, 95% CI -0.44 to 0.24; 1 study, 147 participants/procedures). There may be more matting using foam (RR 6.12, 95% CI 1.04 to 35.98; 2 studies, 187 participants/procedures). All low-certainty evidence. Laser versus any sclerosing agent There was no clear difference in resolution or improvement (or both) of telangiectasias (SMD -0.09, 95% CI -0.25 to 0.07; 5 studies, 593 participants/procedures), or matting (RR 1.00, 95% CI 0.46 to 2.19; 2 studies, 162 participants/procedures), and maybe less hyperpigmentation (RR 0.57, 95% CI 0.40 to 0.80; 4 studies, 262 participants/procedures) in the laser group. All moderate-certainty evidence. High heterogeneity of the studies reporting on pain prevented pooling, and results were inconsistent (low-certainty evidence). Laser plus sclerotherapy (polidocanol) versus sclerotherapy (polidocanol) Low-certainty evidence suggests there may be more resolution or improvement (or both) of telangiectasias in the combined group (SMD 5.68, 95% CI 5.14 to 6.23; 2 studies, 710 participants), and no clear difference in hyperpigmentation (RR 0.83, 95% CI 0.35 to 1.99; 2 studies, 656 participants) or matting (RR 0.83, 95% CI 0.21 to 3.28; 2 studies, 656 participants). There may be more pain in the combined group (RR 2.44, 95% CI 1.69 to 3.55; 1 study, 596 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: Small numbers of studies and participants in each comparison limited our confidence in the evidence. Sclerosing agents were more effective than placebo for resolution or improvement of telangiectasias but also caused more adverse events (moderate-certainty evidence), and may result in more pain (low-certainty evidence). There was no evidence of a benefit in resolution or improvement for any sclerosant compared to another or to laser. There may be more resolution or improvement of telangiectasias in the combined laser and polidocanol group compared to polidocanol alone (low-certainty evidence). There may be differences between treatments in adverse events and pain. Compared to other sclerosing agents polidocanol probably causes less pain; STS resulted in more hyperpigmentation, matting and probably pain; foam may cause more matting (low-certainty evidence); laser treatment may result in less hyperpigmentation (moderate-certainty evidence). Further well-designed studies are required to provide evidence for other available treatments and important outcomes (such as recurrence, time to resolution and delayed adverse events); and to improve our confidence in the identified comparisons.


Assuntos
Telangiectasia , Veias , Feminino , Humanos , Prurido/tratamento farmacológico , Escleroterapia , Telangiectasia/terapia
4.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(1): 94-97, 2021 Jan 09.
Artigo em Chinês | MEDLINE | ID: mdl-34645242

RESUMO

To analysis the treatment effectiveness of maxillofacial arteriovenous malformation (AVM) by means of temporary balloon block and percutaneous puncture sclerotherapy. The treatment outcomes of 20 patients with AVM of maxillofacial deformity, aged (26.8±3.0) 18-36 years, from Dec 2012 to Dec 2019 were collected and retrospectively analyzed. All patients had been diagnosed AVM by digital substraction angiography (DSA). All the cases were treated by using balloons to temporary block responsible artery of the AVM in order to change the high-flow malformations into low-flow venous malformation. Then injection of polyethylene foam cinnamyl alcohol was conducted via percutaneous puncturing for hardening the vascular malformation. Comparing the symptoms and imaging changes before treatment with those 1-6 months after treatment according to Achauer curative effect evaluation standard. Totally 60% (12/20) of the cases were type Ⅱa AVM, and their treatments were effective. However, the treatment effects of type Ⅲb and type Ⅳ patients were relatively poor. The clinical effective rate was 85% (17/20), and the clinical curative rate was 50% (10/20). No skin necrosis, organ damage and other serious complications were observed for the 20 patients. The AVM patients with a main supply artery treated by using a balloon artery temporary block to make high flow malformations into low-flow and followed by percutaneous puncture sclerotherapy, could get good curative effect. It seemed that this approach was safe and effective.


Assuntos
Malformações Arteriovenosas , Malformações Vasculares , Malformações Arteriovenosas/terapia , Humanos , Punções , Estudos Retrospectivos , Escleroterapia , Resultado do Tratamento
5.
Shanghai Kou Qiang Yi Xue ; 30(4): 444-448, 2021 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-34693443

RESUMO

PURPOSE: To investigate the clinical efficacy and safety of bipolar coagulation forceps combined with 1% lauromacrogol foam sclerotherapy in the treatment of microcystic lymphatic malformation of tongue. METHODS: The clinical data of 16 patients with microcystic lymphatic malformation of the tongue admitted to the Department of Stomatology of Foshan First People's Hospital from April 2017 to April 2020 were retrospectively analyzed, including 7 males and 9 females, aging from 15 months to 21 years. The average age of patients was 8.32±1.21 years. The efficacy and complications of the patients were evaluated. RESULTS: All 16 patients were followed up for 6 to 12 months. The clinical response was evaluated as eleven patients (68.75%) for grade Ⅳ, three (18.75%) for grade Ⅲ, two (12.5%) for grade Ⅱ, and the effective rate was 87.5%. Necrosis of tongue mucosa and muscle occurred in 1 patient. CONCLUSIONS: Bipolar coagulation forceps combined with 1% lauromacrogol foam sclerotherapy is a minimally invasive, safe and effective treatment for tongue microcystic lymphatic malformation.


Assuntos
Escleroterapia , Língua , Criança , Feminino , Humanos , Masculino , Polidocanol , Estudos Retrospectivos , Instrumentos Cirúrgicos
6.
Dermatol Ther ; 34(5): e15074, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34338412

RESUMO

Vascular malformations (VM) are congenital, benign, and relatively frequent lesions. Scant data have been published about the epidemiology, clinical presentation, and treatment of VM from a dermatologist's perspective. The substantial differences between subtypes, broad range of specialists consulted and confusing nomenclature used over previous years may hamper a correct diagnosis. The main objective of this study is to describe VM epidemiology. As a secondary endpoint we evaluate clinical characteristics, clinical-radiological correlation and treatment approaches. We carried out an observational, descriptive, retrospective study. Cases presented to the multidisciplinary committee of our hospital from 2009 to 2019 were retrieved. Electronic medical records, monthly committee reports and the iconographic archive were reviewed and statistically analyzed. Overall, venous malformations (VeM) are the most frequent VM, followed by capillary malformations (CM), arterioVeM and lymphatic malformations (LM). Considering only patients under 16, CMs are the most frequent ones. Capillary and LMs are larger than venous or arteriovenous. While CMs are usually asymptomatic, symptomatic cases are threefold more frequent in the other subtypes. Decisions on active or conservative management depend on VM size but not location or patient age. CMs are mainly treated with laser therapy; venous with sclerotherapy or surgery; arteriovenous with surgery and lymphatic with surgery or sirolimus. Dermatologists play an important role in VM diagnosis and management. Our 10-year multidisciplinary experience should contribute to the literature and represent a practical resource for clinicians and researchers.


Assuntos
Anormalidades Linfáticas , Malformações Vasculares , Humanos , Estudos Retrospectivos , Escleroterapia/efeitos adversos , Malformações Vasculares/diagnóstico , Malformações Vasculares/epidemiologia , Malformações Vasculares/terapia , Veias
7.
Cochrane Database Syst Rev ; 8: CD005624, 2021 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-34378180

RESUMO

BACKGROUND: Great saphenous vein (GSV) incompetence, causing varicose veins and venous insufficiency, makes up the majority of lower-limb superficial venous diseases. Treatment options for GSV incompetence include surgery (also known as high ligation and stripping), laser and radiofrequency ablation, and ultrasound-guided foam sclerotherapy. Newer treatments include cyanoacrylate glue, mechanochemical ablation, and endovenous steam ablation. These techniques avoid the need for a general anaesthetic, and may result in fewer complications and improved quality of life (QoL). These treatments should be compared to inform decisions on treatment for varicosities in the GSV. This is an update of a Cochrane Review first published in 2011. OBJECTIVES: To assess the effects of endovenous laser ablation (EVLA), radiofrequency ablation (RFA), endovenous steam ablation (EVSA), ultrasound-guided foam sclerotherapy (UGFS), cyanoacrylate glue, mechanochemical ablation (MOCA) and high ligation and stripping (HL/S) for the treatment of varicosities of the great saphenous vein (GSV). SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, and AMED databases, and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 2 November 2020. We undertook reference checking to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) treating participants for varicosities of the GSV using EVLA, RFA, EVSA, UGFS, cyanoacrylate glue, MOCA or HL/S. Key outcomes of interest are technical success, recurrence, complications and QoL. DATA COLLECTION AND ANALYSIS: Two review authors independently selected trials, applied Cochrane's risk of bias tool, and extracted data. We calculated odds ratios (ORs) with 95% confidence intervals (CIs) and assessed the certainty of evidence using GRADE. MAIN RESULTS: We identified 11 new RCTs for this update. Therefore, we included 24 RCTs with 5135 participants. Duration of follow-up ranged from five weeks to eight years. Five comparisons included single trials. For comparisons with more than one trial, we could only pool data for 'technical success' and 'recurrence' due to heterogeneity in outcome definitions and time points reported. All trials had some risk of bias concerns. Here we report the clinically most relevant comparisons. EVLA versus RFA Technical success was comparable up to five years (OR 0.98, 95% CI 0.41 to 2.38; 5 studies, 780 participants; moderate-certainty evidence); over five years, there was no evidence of a difference (OR 0.85, 95% CI 0.30 to 2.41; 1 study, 291 participants; low-certainty evidence). One study reported recurrence, showing no clear difference at three years (OR 1.53, 95% CI 0.78 to 2.99; 291 participants; low-certainty evidence), but a benefit for RFA may be seen at five years (OR 2.77, 95% CI 1.52 to 5.06; 291 participants; low-certainty evidence). EVLA versus UGFS Technical success may be better in EVLA participants up to five years (OR 6.13, 95% CI 0.98 to 38.27; 3 studies, 588 participants; low-certainty evidence), and over five years (OR 6.47, 95% CI 2.60 to 16.10; 3 studies, 534 participants; low-certainty evidence). There was no clear difference in recurrence up to three years and at five years (OR 0.68, 95% CI 0.20 to 2.36; 2 studies, 443 participants; and OR 1.08, 95% CI 0.40 to 2.87; 2 studies, 418 participants; very low-certainty evidence, respectively). EVLA versus HL/S Technical success may be better in EVLA participants up to five years (OR 2.31, 95% CI 1.27 to 4.23; 6 studies, 1051 participants; low-certainty evidence). No clear difference in technical success was seen at five years and beyond (OR 0.93, 95% CI 0.57 to 1.50; 5 studies, 874 participants; low-certainty evidence). Recurrence was comparable within three years and at 5 years (OR 0.78, 95% CI 0.47 to 1.29; 7 studies, 1459 participants; and OR 1.09, 95% CI 0.68 to 1.76; 7 studies, 1267 participants; moderate-certainty evidence, respectively). RFA versus MOCA There was no clear difference in technical success (OR 1.76, 95% CI 0.06 to 54.15; 3 studies, 435 participants; low-certainty evidence), or recurrence (OR 1.00, 95% CI 0.21 to 4.81; 3 studies, 389 participants; low-certainty evidence). Long-term data are not available. RFA versus HL/S No clear difference in technical success was detected up to five years (OR 5.71, 95% CI 0.64 to 50.81; 2 studies, 318 participants; low-certainty evidence); over five years, there was no evidence of a difference (OR 0.88, 95% CI 0.29 to 2.69; 1 study, 289 participants; low-certainty evidence). No clear difference in recurrence was detected up to three years (OR 0.93, 95% CI 0.58 to 1.51; 4 studies, 546 participants; moderate-certainty evidence); but a possible long-term benefit for RFA was seen (OR 0.41, 95% CI 0.22 to 0.75; 1 study, 289 participants; low-certainty evidence). UGFS versus HL/S Meta-analysis showed a possible benefit for HL/S compared with UGFS in technical success up to five years (OR 0.32, 95% CI 0.11 to 0.94; 4 studies, 954 participants; low-certainty evidence), and over five years (OR 0.09, 95% CI 0.03 to 0.30; 3 studies, 525 participants; moderate-certainty evidence). No clear difference was detected in recurrence up to three years (OR 1.81, 95% CI 0.87 to 3.77; 3 studies, 822 participants; low-certainty evidence), and after five years (OR 1.24, 95% CI 0.57 to 2.71; 3 studies, 639 participants; low-certainty evidence). Complications were generally low for all interventions, but due to different definitions and time points, we were unable to draw conclusions (very-low certainty evidence). Similarly, most studies evaluated QoL but used different questionnaires at variable time points. Rates of QoL improvement were comparable between interventions at follow-up (moderate-certainty evidence). AUTHORS' CONCLUSIONS: Our conclusions are limited due to the relatively small number of studies for each comparison and differences in outcome definitions and time points reported. Technical success was comparable between most modalities. EVLA may offer improved technical success compared to UGFS or HL/S. HL/S may have improved technical success compared to UGFS. No evidence of a difference was detected in recurrence, except for a possible long-term benefit for RFA compared to EVLA or HL/S. Studies which provide more evidence on the breadth of treatments are needed. Future trials should seek to standardise clinical terminology of outcome measures and the time points at which they are measured.


Assuntos
Ablação por Cateter , Veia Safena/cirurgia , Escleroterapia/métodos , Varizes/cirurgia , Insuficiência Venosa/cirurgia , Feminino , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Veia Safena/patologia
8.
J Obstet Gynaecol Res ; 47(11): 4081-4086, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34396645

RESUMO

Uterine arteriovenous fistula is a rare but life-threatening gynecologic entity. Meanwhile, long-term radiation exposure will do serious harm to doctors' health. So we improve the operation method to reduce the radiation exposure time. The patient, a 24-years-old woman with a history of dilation and curettage, had long-term menorrhagia and anemia. Uterine arteriovenous fistula was confirmed by ultrasonography and computed tomography angiograph. Percutaneous anhydrous ethanol sclerotherapy was performed under the guidance of the X-ray imaging. The patient was followed up for 2 years without recurrence and had normal menstruation. Recently, she is successfully pregnant again. Percutaneous anhydrous ethanol sclerotherapy is a new option treating uterine arteriovenous fistula, which can greatly shorten the irradiation time and reduce the recurrence rate and has no obvious adverse effect on fertility.


Assuntos
Fístula Arteriovenosa , Escleroterapia , Adulto , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Etanol , Feminino , Humanos , Gravidez , Ultrassonografia , Útero , Adulto Jovem
9.
Radiology ; 301(2): 464-471, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34402664

RESUMO

Background Percutaneous sclerotherapy with bleomycin has been proven to have a potential benefit in the management of low-flow venous malformations. Liver hemangiomas are considered low-flow venous malformations. Thus, percutaneous sclerotherapy could potentially have a promising result in their management. Purpose To investigate the feasibility, efficacy, and safety of percutaneous sclerotherapy with bleomycin in the management of symptomatic giant liver hemangioma (GLH). Materials and Methods This single-institute prospective study was conducted between September 2018 and July 2020. Percutaneous sclerotherapy was performed using a mixture of bleomycin and ethiodized oil under guidance of US and fluoroscopy in participants with GLH who were experiencing related abdominal pain or fullness. Technical success was recorded. Change in symptom severity, according to visual analog scale (VAS), was considered the primary outcome of the study. Volume change, based on the lesion volume at CT, and complications, based on the classification of the Society of Interventional Radiology, were regarded as secondary outcomes. The primary and secondary outcomes were recorded 6 and 12 months after the procedure. Comparison was performed by using the Wilcoxon signed-rank test or paired t test. Results Twenty-eight participants (mean age, 45 years ± 9; 25 women) were evaluated. Technical success was 100%. The mean VAS score was 8.3 before the procedure, which decreased to 1.4 (84.7% reduction) and 1.5 (83.5% reduction) at 6- and 12-month follow-ups, respectively (P < .001 for both). All participants reported relief of symptoms (17 of 28 participants [61%] with complete relief; 11 [39%] with partial relief) at 12-month follow-up. Mean GLH volumes dropped from 856.3 cm3 to 309.8 cm3 (65.7% reduction) and 206.0 cm3 (76% reduction) at 6- and 12-month follow-ups, respectively (P < .001 for both). No major complications were detected. Conclusion Percutaneous sclerotherapy is a safe and feasible method with promising results in the treatment of patients with symptomatic giant liver hemangioma. Clinical trial registration no. NCT03649113 © RSNA, 2021 See also the editorial by McGahan and Goldman in this issue.


Assuntos
Bleomicina/uso terapêutico , Óleo Etiodado/uso terapêutico , Hemangioma/terapia , Neoplasias Hepáticas/terapia , Escleroterapia/métodos , Adulto , Idoso , Antibióticos Antineoplásicos/uso terapêutico , Estudos de Viabilidade , Feminino , Seguimentos , Hemangioma/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Soluções Esclerosantes/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
AJNR Am J Neuroradiol ; 42(10): 1859-1864, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34446456

RESUMO

BACKGROUND AND PURPOSE: Two-thirds of lymphatic malformations in children are found in the head and neck. Although conventionally managed through surgical resection, percutaneous sclerotherapy has gained popularity. No reproducible grading system has been designed to compare sclerotherapy outcomes on the basis of radiologic findings. We propose an MR imaging-based grading scale to assess the response to sclerotherapy and present an evaluation of its interrater reliability. MATERIALS AND METHODS: A grading system was developed to stratify treatment outcomes on the basis of interval changes observed on MR imaging. By means of this system, 56 consecutive cases from our institution with formally diagnosed head and neck lymphatic malformations treated by sclerotherapy were retrospectively graded. Each patient underwent pre- and posttreatment MR imaging. Each study was evaluated by 3 experienced neuroradiologists. Interrater reliability was assessed using the Krippendorff α statistic, intraclass coefficient, and 2-way Spearman ρ correlation. RESULTS: The overall Krippendorff α statistic was 0.93 (95% CI, 0.89-0.95), denoting excellent agreement among raters. Intraclass coefficients with respect to consistency and absolute agreements were both 0.97 (95% CI, 0.96-0.98), illustrating low variability. Every combination of individual rater pairs demonstrated statistically significant (P < .01) linear Spearman ρ correlations, with values ranging from 0.90 to 0.95. CONCLUSIONS: The proposed radiographic grading scale demonstrates excellent interrater reliability. Adoption of this new scale can standardize reported outcomes following sclerotherapy for head and neck lymphatic malformation and may aid in the investigation of future questions regarding optimal management of these lesions.


Assuntos
Anormalidades Linfáticas , Criança , Cabeça/diagnóstico por imagem , Humanos , Anormalidades Linfáticas/diagnóstico por imagem , Anormalidades Linfáticas/terapia , Pescoço/diagnóstico por imagem , Reprodutibilidade dos Testes , Estudos Retrospectivos , Escleroterapia , Resultado do Tratamento
12.
Vasc Health Risk Manag ; 17: 379-387, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239304

RESUMO

Objective: This study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV). Design: Prospective, single-centre, analytical cohort. Materials and Methods: Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked. Results: The sample was divided into two groups: (Group 1) GSV diameter ≥13.0 mm (median 19.0 [14-24]), 17 subjects, and (Group 2) GSV diameter ≤12.9 mm (median 10.3 [10-12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time. Conclusion: Exclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.


Assuntos
Ablação por Cateter , Veia Safena/cirurgia , Escleroterapia , Varizes/terapia , Adulto , Assistência Ambulatorial , Ablação por Cateter/efeitos adversos , Terapia Combinada , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Escleroterapia/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/diagnóstico por imagem , Varizes/fisiopatologia
14.
BMJ Case Rep ; 14(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253510

RESUMO

Spinal epidermoid cysts are rare lesions and epidermoid cyst in intramedullary location is even rarer. Surgical excision is the mainstay of treatment; however, in cases of recurrence, repeat surgery becomes quite difficult. Treatment of recurrent intramedullary epidermoid cyst by surgery alone is a challenge. We managed one such rare case with repeated aspiration and sclerotherapy. Here, we have highlighted hypertonic saline sclerotherapy as a promising tool to treat recurrent spinal epidermoid cysts.


Assuntos
Cisto Epidérmico , Transtornos Respiratórios , Cisto Epidérmico/cirurgia , Humanos , Recidiva Local de Neoplasia , Reoperação , Escleroterapia
15.
Cardiovasc Intervent Radiol ; 44(10): 1543-1550, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34286368

RESUMO

PURPOSE: To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand. MATERIALS AND METHODS: A retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig's classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments. RESULTS: The mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig's classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients. CONCLUSION: Percutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients. LEVEL OF EVIDENCE: Level 4, Retrospective study.


Assuntos
Soluções Esclerosantes , Escleroterapia , Humanos , Polidocanol , Estudos Retrospectivos , Soluções Esclerosantes/uso terapêutico , Resultado do Tratamento
16.
Einstein (Sao Paulo) ; 19: eGS5920, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34287565

RESUMO

OBJECTIVE: To evaluate the outcomes and costs associated with surgery versus sclerotherapy as treatment of hydroceles. METHODS: A total of 53 men consecutively treated for hydrocele at our organization, between December 2015 and June 2019, were retrospectively analyzed (39 with Jaboulay technique and 14 with sclerotherapy). All charts were reviewed, assessing clinical data, ultrasound findings, surgical data, and post-procedure outcomes. The hospital finance department calculated the cost of outpatient evaluation, complementary tests, supplies, drugs, and professionals' costs throughout all procedures. RESULTS: The median age for both groups was similar (58 and 65 years old). Comorbidities were less frequent in the Surgery Group (20; 51%) than in the Sclerotherapy Group (14; 100%, p<0.05). The median length of hospital stay was 34.5±16.3 hours for the Surgery Group and 4 hours for the Sclerotherapy Group. The mean follow-up period was similar for both groups (85.4±114.8 days after surgery, and 60.9±80.1 days after sclerotherapy, p=0.467). No significant complications occurred in any patient. Success rates were 94.8% after surgery and 92.8% after sclerotherapy. The mean cost per patient was US$2,558.69 in the Surgery Group (Hydrocelectomy Group) and US$463.58 in the Sclerotherapy Group (p<0.0001). Costs directly related to in-hospital treatment procedures were significantly higher for surgery versus sclerotherapy (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0.0001). CONCLUSION: Sclerotherapy is an excellent treatment option for idiopathic hydrocele as compared to traditional Jaboulay. It has a high success rate, low complication rates, fast discharge and patients return quicker to activities of daily living.


Assuntos
Escleroterapia , Hidrocele Testicular , Atividades Cotidianas , Idoso , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Hidrocele Testicular/terapia
17.
BMC Surg ; 21(1): 284, 2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34090388

RESUMO

BACKGROUND: Full-thickness rectal prolapse (FTRP) frequently occurs in elderly women, and more than 100 surgical procedures have been proposed to restore FTRP. The Gant-Miwa-Thiersch (GMT) procedure is the most used treatment in China. However, the recurrence rate of FTRP post-GMT, which is as high as 23.8%, is concerning. We described a new modified GMT combined with internal and external rectal sclerosant injection (nmGMTSI) procedure to address this problem. METHODS: The nmGMTSI was performed under spinal anesthesia in 34 frail, elderly female patients with FTRP. The surgical results of FTRP were assessed. Fecal incontinence and constipation were evaluated using the Wexner score, and anal canal rest pressure (ACRP), maximum anal systolic pressure (MASP), anorectal sensation thresholds (AST), and maximum rectal tolerance (MRT) using anorectal manometry preoperatively and postoperatively. The causes of recurrence and complications were analyzed. RESULTS: All patients were cured according to the clinical cure standard. The perioperative Wexner fecal incontinence score (WFIS) was 10.3 ± 3.31, which became 3.7 ± 2.43 (P < 0.0001) postoperatively. The perioperative ACRP was 2.0 ± 0.56 kPa, which became 8.5 ± 2.25 kPa (P < 0.0001) postoperatively. The perioperative MASP was 4.5 ± 1.16 kPa, which became 18.6 ± 2.50 kPa (P < 0.0001) postoperatively. However, no significant difference was observed between the preoperative and postoperative Wexner constipation scores (WCS) (17.3 ± 2.25 vs. 15.4 ± 2.89, P = 0.1047). The perioperative and postoperative AST were 38.1 ± 5.34 mL and 23.5 ± 3.61 mL, respectively (P = 0.0002). The maximum rectal tolerance (MRT) was 157.1 ± 16.73 mL, which became 121.2 ± 12.45 mL postoperatively (P = 0.0009). The patients developed no serious postoperative complications. The total relapse rate after nmGMTSI was 2.9% in the median two years follow-up period. The most common cause of relapse after nmGMTSI was the removal of infected threads used in the Thiersch procedure. CONCLUSION: The benefits of nmGMTSI include low rates of recurrence, complications, and mortality, cost-effectiveness, wide adaptation, minimal invasiveness, and technical simplicity. Hence, it should be considered the first option for the treatment of FTRP in frail elderly women.


Assuntos
Prolapso Retal , Soluções Esclerosantes , Idoso , China , Feminino , Humanos , Prolapso Retal/cirurgia , Reto/cirurgia , Escleroterapia
18.
J Cardiovasc Surg (Torino) ; 62(5): 456-466, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34105926

RESUMO

The often inexorable growth and expansion of congenital vascular malformations can result in substantial morbidity and, in some cases, premature death of these patients. Despite this, patients suffering from such lesions are often erroneously diagnosed and/or inadequately treated, due to a lack of expertise among primary care practitioners as well as specialists. Venous malformations are the most common type of congenital vascular malformations. Over the last two decades management of these lesions has significantly improved, predominantly due to the introduction and implementation of multidisciplinary team concept as well as improvement in diagnostic and treatment modalities. Relatively recently genetic studies are providing more insights into underlying pathophysiological mechanisms responsible for the development and progression of venous malformations and pharmacotherapy is becoming extensively evaluated for safety and efficacy in the treatment of these often challenging vascular lesions.


Assuntos
Tratamento Conservador , Procedimentos Endovasculares , Escleroterapia , Malformações Vasculares/terapia , Procedimentos Cirúrgicos Vasculares , Veias/cirurgia , Terapia Combinada , Tratamento Conservador/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Humanos , Fatores de Risco , Escleroterapia/efeitos adversos , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Veias/anormalidades , Veias/diagnóstico por imagem , Veias/fisiopatologia
19.
Georgian Med News ; (313): 26-33, 2021 Apr.
Artigo em Russo | MEDLINE | ID: mdl-34103425

RESUMO

The aim of the study is to substantiate the surgical treatment tactics of recurrence varicose veins after endovenous interventions. Early and long-term results of the treatment, quality of life of patients with recurrence of varicose veins were studied. Among the admitted patients, there were 55 (65.5%) women and 29 (34.5%) men, the age of patients varied from 19 to 76 years. Of these, 9 patients underwent crossectomy, endovenous laser coagulation - 22, various stripping options - 4, echosclerotherapy - 20, intraoperative catheter sclerobliteration - 1, ligation of perforating veins - 28 patients. The choice of the treatment method depends on the data of duplex angioscanning, the source of recurrence, the diameter and length of the varicose veins. In the early postoperative period 18 (22.6%) patients had complications and side effects. Most often hyperpigmentation and neurological disorders developed, which were observed in 8 (9.5%) and 7 (8.3%) cases. 2 (2.4%) patients had a slightly painful dense cord after endovenous laser coagulation. 1 (1.2%) patient had a lymphocele in the inguinal incision area. This complication was eliminated by use of the puncture treatment method. Long-term results in terms of 1 to 3 years were studied in 82 (97.6%) patients. In the long-term period, 1 (1.2%) patient noted the varicose veins recurrence due to neovasculogenesis in the groin. The patient underwent micro-foam echosclerotherapy. Patient`s quality of life was studied by using the CIVIQ2 questionnaire before and 1 year after treatment. It was found that 4 main indicators of the quality of life in the long-term period improved by 35.6-48.8% of the preoperative values. At the same time, the most significant positive dynamics of psychological (48.8%) and pain (47.1%) factors was observed. The results justify the need for a differentiated approach, taking into account the individual characteristics of the disease, as well as the expediency of using minimally invasive techniques in patients with varicose veins recurrence.


Assuntos
Ablação por Cateter , Terapia a Laser , Varizes , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Recidiva , Veia Safena/cirurgia , Escleroterapia , Resultado do Tratamento , Varizes/cirurgia , Adulto Jovem
20.
Shanghai Kou Qiang Yi Xue ; 30(2): 145-150, 2021 Apr.
Artigo em Chinês | MEDLINE | ID: mdl-34109352

RESUMO

PURPOSE: To explore the DSA classification and treatment strategy of tongue venous malformation. METHODS: From February 2016 to February 2019, the DSA manifestations of 132 cases with venous malformations of the tongue were summarized. They were classified into 4 types according to imaging characteristics: typeⅠ(non-drainage type), typeⅡ(lower- drainage type), type Ⅲ (higher-drainage type), type Ⅳ(extensive type). Different therapeutic schemes were selected according to the types. The non- drainage type was treated with pingyangmycin alone, the lower-drainage type was treated with lauromacrogol foam alone, the higher- drainage type was treated with absolute alcohol combined with lauromacrogol foam, the extensive type was treated as higher-drainage type first and then combined with plastic resection. Among the cases, therapeutic effects and adverse reactions of each group were recorded and compared. RESULTS: One hundred and thirty-two cases in this study were followed up for 12 to 41 months with an average of 15.8 months. After sclerosing therapy, the venous malformations of the tongue of all patients significantly reduced or even disappeared. Type Ⅰincluded 8 cases with an efficiency of 100%, type Ⅱ included 17 cases with an efficiency of 100%, type Ⅲ included 98 cases with an efficiency of 90.8%, typeⅣincluded 9 cases, with an efficiency of 77.8%.The main adverse reactions were tissue necrosis: 0 in typeⅠ, 1(5.88%) in typeⅡ, 16(16.33%) in type Ⅲ, and 7(77.78%) in type Ⅳ. CONCLUSIONS: The classification of venous malformations of the tongue based on DSA is significant and valuable in guiding clinical treatment. The majority of tongue venous malformations are type Ⅲ, and the smallest propotion is type Ⅰ. Transmucosal sclerotherapy with absolute ethanol is of significance for the treatment of venous malformations of the tongue classified in type Ⅲ and type Ⅳ.


Assuntos
Soluções Esclerosantes , Malformações Vasculares , Humanos , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Língua/diagnóstico por imagem , Resultado do Tratamento , Malformações Vasculares/tratamento farmacológico , Malformações Vasculares/terapia
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