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1.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1194-1199, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353276

RESUMO

Objective: Currently, various treatments such as hemorrhoidectomy, ligation and sclerotherapy injection can be applied in grade II or III hemorrhoids. This study aims to compare the clinical efficacy, safety and economy between Shaobei injection and elastic band ligation in treating patients with grade II or grade III hemorrhoids. Methods: A retrospective cohort study was used. Clinical data of 60 patients with grade II or grade III hemorrhoids at Department of Anorectal Surgery of the Sixth Affiliated Hospital, Sun Yat-sen University between January 2019 and October 2019 were collected. Patients were divided into two groups according to surgical methods. Patients in the Shaobei group received Shaobei injection (n=28), and those in the ligation group received elastic band ligation (n=32). Inclusion criteria: (1) diagnosis of grade II or III hemorrhoid; (2) application of Shaobei injection or elastic band ligation; (3) age between 18-75 years old. Exclusion criteria: (1) comorbidity with anal fissure, anal fistula, anal sinusitis or other perianal diseases; (2) patients with mental disorder or poor compliance; (3) incomplete clinical or follow-up data. Recurrent rate, postoperative pain, anal edema, anal distension, total cost of hospitalization, length of hospitalization, and postoperative life quality EQ-5D-3L score were compared between the two groups at postoperative 6-month. Results: No significant difference was observed in the baseline data (including Nystrom hemorrhoid symptom score) between the two groups (all P>0.05), except gender ratio [male proportion: Shaobei 75% (21/28) vs. ligation 37.5%(12/32), χ(2)=8.485, P=0.004]. No significant difference in recurrent rate was found between the two groups [14.3% (4/28) vs. 9.4% (3/32), χ(2)=0.035, P=0.851]. Compared to the ligation group, Shaobei group showed less pain at postoperative day 1 [VAS median (range): 2 (1-6) vs. 3 (1-7), Z=2.814, P=0.005] and postoperative day 7 [VAS median (range): 0 (0-2) vs. 1 (0-4), Z=3.149, P=0.002]; lower anal edema ratio at postoperative day 1 [10.7% (3/28) vs. 34.4% (11/32), Z=4.673, P=0.037]; lower anal distension ratio at postoperative day 1 [7.1% (2/28) vs. 28.1% (9/32), Z=4.391, P=0.048]; less hospitalization cost [(6343.5±1444.1) yuan vs. (10 587.1± 1719.0) yuan, t=12.515, P<0.001] and shorter postoperative hospital stay [median (range): 1 (1-5) days vs. 3 (1-6) days, Z=5.879, P<0.001]. The EQ-5D-3L scores of two groups were significantly improved six months after treatment [Shaobei group: (0.90±0.16) vs. (0.73±0.14); ligation group: (0.91±0.13) vs. (0.74±0.10); both P<0.001], while there was no statistically significant difference between the two groups (t=0.130, P=0.897). No complications such as massive hemorrhage, infection, iatrogenic anal fistula, rectal stricture and local induration occurred after the injection. Conclusions: Shaobei injection is effective and safe in treating grade II or III hemorrhoids. Compared with elastic band ligation, it can reduce morbidity of complications and hospitalization expenses.


Assuntos
Hemorroidectomia , Hemorroidas , Ligadura , Escleroterapia , Adolescente , Adulto , Idoso , Feminino , Hemorroidectomia/efeitos adversos , Hemorroidectomia/economia , Hemorroidectomia/métodos , Hemorroidas/economia , Hemorroidas/cirurgia , Hemorroidas/terapia , Custos Hospitalares , Hospitalização/economia , Humanos , Injeções Intralesionais/efeitos adversos , Injeções Intralesionais/economia , Injeções Intralesionais/métodos , Ligadura/efeitos adversos , Ligadura/economia , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escleroterapia/efeitos adversos , Escleroterapia/economia , Escleroterapia/métodos , Resultado do Tratamento , Adulto Jovem
2.
Khirurgiia (Mosk) ; (10): 60-67, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33047587

RESUMO

OBJECTIVE: To improve prediction of recurrent bleeding after endoscopic sclerotherapy of esophageal varices. MATERIAL AND METHODS: A prospective, observational, case-control study was performed. Immediate and long-term results of endoscopic sclerotherapy of esophageal varices were studied in 91 patients for the period from 2002 to 2016. Multiple regression analysis with binary response model was applied to analyze the prediction models. RESULTS: Recurrent bleeding occurred in 80.5 (20; 182) days after sclerotherapy (range 0-2557 days). Spearman's correlation analysis revealed a significant relationship between bleeding recurrence and erythrocyte count (R= -0.32), Child-Pugh class of liver cirrhosis (R=0.49), Child-Pugh score (5-15) (R=0.54), content of amino acids, HPro/Pro ratio (R=0.71). Prognostic indicators were selected by stepwise inclusion of predictors. Thus, the final version of regression equation is as follows: Y=exp (-0.17+0.93×Child-Pugh score-106.42×HPro/Pro)/[1+exp(-0.17+0.93×Child-Pugh score-106.42×HPro/Pro)]. High risk of recurrent bleeding from esophageal varices within 1 year after endoscopic sclerotherapy is determined by Y-value >0.5. An accuracy of this model is 89.6%, Se 94.3%, Sp 79.2%, PPV 90.9%, NPV 86.4%, OR 63.3, LR + 4.53, LR - 0.07. CONCLUSION: Thus, the proposed method is highly informative, effective, available and can be widely used in clinical practice.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/etiologia , Escleroterapia/efeitos adversos , Estudos de Casos e Controles , Criança , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/tratamento farmacológico , Varizes Esofágicas e Gástricas/cirurgia , Esofagoscopia/efeitos adversos , Esofagoscopia/métodos , Humanos , Prognóstico , Estudos Prospectivos , Recidiva , Medição de Risco , Escleroterapia/métodos
3.
PLoS One ; 15(9): e0239846, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32986747

RESUMO

OBJECTIVE: To examine the impact of ethanol sclerotherapy (EST) for endometrioma on in vitro fertilization (IVF) cumulative live birth rates (CLBR) in women with moderate-severe endometriosis. METHODS: This retrospective cohort study included women with moderate-severe endometriosis (revised American Fertility Society stage III-IV) and endometrioma who underwent IVF with the ultra-long agonist protocol. We compared two groups: women undergoing EST for endometrioma before IVF (EST group), and women whose endometrioma was left in situ during IVF (No-EST group). The primary outcome was the CLBR per IVF cycle, including fresh and frozen embryo transfers. The secondary endpoints included the complication rate, number of mature oocytes retrieved, clinical pregnancy rate and pregnancy loss rate. RESULTS: Seventy-four women were included in the study, with 37 in the EST group and 37 in the No-EST group, representing 67 and 69 IVF cycles, respectively. The population and cycle characteristics were comparable between the two groups, especially the ovarian response to stimulation. The CLBR was significantly increased in the EST group compared to the No-EST group (31.3% vs. 14.5%, p = 0.03). The clinical and biochemical pregnancy rates were significantly increased in the EST group (37.3% vs. 15.9%, p = 0.01 and 43.3% vs. 23.2%, p = 0.01, respectively). Multivariate analysis revealed a significantly increased chance of live birth in women exposed to EST before IVF with an adjusted OR of 2.68 (95% confidence interval, CI: 1.13-6.36, p = 0.02). In the EST group, we reported one major complication Clavien and Dindo classification grade III, complication involving an ovarian abscess that required a laparoscopic drainage. CONCLUSIONS: EST is an interesting technique to improve IVF success rates in women with moderate-severe endometriosis. EST could be discussed before IVF in infertile women.


Assuntos
Coeficiente de Natalidade , Endometriose/terapia , Etanol/uso terapêutico , Fertilização In Vitro/métodos , Nascimento Vivo , Escleroterapia/métodos , Adulto , Transferência Embrionária/métodos , Feminino , Seguimentos , Humanos , Infertilidade Feminina/terapia , Recuperação de Oócitos/métodos , Gravidez , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas/métodos
4.
Medicine (Baltimore) ; 99(34): e21726, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846792

RESUMO

RATIONALE: The most common critical incidents in pediatric anesthesia are perioperative respiratory adverse events (PRAE), which occur more often in neonates and account for one-third of anaesthesia-related cardiac arrests. It is crucial to maintain an open stable airway during anesthesia in neonates, as this population has a low oxygen reserve, small airways, and the loss of protective airway reflexes under general anesthesia. PATIENT CONCERNS: A 6-day-old premature newborn underwent minimally invasive sclerotherapy under general anesthesia. For high-risk premature neonates, the selections of the anesthesia and airway device are extremely important, as those factors directly affect the prognosis. DIAGNOSES: B ultrasound and computed tomography (CT) revealed a large mass from the left chest wall to axilla, which was suspected to be a lymphocele. INTERVENTIONS: Minimally invasive sclerotherapy was performed under inhalation anesthesia. After the initiation of anesthesia, a laryngeal mask was placed to control airway. Anesthesia was maintained intraoperatively via sevoflurane inhalation with spontaneous breathing. No accidental displacements or PRAE occurred. OUTCOME: The operation and anesthesia process was stable and safe. The patient discharged at 2 days postoperatively. LESSONS: Minimally invasive sclerotherapy in a premature neonate is an operation with an extremely short operation time and minimal trauma, but a very high anesthesia risk and risk of PRAE. Anesthesia management is very important in a premature neonate undergoing a very short surgery under general anesthesia. Total sevoflurane inhalation general anesthesia and laryngeal mask airway control with spontaneous breathing may be an ideal option to reduce PRAE during very short surgery in a premature neonate.


Assuntos
Anestesia Geral/métodos , Recém-Nascido Prematuro , Linfocele/cirurgia , Escleroterapia/métodos , Parede Torácica/cirurgia , Humanos , Recém-Nascido , Parede Torácica/patologia
5.
Med. oral patol. oral cir. bucal (Internet) ; 25(4): e468-e473, jul. 2020. tab
Artigo em Inglês | IBECS | ID: ibc-196498

RESUMO

BACKGROUND: This study compared three different concentrations of EO (1.25%, 2.5% and 5%) for the treatment of oral vascular anomalies (OVAs). MATERIAL AND METHODS: This was a retrospective comparative analysis of patients with OVAs treated with EO. Anomalies smaller than 20 mm were included. The patients were treated with 1.25% (G1), 2.5% (G2), and 5% (G3) and clinical data were obtained. The number of sessions, the final volume and dose of EO were statistically analyzed to verify effectiveness and safety of the treatment. The different concentrations of EO were compared considering the number of sessions, the final volume and total dose of EO. Analysis of covariance (ANCOVA) was used to evaluate the influence of covariates on the outcomes. A p-value < 0.05 was considered significant. RESULTS: Nineteen women and 11 men with a median age of 54 years were included. The OVAs were most frequent in the lip (n = 14) and cheek (n = 9). All lesions exhibited complete clinical healing within 28 days. Patients of G3 required fewer sessions than those of G2 (p = 0.017), a lower final volume compared to the other groups (p < 0.001), and a lower total dose than G1 (p < 0.001). Patients of G1 used a lower total dose than G2 (p = 0.003). CONCLUSIONS: The concentration of 5% EO performed better than 1.25% and 2.5% for sclerotherapy of OVAs measuring up to 20 mm. This preliminary result should be the preferred concentration of EO to provide an effective and safe treatment of OVAs


No disponible


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Ácidos Oleicos/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Malformações Vasculares/terapia , Boca/irrigação sanguínea , Estatísticas não Paramétricas , Fatores de Tempo , Resultado do Tratamento , Reprodutibilidade dos Testes , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 99(24): e20721, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32541523

RESUMO

The aim of this study was to compare the efficacy and safety of cap-assisted endoscopic injection sclerotherapy (EIS) versus direct EIS in the management of esophageal variceal bleeding in patients with cirrhosis.This retrospective study included patients with cirrhosis and esophageal variceal bleeding who underwent EIS with or without the use of a transparent cap at Shandong Provincial Hospital between December 2014 and April 2017. Patients were divided into two groups: Group A (EIS with transparent cap, n = 50) and Group B (direct EIS, n = 45). Data collected included patients' demographics, procedure details, and rates of variceal eradication, variceal rebleeding, variceal recurrence, and survival during the follow-up period. All data were expressed as mean ±â€ŠSD. Quantitative variables were compared with Student t test; qualitative variables were compared with the Fisher exact test or chi-square test. P values less than .05 were considered significant.The mean follow-up duration was similar in both groups (16.3 ±â€Š10.2 mo in Group A and 15.5 ±â€Š9.5 mo in Group B). The volume of sclerosant (64.86 ±â€Š10.62 vs 104.73 ±â€Š21.25 ml, P = .044), mean number of sessions (2.37 ±â€Š1.15 vs 5.70 ±â€Š1.57, P = .042), time required to perform endoscopic treatment (6.57 ±â€Š1.50 vs 11.22 ±â€Š2.29 minutes, P = .049), and time to initial esophageal varices eradication (5.43 ±â€Š1.38 vs 8.93 ±â€Š1.5 wk, P = .041) were significantly smaller in the cap-assisted EIS group than in the direct EIS group. The probability of variceal recurrence and rebleeding was significantly higher in the direct EIS group than in the cap-assisted EIS group (14% versus 35.6% and 20% versus 40%). Only 22 patients (44%) developed complications in the cap-assisted group versus 30 patients (66.7%) in the EIS group (P = .039). The probability of survival was similar in both groups (86% versus 75.6%, P = .133).Modified EIS with the use of a transparent cap resulted in lower rates of esophageal variceal recurrence, rebleeding, and complications, compared with direct EIS.


Assuntos
Endoscopia , Varizes Esofágicas e Gástricas/terapia , Escleroterapia/métodos , Adulto , Desenho de Equipamento , Varizes Esofágicas e Gástricas/complicações , Feminino , Humanos , Injeções/instrumentação , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escleroterapia/instrumentação , Resultado do Tratamento
7.
Medicine (Baltimore) ; 99(22): e20332, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32481409

RESUMO

BACKGROUND: There is a continued discussion on which is the best sclerosant to treat lower extremity varicose veins. Therefore, we did this meta-analysis to determine that foam sclerotherapy versus liquid sclerotherapy, which could perform better in the treatment of lower extremity varicose veins. MATERIALS AND METHODS: We independently searched 5 databases from inception to February 1, 2019, for randomized controlled trials and prospective controlled trials for comparing foam sclerotherapy and liquid sclerotherapy for the treatment of lower extremity varicose veins. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. The primary outcome and secondary outcomes were analyzed using stata 15.0. This meta-analysis was performed according to Cochrane Handbook. RESULTS: There were significant differences in effective rate (P < .001, odd ratios = 5.64, 95% confidence interval = 3.93-8.10) and incidence rate of pain (P = .030, odd ratios = 1.52, 95% confidence interval = 1.04-2.21) between foam sclerotherapy and liquid sclerotherapy. And there were no significant differences among local inflammation (P = .896, rate difference = 0.00, 95% confidence interval = -0.03 to 0.03), thrombophlebitis (P = .90, rate difference = 0.00, 95% confidence interval = -0.02 to 0.02) and hyperpigmentation (P = .336, rate difference = 0.05, 95% confidence interval = -0.05 to 0.14). CONCLUSIONS: Although foam sclerotherapy has a higher incidence rate of complications, it could achieve a more stable clinical efficacy in the treatment of lower extremity varicose veins than liquid sclerotherapy.


Assuntos
Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Varizes/tratamento farmacológico , Ensaios Clínicos como Assunto , Humanos , Incidência , Perna (Membro) , Estudos Prospectivos , Recidiva , Projetos de Pesquisa , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/efeitos adversos
8.
Khirurgiia (Mosk) ; (5): 87-92, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32500695

RESUMO

OBJECTIVE: To evaluate the results of treatment of recurrent nodular goiter using sclerotherapy with polidocanol. MATERIAL AND METHODS: A comparative analysis of sclerotherapy (30 patients) and conventional surgical treatment (17 patients) of recurrent goiter was performed. RESULTS: Sclerotherapy ensures reduction of nodes (linear dimensions of nodes decreased by 14.2±1.1 mm after 3 courses), correction of endocrine imbalance in patients with functional autonomy and relief of initial signs of cervical organ compression in all patients with recurrent goiter. Sclerotherapy is associated with less pain syndrome and no need for inpatient treatment. However, the most significant advantage is reduced risk of complications. Hypoparathyroidism and laryngeal paresis developed in 53 and 24% of patients after conventional surgery while these events were not observed after sclerotherapy. CONCLUSION: Sclerotherapy with polidocanol is a perspective alternative to conventional surgery for recurrent nodular goiter.


Assuntos
Bócio Nodular/terapia , Polidocanol/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Bócio Nodular/cirurgia , Humanos , Recidiva , Escleroterapia/métodos , Tireoidectomia
9.
Clin Imaging ; 65: 8-14, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32353719

RESUMO

PURPOSE: Venous malformations (VMs) are low-flow vascular anomalies that are commonly treated with image-guided percutaneous sclerotherapy. Although many VMs can be safely accessed and treated using ultrasonography and fluoroscopy, some lesions may be better treated with magnetic resonance imaging (MRI)-guided sclerotherapy. The aim of this study is to evaluate the feasibility, efficiency, and outcomes of MRI-guided sclerotherapy of VMs using a 3T MRI system. METHODS: Six patients with VMs in the neck (n = 2), chest (n = 1), and extremities (n = 3) underwent sclerotherapy with 3T MRI guidance. Feasibility was assessed by calculating the technical success rate and procedural efficiency. Efficiency was evaluated by using planning, targeting, intervention, and total procedure times. Outcomes were assessed by measuring VM volumes before and after sclerotherapy, patient-reported pain scores, and occurrence of complications. RESULTS: Technical success was achieved in all 6 procedures. There was a non-significant 30% decrease in mean VM volume after the procedure (P = .350). The procedure resulted in a decrease in mean pain score (on an 11-point scale) of 2.6 points (P = .003). After the procedure, 4 patients reported complete pain resolution, 1 reported partial pain resolution, and 1 reported no change in pain. Procedural efficiency was consistent with similar sclerotherapy procedures performed at our institution. There were no major or minor complications. CONCLUSION: 3T MRI guidance is feasible for percutaneous sclerotherapy of VMs, with promising initial technical success rates, procedural efficiency, and therapeutic outcomes without complications.


Assuntos
Escleroterapia/métodos , Malformações Vasculares/diagnóstico por imagem , Adolescente , Adulto , Feminino , Fluoroscopia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pescoço/patologia , Estudos Retrospectivos , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/efeitos adversos , Soluções Esclerosantes/uso terapêutico , Resultado do Tratamento , Ultrassonografia , Veias/patologia
10.
Intern Med ; 59(14): 1727-1730, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32238724

RESUMO

Small-bowel hemangiomas are a possible source of gastrointestinal bleeding for which there is no established treatment approach. In this report, we describe the case of a 58-year-old woman who presented with hematochezia and who was diagnosed with small bowel hemangioma. She was successfully treated using endoscopic sclerotherapy. Initial capsule endoscopy revealed bleeding in the ileum. Subsequent double-balloon enteroscopy showed a 2-cm, bluish-purple, ileal submucosal tumor with an overlying protrusion. The lesion was responsible for the hematochezia and was treated with intralesional injection of polidocanol. The hematochezia completely resolved and at 4 months after sclerotherapy, the size of the lesion was significantly reduced.


Assuntos
Enteroscopia de Duplo Balão/métodos , Hemangioma/tratamento farmacológico , Hemangioma/cirurgia , Neoplasias do Íleo/tratamento farmacológico , Neoplasias do Íleo/cirurgia , Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
13.
Am J Otolaryngol ; 41(4): 102463, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32229044

RESUMO

Treatment of thoracic duct leaks can be very challenging. Intractable chlye leaks may require image-guided methods to increase the likelihood of treatment success. Near infra-red fluorescence is an easy-to-use nonionizing imaging method that has been described to detect thoracic duct leaks in open surgery or thoracoscopic interventions, yet no application to percutaneous sclerotherapy has been described. The authors suggest near infra-red fluorescence as a feasible and useful tool to guide percutaneous sclerotherapy.


Assuntos
Quilotórax/etiologia , Quilotórax/terapia , Imagem Óptica/métodos , Complicações Pós-Operatórias/terapia , Escleroterapia/métodos , Ducto Torácico/lesões , Idoso , Quilotórax/diagnóstico por imagem , Doxiciclina/administração & dosagem , Humanos , Masculino , Soluções Esclerosantes/administração & dosagem , Resultado do Tratamento
14.
Pediatr Int ; 62(3): 257-304, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32202048

RESUMO

The objective was to prepare guidelines to perform the current optimum treatment by organizing effective and efficient treatments of hemangiomas and vascular malformations, confirming the safety, and systematizing treatment, employing evidence-based medicine (EBM) techniques and aimed at improvement of the outcomes. Clinical questions (CQs) were decided based on the important clinical issues. For document retrieval, key words for literature searches were set for each CQ and literature published from 1980 to the end of September 2014 was searched in Pubmed, Cochrane Library, and Japana Centra Revuo Medicina (JCRM). The strengths of evidence and recommendations acquired by systematic reviews were determined following the Medical Information Network Distribution System (MINDS) technique. A total of 33 CQs were used to compile recommendations and the subjects included efficacy of resection, sclerotherapy/embolization, drug therapy, laser therapy, radiotherapy, and other conservative treatment, differences in appropriate treatment due to the location of lesions and among symptoms, appropriate timing of treatment and tests, and pathological diagnosis deciding the diagnosis. Thus, the Japanese Clinical Practice Guidelines for Vascular Anomalies 2017 have been prepared as the evidence-based guidelines for the management of vascular anomalies.


Assuntos
Hemangioma/terapia , Malformações Vasculares/terapia , Malformações Arteriovenosas/terapia , Embolização Terapêutica/métodos , Medicina Baseada em Evidências , Humanos , Terapia a Laser/métodos , Escleroterapia/métodos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(9): e18839, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118707

RESUMO

This study reports our experience, the therapeutic outcomes and complications of percutaneous sclerotherapy (PS) with polidocanol to treat venous malformations (VMs) in children.A retrospective analysis was conducted of pediatric patients with VMs who underwent PS using polidocanol under continuous ultrasound (US) guidance between January 2015 and January 2018 at our department. Medical records were reviewed to record demographic information, lesion characteristics, treatment sessions, therapeutic outcomes and complications. χ analysis was employed to evaluate the effects of these characteristics on outcomes.Hundred treatment sessions were performed for lesions in 47 patients. The mean age of the patients was 4.1 ±â€Š3.6 years (mean ±â€ŠSD). The female to male ratio was almost 2:1 (female 32, male 15). The location of the VMs included the head and neck in 16 cases (34.0%), upper extremity in 11 cases (23.4%), lower extremity in 10 cases (21.3%), and trunk and perineum in 10 cases (21.3%). The majority of the lesions were focal in 36 cases (76.6%), while 11 (23.4%) were diffuse. Seventeen patients (36.2%) underwent single PS session, 14 patients (29.8%) underwent 2 sessions, 10 patients (21.3%) underwent 3 sessions and 6 patients (12.7%) underwent ≧4 sessions. The mean PS session per patient was 2.1 ±â€Š1.1. The mean follow-up duration was 11.4 ±â€Š7.6 months. After the last PS session, 8 patients (17.0%) had excellent outcomes, 27 (57.4%) had good outcomes, 10 (21.3%) had fair outcomes, and 2 (4.3%) had poor outcomes. Focal lesions were more likely to have good or excellent outcomes than diffuse lesions (χ = 4.522, P = .033). No other lesion characteristic significantly affected the outcomes (good or excellent outcomes), including lesion location (χ = 2.011, P = .570) or lesion size (χ = 1.045, P = .307). After the PS procedure, temporary local swelling occurred in 81 sessions (81.0%), local pain occurred in 15 sessions (15.0%), fever occurred in 27 (27.0%) sessions, and transient local numbness occurred in four sessions (4.0%).PS with polidocanol under the guidance of US appears to be safe and effective for the treatment of VMs in children, especially for focal lesions.


Assuntos
Malformações Arteriovenosas/terapia , Polidocanol/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Estudos Retrospectivos , Escleroterapia/efeitos adversos , Escleroterapia/estatística & dados numéricos , Ultrassonografia de Intervenção
16.
Cochrane Database Syst Rev ; 3: CD011573, 2020 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-32133620

RESUMO

BACKGROUND: Portal hypertension commonly accompanies advanced liver disease and often gives rise to life-threatening complications, including bleeding (haemorrhage) from oesophageal and gastrointestinal varices. Variceal bleeding commonly occurs in children with chronic liver disease or portal vein obstruction. Therefore, prevention is important. Primary prophylaxis of variceal bleeding in adults is the established standard of care because of the results of numerous randomised clinical trials demonstrating the efficacy of non-selective beta-blockers or endoscopic variceal ligation in decreasing the incidence of variceal bleeding. In children, band ligation, beta-blockers, and sclerotherapy have been proposed as alternatives for primary prophylaxis of oesophageal variceal bleeding. However, it is unknown whether those treatments are of benefit or harm when used for primary prophylaxis in children. OBJECTIVES: To assess the benefits and harms of sclerotherapy compared with sham or no intervention for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. SEARCH METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register, CENTRAL, PubMed, Embase Elsevier, and two other registers in February 2019. We scrutinised the reference lists of the retrieved publications, and performed a manual search of the main paediatric gastroenterology and hepatology conference (NASPGHAN and ESPGHAN) abstracts from January 2008 to December 2018. We searched four registries for ongoing clinical trials. There were no language or document type restrictions. SELECTION CRITERIA: We included randomised clinical trials irrespective of blinding, language, or publication status assessing sclerotherapy versus sham or no intervention for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methodology to perform this systematic review. We used the intention-to-treat principle to analyse outcome data, and GRADE to assess the certainty of evidence per outcome. MAIN RESULTS: We found only one randomised clinical trial that fulfilled our inclusion criteria. The trial was at high risk of bias. The trial included 108 Brazilian children with median age of 4.3 years (range 11 months to 13 years). Fifty-six children were randomised to prophylactic sclerotherapy (ethanolamine oleate 2%) and 52 children to no intervention (control). Children were followed up for a median of 4.5 years. Eight children (six from the sclerotherapy group versus two from the control group) dropped out before the end of the trial. The follow-up was from 18 months to eight years. Mortality was 16% (9/56 children) in the sclerotherapy group versus 15% (8/52 children) in the control group (risk ration (RR) 1.04, 95% confidence interval (CI) 0.44 to 2.50; very low-certainty evidence). Upper gastrointestinal bleeding occurred in 21% (12/56) of the children in the sclerotherapy group versus 46% (24/52) in the control group (RR 0.46, 95% CI 0.26 to 0.83; very low-certainty evidence). There were more children with congestive hypertensive gastropathy in the sclerotherapy group than in the control group (14% (8/56) versus 6% (3/52); RR 2.48, 95% CI 0.69 to 8.84; very low-certainty evidence). The incidence of gastric varices was similar between the sclerotherapy group and the control group (11% (6/56) versus 10% (5/52); RR 1.11, 95% CI 0.36 to 3.43; very low-certainty evidence). The incidence of bleeding from gastric varices was higher in the sclerotherapy group than in the control group (4% (3/56) versus 0% (0/52); RR 6.51, 95% CI 0.34 to 123.06; very low-certainty evidence). The study did not assess health-related quality of life. Oesophageal variceal bleeding occurred in 5% (3/56) of the children in the sclerotherapy group versus 40% (21/52) of the children in the control group (RR 0.13, 95% CI 0.04 to 0.42; very low-certainty evidence). The most prevalent complications (defined as non-serious) were pain and fever after the procedure, which promptly resolved with analgesics. However, numerical data on the frequency of these adverse events and their occurrences in the two groups were lacking. No funding information was provided. We found no ongoing trials. AUTHORS' CONCLUSIONS: The evidence, obtained from one randomised clinical trial at high risk of bias, is very uncertain on whether sclerotherapy has an influence on mortality and if it may decrease first upper gastrointestinal or oesophageal variceal bleeding in children. The evidence is very uncertain on whether sclerotherapy has an influence on congestive hypertensive gastropathy, incidence on gastric varices, and incidence of bleeding from gastric varices. Health-related quality of life was not measured. There were no serious events caused by sclerotherapy, and analysis of non-serious adverse events could not be performed due to lack of numerical data. The GRADE assessment of each outcome showed a very low-certainty evidence. The results of the trial need to be interpreted with caution. Larger randomised clinical trials, following the SPIRIT and CONSORT statements, assessing the benefits and harms of sclerotherapy compared with sham or no intervention for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis are needed. The trials should include important clinical outcomes such as death, failure to control bleeding, and adverse events.


Assuntos
Doença Hepática Terminal/complicações , Hemorragia Gastrointestinal/prevenção & controle , Hipertensão Portal/complicações , Escleroterapia/métodos , Trombose Venosa/complicações , Varizes Esofágicas e Gástricas/complicações , Humanos , Ligadura/métodos , Veia Porta , Prevenção Primária , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
17.
Eur J Vasc Endovasc Surg ; 59(6): 1011-1018, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32063463

RESUMO

OBJECTIVE: This study investigated the in vitro stability of a novel sclerosant, bleomycin polidocanol foam (BPF), for venous malformation (VM) sclerotherapy. METHODS: The study was designed with control groups treated with polidocanol (0.5%, 1%, and 3%) only. The experimental groups included 21 BPFs, which was made by dissolving bleomycin at seven different concentrations (0.1%-1.5%) in polidocanol (0.5%, 1%, and 3%). The Tessari method was used to prepare sclerosant foam with a liquid:gas ratio of 1:4 at room temperature in vitro. The foam stability was measured for each group. The decay process, one component of foam stability, was recorded with a camera. Foam decay process experiments were performed 10 times per group. The stability indices included drainage rate, drainage time, half life, and microscopic measurement of the foams (mean bubble diameter, minimum and maximum bubble diameters, wall thickness, and bubble diameter distribution). RESULTS: Compared with the control groups, the half lives of BPFs mainly increased significantly with the addition of bleomycin (p < .001). BPF with 3% polidocanol and 0.1% bleomycin recorded the highest half life (246 ± 1.6 sec), and this group also achieved the smallest bubble diameter and wall thickness (69.9 µm and 5.80 µm) among the experimental groups. For the same polidocanol concentration, the bubble diameter and wall thickness increased when bleomycin was added. CONCLUSION: Bleomycin concentrations account for different BPF stability. BPF stability mainly increased significantly with the addition of a small amount of bleomycin but this advantage was no longer apparent with increasing bleomycin dose.


Assuntos
Bleomicina/química , Polidocanol/química , Soluções Esclerosantes/química , Escleroterapia/métodos , Malformações Vasculares/terapia , Bleomicina/administração & dosagem , Combinação de Medicamentos , Estabilidade de Medicamentos , Humanos , Polidocanol/administração & dosagem , Veias/anormalidades
18.
Artigo em Inglês | MEDLINE | ID: mdl-32031109

RESUMO

The incidence of lymphangioma is 1.2 to 2.8/1000 newborns. They present at birth/before 2 years, with predilection for the head and neck (50%-70%). The buccal mucosa is the second most common site reported (14 cases reported) after the anterior two-thirds of tongue. The scrotum is a rare site with less than 50 cases reported (till 2002). Involvement of vital structures, aesthetic, and functional requirements may necessitate treatments such as surgical excision, radiation, cryotherapy, electrocautery, sclerotherapy, embolization, ligation, and laser. Two rare cases - the first being primary, late-onset buccal lymphangioma, with vesicular presentation, and the second being genital lymphangioma involving the right side of scrotum, thigh, and groin with extension to the left groin - are highlighted.


Assuntos
Linfangioma/diagnóstico , Mucosa Bucal/patologia , Neoplasias Bucais/diagnóstico , Escroto/patologia , Adolescente , Criança , Humanos , Linfangioma/terapia , Masculino , Boca/patologia , Neoplasias Bucais/terapia , Escleroterapia/métodos
19.
Jpn J Radiol ; 38(5): 434-439, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32043235

RESUMO

Treatment of pelvic arteriovenous malformations (AVMs) is frequently challenging because of the complex structures and anatomical diversity among cases. We present a case series of six patients with pelvic AVMs. All patients had a similar anatomical structure consisting of multiple feeders from the unilateral internal iliac artery, collecting into a dilated venous sac in the unilateral paravesical space and draining into a single outflow, eventually joining the pre-prostatic vein or internal iliac vein. Five among these patients were successfully treated by catheter-directed embolo-sclerotherapy. In addition to our six cases, we identified six previous case reports of pelvic AVM with similar anatomical characteristics. Herein, we summarize the clinical and anatomical features of these 12 paravesical AVM cases. In all cases, the patients were men; the AVM was predominantly located at the right paravesical space and demonstrated good therapeutic effect of catheter-directed embolosclerotherapy. These paravesical AVMs may constitute a new subgroup of pelvic vascular anomalies with the same etiology that are treatable by adequate catheter intervention.


Assuntos
Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/terapia , Angiografia por Tomografia Computadorizada/métodos , Pelve/diagnóstico por imagem , Escleroterapia/métodos , Adulto , Idoso , Drenagem , Humanos , Masculino , Pessoa de Meia-Idade
20.
Qual Life Res ; 29(6): 1707-1719, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32020564

RESUMO

PURPOSE: To determine important symptoms and functional effects of venous malformations (VMs) to assess the content validity of commonly used patient-reported outcome (PRO) measures for use with VM patients. METHODS: This cross-sectional, qualitative study involved cognitive interviews with participants with VM aged ≥ 14 years. From February to June 2016, 11 participants (8 female) with a mean (± standard deviation) age of 31 ± 15 years were recruited from three clinical sites. The following subgroups were evaluated: 5 adults (aged ≥ 18) with trunk/extremity VMs; 3 adolescents (aged 14-17) with trunk/extremity VMs; and 3 adults with head/neck VMs. We evaluated the content validity of the Worst Pain Numeric Rating Scale (NRS), Patient-Reported Outcomes Measurement Information System (PROMIS®) Pain Interference 8-item short form, and PROMIS Physical Function 8-item short form. RESULTS: The most common participant-reported VM symptoms were swelling (n = 10), skin discoloration (n = 8), acute episodic pain (n = 8), chronic pain (n = 7), numbness (n = 7), and tingling/burning (n = 6). Participants reported that VMs affected their physical function (n = 10), appearance (n = 10), relationships/social activities (n = 7), and emotional health (n = 3). The Worst Pain NRS and PROMIS Pain Interference measures were relevant to all participants' VM experience. Only adults with head/neck VMs found the PROMIS Physical Function measure to be irrelevant. The assessed PRO measures did not address several symptoms commonly reported by VM patients (swelling, skin discoloration, numbness, and appearance). CONCLUSION: These results suggest that several VM symptoms are not assessed fully by commonly used PRO measures, and that the relevance of functional limitation questions may vary by VM location.


Assuntos
Malformações Arteriovenosas/psicologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/patologia , Medição da Dor/métodos , Pesquisa Qualitativa , Escleroterapia/métodos , Adulto Jovem
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