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1.
An Bras Dermatol ; 94(5): 521-526, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31777351

RESUMO

BACKGROUND: The use of monoethanolamine oleate 5% is effective for the treatment of vascular malformations with low blood flow. OBJECTIVES: To report a case series of vascular malformations in the mouth and oral cavity treated with monoethanolamine oleate 5%. METHODS: A retrospective descriptive study was performed in electronic patient charts covering seven years. Patient demographics, diagnostic resources, lesion site, size, and number of applications of monoethanolamine oleate 5% were collected. RESULTS: A total of 21 vascular malformations were recorded, located mostly on the lower lip (52.3%) and resolved in a single application in 14 patients. The authors found 19 patients treated with sclerotherapy. Thirteen were women and six were men, with a mean age of 61 years. STUDY LIMITATION: Small sample size. CONCLUSIONS: Sclerotherapy is an effective treatment for vascular malformations of the lips and oral cavity, with resolution after only one or two applications (n=16).


Assuntos
Doenças da Boca/terapia , Ácidos Oleicos/administração & dosagem , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Malformações Vasculares/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estética , Feminino , Humanos , Injeções Intralesionais , Lábio/irrigação sanguínea , Lábio/patologia , Masculino , Pessoa de Meia-Idade , Doenças da Boca/patologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Malformações Vasculares/patologia , Adulto Jovem
2.
N Engl J Med ; 381(10): 912-922, 2019 09 05.
Artigo em Inglês | MEDLINE | ID: mdl-31483962

RESUMO

BACKGROUND: Endovenous laser ablation and ultrasound-guided foam sclerotherapy are recommended alternatives to surgery for the treatment of primary varicose veins, but their long-term comparative effectiveness remains uncertain. METHODS: In a randomized, controlled trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of laser ablation, foam sclerotherapy, and surgery. Primary outcomes at 5 years were disease-specific quality of life and generic quality of life, as well as cost-effectiveness based on models of expected costs and quality-adjusted life-years (QALYs) gained that used data on participants' treatment costs and scores on the EuroQol EQ-5D questionnaire. RESULTS: Quality-of-life questionnaires were completed by 595 (75%) of the 798 trial participants. After adjustment for baseline scores and other covariates, scores on the Aberdeen Varicose Vein Questionnaire (on which scores range from 0 to 100, with lower scores indicating a better quality of life) were lower among patients who underwent laser ablation or surgery than among those who underwent foam sclerotherapy (effect size [adjusted differences between groups] for laser ablation vs. foam sclerotherapy, -2.86; 95% confidence interval [CI], -4.49 to -1.22; P<0.001; and for surgery vs. foam sclerotherapy, -2.60; 95% CI, -3.99 to -1.22; P<0.001). Generic quality-of-life measures did not differ among treatment groups. At a threshold willingness-to-pay ratio of £20,000 ($28,433 in U.S. dollars) per QALY, 77.2% of the cost-effectiveness model iterations favored laser ablation. In a two-way comparison between foam sclerotherapy and surgery, 54.5% of the model iterations favored surgery. CONCLUSIONS: In a randomized trial of treatments for varicose veins, disease-specific quality of life 5 years after treatment was better after laser ablation or surgery than after foam sclerotherapy. The majority of the probabilistic cost-effectiveness model iterations favored laser ablation at a willingness-to-pay ratio of £20,000 ($28,433) per QALY. (Funded by the National Institute for Health Research; CLASS Current Controlled Trials number, ISRCTN51995477.).


Assuntos
Procedimentos Endovasculares , Terapia a Laser , Qualidade de Vida , Escleroterapia , Varizes/terapia , Adulto , Análise Custo-Benefício , Procedimentos Endovasculares/economia , Feminino , Seguimentos , Humanos , Análise de Intenção de Tratamento , Terapia a Laser/economia , Masculino , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida , Escleroterapia/economia , Escleroterapia/métodos , Inquéritos e Questionários , Resultado do Tratamento , Ultrassonografia de Intervenção , Varizes/cirurgia
3.
Clinics (Sao Paulo) ; 74: e704, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31433045

RESUMO

OBJECTIVES: This pilot study investigated the safety and efficacy of a novel shunt surgery combined with foam sclerotherapy of varices in patients with prehepatic portal hypertension. METHODS: Twenty-seven patients who were diagnosed with prehepatic portal hypertension and underwent shunt surgeries were divided into three groups by surgery type: shunt surgery alone (Group A), shunt surgery and devascularization (Group B), and shunt surgery combined with foam sclerotherapy (Group C). Between-group differences in operation time, intraoperative blood loss, portal pressure decrease, postoperative complications, rebleeding rates, encephalopathy, mortality rates and remission of gastroesophageal varices were compared. RESULTS: Groups A, B and C had similar operation times, intraoperative bleeding, and portal pressure decrease. The remission rates of varices differed significantly (p<0.001): one patient in Group A and 6 patients in Group B had partial response, and all 9 patients in Group C had remission (2 complete, 7 partial). Two Group A patients and one Group B patient developed recurrent gastrointestinal bleeding postoperatively within 12 months. No postoperative recurrence or bleeding was observed in Group C, and no sclerotherapy-related complications were observed. CONCLUSIONS: Shunt surgery combined with foam sclerotherapy obliterates varices more effectively than shunt surgery alone does, decreasing the risk of postoperative rebleeding from residual gastroesophageal varices. This novel surgery is safe and effective with good short-term outcomes.


Assuntos
Varizes Esofágicas e Gástricas/cirurgia , Hipertensão Portal/cirurgia , Escleroterapia/métodos , Adolescente , Adulto , Criança , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Complicações Intraoperatórias , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Complicações Pós-Operatórias , Hemorragia Pós-Operatória/etiologia , Estudos Retrospectivos , Escleroterapia/efeitos adversos , Adulto Jovem
4.
Expert Rev Gastroenterol Hepatol ; 13(9): 893-897, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31389265

RESUMO

Introduction: The most recent guidelines vary in their approach to the management of variceal bleeding especially with the use of endoscopic sclerotherapy (ES) and endoscopic tissue adhesive (ETA). This review highlights their clinical use for variceal bleeding from different guidelines perspectives. Areas covered: A comprehensive literature review of three major guidelines including the American Association for the Study of Liver Diseases (AASLD) 2017, United Kingdom (UK) guidelines 2015 and Baveno VI Consensus workshop guidelines in 2015 on the use of ES and ETA in variceal bleeding. Expert opinion: While endoscopic band ligation (EBL) completely replaced endoscopic sclerotherapy (ES) for esophageal varices. There is a valuable use of endoscopic sclerotherapy (ES) and endoscopic tissue adhesive (ETA) especially for patients with gastroesophageal varices (GOV2) and isolated gastric varices (IGV2). The current standard of care heading toward portosystemic shunting with Trans-jugular-Intrahepatic Portosystemic Shunt (TIPS) and balloon retrograde transvenous obliteration (BRTO). However, recent advancement in endoscopic ultrasound (EUS) allowing direct injection of sclerosant and tissue adhesive into the varix bringing promising results in achieving hemostasis and lowering the risk of complications. Also, ES and ETA have great clinical value in achieving hemostasis for isolated (ectopic) varices and stomal varices.


Assuntos
Varizes Esofágicas e Gástricas/diagnóstico , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Escleroterapia/métodos , Adesivos Teciduais/administração & dosagem , Endoscopia do Sistema Digestório , Varizes Esofágicas e Gástricas/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Cirrose Hepática/complicações
5.
Acta Otolaryngol ; 139(9): 788-792, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31271329

RESUMO

Background: Although there are studies regarding the efficacy of OK-432 sclerotherapy on thyroglossal duct cyst (TDC), its effects on surgical procedure following this therapy have not been properly described. Objectives: The present study aimed to delineate the prognostic factors of OK-432 sclerotherapy in patients with TDC and investigate its influence on subsequent surgical procedure and the histological characteristics in patients with poor response to OK-432 sclerotherapy. Material and methods: We conducted a retrospective analysis of the medical records of 20 TDC patients treated with OK-432 sclerotherapy. Results: Of the 20 patients, OK-432 sclerotherapy was effective in 5 patients (25.0%). OK-432 showed a lower effective rate in multilocular cysts (9.1%) than in unilocular cysts (44.4%), although not significantly. Five cases were treated with surgery following OK-432 sclerotherapy. There was no significant difference in the operating time and the amount of bleeding between patients with and without OK-432 sclerotherapy. From the results of the histological examination of the cyst wall, two cases had stratified squamous epithelium and two cases showed the absence of lymphocyte infiltration. Conclusion and significance: OK-432 sclerotherapy is an acceptable initial treatment for TDC, especially in unilocular cysts, because of lack of influence on surgical procedure.


Assuntos
Picibanil/uso terapêutico , Escleroterapia/métodos , Cisto Tireoglosso/terapia , Tomografia Computadorizada por Raios X/métodos , Adulto , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Cisto Tireoglosso/diagnóstico por imagem , Cisto Tireoglosso/cirurgia , Resultado do Tratamento
6.
Medicine (Baltimore) ; 98(26): e16201, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261565

RESUMO

BACKGROUND: To compare the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of gastric variceal bleeding (GVB) caused by liver cirrhosis with the traditional sandwich method no accompanied by lauromacrogol via a meta-analysis. METHODS: The Cochrane Library, Pubmed, the China National Knowledge Infrastructure (CNKI) database, the Chinese Wanfang database, and the Chongqing VIP database were searched to identify cohort studies comparing modified to traditional sandwich method in the treatment of GVB with liver cirrhosis. The relative risk for hemostasis rate, gastric varices (GV) remission rate, re-bleeding rate, the incidence of post-operative complications (pain, fever, ulcer or erosion, ectopic embolism), and all-cause mortality were calculated. The mean difference for average tissue adhesive dosage per case was calculated. Relevant data were analyzed with the Reviewer Manager 5.3.5. RESULTS: Four cohort studies with a total of 587 patients were included in this meta-analysis. In the treatment of GVB with liver cirrhosis, compared with the traditional sandwich method, the modified sandwich method was associated with a higher GV remission rate (RR: 1.24, 95% CI: 1.09-1.42; P = .001) according to the pooled results. There were no statistically significant differences between the 2 methods in the rate of hemostasis, re-bleeding, pain, fever, ulcer or erosion, ectopic embolism, and all-cause mortality (P ≧ .05). CONCLUSIONS: This meta-analysis indicated that the modified sandwich method with lauromacrogol is more effective than the traditional sandwich method without lauromacrogol. Due to the limited number of studies and samples, more RCT studies are needed to further validate the efficacy and safety of the modified sandwich method with lauromacrogol in the treatment of GVB with liver cirrhosis.


Assuntos
Varizes Esofágicas e Gástricas/terapia , Hemorragia/terapia , Cirrose Hepática/terapia , Escleroterapia , Varizes Esofágicas e Gástricas/complicações , Hemorragia/etiologia , Humanos , Cirrose Hepática/complicações , Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Adesivos Teciduais/uso terapêutico
7.
Curr Opin Ophthalmol ; 30(5): 380-385, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31232717

RESUMO

PURPOSE OF REVIEW: Currently, there is no ideal management for orbital lymphatic malformations. Significant advances have been made since the discovery of new agents in the treatment. The purpose of this manuscript is to review the recent evidence on new sclerotherapy agents and systemic medications. RECENT FINDINGS: Traditional sclerosants are OK-432, sodium tetradecyl sulphate and ethanol. More recent developments are the use of doxycycline, bleomycin, and pingyangmycin. Sirolimus as a systemic medication has revolutionized the medical management of lymphatic malformations. Other oral drugs such as propranolol and sildenafil are controversial. Future treatment involves targeting lymphangiogenic pathways including inhibition of vascular endothelial growth factors and the phosphatidylinositol 4,5-bisphosphate 3-kinase catalytic subunit. SUMMARY: The development of new agents allows multimodal management either as monotherapy or combined therapy to achieve better outcomes in this difficult to manage disease.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Antineoplásicos/uso terapêutico , Linfangioma/terapia , Neoplasias Orbitárias/terapia , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Sirolimo/uso terapêutico , Bevacizumab/uso terapêutico , Bleomicina/uso terapêutico , Doxiciclina/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Picibanil/uso terapêutico
8.
Surg Clin North Am ; 99(3): 555-569, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047042

RESUMO

In patients with advanced esophageal or gastric cancer, it is highly likely that palliation of symptoms will become a focus of treatment. Dysphagia and obstruction are the most common complaints, and many of these patients can be treated with endoscopic interventions to alleviate symptoms. Bleeding, perforation, and nutritional issues are common problems. Attempts at palliation should be guided by thoughtful discussions regarding patients' goals of care. Owing to the high morbidity and mortality in patients with limited life expectancy, a strategy of working from the least invasive to the most invasive interventions should be guided by the patient's goals.


Assuntos
Neoplasias Esofágicas/terapia , Cuidados Paliativos/métodos , Neoplasias Gástricas/terapia , Coagulação com Plasma de Argônio/métodos , Braquiterapia/métodos , Quimiorradioterapia/métodos , Criocirurgia/métodos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Dilatação/métodos , Endoscopia Gastrointestinal/métodos , Etanol/administração & dosagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Perfuração Intestinal/etiologia , Perfuração Intestinal/terapia , Terapia a Laser/métodos , Estadiamento de Neoplasias/métodos , Apoio Nutricional , Fotoquimioterapia/métodos , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Stents Metálicos Autoexpansíveis
9.
Diagn Interv Radiol ; 25(3): 225-230, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31063139

RESUMO

PURPOSE: We aimed to evaluate the safety and effectiveness of cryoablation in the treatment of low-flow malformations, specifically venous malformation (VM) and fibroadipose vascular anomaly (FAVA). METHODS: We conducted a retrospective review of 11 consecutive patients with low-flow malformations (14 lesions; 9 VM, 5 FAVA), median lesion volume 10.8 cm3, (range, 1.8-55.6 cm3) with a median age of 19 years (range, 10-50 years) who underwent cryoablation to achieve symptomatic control. Average follow-up was at a median of 207 days postprocedure (range, 120-886 days). Indications for treatment included focal pain and swelling. Technical success was achieved if the cryoablation ice ball covered the region of the malformation that corresponded to the patient's symptoms. Clinical success was considered complete if all symptoms resolved and partial if some symptoms persisted but did not necessitate further treatment. RESULTS: The technical success rate was 100%. At 1-month follow-up, 13 of 14 lesions (93%) had a complete response and one (7%) had a partial response. At 6-month follow-up 12 of 13 (92%) had a complete response and 1 (8%) had a partial response. A total of 6 patients underwent primary cryoablation. Out of 9 VM cases, 7 had prior sclerotherapy and 2 had primary cryoablation. Out of the 5 FAVA cases, 1 had prior sclerotherapy and the remaining 4 cases underwent primary cryoablation. There were 3 minor complications following cryoablation including 2 cases of skin blisters and 1 case of transient numbness. These complications resolved with conservative management. CONCLUSION: Cryoablation is safe and effective in the treatment of low-flow vascular malformations, either after sclerotherapy or as primary treatment.


Assuntos
Criocirurgia/métodos , Criocirurgia/estatística & dados numéricos , Malformações Vasculares/terapia , Adolescente , Adulto , Vesícula/etiologia , Criança , Criocirurgia/efeitos adversos , Feminino , Humanos , Hipestesia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Escleroterapia/métodos , Escleroterapia/normas , Resultado do Tratamento , Malformações Vasculares/patologia , Adulto Jovem
11.
Andrologia ; 51(7): e13286, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30983022

RESUMO

Varicocele is a rather common andrological condition in adolescents, which can adversely affect testicular growth and seminal parameters, leading to infertility in about 20% of adults. The aim of this study was to investigate if treating varicocele before the age of 18 is a beneficial option to improve testicular hypotrophy and seminal parameters and if minimally invasive techniques could be an appropriate treatment choice for adolescent varicocele associated with spermatic vein reflux. A percutaneous scleroembolization was performed in sixty-four consecutive young patients (13-19 years old) with left varicocele, preceded by a fluoroscopy. In thirty-four of them, semen samples were also collected. We examined semen samples and testicles dimensions before and after percutaneous varicocelectomy, compared to a nonoperated control group, with a six-month follow-up. Total sperm count and sperm morphology were significantly increased in the intervention group. Left testicular volume significantly increased in both groups, while only correction of varicocele improved spermatozoa release per unit of testis volume. We conclude that early varicocelectomy by percutaneous scleroembolization significantly ameliorates seminiferous tubules activity in the critical adolescent phase of testicular growth. It is suggested that adolescents should be; offered varicocele repair as soon as possible in order to improve reproductive potential.


Assuntos
Embolização Terapêutica/métodos , Escleroterapia/métodos , Túbulos Seminíferos/metabolismo , Espermatozoides/metabolismo , Varicocele/terapia , Adolescente , Humanos , Infertilidade Masculina/etiologia , Infertilidade Masculina/prevenção & controle , Masculino , Túbulos Seminíferos/citologia , Contagem de Espermatozoides , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Varicocele/complicações , Adulto Jovem
12.
J Pediatr Surg ; 54(4): 733-739, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30955589

RESUMO

BACKGROUND: Large fetal head and neck (HN) masses can be life-threatening at birth and postnatally owing to airway obstruction. The two most frequent congenital masses that may obstruct the airway are lymphatic malformation (LM) and teratoma. The aim of this paper was to evaluate the results of our experience in the management of giant congenital HN masses and to conduct a literature review. METHODS: The study involved a consecutive series of 13 newborns (7 females) affected by giant HN masses. Prenatal diagnosis was achieved by means of ultrasound (US) and fetal magnetic resonance imaging (MRI). Delivery was performed by means of EXIT procedure in case of radiological evidence of airway obstruction. In the postnatal period all feasible therapeutic options (surgery, sclerotherapy, medical therapy) were discussed and adopted by a multidisciplinary team. Twelve patients underwent surgery and one received Rapamycin for one month, with consequent surgical resection owing to increasing size of the mass. RESULTS: The histopathological diagnosis was LM in 11 cases and teratoma in 2 cases. Airway obstruction was solved in 11 cases; 2 LM patients required a tracheotomy because of persistent airway obstruction. Major complications were flap necrosis (one patient) and facial nerve palsy (2 cases). Recurrence occurred in 5 patients. CONCLUSIONS: The management of congenital HN masses is always challenging and necessarily requires an interdisciplinary approach. Current therapeutic options include surgery, sclerotherapy, medical therapy or a combination of them. When they are large enough to obstruct the airway, a patient-centered approach should guide timing and modality of treatment. LEVEL OF EVIDENCE: IV.


Assuntos
Neoplasias de Cabeça e Pescoço/terapia , Equipe de Assistência ao Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Parto Obstétrico/métodos , Feminino , Neoplasias de Cabeça e Pescoço/congênito , Humanos , Recém-Nascido , Imagem por Ressonância Magnética/métodos , Masculino , Recidiva Local de Neoplasia/cirurgia , Gravidez , Diagnóstico Pré-Natal/métodos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Escleroterapia/efeitos adversos , Escleroterapia/métodos , Traqueostomia/efeitos adversos
13.
Res Synth Methods ; 10(2): 240-254, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30834677

RESUMO

Network meta-analysis (NMA) uses both direct and indirect evidence to compare the efficacy and harm between several treatments. Structural equation modeling (SEM) is a statistical method that investigates relations among observed and latent variables. Previous studies have shown that the contrast-based Lu-Ades model for NMA can be implemented in the SEM framework. However, the Lu-Ades model uses the difference between treatments as the unit of analysis, thereby introducing correlations between observations. The main objective of this study is to demonstrate how to undertake NMA in SEM using the outcome of treatment arms as the unit of analysis (arm-parameterized model) and to evaluate direct-indirect evidence inconsistency under this framework. We then showed that our models can include trials of within-person designs without the need for complex data manipulation. Moreover, we showed that a novel approach to meta-analysis, the unrestricted weighted least squares, can be readily extended to NMA under our framework. Finally, we demonstrated that the direct-indirect evidence inconsistency can be evaluated by using multiple group analysis in SEM. We then proposed a novel arm-parameterized inconsistency model for inconsistency evaluation. We applied the proposed models to two NMA datasets and showed that our approach yielded results identical to the Lu-Ades model. We also showed that relaxing variance assumptions can reduce the confidence intervals for certain treatment contrasts, thereby yielding greater statistical power. The arm-parameterized inconsistency model unifies current approaches to inconsistency evaluation.


Assuntos
Análise de Classes Latentes , Meta-Análise em Rede , Periodontia/métodos , Projetos de Pesquisa , Escleroterapia/métodos , Algoritmos , Teorema de Bayes , Estudos Clínicos como Assunto , Intervalos de Confiança , Humanos , Análise dos Mínimos Quadrados , Modelos Lineares , Regeneração , Reprodutibilidade dos Testes , Software , Estatística como Assunto
14.
Laryngoscope ; 129(10): 2216-2223, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30908653

RESUMO

OBJECTIVES: Epistaxis is the most frequent clinical manifestation of hereditary hemorrhagic telangiectasia (HHT). Several topical, systemic, and surgical treatments have been tried, but none have been completely effective. The aim of the present study is to evaluate whether a combined treatment sclerotherapy and topical therapy with propranolol 0.5% nasal formulation would reduce the epistaxis due to HHT and improve patient's quality of life. METHODS: An observational cross-sectional study was carried out. The primary outcome measure was frequency and severity of epistaxis as measured by the epistaxis severity score (ESS) at baseline (4 weeks before therapy) and at least 4 weeks after the treatment was implemented. Quality of life was analyzed using EuroQol-5D (EQ-5D) scale and visual analogue (VAS) scale before and after treatment. RESULTS: A total of 38 consecutive patients subjected to the combined treatment were evaluated (mean age: 57.2 years, standard deviation [SD] = 13.9; 60.5% women). The mean time of treatment was 37.1 weeks (SD = 14.9). Combined therapy significantly reduces frequency and severity of epistaxis, with an ESS improvement of 5 points from 6.9 ± 2.6 to 1.9 ± 1.3 (P < 0.05); however, the EQ-5D scale increased from 0.66 ± 0.27 to 0.93 ± 0.12 (P < 0.05). The difference in VAS means showed an increase from 44.6 ± 28.3 to 82.5 ± 12.5 (P < 0.05). The increases in quality of life are in line with the drop in ESS. CONCLUSION: The study demonstrated that combined therapy (sclerotherapy and topical nasal propranolol) significantly reduced the epistaxis due to HHT and increased patients' quality of life. LEVEL OF EVIDENCE: 2c Laryngoscope, 129:2216-2223, 2019.


Assuntos
Epistaxe/terapia , Propranolol/administração & dosagem , Escleroterapia/métodos , Telangiectasia Hemorrágica Hereditária/terapia , Vasodilatadores/administração & dosagem , Administração Intranasal , Administração Tópica , Adulto , Idoso , Terapia Combinada , Estudos Transversais , Epistaxe/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Telangiectasia Hemorrágica Hereditária/complicações , Resultado do Tratamento
15.
Dermatol Surg ; 45(10): 1253-1259, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30882500

RESUMO

OBJECTIVE: To evaluate the efficacy and safety of combination therapy with sclerotherapy and dual-wavelength pulsed dye laser (PDL) & Nd:YAG for infantile hemangiomas (IHs). PATIENTS AND METHODS: Fifty-nine patients with IH received treatment with sclerotherapy and dual-wavelength PDL & Nd:YAG treatment at 4-week intervals. Observers assessed the size and color of IH using a size rating scale and color rating scale before and after treatments. RESULTS: The study showed that IH improved significantly after several sessions of treatment. Sclerotherapy reduced the size of IH, whereas dual-wavelength laser lightened the color of IH. No serious adverse effects occurred. CONCLUSION: Combined sclerotherapy and dual-wavelength laser treatment is an effective and safe option for IH.


Assuntos
Hemangioma Capilar/terapia , Lasers de Corante/uso terapêutico , Terapia com Luz de Baixa Intensidade/métodos , Escleroterapia/métodos , Neoplasias Cutâneas/terapia , Grupo com Ancestrais do Continente Asiático , Cor , Terapia Combinada/efeitos adversos , Terapia Combinada/métodos , Feminino , Humanos , Lactente , Lasers de Corante/efeitos adversos , Terapia com Luz de Baixa Intensidade/efeitos adversos , Terapia com Luz de Baixa Intensidade/instrumentação , Masculino , Escleroterapia/efeitos adversos , Pele/irrigação sanguínea , Pele/efeitos da radiação , Resultado do Tratamento
16.
Ophthalmic Plast Reconstr Surg ; 35(5): 474-477, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30882591

RESUMO

PURPOSE: To investigate the safety and efficacy of direct, intralesional doxycycline hyclate injection for improving the appearance of cosmetically significant lower eyelid festoons and malar edema. METHODS: An Institutional Review Board approved, retrospective review was performed of 15 consecutive patients with malar edema and/or festoons injected with doxycycline hyclate at a concentration of 10 mg/ml. Pre- and postinjection photographs were reviewed and graded on a scale of 0 to 3 (0: no festoon; 1: small festoon; 2: medium festoon; 3: large festoon) by 2 masked physician observers. Patients were excluded from the final analysis if they received an alternate dose concentration, had incomplete photographic records, or did not follow up. Student t test was used for statistical analysis. RESULTS: Twenty consecutive treatment areas of 11 patients were included in the analysis. Final follow up ranged from 3 to 104 weeks, with a mean follow up of 22.5 weeks. The average (standard deviation) initial festoon grade of 2.5 (0.58) decreased to 0.9 (0.82) with a p value of <0.001. The average number of injections performed per side was 1.4 (range: 1-2). The mean volume per injection was 0.72 ml (range: 0.15-2.0 ml). Commonly documented subjective complaints were burning sensation with injection, pain, bruising, and erythema. There were no other dermatologic or visual complications following treatment. CONCLUSIONS: These preliminary results suggest that intralesional injections of doxycycline hyclate at a concentration of 10 mg/ml may be an effective treatment option for cosmetically significant lower eyelid festoons and malar edema. Future prospective studies with increased patient numbers, increasing concentrations, combination therapies with local anesthetic or regional nerve blocks, and longer follow up are needed to validate these results and determine optimal injection technique.


Assuntos
Antibacterianos/administração & dosagem , Doxiciclina/administração & dosagem , Edema/tratamento farmacológico , Doenças Palpebrais/tratamento farmacológico , Escleroterapia/métodos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
17.
World Neurosurg ; 126: 423-427, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904804

RESUMO

BACKGROUND: Different treatment options have been proposed for aneurysmal bone cysts (ABCs) with sclerotherapy favored as primary treatment and surgery remaining the mainstay of treatment in case of compression of neural structures. Recurrent spinal ABCs are burdened by increased risk of spinal deformity and instability, further complicating the management of these cases. CASE DESCRIPTION: A 15-year-old boy presented with acute symptoms and signs of spinal cord compression due to a large thoracic ABC. Subtotal resection of the lesion achieved optimal decompression of neural structures with good neurologic recovery, but the remnant of the lesion rapidly grew with recurrent spinal cord compression after 40 days. The patient underwent total surgical resection with full neurologic recovery. Unfortunately, recurrence of the lesion was documented at 3-months' follow-up. This was successfully treated with percutaneous injection of hydroxyapatite cement. Two years' follow-up ruled out any further recurrence of the lesion. Furthermore, spinal deformity and instability were also excluded. CONCLUSIONS: Percutaneous sclerotherapy with hydroxyapatite cement proved to be highly effective and safe in the treatment of spinal ABC, though surgery remains mandatory in case of spinal cord compression. The main advantage of sclerotherapy with hydroxyapatite cement seems to be the capacity to regenerate bone with normal radiologic features.


Assuntos
Cistos Ósseos Aneurismáticos/terapia , Escleroterapia/métodos , Compressão da Medula Espinal/etiologia , Adolescente , Cistos Ósseos Aneurismáticos/complicações , Humanos , Hidroxiapatitas , Masculino , Recidiva , Escleroterapia/instrumentação , Prevenção Secundária/métodos , Resultado do Tratamento
18.
BMC Gastroenterol ; 19(1): 37, 2019 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-30819091

RESUMO

BACKGROUND: Endoscopic injection sclerotherapy (EIS) is a life-saving procedure for pediatric patients with bleeding gastric varices (GV) associated with advanced liver cirrhosis and severe portal hypertension. Because of the lack of an endoscopic banding ligation device for pediatric patients, EIS is usually performed for bleeding esophageal varices (EV) in infants with congenital biliary atresia. CASE PRESENTATION: We present a case of a 15-month-old female infant with type I biliary atresia with jaundice (total serum bilirubin, 22.2 mg/dL), hypoalbuminemia (serum albumin level, 2.58 g/dL), coagulopathy (prothrombin time > 20 s compared with that of a normal control), ascites, splenomegaly, portal hypertension (portal vein velocity, 3.9-5.6 cm/sec of hepatopetal flow), and repeated bleeding of the varices after receiving three doses of intravascularly administered Histoacryl 1 ampoule mixed with Lipiodol UF 8 mL in the EV. Prominent GV and EV were occluded by EIS. The sclerosing agent was also present in the main portal vein, splenic mesenteric junction, and splenic vein, causing an engorged inferior mesenteric vein. The patient underwent total hepatectomy and living donor liver transplantation (LDLT) by left lateral segment graft (segments 2, 3, and 4 of the middle hepatic vein trunk) and left portal vein graft to the recipient inferior mesenteric vein anastomosis. Portal vein stent placement via segment 4 of the portal vein stump was performed from the inferior mesenteric vein to the umbilical portion of the left portal vein. The patient is still alive and doing well after the LDLT. CONCLUSIONS: EIS is a life-saving procedure in cases involving bleeding EV complicated by gastric, main portal vein, splenic mesenteric junction, and splenic vein occlusions; hence, it should be kept in mind as a treatment for EV complications in pediatric patients.


Assuntos
Endoscopia Gastrointestinal , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/terapia , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas , Escleroterapia/métodos , Insuficiência Venosa/etiologia , Atresia Biliar/complicações , Feminino , Humanos , Lactente , Oclusão Vascular Mesentérica/etiologia , Veias Mesentéricas/patologia , Veia Porta/patologia , Veia Esplênica/patologia , Estômago/irrigação sanguínea , Veias/patologia
19.
Ann Afr Med ; 18(1): 12-16, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30729927

RESUMO

Background: An engorgement and prolapse of the anal cushion lead to haemorrhoidal disease. There are different anatomical sites and presentation of this common pathology which affects the quality of life. Aims: To study the predilection sites, presentation and treatment of haemorrhoidal disease. Patients and Method: A cohort study of patients diagnosed with haemorrhoids at an Endoscopy centre in Port Harcourt, Rivers State Nigeria from February 2014- July 2017.The patients were divided into 2 groups: A - asymptomatic and B- symptomatic. Variables studied included: demographics, anatomic variations, grade of haemorrhoids, clinical presentation and treatment. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 20.0. Armonk, NY. Results: One hundred and twenty- one cases were included in study. There were 76 males and 45 males with age range from 15 -80 years (mean 51.9±13.1yrs). Bleeding per rectum was the most common presentation. The position frequency of haemorrhoids in decreasing order were: right posterior (34.1%); right anterior (28.2%); left lateral (17.1%); left posterior (7.6%). Multiple quadrants were affected in 58(72.5%) cases of external haemorrhoids. Grade I, II and III haemorrhoids were seen in 38 (31%), 31(26%) and 21(17%) cases respectively. Conclusion: The most common anatomical site of external haemorrhoids is the right posterior quadrant position; frequently, multiple sites are simultaneously affected. Goligher classification Grade 1 hemorrhoids are effectively treated by injection sclerotherapy using 50% dextrose solution; a cheap and physiologic sclerotherapy agent.


Assuntos
Canal Anal/cirurgia , Endoscopia , Hemorroidas/terapia , Ligadura/métodos , Reto/cirurgia , Escleroterapia/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal/diagnóstico por imagem , Estudos de Coortes , Feminino , Hemorroidas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Dor Pós-Operatória/epidemiologia , Reto/diagnóstico por imagem , Índice de Gravidade de Doença , Distribuição por Sexo , Resultado do Tratamento , Adulto Jovem
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