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1.
Medicine (Baltimore) ; 100(8): e24500, 2021 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-33663056

RESUMO

BACKGROUND: The varicose veins of the lower extremities showed earthworm-like dilatation and venous protrusion of the lower extremities. Polidocanol foam sclerotherapy, as a minimally invasive treatment with rapid recovery, less trauma and not easy to relapse, has achieved good results in clinical, but it is lack of evidence-based medicine. The purpose of this study is to evaluate the efficacy and safety of polidocanol in the treatment of varicose veins of the lower extremities by meta-analysis. METHOD: Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Scientifific Journals Database, China Biology Medicine disc, PubMed, EMBASE database, Web of Science, and Cochrane Library will be used as search sources to conduct for randomized controlled trials of polidocanol in the treatment of varicose veins of lower extremities. The search time is set from the establishment of the database in December 2020 in this study. Two researchers independently extract, delete files, extract data and evaluate the quality. Revman software version 5.3 will be used for statistical analysis of data. RESULT: In this study, the efficacy and safety of polidocanol in the treatment of varicose veins of the lower extremities will be evaluated in terms of total effective rate, incidence of complications and recurrence rate. CONCLUSION: This study will provide reliable evidence-based evidence for the clinical application of polidocanol in the treatment of varicose veins of lower extremities. ETHICS AND DISSEMINATION: Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/AUR4X.


Assuntos
Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Varizes/cirurgia , Fatores Etários , Humanos , Extremidade Inferior , Polidocanol/administração & dosagem , Polidocanol/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Projetos de Pesquisa , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/efeitos adversos , Índice de Gravidade de Doença , Fatores Sexuais
3.
Medicine (Baltimore) ; 99(32): e21608, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769918

RESUMO

BACKGROUND: Venous leg ulcers (VLUs) are common throughout the world, which seriously affects the patient's work and life. Relevant researches suggested that sclerosing foam (SF) has potential benefits for VLUs. However, there is no consistent conclusion. The purpose of our study is to assess whether SF is effective and safe for VLUs. METHODS: Relevant clinical randomized controlled trials will be obtained from a search of 8 databases (with no language restrictions) from their inception to May 2020: PubMed, the Cochrane Library, EMBASE, Web of Science, China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, and Chinese Biological Medicine. Data will be analyzed using RevMan 5.3 after literature screening and data extraction according to predefined inclusion and exclusion criteria. Cochrane Collaboration Risk of bias Tool will be applied in evaluating the quality of enrolled articles. The primary outcome is Closure of venous leg ulcers, ulcer healing rate, adverse events related to SF. The secondary outcomes include ulcer healing time, ulcer recurrence rate, pain. Risk ratio will be used for categorical data; mean differences will be used for measurement data. Where possible and appropriate, meta-analysis will be performed for each outcome. RESULTS: To clarify whether Sclerosing foam can be safe and efficient on treating venous leg ulcers. CONCLUSION: Our review will provide useful information to judge whether Sclerosing Foam is an effective and safe intervention for patients with venous leg ulcers.


Assuntos
Bandagens/normas , Protocolos Clínicos , Células Espumosas , Soluções Esclerosantes/uso terapêutico , Úlcera Varicosa/terapia , Humanos , Perna (Membro)/anormalidades , Perna (Membro)/irrigação sanguínea , Perna (Membro)/fisiopatologia , Metanálise como Assunto , Soluções Esclerosantes/normas , Revisões Sistemáticas como Assunto
4.
J Oral Maxillofac Surg ; 78(11): 2000-2007, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32589938

RESUMO

Management of vascular malformations depends on the size, type, age of the patient, location, dissemination, and depth of penetration. Treatment options include propranolol, which reduces endothelial vessel proliferation, minimally invasive sclerotherapy to induce fibrosis, or surgery. In 1985, Valerian Popescu described a new approach to treatment consisting of intratumoral ligation by compartmentalization. This technique allows for high doses of the sclerosant agent to be delivered as systemic dissemination is restricted by a series of strangulating suture loops that divide the mass into segments. We describe the management and outcome of 2 patients who presented with vascular malformations in the orofacial region and were managed using a Popescu suturing technique. Vascular obliteration was achieved by a series of strangulating suture loops placed percutaneously throughout each lesion using a curved needle with a resorbable material (Vicryl; Ethicon, Somerville, NJ). The aim was to segment the vascular malformation into manageable sections for subsequent injection of a sclerosant. The compartmentalization also ensured that the sclerosant stayed within these compartments and was not washed out into the general circulation. Good esthetic outcomes were achieved in very visible areas such as the commissure and the vermillion border. In these areas, a surgical resection would have certainly caused a disruption of the esthetics of the lips and, in the second case, probably an alteration of function. Intratumoral ligation can be used safely to achieve control of vascular malformations with good esthetic outcomes.


Assuntos
Estética Dentária , Malformações Vasculares , Humanos , Lábio , Soluções Esclerosantes/uso terapêutico , Escleroterapia
5.
Artigo em Inglês | MEDLINE | ID: mdl-32493683

RESUMO

OBJECTIVE: The objectives of this study were to document the results of using fibrin glue (FG) combined with pingyangmycin (PYM) for the embolism and sclerotherapy of maxillofacial arteriovenous malformations (AVMs). STUDY DESIGN: We reviewed the associated clinical data from December 2012 to June 2017 for 25 patients with maxillofacial AVMs. The major treatment method was direct percutaneous puncture and injection of FG combined with PYM. Treatment outcomes were assessed through physical examination, Doppler ultrasonography, computed tomography, and 3-dimensional computed tomography angiography scans. Follow-up time ranged from 12 months to 3 years after the last treatment (mean 21 months). RESULTS: Of the 25 lesions, 80% showed greater than 90% reduction, 12% showed greater than 75% reduction, and 8% showed greater than 50% reduction. Superficial skin necrosis or mucous ulcer occurred in 3 patients and healed without intervention. Regrowth was observed in 3 patients with extensive lesions involving multiple anatomic regions. CONCLUSIONS: These data suggest that embolization and sclerotherapy with the use of FG combined with PYM are safe and effective for the treatment of small- to medium-sized, locally dilated maxillofacial AVMs. For AVMs involving multiple anatomic regions, combined application of this approach with other options should be considered.


Assuntos
Malformações Arteriovenosas/terapia , Embolização Terapêutica , Bleomicina/análogos & derivados , Adesivo Tecidual de Fibrina , Humanos , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Resultado do Tratamento
6.
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
7.
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
8.
Med Oral Patol Oral Cir Bucal ; 25(4): e468-e473, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32388528

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.


Assuntos
Soluções Esclerosantes/uso terapêutico , Escleroterapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ácidos Oleicos , Estudos Retrospectivos , Resultado do Tratamento
10.
J Craniofac Surg ; 31(4): e393-e394, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32282473

RESUMO

Venous malformations (VMs) are congenital disorders that constitute about 40% of all vascular anomalies. These lesions do not regress spontaneously and may increase in size during childhood. The case of a 10-year-old girl with an extensive oral VM is reported. Intraoral examination revealed the presence of purplish nodules in the alveolar mucosa and gingiva from anterior maxilla. Doppler ultrasound showed a well-defined hypoechoic image and increased vascularization with low blood flow for the alveolar mucosa lesion. The patient was submitted to intralesional injections of the ethanolamine oleate/mepivacaine sclerosing solution. After four sessions, there was a significant reduction of the lesions. However, the patient abandoned the treatment and the oral VM grew progressively. After 1 year, sclerotherapy was resumed and performed weekly. After 10 session of sclerotherapy, the oral VM totally regressed. The childhood is a critical period for oral VM growth. Doppler ultrasound and sclerotherapy can be effective for the management of extensive lesions in children.


Assuntos
Malformações Vasculares/terapia , Angiografia , Criança , Feminino , Humanos , Injeções Intralesionais , Mepivacaína/uso terapêutico , Ácidos Oleicos/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Malformações Vasculares/diagnóstico por imagem
11.
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
12.
J Craniofac Surg ; 31(3): 702-706, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32149978

RESUMO

Venous malformations (VMs) occurring in the tongue base or pharynx are rare, but can cause airway obstruction. Considering the potential issues or morbidity related to surgical resection in the tongue or pharynx region, sclerotherapy is often preferred. We perform sclerotherapy for such lesions without conducting tracheotomy, but keep patients intubated for a certain period. Outcomes of sclerotherapy, and benefits and cautions related with our protocol were investigated.Our subjects were 10 cases in 9 patients who underwent sclerotherapy for VMs of the tongue base (6 patients) or pharynx (3 patients) from 2008 to 2017. One patient underwent treatment sessions twice. The sclerosants used were absolute ethanol (ET) (3 cases), 5% ethanolamine oleate (EO) (4 cases), or both ET and 5%EO (3 cases).In 5 of 9 patients, postoperative MRI was performed, which revealed lesion volume reduction by 12% to 47%. The intubation period varied according to the sclerosant used: ET, 5 to 11 days; 5% EO, 2 to 12 days; and combination of ET and 5% EO, 8 days. Postoperative complications included fever of unknown (n = 2), acute psychosis (n = 3), vocal cord paralysis (n = 2), and bradycardia induced from the use of a sedative agent (n = 1). One patient complained of mild transient swallowing difficulty that lasted for a month postoperatively.Although our method mandatorily requires careful postoperative management in an ICU, including sedation with anesthetic agents and artificial respiration by intubation for a certain period of time, no serious complications or post-therapeutic morbidities occurred.


Assuntos
Faringe/irrigação sanguínea , Malformações Vasculares/terapia , Veias/anormalidades , Adulto , Protocolos Clínicos , Feminino , Humanos , Intubação Intratraqueal , Masculino , Pessoa de Meia-Idade , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Traqueostomia , Resultado do Tratamento
13.
J Craniomaxillofac Surg ; 48(5): 488-493, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32222354

RESUMO

PURPOSE: The aim of this study was to evaluate the effectiveness of percutaneous injection of bleomycin combined with fibrin glue in treating massive venous malformations (MVMs) in the head and neck region. MATERIALS AND METHODS: A retrospective case series analysis of 22 patients who underwent percutaneous sclerotherapy between June 2015 and December 2018 was performed. All the patients were examined by comparing the size of the venous malformations (VMs) and their responses to treatment including complications in the follow-up. RESULTS: The follow-up period ranged from 6 to 24 months. Ten patients (10/22) were completely cured and 10 patients (10/22) exhibited excellent size reduction of their VMs. Two patients (2/22) exhibited reasonable size reduction and were recommended to undergo a second sclerotherapy procedure. However, both patients were satisfied with the outcomes and refused subsequent treatment. Neither systemic nor local complications occurred in this study. All the patients were satisfied with their significant size reductions and symptom improvements without recurrences during follow-up. CONCLUSION: Percutaneous injection of bleomycin combined with fibrin glue is a promising treatment option that yielded excellent size reduction with a low risk of complications on MVMs in the head and neck region.


Assuntos
Bleomicina , Malformações Vasculares , Adesivo Tecidual de Fibrina , Humanos , Pescoço , Estudos Retrospectivos , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Resultado do Tratamento
14.
Br J Oral Maxillofac Surg ; 58(4): 416-420, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32057469

RESUMO

Vascular anomalies are common in the head and neck, and oral lesions are most commonly found on the lips, tongue, mucosa, and palate. Monoethanolamine oleate sclerotherapy (MOS) is an option for treatment, although we know of no established protocols yet. We report the prevalence and characteristics of intraoral vascular anomalies (IVA) and the results achieved with the use of 5% MOS, and suggest a clinical guideline. Data from the medical records of patients with IVA were collected (age, sex, ethnicity, site, size, duration, and treatment). Cases treated with MOS were detailed, and data about number of applications, interval between them, dose, adverse effects, and results were recorded. A total of 65 cases of IVA were found. White-skinned women aged from 61 to 70 years (n=21) were most likely to be affected, and the lower lip (n=25) was the most common site. Twenty-seven were treated with MOS using a mean of 1-2 applications with a seven-day interval. The mean dose applied was 0.3ml/section, which was diluted in local anaesthetic in 38 cases. Twenty-two resolved completely. In summary, we found a prevalence of 4.8% of IVA and European women aged 61 to 70 years were most affected. MOS 5% was effective and safe in the treatment of IVA more than 3cm in size, with minimal morbidity and adverse effects. We therefore suggest a sclerotherapy protocol of 0.3ml of the drug (undiluted with anaesthetic) for each 1cm lesion (maximum 3cm), with weekly revaluations and further applications when necessary within a 14-day period.


Assuntos
Soluções Esclerosantes , Escleroterapia , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Ácidos Oleicos/uso terapêutico , Estudos Retrospectivos , Soluções Esclerosantes/uso terapêutico , Resultado do Tratamento
15.
Eur Radiol ; 30(6): 3462-3472, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32048037

RESUMO

PURPOSE: To evaluate the efficacy and intermediate-term outcome of balloon-occluded retrograde transvenous obliteration (BRTO) for the treatment of hepatic encephalopathy (HE) secondary to portosystemic shunt (PSS) in cirrhotic patients. MATERIALS AND METHODS: Institutional review board (IRB) approval was obtained for this study and hospital records of patients who underwent BRTO, from August 2011 to August 2015, were analyzed. Based on the inclusion and exclusion criteria, 39 patients (age, 54.07 ± 9.1 years (37-67 years); 33 males and 6 females) with cirrhosis and spontaneous PSS were included. Clinical and laboratory parameters and HE grade were evaluated in all patients before and after the procedure. RESULTS: Forty sessions of BRTO were attempted in 39 patients. Follow-up imaging revealed complete obliteration of the treated PSS in all patients with clinical success in 37 patients (94.9%). The 1-, 2-, 3-, 4-, 5-, 6-, and 7-year HE-free survival rates among responders were 91.7%, 91.7%, 88.8%, 85.5%, 80.8%, 80.8%, and 80.8% respectively and overall survival rates were 89.7%, 82.1%, 76.9%, 74.4%, 74.4%, 64.8%, and 64.8% respectively. Logistic regression highlighted Child-Turcotte-Pugh (CTP) score at 6 months as a positive predictive factor of HE recurrence with a cutoff of ≥ 9. Five patients (12.8%) had fever and leukocytosis and 1 (2.6%) patient developed spontaneous bacterial peritonitis after the procedure. CONCLUSION: BRTO is an effective treatment for refractory HE in cirrhotics secondary to large PSS with a few possible complications. KEY POINTS: • BRTO is an effective and safe treatment for refractory HE, arising from PSS in cirrhotic patients. • Patients with preserved liver function show better outcome and CTP score is the most important predictor of relapse during follow-up.


Assuntos
Oclusão com Balão/métodos , Encefalopatia Hepática/terapia , Hipertensão Portal/complicações , Soluções Esclerosantes/uso terapêutico , Tetradecilsulfato de Sódio/uso terapêutico , Adulto , Idoso , Varizes Esofágicas e Gástricas/etiologia , Feminino , Encefalopatia Hepática/etiologia , Humanos , Cirrose Hepática/complicações , Masculino , Pessoa de Meia-Idade , Recidiva , Veias Renais , Estudos Retrospectivos , Veia Esplênica , Taxa de Sobrevida , Tomografia Computadorizada por Raios X , Resultado do Tratamento
17.
Ann Otol Rhinol Laryngol ; 129(6): 548-555, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31910645

RESUMO

OBJECTIVE: To describe results of image guided sclerotherapy of venous malformations (VM) localized in the masseter muscle. METHODS: Retrospective review of prospectively maintained data was done to include consecutive cases treated over 5-year period, with minimum 6 months follow-up. Sclerotherapy was done using ultrasound (US) guided needle puncture(s) of the lesions percutaneously, and 3% polidocanol foam injected under image guidance. RESULTS: Seventeen cases (10 male, 7 female) with mean age 15.6 years (range 6-28 years) were identified. Clinical presentation was with facial asymmetry, becoming pronounced on jaw clenching, and three cases had mild local pain. On US, the lesions appeared as partially compressible masses with anechoic spaces, showing color filling on releasing probe pressure. Fourteen had phleboliths. Eight patients had undergone magnetic resonance imaging, lesions appearing as oval, homogenous, lobulated, T2 hyperintense masses, with heterogeneous contrast enhancement. Number of sclerotherapy sessions were-single in four cases, two in eight cases and three in five cases, for total of 35 sessions (average 2.05 session per patient). The mean dose of drug injected per session was 1.85 mL and total mean dose per patient was 2.79 mL. Post-procedure vomiting occurred in one patient while all had local swelling and mild pain, lasting between 3 to 7 days. No facial nerve palsy or sloughing/ulceration/skin necrosis was noted. On US follow-up (6-26 months, mean 15.9 months), 12 patients had small echogenic masses without any vascularity, and five had small anechoic areas <25%. All patients had complete resolution of swelling and pain. CONCLUSIONS: For VMs localized to the masseter muscle, image guided sclerotherapy is highly effective and safe, and recommended as first line treatment.


Assuntos
Músculo Masseter/irrigação sanguínea , Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Malformações Vasculares/terapia , Veias/diagnóstico por imagem , Adolescente , Adulto , Criança , Estudos de Coortes , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Flebografia , Punções/métodos , Estudos Retrospectivos , Ultrassonografia/métodos , Ultrassonografia Doppler em Cores , Malformações Vasculares/diagnóstico por imagem , Adulto Jovem
18.
J Laparoendosc Adv Surg Tech A ; 30(5): 514-519, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31928507

RESUMO

Background: Percutaneous aspiration with sclerotherapy (PAS) and laparoscopic marsupialization (LM) are minimally invasive treatment modalities for renal cysts. We aimed to compare the efficacy and cost/effectiveness of LM and PAS for the treatment of simple symptomatic renal cysts. Methods: Data were prospectively collected from three health care institutions in which 80 patients with symptomatic simple renal cysts underwent a single session of PAS with 95% ethanol (PAS group, n = 40) or underwent LM under general anesthesia (LM group, n = 40) between March 2012 and May 2016. We compared the patient profile, duration of procedure, duration of hospital stay, radiological and symptomatic success rates, treatment costs, and incidence of complications between the two groups. Results: At the 6-month follow-up, the radiological success rate in the LM group was significantly greater than that in the PAS group (97.5% versus 60%; P < .001). The symptomatic success rate was comparable in the two groups (95% versus 90%; P = .675). The treatment failure rate did not significantly differ between the two groups (5.0% versus 17.5%, P = .154). The mean total cost in the PAS and LM groups was 1256 USD and 2343 USD, respectively (P = .001). No significant between-group difference was noted regarding the overall complication rate (P = .615). Conclusions: Both LM and PAS are effective and safe procedures for the treatment of symptomatic simple renal cysts. A single session of PAS seems to be a cost-effective method for the management of symptomatic simple renal cysts.


Assuntos
Cistos/terapia , Nefropatias/terapia , Laparoscopia , Escleroterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise Custo-Benefício , Cistos/diagnóstico por imagem , Cistos/cirurgia , Etanol/uso terapêutico , Feminino , Custos de Cuidados de Saúde , Humanos , Nefropatias/diagnóstico por imagem , Nefropatias/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/economia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Soluções Esclerosantes/uso terapêutico , Escleroterapia/efeitos adversos , Escleroterapia/economia , Sucção/efeitos adversos , Sucção/economia , Resultado do Tratamento
19.
Eur J Vasc Endovasc Surg ; 59(1): 73-80, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31753745

RESUMO

OBJECTIVE: To compare post-operative compression with no compression, after radiofrequency endothermal ablation (RFA) of a truncal varicose vein and concomitant foam sclerotherapy of the tributaries. METHODS: This prospective randomised controlled, non-inferiority trial recruited patients from two centres in Northern Ostrobothnia, Finland. Patients with clinical class C2-C4 chronic venous disease were randomised to receive no compression after the operation, or to receive compression stockings continuously for two days, and then, during the daytime for five days. In follow up visits, additional foam sclerotherapy was performed for symptoms of distal incompetence. Patients were followed up for six months. The primary outcome was occlusion of the RFA treated truncal vein at six months. Secondary outcomes were return to full activity within 14 days, Aberdeen Varicose Vein Questionnaire (AVVQ) score, post-operative pain, need for painkillers, and postprocedural complications. RESULTS: Of 177 included patients, 90 were allocated to post-operative compression and 87 to no compression. At six months, both groups showed 100% occlusion rates in RFA treated truncal veins (95% confidence interval -0.043-0.042). Within 14 days of treatment, full physical activity was achieved by 87% of the compression group and 81% of the no compression group, (p = .29). At six months, the AVVQ scores were comparable and significantly improved in both groups, compared with baseline. Pain scores were comparable between groups, in day to day analyses, and they were significantly lower in both groups on day 10, compared with pre-operative pain caused by varicose veins. On average, post-operative pain medication was used for 2.3 days and for 2.8 days in the compression and no compression groups, respectively (p = .28). Complications throughout the six month follow up were comparable between groups, although skin rash/blisters occurred more often in the compression group (p = .01). CONCLUSION: After treating C2-C4 varicose veins with RFA and concomitant foam sclerotherapy, no post-operative compression was non-inferior to post-operative compression, in terms of safety and efficacy. ClinicalTrials.gov Identifier: NCT02890563.


Assuntos
Ablação por Cateter/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Escleroterapia/efeitos adversos , Meias de Compressão/normas , Varizes/terapia , Adulto , Idoso , Vesícula/epidemiologia , Vesícula/etiologia , Ablação por Cateter/métodos , Doença Crônica/terapia , Terapia Combinada/métodos , Exantema/epidemiologia , Exantema/etiologia , Feminino , Finlândia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/etiologia , Estudos Prospectivos , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Padrão de Cuidado , Meias de Compressão/efeitos adversos , Resultado do Tratamento , Adulto Jovem
20.
Int J Pediatr Otorhinolaryngol ; 128: 109694, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31562996

RESUMO

We present the case of a 2-year-old male with a complex left cervical venolymphatic malformation who underwent doxycycline sclerotherapy at 12 months of age complicated by new onset pulmonary aspiration. A review of the literature reveals this to be a rare complication of sclerotherapy and only the second reported case. METHODS: Procedural details with associated imaging including endoscopic airway and swallowing evaluation are included. A literature review of cervical and laryngeal sclerotherapy complications was performed and discussed. RESULTS: A 12-month-old male underwent sclerotherapy with doxycycline for a complex parapharyngeal and paralaryngeal venolymphatic malformation. The postoperative course was complicated by new onset dysphagia, aspiration, and decreased laryngeal sensation. Gastric feeding and swallowing therapy were necessary due to prolonged difficulty. The sclerotherapy treatment resulted in near elimination of the cervical components of the lesion at 12 months follow up. The child progressed to total oral feeding by 17 months post-treatment with no evidence of decreased laryngeal sensation. An extensive literature review identified only one reported case of new onset dysphagia and decreased laryngeal sensation after doxycycline sclerotherapy. CONCLUSIONS: Doxycycline sclerotherapy for cervical venolymphatic malformations rarely can cause adjacent neural injury resulting in laryngeal complications. Our case report and literature review suggest that symptom management and appropriate aspiration precautions are necessary in infants or children with presumed vagus or laryngeal nerve injury, and injury is likely only temporary.


Assuntos
Transtornos de Deglutição/etiologia , Anormalidades Linfáticas/terapia , Aspiração Respiratória/etiologia , Escleroterapia/efeitos adversos , Veias/anormalidades , Pré-Escolar , Doxiciclina/uso terapêutico , Humanos , Masculino , Pescoço , Soluções Esclerosantes/uso terapêutico
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