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1.
Skeletal Radiol ; 50(12): 2433-2447, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34013448

RESUMO

OBJECTIVE: To assess the clinical efficacy, technical feasibility, and safety profile of percutaneous sclerotherapy utilizing sodium tetradecyl-sulfate foam (STS) as a first-line treatment strategy for aggressive spinal aneurysmal bone cysts (sABCs) presenting with neurological compromise. MATERIALS AND METHODS: Between July 2013 and September 2019, eight consecutive patients (5 males; 3 females; mean age 22±17, range 7-52) underwent fluoroscopic/CT-guided intraosseous sclerotherapy for sABCs. Pain and/or neurological compromise was the primary indications. Procedural data, complications, imaging, and clinical results were analyzed. RESULTS: Technical success was achieved in all cases. Mean procedure time was 25±15 min (range 6-167); 1 to 5 repeat treatment cycles (mean 3.7±1.2) utilizing a mean 2.6mls±1.3 (range 1-6) of agitated 3% STS, with a DLP mean dose of 158±91 mGy*cm (range 62-331) per procedure. One reported a minor complication (pain), but no significant complications. Two patients had persistent neurological deficit due to cord compression despite successful sclerotherapy, requiring surgical resection (and were thereby excluded from the final outcome analysis). The remaining six patients demonstrated a significant reduction in tumor volume (p = 0.028), pain (p = 0.027), and SINS (spinal instability neoplastic score) (p = 0.027) at up to 5 years of follow-up (mean 20 ± 16.7, range 7-51 months). CONCLUSION: Percutaneous sclerotherapy with STS is a minimally invasive, technically feasible, safe, and effective first-line treatment for primary sABCs causing pain and neurological compromise, alleviating the need for extensive surgery. It is most effective with three or more treatment cycles, in patients with higher SINS, pain scores, or tumor volumes at the initial presentation.


Assuntos
Cistos Ósseos Aneurismáticos , Soluções Esclerosantes , Escleroterapia , Tetradecilsulfato de Sódio , Adolescente , Adulto , Cistos Ósseos Aneurismáticos/tratamento farmacológico , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Soluções Esclerosantes/uso terapêutico , Tetradecilsulfato de Sódio/uso terapêutico , Coluna Vertebral/patologia , Resultado do Tratamento , Adulto Jovem
2.
Cardiovasc Intervent Radiol ; 44(7): 1103-1108, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33709269

RESUMO

PURPOSE: To investigate if the detergent sclerosant sodium tetradecyl sulfate (STS) is deactivated by the lipid-based contrast agent ethiodised oil. METHOD: 3% STS was mixed with ethiodised oil and room air in a 2:1:4 ratio in two luer lock syringes and a three way connector and agitated to make foam (the Tessari technique) to replicate the clinical use of the products. The assay of STS in the mixture was assessed using the British Pharmacopoeia method. Briefly this is a manual titration method where the solution of STS is mixed with an indicator solution and titrated with hyamine solution of known concentration; the concentration of the STS can then be calculated with the titration results. To further mimic the clinical environment with the presence of blood, the effect of adding increasing amounts of albumin to the STS-ethiodised oil mixture was assessed. RESULTS: The assay of STS in the solution after mixing with ethiodised oil was 3% indicating that the ethiodised oil did not deactivate the STS. The addition of albumin to the STS-contrast mixture resulted in near linear neutralisation of the STS with increasing concentrations in the same quantities as with STS alone. CONCLUSIONS: The mixture of the lipid-based contrast agent ethiodised oil with the detergent sclerosant STS did not affect the availability of the sclerosant. The continued use of STS-ethiodised oil in the management of vascular malformations can be supported.


Assuntos
Óleo Etiodado/farmacologia , Escleroterapia/métodos , Tetradecilsulfato de Sódio/farmacologia , Malformações Vasculares/terapia , Meios de Contraste/farmacologia , Humanos , Soluções Esclerosantes/uso terapêutico , Seringas
3.
Phlebology ; 36(7): 576-587, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33736561

RESUMO

OBJECTIVES: To determine the effect of liquid gas fraction (LGF), sclerosant type and concentration, and filter use on foam bubble size and count. METHODS: Sclerosant foam microstructure was investigated using light microscopy for a range of LGFs (1 + 2, 1 + 4 and 1 + 8), for both sodium tetradecyl sulphate (STS) and polidocanol (POL), at a range of concentrations (0.5-3%), with and without the addition of micro-filters. Foam was generated using a modified Tessari method and placed into wells for analysis by light microscopy. Foam microscopic morphology was photographically documented, and bubble diameters and counts were quantified. RESULTS: Spherical bubbles were observed at lower LGF and a trend towards polyhedral morphology was observed at the higher LGF of (1 + 8). The higher gas content in LGF led to larger but fewer bubbles. POL bubble diameters appeared to be more influenced by concentration than STS with smaller bubbles observed at higher concentrations of POL. The mean bubble diameters were slightly larger for STS than POL at the highest concentration of 3% but smaller at lower concentrations of 1% and 1.5%. CONCLUSIONS: LGF is the primary determinant of bubble diameter and count. In contrast to STS, POL concentration influences the foam bubble size with smaller bubbles generated at higher concentrations of POL and larger bubbles appearing at low concentrations of this agent.


Assuntos
Soluções Esclerosantes , Tetradecilsulfato de Sódio , Humanos , Polidocanol
4.
J Vasc Interv Radiol ; 32(1): 80-86, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33139184

RESUMO

PURPOSE: To evaluate feasibility, safety, and results of endovenous mechanochemical ablation (MOCA) for treatment of persistent embryonic and dysplastic veins in pediatric patients with Klippel-Trénaunay syndrome (KTS). MATERIALS AND METHODS: Thirteen MOCA procedures were performed in 11 patients (age range, 4-16 years) with KTS and symptomatic persistent embryonic or dysplastic veins during a 24-month period. All patients were evaluated with color Doppler (CD) ultrasound (US), contrast-enhanced MR imaging, and venography to assess the anatomy of the target vessels and patency of the deep venous system. All procedures were performed under general anesthesia with a ClariVein catheter and liquid sodium tetradecyl sulfate as the sclerosing agent. US and fluoroscopic guidance were used in all cases. Technical success rate, primary occlusion rate, adverse effects, and recanalization rates were evaluated. Clinical and radiological (CD US) controls were performed 1 day, 7 days, 1 month, and 6 months after the procedure and once a year thereafter, with a mean follow-up of 16 months (range, 6-25 months). RESULTS: Technical success and primary occlusion were achieved in all patients with no adverse events. During the follow-up period, CD US demonstrated partial recanalization and symptom recurrence in 2 patients (18%), 14 and 18 months after the initial procedure. These 2 patients had a second ablation procedure with no recanalization or symptom recurrence during the subsequent follow-up period. CONCLUSIONS: MOCA is feasible and appears to be a safe and effective technique for treatment of varicose veins in pediatric patients with KTS.


Assuntos
Técnicas de Ablação , Procedimentos Endovasculares , Síndrome de Klippel-Trenaunay-Weber/complicações , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Tetradecilsulfato de Sódio/administração & dosagem , Varizes/terapia , Técnicas de Ablação/efeitos adversos , Adolescente , Criança , Pré-Escolar , Procedimentos Endovasculares/efeitos adversos , Estudos de Viabilidade , Feminino , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Masculino , Recidiva , Estudos Retrospectivos , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Tetradecilsulfato de Sódio/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico por imagem , Varizes/etiologia
5.
J Vasc Surg Venous Lymphat Disord ; 9(3): 652-659, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-32795619

RESUMO

OBJECTIVE: Mechanochemical ablation (MOCA) is a nonthermal nontumescent method of treating saphenous vein insufficiency. The feasibility and short-term results of MOCA are good, but its long-term results are unknown. A randomized study was performed to compare MOCA with endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in the setting of unilateral great saphenous vein (GSV) insufficiency. METHODS: Venous outpatient clinic patients with varicose veins (CEAP class C2-C4) caused by GSV insufficiency were invited to participate in the study; in total, 132 patients met the inclusion criteria and were willing to participate. Patients were randomized to treatment (2:1:1 for MOCA, EVLA, and RFA, respectively). The state of the GSV with duplex Doppler ultrasound examination and the disease-specific quality of life were assessed at 1 month, 1 year, and 3 years after the treatment. RESULTS: Some patients declined to continue in the study after randomization; in total, 117 patients underwent treatment. At 3 years, the occlusion rate was significantly lower with MOCA than with either EVLA or RFA (82% vs 100%; P = .005). Quality of life was similar between the groups. In the MOCA group, GSVs that were larger than 7 mm in diameter preoperatively were more likely to recanalize during the follow-up period. The partial recanalizations of proximal GSV observed at 1 year progressed during the follow-up. CONCLUSIONS: MOCA is a feasible treatment option in an outpatient setting, but its technical success rates are inferior compared with endovenous thermal ablation. Its use in large-caliber veins should be considered carefully.


Assuntos
Ablação por Cateter , Procedimentos Endovasculares , Terapia a Laser , Veia Safena/cirurgia , Insuficiência Venosa/cirurgia , Adulto , Idoso , Instituições de Assistência Ambulatorial , Procedimentos Cirúrgicos Ambulatórios , Ablação por Cateter/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Finlândia , Humanos , Terapia a Laser/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Veia Safena/diagnóstico por imagem , Veia Safena/fisiopatologia , Soluções Esclerosantes/administração & dosagem , Escleroterapia , Tetradecilsulfato de Sódio/administração & dosagem , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia Doppler Dupla , Insuficiência Venosa/diagnóstico por imagem , Insuficiência Venosa/fisiopatologia , Adulto Jovem
6.
Phlebology ; 36(4): 322-328, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33236673

RESUMO

OBJECTIVES: Little is known how calibre and length of needles affect the stability of sclerosing foam. METHODS: Foams were made of 0.5%, 1%, 2% and 3% polidocanol, and 0.2%, 0.5%, 1% and 3% sodium tetradecyl sulfate (STS), which were mixed with air in the proportion of 4:1. These foams were ejected through needles with the length of: 4 mm, 6 mm and 13 mm, and diameter of: 0.26 mm, 0.3 mm and 0.4 mm. RESULTS: Foams made of more concentrated polidocanol were more stable. Regarding STS an opposite relationship was revealed. Foams made of polidocanol were more stable if ejected through a longer needle, while the length of needle did not significantly affect stability of STS foams. Foams ejected through 0.26 mm diameter needles were very unstable. In the case of 0.5% polidocanol, 0.3x6mm needle provided atypically stable foam. CONCLUSION: In order to inject maximally stable foam, calibre and length of needle should be taken into account.


Assuntos
Agulhas , Soluções Esclerosantes , Humanos , Polidocanol , Polietilenoglicóis , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Tetradecilsulfato de Sódio
7.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-33370935

RESUMO

We report the case of a 35-year-old woman who presented with recurrent macroscopic haematuria and known diagnosis of Klippel-Trenaunay syndrome. Imaging and cystoscopy identified an extensive venous malformation involving a large area of the bladder wall. Holmium laser therapy was ineffective at obtaining symptom control. Following a multidisciplinary team meeting, transvenous sclerotherapy with sodium tetradecyl sulphate was performed under image guidance. A reduction in venous density was observed on cystoscopy and the patient has had complete resolution of symptoms within 6 weeks and continued to be asymptomatic up to 24-month follow-up. We propose that transvenous sclerotherapy is considered first-line treatment in this clinical setting.


Assuntos
Hematúria/terapia , Síndrome de Klippel-Trenaunay-Weber/complicações , Escleroterapia/métodos , Malformações Vasculares/terapia , Veias/patologia , Administração Intravenosa , Adulto , Cistoscopia , Feminino , Hematúria/etiologia , Humanos , Síndrome de Klippel-Trenaunay-Weber/terapia , Lasers de Estado Sólido/uso terapêutico , Angiografia por Ressonância Magnética , Soluções Esclerosantes/administração & dosagem , Tetradecilsulfato de Sódio/administração & dosagem , Resultado do Tratamento , Bexiga Urinária/irrigação sanguínea , Bexiga Urinária/diagnóstico por imagem , Bexiga Urinária/patologia , Malformações Vasculares/diagnóstico , Malformações Vasculares/etiologia , Malformações Vasculares/patologia , Veias/diagnóstico por imagem , Veias/efeitos dos fármacos
8.
Pak J Biol Sci ; 23(8): 1018-1024, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32700852

RESUMO

BACKGROUND AND OBJECTIVE: Varicose veins are the most common complaints of referrals to vascular surgeons. Upon the cause, liquid sclerotherapy could be an efficient solution first in regard to competent main superficial valves. To find the impact of diluted liquid sclerotherapy in varices in patients with no superficial valve refluxes compare to whom wearing only stockings. MATERIALS AND METHODS: Sclerotherapy with 0.3-0.5% liquid form of Sodium Tetradecyl Sulphate (STS) for reticular and spider varicosis, ulcers feeder veins and grade 3-4 sporadic varices were used. Patient's complaints the zone prevalence, response and satisfactoriness were detected clinically and data compared between the two injected cases and who managed by stockings alone with >1 year follow up. RESULTS: Two groups (156 sclerotherapy, 76 only stockings) with three classifications for severity were obtained. Complete recovery of all varices and ulcers were almost achieved with no considerable complication. Logical regression test in unilateral to bilateral varices predict about 70% more recovery (p = 0.048), mild to severe 85% more (p<0.001), moderate to severe 29% more (p = 0.008) and 10-15% response for severe cases. No significant difference for ages and responses between the 2 groups was existed. CONCLUSION: Diluted liquid sclerotherapy by STS was shown efficient in all ranges of varices. Stockings alone also were adequate to relief symptoms compare to sclerotherapy.


Assuntos
Escleroterapia/métodos , Tetradecilsulfato de Sódio/uso terapêutico , Meias de Compressão , Varizes/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Varizes/patologia
9.
Phlebology ; 35(9): 724-733, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32635818

RESUMO

OBJECTIVES: To determine the quality of sclerosant foam produced with an automated preparation system with multiple combinations of sclerosing agents, gases, and device settings. METHODS: Single-use mixing capsules filled with air or O2/CO2 and polidocanol (0.25, 1, or 3%) or sodium tetradecyl sulfate (0.2 or 1%) were coupled to a customized magnetic stirrer. Stirring speed and time were adjusted between 1500 and 4000 r/min and 30 and 60 s, respectively, and characteristics of the foam produced were measured: half-life, bubble diameter, and gas-to-liquid ratio. RESULTS: With optimized device settings, the following foam characteristics were obtained: half-life range, 1.4 ± 0.9 to 5.2 ± 0.6 min; bubble diameter, 84 ± 14 to 119 ± 6 µm; and gas-to-liquid ratio, 5:1-7:1. Sodium tetradecyl sulfate foam was quicker to form than polidocanol but faster to degrade. Foams with low sclerosant concentrations and O2/CO2 required higher speed and longer time. CONCLUSIONS: Suitable foam characteristics could be obtained with all combinations of sclerosing agent, concentration, and gas.


Assuntos
Soluções Esclerosantes , Varizes , Gases , Humanos , Polidocanol , Polietilenoglicóis , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Tetradecilsulfato de Sódio , Varizes/tratamento farmacológico
10.
J Am Vet Med Assoc ; 256(12): 1368-1374, 2020 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-32459582

RESUMO

CASE DESCRIPTION: A 6-year-old 17-kg (37.4-lb) spayed female mixed-breed dog was evaluated because of swelling and intermittent lameness of the right pelvic limb and perianal and vulvar bleeding caused by a suspected arteriovenous malformation. CLINICAL FINDINGS: The right pelvic limb had a diffuse, raised, cobblestone-like appearance with lameness, edema, and multifocal ulcerations. The abdominal skin had multifocal circular erythematous lesions, the perianal region was erythematous, and the vestibule had superficial distended vessels. Ultrasonography and CT did not reveal the presence of an arteriovenous malformation; however, digital subtraction venography confirmed the presence of a venous malformation (VM) throughout the limb. TREATMENT AND OUTCOME: A mixture of foam sclerosant (1.5% sodium tetradecyl sulfate) and contrast medium was agitated with air and injected percutaneously into the VM. The dog received an injection of corticosteroid solution, and a soft-padded bandage was applied to the limb for 3 days. Six weeks later, the dog would intermittently hop when running, and the limb was mildly edematous with ecchymotic lesions; the swelling and lameness had improved considerably. Perianal and vulvar bleeding and dilation of the vestibular vessels had resolved. At 21 months after the procedure, examination revealed no right pelvic limb lameness related to the VM; only small cyst-like lesions and edema around the tarsus remained. CLINICAL RELEVANCE: The favorable clinical outcome for this dog for a 21-month period after treatment of a pelvic limb VM with foam sclerotherapy has suggested that foam sclerotherapy may be used to successfully treat limb VMs in some dogs.


Assuntos
Malformações Arteriovenosas , Cistos , Doenças do Cão , Animais , Malformações Arteriovenosas/terapia , Malformações Arteriovenosas/veterinária , Cistos/veterinária , Doenças do Cão/tratamento farmacológico , Cães , Feminino , Soluções Esclerosantes/uso terapêutico , Escleroterapia/veterinária , Tetradecilsulfato de Sódio/uso terapêutico , Resultado do Tratamento
11.
Electrophoresis ; 41(13-14): 1245-1252, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32297333

RESUMO

In the biopharmaceutical industry, CE-SDS assesses the purity, heterogeneity, and stability of therapeutic proteins. However, for mAb-1 and mAb-2, typical CE-SDS under reducing conditions produced atypical protein peak profiles, which led to biased purity results, thus were not acceptable for biologics manufacturing. This bias was caused by the formation of method-induced higher molecular weight artifacts, the levels of which correlated with protein concentration. Here we show that adding sodium tetradecyl and hexadecyl sulfates to the sample and the sieving gel buffer solutions was required to prevent formation of aggregate artifacts and to maintain detergent:protein uniformity, suggesting their importance during the sample preparation steps of heat denaturation and subsequent cooling as well as during capillary migration. For these proteins, we show that this uniformity was likely due to the ability of these detergents to bind proteins with markedly higher affinities compared to SDS. "CE-SCX S" methods (where CE-SCX S is CGE using detergent composed of a sodium sulfate head group and a hydrocarbon tail, with "CX " representing various tail lengths), were developed with a sodium tetradecyl sulfate sample buffer and a sodium hexadecyl sulfate containing sieving gel buffer that minimized artifacts and provided robust characterization and release results for mAb-1 and mAb-2.


Assuntos
Artefatos , Eletroforese Capilar/métodos , Proteínas/análise , Proteínas/química , Tetradecilsulfato de Sódio/química , Anticorpos Monoclonais/análise , Anticorpos Monoclonais/química , Detergentes/química , Interações Hidrofóbicas e Hidrofílicas , Oxirredução , Agregados Proteicos
12.
J Vasc Surg Venous Lymphat Disord ; 8(6): 1074-1082, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32284312

RESUMO

OBJECTIVE: Congenital vascular malformations are a heterogeneous group of lesions with the potential to cause significant lifelong morbidity in children. Diagnosis and treatment of these lesions may be complex and require a multidisciplinary approach. Sclerotherapy is widely used for the treatment of low-flow vascular malformations (LFVMs) as an alternative to surgical resection in adults; however, limited data of its use in a pediatric setting are available. The purpose of this study was to evaluate the efficacy and safety of sclerotherapy for pediatric LFVMs. METHODS: In this retrospective study, we reviewed our multidisciplinary vascular malformations team database for all patients younger than 18 years treated for congenital vascular malformations from 2008 to 2017. Of these, patients with LFVM treated with foam sclerotherapy were included. Dynamic contrast-enhanced magnetic resonance imaging was used to select patients for sclerotherapy by the multidisciplinary team. Foam sclerotherapy was performed with either polidocanol or sodium tetradecyl sulfate. Patients' characteristics, including demographics, presenting symptoms, and anatomic location of malformation, were assessed. Outcomes included treatment response, number of procedures, and postprocedural complications. RESULTS: The 61 patients with 61 LFVMs included 27 boys (44.3%) and 34 girls (55.7%), with mean age of 10.3 years (standard deviation, ± 5.3 years). The cohort included 32 venous (52.5%), 16 lymphatic (26.2%), and 8 mixed venous and lymphatic (13.1%) malformations along with 5 (8.2%) associated with Klippel-Trénaunay syndrome. Primary indications for intervention included pain and swelling (n = 12 [19.6%]), pain alone (n = 23 [37.7%]), swelling alone (n = 15 [24.6%]), functional impairment (n = 8 [13.1%]), and bleeding (n = 3 [4.9%]). Anatomic distributions varied, with 13 head and neck (21.3%), 5 truncal (8.2%), 10 upper extremity (16.4%), 27 lower extremity (44.3%), and 6 diffuse (9.8%). Among the head and neck lesions, 8 (13.1%) extended to the face; and of the extremity lesions, 5 (8.2%) extended to the hand and 17 (27.9%) to the foot. Overall, sclerotherapy resulted in significant improvement or complete resolution of symptoms in 53 patients (86.9%). Complications were observed in seven patients (11.4%); six cases (9.8%) of superficial skin ulceration resolved without intervention, and one infection (1.6%) required antibiotics. No patients experienced adverse hemodynamic consequences or venous thromboembolism. CONCLUSIONS: This series of pediatric LFVMs, the largest of its kind to date, demonstrates that sclerotherapy with foam-based agents effectively reduces symptoms with an acceptable rate of complications. Further study is needed to determine the optimal sclerosing agents for individual subsets of LFVMs in the pediatric population.


Assuntos
Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia , Tetradecilsulfato de Sódio/uso terapêutico , Malformações Vasculares/terapia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Polidocanol/efeitos adversos , Fluxo Sanguíneo Regional , Estudos Retrospectivos , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Tetradecilsulfato de Sódio/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Malformações Vasculares/diagnóstico por imagem , Malformações Vasculares/fisiopatologia
13.
Phlebology ; 35(8): 566-575, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32216526

RESUMO

OBJECTIVES: To investigate the effects of detergent sclerosants, sodium tetradecyl sulphate and polidocanol, on endothelial cell activation and microparticle release and the effects of detergent sclerosants, sirolimus and propranolol, on apoptosis in vitro. METHODS: Cultured human umbilical vein endothelial cells and murine haemangioendothelioma (EOMA) cell lines were incubated with different concentrations of sodium tetradecyl sulphate and polidocanol, as well as sirolimus and propranolol. Endothelial activation was assessed using flow cytometry for CD62e (E-Selectin), CD54 (ICAM-1), CD105 (endoglin), CD144 (VE-Cadherin), CD146 (MCAM) and the release of endothelial microparticles. Cell proliferation was assessed using [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] and carboxyfluorescein succinimidyl ester assays. Apoptosis was assessed using flow cytometry for lactadherin/propidium iodide staining and for Caspase-3 expression. RESULTS: Sublytic concentrations of sodium tetradecyl sulphate and polidocanol (0.075%-0.3%) increased the expression of the activation markers CD62e and CD54. The expression of CD105 decreased in sclerosant treated cultured human umbilical vein endothelial cells. Both sodium tetradecyl sulphate and polidocanol induced the release of endothelial microparticles. All agents inhibited cell proliferation. Sodium tetradecyl sulphate and polidocanol-induced apoptosis as evidenced by increased phosphatidylserine exposure and caspase-3 expression, whereas sirolimus and propranolol increased caspase-3 expression only. CONCLUSION: Sublytic concentrations of detergent sclerosants induce endothelial activation and the release of endothelial microparticles. All agents were anti-proliferative in EOMA cell lines, with sodium tetradecyl sulphate and polidocanol inducing cellular apoptosis.


Assuntos
Detergentes , Soluções Esclerosantes , Animais , Apoptose , Proliferação de Células , Detergentes/farmacologia , Células Endoteliais da Veia Umbilical Humana , Humanos , Camundongos , Propranolol/farmacologia , Soluções Esclerosantes/farmacologia , Sirolimo/farmacologia , Tetradecilsulfato de Sódio/farmacologia
14.
Pediatr Radiol ; 50(6): 869-876, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32198665

RESUMO

BACKGROUND: Sialorrhea is common in children with neurological disorders and leads to social isolation, aspiration pneumonia and increased caregiver burden. Sialorrhea management includes anticholinergic medications and a variety of surgeries, but these are limited by side effects, recurrence and risks. OBJECTIVE: We present our method of salivary gland ablation, an interventional radiology treatment for sialorrhea, and report safety and efficacy data from pediatric patients who underwent salivary gland ablation. MATERIALS AND METHODS: Salivary gland ablation uses image-guided sotradecol and ethanol dual-drug injection into the salivary glands. Submandibular and sublingual glands are injected percutaneously using ultrasound. Parotid glands are injected retrograde through Stensen ducts using fluoroscopy. We conducted a retrospective review of the medical records of patients who underwent salivary gland ablation at our institution between 2005 and 2019. Pre- and post-procedure Drooling Frequency and Drooling Severity (DFDS) scale scores were compared and caregiver satisfaction was assessed. We devised two cohorts, one to study patient safety and a subcohort to study clinical efficacy using DFDS scores. RESULTS: One hundred and seventy salivary gland ablation procedures were performed in the 99 patients comprising the safety cohort. Of the procedures, 88.8% resulted in no or minimal complications. Respiratory difficulty, temporary nerve palsy and infection represent the majority of the 11.2% of patients who experienced periprocedural complications. There were no complications resulting in permanent sequelae. Twenty-seven patients met our inclusion criteria for the efficacy subcohort with a mean follow-up time of 5.4 years. DFDS at follow-up decreased from a median score of nine to a seven post-procedure (P=0.000018). The proportion of caregivers who were satisfied with the procedure increased as more glands were ablated, which suggests a causal link between the number of glands ablated and the outcome. CONCLUSION: Salivary gland ablation is a safe and effective procedure with the potential for permanent decrease in symptoms related to sialorrhea.


Assuntos
Etanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Sialorreia/tratamento farmacológico , Tetradecilsulfato de Sódio/uso terapêutico , Técnicas de Ablação , Adolescente , Adulto , Criança , Pré-Escolar , Quimioterapia Combinada , Etanol/administração & dosagem , Feminino , Fluoroscopia , Humanos , Injeções , Masculino , Estudos Retrospectivos , Soluções Esclerosantes/administração & dosagem , Tetradecilsulfato de Sódio/administração & dosagem
15.
J Investig Med High Impact Case Rep ; 8: 2324709620904569, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32009454

RESUMO

Ileostomy variceal bleeds can be a serious complication in patients with cirrhosis and ileostomy but make up a small portion of total variceal bleeds. Multiple modalities have been described as therapeutic options for stomal variceal bleeding, but an optimal intervention has yet to be established. We present a case of a 51-year-old patient with preserved ejection fraction heart failure, hepatitis C cirrhosis, recent esophageal varices banding, and colectomy with ileostomy who developed bleeding ileostomy varices that were effectively treated under direct ultrasound-guided percutaneous injection of sodium tetradecyl sulfate to the feeding superior mesenteric venous flow. The patient did not have a recurrence of bleeding at 7-month follow-up. We consider direct ultrasound-guided percutaneous injection of sodium tetradecyl sulfate of acute bleeding stomal varices to be safe and effective in decompensated cirrhotic patients.


Assuntos
Hemorragia Gastrointestinal/terapia , Ileostomia , Escleroterapia/métodos , Tetradecilsulfato de Sódio/uso terapêutico , Varizes/terapia , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/complicações , Masculino , Pessoa de Meia-Idade , Ultrassonografia de Intervenção , Varizes/etiologia
16.
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.
Dermatol Surg ; 46(2): 249-257, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31569112

RESUMO

BACKGROUND: Varicose veins are common clinical entities. Foam sclerotherapy is a minimally invasive and simple procedure; however, the side effects, efficacy, and stability of sclerosing foam are not ideal. OBJECTIVE: To summarize the current studies on sclerosing foam stability and promote foam sclerotherapy development. MATERIALS AND METHODS: We reviewed the literature before June 2018 and included only representatives studies on sclerosing foam stability. We summarized the foam half-life time (FHT) of polidocanol (POL) under 17 preparation conditions and the FHT of sodium tetradecyl sulfate under 21 preparation conditions. The preparation conditions included various combinations of temperature, liquid-gas ratio, preparation method, etc. RESULTS: The FHT of POL varied between 40 and 4,000 seconds under different conditions. The FHT of sodium tetradecyl sulfate varied from 25.7 to 390 seconds. The higher the drug concentration, the lower the temperature required to increase foam stability. The addition of surfactant greatly increased foam stability. For different gas compositions, the FHT sequence was as follows: CO2 < CO2 + O2 < O2 < air. CONCLUSION: Foam stability can be improved by changing the preparation conditions; therefore, the role of surfactants and predictive methods for FHT are worth investigating further.


Assuntos
Gases/farmacocinética , Soluções Esclerosantes/farmacocinética , Escleroterapia/métodos , Tensoativos/farmacocinética , Varizes/terapia , Composição de Medicamentos/métodos , Estabilidade de Medicamentos , Gases/administração & dosagem , Gases/química , Meia-Vida , Humanos , Injeções Intravenosas , Polidocanol/administração & dosagem , Polidocanol/química , Polidocanol/farmacocinética , Soluções Esclerosantes/administração & dosagem , Soluções Esclerosantes/química , Tetradecilsulfato de Sódio/administração & dosagem , Tetradecilsulfato de Sódio/química , Tetradecilsulfato de Sódio/farmacocinética , Tensoativos/administração & dosagem , Tensoativos/química , Temperatura , Fatores de Tempo
18.
Gastrointest Endosc ; 91(2): 321-328.e1, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31437456

RESUMO

BACKGROUND AND AIMS: TC-325 (Hemospray; Cook Medical, Winston-Salem, NC, USA), an endoscopic hemostatic powder, exhibits possible benefits in patients with malignant GI bleeding. Our aim is to assess feasibility and determine estimates of efficacy of TC-325 compared with standard of care (SOC) in terms of initial hemostasis and recurrent bleeding rates in comparable groups of patients with malignant GI bleeding. METHODS: Adult patients presenting with acute malignant upper or lower GI bleeding were randomized to TC-325 or SOC. Measured outcomes included feasibility of recruitment and randomization in the urgent care setting, immediate hemostasis, recurrent bleeding, need for additional treatment modalities, and mortality. RESULTS: A preplanned 20 patients (upper GI source in 85%) were randomized 1:1 to TC-325 or SOC (25% women, age 67.2 ± 15.9 years, oozing in 95%) over 20 months. Immediate hemostasis was achieved in 90% of patients treated initially with TC-325 versus 40% in the SOC group (P = .057). Overall, 83.3% crossed over to TC-325, with hemostasis then achieved at index endoscopy in 80%. Overall, hemostasis at index endoscopy (before or after crossover) was obtained in 87.7% of patients treated with TC-325. Recurrent bleeding over the next 180 days was 20% in the TC-325 group compared with 60% in the SOC group (P = .170). CONCLUSIONS: This pilot trial demonstrates the feasibility of TC-325 in malignant GI bleeding and provides results to help inform a larger randomized trial. Although not powered for such, results suggest that use of TC-325 is a very promising modality in malignant GI bleeding in achieving immediate hemostasis and may even result in decreased subsequent recurrent bleeding. (Clinical trial registration number: NCT02135627.).


Assuntos
Hemorragia Gastrointestinal/terapia , Neoplasias Gastrointestinais/complicações , Hemostase Endoscópica/métodos , Hemostáticos/uso terapêutico , Minerais/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Coagulação com Plasma de Argônio , Eletrocoagulação , Epinefrina/uso terapêutico , Estudos de Viabilidade , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Injeções Intralesionais , Fotocoagulação , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Recidiva , Soluções Esclerosantes/uso terapêutico , Tetradecilsulfato de Sódio/uso terapêutico , Instrumentos Cirúrgicos , Vasoconstritores/uso terapêutico
20.
J Dent Child (Chic) ; 86(3): 169-172, 2019 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-31645260

RESUMO

Venous malformations (VMs) are part of the spectrum of vascular malformations composed of ectatic venous channels. VMs of the oral cavity in pediatric patients are relatively rare but reportedly carry a higher rate of rupture than in adults. We describe the management of an 18-month-old boy with VM who presented with a localized dome-shaped swelling measuring approximately 9.4 mm by 7.4 mm in the anterior third of the palate. Management with sclerotherapy using an intralesional injection of three percent sodium tetradecyl sulphate was used to treat the lesion with minimum armamentarium, cost, and complication. (J Dent Child 2019;86(3):169-72).


Assuntos
Soluções Esclerosantes , Malformações Vasculares , Adulto , Criança , Humanos , Lactente , Masculino , Escleroterapia , Tetradecilsulfato de Sódio , Resultado do Tratamento
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