Sclerotherapy of benign oral vascular lesions with non-diluted ethanolamine oleate / Escleroterapia de lesiones vasculares orales benignas con oleato de etanolamina no diluido

Benign oral vascular lesions are anomalies characterized by the blood vessels proliferation or malformation and the treatment with the sclerosing agent ethanolamine oleate acts irrigating the vessel producing a sterile inflammatory response. The objective of this study was to report and discuss the results from treatment of benign oral vascular lesions with non-diluted ethanolamine oleate through the analysis of clinical records. The sample was composed by the selection of twenty-six patients (12 male and 14 female), with oral vascular malformations. All lesions were treated with intralesional injections of undiluted ethanolamine oleate. These patients attended in Oral Medicine outpatient clinic of the Federal University of Paraná between the years of 2011 to 2015. The average age was 60.65 years, with a higher prevalence for women. The majority of the individuals had one lesion and its location was mostly in the lower lip. The main complaint was about a physical discomfort. The lesions had the average size of 6.52 mm and received a median number of 2.32 applications. Only one patient reported feeling pain in the postoperative week. In most cases the resolution of the lesion was considered partial. Follow-up was obtained up to one month after the end of treatment. The sclerotherapy with undiluted ethanolamine oleate shows acceptable results in the treatment of small benign oral vascular lesions with a few minor side effects.

Las lesiones vasculares orales benignas son anomalías caracterizadas por la proliferación o malformación de los vasos sanguíneos y el tratamiento con el agente esclerosante etanolamina oleato actúa irrigando el vaso produciendo una respuesta inflamatoria estéril. El objetivo de este estudio fue informar y discutir los resultados del tratamiento de lesiones vasculares orales benignas con oleato de etanolamina no diluido a través del análisis de historias clínicas. La muestra estuvo compuesta por la selección de veintiséis pacientes (12 hombres y 14 mujeres), con malformaciones vasculares orales. Todas las lesiones fueron tratadas con inyecciones intralesionales de oleato de etanolamina sin diluir. Estos pacientes acudieron a la clínica ambulatoria de Medicina Oral de la Universidad Federal de Paraná entre los años 2011 a 2015. La edad promedio fue de 60,65 años, con una mayor prevalencia para las mujeres. La mayoría de los individuos tenían una lesión y su ubicación era principalmente en el labio inferior. La queja principal era sobre una molestia física. Las lesiones tenían un tamaño promedio de 6,52 mm y recibieron una mediana de 2,32 aplicaciones. Solo un paciente informó haber sentido dolor en la semana postoperatoria. En la mayoría de los casos, la resolución de la lesión se consideró parcial. El seguimiento se obtuvo hasta un mes después del final del tratamiento. La escleroterapia con oleato de etanolamina sin diluir muestra resultados aceptables en el tratamiento de pequeñas lesiones vasculares orales benignas con algunos efectos secundarios menores.

Sclerotherapy as an esthetic indication in oral vascular malformations: a case series

Abstract 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).

Tratamiento de hemangioma lingual con polidocanol al 0.5 %. Relato de caso clínico. / Treatment of lingual hemangioma with 0.5% polidocanol. Clinical case report

El hemangioma, según la Organización Mundial de la Salud (OMS), es una neoplasia vascular benigna, caracterizada por la proliferación anormal de vasos sanguíneos, se presenta como una lesión única, pudiéndose observar en cualquier parte del organismo, sin embargo es más incidente en el área de cabeza y cuello, con predominio en los labios, en la lengua y en la mucosa yugal. Técnicamente, su exrpación quirúrgica es dicil y desafiante, al estar cargada con complicaciones como hemorragia, escisión incompleta, desfiguración facial y recurrencia. Objevo: relatar el caso clínico de un paciente con hemangioma lingual tratado con Polidocanol al 0,5%. Se necesitaron de 4 sesiones de aplicación del agente esclerosaste para que retrocediera completamente la lesión donde en cada infiltración se ulizó 1ml y en la úlma sesión 0.7 ml, logrando en esta úlma obtener la desaparición de la lesión por lo que el pronósco fue bueno. Conclusión: De acuerdo a los resultados de este trabajo el uso del Polidocanol al 0.5% en tratamientos de hemangioma linguales resulta ser una técnica bastante efecva, ya que con su prácca nos da una disminución del volumen de dicha lesión

The hemangioma, according to theWorldHealthOrganizaon (WHO), is a benign vascular neoplasm, characterized by the abnormal proliferaon of blood vessels, it presents as a single lesion, it can be found anywhere in the body, however it is more incident in thearea of the head and neck, predominantlyonthelips, onthetongue and onthejugal mucosa. Technically, its surgical removal is difficult and challenging, incomplete disease, facial disfigurement and recurrence. Objecve: to report the clinical case of a paentwith lingual hemangioma treatedwith 0.5% Polidocanol. iook 4 sessions of applicaon of thesclerosingagent to completelyretrachelesionwhere 1 ml wasused in eachinfiltraon and 0.7 ml in thelastsession, obtainingthedisappear of thelesion in thelaer, so the prognosis wasgood. Conclusion: According to the results of this study, the use of Polidocanol at 0.5% in lingual hemangioma treatmentsis a very effecve technique, and with its pracce we have a decrease in the volume of this lesion

Vascular sclerosing effects of bleomycin on cutaneous veins: a pharmacopathologic study on experimental animals

Abstract: Background: Varicose veins and the complications of venous disease are common disorders in humans. Objective: To study the effects of bleomycin as a potential new sclerosing agent and its adverse events in treating varicose veins. Methods: Bleomycin-loaded liposomes 0.1ml was injected in the dorsal ear veins of white New Zealand rabbits. Sodium tetradecyl sulfate was used as a positive control. Normal saline was used as negative control. The blood vessels of the treated ears were photographed before and at one hour and two, eight and 45 days after treatment. Biopsies from the treated areas were obtained for histological examination. Blood samples were collected to determine any possible toxicity. Results: Bleomycin by itself was ineffective; therefore, liposomes were used as a vector to deliver bleomycin to the vein lumen. Subsequently, bleomycin started showing its sclerosing effects. Toxicity monitoring showed no apparent hematologic, pulmonary, hepatic or renal toxicities. This study revealed that bleomycin induced vasculitis, which led to vascular occlusion, which was observed on day 1 and day 8. No bleomycin-related injury was noted by histopathological examination of lung sections. The calculation of the lung/body weight coefficient indicated that edema was present in the experimental groups compared with the negative and positive controls. Study limitations: Relatively small number of experimental animals used. Conclusions: This study showed that bleomycin-loaded liposomes were able to induce vasculitis and vascular occlusion without any toxicity or complications. It might be useful, hence, to treat patients suffering from Varicose veins and other ectatic vascular diseases with this agent.

Can proton pump inhibitors reduce rebleeding following Histoacryl sclerotherapy for gastric variceal hemorrhage?

BACKGROUND/AIMS: To evaluate the efficacy of proton pump inhibitors (PPIs) in reducing rebleeding and bleeding-related death rates after endoscopic gastric variceal obliteration (GVO) using N-butyl-2-cyanoacrylate (NBC). METHODS: This study enrolled 341 patients who were consecutively diagnosed with and treated for bleeding gastric varices. The patients were divided into PPI and non-PPI groups, and their endoscopic findings, initial hemostasis outcomes, rebleeding and bleeding-related death rates, and treatment-related complications were analyzed. RESULTS: The rate of initial hemostasis was 97.1%. rebleeding occurred in 2.2% of patients within 2 weeks, 3.9% of patients within 4 weeks, 18.9% of patients within 6 months, and 27.6% of patients within 12 months of the GVO procedure. A previous history of variceal bleeding (relative risk [RR], 1.955; 95% confidence interval [CI], 1.263 to 3.028; p = 0.003) and use of PPIs (RR, 0.554; 95% CI, 0.352 to 0.873; p = 0.011) were associated with rebleeding. Child-Pugh class C (RR, 10.914; 95% CI, 4.032 to 29.541; p < 0.001), failure of initial hemostasis (RR, 13.329; 95% CI, 2.795 to 63.556; p = 0.001), and the presence of red-colored concomitant esophageal varices (RR, 4.096; 95% CI, 1.320 to 12.713; p = 0.015) were associated with bleeding-related death. CONCLUSIONS: The prophylactic use of PPIs reduces rebleeding after GVO using NBC in patients with gastric variceal hemorrhage. However, prophylactic use of PPIs does not reduce bleeding-related death.

Cross-sectional study comparing different therapeutic modalities for cystic lymphangiomas in children

OBJECTIVE: Here, we describe our experience with different therapeutic modalities used to treat cystic lymphangiomas in children in our hospital, including single therapy with OK-432, bleomycin and surgery, and a combination of the three modalities. METHODS: We performed a retrospective, cross-sectional study including patients treated from 1998 to 2011. The effects on macrocystic lymphangiomas and adverse reactions were evaluated. Twenty-nine children with cystic lymphangiomas without any previous treatment were included. Under general anesthesia, patients given sclerosing agents underwent puncture of the lesion (guided by ultrasound when necessary) and complete aspiration of the intralesional liquid. The patients were evaluated with ultrasound and clinical examinations for a maximum follow-up time of 4 years. RESULTS: The proportions of patients considered cured after the first therapeutic approach were 44% in the surgery group, 29% in the bleomycin group and 31% in the OK-432 group. These proportions were not significantly different. Sequential treatment increased the rates of curative results to 71%, 74% and 44%, respectively, after the final treatment, which in our case was approximately 1.5 applications per patient. CONCLUSION: The results of this study indicate that most patients with cystic lymphangiomas do not show complete resolution after the initial therapy, regardless of whether the therapy is surgical or involves the use of sclerosing agents. To achieve complete resolution of the lesions, either multiple operations or a combination of surgery and sclerotherapy must be used and should be tailored to the characteristics of each patient. .

Fluoroscopy-Guided Endovenous Sclerotherapy Using a Microcatheter Prior to Endovenous Laser Ablation: Comparison between Liquid and Foam Sclerotherapy for Varicose Tributaries

OBJECTIVE: To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries. MATERIALS AND METHODS: From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits. RESULTS: A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found. CONCLUSION: Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.

CT-Guided Sclerotherapy for Simple Renal Cysts: Value of Ethanol Concentration Monitoring

OBJECTIVE: The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts. MATERIALS AND METHODS: Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination. RESULTS: After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 +/- 2.0 cm and 2.3 +/- 2.9 cm, respectively, in group A, and 8.4 +/- 1.7 cm and 0.8 +/- 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group. CONCLUSION: Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.

Effectiveness and safety of iodopovidone in an experimental pleurodesis model

OBJECTIVES: Chemical pleurodesis is an important therapeutic tool to control recurrent malignant pleural effusion. Among the various sclerosing agents, iodopovidone is considered effective and safe. However, in a recent study, ocular changes were described after iodopovidone was used in recurrent pneumothorax. The aim of the study was to evaluate the efficacy and morbidity of iodopovidone pleurodesis in an experimental model. METHODS: New Zealand rabbits were submitted to intrapleural injection of iodopovidone at concentrations of 2%, 4% and 10%. Biochemical (lactic dehydrogenase, proteins, triiodothyronine, free thyroxine, urea and creatinine) and immunological (Interleukin-8 [IL-8], VEGF and TGFβ) parameters were measured in the pleural fluid and blood. After 1, 3, 7, 14 and 28 days, groups of animals were euthanized, and macro- (pleura) and microscopic (pleura and retina) analyses were performed. RESULTS: An early pleural inflammatory response with low systemic repercussion was observed without corresponding changes in thyroid or renal function. The higher concentrations (4% and 10%) correlated with greater initial exudation, and maximum pleural thickening was observed after 28 days. No changes were observed in the retinal pigment epithelium of the rabbits. CONCLUSION: Iodopovidone is considered to be an effective and safe sclerosing agent in this animal model. However, its efficacy, tolerance and safety in humans should be further evaluated. .

The Role of Divided Injections of a Sclerotic Agent over Two Days in Balloon-Occluded Retrograde Transvenous Obliteration for Large Gastric Varices

OBJECTIVE: To determine the safety and usefulness of a two-tiered approach to balloon-occluded retrograde transvenous obliteration (B-RTO) as a treatment for large gastric varices after portal hypertension. MATERIALS AND METHODS: 50 patients were studied who underwent B-RTO for gastric varices between October 2004 and October 2011 in our institution. The B-RTO procedure was performed from the right femoral vein and the B-RTO catheter was retained until the following morning. Distribution of sclerotic agents in the gastric varices on fluoroscopy was evaluated in all patients on days 1 and 2. When distribution of sclerotic agents in the gastric varices on day 1 had been none or very scanty even though the volume of the sclerotic agent infused was above the acceptable level, a second infusion was administered on day 2. When distribution was satisfactory, the B-RTO catheter was removed. RESULTS: In 8 (16%) patients, little or no sclerotic agent infused on day 1 was distributed in the gastric varices. However, on day 2, sclerotic agents were distributed in all gastric varices. Mean volume of ethanolamine oleate-iopamidol infused on day 1 was 24.6 mL and was 19.4 mL on day 2. Gastric varices were well obliterated with no recurrence. Complications caused by the sclerotic agent such as pulmonary edema or renal insufficiencies were not seen. CONCLUSION: When gastric varices are very large, a strategy involving thrombosis of only the drainage vein on the first day followed by infusing the sclerotic agent on the following day might be effective and feasible.

Cyst Ablation Using a Mixture of N-Butyl Cyanoacrylate and Iodized Oil in Patients with Autosomal Dominant Polycystic Kidney Disease: the Long-Term Results

OBJECTIVE: We wanted to assess the long-term results of cyst ablation with using N-butyl cyanoacrylate (NBCA) and iodized oil in patients with autosomal dominant polycystic kidney disease (ADPKD) and symptomatic cysts. MATERIALS AND METHODS:Cyst ablation using a mixture of NBCA and iodized oil was performed in 99 cysts from 21 patients who had such symptoms as abdominal distension and pain. The collapse or reaccumulation of the ablated cysts after the procedure was assessed during the follow-up period of 36 to 90 months. The treatment effects, including symptom relief, and the clinical data such as the blood pressure and serum creatinine levels were also assessed, together with the complications. RESULTS: The procedure was technically successful in all 99 cysts from the 21 patients. Any procedure-related significant complications were not detected. Seventy-seven of 99 cysts (78%) were successfully collapsed on the follow-up CT. Twenty-two cysts showed reaccumulation during long-term follow-up period. The clinical symptoms were relieved in 17 of the 21 patients (76%). Four of 12 patients (33%) with hypertension and two of six patients (33%) with azotemia were improved. End stage renal disease (ESRD) occurred in six of the 21 patients (28%) during the follow-up period. The mean age of ESRD in our patients was 57 years. The mean time interval for the development of ESRD was 19 months. CONCLUSION: Ablation using a mixture of NBCA and iodized oil may be an effective, safe method for obtaining symptom relief in patients with ADPKD.

Fluoroscopy guided instillation therapy in chyluria using combination of povidone iodine with contrast agent: is a single instillation sufficient?

PURPOSE: To evaluate the safety and efficacy of a single instillation in a combination of povidone iodine with contrast agent under fluoroscopy guidance for the treatment of chyluria. MATERIALS AND METHODS: From December 1999 to July 2006 a total of 40 patients with chyluria were treated by renal pelvic instillation therapy (RPIS). The sclerosing solution was prepared using povidone iodine with contrast agent diluted with sterile water in a ratio of 1:1:3. It was instilled on the side having chylous efflux using a bulb tip ureteric catheter. Unilateral instillation was done in 26 cases, 10 on the right side and 16 on left. Fourteen patients had bilateral chylous efflux and RPIS was performed on both sides in the same session. Fluoroscopy was used to evaluate the complete filling of the pelvic calyceal system. The sclerosing solution was kept in the system for 5 minutes and the ureteric catheter was then withdrawn. RESULTS: Immediate clearance was observed in 39 patients. Recurrence occurred in five patients. They were treated again using the same procedure with satisfactory results. The longest follow-up was five years and the shortest five months. CONCLUSION: RPIS of chyluria using a single instillation a combination of povidone iodine with contrast agent is safe and effective. Use of fluoroscopy helps to determine the exact amount of sclerosing solution required to completely fill the system and therefore overfilling is avoided. Moreover, the complications, which arise due to pyelointerstitial backflow, are prevented.

Endoscopic abnormalities in the oesophagus after variceal sclerotherapy--a long-term follow up study.

Endoscopic sclerotherapy is a well-established treatment modality for oesophageal varices. Various local, regional and systemic complications occur after sclerotherapy. Altered endoscopic appearances of the oesophagus have been observed on follow-up of patients after sclerotherapy. 171 consecutive patients with extra-hepatic portal venous obstruction on follow up after achieving variceal eradication by sclerotherapy during the period from January 2004 to June 2005 were enrolled in this study. The oesophagus was closely observed for mucosal abnormalities and the endoscopic findings were recorded. Out of 171 patients, 95 (55.5%) patients had no specific endoscopic changes in the oesophagus. The most common finding was mucosal neovascularization which was seen in 56 (32.7%) patients. Oval or oblong depressed areas were seen in 41 (23.9%) patients. Mucosal tags and polypoidal lesions were seen in 37 (21.6%) patients. 25 (15.6%) patients had stenosis of the lower oesophagus and 3 (1.7%) patients had mucosal bridges. On multivariate analysis, these abnormal endoscopic findings in the oesophagus correlated with the total volume of sclerosant injected when compared with those patients without similar findings on endoscopy (p value < 0.001). Endoscopic sclerotherapy leads to various abnormalities at the injection sites like neovascularization, oval or oblong depressed areas, mucosal tags, polypoidal lesions, stenosis and mucosal bridges. Endoscopic abnormalities correlated with the total volume of sclerosant used. The long-term significance of these changes is not known at present and further follow-up studies will be required.

Comparison of CT-Guided Sclerotherapy with Using 95% Ethanol and 20% Hypertonic Saline for Managing Simple Renal Cyst

OBJECTIVE: We wanted to compare the efficacies of 95% ethanol and 20% hypertonic saline (HS) sclerotherapies that were performed in a single session under CT guidance for the management of simple renal cysts. MATERIALS AND METHODS: A prospective series of 74 consecutive patients (average age: 57.6 +/- 8.1 years) with simple renal cysts were enrolled in this study. They were randomized into two groups and 95% ethanol or 20% HS, respectively, corresponding to 25% of the aspiration volume, was injected. Treatment success was determined six months later with follow-up clinical evaluation and performing ultrasonography. RESULTS: The sclerotherapy was accepted as technically successful without major complications in all except two patients who were excluded because of a communication between the simple renal cyst and the pelvicalyceal collecting system. Thirty-six patients in the ethanol group received sclerotherapy with 95% ethanol and 36 patients in the HS group underwent sclerotherapy with 20% HS. The complete regression ratio of the ethanol group was significantly higher (94% versus 72%, respectively) than that of the HS group. There was one patient with partial regression in each group. The failure ratio of the ethanol group was significantly lower (3% versus 25%, respectively) than that of the HS group. CONCLUSION: Ethanol sclerotherapy under CT guidance is a successful and safe procedure and it can be used for the treatment of simple renal cysts. Sclerotherapy with 95% ethanol is more effective than 20% HS sclerotherapy. Sclerotherapy with HS may be an option for patients preferring to undergo a less painful treatment procedure.

Long-term Results of Endoscopic Histoacryl(R) (N-butyl-2-cyanoacrylate) Injection for Treatment of Gastric Varices : A 10-year Experience / 대한소화기학회지

BACKGROUND/AIMS: Gastric variceal bleeding is an infrequent but serious complication of portal hypertension. Endoscopic injection of Histoacryl(R) (N-butyl-2-cyanoacrylate) has been approved as an effective treatment for gastric variceal bleeding. The aim of this study was to evaluate the long-term efficacy and safety of the endoscopic injection of Histoacryl(R) for the treatment of gastric varices. METHODS: Between January 1994 and January 2005, eighty-five patients with gastric varices received endoscopic injections of Histoacryl(R) . Among these 85 patients, 65 received the procedure within 1 week after gastric variceal bleeding, and 13 received as a prophylactic procedure. According to the Sarin classification, 32 patients were GOV1 and 53 were GOV2. Most of the varices were large (F2 or F3, 75 patients). The average volume of Histoacryl(R) per each session was 1.43 ml. Among 85 patients, 72 patients were followed-up and the median duration was 24.5 months. RESULTS: The rate of initial hemostasis was 98.6% and recurrent bleeding occurred in 29.2% (21 of 72). When rebleeding occurred, 76.2% was within 1 year after the initial injection. Treatment failure-related mortality rate was 1.4% (1 of 85). Twenty-seven patients died, mostly due to hepatocelluar carcinoma or liver failure. Two patients experienced pulmonary embolism and one experienced splenic infarction. They recovered without specific treatment. Rebleeding rate had a tendency to increase in patients with hepatocelluar carcinoma (p=0.051) and GOV2 (p=0.061). CONCLUSIONS: Histoacryl(R) injection therapy is a effective treatment method for gastric varices with high initial hemostasis rate and low major complications.

Crosectomía y escleroterapia con espuna en el tratamiento del reflujo de la unión safenofemoral: una alternativa terapéutica mínimamente invasiva / Crosectomy and foam sclerotherapy in the treatment of the saphenophemoral junction reflux: a minimally invasive therapeutic alternative

Evaluar la eficacia y las ventajas de la crosectomía y escleroterapia con espuma en el tratamiento del reflujo de la unión safenofemoral y compararla con la safenectomia convencional. Se trata de un estudio descriptivo, prospectivo, de una muestra seleccionada de casos, conformado por treinta y seis pacientes con enfermedad varicosa producto de reflujo de la unión safenofemoral que acudieron a la consulta del Servicio de Cirugía III del Hospital Universitario de Caracas en el período comprendido entre octubre del 2005 y octubre del 2006. Se realizó crosectomía y escleroterapia con espuma de etoxiesclerol en dieciocho casos y safenectomía convencional en los dieciocho casos restantes. Para la técnica descrita, el tiempo quirúrgico promedio fue de 30 minutos; no se prsentaron complicaciones intraoperatorias. El tiempo promedio de hospitalización fue de un día, con un reintegro a las actividades cotidianas a la segunda semana en todos los casos y una elevada tasa de satisfacción (94,4 por ciento). En el seguimiento durante un período de tres a doce meses no se encontraron recurrencias. Se reportó un caso de hiperpigmentación como única complicación postoperatoria asociada al procedimiento. Se demostró beneficio con respecto a la safenectomía convencional en cuanto a tasa de complicaciones postoperatorias (5,5 por ciento vs 33,3 por ciento, p<0,05). La crosectomía y esclerosis con espuma es una técnica factible, con elevada tasa de éxito, que ofrece las ventajas del tratamiento mínimamente invasivo sin la necesidad de requerir en quirófano de equipos de alto costo, adecuándose de esta manera a centros hospitalarios de menos recursos.

Experimental pleurodesis induced by antibiotics (macrolides or quinolones) / Pleurodese experimental induzida por antibióticos (macrolídeos e quinolonas)

PURPOSE: Chemical pleurodesis is a therapeutic tool for the treatment of recurrent pleural effusions, mainly those of neoplastic etiology. In the past, tetracycline was the sclerosant agent of choice in clinical practice, but presently, there is no consensus about an ideal agent. The aim of this study was to evaluate the effectiveness of macrolides (azithromycin and clarithromycin) or quinolones (levofloxacin and gatifloxacin) in inducing experimental pleurodesis in rabbits. METHOD: Forty New Zealand rabbits randomized into groups of 10 received (at a total volume of 2 mL for each animal) 1 of the 4 drugs by intrapleural injection. After 28 days, the animals were euthanized and the pleural cavity was evaluated macroscopically and microscopically. RESULTS: The intensity of the macroscopic adhesions was mild in all groups. On microscopic analysis, minimal pleural fibrosis and inflammation were observed in all animals. CONCLUSION: The macrolides (azithromycin or clarithromycin) and the quinolones (levofloxacin or gatifloxacin) when injected into the normal pleural space of rabbits are not effective in promoting pleurodesis. Additional research is required to identify sclerosing agents capable of inducing pleurodesis.

OBJETIVO: A pleurodese química representa uma ferramenta terapêutica utilizada no tratamento dos processos pleurais recidivantes, principalmente nos derrames neoplásicos. A escolha do melhor esclerosante pleural é ainda motivo de controvérsia, não havendo consenso com relação ao agente considerado ideal. O objetivo deste estudo é avaliar a efetividade dos macrolídeos (azitromicina e claritromicina) e das quinolonas (levofloxacina e gatifloxacina) na indução de pleurodese experimental em coelhos. MÉTODOS: Quarenta animais randomizados em grupos de 10, receberam, em volume total de 2 mL, estas drogas através de injeção intrapleural. RESULTADOS: Após 28 dias, os animais foram sacrificados sendo avaliada a cavidade pleural. A intensidade das aderências macroscópicas assim como da fibrose e da inflamação observadas à microscopia foi discreta tanto no grupo que recebeu macrolídeos quanto naquele que recebeu quinolonas. CONCLUSÃO: Azitromicina, Claritromicina, Levofloxacina e Gatifloxacina quando injetados na cavidade pleural de coelhos, não são eficazes na indução de pleurodese. Novas pesquisas devem ser realizadas com o intuito de identificar agentes esclerosantes capazes de produzir sínfise pleural.

Inyección de sustancias esclerosantes vasculares en el manejo de lesiones vasculares orbitarias / Injection of vascular sclerosing agent in the treatment of orbital vascular lesions

Objetivo: Evaluar el efecto de la inyección de espuma de polidocanol como sustancia esclerosante vascular en la reducción del tamaño de hemangiomas y linfangiomas orbitarios. Material y Métodos: Estudios prospectivo intervencional de 2 casos con diagnóstico de hemangioma capilar, 7 casos de linfangioma de la región orbitaria y 1 malformación vascular superficial preseptal, que recibieron una o más inyecciones de polidocanol intralesional. Se evaluaron el tipo de tumor, disminución de su tamaño, variación de ptosis palpebral, proptosis y presencia de complicaciones con el procedimiento. Resultados: Se realizaron 4,5 inyecciones promedio con una dosificación final de 0,6 cc al 0,5 por ciento de polidocanol. El seguimiento promedio fue 16,2 meses. Todos los pacientes redujeron el tamaño de la lesión significativamente. La principal complicación fue dolor postinyección. Conclusiones: El uso de inyecciones de polidocanol en el tratamiento de hemangiomas capilares y linfangiomas orbitarios sería una alternativa novedosa y efectiva para reducir el tamaño de las lesiones sin mayores complicaciones.

Endoscopic sclerotherapy for bleeding oesophageal varices: experience in Sudan.

INTRODUCTION: Bleeding due to oesophageal varices is the commonest cause of upper gastrointestinal tract haemorrhage in Sudan. Endoscopic injection sclerotherapy (EST) is a valuable therapeutic modality for the management of variceal bleeding. Other options for treatment such as variceal banding are either expensive or unavailable. STUDY AIMS: A retrospective study to evaluate the outcome of EST in the management of bleeding oesophageal varices due to portal hypertension in a developing country (Sudan). PATIENTS AND METHODS: A total of 1070 patients over a period of 10 years (1986-1996) were studied. Inclusion criteria was bleeding oesophageal varices consequent to portal hypertension. EST was performed using a standard technique. Ethanolamine oleate 5% was the sclerosing agent utilized. The procedure was done on a day- case basis. RESULTS: There were 904 males (84.5%) and 166 females (15.5%). The cause of portal hypertension was schistosomal periportal fibrosis (PPF) in 999 (93.3%) patients, liver cirrhosis 59 (5.5%), mixed PPF and cirrhosis 5 (0.46%), portal vein thrombosis 6 (0.64%) and congenital hepatic fibrosis was present in 1 patient. A total of 100 (9.4%) patients presented with bleeding which occurred after surgery. Full obliteration of varices required a mean of 4 sessions with a range of 2-6. 462 (43.2%) have been followed up until complete sclerosis of varices. CONCLUSION: This study provides evidence that endoscopic injection sclerotherapy is an essential component in the management of bleeding oesophageal varices caused by portal hypertension. It is a feasible and a cost-effective therapeutic strategy in developing countries.