Malformación linfática quística gigante del hígado: dos casos pediátricos con diferente abordaje quirúrgico / Giant cystic lymphatic malformation of the liver: two pediatric cases with different surgical approach

Introducción. Las malformaciones linfáticas quísticas, también llamadas linfangiomas quísticos, aparecen muy raramente de forma aislada en el hígado. Casos clínicos. Se presentan dos pacientes femeninas de edad preescolar con marcada hepatomegalia, dependiente de lesiones quísticas multitabicadas, secundarias a malformación linfática quística gigante del hígado, que fueron tratadas en el Hospital Pediátrico Universitario William Soler, La Habana, Cuba. Resultados. En ambos casos el diagnóstico se apoyó en los estudios de imágenes, la laparoscopia y el análisis histopatológico. En un caso el tratamiento fue la hepatectomía derecha, mientras que en el otro se empleó la escleroterapia, ambas con evolución favorable. Conclusión. A pesar de su rareza, este diagnóstico no debe obviarse ante un paciente pediátrico con lesiones hepáticas quísticas. El tratamiento de elección es la resección quirúrgica, pero su indicación y envergadura debe valorarse de forma individualizada

Introduction. Cystic lymphatic malformations, also called cystic lymphangiomas, are very rarely found in the liver. Clinical cases. Two pediatric female preschool-age patients. presented with hepatomegaly due to multi-septated cystic lesions of the liver, who received treatment at Hospital Pediátrico Universitario William Soler, La Habana, Cuba. Results. We report two pediatric cases with giant cystic lymphatic malformation of the liver. In both cases, the diagnosis were based on imaging, laparoscopy and pathology. In one case the treatment was right hepatectomy, whereas in the other, sclerotherapy was performed, both with a favorable outcome. Conclusion. Despite its rarity, this diagnosis should be considered in pediatric patients with hepatic cystic lesions. The recommended treatment is surgical resection, but its indication and extent should be assessed individually for each patient.

Experimental study of improved sclerotherapy injection in rat model of vertebral arteriocervical spondylopathy / 中国骨伤

OBJECTIVE@#To improve the rat model of cervical spondylosis of vertebral artery type (CSA) induced by injecting sclerosing agent. To evaluate the efficacy of injecting sclerosing agent to induce CSA.@*METHODS@#Forty Health SPF SD rats(20 males and 20 females), were randomly divided into two groups:the model group (20) and the blank group (20). All the animals were followed up for 4 weeks for the observation of general situation, transcranial Doppler(TCD) detection of blood flow velocity, pulsatility index and resistive index of the vertebral artery, measurement of mental distress by open-field test.@*RESULTS@#One to two days after establish the animal model, rats in the model group appeared apathetic with decreased autonomic activities, trembling, squinting, increased eye excrement, etc., and no rats died during the experiment. The mean blood flow velocity of the model group was lower than that of the blank group (P<0.05), and the pulsatilit index and resistive index of the model group were higher than that of the blank group (P<0.05). The mental distress of the model group was significantly higher than that of the blank group.@*CONCLUSION@#The modified injection of sclerosing agent is a practical method to establish the rat model of CSA, with high success rate, high stability, low mortality and simple operation.

Escleroterapia no tratamento de lesões vasculares orais / Escleroterapia en el tratamiento de las lesiones vasculares orales / Sclerotherapy in the treatment of oral vascular injuries

Objetivo: apresentar um caso de lesão vascular em paciente idoso tratado pela técnica da escleroterapia. Relato do caso: paciente masculino, 67 anos, vítima de acidente vascular cerebral, buscou atendimento odontológico por apresentar raízes residuais. Durante o exame físico foi identificada lesão exofítica, de coloração violácea, base séssil, com aproximadamente dois centímetros, localizada em comissura labial esquerda. Para confirmar a origem da alteração foi realizada manobra semiotécnica (diascopia) que revelou tratar-se de lesão vascular. Por ser o paciente idoso, hipertenso, com histórico de acidente vascular cerebral, foi feita a opção por tratamento conservador, sendo realizada a escleroterapia com oleato de monoetanolamina 5%, numa única sessão. No retorno de sete dias, foi observada regressão parcial da lesão e com 30 dias a região se mostrou completamente cicatrizada, sem vestígios da alteração. O oleato de monoetanolamina provoca uma reação inflamatória estéril, aguda, dose-dependente, no endotélio vascular e nos tecidos extravasculares que resulta em fibrose e obliteração dos vasos sanguíneos, induzindo a regressão das lesões. Conclusão: Com base no caso apresentado e nos registros da literatura é possível afirmar que a escleroterapia é uma alternativa terapêutica minimamente invasiva, eficaz, de baixo custo e com resultado estético favorável no tratamento de lesões vasculares orais... (AU)

Objective: to present a case of vascular injury in an elderly patient treated by the sclerotherapy technique. Case report: male patient, 67 years old, victim of a stroke, sought dental care due to residual dental roots. During the physical examination, an exophytic lesion, violet in color, sessile base, approximately two centimeters, located in the left labial commissure, was identified. Diascopy was performed to confirm the origin of the alteration, which revealed that it was a vascular le sion. As the patient was elderly, hypertensive, with a history of stroke, conservative treatment was chosen, with sclerotherapy with 5% mon oethanolamine oleate in a single session. On return after seven days, partial regression of the lesion was observed and, after 30 days, the region was completely healed, with no traces of the alteration. Mon oethanolamine oleate causes a sterile, acute, dose-dependent inflam matory reaction in the vascular endothelium and extravascular tissues that results in fibrosis and obliteration of blood vessels, inducing re gression of the lesions. Conclusion: Based on the case presented and on the literature records, it is possible to affirm that sclerotherapy is a minimally invasive, effective, low-cost therapeutic alternative with a favorable aesthetic result in the treatment of oral vascular lesions... (AU)

Objetivo: presentar un caso de lesión vascular en un paciente de edad avanzada, tratado mediante la técnica de escleroterapia. Reporte de caso: paciente masculino, 67 años, víctima de un derrame cerebral, buscó atención odontológica por raíces dentarias residuales. Durante el examen físico se identificó una lesión exofítica, de color violeta, de base sésil, de aproximadamente dos centímetros, ubicada en la comisura labial izquierda. Se realizó diascopia para confirmar el origen de la alteración, que reveló que se trataba de una lesión vascular. Como el paciente era anciano, hipertenso, con antecedentes de ictus, se optó por tratamiento conservador, con escleroterapia con oleato de monoetanolamina al 5% en una sola sesión. Al regreso a los siete días se observó una regresión parcial de la lesión y, a los 30 días, la región estaba completamente curada, sin rastros de la alteración. El oleato de monoetanolamina provoca una reacción inflamatoria estéril, aguda y dependiente de la dosis en el endotelio vascular y los tejidos extravasculares que produce fibrosis y obliteración de los vasos sanguíneos, lo que induce la regresión de las lesiones. Conclusión: Con base en el caso presentado y en los registros de la literatura, es posible afirmar que la escleroterapia es una alternativa terapéutica mínimamente invasiva, efectiva, de bajo costo y con resultado estético favorable en el tratamiento de las lesiones vasculares orales... (AU)

Use of sirolimus and sclerotherapy for lymphatic malformations in a developing country: a case series / Uso de sirolimus y escleroterapia para malformaciones linfáticas en un país en vías de desarrollo: una serie de casos

Las malformaciones linfáticas y su manejo no han sido bien descritas en República Dominicana. Es por ello, que el objetivo de este artículo es la presentación de tres casos, con diferentes patrones y necesidades de tratamiento, de modo que sirva como referencia para trabajadores de la salud en países en vías de desarrollo.

Lymphatic malformations and its management are not well described in the Dominican Republic. That is why this article's objective is to present 3 cases, with different patterns and treatment needs, so it will work as a reference for healthcare workers in developing countries.

Effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors / 中华肝脏病杂志

Objective: To investigate the effects of primary preventive treatment under endoscope for esophageal and gastric varices on bleeding rate and its relevant factors. Methods: 127 cases with liver cirrhosis accompanied with esophageal and gastric varices without bleeding history were included in the endoscopic and non-endoscopic treatment group, respectively. Informed consent was obtained from both groups. Gastric varices (Lgf) and esophageal varices (Leg) were diagnosed according to LDRf classification criteria, and the corresponding treatment scheme was selected according to the recommended principle of this method.The incidence rate of bleeding from ruptured esophageal varices were observed at 3, 6 months, and 1, and 2 years in the treated and the untreated group, and the patients with different Child-Pugh scores were followed-up for 2 years. Gender, age, etiology, varicose degree, Child-Pugh grade, platelet count, prothrombin activity, portal vein thrombosis, collateral circulation, portal vein width and other factors affecting the bleeding rate were assessed. Measurement data were described as mean ± standard deviation (x¯±s), and qualitative data of categorical variables were expressed as percentage (%), and χ2 test was used. Results: 127 cases were followed up for 2 years. There were 55 cases in the endoscopic treatment group (18 cases underwent band ligation, 2 cases underwent band ligation combined with tissue adhesive embolization, 28 cases underwent sclerotherapy, and 7 cases underwent sclerotherapy combined with tissue adhesive embolization). Recurrent bleeding and hemorrhage was occurred in 5 (9.1%) and 28 cases (38.9%), respectively (P<0.05). In addition, there were 72 cases in the untreated group (P<0.05). Severe varicose veins proportions in treated and untreated group were 91.1% and 85.1%, respectively (P>0.05). There was no statistically significant difference in liver cirrhosis-related medication and β-blocker therapy between the treated and untreated group (P>0.05). There was no statistically significant difference in the bleeding rate between the different treated groups (P>0.05). The bleeding rates at 3, 6 months, 1, and 2 years in endoscopic treated and untreated group were 2.00% vs. 2.59% (P>0.05), 2.30% vs. 5.88% (P>0.05), 3.10% vs. 7.55% (P>0.05) and 4.00% vs. 21.62% (P<0.05), respectively. All patients with Child-Pugh grade A, B and C in the treated and the untreated group were followed-up for 2 years, and the bleeding rates were 1.8% vs. 8.1% (P<0.05), 1.1% vs. 9.4% (P<0.05) and 9.1% vs. 10.1% (P>0.05), respectively. There were statistically significant differences in the rupture and bleeding of esophageal and gastric varices, varices degree, Child-Pugh grade and presence or absence of thrombosis formation in portal vein (P<0.05); however, no statistically significant differences in gender, age, etiology, platelet count, prothrombin activity, collateral circulation and portal vein width (P>0.05). There was no intraoperative bleeding and postoperative related serious complications in the treated group. Conclusion: The risk of initial episodes of bleeding from esophageal and gastric varices is significantly correlated with the varices degree, Child-Pugh grade, and portal vein thrombosis. Primary preventive treatment under endoscope is safe and effective for reducing the long-term variceal bleeding risk from esophageal and gastric varices.

Experimental study on the relationship between foam pressure difference and foam stability / 生物医学工程学杂志

Foam stability affects the efficacy and incidence of side effects of foam sclerotherapy. Exploring the relationship between foam pressure difference and foam stability can provide ideas and basis for obtaining more stable foam. In the experiment, sodium cod liver oleate foam was selected, and poloxamer 188 (concentration of 0%, 4%, 8%, 12%) was added to realize the change of foam pressure. By using the self-written program to process the foam pictures, the foam pressure difference and the relationship between the foam stability indicators (water separation rate curve, half-life) and the foam pressure difference were obtained. The results showed that at first the foam pressure increased with the increase of the concentration, and then it decreased with the increase of the concentration and reached a peak at the concentration of 4%. The foam pressure difference decreases continuously with the increase of decay time. When the additive concentration is low, the foam average pressure difference increases. And if the additive concentration is too high, the foam average pressure difference decreases. The smaller the foam pressure difference is, the better the foam stability is. This paper lays a foundation for the research on the stability of foam hardener.

Malformaciones linfáticas abdominales en una población pediátrica: experiencia en un centro de referencia de Medellín, Colombia / Abdominal lymphatic malformations in a pediatric population: Experience in a referral center in Medellín, Colombia

Introducción. Los linfangiomas son anormalidades benignas del sistema linfático, que corresponden a dilataciones quísticas de estos vasos y se localizan especialmente en el cuello. Solo el 10 % de todas estas malformaciones se encuentran en el abdomen y presentan síntomas variables de acuerdo al tamaño y su ubicación especifica, siendo el dolor abdominal el principal síntoma. Métodos. Se presentan cinco pacientes pediátricos con malformaciones linfáticas abdominales. Se describen su cuadro clínico, localización, tratamiento y la experiencia en el manejo de dicha patología en un hospital de referencia. Resultados. Los métodos más apropiados para hacer una aproximación diagnóstica son la ecografía, la tomografía computarizada y la resonancia nuclear magnética. Dentro de las opciones descritas para el tratamiento están la farmacológica, la escleroterapia y la resección quirúrgica, tanto por vía abierta como por laparoscopia. Conclusión. Existe una variedad de métodos para realizar la resección de los linfangiomas abdominales, pero la cirugía sigue siendo la más efectiva, especialmente cuando se cuenta con la laparoscopia como una herramienta terapéutica.

Introduction. Lymphangiomas are benign abnormalities of the lymphatic system, which correspond to cystic dilations of these vessels and are located especially in the neck. Only 10% of all these malformations are found in the abdomen and present variable symptoms according to size and their specific location, with abdominal pain being the main symptom. Methods. Five pediatric patients with abdominal lymphatic malformations are presented. Their clinical presentation, location, treatment and experience in the management of this pathology in a referral hospital are described. Results. The most appropriate methods to make a diagnostic approach are ultrasound, computed tomography and magnetic resonance imaging. Among the options described for treatment are pharmacological, sclerotherapy and surgical resection, both open and laparoscopic. Conclusion. There are a variety of methods for resecting abdominal lymphangiomas, but surgery remains the most effective, especially when laparoscopy is used as a therapeutic tool.

Comparison of outcomes and costs of surgery versus sclerotherapy to treat hydrocele / Comparação entre resultados e custos de cirurgia e de escleroterapia para tratamento de hidrocele

ABSTRACT Objective: To evaluate the outcomes and costs associated with surgery versus sclerotherapy as treatment of hydroceles. Methods: A total of 53 men consecutively treated for hydrocele at our organization, between December 2015 and June 2019, were retrospectively analyzed (39 with Jaboulay technique and 14 with sclerotherapy). All charts were reviewed, assessing clinical data, ultrasound findings, surgical data, and post-procedure outcomes. The hospital finance department calculated the cost of outpatient evaluation, complementary tests, supplies, drugs, and professionals' costs throughout all procedures. Results: The median age for both groups was similar (58 and 65 years old). Comorbidities were less frequent in the Surgery Group (20; 51%) than in the Sclerotherapy Group (14; 100%, p<0.05). The median length of hospital stay was 34.5±16.3 hours for the Surgery Group and 4 hours for the Sclerotherapy Group. The mean follow-up period was similar for both groups (85.4±114.8 days after surgery, and 60.9±80.1 days after sclerotherapy, p=0.467). No significant complications occurred in any patient. Success rates were 94.8% after surgery and 92.8% after sclerotherapy. The mean cost per patient was US$2,558.69 in the Surgery Group (Hydrocelectomy Group) and US$463.58 in the Sclerotherapy Group (p<0.0001). Costs directly related to in-hospital treatment procedures were significantly higher for surgery versus sclerotherapy (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0.0001). Conclusion: Sclerotherapy is an excellent treatment option for idiopathic hydrocele as compared to traditional Jaboulay. It has a high success rate, low complication rates, fast discharge and patients return quicker to activities of daily living.

RESUMO Objetivo: Avaliar resultados e custos associados à cirurgia e à escleroterapia como tratamentos das hidroceles. Métodos: Foram tratados consecutivamente para hidrocele em nossa instituição 53 homens, entre dezembro de 2015 e junho de 2019, os quais foram analisados retrospectivamente (39 pela técnica de Jaboulay e 14 por escleroterapia). Todos os prontuários foram revisados, avaliando dados clínicos, achados de ultrassom, dados cirúrgicos e desfechos pós-procedimento. O departamento financeiro do hospital calculou o custo da avaliação ambulatorial, dos exames complementares, dos insumos, dos medicamentos e dos profissionais em todos os procedimentos. Resultados: A idade mediana foi semelhante nos dois grupos (58 e 65 anos). Comorbidades foram menos frequentes no Grupo Cirurgia (20; 51%) do que no Grupo Escleroterapia (14; 100%; p<0,05). O tempo mediano de internação hospitalar foi 34,5±16,3 horas para o Grupo Cirurgia e 4 horas para Grupo Escleroterapia. O período médio de seguimento foi semelhante nos dois grupos (85,4±114,8 dias após a cirurgia e 60,9±80,1 dias após escleroterapia; p=0,467). Nenhuma complicação significativa ocorreu nos pacientes. As taxas de sucesso foram de 94,8% após a cirurgia e 92,8% após a escleroterapia. O custo médio por paciente foi de US$2,558.69 para Grupo Cirurgia e US$463.58 para Grupo Escleroterapia (p<0,0001). Os custos relacionados aos procedimentos de tratamento hospitalar foram significativamente maiores para cirurgia em relação à escleroterapia (US$2,219.82±US$1,629.06 versus US$130.64±US$249.60; p<0,0001). Conclusão: A escleroterapia é uma excelente opção de tratamento para hidrocele idiopática em comparação com a tradicional Jaboulay. Apresenta alta taxa de sucesso, baixas taxas de complicações e alta rápida, além de os pacientes retornarem mais rapidamente às atividades diárias.

Experiencia en el manejo de malformaciones linfáticas macroquísticas con alcohol y microquísticas con bleomicina / Experience In the Management of Macrocystic Lymphatic Malformations with Alcohol and Microcystic Malformations with Bleomycin

Las malformaciones linfáticas son anomalías raras de flujo lento y bajo que se presentan en 1 de 6.000 a 1 en 16.000 recién nacidos vivos. Las malformaciones quísticas se clasifican según su tamaño en macroquísticas, microquísticas o mixtas. Esta clasificación tiene impacto sobre el tratamiento y el pronóstico. Las malformaciones linfáticas macroquísticas tienen mejor respuesta al tratamiento, mientras que las microquísticas son difíciles de tratar y con frecuencia recidivan. El objetivo de este trabajo es describir los resultados obtenidos en pacientes con malformaciones linfáticas macro y microquísticas intervenidos con escleroterapia utilizando alcohol y bleomicina, respectivamente. Se realizó un estudio descriptivo de pacientes con malformaciones linfáticas tratadas en el Servicio de Radiología. Se incluyeron 38 pacientes, de los cuales 24 tenían lesiones macroquísticas, 10, microquísticas y 4, mixtas. El 68 % fueron tratados con alcohol y el 32 % con bleomicina. El tratamiento mostró una resolución excelente en 5 pacientes, 25 tuvieron reducción del tamaño de la lesión entre 50 y 90 %, 13 % mostró una respuesta pobre, y solo en un 7 % hubo crecimiento, a pesar del tratamiento esclerosante. De lo anterior se concluye que el tratamiento percutáneo es seguro, reduce el tamaño de las lesiones y hay pocas complicaciones informadas. Se podría utilizar como tratamiento inicial, antes de considerar una cirugía.

Lymphatic malformations are rare slow and low flow abnormalities that occur in 1 of 6,000 to 1 in 16,000 live newborns. Cystic malformations are classified according to their size as macrocystic, microcystic, or mixed. This classification has an impact on treatment and prognosis. Macrocystic lymphatic malformations have a better response to treatment, while microcystic malformations are difficult to treat and frequently recur. The objective of this study is to describe the results obtained in patients with macro and microcystic lymphatic malformations who underwent sclerotherapy using alcohol and Bleomycin, respectively. A descriptive study of patients with lymphatic malformations treated in the Radiology Service of the National Institute of Pediatrics was carried out during the period from 2014 to 2016. Thirty-eight patients were included, 24 with macrocystic, 10 microcystic and 4 mixed lesions. 68% were treated with alcohol and 32% of the patients were treated with Bleomycin. The treatment showed excellent resolution in 5 patients, 25 patients had a lesion size reduction between 50 and 90%, 13% had a poor response, and only 7% had growth despite sclerosing treatment. From the above we conclude that percutaneous treatment is safe, reduces the size of the lesions and there are few reported complications. It could be used as initial treatment before considering surgery.

Escleroterapia con polidocanol en insuficiencia venosa superficial CEAP C1 / Sclerotherapy with polidocanol in superficial venous insufficiency CEAP C1

Insuficiencia venosa es definida como la patología que causa síntomas en los miembros inferiores, incluyendo edema, hiperpigmentación, lipodermatoesclerosis y ulceración e implica una anormalidad funcional del sistema venoso. Objetivo: Se compararon los resultados en cuanto a complicaciones y satisfacción reportada por las pacientes, con la Escleroterapia con Polidocanol utilizando aire y agua como diluyente. Métodos: Se incluyeron en el estudio a 60 pacientes del sexo femenino con diagnóstico de Insuficiencia Venosa Superficial CEAP C1, divididas en dos grupos, a las cuales se les aplicó Escleroterapia con Polidocanol mezclado con agua y aire. Se realizó seguimiento durante cuatro semanas donde se recogió la información del paciente con respecto a la mejoría de los síntomas antes de iniciar el tratamiento y los efectos adversos del Polidocanol con ambas terapias. Resultados: Dentro de las complicaciones de ambos tratamientos únicamente fue reportado el Matting en rango leve durante la primera semana. El único síntoma reportado como severo fue Dolor en la escleroterapia con polidocanol mezclado con aire. Los demás signos síntomas fueron reportados dentro del rango de moderado el cual descendió hasta leve entre la segunda y tercera semana, no encontrando reportes a la cuarta semana. La única complicación reportada fue el Matting en la escleroterapia con polidocanol mezclado con aire. Conclusión: No se encontraron diferencias significativas en grado de satisfacción con la eficacia del tratamiento, los efectos adversos, la forma en que se administra el medicamento entre ambos tratamientos de escleroterapia, oscilando los rangos de satisfacción entre el 43 al 70%. (AU)

Venous insufficiency is defined as the pathology that causes symptoms in the lower limbs, including edema, hyperpigmentation, lipodermatosclerosis and ulceration and implies a functional abnormality of the venous system. Objective: The results in terms of complications and satisfaction reported by the patients were compared with Sclerotherapy with Polidocanol using air and water as diluent. Methods: 60 female patients with a diagnosis of Superficial Venous Insufficiency CEAP C1 were included in the study, divided into two groups, to which Sclerotherapy with Polidocanol mixed with water and air was applied. A follow-up was carried out for four weeks where information from the patient was collected regarding the improvement of symptoms before starting treatment and the adverse effects of Polidocanol with both therapies. Results: Within the complications of both treatments, only Matting was reported in a mild range during the first week. The only symptom reported as severe was pain in sclerotherapy with polidocanol mixed with air. The other signs and symptoms were reported within the moderate range, which decreased to mild between the second and third week, finding no reports at the fourth week. The only complication reported was Matting in sclerotherapy with polidocanol mixed with air. Conclusion: No significant differences were found in the degree of satisfaction with the efficacy of the treatment, the adverse effects, the way in which the drug is administered between both sclerotherapy treatments, the satisfaction ranges ranging from 43 to 70%. (AU)

Escleroterapia com espuma de polidocanol em veias safenas magnas e suas tributárias bilateralmente em tempo único / Bilateral foam polidocanol sclerotherapy of great saphenous veins and their tributaries in synchronous procedure

Resumo Contexto A insuficiência venosa crônica é uma entidade com alta prevalência. Os casos avançados apresentam morbidade elevada. Objetivos Avaliar os riscos e benefícios da escleroterapia com espuma de polidocanol em pacientes que foram submetidos ao tratamento das veias safenas magnas bilateralmente em tempo único. Métodos Foram revistos retrospectivamente 55 pacientes (110 membros) portadores de incompetência bilateral das veias safenas magnas submetidas a tratamento escleroterápico com espuma bilateralmente, em tempo único, usando uma dose máxima de 20 mL de espuma de polidocanol por paciente. Resultados Das 110 safenas analisadas, obteve-se a oclusão de 81 (73,6%) com uma sessão, de 106 (96,3%) com duas sessões e de 110 (100%) com três sessões. Houve oclusão bilateral das safenas magnas em 27 pacientes (50%) em uma sessão, em 34 (62%) em duas sessões e em 55 (100%) em três sessões. De 11 pacientes portadores de úlceras, houve cicatrização total de sete (63%) e parcial de três (27%) 42 dias após a escleroterapia. Houve lipotimia autolimitada e escotomas visuais em um paciente (1,8%) e manchas em três (5,45%); 19 pacientes (34,5%) foram submetidos a punção para drenagem de coágulo retido. Conclusões A escleroterapia com espuma de polidocanol em veias safenas magnas em tempo único mostrou-se uma técnica segura e eficaz em pacientes selecionados.

Abstract Background Chronic venous insufficiency is a highly prevalent disease. Advanced cases have high morbidity. Objectives To evaluate the risks and benefits of foam sclerotherapy in patients who underwent bilateral treatment of the great saphenous veins in a single procedure, in selected cases of advanced venous insufficiency. Methods We retrospectively reviewed 55 patients (110 limbs) with bilateral incompetence of the great saphenous veins who had undergone foam sclerotherapy treatment bilaterally, using a maximum dose of 20 ml of foam per patient and inelastic compression. Results In 81 (73.6%) of the 110 saphenous veins analyzed, occlusion was obtained in the first session. After a second session this figure rose to 106 (96.3%) and all 110 (100%) veins were occluded after three sessions. Bilateral occlusion of the great saphenous veins was achieved in 27 patients (50%) in one session, in 34 (62%) patients in two sessions, and in 55 (100%) patients in three sessions. At 42 days after sclerotherapy, there was complete ulcer healing in seven (63%) of the 11 patients with ulcers and partial healing in 3 (27%) of these patients. One patient (1.8%) had self-limited lipothymia and visual scotomas, 3 patients (5.45%) had skin spots, and 19 patients (34.5%) developed retained intravascular coagulum. Conclusions Bilateral foam sclerotherapy in a synchronous procedure is an option to be considered for treatment of varicose veins of the lower limbs.

Fotobiomodulação associada à escleroterapia no tratamento de hemangioma em palato duro / Photobiomodulation associated with sclerotherapy for treatment of hemangioma in the hard palate

Resumo As alterações vasculares ocorrem frequentemente em região de cabeça e pescoço, sendo o hemangioma a mais comum. Paciente do sexo feminino, 61 anos, queixou-se de dor intensa em palato duro. Notou-se lesão arroxeada, de 1,5 cm, sensível à palpação e com histórico de hemorragia. A paciente era edêntula total, e a prótese total superior comprimia o local da lesão. Foi realizada a vitropressão, confirmando a origem vascular. A hipótese diagnóstica foi de hemangioma. Na primeira sessão, aplicou-se o laser vermelho (660 nm) em quatro pontos ao redor da lesão, sendo 0,5 J em cada ponto afim de se obter analgesia e iniciar o processo de reparo, além do reembasamento da prótese total superior. Na segunda sessão, foi feita aplicação de 2 mL de oleato de monoetanolamina 5%. Após 14 dias, observou-se regressão total da lesão. Os cirurgiões-dentistas devem estar aptos a reconhecer, diagnosticar e tratar as lesões vasculares em cavidade oral.

Abstract Vascular changes frequently involve the head and neck region and hemagioma is the most common. A 61-year-old female patient complained of severe pain in the hard palate. A purple lesion was found, measuring 1.5 cm, sensitive to palpation, and with a history of hemorrhage. The patient was fully edentulous and her upper denture compressed the lesion site. Diascopy confirmed the lesion's vascular origin. A diagnostic hypothesis of hemangioma was raised. In the first session, red laser light (660nm) was applied at 4 points around the lesion, with 0.5 J at each point, in order to obtain analgesia and trigger the repair process. The upper denture was also relined. In the second session, 2 mL of 5% monoethanolamine oleate was applied. After 14 days, total regression of the lesion was observed. Dental surgeons must be able to recognize, diagnose and treat vascular lesions in the oral cavity.

Elimination of saphenous reflux after tributary sclerotherapy: report of two cases / Abolição do refluxo de safena após escleroterapia de colaterais: relato de dois casos

Abstract Most patients with chronic venous disease (CVD) and reflux in the saphenous vein are treated with saphenous stripping or ablation. The venous hemodynamics approach offers the possibility of treating saphenous reflux without eliminating the saphenous vein. We present 2 cases in which venous reflux was eliminated while preserving the great saphenous vein, after treatment with hemodynamic sclerotherapy using a protocol of synergic use of Dextrose and long pulse Nd YAG 1064 laser. These cases show that treating the tributaries responsible for saphenous reflux can correct hemodynamic imbalances and restore normal flow in the great saphenous vein with improvements in symptoms and esthetics. Long-term results are still uncertain.

Resumo A maioria dos pacientes com insuficiência venosa crônica e refluxo na veia safena é tratada com retirada ou ablação da safena. A hemodinâmica venosa traz a possibilidade de tratar esses pacientes sem eliminar a veia safena. Nós apresentamos dois casos de refluxo parcial de veia safena magna resolvidos com escleroterapia hemodinâmica. Usamos um protocolo de uso sinergístico de glicose 75% e Nd-YAG laser 1064. Os casos nos mostram que o tratamento das tributárias pode corrigir o refluxo da veia safena e obter melhora clínica e cosmética. Os resultados de longo prazo ainda são incertos.

Endoscopic prophylaxis and factors associated with bleeding in children with extrahepatic portal vein obstruction / Profilaxia endoscópica e fatores associados ao sangramento em crianças com obstrução extra-hepática da veia porta

Abstract Objectives: This study aimed to evaluate factors associated with upper digestive hemorrhage and primary and secondary endoscopic prophylaxis outcomes in children with extrahepatic portal vein obstruction. Methods: This observational and prospective study included 72 children with extrahepatic portal vein obstruction who were followed from 2005 to 2017. Risk factors associated with upper digestive hemorrhage and the results of primary and secondary prophylaxis of these patients were evaluated. Results: Fifty patients (69.4%) had one or more episodes of bleeding during follow-up, with a median age at first hemorrhage of 4.81 years. The multivariate analysis showed that medium- to large-caliber esophageal varices were associated with an 18-fold risk of upper digestive hemorrhage (95% CI: 4.33-74.76; p < 0.0001). Primary prophylaxis was administered to 14 patients, with eradication in 85.7%; however, 14.3% of these patients had hemorrhages during the follow-up period and 41.7% had a relapse of varices. Secondary prophylaxis was administered to 41 patients. Esophageal varices were eradicated in 90.2% of patients. There were relapse and re-bleeding of esophageal varices in 45.9% and 34.1% of the children, respectively. Conclusion: Primary and secondary endoscopic prophylaxes showed high rates of esophageal varix eradication, but with significant relapses. Eradication of esophageal varices cannot definitively prevent recurrent upper digestive hemorrhage, since bleeding from alternate sites can occur. Medium- and large-caliber esophageal varices were associated with upper digestive hemorrhage in patients with extrahepatic portal vein obstruction. To the best of the authors' knowledge, this study is the first to evaluate bleeding risk factors in children with extrahepatic portal vein obstruction.

Resumo Objetivos: Este estudo visou avaliar fatores associados à hemorragia digestiva alta e resultados da profilaxia endoscópica primária e secundária em crianças com obstrução extra-hepática da veia porta. Métodos: Este estudo observacional e prospectivo incluiu 72 crianças com obstrução extra-hepática da veia porta acompanhadas de 2005 a 2017. Os fatores de risco associados à hemorragia digestiva alta e os resultados da profilaxia primária e secundária desses pacientes foram avaliados. Resultados: Dos pacientes, 50 (69,4%) apresentaram ≥ 1 episódio de sangramento durante o acompanhamento, com idade média da primeira hemorragia de 4,81 anos. A análise multivariada mostrou que varizes esofágicas de médio a grande calibre estavam associadas a um risco 18 vezes maior de hemorragia digestiva alta (IC de 95% 4,33-74,76; p < 0,0001). Foi administrada profilaxia primária em 14 pacientes, com erradicação em 85,7%; contudo, 14,3% desses pacientes apresentaram hemorragias durante o período de acompanhamento e 41,7% apresentaram recidiva de varizes. Foi administrada profilaxia secundária em 41 pacientes. As varizes esofágicas foram erradicadas em 90,2% dos pacientes. Houve recidiva e novos sangramentos de varizes esofágicas em 45,9% e 34,1% das crianças, respectivamente. Conclusão: As profilaxias esofágicas primárias e secundárias apresentaram altas taxas de erradicação de varizes esofágicas, porém com recidivas significativas. A erradicação de varizes esofágicas não pode prevenir de forma definitiva a hemorragia digestiva alta recorrente, pois pode ocorrer sangramento de outros locais. Varizes esofágicas de médio e grande calibre estavam associadas à hemorragia digestiva alta em pacientes com obstrução extra-hepática da veia porta. No melhor de nosso conhecimento, nosso estudo é o primeiro a avaliar os fatores de risco de sangramento em crianças com obstrução extra-hepática da veia porta.

Tratamento de hemangioma em mucosa labial por escleroterapia: relato de caso clínico / Treatment of hemangioma in labial mucosa by sclerotherapy: clinical case report

O hemangioma é uma lesão vascular, podendo represen-tar-se como uma neoplasia benigna dos vasos sanguíneos, relativamente rara na cavidade oral, podendo causar prejuízo estético e funcional a depender da sua região. Sua localiza-ção mais frequente é o lábio superior, mas pode ocorrer em outras regiões, como língua, mucosa jugal e palato. O seu tratamento depende, principalmente, do correto diagnóstico da lesão, bem como da localização anatômica da mesma e pode ser realizado com esclerose química, crioterapia, la-serterapia, excisão cirúrgica convencional, embolia arterial ou eletrocautério. O objetivo desse trabalho é apresentar um caso clínico, de um paciente do gênero masculino, 63 anos de idade, apresentando hemangioma desde os 16 anos de idade, com recidiva há dez anos em lábio superior. Ao exame físico intrabucal observou-se uma lesão tumoral, de coloração arroxeada, base séssil, assintomática, com limites bem definidos, medindo aproximadamente 4 cm em seu maior diâmetro, localizada na mucosa labial superior. Foi realizada manobra de vitropressão que apresentou um esmaecimento da coloração arroxeada, permitindo diag-nóstico clínico de hemangioma. O tratamento proposto foi a esclerose terapêutica com cinco aplicações de oleato de monoetanolamina 5%, considerando as características clínicas e os métodos de diagnóstico desta lesão. Por meio de um diagnóstico preciso e uma conduta terapêutica ade-quada, o caso apresenta-se com um acompanhamento de dois meses com significativa redução até o momento, e com um resultado estético funcional satisfatório. Conclui-se que a eficácia da escleroterapia realizada com o uso do oleato de monoetanolamina 5% é uma alternativa terapêutica segura.

Hemangioma is a vascular lesion, and may represent a benign neoplasm of blood vessels, relatively rare in the oral cavity, and may cause aesthetic and functional impairment depending on its region. Its most frequent location is the upper lip, but may occur in other regions, such as tongue, jugal mucosa and palate. Its treatment depends mainly on the correct diagnosis of the lesion, as well as its anatomical location and can be performed with chemical sclerosis, cryotherapy, laser therapy, conventional surgical excision, arterial embolism or electrocautery. The aim of this paper is to present a case report of a 63-year-old male patient with hemangioma since he was 16 years old, with a recurrence of the upper lip for 10 years. Physical examination revealed an asymptomatic purplish-colored, lesion-shaped tumor with well-defined limits, measuring approximately 4 cm in its largest diameter, located in the upper lip mucosa. A vitropression maneuver was performed that showed a faint purplish coloration, allowing a clinical diagnosis of hemangioma. The proposed treatment was therapeutic sclerosis with five applications of 5% mono-ethanolamine oleate, considering the clinical characteristics and diagnostic methods of this lesion. Through an accurate diagnosis and an appropriate therapeutic approach, the case presents a two-month follow-up with significant reduction so far, and a satisfactory functional aesthetic result. It is concluded that the effectiveness of sclerotherapy perfor-med with the use of 5% monoethanolamine oleate is a safe therapeutic alternative.

Tratamento de linfocele mediante ecoescleroterapia com polidocanol: relato de casos e revisão / Polidocanol echosclerotherapy treatment for lymphocele: case report and review

Resumo A formação de linfocele, resultante da transecção dos canais linfáticos durante procedimentos cirúrgicos ou traumas, é relativamente comum, sendo relatada em aproximadamente 30% dos pós-operatórios de ressecção de linfonodos. Ela pode evoluir assintomática ou pode apresentar complicações, como dor, infecção secundária, compressão de vasos sanguíneos, a qual evolui para estase, trombose e edema. Seu tratamento ainda é de difícil consenso. Este artigo propõe descrever três casos em que o tratamento foi realizado a partir de ecoescleroterapia com polidocanol. Sua relevância está na escassez de relatos na literatura.

Abstract Formation of lymphocele secondary to transection of lymphatic channels during surgical procedures or traumas is relatively common and is reported in the postoperative period of approximately 30% of lymph node resection procedures. The condition may be asymptomatic or can present with complications such as pain, secondary infection, and compression of blood vessels, which can cause stasis, thrombosis, and edema. There is no consensus on treatment. This article describes three cases in which treatment was provided using polidocanol echosclerotherapy. Its relevance lies in the scarcity of reports in the literature.

Escleroterapia de Hemangioma Intraoral guiada por ultrassonografia: caso clínico / Ultrasound-guided intraoral hemangioma sclerotherapy: a case report

O hemangioma é uma neoplasia benigna que se caracteriza pela proliferação anormal de vasos sanguíneos, comum na região de cabeça e pescoço, e é relativamente raro na cavidade oral; porém, quando essa região é acometida, comumente, atinge lábios, língua e mucosa jugal. O objetivo deste trabalho foi descrever um caso clínico de hemangioma em mucosa jugal direita, o qual foi tratado através de escleroterapia com Oleato de Etanolamina (Ethamolin®), e ultras sonografia para guiar as aplicações intralesionais. No momento, a paciente está com 2 anos de acompanhamento, o que possibilitou observar a fibrose da lesão. A escleroterapia com Ethamolin® guiada por ultrassom é um procedimento seguro que pode ser realizado em lesões mais profundas, minimizando a possibilidade de complicações e favorecendo a recuperação do paciente.

Hemangioma is a benign neoplasm characterized by an abnormal proliferation of blood vessels, common in the head and neck region. It is relatively rare in the oral cavity, but if this region is affected, it occurs more commonly in the lips, tongue, and oral mucosa. The aim of this study was to describe a clinical case of hemangioma in the right jugal mucosa, which was treated through sclerotherapy with Ethanolamine Oleate (Ethamolin®), and the use of ultrasonography to guide the intralesional applications. Now, the patient has a 2-year follow-up, which allowed the observation of the involution of the lesion. The ultrasound-guided sclerotherapy with Ethamolin® is a safe procedure that can be performed in deeper lesions, minimizing the possibility of complications, and favoring the patient's recovery.