Nonsurgical management of vascular malformation of masseter.

Intramuscular vascular anomalies are rare congenital hamartomatous lesions. Less than 1% of these occur in skeletal muscle out of which 15% arise in head and neck musculature. In the head and neck region, masseter muscle is the most common site. It accounts for about 5% of intramuscular vascular malformations. They are present from birth but are clinically apparent during infancy and childhood and occasionally during adulthood. Due to its location it is often mistaken for a parotid swelling. The usual treatment of choice is surgical excision with a margin. This is associated with loss of motor function, hemorrhage, nerve damage. Intralesional sclerotherapy, embolization are nonsurgical alternatives for treatment of slow flow venous malformations. Sclerotherapy can be used solely in multiple sittings or as an adjunct to surgery. This article presents a case report of a 28‑year‑old male with recurrent intramuscular vascular malformation in the masseter muscle, which was successfully treated by ethanol sclerotherapy.

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.

Surgical resection or aspiration with ethanol sclerotherapy of endometrioma before in vitro fertilization in infertilie women with endometrioma

OBJECTIVE: To evaluate whether the surgical resection or aspiration with ethanol sclerotherapy (AEST) of endometrioma before in vitro fertilization (IVF) affect controlled ovarian stimulation (COS) and IVF outcome in the infertilie women with endometroma undergoing IVF. METHODS: In this retrospective cohort study, 101 consecutive IVF/intracytoplasmic sperm injection cycles that were performed in 101 patients with endometrioma(s) between January 2008 and December 2012 were included. Before IVF, 36 patients underwent surgical resection of endometrioma (resection group), 29 patients had transvaginal endometrioma AEST (aspiration group), and 36 patients did not take any surgical intervention (control group). The three groups were compared in terms of COS and IVF outcomes. RESULTS: Total antral follicle count was significantly lower in the resection group than in the aspiration or control group. The numbers of follicles with a diameter of 14 to 17 mm on the human chorionic gonadotropin day, retrieved oocytes, mature oocytes, and fertilized oocytes were significantly lower in the resection group than in two other groups. However, three groups were similar in terms of clinical pregnancy rate (CPR) per initiated cycle, CPR per embryo transfer, embryo implantation rate, and miscarriage rate. CONCLUSION: Neither of surgical resection and AEST of endometrioma before IVF treatment can give any beneficial effect on IVF outcomes. Moreover, surgical resection of endometrioma can affect the ovarian reserve and ovarian response during COS.

Long-term Follow-up Sonography of Benign Cystic Thyroid Nodules after a Percutaneous Ethanol Injection: The Incidence of Malignancy-mimicking Nodules

PURPOSE: To evaluate the incidence of malignancy-mimicking sclerosed thyroid nodules, from long-term follow-up ultrasonography (US) after an US-guided percutaneous ethanol injection (PEI). MATERIALS AND METHODS: We examined 86 benign cystic thyroid nodules from 80 patients. The nodules were classified into two groups based on whether an aspiration (Group A, n=26) or non-aspiration (Group B, n=60) of infused ethanol was performed. The final follow-up US over 12 months was performed in all patients. RESULTS: Of the 86 nodules, the cystic portion of 82 (95.3%) cases, from 76 patients, completely disappeared subsequent to the first follow-up US (Group A, n=24, Group B, n=58) (Chi-square test, p>0.05). Moreover, 46 sclerosed thyroid nodules showed two or more of the 'five sonographic criteria' upon a follow-up US (Group A, n=13, 50.0%, Group B, n=32, 53.3%). A higher ratio of the cystic portion of the nodules was associated with a higher incidence of the 'five sonographic criteria' for malignancies detected via a follow-up US (p<0.01; Student's t-test). CONCLUSION: For the long-term follow-up US, the 'five sonographic criteria' were observed in half the patients who received US-guided PEI. Also, by acknowledging the possibility that sonographic findings mimic a malignancy, since the sclerosed thyroid nodule, patients may avoid an unnecessary biopsy.

Atrial Fibrillation during Ethanol Sclerotherapy in a Patient with Lower Limb Arteriovenous Malformation: A case report / 대한마취과학회지

Alcohol embolization or sclerotherapy has been commonly used for a treatment of arteriovenous malformation (AVM). Alcohol sclerotherapy frequently produces minor local complications but may rarely produce catastrophic cardiopulmonary complications. In this case, general anesthesia was induced and the pulmonary artery pressure was monitored. After absolute alcohol (99.6% ethanol) injection, the systolic pulmonary artery pressure was increased, the systemic blood pressure was decreased and the EKG rhythm revealed supraventricular tachycardia and atrial fibrillation. Nitroglycerine, dobutamine, and milrinone infusions were started for the treatment of pulmonary hypertension. The EKG was restored to normal sinus rhythm two hours after judicious fluid administration and other vital signs were also recovered. The anesthesiologists must be aware of potentially serious cardiopulmonary complications possible with alcohol sclerotherapy and be prepared to manage severe cardiovascular compromise.