Malformaciones linfáticas: tratamiento percutáneo con bleomicina / Lymphatic malformations: percutaneus treatment with bleomycin

Las malformaciones linfáticas son anomalías del desarrollo del sistema linfático que tienden a sufrir complicaciones en su evolución. En la última década, la terapia con agentes esclerosantes ha ido ganando popularidad sobre la cirugía, por su eficacia, sus menores complicaciones y sus excelentes resultados estéticos. Presentamos una serie de 24 pacientes tratados mediante esclerosis percutánea con bleomicina. Los resultados fueron excelentes (reducción de volumen ≥ 95% y asintomáticos) en 12 pacientes, buenos (reducción de volumen entre 50% y 95% y asintomáticos) en 5 pacientes, regulares (reducción de volumen < 50% y asintomáticos) en 4 pacientes, y malos (sin cambios de volumen respecto al inicio o sin desaparición de síntomas iniciales) en 3 pacientes. Estos resultados estuvieron directamente relacionados con el tipo de malformación. Las complicaciones observadas fueron de escasa relevancia clínica. La escleroterapia con bleomicina es un método eficaz y seguro en el tratamiento de pacientes con malformación linfática uniquística o macroquística. Su indicación también podría extenderse a pacientes con malformación linfática microquística o cavernosa que serán sometidos a cirugía, para obtener una reducción de su tamaño y menor linforragia postoperatoria, y a pacientes postquirúrgicos sintomáticos, en quienes no fue posible la resección total de la malformación.

Lymphatic malformations are developmental abnormalities of the lymphatic system, which tend to complicate during their evolution. In the last decade, therapy with sclerosing agents has gained popularity over surgery due to its effectiveness, fewer complications, and excellent cosmetic results. We present a series of 24 patients treated with percutaneous bleomycin injection. Results were excellent (volume reduction ≥ 95%, without symptoms) in 12 patients, good (volume reduction between 50% and 95%, without symptoms) in 5 patients, fair (volume reduction <50%, without symptoms) in 4 patients, and poor (no change in volume from baseline and persistence of symptoms) in 3 patients. These results were directly related to the type of lymphatic malformation. The complications found had little clinical relevance. Sclerotherapy with bleomycin is an effective and safe treatment for patients with unicystic or macrocystic lymphatic malformations. It could also be used in patients with microcystic or cavernous lymphatic malformation undergoing surgery to reduce both the malformation size and postoperative lymphorrhea, and in postoperative symptomatic patients whose malformation could not be totally resected.

Percutaneous Treatment of Renal Cysts with OK-432 Sclerosis

PURPOSE: The aim of this study was to demonstrate OK- 432 sclerotherapy efficacy for treatment of simple renal cysts. MATERIALS AND METHODS: Twenty patients with 25 symptomatic or large simple cysts were treated by ultrasonography (US)-guided percutaneous aspiration and injection of OK-432 (8 men and 12 women, mean age 63.6 years, SD 9.5). Six patients presented with flank pain, 14 presented with renal mass; renal cyst location was right, left, or bilateral sided in 9, 8, and 8 kidneys, respectively. Patients were evaluated by clinical assessment, US, or CT scan 3 months following the procedure. Complete and partial success was defined as symptom resolution with either total cyst ablation or greater than 70% reduction, respectively. Failure was defined as 30% of cyst size recurrence and/or persistent symptoms. RESULTS: Average reduction was 93.0%. Complete and partial resolution occurred in 11 (44.0%) and 13 (52.0%) cysts, respectively. One case was defined as failure, with a 64.2% size reduction from 10.9cm to 3.9cm (volume reduction rate 95.4%). Renal pain improved in all patients, regardless of complete or partial resolution. Minor complications occurred in 3 patients, 2 developed leukocytosis and 1 had mild fever (< 38.5 degrees C) following aspiration and sclerotherapy. Successful treatment was achieved with conservative measures and NSAID therapy. CONCLUSION: Percutaneous treatment of simple renal cysts with OK-432 sclerotherapy was found to be a safe, effective and minimally invasive procedure.

Comparison of Single and Repeated Sclerotherapy Using a Pigtail Catheter for Simple Renal Cyst / 대한비뇨기과학회지

PURPOSE: Although simple renal cysts are benign and most of them do not require treatment, intervention is needed when symptom or urinary obstruction appears. Sclerotherapy of renal cyst is usually performed in conjuction with aspiration in simple renal cyst because of the high recurrence rate of 30-70% in aspiration alone. We compared the results of single and repeated percutaneous slcerotherapy in patients with simple renal cyst. MATERIALS AND METHOD: Sixty three patients with symptomatic or urinary obstruction causing simple renal cysts received ultrasound guided needle aspiration and sclerotherapy between March 1990 to December 1996. 42 patients received sclerotherapy once immediately after aspiration(group 1), and 21 patients received sclerotherapy at least twice after indwelling a 6.0 Fr pigtail catheter into the renal cyst(group ll). Follow-up with ultrasonography was performed in a 3 month internal for at least 6 months. Disappearance of the renal cyst was considered as complete regression and more than 50% reduction in the diameter of the remaining cyst as partial regression. RESULTS: The mean diameter of the renal cyst in group 1 (6.12cm) and 2(6.75cm) were not significantly different. Complete and partial regression were 8/42 (19.0%), 16/42(38.1%) for group 1 and 15/21(71.4%), 5/21(23.8%) for group 2, respectively. The overall success rate was significantly better in group 2(95.2%) compared to group 1(57.1%)(p<0.001). The pre-operative size of the cyst was not related to recurrence rate(p=0.184). CONCLUSIONS: These data suggest that repeated sclerotherapy using a pigtail catheter is better than single session for reducing the recurrence of simple renal cyst.

Percutaneous sclerotherapy of varicocele with absolute ethanol / 대한비뇨기과학회지

Percutaneous trans-jugular sclerotherapy of the internal spermatic vein was performed in 7 infertile men with varicoceles. The occlusion of spermatic vein was undertaken with hot contrast media at a temperature of 100 degrees C in 2 patients and absolute ethanol in 5 ones, respectively. All procedures were performed satisfactorily and no recurrence was noted in the follow up period. Hot contrast media produced severe pain whereas absolute ethanol revealed no complication during procedure. Percutaneous sclerotherapy is a safe and effective alternative to surgical method in the treatment of varicoceles. Moreover absolute ethanol seems to be superior to hot contrast media as sclerosing agent.