ABSTRACT
PURPOSE: To assess the use of doxycycline as a sclerosing agent after percutaneous drainage of postoperative lymphoceles. MATERIALS AND METHODS: Symptomatic postoperative lymphoceles (n = 21) in 18 patients were treated by percutaneous tube drainage for an average of 10.8 days. Sclerosis was performed when the patient became asymptomatic, drainage had slowed to less than 30 mL/d and follow-up imaging (CT or US) showed either near complete or total resolution of the lymphocele. Doxycycline (500 mg) combined with 1% lidocaine (5 mL) was instilled into the cavity with use of a syringe after any remaining lymphocele fluid was removed through the tube. When possible, patients were instructed to perform a series of maneuvers for the next hour to distribute the sclerosing agent evenly throughout the cavity. After 1 hour, the sclerosing agent was aspirated from the cavity and the drainage tube was removed. Three patients with four lymphoceles underwent sclerotherapy immediately after percutaneous insertion of a drainage tube and aspiration of the lymphocele. No patients underwent previous sclerosis with any agent. RESULTS: Successful treatment of postoperative lymphoceles was achieved in 17 of 18 patients. Primary success was achieved in 17 of 21 lymphoceles treated. There were four lymphocele recurrences in three patients. Three of the four recurrences were successfully treated by means of repeated drainage and sclerotherapy. One recurrent lymphocele persisted after re-treatment with 1 g of doxycycline. This patient underwent successful surgical repair. There were no complications related to doxycycline sclerosis. The mean duration of drainage for initial and recurrent lymphoceles was 10.8 days (range, 0-30 days). CONCLUSION: Sclerotherapy with use of doxycycline after percutaneous drainage is an easy, safe, inexpensive, and effective means of treating postoperative lymphoceles.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Doxycycline/therapeutic use , Drainage/methods , Lymphocele/therapy , Sclerosing Solutions , Sclerotherapy/methods , Aged , Aged, 80 and over , Anti-Bacterial Agents/administration & dosage , Doxycycline/administration & dosage , Female , Humans , Male , Middle Aged , Postoperative Complications/therapy , Sclerosing Solutions/administration & dosageSubject(s)
Delirium/diagnosis , Lyme Disease/diagnosis , Delirium/psychology , Diagnosis, Differential , Female , Humans , Lyme Disease/psychology , Mental Status Schedule , Middle Aged , Neurologic Examination , Paresthesia/diagnosis , Paresthesia/psychology , Patient Care Team , Polyradiculoneuropathy/diagnosis , Polyradiculoneuropathy/psychologyABSTRACT
Physician participation in euthanasia and assisted suicide has been the subject of long-standing debate and is unlikely to be resolved easily or soon. The Pennsylvania Medical Society's Medical Student Section explored this topic recently in a second "mock trial" held in conjunction with the Temple University School of Law and co-sponsored by the Pennsylvania Medical Society Liability Insurance Company. This is an account and essay from that trial.
