Ultrasound guided foam sclerotherapy: factors associated with outcomes and complications.

OBJECTIVES: In recent years ultrasound guided foam sclerotherapy (UGFS) has become an increasingly popular treatment for varicose veins. Although many published series detail the results of UGFS, little is known about the factors which are associated with outcomes and complications. The aim of this study was to identify these factors. DESIGN: A review of a prospectively collected database of UGFS which commenced in July 2007. METHODS: A successful outcome was defined as complete occlusion of the target vein on duplex scanning at follow-up. Eight factors were assessed to determine whether they were associated with outcomes and complications. These factors were age, gender, compliance with post-procedure compression hosiery, previous varicose vein surgery, single or multiple sites of injection, concentration of sclerosant, volume of sclerosant and pre-procedure severity score. RESULTS: Between July 2007 and July 2009, a total of 126 patients (60 men, 66 women) attended follow-up visits and had a post-procedure duplex scan. Targets for UGFS included the great saphenous vein (n = 75), small saphenous vein (n = 13) and anterior accessory great saphenous vein (n = 8). The remainder of procedures involved other veins or more than a single target vein. The median timing of follow-up was 3 months (range 1.5-14 months) with duplex scans revealing complete occlusion of the target vein in 79% of patients. The only factor associated with a successful outcome was compliance with post-procedure compression hosiery (p < 0.05). The most frequently encountered complications following UGFS were skin staining (28%), superficial thrombophlebitis (18%) and pain (14%). The only factor associated with post-UGFS complications was female gender (p < 0.05). When complications were analysed in isolation female gender was also significantly associated with skin staining (p < 0.05), but no other complication. CONCLUSIONS: These data suggest that compliance with post-procedure compression hosiery and gender are important factors associated with a successful outcome and reported complications following UGFS, respectively.

Spontaneous common iliac arteries rupture in Ehlers-Danlos syndrome type IV: report of two cases and review of the literature.

Two patients with previously undiagnosed Ehlers-Danlos syndrome type IV (EDS IV) presented acutely with clinical features suggestive of hypovolemic shock. Emergency laparotomies in both of them revealed spontaneous rupture of the common iliac arteries. The clinical features, operative findings, surgical approach, outcome and implications are discussed.

Enterolith ileus complicating jejunal diverticulosis.

Small intestinal obstruction caused by enteroliths originating in jejunal diverticula is rare. We present our experience with three elderly female patients who were successfully treated for this condition. The diagnosis, in all three cases, was made on laparotomy. Two patients underwent enterolithotomy while the third, who had a acutely inflamed jejunal diverticulum, had a jejunal resection.

The use of spleen transplantation and cyclosporine treatment to induce unresponsiveness to pancreatic islet transplantation in rats.

One way of achieving permanent survival of allografted islets in the rat has been to first transplant a kidney of the same strain as the islets and induce acceptance of the kidney using cyclosporin A treatment. Rats bearing long-surviving renal allografts will then accept islets of the same strain without further immunosuppression. Such an approach may be effective for combined renal and islet grafting, but transplantation of the kidney as well as islets may not always be desirable, and the question arises as to whether another organ could be used to achieve the same effect. Auxiliary spleen transplants were performed from LEW to DA rats, followed by cyclosporine 10 mg/kg for 14 days. Twelve rats with long-surviving grafts were then made diabetic with streptozotocin and given LEW islets placed under the kidney capsule, 6 rats being given a further course of cyclosporine 10 mg/kg for 7 days after islet transplantation. Rats that did not reject their islets then underwent removal of the spleen transplant, and if this did not result in rejection islet function was proven by removal of the kidney bearing the islets. The results show that spleen allograft rejection can be prevented by cyclosporine treatment and that 50% of animals with long-surviving spleen allografts will accept subsequent islet allografts from rats of the same donor strain. The acceptance of islet allografts can be increased to 100% by a further short course of cyclosporine treatment. It is concluded that spleen allografts can be used to produce unresponsiveness to islets in rats.

Isolated pancreatic islet allografts in rats rendered immunologically unresponsive to renal allografts. The effect of the site of transplantation.

Long-surviving Lewis (RT-1(1)) renal allografts (LS-LEW) were induced in 20 DA (RT-1a) rats by 14-day treatment with cyclosporine . All were made diabetic 100 days after transplantation using streptozotocin; 7 LS-LEW were untreated and all remained diabetic; 5 LS-LEW were given Lewis islets beneath the kidney capsule without further immunosuppression. Prolonged graft survival (greater than 100 days) was seen in 4 rats. Lewis islets were given into the portal vein in 5 LS-LEW. Prolonged graft survival was seen in 4 rats. Third-party BN islets were given beneath the kidney capsule in 3 LS-LEW; these islets were rejected in less than 9 days. In contrast Lewis islets transplanted into untreated diabetic DA rats beneath the renal capsule or into the portal vein survived for a mean of 8.3 days and 4 days, respectively. In a separate experiment long-surviving Lewis renal allografts were induced in 7 PVG rats (LS-PVG) by cyclosporine treatment. These animals were made diabetic 100 days after transplantation and then were given Lewis islets under the renal capsule of the transplant kidney. Prolonged islet graft survival was seen in 6 rats, and 5 diabetic PVG rats given Lewis islets beneath the renal capsule rejected the islets within 8 days. Thus, once a recipient rat has accepted a renal allograft under the influence of cyclosporine treatment, it will accept permanently an islet allograft of the same strain as the kidney. This effect applies to both strain combinations tested, is not influenced by the site of islet implantation, and is specific for islets of the same strain as the renal allograft.