Ultrasound-guided foam sclerotherapy is safe and effective in the management of superficial venous insufficiency of the lower extremity.

BACKGROUND: Superficial venous disease of the lower extremity has a significant impact on quality of life. Both truncal and tributary vein reflux contribute to this disease process. Endovenous foam sclerotherapy is a widely used technique throughout the world for the management of superficial venous reflux and ultrasound guidance improves its safety and efficacy. METHODS: A PubMed search for ultrasound-guided foam sclerotherapy (UGFS) was conducted and all abstracts were reviewed to identify clinical trials and systematic reviews for a full-text analysis. Additional articles were also identified through searching the references of the selected studies. RESULTS: The production of foam for sclerotherapy in a 1:3 or 1:4 ratio of air to sclerosant is optimal in a low silicone, low-volume syringe system. Physiologic gas may decrease any side effects, with the trade-off of decreased foam stability. Proper technique with appropriate sterility and cleansing protocols are paramount for safe and effective treatment. The technical success of UGFS for great saphenous vein disease is inferior to endothermal and surgical modalities and retreatment is more common. However, the clinical improvement in patient-reported quality of life is similar between these three modalities. When used for tributary veins in combination with endothermal approaches of the truncal veins, UGFS has high rates of success with excellent patient satisfaction. UGFS has demonstrated an excellent safety profile comparable with or superior to other modalities. CONCLUSIONS: With proper technique, UGFS is safe and effective for the management of superficial venous disease.

Duration of oral antibiotic therapy for the treatment of adult acne: a retrospective analysis investigating adherence to guideline recommendations and opportunities for cost-savings.

BACKGROUND: The duration of oral antibiotic acne therapy for adolescents compared with guidelines was recently investigated; however it was uncertain if duration of antibiotics for adult acne therapy differed. OBJECTIVE: This study aimed to evaluate duration of oral antibiotics for adult acne compared with guidelines and determine possible cost-savings. METHODS: This was a retrospective cohort study of MarketScan Commercial Claims and Encounters database that incorporated claims data to determine duration and costs of antibiotic treatment among adults ages 21 years and older. RESULTS: Of 17,448 courses, 84.5% (14,737) aligned with duration guidelines, although 12,040 (69.0%) courses did not include concomitant topical retinoid therapy. Mean savings of $592.26 per person could result if prolonged courses met guidelines. Mean (median) costs of generic and branded formulations for the most frequent course duration (90-179 days) were $103.77 ($54.27) and $1421.61 ($1462.25), respectively. LIMITATIONS: Actual patient prescription adherence is uncertain and database lacks information regarding acne severity, patient physical characteristics, and clinical outcomes. CONCLUSIONS: The majority of oral antibiotic course durations follow guidelines, although topical retinoids are underused. Costs of antibiotic therapy were lower for shorter courses and those using generic medications; the cost-effectiveness of these modifications has not been investigated.

Prevalence of smoke exposure amongst children who undergo tonsillectomy for recurrent tonsillitis.

PURPOSE: The hypothesis tested was that smoke exposure has a detrimental effect on the developing upper respiratory tract. The purpose of this study was to determine if more children undergoing tonsillectomy for recurrent tonsillitis had smoke exposure in comparison to a control group of children undergoing hernia repair. METHODS: This was a retrospective case-control study. Medical records of children less than 15 years of age that underwent tonsillectomy for recurrent tonsillitis at Penn State Hershey Medical Center from July 2009 to October 2012 were retrospectively reviewed to determine exposure to smoking contacts. Records of children less than 15 years of age that underwent hernia repair surgery at this facility during the same time, were also retrospectively reviewed for smoke exposure. RESULTS: A total of 256 children who underwent tonsillectomy for recurrent tonsillitis and 241 children who underwent hernia repair surgery met the inclusion criteria. Of the children in the tonsillectomy for recurrent tonsillitis group, 121 (47.27%) had previous smoke exposure, compared to 67 (27.80%) in the hernia repair group. Further analysis of the data using logistic regression yielded an odds ratio of 2.49 (P=0.004), indicating that children with smoke exposure had more than twice the odds of having tonsillectomy for recurrent tonsillitis compared to those with no exposure. CONCLUSIONS: Exposure to smoking contacts was more common in children who underwent tonsillectomy for recurrent tonsillitis than children who underwent hernia repair surgery. Future studies could address the relation of smoke exposure quantity to health outcomes in children.

Indications for tonsillectomy: a 10 year retrospective review.

OBJECTIVE: Recurrent tonsillitis and obstructive sleep apnea (OSA) are the most common indications for tonsillectomy. This study was undertaken to determine if recurrent tonsillitis is increasing as an indication for tonsillectomy by reviewing the recent trend at a single institution. METHODS: A retrospective chart review of patients undergoing tonsillectomy from 2003 to 2012 was performed. Data was gathered from pre-operative symptoms and sleep study results. Patients were categorized by the following indications: (1) obstructive sleep apnea, (2) recurrent tonsillitis and OSA, (3) recurrent tonsillitis alone and (4) other. Literature review was conducted to find similar studies; the results of the literature review were compared to our results. RESULTS: A total of 2369 patients were included, 52% were boys. Over the study period OSA was the indication for surgery for 67% of patients. There was an increasing trend in OSA as the indication for tonsillectomy (p<0.0001). Girls were more likely to have tonsillitis as an indication for tonsillectomy (21% vs. 17%, OR: 1.32, p<0.0001). Children younger than 2 or 2-5 are less likely than those older than 5 to have tonsillitis as an indication for surgery (2.30% and 6.26% vs. 27.46%, OR=0.06 and 0.18, p<0.0001). 987 of 2370 (42%) patients undergoing tonsillectomy had a pre-operative sleep study. Younger children were more likely to have had a sleep study. CONCLUSION: There were mild variations from year to year; however, obstructive sleep apnea is the most common reason for tonsillectomy.