Ultrasound-guided foam sclerotherapy as a therapeutic modality in venous ulceration

ObjectivesThe objective of this systematic review and meta-analysis was to evaluate rates of ulcer healing following ultrasound-guided foam sclerotherapy (UGFS).MethodsThe MEDLINE, CENTRAL and Embase databases were used to search for relevant studies using the terms ' (sclerotherapy AND ulcer) OR (vein AND ulcer) OR (sclerotherapy AND vein)'. Heterogeneity between studies was quantified using the I² statistic. A random effects model was used to calculate risk ratios where substantial heterogeneity was found.ResultsThe initial search yielded 8266 articles. 8 studies were included in the qualitative synthesis and 3 in the meta-analysis. Superior complete ulcer healing rates were noted in patients treated with foam sclerotherapy versus compression therapy alone (pooled OR 6.41, 95% CI = 0.3–148.2, p = 0.246, random effects method). A marked degree of heterogeneity was observed between studies (I² = 81%).ConclusionA prospective, trial is warranted in order to determine the true merits of UGFS in the setting of venous ulceration.     

Retrograde Inversion Stripping as a Complication of the Clarivein? Mechanochemical Venous Ablation Procedure

The endovenous revolution has accelerated the development of new techniques and devices for the treatment of varicose veins. The ClariVein^® mechanochemical ablation device offers tumescentless treatment with a rotating ablation tip that can theoretically become stuck in tissue. We present the first report of retrograde stripping of the small saphenous vein without anaesthesia following attempted use of the ClariVein^® device, without adverse sequelae.     

Sequential treatment by polidocanol and radiofrequency ablation of large benign partially cystic thyroid nodules with solid components: Efficacy and safety

PurposeThe purpose of this study was to retrospectively evaluate the efficacy and safety of a sequential treatment including percutaneous polidocanol sclerotherapy and radiofrequency ablation (RFA) in terms of volume reduction and complication rate in large, benign, partially cystic thyroid nodules with solid components.Materials and methodFrom April 2017 to April 2019, 46 patients with 47 large benign partially cystic thyroid nodules underwent sequential treatment. There were 14 men and 32 women with a mean age of 49.9 ± 11.5 (SD) years (range: 18–75 years). The volume of initial nodules was 12.7 ± 12.3 (SD) mL (range: 2.16–75.62 mL). Volume reduction after percutaneous polidocanol sclerotherapy and further RFA was evaluated respectively. Patients had clinical and ultrasound evaluations at a follow-up time of 12.1 ± 5.3 (SD) months (range: 1.5–23.9 months). Technical success and complications were accessed retrospectively.ResultsAfter unsatisfying results with polidocanol sclerotherapy alone the 46 patients with 47 large benign partially cystic thyroid nodules had further RFA. Mean volume reduction of 47 nodules was 90.5 ± 11.3 (SD) % (range: 43.9–99.3%) one month after RFA, 94.9 ± 6.2 (SD) % (range: 66.9–99.5%) three months after RFA, and 95.8 ± 5.5 (SD) % (range: 71.0–99.8%) six months after RFA. No recurrence or nodule enlargement after RFA was observed at the last follow-up. The complication rate of RFA was 12.5% (8/46 patients), with minor complications only.ConclusionsThe sequential treatment regimen, including percutaneous polidocanol sclerotherapy and RFA, is an appropriate and safe treatment strategy for large benign partially cystic thyroid nodules with solid components.     

1％聚桂醇硬化剂治疗下肢毛细血管扩张

目的探讨硬化剂治疗下肢毛细血管扩张的效果。方法2010年9月-2011年7月,运用1％聚桂醇硬化剂注射治疗108例下肢毛细血管扩张,一次治疗总剂量2～10ml,治疗1—2次,治疗后使用长统弹力袜（压力20～30mmHg）至少4周。随访1年,记录毛细血管消退和症状改善情况。结果随访1～12个月,（7．8±2．5）月。97例（90％）扩张毛细血管全部消退,11例（10％）部分消退。57例有症状患者中,28例症状消失,29例症状改善。2例聚桂醇过敏,5例头痛,54例皮下硬结,60例局部皮肤色素沉着（其中10例6个月后仍残留皮肤色素沉着）,1例局部皮肤点状坏死。结论聚桂醇硬化注射是治疗下肢毛细血管扩张安全有效的方法,可以改善症状,并极好地解决美容问题。     

MRI引导头颈及躯干部静脉血管畸形硬化治疗的可行性

目的评价MRI在头颈及躯干部静脉血管畸形硬化治疗中的应用价值。方法在MRI引导下对21例头颈及躯干部静脉血管畸形患者进行硬化治疗。治疗后随访12～36个月,分别对比治疗前、后临床症状及MRI的变化,评估治疗效果。结果对21例患者共行29次穿刺及硬化治疗,技术成功率为100%（29/29）,未出现严重并发症。21例患者平均随访时间为（23.3±6.9）个月,其中17例（17/21,80.95%）症状有所改善。13例患者在随访时接受MR检查,首次治疗到随访MR的平均时间间隔为（19.0±4.2）个月。MRI见9例（9/13,69.23%）病灶缩小,其中6例（6/13,46.15%）病灶轻度变小,3例（3/13,23.08%）病灶明显变小,4例（4/13,30.77%）病灶体积无明显变化或增大。结论 MRI可以作为硬化治疗头颈及躯干部静脉血管畸形的影像学引导手段。     

聚多卡醇治疗红斑毛细血管扩张型玫瑰痤疮12例疗效观察

目的探讨聚多卡醇治疗红斑毛细血管扩张型玫瑰痤疮的临床疗效和安全性。方法采用局部注射聚多卡醇治疗12例红斑毛细血管扩张型玫瑰痤疮患者,并观察临床疗效。结果 12例患者均达痊愈标准,治疗后局部无再出血、渗出、破溃、色素沉着及瘢痕。随访6个月,未见复发。结论聚多卡醇局部注射治疗红斑毛细血管扩张型玫瑰痤疮疗效显著,美容效果好,具有很好的临床应用前景。     

Cap-assisted endoscopic sclerotherapy for hemorrhoids: Methods,feasibility and efficacy

AIM: To evaluate the methodology, feasibility, safety and efficacy of a novel method called cap-assisted endoscopic sclerotherapy(CAES) for internal hemorrhoids.METHODS: A pilot study on CAES for grade Ⅰ to Ⅲ internal hemorrhoids was performed. Colon and terminal ileum examination by colonoscopy was performed for all patients before starting CAES. Polypectomy and excision of anal papilla fibroma were performed if polyps or anal papilla fibroma were found and assessed to be suitable for resection under endoscopy. CAES was performed based on the requirement of the cap, endoscope, disposable endoscopic long injection needle, enough insufflated air and sclerosing agent.RESULTS: A total of 30 patients with grade Ⅰ to Ⅲ internal hemorrhoids was included. The follow-up was more than four weeks. No bleeding was observed after CAES. One(3.33%) patient claimed mild tenesmus within four days after CAES in that an endoscopist performed this procedure for the first time. One hundred percent of patients were satisfied with this novel procedure, especially for those patients who underwent CAES in conjunction with polypectomy or excision of anal papilla fibroma.CONCLUSION: CAES as a novel endoscopic sclerotherapy should be a convenient, safe and effective flexible endoscopic therapy for internal hemorrhoids.     

Bleomycin sclerotherapy in lymphangiomas of the head and neck region: a prospective study

Intralesional sclerotherapy for lymphatic malformations (LMs) has become a modality of choice because of the high morbidity and recurrence rates with surgical excision. Traditionally, the macrocystic variant has shown good results with sclerotherapy. This prospective study was performed to evaluate the role of bleomycin sclerotherapy in the management of different radiological variants of LM. A total of 142 patients were included in this study. The lesions were classified as macrocystic, microcystic, or mixed LMs on the basis of ultrasonography. All patients were managed by intralesional injection of bleomycin and were recalled after 4 weeks for evaluation. Colour photographs of the patients were taken before the onset of treatment and at each monthly visit, and were utilized to assess the response. Following the second, third, and fourth doses, the response was better in patients with the macrocystic variant than in those with the other two variants. However, after the completion of six doses, 80.3% of patients with the macrocystic variant, 67.4% with the microcystic variant, and 71.4% with the mixed type had a complete response. There was no difference in the overall response between the three types (P = 0.28). Oedema, erythema, and local induration with fever were the most common adverse effects and were more common in younger children.