Efficacy of percutaneous ethanol sclerotherapy for venous malformation in lower extremities: a retrospective review of 21 cases

Background

Venous malformations (VM) of lower extremities have characteristic symptoms, especially swelling, pain at rest or with dependence, or in the morning, or with exertion. Sclerotherapy has been applied and has been showed to alleviate the associated signs and symptoms. The aim of this study is to evaluate the outcomes of ethanol sclerotherapy for VM of lower extremities.

Methods

The 21 patients of intramuscular VM of the lower extremities, who received percutaneous sclerotherapy using absolute ethanol in our institute, were reviewed retrospectively. The average age at the time of the initial diagnosis was 18.6 years, and average follow-up period after last sclerotherapy is 19.4?±?13.5 months. The postinterventional changes of the associated signs and symptoms were evaluated by utilizing original VM scoring system.

Results

The average number of sclerotherapy sessions was 2.6 times per case. The average total amount of ethanol used in each patient was 41.3 ml. Sclerotherapy reduced the associated signs and symptoms in many of the patients (n?=?19/21). Preinterventional VM score as the overall baseline status was 10, and the average VM score after sclerotherapy was 4.1. There was no inverse correlation between the amount of ethanol used and the VM score. In seven cases treated more than three times, reverse correlation between the “VM score” and the number of sclerotherapy sessions was demonstrated (p?<?0.05, ρ?=?0.8214).

Conclusions

The characteristic symptoms and signs of the VM were improved by sclerotherapy. More than three sessions of ethanol sclerotherapy improved the overall status of extensive intramuscular VM in lower extremities. Level of Evidence: Level IV, therapeutic study.     

Efficacy of endotracheal lidocaine administration with continuous infusion of remifentanil for attenuating tube-induced coughing during emergence from total intravenous anesthesia

Purpose

Although attenuation of tube-induced coughing is necessary in specific types of surgery, the best method for such attenuation is still unclear. We studied the combined intervention of endotracheal lidocaine and intravenous remifentanil compared to intravenous remifentanil alone with respect to coughing during emergence from anesthesia.

Methods

We examined 60 ASA 1–2 patients (age, 20–69 years) undergoing tympanoplasty under general anesthesia. Anesthesia was induced with propofol, remifentanil, and rocuronium. The trachea was intubated using a laryngotracheal instillation of topical anaesthetic (LITA) tracheal tube. Anesthesia was maintained with propofol and remifentanil (0.1–0.3 μg/kg/min). Propofol was discontinued and remifentanil (0.1 μg/kg/min) was continued at the end of the operation. Patients were randomly allocated to the lidocaine (n = 30) and control groups (n = 30). We administered 3 ml 4 % lidocaine via the LITA tube to patients in lidocaine group at the end of the operation. The trachea was extubated when the patient regained consciousness and followed orders. Coughing was evaluated using a 4-point scale by an observer who examined the video records at extubation.

Results

Fewer patients in lidocaine group (8 of 30) than in control group (18 of 30, p < 0.01) coughed. Fewer patients in lidocaine group (2 of 30) than in control group (12 of 30, p < 0.01) had moderate or severe cough (scale 2 or 3).

Conclusions

This study is consistent with the finding that endotracheal lidocaine administration and continuous infusion of remifentanil before extubation is useful to prevent coughing on emergence from anesthesia.     

Hyponatremia at admission is associated with in-hospital death in patients with hip fracture

Purpose

Hyponatremia in hospitalized patients has been reported to be associated with in-hospital mortality. We studied patients treated at our hospital for hip fracture regarding the factors related to hyponatremia at admission.

Methods

Among 580 patients aged 60 years or above who were admitted to our hospital since January 1997 for treatment of hip fracture, 512 patients (110 males, 402 females) from whom serum sodium level at admission was available were studied. In 512 patients, the age at injury ranged from 60 to 103 (mean 82.6) years. Fracture types were femoral neck fracture in 191 patients, and trochanteric fracture in 321. These patients were divided into two groups by the blood sodium level at admission: a hyponatremia group with sodium levels lower than 135 mEq/L, and a normonatremia group with sodium levels within normal range. The age, gender, fracture type, residence before injury, pre-injury walking capability, anemia at admission, liver function, kidney function, inflammatory status, urinary glucose status, lung disease, ECG abnormality, systemic chronic disease, status of dementia, treatment modality, hospital stay (days), and in-hospital death were investigated. First a univariate study was conducted to identify the factors that differ significantly between the two groups. Then multivariate analysis was conducted using the parameters with significant difference as independent variables

Results

Hyponatremia was found in 49 of 512 (9.6 %) patients. In univariate analyses, six factors (age; residence before injury; anemia; dementia; treatment modality; in-hospital death) were significantly different between the hyponatremia group and normonatremia group. Multivariate analysis identified in-hospital death [odds ratio (OR) = 3.64, p = 0.035] and age (OR = 1.05, p = 0.029) as independently associated with hypernatremia.

Conclusion

Hyponatremia at admission is prevalent in old aged patients with fracture, and is related to in-hospital death.     

A case of mesenteric cystic lymphangioma in an adult which caused duodenal stenosis after resection

INTRODUCTIONWe present a rare case of mesenteric lymphangioma in a middle-aged female.PRESENTATION OF CASEA 56-year-old female was admitted to the hospital with upper abdominal pain. Abdominal computed tomography revealed a multicystic mass surrounding the mesentery. We made the decision to resect the mass, suspecting that was a mesenteric lymphangioma based on additional imaging studies. The tumor adhered strongly to parts of the duodenum and the upper jejunum. In order to preserve the jejunum, we dissected its serosa away from the tumor. Approximately 1 week after surgery the patient experienced a constriction of the third portion of the duodenum. Her symptoms were improved with conservative therapy, and she was discharged from the hospital 62 days after surgery.DISCUSSIONLymphangioma originating from the mesentery may have cause adhesions due to exfoliated tumor cells; it is necessary to be concerned about postoperative obstruction.CONCLUSIONThe preoperative diagnosis of lymphangioma is based on various imaging modalities.     

Reproducibility of three-dimensional coordinate systems based on craniofacial landmarks

Abstract Objectives: To propose a method for evaluating the reproducibility of anatomical coordinate systems based on craniofacial skeletal landmarks and to tentatively evaluate four systems created on preoperative cone-beam computed tomography (CBCT) data obtained from mandibular prognathism patients in order to confirm the utility for actual patients' data. Materials and Methods: In three-dimensional images of 10 patients obtained by a CBCT with a large field of view, six dentists set four coordinate systems that were created in different ways, twice by plotting some landmarks situated in the superior portion of the maxillofacial skeletons. The 95% confidence ellipse of six objective landmarks related to the jaw and teeth (upper incisor, left upper first molar, lower incisor, left lower first molar, menton, and left gonion) were three-dimensionally drawn for each coordinate system. The ellipsoid volume was calculated to evaluate the reproducibility of the coordinate systems. Results: The reproducibility could be evaluated for each coordinate system using the method proposed. The coordinate systems that were created by landmarks situated at greater distances from each other showed relatively small ellipsoid volume in comparison to those with shorter distances between landmarks. Conclusion: Anatomical coordinate systems with larger distances between the landmarks used were stable when landmarks related to the jaw and teeth were assigned as objective landmarks. The method proposed here was effective in terms of the reproducibility evaluation of a coordinate system.