Microfoam Ultrasound-Guided Sclerotherapy Treatment for Varicose Veins in a Subgroup with Diameters at the Junction of 10 mm or Greater Compared with a Subgroup of Less Than 10 mm

OBJECTIVE: The objective was to analyze the effectiveness of foam ultrasound-guided sclerotherapy treatment in saphenous veins and tributary veins with a diameter at the saphenofemoral or saphenopopliteal junction of > or =10 mm and compare these results with a subgroup of veins with diameters of < 10 mm. METHODS: A subgroup of 17 saphenous veins with a diameter at the saphenofemoral or saphenopopliteal junction of > or =10 mm were compared with a subgroup of 98 saphenous veins with a diameter of < 10 mm at the saphenofemoral or saphenopopliteal junction for clinical efficacy and patient satisfaction at a mean 2-year follow-up. RESULTS: A mean number of 2.15 treatments utilizing an average of 8.37 mL of foam sclerosing solution (3% sodium tetradecyl sulfate) were required to close all incompetent varicose veins in the < 10-mm group versus a mean of 2.8 treatments and 13.9 mL foam (3% sodium tetradecyl sulfate) for the > or =10-mm group. A total of 27.5% of saphenous veins of < 10 mm and 37.5% of saphenous veins > or = 10 mm required a second treatment at 3 months. One-hundred percent of patients believed that their legs were successfully treated at 2-year follow-up in both groups with 94% of the < 10-mm group noting improvements in quality of life and 100% in the > or =10-mm group. CONCLUSIONS: Ultrasound-guided foam sclerotherapy is effective in treating all sizes of varicose veins with high patient satisfaction and improvement in quality of life. Duplex ultrasound findings demonstrated a small increase in failure to close the saphenofemoral or saphenopopliteal junction with increasing size of junction diameter, but this does not significantly alter the results with respect to clearance of visible varicosities and patient satisfaction with results.     

A randomized trial of tacrolimus (FK506) versus total lymphoid irradiation for the control of repetitive rejection after cardiac transplantation

Recurrent cardiac rejection is a major cause of morbidity during the initial 6 months following transplantation. We compared treatment with tacrolimus versus total lymphoid irradiation in 13 heart transplant recipients on a cyclosporine, azathioprine, and prednisolone regimen, who experienced repetitive rejection. The mean number of episodes of rejection significantly decreased in both groups, with no deaths and no increase in the incidence of infection, hypertension, diabetes, or renal impairment following either treatment at 12-month follow-up. Conversion to tacrolimus or a course of lymphoid irradiation are equipotent strategies, of comparable cost, for the prevention of further rejection in patients with recurrent rejection.     

Coexistent orbital and cerebellar venous anornalies in linear sebaceous naevus syndrome

Background: Orbital venous anomalies can result in significant morbidity and have been reported in association with other venous anomalies, some with the potential for serious complication.
Methods/results: We present a case of an orbital venous anomaly coexistent with a large cerebellar venous angioma and a linear sebaceous naevus. Clinical features, asSociations, complications and management principles are presented.
Conclusion: Upon clinical recognition of an orbital venous anomaly, brain imaging and appropriate clinical assessment should be considered in light of the possibility of coexistence of potentially life-threatening lesions.     

Primary and Recurrent Colorectal Cancer Masquerading as Gynaecological Malignancy

To make clinicians more aware of the phenomenon of primary and recurrent colorectal and anal carcinoma masquerading as primary gynaecological malignancy, we reviewed the records of 8 women referred to our gynaecological oncology unit with primary colorectal cancer (1), recurrent colorectal cancer (6) and primary anal cancer (1). Seven of these patients presented with abnormal vaginal bleeding or discharge. All patients had Papanicolaou smears performed; 7 were abnormal and 1 unsuitable for cytological assessment. None of the 6 patients with recurrent carcinoma had been previously treated with more than standard anterior or abdominoperineal resection; no radiotherapy had been given, and only 1 patient had received chemotherapy. These patients were treated in our gynaecological oncology unit for their recurrence by surgery and/or chemotherapy and/or irradiation. All 6 had further recurrences in the pelvis despite this aggressive therapy. Follow-up of colorectal cancer in women should involve gynaecological history, pelvirectal examination and Pap smear at each visit. Correct diagnosis of the colorectal origin of a genital tract tumour is made on careful history, examination and biopsy. An abnormal Pap smear may be the first indication of recurrent colorectal cancer in the cervix and vagina, although most patients ultimately present with abnormal vaginal bleeding. The presence of a tumour invading both cervix and posterior vaginal wall is suggestive of spread from a colorectal tumour compared to the more common lateral spread of a cervical primary.     

Pericardial Metastasis in Carcinoma of the Uterine Cervix

Cardiac metastasis from gynecological malignancies is rare. Only six cases of carcinoma of the uterine cervix have been reported where the diagnosis of malignant pericardial effusion was made antemortem. The treatment of neoplastic pericardial effusion is controversial; both surgical and nonsurgical treatments are advocated. We present a patient with pericardial effusion secondary to carcinoma of the cervix and recommend subxiphoid pericardial fenestration for reliable long-term control of malignant effusion.     

Microfoam Ultrasound-Guided Sclerotherapy of Varicose Veins in 100 Legs

OBJECTIVE: To demonstrate the efficacy of duplex-guided foam sclerotherapy measured against patient symptom relief and quality of life. METHODS: An analysis was performed of 100 randomly chosen legs with varicose veins treated with ultrasound-guided foam sclerotherapy with a mean follow-up of 22.5 months. RESULTS: An average number of 2.1 treatments using an average of 8.7 mL of foam sclerosing solution were required to close incompetent varicose veins. Thirty-one percent of leg varicose veins required a second treatment at 3 months; 100% of patients felt that their legs were successfully treated with resolution of all symptoms in 85% and resolution in all varicose veins in 92%. CONCLUSION: Ultrasound-guided foam sclerotherapy is effective in treating varicose veins with high patient satisfaction with results and improvement in quality of life.     

False positive diagnosis of subarachnoid haemorrhage on computed tomography scan

Five cases are presented in which subarachnoid haemorrhage (SAH) was diagnosed by clinicians and/or radiologists on computed tomography (CT) scan. No macroscopic SAH was present on neuropathologic examination. In retrospect it was considered that the neurologic signs and the neuropathologic features close to the time of CT scan were in keeping with the patients being brain dead, i.e. had no cerebral blood flow at the time of the scans. On review of the CT scans it was considered the hyperdense material seen in the subarachnoid space must have been blood in congested subarachnoid blood vessels. The cases demonstrate that if a patient presents comatose and CT scan shows cerebral oedema then the presence of high attenuation material in the subarachnoid space should not necessarily be considered to represent SAH. The value of seeking radiological opinion is highlighted but even then diagnosis may be difficult.     

An audit of carotid endarterectomy for internal carotid artery disease at Dunedin Hospital

Carotid endarterectomy, mostly for symptomatic internal carotid artery stenosis, has been successfully performed in both the vascular and neurological surgery units at Dunedin Hospital. This study was performed to compare our results with those of the North American Symptomatic Carotid Endarterectomy Trial and the European Carotid Surgery Trial. The 30-day perioperative morbidity and mortality rate was 4.3% (1.2% < 95% Cl > 7.4%) which compares favourably with an estimated upper limit of 5.5% based on recent trial reports. The present study highlights the difficulty in modelling local clinical practice on results of major trials when standards of patient evaluation and surgical skill may differ from those of the large studies. To justify generalization of indications for intervention based on the multicentre trials, there must be continual monitoring of local surgical results, and standardized use of diagnostic investigations.