Facial teleangectasias: our experience in treatment with IPL

BACKGROUND AND OBJECTIVES: Facial teleangectasias can be a relevant cosmetic problem, which the patient usually hides with a thick layer of makeup. This study will describe the response on these vascular lesions using the intense pulsed light (IPL) source. METHODS: Five hundred eighteen consecutive patients were treated with Photoderm VL (Lumenis Ltd.). The average age of patients of various skin types (Fitzpatrick I to IV) was 48.5 years. They were subjected to a mean of 1.69 treatments (range 1-9) followed up 48 hours, 72 hours, 1 week, 3 weeks, and 1 month after each treatment. All patients were followed up after 2 months from the last treatment and the percentage of clearance was assessed by comparing pre- and post-treatment photographs. The patients also answered a questionnaire in which they expressed personal satisfaction. The physicians evaluation was also recorded on the same form. RESULTS: Patients (87.64%) presented a clearance of 75%-100%. The results appear not correlated with lesions size, age, skin type but with operator experience. Minimal side adverse effects occurred in 20% of the patients. CONCLUSION: The IPL source, Photoderm VL, can be considered an alternative or a supplement to the existing laser devices for facial teleangectasias treatment.     

Fiberendoskopische Verödung von Oesophagusvaricen

Zusammenfassung Anhand einer 2jährigen Erfahrung berichten wir über die fiberendoskopische Verödung von Oesophagusvaricen. 170 Patienten wurden behandelt: 61 Frauen und 109 Männer zwischen 15 und 83 Jahren mit einem Altersgipfel im 5. Dezennium. Ursachen der portalen Hypertension waren in 162 Fällen eine Lebercirrhose und 8mal eine Milzvenen- bzw. Pfortaderthrombose. Die Varicenverödung erfolgte bei 47 Patienten während der Blutungsphase, in 101 Fällen im Intervall und 22mal prophylaktisch. Mit maximal drei Behandlungssitzungen ließen sich die Varicen nach der modifizierten intravasalen Injektionstechnik veröden. Akute Blutungen konnten in 83 % erfolgreich gestillt werden. Die Krankenhausletalität der akut behandelten Patienten betrug 30 %. In der Intervall-Gruppe lag sie bei 5 %. Keiner der prophylaktisch sklerosierten Patienten starb während der Behandlung. Die globale Spätletalität im Zeitraum bis zu 22 Monaten betrug 11,8 %. Häufigste Todesursache war terminale Leberinsuffizienz. Rezidivblutungen traten in 11,2 % auf und endeten bei jedem 5. Fall tödlich. Häufigste Komplikationen stellten Stenosen dar, die in 4 von 16 Fällen bougiert werden mußten. 2mal entwickelten sich oesophagopleurale Fisteln, die mit Bülau-Drainagen beherrscht werden konnten. Die Komplikationsrate betrug insgesamt 10,6 % ohne einen letalen Ausgang.

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Fiberscopic obliteration of esophageal varices

Summary We are reporting our 2 years experience in the fiberscopic sclerotherapy of esophageal varices. 170 patients from 15–83 years of age were treated (61 females and 109 males), the majority being around 50 years of age. In 162 cases, the cause of the portal hypertension was cirrhosis of the liver and in 8 cases thrombosis of the splenic or portal vein. 47 patients were treated during acute bleeding, 101 in the interval, and 22 prophylactically. Using the modified intravascular technique, most varices could be sclerosed after a maximum of three treatments. In 83 %, acute hemorrhages were stopped. The hospital mortality amounted to 30 %, while in the interval group only it was 5 %. None of the prophylactically treated patients died during their stay in hospital. The mortality after an average of 11.2 months amounted to 11.8 %: The main cause was liver failure. Bleeding reoccurred in 11.2 % and resulted in death in every fifth case. The most common complication, namely stenosis, arose in 16 cases and 4 of these necessitated dilation therapy. Esophagothoracic fistulae occurred in 2 cases and could be cured by siphon drainage. The rate of complication amounted to 10.6 %, without any lethal outcome.

     

Single-session percutaneous ethanol sclerotherapy in simple renal cysts in children: long-term follow-up

Background: Simple renal cysts are rare in children and managed conservatively unless symptomatic. Objective: To demonstrate the efficacy and long-term results of single-session ethanol sclerotherapy in symptomatic simple renal cysts in children. Materials and methods: Three simple renal cysts in three children (age 1, 5 and 16 years) were included in the study. Indications for treatment were flank pain (n=1), hypertension (n=1), and increasing cyst size and urinary tract infection (n=1). The mean follow-up period was 5.5 years (range 3–7 years). The procedures were performed with the guidance of US and fluoroscopy and under IV sedation. After the cystogram, 95% ethanol with a volume of 40% of the cyst volume (but not more than 100 ml) was used as the sclerosing agent. Results: Two cysts disappeared completely, while the volume reduction was 99% for the third cyst at the end of the first year. CT demonstrated calcification of the cyst without an enhancing soft-tissue component in the third one 7 years after sclerotherapy. After the procedures, hypertension and pain resolved without any medication. There were no complications during the procedures or during follow-up. Cytological examination was unremarkable in all patients. Conclusions: Percutaneous treatment of symptomatic simple renal cysts in children with single-session ethanol sclerotherapy is a safe, effective and minimally invasive procedure. Calcification owing to sclerotherapy can be observed on follow-up.     

内镜下硬化疗法对肝硬化食管静脉曲张出血的疗效

[研究背景 ]食道静脉曲张出血是肝硬化的严重并发症和常见死亡原因之一 .　 [病例报告 ]将肝硬化合并食管静脉曲张出血患者 16 4例分为硬化组 79例和药物组 85例 ,分别给予内镜下 5 0 g/L鱼肝油酸钠静脉内硬化治疗与一般传统药物治疗 .结果 ,6个月 ,1,3,5年内硬化组再出血率显著低于药物组 ,而硬化组生存率高于药物组 .[讨论 ]内镜下硬化疗法在降低肝硬化食管静脉曲张出血患者的再出血率和提高生存率方面均优于传统的药物疗法     

Injection Sclerotherapy for Recurrent Esophageal Varices after Surgical Procedures

Abstract: Thirteen patients, who had recurrent esophageal varices after esophageal transection or esophagoproximal gastrectomy were treated by endoscopic injection sclerotherapy. Four patients successfully underwent emergency sclerotherapy to control active variceal hemorrhaging. Three of these patients and the remaining nine patients (including six rebleeding patients who were conservatively treated) underwent elective sclerotherapy. None of the patients had variceal rebleeding in the follow-up study with sclerotherapies. Only one patient with recurrent varices did not undergo any additional sclerotherapy following emergency treatment. In this study, no deaths occured nor any major complications. Minor complications such as low grade fever and chest pain were observed, but they were transient and disappeared within 2 or 3 days without specific treatments. It is concluded that endoscopic injection sclerotherapy is considered to be the most effective procedure for recurrent varice following surgery.     

Histologic and Manometric Studies on the Esophagus Following Endoscopic Sclerotherapy

Objective The aim of this work was to study the histologic and manometric changes in the distal esophagus beyond 2 years following endoscopic sclerotherapy (EST) and/or surgical intervention, and to try to understand the etiological factors associated with these changes. Patients and interventions Forty patients, with an average age of 61.5 years, were studied for 2–12 years following sclerotherapy and/or surgical intervention. The causes of liver disease were alcoholic cirrhosis (78.6%), primary biliary cirrhosis (14.3%), and chronic aggressive hepatitis (7.1%). A predominant number of cases (65%) had a mesocaval interposition shunt due to the failure of EST, 32.5% EST alone, and 2.5% esophageal devascularization. All patients had esophageal manometry following mucosal biopsies taken in duplicate endoscopically from three levels of the distal esophagus. Results In the EST and shunt groups, 88.5% had manometric abnormalities, esophagitis, and chronic inflammatory changes. In the EST group, all but two patients had manometric abnormalities and chronic inflammatory changes. Analysis of the patient groups on the basis of the number of EST sessions and the amount of sclerosant injected showed that both histologic changes and dysmotility were more profound in those treated over five times with EST. The differences were significant. Conclusion It appears that EST causes persistent manometric abnormalities and chronic inflammatory changes in the distal esophagus, the severity of which seems to vary directly with the frequency of sclerotherapy and not amount of sclerosant injected.     

硬化剂注射预防食管静脉曲张破裂出血远期疗效研究

目的观察肝硬化食管静脉曲张患者分别行内镜下注射硬化剂（endoscopic injection sclerotherapy,EIS）和口服卡维地洛后的再出血发生率、死亡率和治疗前后食管静脉曲张程度以及肝功能的分级变化。方法入选患者89例,其中50例患者采用EIS治疗,39例患者采用药物预防性治疗,EIS组患者给予多次注射硬化剂,直至曲张静脉消失,药物治疗组给予卡维地洛,起始剂量为6.25mg,每日2次,逐渐增加剂量至最大耐受量12.5mg,每日2次。全部患者观察36个月,对比两组间的再出血发生率和死亡率、治疗前后静脉曲张程度以及肝功能分级变化。结果 EIS治疗组有效随访44例,期间发生出血7例（15.9%）,死亡3例（6.8%）。药物治疗组有效随访34例,期间发生出血10例（29.4%）,死亡4例（11.8%）。两组间再出血发生率和死亡率差异有统计学意义（P〈0.05）。EIS治疗组静脉曲张总消失率为40.9%（18/44）,卡维地洛治疗组曲张静脉均未消失;比较两组治疗前后肝功能Child-Pugh评分未见明显差异（P〉0.05）。结论与药物卡维地洛治疗相比,EIS治疗可以降低再出血发生率、死亡率和静脉曲张程度,同时患者肝功能无明显损害。     

肝硬化食管静脉曲张患者硬化与套扎治疗对食管动力的影响

研究肝硬化门脉高压合并食管静脉曲张患者行硬化、套扎治疗对食管测压的影响。硬化与套扎治疗组均于治疗前及治疗后各测压一次，结果显示：（1）硬化剂治疗后，食管下端括约肌（LES）息压及松弛压力降低，松弛率升高，松弛持续时间缩短；套扎治疗仅对LES静息压有影响。（2）硬化剂治疗使治疗部位及其以下食管的蠕动波幅值下降，蠕动持续时间延长，蠕动波速度加快；套扎治疗使治疗部位及其以下食管的蠕动持续时间缩短，异常蠕动性收缩增加。提示经治疗后应使用既能降低胃酸酸碱度，又能增加LES压力的抗酸药物，而套扎治疗后应使用胃动力药物。     

Effects of Cyanoacrylate on the Gastric Mucosa of Dogs –Endoscopic and Histopathological Studies for Sclerotherapy of Gastric Varices–

Abstract: The effect of cyanoacrylate tissue adhesive (C. A.) on the gastric mucosa of dogs was investigated endoscopically and histopathologically. When C. A. was applied to the surface of the gastric mucosa, the endoscopic findings the next day showed local redness at the applied site (Fig. 1-a) and histopathology revealed degenerative changes in the gastric mucosa (Fig. 1-b). When C. A. was endoscopically injected into the gastric mucosa, the endoscopic findings revealed a submucosal tumor-like lesion (Fig. 2-a). One day after treatment, the endoscopic findings showed a hemorrhagic erosion on the surface of the lesion (Fig. 2-b). An histopathological examination of the resected stomach revealed C. A. in the submucosal layer (Fig. 3-a, 3-b) and the lymph duct around the muscularis mucosa with severe acute inflammation (Fig. 4-a, 4-b). One week after treatment, a deep ulcer (Ul-IV) was observed (Fig. 5, 6) and a histopathological examination of the resected specimen revealed C. A. at the site of the ulcer and inflammatory cell infiltration by fibroblasts and giant cells (Fig. 7-a, 7-b). One month after treatment, the ulcer had healed and was replaced by a scar (Fig. 8). Histopathological examination of the resected stomach revealed C. A. in both the muscularis mucosa and the submucosa and also inflammatory cell infiltration by giant cells in addition to the fibrosis (Fig. 9). When using endoscopic sclerotherapy with C. A., it should be kept in mind that there is the possibility of such a lesion occurring as demonstrated by our study.