Percutaneous sclerotherapy of massive macrocystic lymphatic malformations of the face and neck using fibrin glue with OK-432 and bleomycin

Picibanil (OK-432) and bleomycin have been used as alternative sclerosing agents for lymphatic malformations. This study evaluated the clinical curative effect of sclerotherapy using fibrin glue combined with OK-432 and bleomycin for the treatment of macrocystic lymphatic malformations of the face and neck. Fifteen paediatric patients (6 males; 9 females, aged 13 months to 14 years) who had received percutaneous sclerotherapy for massive macrocystic lymphatic malformations of the face and neck were retrospectively reviewed. Affected regions included the neck, parotid region and parapharynx, mouth floor, face and cheek, and orbital regions. All patients showed preoperative symptoms of space-occupying lesions between 4 cm × 5 cm and 12 cm × 16 cm in size. Fibrin glue with OK-432 and bleomycin was injected under general anaesthesia. All patients received preoperative and follow-up CT scans. Outcomes were assessed by three surgeons. All patients exhibited mid-facial swelling for 3-4 weeks after surgery, but no major complications. Follow-up periods ranged from 8 to 16 months. Eight lesions were completely involuted, five were mostly involuted, and two were partially involuted. Percutaneous sclerotherapy using fibrin glue with OK-432 and bleomycin provided a simple, safe, and reliable alternative treatment for massive macrocystic lymphatic malformations of the face and neck.     

Thoracic duct cyst: sclerotherapy as alternative for surgical treatment

BACKGROUND: Thoracic duct cysts of the cervical portion are rare benign lesions for which surgery is the treatment of choice. METHODS: We present 2 cases of a thoracic duct cyst of the cervical portion. One patient was treated by surgery and the other patient by ethanol sclerotherapy. RESULTS: After establishing diagnosis by radiologic assessment and chemical and cytological fine-needle aspirate of the cystic masses, both patients were treated successfully. CONCLUSION: Ethanol sclerotherapy provides an alternative therapy for thoracic duct cyst when evaluation establishes a high likelihood of clinical diagnosis.     

Varicocele sclerotherapy improves serum inhibin B levels and seminal parameters

The usefulness of treating varicocele in order to improve fertility is still a matter of debate. The aim of this study was to evaluate variations in seminal parameters and inhibin B concentrations in a group of males affected by varicocele and treated by percutaneous retrograde sclerotherapy in comparison with a group of patients who did not undergo varicocele treatment. Thirty-eight patients with left varicocele underwent spermatic vein phlebography and percutaneous retrograde sclerotherapy with hydroxy-polyaethoxy-dodecanol. Serum inhibin B, follicle-stimulating hormone (FSH), testosterone levels and seminal parameters (sperm concentration, motility and morphology) were performed before and 6 months after sclerotherapy. Forty patients with left varicocele who did not undergo sclerotherapy were studied as controls. A significant increase (p < 0.01) in serum inhibin B levels and a significant decrease (p < 0.05) in FSH levels were observed 6 months after treatment. Semen analysis showed a significant improvement in sperm concentration (p < 0.05) and progressive motility (p < 0.01) after treatment. In control group no significant variations in hormonal and seminal parameters were observed 6 months after the basal examination. Six months after the basal evaluation, inhibin B levels were significantly higher in treated subjects than in controls (p < 0.05) whereas FSH levels were significantly lower (p < 0.05). Sperm concentration and progressive motility were significantly increased (p < 0.05 and p < 0.001, respectively) in treated subjects in comparison with controls. In conclusion, varicocele sclerotherapy improves inhibin B levels and seminal parameters, confirming the positive effect of this treatment on spermatogenesis and Sertoli cell function.     

小剂量硬化剂加固对食管静脉曲张术后的影响

目的探讨在密集套扎疗法的基础上进行硬化加固治疗对于食管静脉曲张复发的防治作用。方法对食管静脉曲张套扎治疗后食管曲张静脉消失或基本消失的患者进行硬化剂加固治疗,从齿状线开始依次向上在残存小曲张静脉内与血管旁粘膜下层注射5％鱼肝油酸钠,每点注射1—2ml,每次共注射10—14ml。观察其对静脉曲张消失后复发的预防作用。结果加固治疗组49例共行硬化治疗132次,平均2．7次,最多治疗4次。随访12～25个月,平均18个月。结果40例（81．9％）患者未发现食管静脉曲张再出现,原有细小静脉明显减轻或消失,9例复发。加固组与单纯套扎组再出血率有明显差异（10．2％对23．4％,P〈0．05）;超声内镜检查显示加固治疗组食管曲张静脉发现率明显低于单纯套扎组（42．9％对76．6％,P〈0．01）;加固治疗组与单纯套扎组穿通支血管检出率无明显差异（42．8％对57．4％,P〉0．05）。治疗后未发现严重并发症。结论套扎治疗后小剂量硬化剂加固治疗可显著减少套扎术后残留的食管曲张静脉、防止闭塞消失的静脉再通、预防再出血,有助于提高结扎术的长期疗效,延缓静脉曲张的复发。     

Concordance of Inflammatory Bowel Disease among Danish Twins: Results of a Nationwide Study

Background: Previous studies have shown an increased risk of inflammatory bowel disease (IBD) among relatives of patients with Crohn disease and ulcerative colitis. In the present study the probandwise concordance rates for ulcerative colitis and Crohn disease among mono- and dizygotic twins were estimated. Further we aimed to evaluate whether smoking habits might influence the concordance, and to look for clinical characteristics of concordant versus discordant twin pairs. Methods: Among the 38,507 identified twins born in Denmark from 1953 to 1982, a questionnaire was sent to the 34,076 who previously had accepted to participate in studies. For twins reporting IBD, the diagnosis was verified by applying standard criteria to records requested from hospitals or practitioners. Results: Among the 29,421 (86.3%) twins answering the questionnaire, 103 pairs had at least one twin who suffered from IBD. In the Crohn disease group five of 10 monozygotic pairs, but none of 27 dizygotic pairs were concordant. In the ulcerative colitis group three of 21 monozygotic, and two of 44 dizygotic pairs were concordant. The probandwise concordance rate among monozygotic pairs was 58.3% for Crohn disease and 18.2% for ulcerative colitis; among the dizygotic pairs the rates were 0 and 4.5%, respectively. The frequency of smokers was higher among twins with Crohn disease and lower among twins with ulcerative colitis compared to the frequency in the twin register. Furthermore, smoking habits were found to be of significance for discordance for disease. Regarding the clinical characteristics no homogenous pattern was observed within the concordant pairs and the differences between concordant and discordant pairs were not significant. Conclusion: The observation of a significantly higher concordance rate among monozygotic than among dizygotic twin pairs strongly points to a genetic influence on occurrence of IBD, which seems to be more pronounced with regard to Crohn disease than to ulcerative colitis. Differences in smoking habits among the members of the discordant twin pairs may influence the discordance.     

Efficacy and safety of alcohol sclerotherapy involving single-session multiple injections to treat simple renal cysts: a multicenter, prospective, randomized, controlled trial

Background  Alcohol has been used for treating simple renal cysts since 1981. Since then, various observational studies have examined the technique, but they differ significantly in the details of the procedures and efficacy measures used. This has made it difficult to assess the safety and efficacy of this technique. We carried out a randomized controlled trial to evaluate the efficacy and safety of ultrasound-guided alcohol sclerotherapy involving single-session multiple injections to treat simple renal cysts.

Methods  A total of 144 patients with simple renal cysts were randomly allocated to either the treatment group (ultrasound-guided percutaneous drainage and alcohol sclerotherapy with single-session multiple injections) or control group (ultrasound-guided simple percutaneous drainage). Follow-up CT scans of ablated cysts were collected 3 and 6 months after the procedure. The outcome was considered successful if cyst volume between baseline and 6 months decreased by at least 87.5%.

Results  Intention-to-treat analysis revealed an average volume reduction of 94.2% in the treatment group and 50.8% in the control group (P <0.0001). The percentage of patients achieving successful outcomes was 88.9% (95% CI 77.0%-100.0%) in the treatment group and 22.2% (95% CI 6.54%-37.9%) in the control group (P <0.0001). The corresponding results in the per-protocol analysis were an average volume reduction of 96.4% in the treatment group and 50.8% in the control group (P <0.0001). The percentage of patients achieving a successful outcome was 94.3% (95% CI 85.6%-100.0%) in the treatment group and 22.2% (95% CI 6.54%-37.9%) in the control group (P <0.0001).

Conclusion  Alcohol sclerotherapy involving single-session multiple injections is safe and efficacious in the treatment of renal cysts. (ChiCTR-TRC-10001114, http://www.chictr.org)

     

新型泡沫硬化剂联合高位结扎治疗大隐静脉曲张临床效果观察

目的探讨聚桂醇泡沫硬化剂联合大隐静脉高位结扎治疗大隐静脉曲张的临床效果。方法2010年6月-2012年4月对68例无深静脉瓣膜功能不全的大隐静脉曲张患者,实施大隐静脉高位结扎联合导管引导下大隐静脉主干泡沫硬化剂注射治疗。结果68例均治疗成功,术中、术后无深静脉血栓、肺栓塞等严重并发症发生,5例出现小腿局限的轻度肿胀,6例出现小腿部大隐静脉走行轻微浅静脉炎,经应用抗生素、活血化瘀对症处理3d症状消失,8例出现色素沉着,逐渐消退。3个月后复诊血管超声示大隐静脉主干闭塞。平均随访6个月,患者患肢活动后酸胀、乏力消失,无复发病例。结论高位结扎联合泡沫硬化剂治疗大隐静脉曲张疗效肯定、安全、微创,操作简单,学习时间短,值得推广应用。     

介入硬化与传统手术方法治疗卵巢巧克力囊肿对卵巢功能的影响

目的：探讨介入硬化治疗和开腹卵巢巧克力囊肿剥除术后对卵巢功能的影响。方法：回顾性分析2008年3月～2012年3月我院超声引导下介入硬化治疗与经腹行巧克力囊肿剥除术108例临床资料。分为介入组66例和开腹组42例。所有患者分别于术前、术后3、6、12个月抽血测定促卵泡生成素（FSH）、促黄体生成素（LH）、雌二醇（E2）的水平,同时比较两组术中及术后随访的各项指标。结果：介入组术后3、6、12个月FSH、LH水平下降、E2水平升高,且与术前比较差异有统计学意义（P〈0．01）;开腹组术后3、6个月血清FSH、LH水平升高、E2水平下降,与术前比较差异有统计学意义（P〈0．01）;开腹组术后12个月血清FSH、LH水平与术前比较,差异无统计学意义;E2水平与术前及介入组比较,差异有统计学意义（P〈0．01）。两组患者在医疗费用、住院时间和心理精神影响、并发症及术后妊娠率方面差异有统计学意义（P〈0,01）;疗效与术后复发率两组间差异无统计学意义（P〉0．05）。结论：介入硬化治疗卵巢巧克力囊肿对卵巢功能较术前有明显改善,妊娠率提高;开腹巧克力囊肿剥除术后中、短期可影响卵巢功能,远期对卵巢功能改善不明显。介入硬化治疗与开腹治疗巧克力囊肿相比介入硬化具有创伤小,费用低,无需住院、术后恢复快,对病人精神心理影响小,可重复性好,妊娠率高等优点,是一种较为理想的微创治疗方法,值得推广。     

激光闭合联合点式剥脱术与激光闭合联合泡沫硬化剂注射术治疗下肢静脉曲张的临床疗效比较

目的比较激光闭合联合泡沫硬化剂注射术与激光闭合联合点式剥脱术治疗下肢大隐静脉曲张的疗效。方法选取大隐静脉曲张患者380例,采用激光闭合联合点式剥脱术和激光闭合联合泡沫硬化剂治疗术。比较手术时间、术后恢复时间、术后并发症、CEAP分级及复发等指标。结果激光闭合联合泡沫硬化剂注射术在手术时间、术后平均恢复时间等方面均较激光闭合联合剥脱术有所缩短,且差异有统计学意义（P〈0．05）。两种手术方式CEAP分级均较术前明显降低,再通率均较低,但组间无显著差异。结论与激光闭合联合剥脱术相比,激光闭合联合泡沫硬化剂注射可以缩短手术时间、术后恢复时间,减少术后并发症,并且能同样达到较好的治疗效果。