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Sample records for polidocanol endovenous microfoam

  1. Novel developments in foam sclerotherapy: Focus on Varithena® (polidocanol endovenous microfoam) in the management of varicose veins.

    Science.gov (United States)

    Star, Phoebe; Connor, David E; Parsi, Kurosh

    2018-04-01

    Scope Varithena® is a recently approved commercially available drug/delivery unit that produces foam using 1% polidocanol for the management of varicose veins. The purpose of this review is to examine the benefits of foam sclerotherapy, features of the ideal foam sclerosant and the strengths and limitations of Varithena® in the context of current foam sclerotherapy practices. Method Electronic databases including PubMed, Medline (Ovid) SP as well as trial registries and product information sheets were searched using the keywords, 'Varithena', 'Varisolve', 'polidocanol endovenous microfoam', 'polidocanol' and/or 'foam sclerotherapy/sclerosant'. Articles published prior to 20 September 2016 were identified. Results Foam sclerosants have effectively replaced liquid agents due to their physiochemical properties resulting in better clinical outcomes. Medical practitioners commonly prepare sclerosant foam at the bedside by agitating liquid sclerosant with a gas such as room air, using techniques as described by Tessari or the double syringe method. Such physician-compounded foams are highly operator dependent producing inconsistent foams of different gas/liquid compositions, bubble size, foam behaviour and varied safety profiles. Varithena® overcomes the variability and inconsistencies of physician-compounded foam. However, Varithena® has limited applications due to its fixed sclerosant type and concentration, cost and lack of worldwide availability. Clinical trials of Varithena® have demonstrated efficacy and safety outcomes equivalent or better than physician-compounded foam but only in comparison to placebo alone. Conclusion Varithena® is a promising step towards the creation of an ideal sclerosant foam. Further assessment in independent randomised controlled clinical trials is required to establish the advantages of Varithena® over and above the current best practice physician-compounded foam.

  2. High strain rate behaviour of polypropylene microfoams

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    Martínez A.B.

    2012-08-01

    Full Text Available Microcellular materials such as polypropylene foams are often used in protective applications and passive safety for packaging (electronic components, aeronautical structures, food, etc. or personal safety (helmets, knee-pads, etc.. In such applications the foams which are used are often designed to absorb the maximum energy and are generally subjected to severe loadings involving high strain rates. The manufacture process to obtain polymeric microcellular foams is based on the polymer saturation with a supercritical gas, at high temperature and pressure. This method presents several advantages over the conventional injection moulding techniques which make it industrially feasible. However, the effect of processing conditions such as blowing agent, concentration and microfoaming time and/or temperature on the microstructure of the resulting microcellular polymer (density, cell size and geometry is not yet set up. The compressive mechanical behaviour of several microcellular polypropylene foams has been investigated over a wide range of strain rates (0.001 to 3000 s−1 in order to show the effects of the processing parameters and strain rate on the mechanical properties. High strain rate tests were performed using a Split Hopkinson Pressure Bar apparatus (SHPB. Polypropylene and polyethylene-ethylene block copolymer foams of various densities were considered.

  3. High strain rate behaviour of polypropylene microfoams

    Science.gov (United States)

    Gómez-del Río, T.; Garrido, M. A.; Rodríguez, J.; Arencón, D.; Martínez, A. B.

    2012-08-01

    Microcellular materials such as polypropylene foams are often used in protective applications and passive safety for packaging (electronic components, aeronautical structures, food, etc.) or personal safety (helmets, knee-pads, etc.). In such applications the foams which are used are often designed to absorb the maximum energy and are generally subjected to severe loadings involving high strain rates. The manufacture process to obtain polymeric microcellular foams is based on the polymer saturation with a supercritical gas, at high temperature and pressure. This method presents several advantages over the conventional injection moulding techniques which make it industrially feasible. However, the effect of processing conditions such as blowing agent, concentration and microfoaming time and/or temperature on the microstructure of the resulting microcellular polymer (density, cell size and geometry) is not yet set up. The compressive mechanical behaviour of several microcellular polypropylene foams has been investigated over a wide range of strain rates (0.001 to 3000 s-1) in order to show the effects of the processing parameters and strain rate on the mechanical properties. High strain rate tests were performed using a Split Hopkinson Pressure Bar apparatus (SHPB). Polypropylene and polyethylene-ethylene block copolymer foams of various densities were considered.

  4. Embolia atrial de trombo flutuante da veia safena magna após escleroterapia com microespuma ecoguiada Atrial embolism of floating thrombus of the great saphenous vein after microfoam ultrasound-guided sclerotherapy

    Directory of Open Access Journals (Sweden)

    Rubens Pierry Ferreira Lopes

    2010-12-01

    Full Text Available A escleroterapia com microespuma vem sendo utilizada amplamente no tratamento da doença venosa varicosa. No entanto, a despeito da sua pouca invasividade e segurança, complicações potencialmente graves e letais já foram descritas, como o acidente vascular cerebral e parada cardiorrespiratória. Descrevemos um caso de embolia atrial tardia de trombo flutuante da junção safeno-femoral de veia safena magna varicosa, após escleroterapia com microespuma de polidocanol guiada por ultrassom, e o tratamento dessa complicação.Microfoam sclerotherapy has been widely used in the treatment of varicose vein disease. However, despite its low invasiveness and safety, potentially serious and lethal complications have been described, such as stroke and cardiorespiratory arrest. We describe a case of delayed atrial embolism of floating thrombus in the saphenofemoral junction of a great saphenous varicose vein after microfoam ultrasound-guided sclerotherapy, as well as the treatment of this complication.

  5. No beneficial effect of Polidocanol treatment in Achilles tendinopathy

    DEFF Research Database (Denmark)

    Ebbesen, B H; Mølgaard, C M; Olesen, J L

    2017-01-01

    PURPOSE: Polidocanol injections have been used to treat chronic Achilles tendinopathy in clinical settings, but the few studies published show inconsistent results. The aim of this study was to evaluate the mid-term effect of Polidocanol in patients with chronic Achilles tendinopathy. It was hypo......PURPOSE: Polidocanol injections have been used to treat chronic Achilles tendinopathy in clinical settings, but the few studies published show inconsistent results. The aim of this study was to evaluate the mid-term effect of Polidocanol in patients with chronic Achilles tendinopathy...... of Achilles tendinopathy for at least 3 months and with neovascularisation demonstrated by ultrasonography was included. A minimum of 3 months of eccentric exercise treatment was required before participating. The patients were allocated to a maximum of two injection of either Polidocanol or Lidocaine...... an improvement at 3- and 6-month follow-up, but no mid-term differences between the groups were seen. An equal number of patients in the two groups were satisfied with the treatment at follow-up. CONCLUSIONS: The results indicate that Polidocanol is a safe treatment, but the mid-term effects are the same...

  6. Suitability of Varicose Veins for Endovenous Treatments

    International Nuclear Information System (INIS)

    Goode, S. D.; Kuhan, G.; Altaf, N.; Simpson, R.; Beech, A.; Richards, T.; MacSweeney, S. T.; Braithwaite, B. D.

    2009-01-01

    The aim of the study was to assess the suitability of radiofrequency ablation (RFA), endovenous laser ablation (EVLA), and foam sclerotherapy (FS) for patients with symptomatic varicose veins (VVs). The study comprised 403 consecutive patients with symptomatic VVs. Data on 577 legs from 403 consecutive patients with symptomatic VVs were collected for the year 2006. Median patient age was 55 years (interquartile range 45-66), and 62% patients were women. A set of criteria based on duplex ultrasonography was used to select patients for each procedure. Great saphenous vein (GSV) reflux was present in 77% (446 of 577) of legs. Overall, 328 (73%) of the legs were suitable for at least one of the endovenous options. Of the 114 legs with recurrent GSV reflux disease, 83 (73%) were suitable to receive endovenous therapy. Patients with increasing age were less likely to be suitable for endovenous therapy (P = 0.03). Seventy-three percent of patients with VVs caused by GSV incompetence are suitable for endovenous therapy.

  7. Endovenous Laser Ablation and Concomitant Foam Sclerotherapy: Experience in 504 Patients

    International Nuclear Information System (INIS)

    Yilmaz, Saim; Ceken, Kagan; Alparslan, Ahmet; Durmaz, Sedat; Sindel, Timur

    2012-01-01

    Purpose: To investigate the value of endovenous laser ablation (ELA) and concomitant ultrasound-guided foam sclerotherapy (USGFS) in patients with chronic venous insufficiency. Methods: During a 6-year period, concomitant USGFS of the varicose veins were performed in 504 out of 610 patients who underwent ELA for truncal or perforating vein insufficiency. In these 504 patients (944 legs; bilateral in 440 patients), the incompetent veins were greater saphenous vein in 615 legs, small saphenous vein in 118 veins, perforating veins in 42 legs, and a combination of these in 169 legs. In all patients, after ELA of the incompetent veins, USGFS was performed for the remaining varicosities with 1–3% polidocanol foam. Patients were followed up clinically and with color Doppler ultrasound at 1, 6, and 12 months. Results: ELA was technically successful in all cases, although another venous puncture was necessary in 29 legs. Concomitant USGFS was also technically successful in all cases, but one to three additional sclerotherapy sessions were performed in 203 legs with persistent varicosities. During the follow-up, recanalization of the laser-ablated refluxing veins occurred in 16 legs (1.7%) and was treated with repeat ELA or USGFS. Major complications occurred in 1.4% of the treated legs and included skin necrosis and calf vein thrombosis. Conclusion: ELA and concomitant foam sclerotherapy is feasible and effective. The procedures are associated with a low complication rate and can be performed in both legs in the same session. Concomitant use of laser and foam may potentially decrease the recanalization rate of laser-ablated vessels.

  8. Optimal and safe treatment of spider leg veins measuring less than 1.5 mm on skin type IV patients, using repeated low-fluence Nd:YAG laser pulses after polidocanol injection.

    Science.gov (United States)

    Moreno-Moraga, Javier; Hernández, Esteban; Royo, Josefina; Alcolea, Justo; Isarría, M Jose; Pascu, Mihail Lucian; Smarandache, Adriana; Trelles, Mario

    2013-05-01

    Treatment of micro-veins of less than 1.5 mm with laser and with chemical sclerosis is technically challenging because of their difficulty to remedy. Laser treatment is even more difficult when dark phototypes are involved.Three groups of 30 patients each, skin type IV, and vessels measuring less than 1.5 mm in diameter, were enrolled for two treatment sessions 8 weeks apart: group A, polidocanol (POL) micro-foam injection; group B, Nd:YAG laser alone; and group C, laser after POL injection. Repeated 8-Hz low-fluence pulses, moving the hand piece over a 3-cm vein segment with an average of five laser passes maximum and with a total time irradiation of 1 s were used. Sixteen weeks after the second treatment, statistically, degree of clearance after examining photographs and patients satisfaction index, plotted on a visual analogue scale and comparing results of all three groups, results were significantly better for group C (psafe and satisfactory in 96 % of patients using low-fluence laser pulses with a total cumulative energy in the 3 cm venous segment, lower than that of conventional treatment. Very few and transient complications were observed. POL foam injection followed by laser pulses is safe and efficient for vein treatment in dark-skinned patients.

  9. Volumetric optoacoustic monitoring of endovenous laser treatments

    Science.gov (United States)

    Fehm, Thomas F.; Deán-Ben, Xosé L.; Schaur, Peter; Sroka, Ronald; Razansky, Daniel

    2016-03-01

    Chronic venous insufficiency (CVI) is one of the most common medical conditions with reported prevalence estimates as high as 30% in the adult population. Although conservative management with compression therapy may improve the symptoms associated with CVI, healing often demands invasive procedures. Besides established surgical methods like vein stripping or bypassing, endovenous laser therapy (ELT) emerged as a promising novel treatment option during the last 15 years offering multiple advantages such as less pain and faster recovery. Much of the treatment success hereby depends on monitoring of the treatment progression using clinical imaging modalities such as Doppler ultrasound. The latter however do not provide sufficient contrast, spatial resolution and three-dimensional imaging capacity which is necessary for accurate online lesion assessment during treatment. As a consequence, incidence of recanalization, lack of vessel occlusion and collateral damage remains highly variable among patients. In this study, we examined the capacity of volumetric optoacoustic tomography (VOT) for real-time monitoring of ELT using an ex-vivo ox foot model. ELT was performed on subcutaneous veins while optoacoustic signals were acquired and reconstructed in real-time and at a spatial resolution in the order of 200μm. VOT images showed spatio-temporal maps of the lesion progression, characteristics of the vessel wall, and position of the ablation fiber's tip during the pull back. It was also possible to correlate the images with the temperature elevation measured in the area adjacent to the ablation spot. We conclude that VOT is a promising tool for providing online feedback during endovenous laser therapy.

  10. Sclerotherapy with 6% polidocanol solution in patients with placenta accreta.

    Science.gov (United States)

    Malagón Reyes, Ricardo Mauricio; Castorena de Ávila, Rubén; Ángeles Vázquez, María de Jesús; Núñez Monteagudo, César Augusto; Mendieta Zerón, Hugo

    2016-10-01

    Placenta accreta is one of the main obstetrical complications worldwide. The aim of this study was to report the experience of managing placenta accreta with a 6% polidocanol solution sclerotherapy. We selected patients between 37 weeks of gestation and 38 weeks of gestation, diagnosed with placenta accreta, treated at the Maternal Perinatal Hospital "Monica Pretelini Sáenz", Toluca, Mexico, during the period from November 2013 to August 2014. The surgical technique has two steps: (1) fundic-arciform caesarean section followed by a 6% polidocanol sclerosing solution through a 6Fr neonatal feeding tube upon its reaching the placental bed; (2) total abdominal hysterectomy with internal hypogastric artery ligation. Data were collected from 11 patients with a mean age of 33.9 years (range, 26-42 years) and 2.8±0.6 days of hospitalization in the obstetrical intensive care unit. The majority of patients were classified as having pregnancies at an advanced age. All women were multigravidas. Bleeding volume exhibited a range between 2.5 L and 3 L without any case of neonatal death but one mother died because of coagulopathy. We conclude that the technique that we are reporting is feasible for implementation in obstetric hospitals, with technical and economic feasibility. Copyright © 2016. Published by Elsevier B.V.

  11. Improvement of stability of polidocanol foam for nonsurgical permanent contraception.

    Science.gov (United States)

    Guo, Jian Xin; Lucchesi, Lisa; Gregory, Kenton W

    2015-08-01

    Polidocanol foam (PF), used clinically as a venous sclerosant, has recently been studied as a safe and inexpensive means for permanent contraception. Delivering the sclerosant to the fallopian tubes as a foam rather than a liquid increases the surface areas and thus enhances the desired epithelial disrupting activity of the agent. However, the foam is inherently unstable and degrades with time. Therefore, increasing foam stability and thus duration of the agent exposure time could increase epithelial effect while allowing reduction in agent concentration and potential toxicity. We studied methods to improve foam properties that might improve safety and efficacy of PF for intrauterine application. Several types of microporous filters adapted to a syringe-based foaming device were used to study the effect of pore structures on the formation of PF. The foam drainage time and bubble size were characterized. The addition of benzalkonium chloride (BZK) to polidocanol was also investigated for its effects on foam characteristics. A syringe-based foaming device adapted with an inline filter produced smaller bubble PF with a longer foam drainage time. PF generated with a circular pore filter lasts longer than with a noncircular pore filter. The addition of 0.01% of BZK also improved the stability of PF. The stability of PF is affected by the pore characteristics of the filter used for foam generation and enhanced by the presence of a small amount of BZK. The improved foam, if shown to be efficacious in animal models of contraception, could lead to a safe, simple and inexpensive method alternative to surgical contraception. Copyright © 2015 Elsevier Inc. All rights reserved.

  12. Treatment of 63 Subjects With Digital Mucous Cysts With Percutaneous Sclerotherapy Using Polidocanol.

    Science.gov (United States)

    Esson, Gavin A; Holme, Stephen A

    2016-01-01

    Digital mucous cysts (digital myxoid cysts or DMCs) are benign cystic swellings typically affecting the digital distal interphalangeal joint or the proximal nail fold. Many treatment modalities exist; however, permanent scarring, wound infection, and recurrence are common. Polidocanol sclerotherapy has been reported as a potential treatment. To assess the efficacy and safety of percutaneous polidocanol sclerotherapy in the treatment of DMC. The authors performed polidocanol sclerotherapy in 63 patients (23 men and 40 women). For each patient, the DMC contents were extruded and 3% polidocanol (0.02-0.5 mL) was injected to gently refill the cyst to its previous size. Subjects were reviewed after 6 weeks and offered a second treatment if necessary, and reviewed again after 12 weeks. Changes in lesions and adverse reactions were noted. Of the 63 subjects treated, 43 (68.3%) experienced complete resolution of the cyst by 6 weeks, and 49 (77.8%) experienced complete resolution by 12 weeks. Side effects were minor and had resolved in all patients by 12-week review. Percutaneous polidocanol sclerotherapy is a simple, safe, and effective approach to treating DMC, and is suitable for office-based practice.

  13. Ins and outs of endovenous laser ablation: afterthoughts

    NARCIS (Netherlands)

    Neumann, H. A. Martino; van Gemert, Martin J. C.

    2014-01-01

    Physicists and medical doctors "speak" different languages. Endovenous laser ablation (EVLA) is a good example in which technology is essential to guide the doctor to the final result: optimal treatment. However, for the doctor, it is by far insufficient just to turn on the knobs of the laser. He

  14. Ins and outs of endovenous laser ablation: Afterthoughts

    NARCIS (Netherlands)

    H.A.M. Neumann (Martino); M.J.C. van Gemert (Martin)

    2014-01-01

    textabstractPhysicists and medical doctors "speak" different languages. Endovenous laser ablation (EVLA) is a good example in which technology is essential to guide the doctor to the final result: optimal treatment. However, for the doctor, it is by far insufficient just to turn on the knobs of the

  15. Familial disseminated cutaneous glomuvenous malformation: Treatment with polidocanol sclerotherapy

    Directory of Open Access Journals (Sweden)

    Aditi Jha

    2016-01-01

    Full Text Available Glomuvenous malformations (GVMs present as asymptomatic multiple pink-to-blue nodules or plaques. Disseminated lesions are rare, representing 10% of all the cases. Familial cases are caused by mutations in the glomulin gene. A young male presented with multiple bluish-to-dusky red-coloured nodules 10-15 in numbers over the trunk, limbs and buttocks since 12 years of age. They ranged in size from 1 to 3 cm, partially to non-compressible and tender on palpation. There was no history of any systemic complaint. His sister and mother had similar lesions but in a limited distribution. Biopsy showed multiple ectatic dilated vascular channels lined by multiple layers of glomus cells consistent with the diagnosis of GVM. The biopsy of the lesions from the mother and sister also showed similar features. Mutation analysis for glomulin gene could not be done because of the unavailability of the facility at our setting. He underwent sclerotherapy with 3% polidocanol every 2 weeks, and there was significant improvement in the lesions after six sessions of sclerotherapy. The patient is under follow-up and there is no recurrence of the lesions over treated sites after 6 months.

  16. Polidocanol injection for chemical delay and its effect on the survival of rat dorsal skin flaps.

    Science.gov (United States)

    Menevşe, Gülsüm Tetik; TeomanTellioglu, Ali; Altuntas, Nurgül; Cömert, Ayhan; Tekdemir, Ibrahim

    2014-06-01

    Surgical delay is an invasive method requiring a two-stage surgical procedure. Hence, methods that may serve as an alternative to surgical delay have become the focus of interest of research studies. From a conceptual view, any technique that interrupts the blood flow along the edges of a proposed flap will render the flap ischemic and induce a delay phenomenon. Polidocanol (Aethoxysklerol(®)-Kreussler) was initially used as a local anesthetic. Nowadays, it has been used as a sclerosing agent to treat telangiectasias and varicose veins. The aim of this experimental study was to investigate the effects of polidocanol injected around the periphery of a random flap as a sclerosing agent on flap delay and survival in a random flap model. A preliminary histopathologic study was performed on two rats to evaluate the sclerosing effect and distribution of polidocanol injection. After the preliminary study, the main study was carried out with three groups: group 1: dorsal flap (n = 10); group 2: dorsal flap + surgical delay (n = 10), group 3: dorsal flap + chemical delay (n = 10). Tissue samples obtained from the flap and injection area revealed destruction of intradermal vessels. The area affected with sclerosis was limited to 0.1 cm beyond the injection site. Mean viable flap areas were 52.1 ± 4.38% (44.0-58.2) in group 1, 64.8 ± 8.92% (57.2-89.2) in group 2, and 71.8 ± 5.18% (64.0-84.0) in group 3. A statistically highly significant difference was found between the surgical delay and chemical delay groups versus the group without delay (p injection around the dorsal flap in the rat is a safe and easy method for nonsurgical delay. The results have shown a flap survival benefit that is superior to controls and equivalent to surgical delay. The clinical application of polidocanol, already in clinical practice for occlusal of telangiectasias, for surgical delay appears feasible. Copyright © 2014 British Association of Plastic, Reconstructive and Aesthetic Surgeons

  17. Endovenous Laser Ablation as a Treatment for Postsurgical Recurrent Saphenous Insufficiency

    International Nuclear Information System (INIS)

    Anchala, Praveen R.; Wickman, Christopher; Chen, Richard; Faundeen, Tonya; Pearce, William; Narducy, Lisa; Resnick, Scott A.

    2010-01-01

    The purpose of this study was to investigate the safety and efficacy of endovenous laser ablation as a treatment for recurrent symptomatic saphenous insufficiency occurring after saphenous vein ligation and stripping. A single-center retrospective review of patients who received endovenous laser ablation as a treatment for recurrent symptomatic saphenous insufficiency after ligation and stripping between November 2003 and October 2006 was performed. Fifty-six insufficient saphenous systems were identified in 38 patients. Follow-up consisted of a clinical examination in all patients as well as selective lower-extremity duplex ultrasound as clinically indicated. All 38 patients demonstrated complete closure of the insufficient saphenous vein by clinical examination and/or duplex ultrasound evaluation. Preoperative symptoms resolved after treatment in all 38 patients. No major complications were identified. Endovenous laser ablation of recurrent symptomatic saphenous venous insufficiency is a safe and effective treatment in patients who develop recurrent symptoms after saphenous vein ligation and stripping.

  18. Factors affecting optimal linear endovenous energy density for endovenous laser ablation in incompetent lower limb truncal veins - A review of the clinical evidence.

    Science.gov (United States)

    Cowpland, Christine A; Cleese, Amy L; Whiteley, Mark S

    2017-06-01

    Objectives The objective is to identify the factors that affect the optimal linear endovenous energy density (LEED) to ablate incompetent truncal veins. Methods We performed a literature review of clinical studies, which reported truncal vein ablation rates and LEED. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flow diagram documents the search strategy. We analysed 13 clinical papers which fulfilled the criteria to be able to compare results of great saphenous vein occlusion as defined by venous duplex ultrasound, with the LEED used in the treatment. Results Evidence suggests that the optimal LEED for endovenous laser ablation of the great saphenous vein is >80 J/cm and water might have a lower optimal LEED. A LEED 80 J/cm and <95 J/cm based on current evidence for shorter wavelength lasers. There is evidence that longer wavelength lasers may be effective at LEEDs of <85 J/cm.

  19. Fluoroscopy-guided endovenous sclerotherapy using a microcatheter prior to endovenous laser ablation: Comparison between liquid and foam sclerotherapy for varicose tributaries

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sang Woo; Yun, Ik Jin; Hwang, Jae Joon; Lee, Song Am; Kim, Jun Seok; Chee, Hyun Keun; Chang, Il Soo [Konkuk University Hospital, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2014-08-15

    To compare the efficacy and adverse effects of endovenous foam sclerotherapy (EFS) and liquid sclerotherapy (ELS) using a microcatheter for the treatment of varicose tributaries. From December 2007 to January 2009, patients with venous reflux in the saphenous vein were enrolled. The foam or liquid sclerosant was injected through a microcatheter just before endovenous laser ablation (EVLA). Patients were evaluated for the technical success, clinical success, and procedure-related complications during the procedure and follow-up visits. A total of 94 limbs were included: 48 limbs (great saphenous vein [GSV], 35; small saphenous vein [SSV], 13) were managed using EFS and EVLA (foam group; FG), and 46 limbs (GSV, 37; SSV, 9) were treated by ELS and EVLA (liquid group; LG). Varicose tributaries demonstrated complete sclerosis in 92.7% with FG and in 71.8% with LG (p = 0.014). Bruising (78.7% in FG vs. 73.2% in LG, p > 0.05), pain or tenderness (75.6% in FG vs. 51.2% in LG, p = 0.0237) were noted. Hyperpigmentation (51.2% in FG vs. 46.2% in LG, p > 0.05) was found. Endovenous foam sclerotherapy using a microcatheter is more effective than ELS for eliminating remnant varicose tributaries prior to EVLA. However, EFS is more commonly associated with local complications such as pain or tenderness than ELS. Furthermore, both techniques seem to prolong the duration of hyperpigmentation along with higher costs.

  20. Compression Stockings after Endovenous Laser Ablation of the Great Saphenous Vein : A Prospective Randomized Controlled Trial

    NARCIS (Netherlands)

    Bakker, N. A.; Schieven, L. W.; Bruins, R. M. G.; van den Berg, M.; Hissink, R. J.

    2013-01-01

    Objectives: To determine if the duration of wearing compression stockings after endovenous laser ablation (EVLA) of the great saphenous vein (GSV) has influence on pain and quality of life. Methods: This was a prospective randomized controlled trial. Between December 2006 and February 2008, 109

  1. Endovenous laser ablation (EVLA): a review of mechanisms, modeling outcomes, and issues for debate

    NARCIS (Netherlands)

    W.S.J. Malskat (Wendy S.); A.A. Poluektova (Anna); C.W.M. van der Geld (Cees); H.A.M. Neumann (Martino); R.A. Weiss (Robert); C.M.A. Bruijninckx; M.J.C. van Gemert (Martin)

    2013-01-01

    textabstractEndovenous laser ablation (EVLA) is a commonly used and very effective minimally invasive therapy to manage leg varicosities. Yet, and despite a clinical history of 16 years, no international consensus on a best treatment protocol has been reached so far. Evidence presented in this paper

  2. US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation

    International Nuclear Information System (INIS)

    Yilmaz, Saim; Ceken, Kagan; Alimoglu, Emel; Sindel, Timur

    2013-01-01

    Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocaine solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1–10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.

  3. Reduced recanalization rates of the great saphenous vein after endovenous laser treatment with increased energy dosing: definition of a threshold for the endovenous fluence equivalent.

    Science.gov (United States)

    Proebstle, Thomas Michael; Moehler, Thomas; Herdemann, Sylvia

    2006-10-01

    Recent reports indicated a correlation between the amount of energy released during endovenous laser treatment (ELT) of the great saphenous vein (GSV) and the success and durability of the procedure. Our objective was to analyze the influence of increased energy dosing on immediate occlusion and recanalization rates after ELT of the GSV. GSVs were treated with either 15 or 30 W of laser power by using a 940-nm diode laser with continuous fiber pullback and tumescent local anesthesia. Patients were followed up prospectively with duplex ultrasonography at day 1 and at 1, 3, 6, and 12 months. A total of 114 GSVs were treated with 15 W, and 149 GSVs were treated with 30 W. The average endovenous fluence equivalents were 12.8 +/- 5.1 J/cm2 and 35.1 +/- 15.6 J/cm2, respectively. GSV occlusion rates according to the method of Kaplan and Meier for the 15- and 30-W groups were 95.6% and 100%, respectively, at day 1, 90.4% and 100% at 3 months, and 82.7% and 97.0% at 12 months after ELT (log-rank; P = .001). An endovenous fluence equivalent exceeding 20 J/cm2 was associated with durable GSV occlusion after 12 months' follow-up, thus suggesting a schedule for dosing of laser energy with respect to the vein diameter. Higher dosing of laser energy shows a 100% immediate success rate and a significantly reduced recanalization rate during 12 months' follow-up.

  4. Endovenous and perivenous 808-nm laser treatment of lower limb collateral, reticular and telangiectasiac veins.

    Science.gov (United States)

    Bugiantella, Walter; Bovani, Bruno; Zini, Francesco

    2017-02-01

    Visible leg veins are not only a mere aesthetic problem, but may also be manifestation of altered microcirculation and superficial venous incompetency. Sclerotherapy is the first-line treatment for leg veins veins: the greater, the harder photothermolysis is, so that higher powers may lead to aesthetic complications. We report our experience in the treatment of small collateral (reticular and telangiectasiac veins with endovenous and perivenous 808-nm laser. Overall, 325 treatments were performed on 113 patients. The endovenous and perivenous treatment proved to be a safe, quick, well-tolerated and effective procedure. It ensured an optimal closure of the target veins right from the first treatment in most patients. Sometimes, a second treatment of the same vein was needed. The endovenous and perivenous 808-nm laser photothermal sclerosis ensures a quick coagulation-fibrosis of the veins of the lower limbs, thus allowing rapid healing and good aesthetic results (stable in 95% of patients after an average follow-up of 18 months). It may be an effective alternative to sclerotherapy.

  5. Prevalence of venous obstruction in permanent endovenous pacing in newborns and infants: follow-up study.

    Science.gov (United States)

    Stojanov, Petar; Vranes, Mile; Velimirovic, Dusan; Zivkovic, Mirjana; Kocica, Mladen J; Davidovic, Lazar; Neskovic, Voislava; Stajevic, Mila

    2005-05-01

    We examined the prevalence of venous obstruction in 12 newborns and infants with permanent endovenous ventricular pacing, clinically, and by ultrasonographic assessment of hemodynamics (spontaneity, phasicity, velocity, and turbulence of flow) and morphologic parameters (compressibility, wall thickness, and thrombus presence). All implantations of single ventricular unipolar endovenous steroid leads, were performed via cephalic vein, and pacemakers were placed in subcutaneous pocket in right prepectoral region. After the vascular surgeon has carefully examined all children for presence of venous collaterals in the chest wall, morphologic and hemodynamic parameters of the subclavian, axillary, and internal jugular veins, were assessed by linear-array color Doppler. Lead capacity (LC) was calculated for each patient. Mean age of patients at implant was 6.2 months (range 1 day-12 months), mean weight 6.5 kg (range 2.25-10 kg), and mean height 60.9 cm (range 48-78 cm). Mean LC was 1.99 (range 1.14-3.07). Total follow-up was 1023 and mean follow-up 85.2 pacing months (range 3-156). No clinical signs of venous obstruction were observed. Mild stenosis (20%) of subclavian vein was found by color Doppler in 2/12 patients. Both had adequate lead diameter for body surface. Permanent endovenous pacing is a feasible procedure, even in children of body weight less than 10 kg, with quite acceptable impact on venous system patency.

  6. Moving heat source in a confined channel: Heat transfer and boiling in endovenous laser ablation of varicose veins : Heat transfer and boiling in endovenous laser ablation of varicose veins

    NARCIS (Netherlands)

    de Boer, A.; Oliveira, J.L.G.; van der Geld, C.W.M.; Malskat, Wendy S.J.; van den Bos, Renate; Nijsten, Tamar; van Gemert, M.J.C.

    2017-01-01

    Motion of a moving laser light heat source in a confined volume has important applications such as in endovenous laser ablation (EVLA) of varicose veins. This light heats up the fluid and the wall volume by absorption and heat conduction. The present study compares the flow and temperature fields in

  7. Endovenous mechanochemical ablation of great saphenous vein incompetence using the ClariVein device: a safety study

    NARCIS (Netherlands)

    Eekeren, R. van; Boersma, D.; Elias, S.; Holewijn, S.; Werson, D.A.; Vries, J.P. de; Reijnen, M.M.P.J.

    2011-01-01

    PURPOSE: To evaluate the feasibility and safety of endovenous mechanochemical ablation (MOCA) for the treatment of great saphenous vein (GSV) incompetence. METHODS: The newly developed ClariVein device uses a technique that combines mechanical endothelial damage using a rotating wire with the

  8. Implementation of Endovenous Laser Ablation for Varicose Veins in a Large Community Hospital : The First 400 Procedures

    NARCIS (Netherlands)

    van den Bremer, J.; Joosten, P. Ph. A. Hedeman; Hamming, J. F.; Moll, F. L.

    Endovenous Laser ablation (ELA) has become a standard treatment of the incompetent great saphenous vein (GSV). Our prospective audit examines the implementation of this new method in a large community hospital with special attention to obstacles, technical results, pain scores, failures and our

  9. Moving heat source in a confined channel: Heat transfer and boiling in endovenous laser ablation of varicose veins

    NARCIS (Netherlands)

    de Boer, Amit; Oliveira, Jorge L. G.; van der Geld, Cees W. M.; Malskat, Wendy S. J.; van den Bos, Renate; Nijsten, Tamar; van Gemert, Martin J. C.

    2017-01-01

    Motion of a moving laser light heat source in a confined volume has important applications such as in endovenous laser ablation (EVLA) of varicose veins. This light heats up the fluid and the wall volume by absorption and heat conduction. The present study compares the flow and temperature fields in

  10. Endovascular optical coherence tomography ex vivo: venous wall anatomy and tissue alterations after endovenous therapy

    International Nuclear Information System (INIS)

    Meissner, Oliver A.; Schmedt, Claus-Georg; Steckmeier, Bernd M.; Hunger, Kathrin; Reiser, Maximilian; Mueller-Lisse, Ullrich; Hetterich, Holger; Rieber, Johannes; Sroka, Ronald; Babaryka, Gregor; Siebert, Uwe

    2007-01-01

    Endovascular optical coherence tomography (OCT) is a new imaging modality providing histology-like information of the venous wall. Radiofrequency ablation (RFA) and laser therapy (ELT) are accepted alternatives to surgery. This study evaluated OCT for qualitative assessment of venous wall anatomy and tissue alterations after RFA and ELT in bovine venous specimens. One hundred and thirty-four venous segments were obtained from ten ex-vivo bovine hind limbs. OCT signal characteristics for different wall layers were assessed in 180/216 (83%) quadrants from 54 normal venous cross-sections. Kappa statistics (κ) were used to calculate intra- and inter-observer agreement. Qualitative changes after RFA (VNUS-Closure) and ELT (diode laser 980 nm, energy densities 15 Joules (J)/cm, 25 J/cm, 35 J/cm) were described in 80 venous cross-sections. Normal veins were characterized by a three-layered appearance. After RFA, loss of three-layered appearance and wall thickening at OCT corresponded with circular destruction of tissue structures at histology. Wall defects after ELT ranged from non-transmural punctiform damage to complete perforation, depending on the energy density applied. Intra- and inter-observer agreement for reading OCT images was very high (0.90 and 0.88, respectively). OCT allows for reproducible evaluation of normal venous wall and alterations after endovenous therapy. OCT could prove to be valuable for optimizing endovenous therapy in vivo. (orig.)

  11. Short endovenous laser ablation of the great saphenous vein in a modified CHIVA strategy

    Directory of Open Access Journals (Sweden)

    Sergio Gianesini

    2013-09-01

    Full Text Available Mini-invasiveness, ease of use and execution speed represent the reasons for endovenous laser ablation success. Nevertheless, the strategic choice remains the ablation of the saphenous trunk. Hemodynamic correction (CHIVA represents an option, based on a saphenous-sparing therapeutic strategy. We tested the feasibility of a modified CHIVA strategy by means of endovenous lasers (EL shrinkage of segmental great saphenous vein (GSV tracts, in networks characterized by sapheno-femoral incompetence and re-entry perforators focused on the GSV. We report the follow up of the first 2 chronic venous disease [C1,2,3sEpAsPr1,2,3, venous clinical severity score (VCSS 8 and 9 respectively] treated cases. At 1-year follow up both patients were C1,2,3sEpAsPr1,2,3 and the VCSS were 1 and 2 respectively. The non-treated GSV tracts maintained their patency. ELs were herein used within a saphenous-sparing therapeutic plan, thanks to an accurate pre-operative hemodynamic assessment, which allowed the shrinkage of only the first saphenous trunk tract only. Proper technical and hemodynamic considerations are discussed.

  12. Treatment of male varicoceles by transcatheter polidocanol foam sclerotherapy: evaluation of clinical success, complications, and patients' satisfaction with regard to alternative techniques

    Energy Technology Data Exchange (ETDEWEB)

    Ali, Alma; Wirth, Stefan; Treitl, Karla Maria; Treitl, Marcus [Hospital of the Ludwig-Maximilians University of Munich, Institute for Clinical Radiology, Munich (Germany)

    2015-10-15

    We report our experience with polidocanol foam sclerotherapy with no additional coils, evaluating clinical success, patients' satisfaction, and complications. We conducted a retrospective study of 141 patients with 146 varicoceles (mean age: 29.3 years; range: 13 - 60 years) who underwent foam sclerotherapy with polidocanol 2 % (range: 2 - 12 ml) in an outpatient setting between January 2007 and December 2013. For the follow-up, telephone interviews with the patients were conducted (mean follow-up time: 46.4 months, standard deviation: 20.17 months). The technical success rate was 91.8 %. There was a 55.8 % response rate to the telephone interviews. Follow-up revealed a clinical success rate of 83.9 % and a persistence or relapse rate of 16.1 %. Of the patients, 81.9 % were absolutely satisfied with the outcome. In 94.9 % of cases, pain or discomfort resolution was reported, and in 97 % of cases, aesthetic issues were no longer a problem. Of partners, 63.2 % achieved pregnancy, and in 50 % of patients with preprocedural testicular atrophy, catch-up growth was observed. One patient with pampiniform plexus phlebitis received inpatient treatment with no long-term damage recorded. Polidocanol foam varicocele sclerotherapy is a safe and effective procedure, with a high rate of patients' satisfaction, clinical and technical success, and considerable catch-up growth and pregnancy achievement. (orig.)

  13. Treatment of male varicoceles by transcatheter polidocanol foam sclerotherapy: evaluation of clinical success, complications, and patients' satisfaction with regard to alternative techniques

    International Nuclear Information System (INIS)

    Ali, Alma; Wirth, Stefan; Treitl, Karla Maria; Treitl, Marcus

    2015-01-01

    We report our experience with polidocanol foam sclerotherapy with no additional coils, evaluating clinical success, patients' satisfaction, and complications. We conducted a retrospective study of 141 patients with 146 varicoceles (mean age: 29.3 years; range: 13 - 60 years) who underwent foam sclerotherapy with polidocanol 2 % (range: 2 - 12 ml) in an outpatient setting between January 2007 and December 2013. For the follow-up, telephone interviews with the patients were conducted (mean follow-up time: 46.4 months, standard deviation: 20.17 months). The technical success rate was 91.8 %. There was a 55.8 % response rate to the telephone interviews. Follow-up revealed a clinical success rate of 83.9 % and a persistence or relapse rate of 16.1 %. Of the patients, 81.9 % were absolutely satisfied with the outcome. In 94.9 % of cases, pain or discomfort resolution was reported, and in 97 % of cases, aesthetic issues were no longer a problem. Of partners, 63.2 % achieved pregnancy, and in 50 % of patients with preprocedural testicular atrophy, catch-up growth was observed. One patient with pampiniform plexus phlebitis received inpatient treatment with no long-term damage recorded. Polidocanol foam varicocele sclerotherapy is a safe and effective procedure, with a high rate of patients' satisfaction, clinical and technical success, and considerable catch-up growth and pregnancy achievement. (orig.)

  14. Deep venous thrombosis after saphenous endovenous radiofrequency ablation: is it predictable?

    Science.gov (United States)

    Jacobs, Chad E; Pinzon, Maria Mora; Orozco, Jennifer; Hunt, Peter J B; Rivera, Aksim; McCarthy, Walter J

    2014-04-01

    Endovenous radiofrequency ablation (RFA) is a safe and effective treatment for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) is a known complication of this procedure. The purpose of this study is to describe the frequency of DVT after RFA and the associated predisposing factors. A retrospective analysis was performed using prospectively collected data from December 2008 to December 2011; a total of 277 consecutive office-based RFA procedures were performed at a single institution using the VNUS ClosureFast catheter (VNUS Medical Technologies, San Jose, CA). Duplex ultrasonography scans were completed 2 weeks postprocedure in all patients. Risk factors assessed for the development of DVT included: great versus small saphenous vein (SSV) treated, right versus left side treated, number of radiofrequency cycles used, hypercoagulable state, history of DVT, tobacco use, medications (i.e., oral contraceptives, aspirin, warfarin, and clopidogrel), and vein diameter at the junction of the superficial and deep systems. Seventy-two percent of the patients were women, 56% were treated on the right side, and 86% were performed on the great saphenous vein (GSV). The mean age was 54 ± 14 years (range: 23-88 years). Three percent of patients had a preprocedure diagnosis of hypercoagulable state, and 8% had a history of previous DVT. On postprocedural ultrasound, thrombus protrusion into the deep system without occlusion (endovenous heat-induced thrombosis) was present in 11 patients (4%). DVT, as defined by thrombus protrusion with complete occlusion of the femoral or popliteal vein, was identified in 2 patients (0.7%). Previous DVT was the only factor associated with postprocedural DVT (P = 0.018). Although not statistically significant, there was a trend toward a higher risk of DVT in SSV-treated patients. Factors associated with endovascular heat-induced thrombosis alone were male sex (P = 0.02), SSV treatment (P = 0.05), aspirin use (P = 0.008), and

  15. Endovenous radiofrequency ablation using stent-type electrode for varicose veins: an experimental study in goats

    Energy Technology Data Exchange (ETDEWEB)

    Won, Je Hwan; Han, Jae Ho; Oh, Chang Kwon [Ajou University Hospital, Suwon (Korea, Republic of); Kwak, Young Lan [Yonsei University College of Medicine, Seoul (Korea, Republic of); Park, Sung Il [Ulsan University GangNeung Asan Hospital, Gangeung (Korea, Republic of)

    2004-10-15

    The purpose of this study was to investigate the feasibility and the optimal conditions of radiofrequency (RF) ablation by using the stent-type electrode upon the saphenous vein of goats for the endovenous treatment of varicose veins. A self-expandable nitinol stent electrode (6 mm diameter, 2 cm length, cell size; 1.3 x 2 mm) was designed to expose the distal 1 cm segment to allow for contact with the venous wall. The proximal part of the electrode was connected to the RF generator by insulated copper wires located within the stent electrode introducer. Initially, to optimize the power setting, ablation of 6 saphenous veins in 3 goats was performed with power settings of 10, 20 and 30 W. Pull back rate of the electrode was 2 and 4 cm/min for each power level, respectively. The goats were sacrificed 4-6 weeks later and histologic examinations of the saphenous veins were done. For the second part of the experiment, RF ablation of 4 saphenous veins from 2 goats was done by applying the optimal power, based upon the first examination; these procedure was performed with variable pull back rates. Again, the goats were sacrificed 1-6 weeks later and histologic examinations were done. Endovenous ablation of the goat saphenous veins at 20 W caused complete obliteration without complication. There was incomplete occlusion at 10 W, and there were vessel perforation, extravasation, and adjacent tissue injury at 30 W. In second part of the study, the complete circumferential obliteration of the vein was demonstrated at a pull back rate of 1 cm/min and 3 cm/min with the power of 20 W. The stent-type electrode may be useful in endovenous RF ablation for treatment of varicose veins. For stents with a diameter of 6 mm, the optional combination of 20 W of power with a pull back rate of 1-3 cm/min produced the most favorable results. Further study and clinical investigations are warranted.

  16. Endovenous radiofrequency ablation using stent-type electrode for varicose veins: an experimental study in goats

    International Nuclear Information System (INIS)

    Won, Je Hwan; Han, Jae Ho; Oh, Chang Kwon; Kwak, Young Lan; Park, Sung Il

    2004-01-01

    The purpose of this study was to investigate the feasibility and the optimal conditions of radiofrequency (RF) ablation by using the stent-type electrode upon the saphenous vein of goats for the endovenous treatment of varicose veins. A self-expandable nitinol stent electrode (6 mm diameter, 2 cm length, cell size; 1.3 x 2 mm) was designed to expose the distal 1 cm segment to allow for contact with the venous wall. The proximal part of the electrode was connected to the RF generator by insulated copper wires located within the stent electrode introducer. Initially, to optimize the power setting, ablation of 6 saphenous veins in 3 goats was performed with power settings of 10, 20 and 30 W. Pull back rate of the electrode was 2 and 4 cm/min for each power level, respectively. The goats were sacrificed 4-6 weeks later and histologic examinations of the saphenous veins were done. For the second part of the experiment, RF ablation of 4 saphenous veins from 2 goats was done by applying the optimal power, based upon the first examination; these procedure was performed with variable pull back rates. Again, the goats were sacrificed 1-6 weeks later and histologic examinations were done. Endovenous ablation of the goat saphenous veins at 20 W caused complete obliteration without complication. There was incomplete occlusion at 10 W, and there were vessel perforation, extravasation, and adjacent tissue injury at 30 W. In second part of the study, the complete circumferential obliteration of the vein was demonstrated at a pull back rate of 1 cm/min and 3 cm/min with the power of 20 W. The stent-type electrode may be useful in endovenous RF ablation for treatment of varicose veins. For stents with a diameter of 6 mm, the optional combination of 20 W of power with a pull back rate of 1-3 cm/min produced the most favorable results. Further study and clinical investigations are warranted

  17. Retrograde endovenous laser ablation through saphenopopliteal junctional area for incompetent small saphenous vein; Comparison with antegrade approach

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jun Seok; Park, Sang Woo; Yun, Ik Jin; Hwang, Jae Joon; Lee, Song Am; Chee, Hyun Keun; Hwang, Jin Ho [Konkuk University Hospital, Konkuk University School of Medicine, Seoul (Korea, Republic of)

    2016-06-15

    To evaluate the safety and efficacy of retrograde endovenous laser ablation (EVLA) and to compare it with the conventional antegrade EVLA for incompetent small saphenous vein (SSV). Small saphenous vein was cannulated via two approaches under ultrasound-guidance. One method involved puncturing the SSV cranially at mid-calf (the antegrade group). If the antegrade puncture into the SSV failed twice, the other approach for puncture was selected that involved puncturing the SSV toward the ankle (the retrograde group). Patients were evaluated in terms of technical and clinical success, closure rates of the SSV, and complications including pain, bruising, or paresthesia at all follow-up visits. The 1470 nm endovenous laser was used in all limbs. Technical success was seen in all limbs in both groups (100%). Closure rate in both groups showed about 95%, without significant difference (p = 0.685). Similar linear endovenous energy density was supplied during the EVLA in both groups (p = 0.876). Three frequent complications including bruising, pain, and paresthesia did not show statistical significance between groups (p = 0.465, 0.823, 1.000, respectively). Major complications were absent in both groups. The EVLA for the incompetent SSV using a retrograde approach is safe and effective and should be considered the alternative method if the antegrade access fails due to vasospasm or small SSV diameter.

  18. Retrograde endovenous laser ablation through saphenopopliteal junctional area for incompetent small saphenous vein; Comparison with antegrade approach

    International Nuclear Information System (INIS)

    Kim, Jun Seok; Park, Sang Woo; Yun, Ik Jin; Hwang, Jae Joon; Lee, Song Am; Chee, Hyun Keun; Hwang, Jin Ho

    2016-01-01

    To evaluate the safety and efficacy of retrograde endovenous laser ablation (EVLA) and to compare it with the conventional antegrade EVLA for incompetent small saphenous vein (SSV). Small saphenous vein was cannulated via two approaches under ultrasound-guidance. One method involved puncturing the SSV cranially at mid-calf (the antegrade group). If the antegrade puncture into the SSV failed twice, the other approach for puncture was selected that involved puncturing the SSV toward the ankle (the retrograde group). Patients were evaluated in terms of technical and clinical success, closure rates of the SSV, and complications including pain, bruising, or paresthesia at all follow-up visits. The 1470 nm endovenous laser was used in all limbs. Technical success was seen in all limbs in both groups (100%). Closure rate in both groups showed about 95%, without significant difference (p = 0.685). Similar linear endovenous energy density was supplied during the EVLA in both groups (p = 0.876). Three frequent complications including bruising, pain, and paresthesia did not show statistical significance between groups (p = 0.465, 0.823, 1.000, respectively). Major complications were absent in both groups. The EVLA for the incompetent SSV using a retrograde approach is safe and effective and should be considered the alternative method if the antegrade access fails due to vasospasm or small SSV diameter

  19. Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

    International Nuclear Information System (INIS)

    Sharifi, Mohsen; Bay, Curt; Skrocki, Laura; Lawson, David; Mazdeh, Shahnaz

    2012-01-01

    Objectives: The purpose of this study was to evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT).BackgroundPEVI has emerged as a powerful tool in the management of acute proximal DVT. Instrumentation of extensive fresh thrombus is potentially associated with iatrogenic pulmonary embolism (PE). The true frequency of this complication has not been studied in a randomized fashion. We evaluated IVC filter implantation during PEVI for DVT. Methods: A total of 141 patients with symptomatic proximal DVT undergoing PEVI for symptomatic DVT were randomized to receive an IVC filter (70 patients) or no filter (71 patients; control group). The anticoagulation and PEVI regimen were similar between the two groups. Patients with development of symptoms suggestive of PE underwent objective testing for PE. Results: PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P = 0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of ≥7 mm with preserved architecture. Conclusions: IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI.

  20. Role of IVC Filters in Endovenous Therapy for Deep Venous Thrombosis: The FILTER-PEVI (Filter Implantation to Lower Thromboembolic Risk in Percutaneous Endovenous Intervention) Trial

    Energy Technology Data Exchange (ETDEWEB)

    Sharifi, Mohsen, E-mail: seyedmohsensharifi@yahoo.com [Arizona Cardiovascular Consultants (United States); Bay, Curt [A.T. Still University, Arizona School of Health Sciences (United States); Skrocki, Laura; Lawson, David; Mazdeh, Shahnaz [Arizona Cardiovascular Consultants (United States)

    2012-12-15

    Objectives: The purpose of this study was to evaluate the necessity of and recommend indications for inferior vena cava (IVC) filter implantation during percutaneous endovenous intervention (PEVI) for deep venous thrombosis (DVT).BackgroundPEVI has emerged as a powerful tool in the management of acute proximal DVT. Instrumentation of extensive fresh thrombus is potentially associated with iatrogenic pulmonary embolism (PE). The true frequency of this complication has not been studied in a randomized fashion. We evaluated IVC filter implantation during PEVI for DVT. Methods: A total of 141 patients with symptomatic proximal DVT undergoing PEVI for symptomatic DVT were randomized to receive an IVC filter (70 patients) or no filter (71 patients; control group). The anticoagulation and PEVI regimen were similar between the two groups. Patients with development of symptoms suggestive of PE underwent objective testing for PE. Results: PE developed in 1 of the 14 symptomatic patients in the filter group and 8 of the 22 patients in the control group (P = 0.048). There was no mortality in any group. Three patients (4.2%) in the control group had transient hemodynamic instability necessitating resuscitory efforts. Predictors of iatrogenic PE were found to be PE at admission; involvement of two or more adjacent venous segments with acute thrombus; inflammatory form of DVT (severe erythema, edema, pain, and induration); and vein diameter of {>=}7 mm with preserved architecture. Conclusions: IVC filter implantation during PEVI reduces the risk of iatrogenic PE by eightfold without a mortality benefit. A selective approach may be exercised in filter implantation during PEVI.

  1. Lower Energy Endovenous Laser Ablation of the Great Saphenous Vein with 980 nm Diode Laser in Continuous Mode

    International Nuclear Information System (INIS)

    Kim, Hyun S.; Nwankwo, Ikechi J.; Hong, Kelvin; McElgunn, Patrick S.J.

    2006-01-01

    Purpose. To assess clinical outcomes, complication rates, and unit energy applied using 980 nm diode endovenous laser treatment at 11 watts for symptomatic great saphenous vein (GSV) incompetence and reflux disease. Methods. Thirty-four consecutive ablation therapies with a 980 nm diode endovenous laser at 11 watts were studied. The diagnosis of GSV incompetence with reflux was made by clinical evaluation and duplex Doppler examinations. The treated GSVs had a mean diameter of 1.19 cm (range 0.5-2.2 cm). The patients were followed with clinical evaluation and color flow duplex studies up to 18.5 months (mean 12.19 months ± 4.18). Results. Using 980 nm diode endovenous laser ablation in continuous mode, 100% technical success was noted. The mean length of GSVs treated was 33.82 cm (range 15-45 cm). The mean energy applied during the treatment was 1,155.81 joules (J) ± 239.50 (range 545.40-1620 J) for a mean treatment duration of 90.77 sec ± 21.77. The average laser fiber withdrawal speed was 0.35 cm/sec ± 0.054. The mean energy applied per length of GSV was 35.16 J/cm ± 8.43. Energy fluence, calculated separately for each patient, averaged 9.82 J/cm 2 ± 4.97. At up to 18.5 months follow-up (mean 12.19 months), 0% recanalization was noted; 92% clinical improvement was achieved. There was no major complication. Minor complications included 1 patient with hematoma at the percutaneous venotomy site, 1 patient with thrombophlebitis on superficial tributary varices of the treated GSV, 24% ecchymoses, and 32% self-limiting hypersensitivity/tenderness/'pulling' sensation along the treatment area. One patient developed temporary paresthesia. Four endovenous laser ablation treatments (12%) were followed by adjunctive sclerotherapies for improved cosmetic results. Conclusion. Endovenous laser ablation treatment of GSV using a 980 nm diode laser at 11 watts in continuous mode appears safe and effective. Mean energy applied per treated GSV length of 35.16 J/cm or mean

  2. Endovenous laser therapy for occlusion of incompetent saphenous veins using 1940nm

    Science.gov (United States)

    Sroka, Ronald; Pongratz, Thomas; Esipova, Anna; Dikic, Slobodan; Demhasaj, Sahit; Comsa, Florin; Schmedt, Claus-Georg

    2015-07-01

    Objective: Several studies indicate that ELT using wavelengths of high water absorption showed advantages compared to conventional ELT. Thulium-Lasers emit nearby the local absorption maximum of water at 1940nm. In this clinical study the effectiveness, safety and the feasibility of 1940nm-ELT is proven. Materials and Method: A single centric, prospective observational study was performed. 1940nm-laserenergy was applied using radial emitting fibres with continuous pullback (1mm/s). Treatment was performed under anesthesia (general, spinal, tumescent) thus simultaneous miniphlebectomy and ligation of perforators could be applied. Patient and technical details were systematically collected. Evaluation included: standardized questionnaire, clinical examination, color-duplex ultrasonography preoperatively, 3d, 4w, 6m postoperatively, statistic. Results: The 1940nm-ELT study include 55 patients (female/men=34/21, mean age 55y, range 23-90y) treating n=72 vessels. The mean maximum diameter of great saphenous veins (GSV, n=59) was 7.5mm (range 3.7-11.3mm) and of small saphenous veins (SSV, n=13) was 5.3mm (3.0-10.0mm). The mean applied longitudinal endovenous energy density (LEED) was 64.3J/cm (40.3-98.2J/cm) in GSVs and 51.0J/cm (37.6-72.7J/cm) in SSVs. Complete occlusion of the vein without sign of reflux was achieved in 100%. The mean length of non-occluded stump at the sapheno-femoral junction was 6.0mm (1.0-20.0mm). Postoperative reduction of the diameter of GSV was 1.6mm (21.3%) and 2.0mm (37.7%) in SSV. One (1.4%) endovenous heat induced thrombus (EHIT) was observed. Further adverse events were: paresthesia 10/72 (13.9%), ecchymosis 1/72 (1.4%), lymphocele 1/72 (1.4%), hyperpigmentation 1/72 (1.4%). The mean postoperative pain intensity was 1.3 and 1.8 single doses of analgesics were administered. Normal physical activity was reached after 3d (1-21d). Conclusion: 1940nm-ELT using radial light application effectively eliminates the reflux in insufficient saphenous

  3. Endovenous treatment of primary varicose veins: an effective and safe therapeutic alternative to stripping?

    International Nuclear Information System (INIS)

    Kluner, C.; Fischer, T.; Filimonow, S.; Hamm, B.; Kroencke, T.

    2005-01-01

    Endovenous laser therapy (EVLT) is a new, minimally invasive therapeutic option for treating primary varicose veins and provides an effective and safe alternative to conventional surgical management (stripping). Short-term and intermediate-term outcome is comparable to surgical stripping in terms of elimination of venous reflux (90% - 98%), resolution of visible varices (85%), and improvement of subjective complaints such as sensations of heaviness and tension (96%). Complications occur in 1% - 3% of cases, which is markedly below the rate of conventional surgical management (up to 30%). The intermediate-term incidence of recurrent varicosis in a vein treated by EVLT depends on the laser fluence applied and is reported to range from 7% - 9% compared to 10% - 20% after surgical intervention. Based on a review of the current literature and our own experience, this survey article presents an overview of the indications and contraindications, the technique and pathophysiology of laser-induced venous occlusion, and the results and possible complications of EVLT. (orig.)

  4. Effect of optical fiber type and absorption medium on the endovenous laser ablation mechanism

    Science.gov (United States)

    Ignatieva, N. Yu; Zakharkina, O. L.; Mazayshvili, C. V.; Bagratashvili, V. N.; Lunin, V. V.

    2017-10-01

    Our experimental investigation was aimed at revealing the mechanism behind the action of laser radiation on venous wall under endovenous laser ablation conditions. We determined the critical laser power P cr at which the objective effect of complete denaturation of the vascular tissue collagen was attained for two types of optical fiber in the presence and absence of blood cells. We demonstrated that for the radial optical fiber the presence of blood cells had no effect on the magnitude of P cr, which came to 4.3  ±  0.1 and 5.6  ±  01 W for 1.56 and 1.47 µm lasers, respectively. For the bare fiber and 1.56 µm laser, P cr increased up to 5.2  ±  0.2 W in a blood-filled vessel and up to 7.1  ±  0.2 W when the blood was replaced by a sodium chloride solution. Our data show that the heating and degradation of insufficient veins go on more effectively when the tissue is heated by laser radiation directly absorbed therein, rather than the red-hot carbonized optical fiber tip.

  5. Endovenous Laser Ablation of the Small Saphenous Vein Sparing the Saphenopopliteal Junction

    International Nuclear Information System (INIS)

    Janne d'Othee, Bertrand; Walker, T. Gregory; Kalva, Sanjeeva P.; Ganguli, Suvranu; Davison, Brian

    2010-01-01

    To assess outcomes after endovenous laser ablation (EVLA) of the small saphenous vein (SSV). Retrospective review was performed of all consecutive EVLA procedures performed over a 39-month period at three neighboring vein practices for symptomatic, duplex ultrasound-proven incompetence of the SSV. EVLA was performed under ultrasound guidance with an 810- or 980-nm diode laser in continuous mode using the pullback method while sparing the deep, most cephalad segment of the SSV near the saphenopopliteal junction. Follow-up after EVLA included patient symptoms, physical examination, and duplex ultrasound. Pretreatment variables were similar across all three practices. EVLA was performed to treat 67 incompetent SSVs in 63 patients (86% women; mean age and 95% confidence interval, 50 ± 3 years; range, 20-82 years). Average energy delivered was 92 J/cm. Immediate technical success and occlusion of the treated vein at 1-2 weeks was 100%. Imaging follow-up length was 243 ± 65 days (range, 3-893 days). Clinical follow-up (243 ± 66 days) showed symptomatic improvement in 66 (99%) of 67 patients; one patient had recanalization with recurrent reflux by ultrasound (2%). Complications included one case of paresthesias lasting beyond 1 month of follow-up (2%) and three cases of superficial phlebitis (4%), but no deep vein thrombosis, skin burns, or other complications. Although ablation involved only the superficial portion of the SSV and spared its deep segment in the popliteal fossa, SSV occlusion typically extended up to the saphenopopliteal junction or to a gastrocnemial collateral, without popliteal vein involvement. EVLA of the SSV is safe and effective when the saphenopopliteal junction and popliteal fossa are avoided. This approach may help reduce the risk of paresthesias or other complications while maintaining low recanalization rates.

  6. Changes of blood levels of LPO, SOD and GSH-Px after endovenous laser treatment of varicose greater saphenous vein

    International Nuclear Information System (INIS)

    Han Li'na; Gu Ying; Liu Fanguang

    2004-01-01

    Objective: To investigate the changes of the blood levels of lipid peroxide (LPO), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) after treatment of varicose greater saphenous vein with either endovenous laser or conventional surgery (high ligation plus stripping). Methods: Thirty-seven patients with varicose greater saphenous vein were treated with endovenous laser and another 33 patients were treated with conventional surgery. Levels of LPO (serum, with TBA fluorescein), SOD (whole blood, with RIA) and GSH-Px (whole blood, with direct DTNB) were determined in these patients both before and 1, 3, 5, 7, 10, 15 days after treatment. Levels in 30 controls were also measured. Results: The levels of LPO were higher and levels of SOD, GSH-Px lower in the patients than those in the controls. After either form of therapy, the levels LPO rose and levels of SOD, GSH-Px dropped immediately but gradually approached the control values by the 15 th day (slower with SOD and GSH-Px). However, the early increase of LPO levels were less and recovery sooner in the group of patients treated with laser. Conclusion: Changes of levels of LPO, SOD and GSH-Px were closely related to the degree of stress and recovery condition after the treatment

  7. Venous duplex and pathologic differences in thrombus characteristics between de novo deep vein thrombi and endovenous heat-induced thrombi.

    Science.gov (United States)

    Santin, Brian J; Lohr, Joanne M; Panke, Thomas W; Neville, Patrick M; Felinski, Melissa M; Kuhn, Brian A; Recht, Matthew H; Muck, Patrick E

    2015-04-01

    Superficial venous reflux disease has been treated with endovenous ablation techniques for more than 15 years. Thrombi discovered in the postoperative period are referred to as endovenous heat-induced thrombi (EHIT). In spite of the few studies of the ultrasound differentiation between EHIT and deep vein thrombi (DVT), there remains a paucity of literature regarding the evaluation of ultrasound examination and pathologic differentiation. Six Yorkshire cross swine underwent femoral vein thrombosis by suture ligation or endovenous radiofrequency ablation. At 1 week after the procedure, each femoral vein was imaged by color Duplex ultrasound and sent for histologic interpretation for differentiation between EHIT and DVT. Five blinded vascular surgery faculty, two vascular surgery fellows, and three vascular surgery residents reviewed the ultrasound images. Thrombi associated with radiofrequency ablation demonstrated a greater degree of hypercellular response, fibroblastic reaction, and edema (3.42 vs 2.92; 3.75 vs 2.42; 2.83 vs 1.33). Specimens harvested from the iatrogenic-induced DVT swine demonstrated a more prolific response to trichrome staining (3.42 vs 2.67). Evidence of revascularization was found in all of the EHIT specimens but in 33% of DVT specimens. On the basis of histologic findings, the pathologist predicted correct modality 92% of the time. Subgroup analysis comparing paired specimens from each swine failed to demonstrate any marked pathologic differences. Recorded ultrasound images from EHIT and DVT samples were reviewed by fellows, residents, and vascular surgery staff to determine whether clot was stationary or free-floating (n = 111; 93%), evidence of retracted or adherent vein (n = 105; 88%), and absence of color flow (n = 102; 85%). The degree of occlusion (partial vs total) and degree of distention of a visualized vein were least likely to be agreed on by reviewers (n = 95; 79% each, respectively). In subgroup (DVT vs EHIT) analyses, the

  8. Deep Venous Reflux Associated with a Dilated Popliteal Fossa Vein Reversed with Endovenous Laser Ablation and Sclerotherapy

    Directory of Open Access Journals (Sweden)

    Daniel P. Link

    2013-01-01

    Full Text Available Objective. To report an incidence of reflux in the deep venous system reversed by ablation of a popliteal fossa vein (PFV. Method. A 40-year-old man with pain and swelling in the medial upper calf was found to have an incompetent PFV. Results. Reflux in the femoral and popliteal veins was reversed utilizing endovenous laser ablation and foam sclerotherapy, documented on Duplex studies before and after the intervention. There was also resolution of symptoms. Conclusion. A PFV can be associated with deep venous reflux. Correction of this reflux with ablation of the PFV suggests that his type of reflux is secondary to volume effects of the incompetent popliteal vein.

  9. Endovenous laser ablation of the great saphenous vein using a bare fibre versus a tulip fibre: a randomised clinical trial.

    Science.gov (United States)

    Vuylsteke, M E; Thomis, S; Mahieu, P; Mordon, S; Fourneau, I

    2012-12-01

    This clinical trial aimed to evaluate the clinical results of the use of a tulip fibre versus the use of a bare fibre for endovenous laser ablation. In a multicentre prospective randomised trial 174 patients were randomised for the treatment of great saphenous vein reflux. A duplex scan was scheduled 1 month, 6 months and 1 year postoperatively. Ecchymosis was measured on the 5th postoperative day. In addition, pain, analgesics requirement, postoperative quality of life (CIVIQ 2) and patient satisfaction rate were noted. Patients treated with a tulip fibre had significantly less postoperative ecchymosis (0.04 vs. 0.21; p tulip fibre for EVLA of the great saphenous vein results, when compared with the use of a bare fibre, in equal occlusion rates at 1 year but causes less postoperative ecchymosis and pain and in a better postoperative quality of life. Copyright © 2012 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.

  10. Nitrous oxide/oxygen inhalation provides effective analgesia during the administration of tumescent local anaesthesia for endovenous laser ablation.

    Science.gov (United States)

    Meier, Thomas Oleg; Jacomella, Vincenzo; Clemens, Robert Karl Josef; Amann-Vesti, Beatrice

    2015-11-01

    Tumescent anaesthesia (TA) is an important but sometimes very painful step during endovenous thermal ablation of incompetent veins. The aim of this study was to examine whether the use of fixed 50% nitrous oxide/oxygen mixture (N2O/O2), also called equimolar mixture of oxygen and nitrous oxide, reduces pain during the application of TA. Patients undergoing endovenous laser ablation (EVLA) of incompetent saphenous veins were included. Thirty consecutive patients inhaled N2O/O2 during the application of TA. Thirty consecutive patients received TA alone (controls). Patients were asked to complete a questionnaire immediately after the intervention to assess satisfaction with the intervention and pain-levels during the different steps of the intervention (0=not at all, 10=very much). Adverse events during the treatment were monitored. 30 patients (14 men, mean age of 44 years) were included in the N2O/O2 group and 30 patients (9 men, mean age 48 years) were included in the control group. In the N2O/O2 group a significantly lower pain score was noted (mean 2.45 points, range 0-6) compared to the controls (mean 4.3 points, range 1-9, p<0.001). Overall, 64.5% of the patients were perfectly satisfied with the N2O/O2-Inhalation. Only 4 patients receiving N2O/O2 complained of adverse effects such as unpleasant loss of control (2 patients), headache (1 patient) and dizziness (1 patient). N2O/O2 is a safe and effective method to reduce pain during the application of tumescent anaesthesia for EVLA.

  11. Endovenous ablation (radiofrequency and laser and foam sclerotherapy versus conventional surgery for great saphenous vein varices

    Directory of Open Access Journals (Sweden)

    Craig Nesbitt

    Full Text Available BACKGROUND: Minimally invasive techniques to treat great saphenous varicose veins include ultrasound-guided foam sclerotherapy (USGFS, radiofrequency ablation (RFA and endovenous laser therapy (EVLT. Compared with conventional surgery (high ligation and stripping (HL/S, proposed benefits include fewer complications, quicker return to work, improved quality of life (QoL scores, reduced need for general anaesthesia and equivalent recurrence rates. OBJECTIVE : To review available randomized controlled clinical trials (RCT data comparing USGFS, RFA, EVLT to HL/S for the treatment of great saphenous varicose veins. METHODS : Search methods: The Cochrane Peripheral Vascular Diseases (PVD Group searched their Specialized Register (July 2010 and CENTRAL (The Cochrane Library 2010, Issue 3. In addition the authors performed a search of EMBASE (July 2010. Manufacturers of EVLT, RFA and sclerosant equipment were contacted for trial data. Selection criteria: All RCTs of EVLT, RFA, USGFS and HL/S were considered for inclusion. Primary outcomes were recurrent varicosities, recanalization, neovascularization, technical procedure failure or need for re-intervention, patient quality of life (QoL scores and associated complications. Secondary outcomes were type of anaesthetic, procedure duration, hospital stay and cost. Data collection and analysis: CN, RE, VB, PC, HB and GS independently reviewed, assessed and selected trials which met the inclusion criteria. CN and RE extracted data. The Cochrane Collaboration's tool for assessing risk of bias was used. CN contacted trial authors to clarify details. MAIN RESULTS: Thirteen reports from five studies with a combined total of 450 patients were included. Rates of recanalization were higher following EVLT compared with HL/S, both early (within four months (5/149 versus 0/100; odds ratio (OR 3.83, 95% confidence interval (CI 0.45 to 32.64 and late recanalization (after four months (9/118 versus 1/80; OR 2.97; 95% CI 0

  12. Adoption of endovenous laser treatment as the primary treatment modality for varicose veins: the Auckland City Hospital experience.

    Science.gov (United States)

    Fernando, Ruchira S W; Muthu, Carl

    2014-08-01

    To assess the effectiveness of adopting endovenous laser treatment (EVLT) as the primary treatment modality for varicose veins at Auckland City Hospital (Auckland, New Zealand). The outcomes of 354 consecutive EVLT procedures performed between 2007 and 2013 were reviewed. Data was collected from a prospectively maintained procedural database and by retrospective chart review. Of the 319 patients who had an ultrasound, at 1 month post-procedure there was a saphenous vein occlusion rate of 96%. Side effects were minimal with no cases of DVT or skin burns and one case of self-limiting neuralgia. The procedure was well tolerated with a median pain score of 3. Since the adoption of EVLT there has been a large increase in the number of patients treated for varicose veins (28 in 2007 compared to 176 in 2013). EVLT is a safe and effective treatment for varicose veins and its adoption has allowed a large increase in the number of varicose vein patients treated at Auckland City Hospital.

  13. LASER MEDICINE: Effect of laser radiation absorption in water and blood on the optimal wavelength for endovenous obliteration of varicose veins

    Science.gov (United States)

    Zhilin, K. M.; Minaev, V. P.; Sokolov, Aleksandr L.

    2009-08-01

    This work examines laser radiation absorption in water and blood at the wavelengths that are used in endovenous laser treatment (EVLT): 0.81-1.06, 1.32, 1.47, 1.5 and 1.56 μm. It is shown that the best EVLT conditions are ensured by 1.56-μm radiation. Analysis of published data suggests that even higher EVLT efficacy may be achieved at wavelengths of 1.68 and 1.7 μm.

  14. Polidocanol versus hypertonic glucose for sclerotherapy treatment of reticular veins of the lower limbs: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Bertanha, Matheus; Sobreira, Marcone Lima; Pinheiro Lúcio Filho, Carlos Eduardo; de Oliveira Mariúba, Jamil Victor; Farres Pimenta, Rafael Elias; Jaldin, Rodrigo Gibin; Moroz, Andrei; Moura, Regina; Rollo, Hamilton Almeida; Yoshida, Winston Bonetti

    2014-12-19

    The prevalence of chronic venous disease is high and occurs more frequently in females. According to the clinical, etiological, anatomical, and pathological classification (CEAP) definition, the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints. Several invasive techniques are used for treatment, including mini phlebectomy, laser ablation, and radiofrequency ablation. However, a wide range of sclerosing agents may serve as minimally invasive alternatives, promoting chemical sclerosis of the vein wall. Although this technique is routinely performed around the world, there is no consensus on the most efficacious and safe chemical agent to be used. Inclusion criteria are women between 18 and 69 years old with at least 10 cm long reticular veins in the lower limbs, on the outer side of the leg/thigh. Patients with CEAP 2 to 6, or with allergies, pregnancy, performing breastfeeding, or with any dermatologic or clinical problems will be excluded. Patients with venous ultrasound mapping showing involvement of saphenous trunks and/or a deep venous system will also be excluded. Patients will be randomized into two groups, one receiving 75% pure glucose and the other group receiving 0.2% polidocanol diluted in 70% glucose. Just one limb and one session per patient will be performed. The sclerosing agent volume will not exceed 5 mL. Clinical follow-up will include visits on days 7 and 60, always with photographic documentation. This project aims to enroll 96 patients and subject them to a double-blind treatment after the randomization process. The design is intended to evaluate efficacy through a primary end point and safety through a secondary end point. Forty-eight patients have currently been enrolled. Preliminary results for these patients showed that 25 received treatment, 2 were excluded, and 22 returned after 7 days and showed no greater adverse events. To date, establishing efficacy criteria has not been possible, and no

  15. Inferior vena cava filter insertion through the popliteal vein: enabling the percutaneous endovenous intervention of deep vein thrombosis with a single venous access approach in a single session

    Science.gov (United States)

    Kim, Hyoung Ook; Kim, Jae Kyu; Park, Jin Gyoon; Yim, Nam Yeol; Kang, Yang Jun; Jung, Hye Doo

    2016-01-01

    PURPOSE We aimed to evaluate the efficiency of placing an inferior vena cava (IVC) filter through the same popliteal vein access site used for percutaneous endovenous intervention in patients with extensive lower extremity deep vein thrombosis. METHODS This retrospective study included 21 patients who underwent IVC filter insertion through the popliteal vein over a three-year period. Patient medical records were reviewed for the location of the deep vein thrombosis, result of filter removal, and total number of endovascular procedures needed for filter insertion and recanalization of the lower extremity venous system. Follow-up lower extremity computed tomography (CT) venography was also reviewed in each patient to assess the degree of filter tilt in the IVC. RESULTS All patients had extensive lower extremity deep vein thrombosis involving the iliac vein and/or femoral vein. Seventeen patients showed deep vein thrombosis of the calf veins. In all patients, IVC filter insertion and the recanalization procedure were performed during a single procedure through the single popliteal vein access site. In the 17 patients undergoing follow-up CT, the mean tilt angle of the filter was 7.14°±4.48° in the coronal plane and 8.77°±5.49° in the sagittal plane. Filter retrieval was successful in 16 of 17 patients (94.1%) in whom filter retrieval was attempted. CONCLUSION Transpopliteal IVC filter insertion is an efficient technique that results in low rates of significant filter tilt and enables a single session procedure using a single venous access site for filter insertion and percutaneous endovenous intervention. PMID:27559713

  16. Endovenous laser surgery clinical research for the treatment of lower extremity varicose veins%静脉腔内激光术治疗下肢静脉曲张的临床研究

    Institute of Scientific and Technical Information of China (English)

    郑新闻

    2014-01-01

    目的:通过比较分析静脉腔内激光术与传统治疗方法的临床治疗效果,总结治疗经验。方法:将2010年8月至2013年12月在医院接受治疗的下肢静脉曲张患者211例,随机分为静脉腔内激光术治疗组和传统点式抽剥术组。观察两组患者手术时间、住院天数、术后疼痛、术后并发症。结果:静脉腔内激光术治疗组手术时间短、住院天数少、术后疼痛轻、无淋巴漏、内踝部麻木不适感少,静脉腔内激光术治疗组优于传统手术组。结论:静脉腔内激光术治疗下肢静脉曲张微创手术切口小、出血少、无需拆线、美观,无疤痕;术后并发症,痛苦少而且恢复快。%Objective:Through the comparative analysis of v Endovenous laser technique and clinical therapeutic effect of traditional treatment methods, summarize the treatment experience.Methods: Wil be in August 2010 to December 2013 in the hospital for treatment of 211 patients with lower extremity varicose veins were randomly divided into the treatment of Endovenous laser group and traditional point smoke shel . Observe two groups of patients with operation time, hospitalization days, postoperative pain, postoperative complications.Results:For the treatment of Endovenous laser group of shorter operation time, hospitalization days, less postoperative pain and numbness, no lymphatic leakage and medial mal eolus department less discomfort, venous cavity laser treatment group is bet er than traditional surgery group.Conclusions:Endovenous laser treatment of varicose veins of lower extremities minimal y invasive operation and smal incision, less bleeding, no stitch, beautiful, without scar;The postoperative complications, less pain and faster recovery.

  17. Impact of Laser Fiber Design on Outcome of Endovenous Ablation of Lower-Extremity Varicose Veins: Results from a Single Practice

    International Nuclear Information System (INIS)

    Prince, Ethan A.; Soares, Gregory M.; Silva, MaryLou; Taner, Anil; Ahn, SunHo; Dubel, Gregory J.; Jay, Bryan S.

    2011-01-01

    The design of laser fibers used for endovenous laser ablation (EVLA) in the management of lower-extremity varicose vein disease may affect treatment success. The purpose of this investigation is to report our experience using the gold-tip NeverTouch VenaCure laser fiber (AngioDynamics, Queensbury, NY) and to compare that to our experience with standard bare-tip fibers. A retrospective chart review of 363 consecutive EVLA treatments using the gold-tip laser fiber was performed. Demographic data including patient age, sex, history of previous varicose vein stripping, vein identity, laterality, treatment length, total applied energy in joules (J), use of adjuvant sclerotherapy and ambulatory phlebectomy, treatment-related complications, and treatment failure, which was defined as recanalization of any portion of the treated vein during follow-up as assessed by duplex ultrasound examination―were entered into a spreadsheet. These data were compared with a control group of 471 EVLA treatments performed with a standard bare-tip laser fiber. Data were analyzed using independent-samples Student’s t test, chi-square test, and multivariate analysis. Demographic data were similar between the two groups. Treatments with the gold-tip fiber had a failure rate of 11.1%, whereas treatment with a bare-tip fiber had a failure rate of 2.3% during a similar follow-up period. This difference was highly statistically significant (p < 0.0001). Multivariate analysis showed fiber type as the most significant factor associated with treatment failure. We conclude that laser fiber design has a significant effect on treatment success in the performance of EVLA.

  18. Persistent below-knee great saphenous vein reflux after above-knee endovenous laser ablation with 1470-nm laser: a prospective study

    Directory of Open Access Journals (Sweden)

    Walter Junior Boim de Araujo

    2016-01-01

    Full Text Available Abstract Background In endovenous laser ablation (EVLA, the great saphenous vein (GSV is usually ablated from the knee to the groin, with no treatment of the below-knee segment regardless of its reflux status. However, persistent below-knee GSV reflux appears to be responsible for residual varicosities and symptoms of venous disease. Objectives To evaluate clinical and duplex ultrasound (DUS outcomes of the below-knee segment of the GSV after above-knee EVLA associated with conventional surgical treatment of varicosities and incompetent perforating veins. Methods Thirty-six patients (59 GSVs were distributed into 2 groups, a control group (26 GSVs with normal below-knee flow on DUS and a test group (33 GSVs with below-knee reflux. Above-knee EVLA was performed with a 1470-nm bare-fiber diode laser and supplemented with phlebectomies of varicose tributaries and insufficient perforating-communicating veins through mini-incisions. Follow-up DUS, clinical evaluation using the venous clinical severity score (VCSS, and evaluation of complications were performed at 3-5 days after the procedure and at 1, 6, and 12 months. Results Mean patient age was 45 years, and 31 patients were women (86.12%. VCSS improved in both groups. Most patients in the test group exhibited normalization of reflux, with normal flow at the beginning of follow-up (88.33% of GSVs at 3-5 days and 70% at 1 month. However, in many of these patients reflux eventually returned (56.67% of GSVs at 6 months and 70% at 1 year. Conclusions These data suggest that reflux in the below-knee segment of the GSV was not influenced by the treatment performed.

  19. Fill and aspirate foam sclerotherapy (FAFS): a new approach for sclerotherapy of large superficial varicosities concomitant to endovenous laser ablation of truncal vein

    International Nuclear Information System (INIS)

    Atasoy, M.M.

    2015-01-01

    Aim: To define and assess the short-term clinical feasibility of fill and aspirate foam sclerotherapy (FAFS) for treating large superficial varicose veins concomitant to endovenous laser ablation (EVLA). Materials and methods: Twenty-seven patients who refused to have phlebectomies with great saphenous vein reflux and large superficial varicosities were included in the study. Both EVLA and FAFS were performed concomitantly. FAFS is a technique in which all or most of the bubbles and blood–foam mixture are removed from the targeted large varicose veins immediately after the foam has caused sufficient damage to the endothelial cells. Patients were reviewed 1 month and 6 months after the treatment. Improvement in the clinical, aetiological, anatomical, and pathological classification (CEAP), and clinical severity was graded using the revised venous clinical severity score (rVCSS) and cosmetic results were investigated at the 6 month visit. Results: Ablation of GSV was performed in 27 limbs in 27 patients (19 males, 70.3%; mean age 44 years; range 21–69 years). All patients had a technically successful FAFS treatment. The CEAP classification score, the rVCSS values, and the cosmetic results showed prominent improvement 6 months after the treatment. There were no significant complications, such as stroke, skin burns, necrosis, paresthesia, deep-vein thrombosis, or allergic reaction. None of the patients experienced neurological events. Conclusion: FAFS is a promising safe and effective technique for treating large superficial varicosities concomitant to EVLA of the truncal veins with excellent clinical results. Randomized prospective studies with larger series are required to compare the FAFS with ambulatory phlebectomy and standard foam sclerotherapy. - Highlights: • Fill and aspirate foam sclerotherapy (FAFS) is a easy and feasible alternative to the ambulatory phlebectomy for the treatment of large superficial varicose veins. • By using FAFS, foam can be

  20. Endovenous laser treatment of the small saphenous varicose vein: clinical analysis of 78 cases%腔内激光治疗小隐静脉曲张78例临床分析

    Institute of Scientific and Technical Information of China (English)

    唐博; 龚建平; 罗文军; 陈以宽; 孙建明

    2011-01-01

    Objective: Endovenous laser treatment is a new minimally invasive technique for ablation of the incompetent saphenous vein.Compared with the GSV,fewer data are available on small saphenous vein(SSV) laser ablation.This study evaluated the feasibility,safety,and efficacy of endovenous laser ablation to treat SSVs.Methods:Between February 2007 and February 2011,78 patients(93 limbs) with incompetent SSVs(evaluated by the CEAP classification) who were eligible for surgery underwent consecutive laser ablation procedures.Many required additional treatment for varicose tributaries.Ablations were performed with duplex ultrasound(DU) guidance.Follow-up was with clinical examination and DU imaging.Results:DU imaging showed immediate occlusion of the SSV with no thrombosis in the proximal veins.No complications occurred intraoperatively.Some patients had postoperative pain,sugillation,paresthesia and superficial thrombophlebitis,but it was minimal.Patients could discharge 3 to 7 days later.All cases were followed up for 1-43 months.The mean follow-up was 16±9 months.Symptoms resolved in most patients soon after the operation.Conclusion:Endovenous laser ablation of the SSV has excellent early and midterm results.The prevalence of complications is very low and light.Symptom relief is very good,but regular procedures are necessary in practical operation.%目的;腔内激光是目前最新的治疗静脉曲张的微创技术,大隐静脉曲张的腔内激光治疗已在临床得到认同并广泛应用,但腔内激光治疗小隐静脉曲张尚缺乏相关的临床研究,本研究将探讨腔内激光治疗小隐静脉曲张的临床疗效,并评价其安全性及有效性。方法:2007年2月至2011年2月78例小隐静脉曲张患者93条患肢,按照国际静脉联盟CEAP分级,采用彩超定位下连续性静脉腔内激光闭塞治疗,部分患者同时需手术结扎大隐静脉或剥脱散在静脉属支。术后随访血管彩超和临床CEAP

  1. Evaluation of great saphenous vein occlusion rate and clinical outcome in patients undergoing laser thermal ablation with a 1470-nm bare fiber laser with low linear endovenous energy density

    Directory of Open Access Journals (Sweden)

    Walter Junior Boim Araujo

    2015-12-01

    Full Text Available Abstract Background Water-specific 1470-nm lasers enable vein ablation at lower energy densities and with fewer side effects because they target interstitial water in the vessel wall. Objectives To determine great saphenous vein (GSV occlusion rate after thermal ablation with 1470-nm laser using 7W power and to evaluate clinical outcomes and complications. Method Nineteen patients (31 GSVs underwent thermal ablation. Follow-up duplex scanning, clinical evaluation using the Venous Clinical Severity Score (VCSS, and evaluation of procedure-related complications were performed at 3-5 days after the procedure and at 30 and 180 days. Results Mean patient age was 46 years and 17 of the patients were female (89.47%. Of 31 limbs treated, 2 limbs were clinical class C2, 19 were C3, 9 were C4, and 1 limb was C5 according to the Clinical-Etiology-Anatomy-Pathophysiology (CEAP classification. Mean linear endovenous energy density was 33.53 J/cm. The GSV occlusion rate was 93.5% immediately after treatment, 100% at 3-5 days and 100% at 30 days after treatment and 87.1% 180 days after treatment. There was a significant reduction in VCSS at all time points. Conclusions The data from this study support the possibility that the incidence of complications can be reduced without significantly affecting the clinical outcomes, by using lower energy density. However, this appears to be at the cost of reduced efficacy in terms of GSV occlusion rates.

  2. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial.

    Science.gov (United States)

    Brittenden, Julie; Cotton, Seonaidh C; Elders, Andrew; Tassie, Emma; Scotland, Graham; Ramsay, Craig R; Norrie, John; Burr, Jennifer; Francis, Jill; Wileman, Samantha; Campbell, Bruce; Bachoo, Paul; Chetter, Ian; Gough, Michael; Earnshaw, Jonothan; Lees, Tim; Scott, Julian; Baker, Sara A; MacLennan, Graeme; Prior, Maria; Bolsover, Denise; Campbell, Marion K

    2015-01-01

    BACKGROUND Foam sclerotherapy (foam) and endovenous laser ablation (EVLA) have emerged as alternative treatments to surgery for patients with varicose veins, but uncertainty exists regarding their effectiveness in the medium to longer term. OBJECTIVES To assess the clinical effectiveness and cost-effectiveness of foam, EVLA and surgery for the treatment of varicose veins. DESIGN A parallel-group randomised controlled trial (RCT) without blinding, and economic modelling evaluation. SETTING Eleven UK specialist vascular centres. PARTICIPANTS Seven hundred and ninety-eight patients with primary varicose veins (foam, n = 292; surgery, n = 294; EVLA, n = 212). INTERVENTIONS Patients were randomised between all three treatment options (eight centres) or between foam and surgery (three centres). PRIMARY OUTCOME MEASURES Disease-specific [Aberdeen Varicose Vein Questionnaire (AVVQ)] and generic [European Quality of Life-5 Dimensions (EQ-5D), Short Form questionnaire-36 items (SF-36) physical and mental component scores] quality of life (QoL) at 6 months. Cost-effectiveness as cost per quality-adjusted life-year (QALY) gained. SECONDARY OUTCOME MEASURES Quality of life at 6 weeks; residual varicose veins; Venous Clinical Severity Score (VCSS); complication rates; return to normal activity; truncal vein ablation rates; and costs. RESULTS The results appear generalisable in that participants' baseline characteristics (apart from a lower-than-expected proportion of females) and post-treatment improvement in outcomes were comparable with those in other RCTs. The health gain achieved in the AVVQ with foam was significantly lower than with surgery at 6 months [effect size -1.74, 95% confidence interval (CI) -2.97 to -0.50; p = 0.006], but was similar to that achieved with EVLA. The health gain in SF-36 mental component score for foam was worse than that for EVLA (effect size 1.54, 95% CI 0.01 to 3.06; p = 0.048) but similar to that for surgery. There were no

  3. Clinical effectiveness and cost-effectiveness of foam sclerotherapy, endovenous laser ablation and surgery for varicose veins: results from the Comparison of LAser, Surgery and foam Sclerotherapy (CLASS) randomised controlled trial.

    Science.gov (United States)

    Brittenden, Julie; Cotton, Seonaidh C; Elders, Andrew; Tassie, Emma; Scotland, Graham; Ramsay, Craig R; Norrie, John; Burr, Jennifer; Francis, Jill; Wileman, Samantha; Campbell, Bruce; Bachoo, Paul; Chetter, Ian; Gough, Michael; Earnshaw, Jonothan; Lees, Tim; Scott, Julian; Baker, Sara A; MacLennan, Graeme; Prior, Maria; Bolsover, Denise; Campbell, Marion K

    2015-04-01

    Foam sclerotherapy (foam) and endovenous laser ablation (EVLA) have emerged as alternative treatments to surgery for patients with varicose veins, but uncertainty exists regarding their effectiveness in the medium to longer term. To assess the clinical effectiveness and cost-effectiveness of foam, EVLA and surgery for the treatment of varicose veins. A parallel-group randomised controlled trial (RCT) without blinding, and economic modelling evaluation. Eleven UK specialist vascular centres. Seven hundred and ninety-eight patients with primary varicose veins (foam, n = 292; surgery, n = 294; EVLA, n = 212). Patients were randomised between all three treatment options (eight centres) or between foam and surgery (three centres). Disease-specific [Aberdeen Varicose Vein Questionnaire (AVVQ)] and generic [European Quality of Life-5 Dimensions (EQ-5D), Short Form questionnaire-36 items (SF-36) physical and mental component scores] quality of life (QoL) at 6 months. Cost-effectiveness as cost per quality-adjusted life-year (QALY) gained. Quality of life at 6 weeks; residual varicose veins; Venous Clinical Severity Score (VCSS); complication rates; return to normal activity; truncal vein ablation rates; and costs. The results appear generalisable in that participants' baseline characteristics (apart from a lower-than-expected proportion of females) and post-treatment improvement in outcomes were comparable with those in other RCTs. The health gain achieved in the AVVQ with foam was significantly lower than with surgery at 6 months [effect size -1.74, 95% confidence interval (CI) -2.97 to -0.50; p = 0.006], but was similar to that achieved with EVLA. The health gain in SF-36 mental component score for foam was worse than that for EVLA (effect size 1.54, 95% CI 0.01 to 3.06; p = 0.048) but similar to that for surgery. There were no differences in EQ-5D or SF-36 component scores in the surgery versus foam or surgery versus EVLA comparisons at 6 months. The

  4. Mechanochemical endovenous ablation and new frontiers in venous intervention

    NARCIS (Netherlands)

    Boersma, D

    2017-01-01

    Venous insufficiency of the lower extremities is a common condition and related to various symptoms, including venous ulcers. The effect of venous insufficiency on patients’ health-related quality of life is substantial and comparable with other chronic diseases such as arthritis, diabetes, and

  5. Varicose Vein Treatment (Endovenous Ablation of Varicose Veins)

    Science.gov (United States)

    ... associated veins. top of page What are the benefits vs. risks? Benefits No surgical incision is needed—only a small ... risk of infection. The chance of infection requiring antibiotic treatment appears to be less than one in ...

  6. La comunicación terapéutica durante instalación de venoclisis: uso de la simulación filmada A comunicação terapêutica durante instalação de terapia endovenosa: uso de simulação filmada The therapeutic communication during installation of endovenous therapy: the use of video-taped simulation

    Directory of Open Access Journals (Sweden)

    Martha Landeros López

    2006-10-01

    enfermeiros assistenciais e 12 docentes de enfermagem. Os passos metodológicos foram: Construção e validação do texto; Filmagem do texto com atores e validação; Apresentação do vídeo aos enfermeiros e aos docentes e aplicação de questionário semi-estruturado para identificar as técnicas de comunicação terapêutica presentes na simulação; a percepção da qualidade da comunicação enfermeiro-paciente; a percepção de semelhanças entre a sua prática e a simulação; e as dificuldades para utilização destas técnicas na prática cotidiana. Os participantes consideraram como "bom" o relacionamento interpessoal apresentado; identificaram as técnicas de comunicação terapêutica que majoritariamente correspondem à descrição da experiência e expressão de pensamentos e sentimentos; não foram encontradas diferenças substanciais entre docentes e enfermeiros. A dificuldade mais freqüente para utilizar técnicas comunicativas foi atribuída aos problemas do paciente para se relacionar.The use of therapeutic communication contributes to nursing care quality, mainly in procedures that cause fear and anxiety in patients, such as the installation of endovenous therapy. This study aimed to identify how nurses perceive therapeutic communication during the installation of endovenous therapy, as shown in a filmed simulation. This exploratory-descriptive and comparative study was developed in a Mexican city and involved 30 clinical nurses and 12 nursing faculty. The methodological process was: Construction and validation of textual content; Filming textual content with actors and validation; Presentation of the video to nurses and faculty and application of the semistructured questionnaire to identify therapeutic communication techniques in the simulation; perception of nurse-patient communication quality; perception of similarities between care practice and simulation; and difficulties to use these techniques in daily practice. Participants perceived the

  7. Polidocanol concentration and time affect the properties of foam used for sclerotherapy

    NARCIS (Netherlands)

    Deurzen, van H.J.M.; Ceulen, R.P.; Tellings, S.S.; Geld, van der C.W.M.; Nijsten, T.

    2011-01-01

    BACKGROUND How foam is created for sclerotherapy varies and is not standardized. Moreover, the effect of several factors on the quality of the foam is not well studied. OBJECTIVE To investigate the effects of different parameters on foam stability and bubble size. METHODS As a measure of foam

  8. Physical basics of endovenous laser treatment and potential of innovative developments

    Science.gov (United States)

    Sroka, R.; Esipova, A.; Schmedt, C. G.

    2017-04-01

    During the last decade, endoluminal laser treatment (ELT) has been rapidly developing. Protocols using radially emitting ELT fibres in combination with infrared laser light show clinical advantages over the bare-fibre technique and near infrared irradiation. Although the clinical response rate is high several side effects occurred. Innovative light application systems and feedback systems are therefore being under development to potentially improve the clinical situation. The irradiation patterns of bare fibres and radially emitting 1-ring and 2-ring fibres were measured using the goniometer technique. The device robustness, device handling and tissue effects were investigated using the established ox-foot-model. Furthermore, temperature measurements were performed either intraluminal within the irradiation field using a tiny temperature sensor and on the outer surface of the vessel wall by means of a thermocamera. All fibres showed sufficient mechanical and thermal robustness. The destruction threshold is far beyond the light powers employed during clinical application. The 1-ring fibre showed very high peak temperatures for a short time, while the 2-ring-fibre hold its somewhat lower maximum temperature for a longer time. Both forms of energy application resulted in the desired shrinkage and destruction effect. In this regard, the handling of the 2-ring fibre appears subjectively more convenient with reduced sticking-related problems. Acute tissue effects could be investigated to improve the understanding especially of the interaction between handling, maneuvers and tissue effects. The 2-ring radially emitting fibre in combination with IR laser light and specific application parameters showed improved handling and safety features.

  9. Update of endovenous treatment modalities for insufficient saphenous veins-A review of literature

    NARCIS (Netherlands)

    van Eekeren, Ramon R. J. P.; Boersma, Doeke; de Vries, Jean-Paul P. M.; Zeebregts, Clark J.; Reijnen, Michel M. P. J.

    Lower-limb venous insufficiency resulting from saphenous vein incompetence is a common disorder, increasing with age. For decades, surgical stripping of the great saphenous vein has been the gold standard in varicose vein treatment. The desire to optimize outcomes of treatment and reduce surgical

  10. Pulmonary Embolism following Endovenous Laser Ablation (EVLA of the Great Saphenous Vein

    Directory of Open Access Journals (Sweden)

    Nnamdi Nwaejike

    2008-08-01

    Full Text Available

    A 70yr old lady presented to accident and emergency with sudden onset pleuritic chest pain. A pulmonary embolus (PE was diagnosed by CTPA. Ten days earlier she had bilateral EVLA for recurrent long saphenous vein disease. Confounding risk factors for pulmonary embolism included bilateral ligation and stripping of the long saphenous vein a year earlier, malignancy, EVLA and phlebitic tributary varices. EVLA has been shown to be an effective treatment for superficial venous insufficiency with low morbidity and high patient satisfaction. The investigation of confounding risk factors and possible causes should not compromise the initial treatment of PE.

  11. Polidocanol versus hypertonic glucose for sclerotherapy treatment of reticular veins of the lower limbs: study protocol for a randomized controlled trial

    OpenAIRE

    Bertanha, Matheus [UNESP; Sobreira, Marcone Lima [UNESP; Lúcio Filho, Carlos Eduardo Pinheiro [UNESP; Mariúba, Jamil Victor de Oliveira [UNESP; Pimenta, Rafael Elias Farres [UNESP; Jaldin, Rodrigo Gibin [UNESP; Moroz, Andrei [UNESP; Moura, Regina [UNESP; Rollo, Hamilton Almeida [UNESP; Yoshida, Winston Bonetti [UNESP

    2014-01-01

    Background The prevalence of chronic venous disease is high and occurs more frequently in females. According to the clinical, etiological, anatomical, and pathological classification (CEAP) definition, the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints. Several invasive techniques are used for treatment, including mini phlebectomy, laser ablation, and radiofrequency ablation. However, a wide range of sclerosing agents may serve as minimally in...

  12. One-year results of the use of endovenous radiofrequency ablation utilising an optimised radiofrequency-induced thermotherapy protocol for the treatment of truncal superficial venous reflux.

    Science.gov (United States)

    Badham, George E; Dos Santos, Scott J; Lloyd, Lucinda Ba; Holdstock, Judy M; Whiteley, Mark S

    2018-06-01

    Background In previous in vitro and ex vivo studies, we have shown increased thermal spread can be achieved with radiofrequency-induced thermotherapy when using a low power and slower, discontinuous pullback. We aimed to determine the clinical success rate of radiofrequency-induced thermotherapy using this optimised protocol for the treatment of superficial venous reflux in truncal veins. Methods Sixty-three patients were treated with radiofrequency-induced thermotherapy using the optimised protocol and were followed up after one year (mean 16.3 months). Thirty-five patients returned for audit, giving a response rate of 56%. Duplex ultrasonography was employed to check for truncal reflux and compared to initial scans. Results In the 35 patients studied, there were 48 legs, with 64 truncal veins treated by radiofrequency-induced thermotherapy (34 great saphenous, 15 small saphenous and 15 anterior accessory saphenous veins). One year post-treatment, complete closure of all previously refluxing truncal veins was demonstrated on ultrasound, giving a success rate of 100%. Conclusions Using a previously reported optimised, low power/slow pullback radiofrequency-induced thermotherapy protocol, we have shown it is possible to achieve a 100% ablation at one year. This compares favourably with results reported at one year post-procedure using the high power/fast pullback protocols that are currently recommended for this device.

  13. Convective heat transfer in foams under laminar flow in pipes and tube bundles.

    Science.gov (United States)

    Attia, Joseph A; McKinley, Ian M; Moreno-Magana, David; Pilon, Laurent

    2012-12-01

    The present study reports experimental data and scaling analysis for forced convection of foams and microfoams in laminar flow in circular and rectangular tubes as well as in tube bundles. Foams and microfoams are pseudoplastic (shear thinning) two-phase fluids consisting of tightly packed bubbles with diameters ranging from tens of microns to a few millimeters. They have found applications in separation processes, soil remediation, oil recovery, water treatment, food processes, as well as in fire fighting and in heat exchangers. First, aqueous solutions of surfactant Tween 20 with different concentrations were used to generate microfoams with various porosity, bubble size distribution, and rheological behavior. These different microfoams were flowed in uniformly heated circular tubes of different diameter instrumented with thermocouples. A wide range of heat fluxes and flow rates were explored. Experimental data were compared with analytical and semi-empirical expressions derived and validated for single-phase power-law fluids. These correlations were extended to two-phase foams by defining the Reynolds number based on the effective viscosity and density of microfoams. However, the local Nusselt and Prandtl numbers were defined based on the specific heat and thermal conductivity of water. Indeed, the heated wall was continuously in contact with a film of water controlling convective heat transfer to the microfoams. Overall, good agreement between experimental results and model predictions was obtained for all experimental conditions considered. Finally, the same approach was shown to be also valid for experimental data reported in the literature for laminar forced convection of microfoams in rectangular minichannels and of macrofoams across aligned and staggered tube bundles with constant wall heat flux.

  14. Less promising results with sclerosing ethoxysclerol injections for midportion achilles tendinopathy: a retrospective study

    NARCIS (Netherlands)

    van Sterkenburg, Maayke N.; de Jonge, Milko C.; Sierevelt, Inger N.; van Dijk, C. Niek

    2010-01-01

    BACKGROUND: Local injections of the sclerosing substance polidocanol (Ethoxysclerol) have shown good clinical results in patients with chronic midportion Achilles tendinopathy. After training by the inventors of the technique, sclerosing Ethoxysclerol injections were applied on a group of patients

  15. Three-year follow-up and quality of life of endovenous radiofrequency ablation of the great saphenous vein with the ClosureFast™ procedure: Influence of BMI and CEAP class.

    Science.gov (United States)

    Casana, Renato; Tolva, Valerio Stefano; Odero, Andrea; Malloggi, Chiara; Parati, Gianfranco

    2018-01-01

    Purpose Endovascular ablation of the great saphenous vein has been proposed as a less invasive alternative to conventional ligation and stripping of varicose veins. Outcomes of patients treated with the radiofrequency ablation ClosureFast™ system over an eight-year period from a single-center were evaluated. Methods Three-year follow-up data included duplex ultrasound scan, complication rate, and questionnaires to assess patients' QOL, level of pain, and days off work. Results A total of 1080 consecutive patients (49.5 ± 18.6 years, 72% female, mean body mass index: 25.44 ± 4.1 kg m -2 ) underwent radiofrequency ablation for incompetent saphenous veins in a single institution. Occlusion of the great saphenous vein was obtained in 98.6% and 93.8% cases at the end of the procedures and within 36 months, respectively. Only three deep venous thromboses and minor complications occurred in this series throughout the first week from the procedure. A decrease of the external vein diameter, equal to 72.7% and 31.1% of the pretreatment diameter, was observed at 1 week and 36 months, respectively. The average Aberdeen Varicose Vein Questionnaire score improved from 18.06 ± 9.47 before treatment to 11.56 ± 10.23 at 12 months, with no significant differences in the subsequent follow-up. SF-36 QOL scores significantly improved after the procedure in all domains, while there were no changes over time. Patients reported a prompt return to normal daily activities (1.5 ± 0.7 days) and work (3.1 ± 1.9 days). Body mass index influenced QOL scores, while it did not affect great saphenous vein diameter reduction during the follow-up. On the contrary, Clinical Etiologic Anatomic Pathophysiologic class significantly influenced both great saphenous vein diameter reduction after the treatment and QOL scores within 36 months. Conclusion Results of this retrospective monocentric, large patients study suggest that radiofrequency ablation of the great saphenous vein may be a safe and efficient alternative to conventional surgery.

  16. Ultrasound-guided sclerosis of neovessels in painful chronic patellar tendinopathy: a randomized controlled trial.

    Science.gov (United States)

    Hoksrud, Aasne; Ohberg, Lars; Alfredson, Håkan; Bahr, Roald

    2006-11-01

    Color Doppler ultrasound examination frequently reveals neovascularization in chronic painful Achilles and patellar tendinopathy. Sclerosing the area with vascular ingrowth using polidocanol has shown promising clinical results in patients with Achilles tendinopathy. To investigate sclerosing treatment using polidocanol on a group of elite athletes with patellar tendinopathy. Randomized controlled trial/cross-over study; Level of evidence, 1. The authors recruited 33 patients (42 tendons), mainly from the Norwegian elite divisions in basketball, team handball, and volleyball. Seventeen patients (23 knees) were randomized to the treatment group (polidocanol injections in the area of neovascularization) and 16 patients (20 knees) to the control group (similar injections with lidocaine/epinephrine). After 4 months of treatment, the control group was crossed over to active treatment. Pain and function were recorded using the Victorian Institute of Sport Assessment score before the start of treatment and 4, 8, and 12 months after the first injection. Victorian Institute of Sport Assessment scores between groups were compared using multivariate analysis of variance for repeated measures. The treatment group reported a significant improvement in Victorian Institute of Sport Assessment score from 51 to 62 after 4 months; there was no change for the control group (group by time interaction, P = .052). After 8 months, when the control group had also received active treatment with polidocanol, they had a greater improvement in Victorian Institute of Sport Assessment score (58-79) than did the treatment group (54-70; group by time interaction, P = .022; time effect, P patellar tendinopathy.

  17. A randomized prospective long-term (>1 year) clinical trial comparing the efficacy and safety of radiofrequency ablation to 980 nm laser ablation of the great saphenous vein.

    Science.gov (United States)

    Sydnor, Malcolm; Mavropoulos, John; Slobodnik, Natalia; Wolfe, Luke; Strife, Brian; Komorowski, Daniel

    2017-07-01

    Purpose To compare the short- and long-term (>1 year) efficacy and safety of radiofrequency ablation (ClosureFAST™) versus endovenous laser ablation (980 nm diode laser) for the treatment of superficial venous insufficiency of the great saphenous vein. Materials and methods Two hundred patients with superficial venous insufficiency of the great saphenous vein were randomized to receive either radiofrequency ablation or endovenous laser ablation (and simultaneous adjunctive therapies for surface varicosities when appropriate). Post-treatment sonographic and clinical assessment was conducted at one week, six weeks, and six months for closure, complications, and patient satisfaction. Clinical assessment of each patient was conducted at one year and then at yearly intervals for patient satisfaction. Results Post-procedure pain ( p radiofrequency ablation group. Improvements in venous clinical severity score were noted through six months in both groups (endovenous laser ablation 6.6 to 1; radiofrequency ablation 6.2 to 1) with no significant difference in venous clinical severity score ( p = 0.4066) or measured adverse effects; 89 endovenous laser ablation and 87 radiofrequency patients were interviewed at least 12 months out with a mean long-term follow-up of 44 and 42 months ( p = 0.1096), respectively. There were four treatment failures in each group, and every case was correctable with further treatment. Overall, there were no significant differences with regard to patient satisfaction between radiofrequency ablation and endovenous laser ablation ( p = 0.3009). There were no cases of deep venous thrombosis in either group at any time during this study. Conclusions Radiofrequency ablation and endovenous laser ablation are highly effective and safe from both anatomic and clinical standpoints over a multi-year period and neither modality achieved superiority over the other.

  18. ALLOTRANSPLANTATION OF MACROENCAPSULATED PARATHYROID CELLS IN SEVERE POSTSURGICAL HYPOPARATHYROIDISM: A CASE REPORT

    Directory of Open Access Journals (Sweden)

    V. Ja. Khryshchanovich

    2011-01-01

    Full Text Available The last therapeutic alternative in severe postsurgical hypoparathyroidism is allotransplantation of macroen- capsulated parathyroid cells. With this technique, it is possible to implant cells or tissue of parathyroid origin to replace them in such patients, without immusupression. We report an allotransplant of parathyroid cells in a patient with continous endovenous requirement of calcium to survive. The macroencapsulation was carried out with a polyvinylidine difluoride (PVDF. We implant ~100 000 parathyroid cells in the deep femoral artery. In this article, we show functionality of the graft for at least 3 months without requirement of endovenous calcium. We report this procedure as a therapeutical alternative in severe hypoparathyroidism. 

  19. Generation of sclerosant foams by mechanical methods increases the foam temperature.

    Science.gov (United States)

    Tan, Lulu; Wong, Kaichung; Connor, David; Fakhim, Babak; Behnia, Masud; Parsi, Kurosh

    2017-08-01

    Objective To investigate the effect of agitation on foam temperature. Methods Sodium tetradecyl sulphate and polidocanol were used. Prior to foam generation, the sclerosant and all constituent equipment were cooled to 4-25℃ and compared with cooling the sclerosant only. Foam was generated using a modified Tessari method. During foam agitation, the temperature change was measured using a thermocouple for 120 s. Results Pre-cooling all the constituent equipment resulted in a cooler foam in comparison with only cooling the sclerosant. A starting temperature of 4℃ produced average foam temperatures of 12.5 and 13.2℃ for sodium tetradecyl sulphate and polidocanol, respectively. It was also found that only cooling the liquid sclerosant provided minimal cooling to the final foam temperature, with the temperature 20 and 20.5℃ for sodium tetradecyl sulphate and polidocanol, respectively. Conclusion The foam generation process has a noticeable impact on final foam temperature and needs to be taken into consideration when creating foam.

  20. Conventional operation and laser therapy in the treatment of varicose veins

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Objective: To evaluate the effectiveness of endovenous laser therapy and conventional therapy on the varicose of great saphenous vein. Methods: Thirty-two patients received endovenous laser therapy and 32 patients were operated by conventional therapy (high ligation and stripping). The observation results of great saphenous vein(GSV) were recorded by clinical evaluation and duplex ultrasound examination. And the operating time, intraoperative blood loss, time to become moveable, duration of hospitalization and degree of feeling pain were compared between the two groups. Results: Compared with conventional therapy, laser therapy had good curative effect with less complications and no scars and no pains. There were significant differences between the two groups (P<0.01). Conclusion: Laser therapy for varicose of great saphenous vein is better than the conventional therapy. It deserves to be widely used in clinical treatment.

  1. Uso do fluconazol endovenoso no tratamento da endoftalmite fúngica endógena: relato de caso Intravenous fluconazole use in the treatment of fungic endogenous endophthalmitis: case report

    Directory of Open Access Journals (Sweden)

    Patrícia de Freitas Dotto

    2005-08-01

    Full Text Available Os autores descrevem um caso de endoftalmite endógena por Candida albicans, em recém-nascido prematuro, refratária ao tratamento com anfotericina B endovenosa e que apresentou resolução com o uso do fluconazol endovenoso. Ressaltam ainda os aspectos clínicos da endoftalmite endógena por Candida albicans por meio de revisão da literatura.The authors describe a case of endogenous Candida albicans endophthalmitis in one extremely low birth-weight newborn refractory to endovenous amphotericin B treatment that presented resolution with the use of endovenous fluconazole. Clinical aspects of endogenous Candida albicans endophthalmitis are also pointed out by a review of the literature.

  2. Cell-mediated immunity in patients with carcinoma under immunotheraphy

    International Nuclear Information System (INIS)

    Almeida, C.E.

    1985-01-01

    'In vivo' and 'in vitro' cellular immunity is evaluated in 32 patients with carcinoma under immunotheraphy with subcutaneous or endovenous glucan, transfer factor and levamisole. The immunotheraphy is done relatively by intradermal tests with common antigens, by sensitization with dinitrochlorinebenzene and lymphocytes culture from whole blood. The levels of blood serum of human T lymphotocyte soluble receptor for sheep erythrocytes are detected. (M.A.C.) [pt

  3. Modified Pair Technique for Treatment of Hydatid Cysts in the Spleen

    Directory of Open Access Journals (Sweden)

    Enver Zerem

    2005-08-01

    Full Text Available The aim of this study was to evaluate the results of single-session sclerotherapy with mixture of alcohol and polidocanol and a subsequent injection of albendazole for devisceration of hydatid cysts in the spleen. Eight patients (four women and four men, average age 22.9±11.4 with hydatid cyst in the spleen were treated with 10 minutes time of exposure to mixture of ethanol 95% and polidocanol 1%. After that, 2 to 5 ml of albendazole was injected into the cyst cavity. Two patients had 2 cysts. At follow-up the patients were examined with clinical and biochemical examinations, ultrasonography, and serologic test for echinococcal antibody titres. The mean hospital stay was 2.5±0.93 days. During the follow-up period, mean cyst diameter decreased from 46±16.4 mm to 13.6±16.26 mm. In all ten cysts, a reduction of post procedural recolection of fluid over 40% was observed. Five cysts (50% disappeared during the follow-up period. All cysts (5 smaller then 50 mm in diameter disappeared during follow-up period. After an initial rise, the echinococcal-an-tibody titres fell progressively and at the last follow-up were negative (< 1: 160 in 7 (88% patients. No complications were observed, except for pain, fever and urticaria during the first 24-hours after the procedure. Sclerotherapy using only one session and 10 min time of exposure to the mixture of ethanol and polidocanol, and a subsequent injection of al-bendasole solution represents an effective treatment of hydatid cysts in the spleen. This procedure is even more efficacious for hydatid cyst with diametar smaller then 50mm.

  4. Sclerotherapy for Reticular Veins in the Lower Limbs: A Triple-Blind Randomized Clinical Trial.

    Science.gov (United States)

    Bertanha, Matheus; Jaldin, Rodrigo Gibin; Moura, Regina; Pimenta, Rafael Elias Farres; Mariúba, Jamil Victor de Oliveira; Lúcio Filho, Carlos Eduardo Pinheiro; Alcantara, Giovana Piteri; Padovani, Carlos Roberto; Yoshida, Winston Bonetti; Sobreira, Marcone Lima

    2017-12-01

    Reticular veins are subdermal veins located in the lower limbs and are mainly associated with aesthetic complaints. Although sclerotherapy is the treatment of choice for reticular veins in the lower limbs, no consensus has been reached regarding to the optimal sclerosant. To compare the efficacy and safety of 2 sclerosants used to treat reticular veins: 0.2% polidocanol diluted in 70% hypertonic glucose (HG) (group 1) vs 75% HG alone (group 2). Prospective, randomized, triple-blind, controlled, parallel-group clinical trial with patients randomly assigned in a 1:1 ratio between the 2 treatment groups from March through December 2014, with 2 months' follow-up. The study was conducted in a single academic medical center. Eligible participants were all women, aged 18 to 69 years, who had at least 1 reticular vein with a minimum length of 10 cm in 1 of their lower limbs. The patients underwent sclerotherapy in a single intervention with either 0.2% polidocanol plus 70% HG or 75% HG alone to eliminate reticular veins. The primary efficacy end point was the disappearance of the reticular veins within 60 days after treatment with sclerotherapy. The reticular veins were measured on images obtained before treatment and after treatment using ImageJ software. Safety outcomes were analyzed immediately after treatment and 7 days and 60 days after treatment and included serious adverse events (eg, deep vein thrombosis and systemic complications) and minor adverse events (eg, pigmentation, edema, telangiectatic matting, and hematomas). Ninety-three women completed the study, median (interquartile range) age 43.0 (24.0-61.0) years for group 1 and 41.0 (27.0-62.0) years for group 2. Sclerotherapy with 0.2% polidocanol plus 70% HG was significantly more effective than with 75% HG alone in eliminating reticular veins from the treated area (95.17% vs 85.40%; P vein pigmentation length for group 1 and 7.09% for group 2, with no significant difference between the groups (P = .09

  5. Surface morphological modification of crosslinked hydrophilic co-polymers by nanosecond pulsed laser irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Primo, Gastón A.; Alvarez Igarzabal, Cecilia I. [IMBIV (CONICET), Departamento de Química Orgánica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Haya de la Torre y Medina Allende, Edificio de Ciencias II, Ciudad Universitaria, Córdoba X5000HUA (Argentina); Pino, Gustavo A.; Ferrero, Juan C. [INFIQC (CONICET), Departamento de Fisicoquímica, Facultad de Ciencias Químicas, and Centro Láser de Ciencias Moleculares, Universidad Nacional de Córdoba, Córdoba X5000IUS (Argentina); Rossa, Maximiliano, E-mail: mrossa@fcq.unc.edu.ar [INFIQC (CONICET), Departamento de Fisicoquímica, Facultad de Ciencias Químicas, and Centro Láser de Ciencias Moleculares, Universidad Nacional de Córdoba, Córdoba X5000IUS (Argentina)

    2016-04-30

    Graphical abstract: - Highlights: • Laser-induced surface modification of crosslinked hydrophilic co-polymers by ns pulses. • Formation of ablation craters observed under most of the single-pulse experimental conditions. • UV laser foaming of dried hydrogel samples resulting from single- and multiple-pulse experiments. • Threshold values of the incident laser fluence reported for the observed surface modifications. • Lower threshold fluences for acrylate-based, compared to acrylamide-based hydrogels. - Abstract: This work reports an investigation of the surface modifications induced by irradiation with nanosecond laser pulses of ultraviolet and visible wavelengths on crosslinked hydrophilic co-polymeric materials, which have been functionalized with 1-vinylimidazole as a co-monomer. A comparison is made between hydrogels differing in the base co-monomer (N,N-dimethylaminoethyl methacrylate and N-[3-(dimethylamino)propyl] methacrylamide) and in hydration state (both swollen and dried states). Formation of craters is the dominant morphological change observed by ablation in the visible at 532 nm, whereas additional, less aggressive surface modifications, chiefly microfoams and roughness, are developed in the ultraviolet at 266 nm. At both irradiation wavelengths, threshold values of the incident laser fluence for the observation of the various surface modifications are determined under single-pulse laser irradiation conditions. It is shown that multiple-pulse irradiation at 266 nm with a limited number of laser shots can be used alternatively for generating a regular microfoam layer at the surface of dried hydrogels based on N,N-dimethylaminoethyl methacrylate. The observations are rationalized on the basis of currently accepted mechanisms for laser-induced polymer surface modification, with a significant contribution of the laser foaming mechanism. Prospective applications of the laser-foamed hydrogel matrices in biomolecule immobilization are suggested.

  6. Central Retinal and Posterior Ciliary Artery Occlusion After Intralesional Injection of Sclerosant to Glabellar Subcutaneous Hemangioma

    International Nuclear Information System (INIS)

    Matsuo, Toshihiko; Fujiwara, Hiroyasu; Gobara, Hideo; Mimura, Hidefumi; Kanazawa, Susumu

    2009-01-01

    The aim of this study is to describe vision loss caused by central retinal artery and posterior ciliary artery occlusion as a consequence of sclerotherapy with a polidocanol injection to a glabellar hemangioma. An 18-year-old man underwent direct injection with a 23-gauge needle of 1 mL of a polidocanol-carbon dioxide emulsion into the glabellar subcutaneous hemangioma under ultrasound visualization of the needle tip by radiologists. He developed lid swelling the next day, and 3 days later at referral, the visual acuity in the left eye was no light perception. Funduscopy revealed central retinal artery occlusion and fluorescein angiography disclosed no perfusion at all in the left fundus, indicating concurrent posterior ciliary artery occlusion. The patient also showed mydriasis, blepharoptosis, and total external ophthalmoplegia on the left side. Magnetic resonance imaging demonstrated the swollen medial rectus muscle. In a month, blepharoptosis and ophthalmoplegia resolved but the visual acuity remained no light perception. Sclerosing therapy for facial hemangioma may develop a severe complication such as permanent visual loss.

  7. Short-term reconsultation, hospitalisation, and death rates after discharge from the emergency department in patients with acute heart failure and analysis of the associated factors. The ALTUR-ICA Study.

    Science.gov (United States)

    Miró, Òscar; Gil, Víctor; Martín-Sánchez, Francisco Javier; Herrero, Pablo; Jacob, Javier; Sánchez, Carolina; Xipell, Carolina; Aguiló, Sira; Llorens, Pere

    2018-03-09

    The aim of this study was to define the following in patients with acute heart failure (AHF) discharged directly from accident and emergency (A&E): rates of reconsultation to A&E and hospitalisation for AHF, and all-cause death at 30 days, rate of combined event at 7 days and the factors associated with these rates. The study included patients consecutively diagnosed with AHF during 2 months in 27 Spanish A&E departments who were discharged from A&E without hospitalisation. We collected 43 independent variables, monitored patients for 30 days and evaluated predictive factors for adverse events using Cox regression analysis. We evaluated 785 patients (78±9) years, 54.7% women). The rates of reconsultation, hospitalisation, and death at 30 days and the combined event at 7 days were: 26.1, 15.7, 1.7 and 10.6%, respectively. The independent factors associated with reconsultation were no endovenous diuretics administered in A&E (HR 2.86; 95% CI 2.01-4.04), glomerular filtration rate (GFR)<60ml/min/m 2 (1.94; 1.37-2.76) and previous AHF episodes (1.48; 1.02-2.13); for hospitalisation these factors were no endovenous diuretics in A&E (2.97; 1.96-4.48), having heart valve disease (1.61; 1.04-2.48), blood oxygen saturation at arrival to A&E<95% (1.60; 1.06-2.42); and for the combined event no endovenous diuretics in A&E (3.65; 2.19-6.10), GFR<60ml/min/m 2 (2.22; 1.31-3.25), previous AHF episodes (1.95; 1.04-3.25), and use of endovenous nitrates (0.13; 0.02-0.99). This is the first study in Spain to describe the rates of adverse events in patients with AHF discharged directly from A&E and define the associated factors. These data should help establish the most adequate approaches to managing these patients. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  8. Asthma of difficult handling, not all that hiss is asthma

    International Nuclear Information System (INIS)

    Pedraza, AM; Taffur, A; Larrota, M

    2000-01-01

    The paper tries about a patient of masculine sex 13 years old who consults initially for square that begins in February of 1999, consistent in cough, breathlessness and difficulty to breathe, he consults to one hospital where it is managed with beta two micronebulized, corticoids endovenous and oxygen being obtained improvement, reason why they give exit. Three days later he consults again for similar square; receiving the same treatment; a week later he presents cough and severe breathing difficulty, for that again consult and he is remitted to the Hospital San Rafael (Bogota) for no-improvement of the square. The paper includes the antecedents, exams, clinical evolution and paraclinics

  9. Cardiac hydatic cyst. Studied case by US, CT and MR. Quiste hidatidico cariaco. Presentacion de un caso estudiado por US, TC, y RM

    Energy Technology Data Exchange (ETDEWEB)

    Led, A.; Mazas-Artasona, L.; Cabello, A.; Arconada, J.A.; Balmaseda, C. (Complejo Hospitalario de la S.S. San Millan-San Pedro. Logrono (Spain))

    1993-01-01

    We present a cardiac hydatid cyst in a seventeen year-old male, who was operated on, five years ago, for hydatid disease in the lung and in the liver. In the follow-up a Computed Tomography was carried out in which an intracardiac rounded image was visible, showing to be non-enhancing after endovenous contrast injection. Due to this characteristic, the history of hydatid disease and the high incidence of this entity in our country, an intracardiac hydatid cyst was suspected. The diagnosis was reinforced by real-time echocardiography and Magnetic Nuclear Resonance, and confirmed in the surgical intervention. (Author)

  10. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Krogh, Thøger Persson; Bartels, Else Marie; Ellingsen, Torkell; Stengaard-Pedersen, Kristian; Buchbinder, Rachelle; Fredberg, Ulrich; Bliddal, Henning; Christensen, Robin

    2013-06-01

    Injection therapy with glucocorticoids has been used since the 1950s as a treatment strategy for lateral epicondylitis (tennis elbow). Lately, several novel injection therapies have become available. To assess the comparative effectiveness and safety of injection therapies in patients with lateral epicondylitis. Systematic review and meta-analysis. Randomized controlled trials comparing different injection therapies for lateral epicondylitis were included provided they contained data for change in pain intensity (primary outcome). Trials were assessed using the Cochrane risk of bias tool. Network (random effects) meta-analysis was applied to combine direct and indirect evidence within and across trial data using the final end point reported in the trials, and results for the arm-based network analyses are reported as standardized mean differences (SMDs). Seventeen trials (1381 participants; 3 [18%] at low risk of bias) assessing injection with 8 different treatments-glucocorticoid (10 trials), botulinum toxin (4 trials), autologous blood (3 trials), platelet-rich plasma (2 trials), and polidocanol, glycosaminoglycan, prolotherapy, and hyaluronic acid (1 trial each)-were included. Pooled results (SMD [95% confidence interval]) showed that beyond 8 weeks, glucocorticoid injection was no more effective than placebo (-0.04 [-0.45 to 0.35]), but only 1 trial (which did not include a placebo arm) was at low risk of bias. Although botulinum toxin showed marginal benefit (-0.50 [-0.91 to -0.08]), it caused temporary paresis of finger extension, and all trials were at high risk of bias. Both autologous blood (-1.43 [-2.15 to -0.71]) and platelet-rich plasma (-1.13 [-1.77 to -0.49]) were also statistically superior to placebo, but only 1 trial was at low risk of bias. Prolotherapy (-2.71 [-4.60 to -0.82]) and hyaluronic acid (-5.58 [-6.35 to -4.82]) were both more efficacious than placebo, whereas polidocanol (0.39 [-0.42 to 1.20]) and glycosaminoglycan (-0.32 [-1.02 to 0

  11. Air contamination in the sclerosing foam for the treatment of varicose veins.

    Science.gov (United States)

    de Franciscis, S; Nobile, Cga; Larosa, E; Montemurro, R; Serra, R

    2016-03-01

    Fluids and drugs formulated for intravenous infusion may potentially promote the growth of microorganisms that can cause infections. The aim of this study is to test the sterility of sclerosing foam. Polidocanol was used for the production of the foam. The Tessari method was used in order to generate the foam. The preparation was carried out both in the operating theater and in an outpatient room. A validation test with microorganisms was also performed. The measurements showed no evident growth of microorganisms and in the validation tests the foam appeared to even display bacteriostatic and/or bactericide properties. Sclerosing foam seems to be safe from a microbiological point of view. © The Author(s) 2014.

  12. From clinical evidence to everyday practice: implementing findings from a cost-effectiveness analysis for endoscopic injection therapy for upper-gastrointestinal bleeding.

    Science.gov (United States)

    Sitter, Helmut; Lorenz, Wilfried; Nicolay, Uwe; Krack, Walter; Hellenbrandt, Armin; Zielke, Andreas; Gajek, Hartwig; Ledertheil, Gertrud

    2003-03-01

    A previous upper-gastrointestinal bleeding trial showed that patients treated with repeated fibrin glue injection for upper-gastrointestinal bleeding have significantly less rebleeding than those treated with polidocanol. To analyse the cost and effectiveness of repeated fibrin glue injection and to investigate whether these results change physicians' attitudes. A retrospective random sample of five hospitals from the previous study, collection of cost identification, and follow-up data on 320 patients (155 in the polidocanol group, 165 in the fibrin glue group). An incremental cost-effectiveness analysis and comparison of outcomes was performed using chi-squared tests and Kaplan-Meier survival analysis. A survey was carried out using a questionnaire in the five hospitals on local guidelines for management of ulcer bleeding, and its results were analysed qualitatively. The measure of effectiveness is the number of prevented rebleedings. Further variables were length of hospital stay and length of intensive care unit (ICU) stay. The cost for the prevention of one additional rebleeding by repeated fibrin glue treatment amounts to 14,316 +/- 4981 euros (incremental cost-effectiveness ratio). There were no significant differences in length of stays in ICU or in hospital. The physicians did not change their management plans for patients with upper-gastrointestinal bleeding. In a survey, it was seen that other factors, such as local guidelines, attitudes towards new treatment options, and ease of handling of drugs, are more important than a result of a single study for a behavioural change of the doctors. The study was not designed prospectively to address a pharmacoeconomic question. As relevant variables (e.g. length of ICU stay) could not be reliably ascertained retrospectively, this may lead to biased estimates of the incremental cost-effectiveness ratio.

  13. The sapheno femoral junction involvement in the treatment of varicose veins disease

    Directory of Open Access Journals (Sweden)

    Stefano Ricci

    2017-07-01

    Full Text Available Sapheno femoral junction (SFJ incompetence has been considered the most important cause of chronic venous insufficiency in a high percent of cases since the beginning of history varicose veins treatment. As a consequence SFJ dissection, ligation and section has been practiced all along the last century, generally associated to great saphenous vein stripping, with the porpoise of stopping the effect of hydrostatic pressure considered the origin of varicose veins. Recurrence prevalence at the site of SFJ, even in correctly performed dissection suggests that this attitude may not be the ideal one. Moreover, with the introduction of catheter-based systems of endovenous heating of the great saphenous vein with radiofrequency or endovenous laser ablation, it was shown that venous ablation could be achieved without high ligation of the SFJ. Also foam sclerotherapy demonstrated good results, even if less effective, always leaving the SFJ untouched. Following this trend several methods have been suggested that spare the SFJ, so that this site have lost its strategical importance. In this review history of the SFJ involvement in the varicose vein strategy is analyzed with particular attention to the new generation methods, technology assisted, launched on the market.

  14. Mechanical Characterization and Numerical Modelling of Rubber Shockpads in 3G Artificial Turf

    Directory of Open Access Journals (Sweden)

    David Cole

    2018-02-01

    Full Text Available Third generation (3G artificial turf systems use in sporting applications is increasingly prolific. These multi-component systems are comprised of a range of polymeric and elastomeric materials that exhibit non-linear and strain rate dependent behaviours under the complex loads applied from players and equipment. To further study and better understand the behaviours of these systems, the development of a numerical model to accurately predict individual layers’ behaviour as well as the overall system response under different loading conditions is necessary. The purpose of this study was to characterise and model the mechanical behaviour of a rubber shockpad found in 3G artificial surfaces for vertical shock absorption using finite element analysis. A series of uniaxial compression tests were performed to characterise the mechanical behaviour of the shockpad. Compression loading was performed at 0.9 Hz to match human walking speeds. A Microfoam material model was selected from the PolyUMod library and optimised using MCalibration software before being imported into ABAQUS for analysis. A finite element model was created for the shockpad using ABAQUS and a compressive load applied to match that of the experimental data. Friction coefficients were altered to view the effect on the loading response. The accuracy of the model was compared using a series of comparative measures including the energy loss and root mean square error.

  15. Physiochemical properties and reproducibility of air-based sodium tetradecyl sulphate foam using the Tessari method.

    Science.gov (United States)

    Watkins, Mike R; Oliver, Richard J

    2017-07-01

    Objectives The objectives were to examine the density, bubble size distribution and durability of sodium tetradecyl sulphate foam and the consistency of production of foam by a number of different operators using the Tessari method. Methods 1% and 3% sodium tetradecyl sulphate sclerosant foam was produced by an experienced operator and a group of inexperienced operators using either a 1:3 or 1:4 liquid:air ratio and the Tessari method. The foam density, bubble size distribution and foam durability were measured on freshly prepared foam from each operator. Results The foam density measurements were similar for each of the 1:3 preparations and for each of the 1:4 preparations but not affected by the sclerosant concentration. The bubble size for all preparations were very small immediately after preparation but progressively coalesced to become a micro-foam (foams developed liquid more rapidly when made in a 1:3 ratio (37 s) than in a 1:4 ratio (45 s) but all combinations took similar times to reach 0.4 ml liquid formation. For all the experiments, there was no statistical significant difference between operators. Conclusions The Tessari method of foam production for sodium tetradecyl sulphate sclerosant is consistent and reproducible even when made by inexperienced operators. The best quality foam with micro bubbles should be used within the first minute after production.

  16. Supercritical transitiometry of polymers.

    Science.gov (United States)

    Randzio, S L; Grolier, J P

    1998-06-01

    Employing supercritical fluids (SCFs) during polymers processing allows the unusual properties of SCFs to be exploited for making polymer products that cannot be obtained by other means. A new supercritical transitiometer has been constructed to permit study of the interactions of SCFs with polymers during processing under well-defined conditions of temperature and pressure. The supercritical transitiometer allows pressure to be exerted by either a supercritical fluid or a neutral medium and enables simultaneous determination of four basic parameters of a transition, i.e., p, T, Δ(tr)H and Δ(tr)V. This permits determination of the SCF effect on modification of the polymer structure at a given pressure and temperature and defines conditions to allow reproducible preparation of new polymer structures. Study of a semicrystalline polyethylene by this method has defined conditions for preparation of new microfoamed phases with good mechanical properties. The low densities and microporous structures of the new materials may make them useful for applications in medicine, pharmacy, or the food industry, for example.

  17. Mucormycosis and bone scintillography of three phases. Case description

    International Nuclear Information System (INIS)

    Papadakis S, M.; Larrea R, E.; Carrasco R, C.A.; Garrido A, R.A.; Olmedo T, D.; Perez C, M.

    2007-01-01

    The purpose of presenting this work, besides the interest that shows the mucormycosis pathology not so frequent, it is to carry out a clinical correlation photographic with the imagenology, particularly with the bone scintillography. In the Nuclear Medicine Service it is carried out bone scintillography of three phases previous endovenous administration of 30 mCi (1110 MBq) of 99m Tc-MDP. The images are obtained with a gamma camera model Elscint APEX SPX, first each 2 seconds during the first minute, then early image to the 5 minutes and finally the late ones to the 3 hs. The bone scintillography in the phases 2 and 3 detects bigger radioactive density in left hemi side, with increment of the osteoblast activity mainly in the medial border and the floor of the orbit, in the malar bone and a little more tenuous in the superior maxillary. (Author)

  18. Varicose vein therapy and nerve lesions.

    Science.gov (United States)

    Hirsch, Tobias

    2017-03-01

    Treating varicose veins using endovenous thermal techniques - especially laser and radio frequency ablation - has emerged as an effective alternative to open surgery with stripping and high ligation. Even though these methods are very gentle and patient-friendly, they are nevertheless accompanied by risks and side effects. Compared to open surgical therapy, the risk of damage to peripheral and motor nerves is reduced; however, it still exists as a result of heat exposure and tumescent anaesthesia. Non-thermal methods that can be applied without tumescent anaesthesia have been introduced to the market. They pose a considerably lower risk of nerve lesions while proving to be much more effective. This paper investigates data on postoperative nerve damage and paraesthesia using internet research (PubMed). It analyses the current state of knowledge regarding non-thermal treatment methods and takes into account the latest developments in the use of cyanoacrylate to close insufficient saphenous veins.

  19. Preparation of carrier-free 67Ga, by irradiation of natural zinc with protons

    International Nuclear Information System (INIS)

    Fernandes, L.; Silva, C.P.G. da; Barbosa, M.F. de.

    1983-02-01

    A method for the preparation of carrier-free 67 Ga is described. Natural zinc plates were irradiated with protons. After a decay period of four days, the irradiated targets were dissolved in concentrated hydrochloric acid and the solution percolated through a glass column containing a cationic resin. 67 Ga was eluted with 3,5 N HCl; the eluted solution was evaporated to dryness, taken up in 3,8% sodium citrate solution and sterilized. Sterility tests were carried out according to the requirements of the U.S. Pharmacopeia. Chemical purity of 67 Ga citrate was determined by spot tests and by atomic absorption spectrophotometry. The radioactive purity was verified by gamma spectrometry. The product was endovenously injected into Wistar rats with experimental abcesses, and in a patient with adrenal neuroblastoma. The results shown a high accumulation of 67 Ga in soft tissue tumors. (Author) [pt

  20. Mucormycosis and bone scintillography of three phases. Case description; Mucormicosis y centelleografia osea de tres fases. Descripcion de un caso

    Energy Technology Data Exchange (ETDEWEB)

    Papadakis S, M; Larrea R, E; Carrasco R, C A; Garrido A, R A; Olmedo T, D; Perez C, M [Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, 14000 Mexico D.F. (Mexico)

    2007-07-01

    The purpose of presenting this work, besides the interest that shows the mucormycosis pathology not so frequent, it is to carry out a clinical correlation photographic with the imagenology, particularly with the bone scintillography. In the Nuclear Medicine Service it is carried out bone scintillography of three phases previous endovenous administration of 30 mCi (1110 MBq) of {sup 99m} Tc-MDP. The images are obtained with a gamma camera model Elscint APEX SPX, first each 2 seconds during the first minute, then early image to the 5 minutes and finally the late ones to the 3 hs. The bone scintillography in the phases 2 and 3 detects bigger radioactive density in left hemi side, with increment of the osteoblast activity mainly in the medial border and the floor of the orbit, in the malar bone and a little more tenuous in the superior maxillary. (Author)

  1. Varicose vein disease in children with klippel-trenaunay syndrome

    Directory of Open Access Journals (Sweden)

    Yu.O. Syniachenko

    2017-02-01

    Full Text Available The article presents a review of the literature, which describes the clinical picture and diagnosis of varicose vein disease in Klippel-Trenaunay syndrome, methods of treatment with intravenous and transcutaneous laser coagulation, endovenous radioablation, foam sclerotherapy of vessels and venectomy. There are underlined genetic defects in the genesis of the disease, the role of pro-inflammatory and immunoregulatory imbalance of cytokines, growth factors, cell adhesion molecules, matrix metalloproteinases etс. in pathogenic constructions of venous damage. This congenital vascular patho­logy is not as rare as it is commonly thought, and the patients suffering from this pathology since childhood are often being unsuccessfully treated in adulthood for varicose veins, elephantiasis and recurrent phlebothrombosis, when diagnosis of Klippel-Trenaunay syndrome have never previously established. This literature review has to attract the attention to the problem under discussion not only of pediatricians, but also of therapeutists and vascular surgeons-phlebologists.

  2. Venous Ulcers

    Science.gov (United States)

    Caprini, J.A.; Partsch, H.; Simman, R.

    2013-01-01

    Venous leg ulcers are the most frequent form of wounds seen in patients. This article presents an overview on some practical aspects concerning diagnosis, differential diagnosis and treatment. Duplex ultrasound investigations are essential to ascertain the diagnosis of the underlying venous pathology and to treat venous refluxes. Differential diagnosis includes mainly other vascular lesions (arterial, microcirculatory causes), hematologic and metabolic diseases, trauma, infection, malignancies. Patients with superficial venous incompetence may benefit from endovenous or surgical reflux abolition diagnosed by Duplex ultrasound. The most important basic component of the management is compression therapy, for which we prefer materials with low elasticity applied with high initial pressure (short-stretch bandages and Velcro-strap devices). Local treatment should be simple, absorbing and not sticky dressings keeping adequate moisture balance after debridement of necrotic tissue and biofilms are preferred. After the ulcer is healed compression therapy should be continued in order to prevent recurrence. PMID:26236636

  3. Preparation of radioactive colloidal gold 198Au

    International Nuclear Information System (INIS)

    Cammarosano, S.A.

    1979-01-01

    The preparation with simple equipment of radioactive colloidal gold of particle size about approximately 300 A from seed colloid stabilized by gelatine is described. Some physico-chemical parameters which can affect the process of formation of these colloidal particles are analysed; particle size has been meassured with an electron microscope. The colloid stability has been studied as a function of dilution, age and pH. Nucleation and growth of radioactive colloidal gold have been studied using spectrophotometry. Absorption spectra of the two ones are presented and compared. Quality control of the production process is verified through measurement of parameters, such as radioactive and radiochemical purity and biological distribution in laboratorial animals. This distribution was evalusted for rats injected endovenously with the gold colloidal solution.(Author) [pt

  4. Exacerbation of alopecia areata: A possible complication of sodium tetradecyl sulphate foam sclerotherapy treatment for varicose veins

    Directory of Open Access Journals (Sweden)

    Mark S Whiteley

    2017-05-01

    Full Text Available A 40-year-old woman with a history of alopecia areata related to stress or hormonal changes was treated for bilateral primary symptomatic varicose veins (CEAP clinical score C2S of pelvic origin, using a staged procedure. Her first procedure entailed pelvic vein embolisation of three pelvic veins using 14 coils and including foam sclerotherapy of the tributaries, using 3% sodium tetradecyl sulphate. Following this procedure, she had an exacerbation of alopecia areata with some moderate shedding of hair. Subsequently, she underwent endovenous laser ablation under local anaesthetic without incident. Seven months after the pelvic vein embolisation, she underwent foam sclerotherapy of leg and labial varicose veins using sodium tetradecyl sulphate. Two days following this procedure, she had a severe exacerbation of alopecia areata with gross shedding of hair. These two episodes of exacerbation of alopecia areata appear to be associated with sodium tetradecyl sulphate foam sclerotherapy of veins.

  5. Exacerbation of alopecia areata: A possible complication of sodium tetradecyl sulphate foam sclerotherapy treatment for varicose veins.

    Science.gov (United States)

    Whiteley, Mark S; Smith, Victoria C

    2017-01-01

    A 40-year-old woman with a history of alopecia areata related to stress or hormonal changes was treated for bilateral primary symptomatic varicose veins (CEAP clinical score C2S) of pelvic origin, using a staged procedure. Her first procedure entailed pelvic vein embolisation of three pelvic veins using 14 coils and including foam sclerotherapy of the tributaries, using 3% sodium tetradecyl sulphate. Following this procedure, she had an exacerbation of alopecia areata with some moderate shedding of hair. Subsequently, she underwent endovenous laser ablation under local anaesthetic without incident. Seven months after the pelvic vein embolisation, she underwent foam sclerotherapy of leg and labial varicose veins using sodium tetradecyl sulphate. Two days following this procedure, she had a severe exacerbation of alopecia areata with gross shedding of hair. These two episodes of exacerbation of alopecia areata appear to be associated with sodium tetradecyl sulphate foam sclerotherapy of veins.

  6. Clinical course and effective treatment of varicose vein of lower limb in diabetic patients

    Directory of Open Access Journals (Sweden)

    Yu.O. Syniachenko

    2017-02-01

    Full Text Available Background. Type 2 diabetes mellitus (DM2 is a risk factor for arteriosclerosis of the lower extremities, and the relationship with the state of the feet venous vascular territory remains insufficiently studied, the effectiveness of surgical treatment of patients with varicose veins is not defined. Objective: to analyze the clinical course of foot varicose veins and the effectiveness of medical measures on the background of DM2. Materials and methods. The study included 302 patients (227 men and 75 women aged 29–72 years old, 16 % of which had previous phlebothrombosis and the prevalece of II, III, IV, V and VI class of venous insufficiency was 10, 14, 37 16 and 23 %, respectively. 263 patients underwent endovenous laser coagulation, and 39 — the traditional phlebectomy and ligation of perforating veins. Results. Among the examined patients with varicose veins of lower extremities DM2 was diagnosed in 9 % of cases, more often in males and elderly patients on the background of atherosclerosis of the foot vessels (iliac, femoral, tibial, popliteal artery, which was accompanied by more frequent involvement of the great saphenous vein in the process and its gate extension, the prevalence of severe grades of venous insufficiency, significantly worse the results of surgical treatment of varicose veins and greater frequency of complications, despite more frequent using of rivaroxaban and low molecular weight heparins, and the effectiveness of endovenous laser ablation after four weeks of its implementation is inferior to that in the group without DM2, while glycemic index inversely correlated with the surface tension of the venous blood, which has prognostic significance in the context of future medical interventions. Conclusions. The presence of DM2 is a risk factor for more severe feet varicose veins, is a negative predictive factor in the effectiveness of surgical treatment of the disease and the complications number.

  7. [Early results after varicose vein surgery--a multicenter patient inquiry].

    Science.gov (United States)

    Hermanns, H-J

    2008-08-01

    Beside varicose vein surgery, endovenous procedures (endovenous laser therapy, VNUS and foam sclerotherapy) are now therapeutic options with the following advantages: low invasiveness, only out-patient operations, quick resumption of general activities. Whether or not classical vein surgery today still fulfills patient demands was analysed by a study group of German vascular surgeons (ANG) as a multicentre patient questioning. The questionnaire was subdivided into eight main complexes with 24 questions about the early results of stripping operations (from start of preparation until suture removal) and the patients answers were analysed. Answers with points (1-6) and free answers were possible. Between 1.1.2005 and 31.3.2005 18 centres for vascular surgery collected 1708 questionnaires from patients after stripping operations. The complex "preparation and information about the operation" was scored with 1.33 to 1.39. The "general organisation" of the vascular centre was scored between 1.22 and 1.30. "Pain after operation" was rated at 1.98 (immediately), 2.26 (first day) and 2.12 (third day after operation). Reasons for other problems after surgery were haematoma (3.09), problems with the compression dressing (1.67), circulatory collapse (1.51), headache (1.33), nausea (1.25). The total score for all centres was 1.47. The early results after varicose vein surgery are good up to very good. The patients' reconvalescence time is short and there is a quick resumption of general activities. The invasiveness of vein surgery seems to be overestimated. Comparative studies to evaluate the new methods are necessary. Benchmarking projects like this study are essential parts of current quality control systems.

  8. Post ablation recanalization of varicose veins of the limbs: Comparison ablation method of mechanochemical and laser procedure

    Science.gov (United States)

    Suhartono, R.; Irfan, W.; Wangge, G.; Moenadjat, Y.; Destanto, W. I.

    2017-08-01

    Endovenous ablation has been performed for varicose veins of the limbs in Indonesia since 2010. Endovenous laser ablation (EVLA) therapy has been performed in Cipto Mangunkusumo Hospital (RSCM) in Jakarta, and mechanochemical ablation (MOCA) has been conducted in Fatmawati Hospital. This was a descriptive analytical study, with a cross-sectional design to analyze post-ablation recanalization after MOCA and EVLA procedures. Patients who had undergone MOCA or EVLA treatment were interviewed 3-18 months after the procedures. All the patients underwent vascular ultrasonography (USG) of the operated limb to assess recanalization. Secondary presurgery data were obtained from the patients’ from patients’ medical records. The clinical characteristics of the subjects were recorded to compare the potential correlation between these characteristics and recanalization post-MOCA and EVLA procedures. All the data were analyzed using SPSS ver. 20.0. The study consisted of 43 limbs: 24 treated by MOCA and 19 treated by EVLA. Most subjects in the MOCA group were 7 mm in 13/19 extremities. In the MOCA group, total recanalization occurred in 2/24 extremities, and partial recanalization occurred in 8/24 extremities. In the EVLA group, total recanalization occurred in 1/19 extremities, and partial recanalization occurred in 3/19 extremities. The association between the clinical characteristics of the patients and recanalization was not statistically significant (p > 0.05). The recanalization tendency was higher in the MOCA group than in the EVLA group. Although there was no statistically significant association between the clinical characteristics of the patients and recanalization, the largest diameter of the VSM presurgery (>7 mm) was higher in 3/4 extremities in the MOCA group, as compared to 3/13 extremities in the EVLA group.

  9. [Foetal/neonatal alloimmune thrombocytopenia. A review and case report].

    Science.gov (United States)

    Rodríguez Wilhelmi, P; Aranguren, A; Muñiz, E; Aranburu, E; Ezpeleta, I; Ardanaz, M F; Ayape, M L

    2008-01-01

    Foetal/neonatal alloimmune thrombocytopenia is the most common cause of severe thrombocytopenia in the newborn. It is an acute disorder which implies that foetal platelets are destroyed during the pregnancy due to a maternal alloimmune IgG antibody. More than 80% of Caucasians are HPA-1a specific. Intracranial haemorrhage, which occurs in 30% of cases, is the most serious complication, with a 10% mortality rate or a 20% rate of irreversible neurological sequels. The high risk of a recurrence of serious bleeding in future pregnancies led us to consider prophylaxis or prenatal treatment. An early diagnosis of this process allows an effective therapy to be carried out based on the infusion of compatible phenotype HPA platelets or endovenous immunoglobulins. We present the case of a 27 year old pregnant woman, who in the 35th week of a second pregnancy was diagnosed using echography with a bilateral foetal hydrocephaly. After caesarean delivery in the 36th week, the newborn presented haematomas in the left shoulder and gluteus, macrocephalia with tension of the fontanellas and hemorrhagic cerebrospinal fluid after insertion of an external ventricular derivation catheter. The haemogram revealed a severe trombocytopenia (9 x 109/L). In the light of clinical suspicion of foetal/neonatal alloimmune thrombocytopenia, infusion was made of platelets from a non-phenotyped donor for the HPA-1a system, and an endovenous immunoglobulin treatment was followed, with a recovery of platelet counts, but with neurological sequels that are probably irreversible. The immunohaematologal study confirmed the negative HPA-1a maternal phenotype, the neonatal HPA-1a positive phenotype and the presence of anti-HPA-1a alloantibodies in the maternal serum. Nowadays, the prophylaxis and treatment continue to be a controversial issue that is open to discussion, as is the possibility of implementing antenatal screening.

  10. Foam Transport in Porous Media - A Review

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Z. F.; Freedman, Vicky L.; Zhong, Lirong

    2009-11-11

    Amendment solutions with or without surfactants have been used to remove contaminants from soil. However, it has drawbacks such that the amendment solution often mobilizes the plume, and its movement is controlled by gravity and preferential flow paths. Foam is an emulsion-like, two-phase system in which gas cells are dispersed in a liquid and separated by thin liquid films called lamellae. Potential advantages of using foams in sub-surface remediation include providing better control on the volume of fluids injected, uniformity of contact, and the ability to contain the migration of contaminant laden liquids. It is expected that foam can serve as a carrier of amendments for vadose zone remediation, e.g., at the Hanford Site. As part of the U.S. Department of Energy’s EM-20 program, a numerical simulation capability will be added to the Subsurface Transport Over Multiple Phases (STOMP) flow simulator. The primary purpose of this document is to review the modeling approaches of foam transport in porous media. However, as an aid to understanding the simulation approaches, some experiments under unsaturated conditions and the processes of foam transport are also reviewed. Foam may be formed when the surfactant concentration is above the critical micelle concentration. There are two main types of foams – the ball foam (microfoam) and the polyhedral foam. The characteristics of bulk foam are described by the properties such as foam quality, texture, stability, density, surface tension, disjoining pressure, etc. Foam has been used to flush contaminants such as metals, organics, and nonaqueous phase liquids from unsaturated soil. Ball foam, or colloidal gas aphrons, reportedly have been used for soil flushing in contaminated site remediation and was found to be more efficient than surfactant solutions on the basis of weight of contaminant removed per gram of surfactant. Experiments also indicate that the polyhedral foam can be used to enhance soil remediation. The

  11. Selective cell response on natural polymer bio-interfaces textured by femtosecond laser

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    Daskalova, A.; Trifonov, A.; Bliznakova, I.; Nathala, C.; Ajami, A.; Husinsky, W.; Declercq, H.; Buchvarov, I.

    2018-02-01

    This study reports on the evaluation of laser processed natural polymer-chitosan, which is under consideration as a biointerface used for temporary applications as skin and cartilage substitutes. It is employed for tissue engineering purposes, since it possesses a significant degree of biocompatibility and biodegradability. Chitosan-based thin films were processed by femtosecond laser radiation to enhance the surface properties of the material. Various geometry patterns were produced on polymer surfaces and employed to examine cellular adhesion and orientation. The topography of the modified zones was observed using scanning electron microscopy and confocal microscopy. Test of the material cytotoxicity was performed by evaluating the life/dead cell correlation. The obtained results showed that texturing with femtosecond laser pulses is appropriate method to initiate a predefined cellular response. Formation of surface modifications in the form of foams with an expansion of the material was created under laser irradiation with a number of applied laser pulses from N = 1-5. It is shown that irradiation with N > 5 results in disturbance of microfoam. Material characterization reveals a decrease in water contact angle values after laser irradiation of chitosan films. Consequently, changes in surface roughness of chitosan thin-film surface result in its functionalization. Cultivation of MC3T3 and ATMSC cells show cell orientational migration concerning different surface patterning. The influence of various pulse durations (varying from τ = 30-500 fs) over biofilms surface was examined regarding the evolution of surface morphology. The goal of this study was to define the optimal laser conditions (laser energy, number of applied pulses, and pulse duration) to alter surface wettability properties and porosity to improve material performance. The acquired set of results indicate the way to tune the surface properties to optimize cell-interface interaction.

  12. Novel approaches for the management of tendinopathy.

    Science.gov (United States)

    Maffulli, Nicola; Longo, Umile Giuseppe; Denaro, Vincenzo

    2010-11-03

    Tendinopathy is a failed healing response of the tendon. Despite an abundance of therapeutic options, very few randomized prospective, placebo-controlled trials have been carried out to assist physicians in choosing the best evidence-based management. Eccentric exercises have been proposed to promote collagen fiber cross-link formation within the tendon, thereby facilitating tendon remodeling. Overall results suggest a trend for a positive effect of eccentric exercises, with no reported adverse effects. Combining eccentric training and shock wave therapy produces higher success rates compared with eccentric loading alone or shock wave therapy alone. The use of injectable substances such as platelet-rich plasma, autologous blood, polidocanol, corticosteroids, and aprotinin in and around tendons is popular, but there is minimal clinical evidence to support their use. The aim of operative treatment is to excise fibrotic adhesions, remove areas of failed healing, and make multiple longitudinal incisions in the tendon to detect intratendinous lesions and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New operative procedures include endoscopy, electrocoagulation, and minimally invasive stripping. The aim of these techniques is to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. Randomized controlled trials are necessary to better clarify the best therapeutic options for the management of tendinopathy.

  13. Costos del tratamiento de las telangiectasias y várices tronculares con escleroterapia con espuma en el Hospital "Freyre de Andrade" de La Habana

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    Anai García Fariñas

    2013-03-01

    Full Text Available Objetivo: determinar cuánto cuesta por paciente el tratamiento de várices por la técnica de escleroterapia con espuma en la consulta externa de Angiología y Cirugía Vascular del Hospital C.Q. "Freyre de Andrade". Método: evaluación económica del tipo descripción de costo. Se estudió el costo directo institucional del tratamiento ambulatorio para várices en extremidades inferiores con escleroterapia con espuma y donde el principio activo fue Polidocanol al 0,5% a una dosis de 2ml. Se emplearon las partidas recursos humanos, material gastable y medicamento. Se determinó el costo promedio por paciente, total y según tipo de consulta. Resultados: el costo total por paciente atendido fue de 68,60 pesos cubanos. El costo medio por paciente de la consulta de clasificación fue de 0,18 centavos de pesos cubanos (DS 95%= 0,12. El costo medio de la consulta de tratamiento fue de 50,60 pesos cubanos (DS 95%=7,65. No hubo diferencias significativas entre los diferentes tipos de varices a tratar. Conclusiones: el costo directo institucional del tratamiento de telangiectasias y varices tronculares con escleroterapia con espuma fue similar. A corto plazo, el tratamiento de las várices con escleroterapia con espuma genera menores costos que la opción quirúrgica.

  14. EFEITO DA RANITIDINA E DO OMEPRAZOL SOBRE O pH GÁSTRICO EM CÃES

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    Silvio Abrahão

    1999-01-01

    Full Text Available O objetivo deste trabalho foi investigar o efeito da ranitidina e omeprazol sobre o pH gástrico em 24 cães adultos, machos, sem raça definida, distribuídos em 3 grupos: grupo A - controle, grupo B - ranitidina e grupo C - omeprazol. O pH gástrico foi medido, após coleta do suco gástrico, com seringa, em cães submetidos a gastrotomia. Esta medida foi feita no grupo controle nos tempos zero, 30, 60, 90 e 120 minutos, no grupo ranitidina a medida foi feita no tempo zero, seguida de aplicação de 0,85 mg/kg de ranitidina por via endovenosa, sendo realizada nova medida nos tempos 30, 60, 90 e 120 minutos e, no grupo omeprazol a medida foi feita no tempo zero, seguida de aplicação de 0,68 mg/kg de omeprazol por via endovenosa, sendo realizada nova medida nos tempos 30,60, 90 e 120 minutos. A comparação entre os grupos mostrou um aumento significante do pH gástrico após o uso de ranitidina e omeprazol. Entretanto, os efeitos comparados da ranitidina e omeprazol não apresentaram diferenças significantes na variação do pH.The aim of this work was the ranitidine and omeprazole gastric pH effect investigation. 24 adults, male, mongrel dogs were distributed in 3 groups: group A - control, group B - ranitidine and group C - omeprazole. Gastric pH was measured after gastric juice syringe collection in dogs submitted to gastrotomy. Control group measurements were done at times zero, 30, 60, 90 and 120 minutes. Ranitidine group measurements were done at time zero, followed by 0,85 mg/kg endovenous ranitidine, and also at times 30, 60, 90 and 120 minutes. Omeprazole group measurements were done at time zero, followed by 0,68 mg/kg endovenous omeprazole and also at times 30, 60, 90 and 120 minutes. A significant increase in gastric pH, was observed, comparing groups, after ranitidine and omeprazole use. However, ranitidine and omeprazole compared effects presented no significant differences in pH variation.

  15. Impact of UK NICE clinical guidelines 168 on referrals to a specialist academic leg ulcer service.

    Science.gov (United States)

    Davies, Huw Ob; Popplewell, Matthew; Bate, Gareth; Kelly, Lisa; Darvall, Katy; Bradbury, Andrew W

    2018-03-01

    Background Leg ulcers are a common cause of morbidity and disability and result in significant health and social care expenditure. The UK National Institute for Health and Care Excellence (NICE) Clinical Guideline (CG)168, published in July 2013, sought to improve care of patients with leg ulcers, recommending that patients with a break in the skin below the knee that had not healed within two weeks be referred to a specialist vascular service for diagnosis and management. Aim Determine the impact of CG168 on referrals to a leg ulcer service. Methods Patients referred with leg ulceration during an 18-month period prior to CG168 (January 2012-June 2013) and an 18-month period commencing six months after (January 2014-June 2015) publication of CG168 were compared. Results There was a two-fold increase in referrals (181 patients, 220 legs vs. 385 patients, 453 legs) but no change in mean age, gender or median-duration of ulcer at referral (16.6 vs. 16.2 weeks). Mean-time from referral to specialist appointment increased (4.8 vs. 6 weeks, p = 0.0001), as did legs with superficial venous insufficiency (SVI) (36% vs. 44%, p = 0.05). There was a trend towards more SVI endovenous interventions (32% vs. 39%, p = 0.271) with an increase in endothermal (2 vs. 32 legs, p = 0.001) but no change in sclerotherapy (24 vs. 51 legs) treatments. In both groups, 62% legs had compression. There was a reduction in legs treated conservatively with simple dressings (26% vs. 15%, p = 0.0006). Conclusions Since CG168, there has been a considerable increase in leg ulcer referrals. However, patients are still not referred until ulceration has been present for many months. Although many ulcers are multi-factorial and the mainstay of treatment remains compression, there has been an increase in SVI endovenous intervention. Further efforts are required to persuade community practitioners to refer patients earlier, to educate patients and encourage further investment in

  16. Endoluminal laser delivery mode and wavelength effects on varicose veins in an ex vivo model.

    Science.gov (United States)

    Massaki, Ane B M N; Kiripolsky, Monika G; Detwiler, Susan P; Goldman, Mitchel P

    2013-02-01

    Endovenous laser ablation (EVLA) has been shown to be effective for the elimination of saphenous veins and associated reflux. Mechanism is known to be heat related, but precise way in which heat causes vein ablation is not completely known. This study aimed to determine the effects of various endovenous laser wavelengths and delivery modes on ex vivo human vein both macroscopically and microscopically. We also evaluated whether protected-tip fibers, consisting of prototype silica fibers with a metal tube over the distal end, reduced vein wall perforations compared with non-protected-tip fibers. An ex vivo EVLA model with human veins harvested during ambulatory phlebectomy procedures was used. Six laser fiber combinations were tested: 810 nm continuous wave (CW) diode laser with a flat tip fiber, 810 CW diode laser with a protected tip fiber, 1,320 nm pulsed Nd:YAG laser, 1,310 nm CW diode laser, 1,470 nm CW diode laser, and 2,100 nm pulsed Ho:YAG laser. Perforation or full thickness necrosis of a portion of the vein wall was observed in 5/11 (45%), 0/11 (0%), 3/22 (14%), 7/11 (64%), 4/6 (67%), and 5/10 (50%) of cross-sections of veins treated with the 810 nm CW diode laser with a flat tip fiber, the 810 CW diode laser with a protected tip fiber, the 1,320 nm pulsed Nd:YAG laser, the 1,310 nm CW diode laser, the 1,470 nm CW diode laser, and the 2,100 nm pulsed Ho:YAG laser, respectively. Our results have shown that the delivery mode, pulsed Nd:YAG versus CW, may be just as important as the wavelength. Therefore, the 1,310 nm CW laser may not be equivalent to the 1,320 nm pulsed laser. In addition, protected 810 nm fibers may be less likely to yield wall perforations than their non-protected counterparts. Copyright © 2012 Wiley Periodicals, Inc.

  17. A survey of current practice of vascular surgeons in venous disease management.

    Science.gov (United States)

    Bush, Ruth L; Gloviczki, Peter

    2013-01-01

    Acute venous thromboembolism and chronic venous diseases are common conditions that affect a large proportion of the United States population. The diagnosis of venous disease has improved, and the treatment options have rapidly evolved over the past decade. To date, it is unclear to what extent vascular surgeons have become involved in the modern management of venous disorders. This survey was undertaken to explore the current interest and practice of vascular surgeons in the contemporary care of venous disease. A survey was administered via a web-based platform to active and candidate members of the Society for Vascular Surgery (SVS). The survey included 30 questions investigating the characteristics of venous surgeons and scope of venous practice. Open-ended questions were also included for commentary. A total of 1879 surveys were sent to SVS members nationwide, and 385 members participated (response rate of 20.5%). The participants were mostly men (89.6%) with 37.7% practicing in an academic setting and 59.2% in private practice. The respondents treated superficial veins (92.9%) and deep veins (85.8%) in clinical practice, with 89.9% having their own vascular laboratory. A wide spectrum of interventions for superficial (91.9%), deep (85.8%), and perforator veins (52.7% endovenous, 19.4% subfascial endoscopic perforator surgery) are being performed by respondents. Only 26.2% had learned endovenous thermal ablation in their training program; however, over 96% of those performing venous interventions utilized this technique. Overall, the majority (85.5%) devoted 50% or less of practice to venous disorders. Respondents indicated that limitations to expansion of vein practices mainly involved challenges with third party payers, local competition, and existing large volumes of arterial interventions needing to be performed. Despite the widespread incorporation of venous disease into current vascular practices, 66.1% are not members of the American Venous Forum (AVF

  18. Standard guidelines for care: Sclerotherapy in dermatology

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    Niti Khunger

    2011-01-01

    Full Text Available Definition: Sclerotherapy is defined as the targeted elimination of small vessels, varicose veins and vascular anomalies by the injection of a sclerosant. The aim of sclerotherapy is to damage the vessel wall and transform it into a fibrous cord that cannot be recanalized. It is a simple, cost-effective, efficacious and esthetically acceptable modality for both therapeutic and esthetic purposes. Indications: Therapeutic indications include varicose veins and vascular malformations. Esthetic indications include telangiectasias and reticular veins. In the management of varicose veins, it may need to be combined with other surgical methods of treatment, such as ligation of the saphenofemoral junction, stab ligation of perforators and stripping. A surgical opinion may be necessary. Methodology: A thorough knowledge of the anatomy and physiology of the venous system of the legs, basic principles of venous insufficiency, methods of diagnosis and, in addition, uses, mechanisms of action and complications of sclerosing agents and proper compression techniques are important pre-requisites to successful sclerotherapy. Although various sclerosing agents are available, polidoconal and sodium tetradecyl sulfate are most commonly used. More recently, these sclerosants have been used in microfoam form for increased efficacy. The basic principle of a successful sclerotherapy technique is the use of an optimal volume and concentration of the sclerosant according to the size of the vessel. The sclerosant is injected carefully into the vessel and compression is applied. Contraindications: Contraindications include superficial and deep venous thrombosis, sapheno-femoral junction incompetence, pregnancy, myocardial decompensation, migraine, hypercoagulable state, serious systemic illness, dependency edema, immobility, arterial disease, diabetes mellitus and allergic reactions to sclerosants. Complications: While sclerotherapy is usually a safe procedure

  19. Combination therapy of hyaluronic acid mesotherapic injections and sclerotherapy for treatment of lower leg telangiectasia without major venous insufficiency: a preliminary clinical study.

    Science.gov (United States)

    Iannitti, Tommaso; Rottigni, Valentina; Torricelli, Federica; Palmieri, Beniamino

    2014-04-01

    Telangiectasia is the dilation of dermal capillaries mainly due to hypertension and vein insufficiency. Treatments of choice for this condition are sclerotherapy with foam liquid or intradermal fiber optic laser energy delivery. The aim of this study was to assess the efficacy of a new therapeutic approach consisting in the use of polymerized hyaluronic acid mesotherapic injections following sclerotherapy in the areas of the skin affected by telangiectasia in patients without major vein insufficiency. A total of 20 women, aged between 19 and 64 years, affected by recurrent lower leg telangiectasia, were included in this study. Patients were preliminarily submitted to echo color Doppler sonography to rule out severe saphenofemoral valve and lower limb major vein insufficiency. All patients underwent 3 sessions a month of polidocanol 1% capillary injections for 2 months. This was followed by 0.1 ml cross-linked hyaluronic acid introduction in the polidocanol 1% needle track. A total of 50 mesotherapic injections (0.05 ml each) were performed on the skin surface where an ice pack was previously applied for 4 to 5 minutes. A follow-up visit was performed at 3 months. The results, based on photographic examination, were rated as follows: poor improvement (0%-50%), good improvement (51%-75%), and very good improvement (76%-100%). The side effects of the clinical procedure, in terms of pain, itching, paresthesia, ecchymosis, and relapse of telangiectasia over the treated skin surface, as well as a persisting pigmentation in the injection spots and induced benefits related to leg heaviness and comfort, were recorded. In total, 6 patients displayed a slight venous insufficiency, 3 patients displayed patent venous insufficiency, and 11 patients did not show any venous insufficiency. Before treatment, itching was present in 18 out of 20 patients, paresthesia in 15 out of 20 patients, ecchymosis in 16 out of 20 patients, and leg heaviness in 15 out of 20 patients. At the 3

  20. Costos del tratamiento de las telangiectasias y várices tronculares con escleroterapia con espuma en el Hospital "Freyre de Andrade" de La Habana Cost of the treatment of t elangiectases and varicose veins with foam sclerotherapy in ¨Freyre de Andrade¨hospital in Havana

    Directory of Open Access Journals (Sweden)

    Anai García Fariñas

    2013-03-01

    Full Text Available Objetivo: determinar cuánto cuesta por paciente el tratamiento de várices por la técnica de escleroterapia con espuma en la consulta externa de Angiología y Cirugía Vascular del Hospital C.Q. "Freyre de Andrade". Método: evaluación económica del tipo descripción de costo. Se estudió el costo directo institucional del tratamiento ambulatorio para várices en extremidades inferiores con escleroterapia con espuma y donde el principio activo fue Polidocanol al 0,5% a una dosis de 2ml. Se emplearon las partidas recursos humanos, material gastable y medicamento. Se determinó el costo promedio por paciente, total y según tipo de consulta. Resultados: el costo total por paciente atendido fue de 68,60 pesos cubanos. El costo medio por paciente de la consulta de clasificación fue de 0,18 centavos de pesos cubanos (DS 95%= 0,12. El costo medio de la consulta de tratamiento fue de 50,60 pesos cubanos (DS 95%=7,65. No hubo diferencias significativas entre los diferentes tipos de varices a tratar. Conclusiones: el costo directo institucional del tratamiento de telangiectasias y varices tronculares con escleroterapia con espuma fue similar. A corto plazo, el tratamiento de las várices con escleroterapia con espuma genera menores costos que la opción quirúrgica.Objective: to determine the cost of the treatment of varicose veins per patient with the foam sclerotherapy in the angiology and vascular surgery outpatient service of ¨Freyre de Andrade¨ clinical and surgical hospital. Method: a cost description-type economic assessment. The institutional direct cost of the leg varicose veins treatment with foam sclerotherapy at the outpatient service, using the active principle called 0.5% polidocanol at a dose of 2 ml, was studied. The variables were human resources, disposable materials and drugs. The average cost per patient, the total cost and type of service-depending cost were all estimated. Results: the total cost per patient was 68.60 Cuban

  1. Less promising results with sclerosing ethoxysclerol injections for midportion achilles tendinopathy: a retrospective study.

    Science.gov (United States)

    van Sterkenburg, Maayke N; de Jonge, Milko C; Sierevelt, Inger N; van Dijk, C Niek

    2010-11-01

    Local injections of the sclerosing substance polidocanol (Ethoxysclerol) have shown good clinical results in patients with chronic midportion Achilles tendinopathy. After training by the inventors of the technique, sclerosing Ethoxysclerol injections were applied on a group of patients in our center. Sclerosing Ethoxysclerol injections will yield good results in the majority of patients. Case series; Level of evidence, 4. In 113 patients (140 tendons) with Achilles tendinopathy, we identified 62 patients (70 tendons) showing neovascularization on color Doppler ultrasound. Fifty-three Achilles tendons (48 patients) were treated with sclerosing Ethoxysclerol injections, with intervals of 6 weeks and a maximum of 5 sessions. Treatment was completed when neovascularization or pain had disappeared, or when there was no positive treatment effect after 3 to 4 sessions. Forty-eight patients (20 women and 28 men) with a median age of 45 years, (range, 33-68 years) were treated. Median symptom duration was 23 months (range, 3-300 months). Fifty-three tendons were treated with a median of 3 sessions of Ethoxysclerol injections. Six weeks after the last injection, 35% of patients had no complaints, 9% had minimal symptoms, 42% were the same, and 14% had more complaints. Women were 3.8 times (95% confidence interval: 1.1-13.8) more likely to have unsatisfactory outcome than men. Pain correlated positively with neovessels on ultrasound (P < .01). At 2.7 to 5.1 year follow-up, 53% had received additional (surgical/conservative) treatment; 3 of these patients (7.5%) still had complaints of Achilles tendinopathy. In 6 patients, complaints that were still present 6 weeks after treatment had resolved spontaneously by final follow-up. Our study did not confirm the high beneficial value of sclerosing neovascularization in patients with midportion Achilles tendinopathy. Despite the retrospective design of our study, we consider it important to stress that injection of Ethoxysclerol may

  2. Flexible video-endsocopic injection sclerotherapy for second and third degree internal hemorrhoids

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    Sandeep Nijhawan

    2011-01-01

    Full Text Available Background and objectives: Bleeding from hemorrhoids is the commonest cause of rectal bleeding in adults. Injection sclerotherapy of internal hemorrhoids is one of the non-surgical treatments, and is simple, safe and feasible. Conventionally sclerotherapy is performed with rigid proctoscope which has limitations of maneuverability, narrower field of vision and documentation compared to flexible videoendoscope. Therefore, we assessed the efficacy and safety of video-colonoscopic sclerotherapy for bleeding internal hemorrhides. Methods: Seventy-nine patients of bleeding internal hemorrhoids were subjected to colonoscopic sclerotherapy using 1.5% polidocanol in retroflexed or forward viewing positions. Success of treatment was defined as cessation of bleeding for six weeks. Patients were observed for complications and were followed up regularly for 3 months. Results: A total of 79 evaluable patients, 61 had grade II and 18 had grade III hemorrhoids. There was no statistically significant differences in achieving excellent or good results for control of bleeding between patients with grade II and grade III hemorrhoids (100% vs 94,5%; p>0.05. The number of sessions of sclerotherapy required were significantly more in grade II than grade III hemorrhoids (1.1 ± 0.3 vs 1.3 ± 0.7; p = 0.04. No significant complications were noted except for bloating in ten patients (12.6 % and rectal pain in 6 (7.6% patients. Median time taken for the procedure was 30 minutes. Conclusions: Video-endoscopic sclerotherapy is safe, well-tolerated and effective treatment for bleeding internal hemorrhoids.

  3. New options in the management of tendinopathy

    Science.gov (United States)

    Maffulli, Nicola; Longo, Umile Giuseppe; Loppini, Mattia; Spiezia, Filippo; Denaro, Vincenzo

    2010-01-01

    Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an “acute tendinopathy” is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic lesion, but act only to denervate them. They include endoscopy, electrocoagulation, and minimally invasive stripping. Further randomized controlled trials are necessary to clarify better the best therapeutic options for the management of tendinopathy. PMID:24198540

  4. New options in the management of tendinopathy

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    Nicola Maffulli

    2010-03-01

    Full Text Available Nicola Maffulli1, Umile Giuseppe Longo2, Mattia Loppini2, Filippo Spiezia2, Vincenzo Denaro21Centre for Sports and Exercise Medicine, Queen Mary University of London, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, England; 2Department of Orthopedic and Trauma Surgery, Campus Biomedico University, Rome, ItalyAbstract: Tendon injuries can be acute or chronic, and caused by intrinsic or extrinsic factors, either alone or in combination. Tendinopathies are a common cause of disability in occupational medicine and account for a substantial proportion of overuse injuries in sports. Tendinopathy is essentially a failed healing response, with haphazard proliferation of tenocytes, abnormalities in tenocytes, with disruption of collagen fibres and subsequent increase in noncollagenous matrix. The scientific evidence base for managing tendinopathies is limited. What may appear clinically as an “acute tendinopathy” is actually a well advanced failure of a chronic healing response in which there is neither histologic nor biochemical evidence of inflammation. In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections and surgery. Open surgery aims to excise fibrotic adhesions, remove areas of failed healing and make multiple longitudinal incisions in the tendon to detect intratendinous lesions, and to restore vascularity and possibly stimulate the remaining viable cells to initiate cell matrix response and healing. New surgical techniques aim to disrupt the abnormal neoinnervation to interfere with the pain sensation caused by tendinopathy. These procedures are intrinsically different from the classical ones in present use, because they do not attempt to address directly the pathologic

  5. Comparison of Local Sclerotherapy With Lauromacrogol Versus Nasal Packing in the Treatment of Anterior Epistaxis.

    Science.gov (United States)

    Farneti, Paolo; Pasquini, Ernesto; Sciarretta, Vittorio; Macrì, Giovanni; Gramellini, Giulia; Pirodda, Antonio

    2016-06-01

    Epistaxis is one of the most common otorhinolaryngologic emergencies representing more than 12% of conditions managed at the Ear, Nose and Throat (ENT) Emergency Consulting Room of our Otorhinolaryngologic Unit each year. The elevated frequency of this pathology makes it necessary to adopt the most effective and least expensive therapeutic strategy available. The aim of this study was to compare the efficacy, costs and morbidity of nasal packing (NP), which is the mainstay of treatment for anterior epistaxis in our ENT Emergency Consulting Room versus submucosal infiltrations of lauromacrogol (LA). A retrospective study was designed from August 2012 to April 2013 involving 53 patients suffering from anterior epistaxis. Anterior NP was used in 27 patients versus 26 patients undergoing 27 procedures performed with submucosal infiltrations of LA (or polidocanol). Outcomes for each treatment were evaluated. Patients in group 1 were treated with LA 400 injection next to the bleeding point: 0.5- to 1-mL single or multiple infiltrations with a 27-gauge needle. The whitening of the nasal mucosa around the bleeding point during infiltration was considered a marker of correct procedure in order to achieve the best results. Bilateral treatment was also performed at the same time. Patients in group 2 were treated with standard NP. Bleeding recurrence was higher in the NP group even if it was not statistically significant (P=0.2935). However, the LA infiltrations were better tolerated with lower morbidity and costs as compared to NP. No complications were observed in either group. LA infiltrations were shown to be a viable alternative in anterior epistaxis treatment. They are safe, easy to use with good efficacy and have a low cost.

  6. Timing and modality of the sclerosing agents binding to the human proteins: laboratory analysis and clinical evidences

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    Lorenzo Tessari

    2014-07-01

    Full Text Available Sclerosing agents (SA are blood inactivated. Nevertheless, investigations concerning the interaction among SA and blood components have never been deeply investigated. Aim of the study is to precisely identify SA blood ligands, to determine their binding time and to highlight the clinical consequences. Thirty-one blood samples were collected from chronic venous disease patients and tested by capillary and agarose gel (AGE electrophoresis before and after adding polidocanol (POL and sodiumtetradecylsulphate (STS. The two different types of electrophoresis allowed an evaluation of the blood proteins binding with the sclerosing agents, with a reaction time lower than 8 seconds for the AGE. Subsequently six patients underwent foam sclerotherapy and then were subdivided in group A (4 patients and B (2 patients. In group A blood sample was obtained from the ipsilateral brachial vein immediately before (T0 and repeated 1, 3, 5, and 10 minutes after injection of STS 3% injection into the GSV. In group B, the same procedure was performed with the same timing from the ipsilateral femoral vein. Free STS (fSTS and total proteinbound STS (bSTS were measured. POL mainly binds to β-globulins (11%, while STS to albumin and α-globulins (62.6% and 30.7% on the protidogram, respectively. Both in the brachial and in the femoral vein, the average fSTS was always 0. STS binds to albumin (62.6% and α-globulins (30.7%, while POL is bound mainly by the b-globulins (11%. The present paper demonstrates how the vast majority of the sclerosing agent is bound to the blood proteins, suggesting the need to look for possible sclerotherapy complications factors also in the used gas and/or in the subsequent cathabolites release.

  7. Venous ulcers of the lower limb: Where do we stand?

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    Chatterjee S Sasanka

    2012-01-01

    Full Text Available Venous ulcers are the most common ulcers of the lower limb. It has a high morbidity and results in economic strain both at a personal and at a state level. Chronic venous hypertension either due to primary or secondary venous disease with perforator paucity, destruction or incompetence resulting in reflux is the underlying pathology, but inflammatory reactions mediated through leucocytes, platelet adhesion, formation of pericapillary fibrin cuff, growth factors and macromolecules trapped in tissue result in tissue hypoxia, cell death and ulceration. Duplex scan with colour flow is the most useful investigation for venous disease supplying information about patency, reflux, effects of proximal and distal compression, Valsalva maneuver and effects of muscle contraction. Most venous disease can be managed conservatively by leg elevation and compression bandaging. Drugs of proven benefit in venous disease are pentoxifylline and aspirin, but they work best in conjunction with compression therapy. Once ulceration is chronic or the patient does not respond to or cannot maintain conservative regime, surgical intervention treating the underlying venous hypertension and cover for the ulcer is necessary. The different modalities like sclerotherapy, ligation and stripping of superficial varicose veins, endoscopic subfascial perforator ligation, endovenous laser or radiofrequency ablation have similar long-term results, although short-term recovery is best with radiofrequency and foam sclerotherapy. For deep venous reflux, surgical modalities include repair of incompetent venous valves or transplant or transposition of a competent vein segment with normal valves to replace a post-thrombotic destroyed portion of the deep vein.

  8. Conditioned Medium of Bone Marrow-Derived Mesenchymal Stromal Cells as a Therapeutic Approach to Neuropathic Pain: A Preclinical Evaluation

    Directory of Open Access Journals (Sweden)

    Kelly Barbosa Gama

    2018-01-01

    Full Text Available Neuropathic pain is a type of chronic pain caused by injury or dysfunction of the nervous system, without effective therapeutic approaches. Mesenchymal stromal cells (MSCs, through their paracrine action, have great potential in the treatment of this syndrome. In the present study, the therapeutic potential of MSC-derived conditioned medium (CM was investigated in a mouse model of neuropathic pain induced by partial sciatic nerve ligation (PSL. PSL mice were treated by endovenous route with bone marrow-derived MSCs (1 × 106, CM, or vehicle. Gabapentin was the reference drug. Twelve hours after administration, neuropathic mice treated with CM exhibited an antinociceptive effect that was maintained throughout the evaluation period. MSCs also induced nonreversed antinociception, while gabapentin induced short-lasting antinociception. The levels of IL-1β, TNF-α, and IL-6 were reduced, while IL-10 was enhanced on sciatic nerve and spinal cord by treatment with CM and MSCs. Preliminary analysis of the CM secretome revealed the presence of growth factors and cytokines likely involved in the antinociception. In conclusion, the CM, similar to injection of live cells, produces a powerful and long-lasting antinociceptive effect on neuropathic pain, which is related with modulatory properties on peripheral and central levels of cytokines involved with the maintenance of this syndrome.

  9. Ambulatory phlebectomy at radiologic outpatient clinic

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Chang Jin; Kang, Sung Gwon; Choi, Sang Il [Seoul National University Bundang Hospital, Seongnam (Korea, Republic of); Lee, Whal; Chung, Jin Wook; Park, Jae Hyung [Seoul National University, Medical College, Seoul (Korea, Republic of)

    2007-03-15

    To evaluate safety, efficacy, and patient's satisfaction of an ambulatory phlebectomy, performed at a radiology outpatient clinic. Between 2003 and 2006, an ambulatory phlebectomy was performed in 12 patients. Endovenous radiofrequency ablation was performed through a venotomy. The venotomy was ligated after RF ablation, and the ambulatory phlebectomy was performed. The patients visited the radiology outpatient clinic one day, one week, and 2 months after the procedure. The improvement in the clinical symptoms, cosmetic change in varicosity, and the procedure related complications were evaluated. The patient's satisfaction was evaluated using a 5-grade scale. RF ablation through a venotomy was performed successfully in all 12 patients. On average, 4.5 incisions were made, and 12.5 cm of varicosity had been removed. The mean procedure time was one hour and forty minutes. The complications of the ambulatory phlebectomy were bruising in one patient, and skin pigmentation in another. The complications associated with RF ablation were a hard palpable vein in 7 patients, numbness in 7 patients, and skin pigmentation along the vein in 2 patients. Follow-up duplex sonography was performed at 2 months after the procedure, showed complete occlusion in all 12 patients. The clinical symptoms had improved in 11 patients, and the varicosity disappeared cosmetically in 11 patients. An ambulatory phlebectomy, combined with RF ablation of the greater saphenous vein, can be performed safely and effectively at a radiology outpatient clinic.

  10. Simultaneous Determination of Dexamethasone, Ondansetron, Granisetron, Tropisetron, and Azasetron in Infusion Samples by HPLC with DAD Detection

    Directory of Open Access Journals (Sweden)

    Fu-chao Chen

    2017-01-01

    Full Text Available A simple and rapid high-performance liquid chromatography with diode array detector (HPLC-DAD method has been developed and validated for simultaneous quantification of five antiemetic agents in infusion samples: dexamethasone, ondansetron, granisetron, tropisetron, and azasetron. The chromatographic separation was achieved on a Phenomenex C18 column (4.6 mm × 150 mm, 5 μm using acetonitrile-50 mM KH2PO4 buffer-triethylamine (25 : 74 : 1; v/v; pH 4.0. Flow rate was 1.0 mL/min with a column temperature of 30°C. Validation of the method was made in terms of specificity, linearity, accuracy, and intra- and interday precision, as well as quantification and detection limits. The developed method can be used in the laboratory to routinely quantify dexamethasone, ondansetron, granisetron, tropisetron, and azasetron simultaneously and to evaluate the physicochemical stability of referred drugs in mixtures for endovenous use.

  11. Ambulatory phlebectomy at radiologic outpatient clinic

    International Nuclear Information System (INIS)

    Yoon, Chang Jin; Kang, Sung Gwon; Choi, Sang Il; Lee, Whal; Chung, Jin Wook; Park, Jae Hyung

    2007-01-01

    To evaluate safety, efficacy, and patient's satisfaction of an ambulatory phlebectomy, performed at a radiology outpatient clinic. Between 2003 and 2006, an ambulatory phlebectomy was performed in 12 patients. Endovenous radiofrequency ablation was performed through a venotomy. The venotomy was ligated after RF ablation, and the ambulatory phlebectomy was performed. The patients visited the radiology outpatient clinic one day, one week, and 2 months after the procedure. The improvement in the clinical symptoms, cosmetic change in varicosity, and the procedure related complications were evaluated. The patient's satisfaction was evaluated using a 5-grade scale. RF ablation through a venotomy was performed successfully in all 12 patients. On average, 4.5 incisions were made, and 12.5 cm of varicosity had been removed. The mean procedure time was one hour and forty minutes. The complications of the ambulatory phlebectomy were bruising in one patient, and skin pigmentation in another. The complications associated with RF ablation were a hard palpable vein in 7 patients, numbness in 7 patients, and skin pigmentation along the vein in 2 patients. Follow-up duplex sonography was performed at 2 months after the procedure, showed complete occlusion in all 12 patients. The clinical symptoms had improved in 11 patients, and the varicosity disappeared cosmetically in 11 patients. An ambulatory phlebectomy, combined with RF ablation of the greater saphenous vein, can be performed safely and effectively at a radiology outpatient clinic

  12. Racionalización de la técnica para la determinación de la concentración de lidocaína al 2 %

    Directory of Open Access Journals (Sweden)

    María Victoria Licea Tornés

    1997-12-01

    Full Text Available El clorhidrato de lidocaína es un anestésico local que se utiliza tanto por vía endovenosa como subcutánea, en dependecia de su forma de presentación, con o sin preservo respectivamente. La determinación de la concentración de clorhidrato de lidocaína en el inyectable se realiza mediante un método anhidrovolumétrico que requiere un gasto considerable de reactivo de importación. Para racionalizar esta técnica, se realizaron ensayos preliminares en los cuales se varió el volumen de extrayente y el número de extracciones. Los mejores resultados se obtuvieron con 10 mL de cloroformo en 3 extracciones, lo que permitió un ahorro aproximado del 70 % de este solvente.The lidocaine chlorhydrate is a local anesthestic that may be used by endovenous or subcutaneous route, depending of its form of presentation, with or without preserve. The concentration of lidocaine chlorhydrate in the injection is determined by an anhydrovolumetric method that requires a considerable use of imported reactive. Preliminary assays were made in which the volumen of extraction as well as the number of extractions were varied in order to rationalize this technique. The best results were obtained with 10 mL of chloroform in 3 extractions, which allowed the saving of 70 % of this solvent.

  13. Cytogenetic analysis of 153 Sm-EDTMP in peripheral lymphocytes from patients with bone cancer metastasis

    International Nuclear Information System (INIS)

    Silva, M.A. da; Suzuki, M.F.; Rogero, J.R.; Okazaki, K.; Guimaraes, M.I.C.C.; Buchpiguel, C.A.

    2002-01-01

    The 153 Sm-EDTMP is a radiopharmaceutical used in nuclear medicine with promising results for the relief of metastatic pain. Therefore, there are few knowledge about the effects of 153 Sm-EDTMP at cellular level. The present study was conducted with the aim of evaluating the cytogenetic effects of 153 Sm-EDTMP in peripheral lymphocytes from patients with bone metastasis (with and without previous radio and/or chemotherapy) by the chromosome aberration technique. For that, the blood samples were collected before and one hour after the endovenous administrations of 153 Sm-EDTMP (mean activity of 42.53 ± 5.31 MBq/kg body weight), taking into account the rapid blood clearance. The principal types of structural chromosome aberrations found gaps and breaks, acentric fragments centric rings, double minutes and dicentrics. The statistical analysis showed that the group submitted to previous radio and chemotherapy before 153 Sm-EDTMP administration showed significant difference in chromosome aberrations frequency one hour after the treatment. The analysis of the chromosome modal number and the kinetics of cellular cycle showed no statistical difference among the groups, suggesting that the treatment with 153 Sm-EDTMP, did not influence these parameters. The obtained data showed that the therapy with 153 Sm-EDTMP induced a few quantity of cytogenetic damages in peripheral lymphocytes one hour after its administration in patients, although, theoretically, a long term stochastic effect cannot be disregarded. (author)

  14. Studies concerning chronic and acute effects of L-carnitina in elite athletes.

    Science.gov (United States)

    Drăgan, I G; Vasiliu, A; Georgescu, E; Eremia, N

    1989-01-01

    Chronic and acute effects of L-Carnitina (vials of 1 g L-Carnitina endovenous; per orally administered vials of 1 g L-Carnitina; tablets of 1 g L-Carnitina) were recorded in 110 top athletes (rowing, kayak-canoe, swimming, weightlifting medium and long-distance runners), 47 girls and 63 boys, by six double blind placebo trials and cross over. Significant changes were registered after L-Carnitina treatment (both for a single dose or after 3 weeks of treatment) compared to placebo, for FFA, triglycenides, lactic acid after exercise, evoked muscular potential, plasma carnitine (free and acetyl-carnitine), urine carnitine (free carnitine) and others. The authors explain these changes by the increase of free carnitine, which permits a larger quantity of FFA to enter the mitochondria and to be more extensively used as energy source in endurance and strength efforts. Based on these results the authors recommend L-Carnitina as an ergogenic aid in elite athletes, especially in endurance and strength sports.

  15. Evaluation of genotoxic and cytotoxic effects of 153 Sm-EDTMP in peripheral blood lymphocytes of bone metastasis patients

    International Nuclear Information System (INIS)

    Suzuki, Miriam Fussae

    2003-01-01

    In this study the cellular damage in peripheral lymphocytes after exposure to 153 Sm-EDTMP (Samarium-153 ethylene-diamine-tetramietylene-phosphonate) was determined using the technique of micronuclei analysis and differential coloration. 153 Sm-EDTMP is a radiopharmaceutical used for pain relief in patients with bone metastases. The analysis of the frequency of micronuclei in patient blood samples obtained one hour after endovenous administration of radiopharmaceutical (41 MBq/kg) showed no statistical difference in relation to basal values in binucleated cells. However the analysis of damage distribution in mononucleated cells, showed that the patients without previous radiotherapy treatment presented a significant increase in the frequency of cells with one micronucleus and in those who had taken previous radiotherapy treatment, in cells with two or more micronuclei. The in vitro experiments conducted with the exposition of total blood to three radiation concentrations of 153 Sm-EDTMP (0.370, 0.555 and 1.110 MBq/mL) during one hour showed an increase in the frequency of micronuclei and necrotic and apoptotic cells with increasing radiation dose. Dose-response curves for healthy donors and patients with bone metastasis without previous radiotherapy treatment were constructed. The comparison of the curves showed that patients presented higher radiosensitivity, either micronuclei or dead cell (necrotic or apoptotic) percentages, than healthy donors. (author)

  16. Kinetics of elimination and distribution in blood and liver of biocompatible ferrofluids based on Fe{sub 3}O{sub 4} nanoparticles: An EPR and XRF study

    Energy Technology Data Exchange (ETDEWEB)

    Gamarra, L.F. [Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, Sao Paulo 05651-901 (Brazil); Instituto de Fisica, Universidade de Sao Paulo, Sao Paulo 05315-970 (Brazil)], E-mail: lgamarra@if.usp.br; Pontuschka, W.M. [Instituto de Fisica, Universidade de Sao Paulo, Sao Paulo 05315-970 (Brazil); Amaro, E. [Instituto de Ensino e Pesquisa, Hospital Israelita Albert Einstein, Sao Paulo 05651-901 (Brazil); Instituto de Radiologia, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo 05403-001 (Brazil); Costa-Filho, A.J. [Instituto de Fisica de Sao Carlos, Universidade de Sao Paulo, Sao Carlos 13560-970 (Brazil); Brito, G.E.S. [Instituto de Fisica, Universidade de Sao Paulo, Sao Paulo 05315-970 (Brazil); Vieira, E.D. [Instituto de Fisica de Sao Carlos, Universidade de Sao Paulo, Sao Carlos 13560-970 (Brazil); Carneiro, S.M. [Laboratorio de Biologia Celular, Instituto Butantan, Sao Paulo 05503-900 (Brazil); Escriba, D.M. [Instituto de Fisica, Universidade de Sao Paulo, Sao Paulo 05315-970 (Brazil); Falleiros, A.M.F. [Centro de Ciencias Biologicas, Universidade Estadual de Londrina 86051-990 (Brazil); Salvador, V.L. [Centro de aplicacoes e Lasers, IPEN, Sao Paulo 05508-000 (Brazil)

    2008-05-01

    In this study, we evaluated the biodistribution and the elimination kinetics of a biocompatible magnetic fluid, Endorem{sup TM}, based on dextran-coated Fe{sub 3}O{sub 4} nanoparticles endovenously injected into Winstar rats. The iron content in blood and liver samples was recorded using electron paramagnetic resonance (EPR) and X-ray fluorescence (XRF) techniques. The EPR line intensity at g = 2.1 was found to be proportional to the concentration of magnetic nanoparticles and the best temperature for spectra acquisition was 298 K. Both EPR and XRF analysis indicated that the maximum concentration of iron in the liver occurred 95 min after the ferrofluid administration. The half-life of the magnetic nanoparticles (MNP) in the blood was (11.6 {+-} 0.6) min measured by EPR and (12.6 {+-} 0.6) min determined by XRF. These results indicate that both EPR and XRF are very useful and appropriate techniques for the study of kinetics of ferrofluid elimination and biodistribution after its administration into the organism.

  17. Kinetics of elimination and distribution in blood and liver of biocompatible ferrofluids based on Fe3O4 nanoparticles: An EPR and XRF study

    International Nuclear Information System (INIS)

    Gamarra, L.F.; Pontuschka, W.M.; Amaro, E.; Costa-Filho, A.J.; Brito, G.E.S.; Vieira, E.D.; Carneiro, S.M.; Escriba, D.M.; Falleiros, A.M.F.; Salvador, V.L.

    2008-01-01

    In this study, we evaluated the biodistribution and the elimination kinetics of a biocompatible magnetic fluid, Endorem TM , based on dextran-coated Fe 3 O 4 nanoparticles endovenously injected into Winstar rats. The iron content in blood and liver samples was recorded using electron paramagnetic resonance (EPR) and X-ray fluorescence (XRF) techniques. The EPR line intensity at g = 2.1 was found to be proportional to the concentration of magnetic nanoparticles and the best temperature for spectra acquisition was 298 K. Both EPR and XRF analysis indicated that the maximum concentration of iron in the liver occurred 95 min after the ferrofluid administration. The half-life of the magnetic nanoparticles (MNP) in the blood was (11.6 ± 0.6) min measured by EPR and (12.6 ± 0.6) min determined by XRF. These results indicate that both EPR and XRF are very useful and appropriate techniques for the study of kinetics of ferrofluid elimination and biodistribution after its administration into the organism

  18. 980-nm laser therapy versus varicose vein surgery in racially diverse Penang, Malaysia.

    Science.gov (United States)

    Lakhwani, Murli N; Dadlani, Navin I; Wong, Yong C

    2009-05-01

    Chronic venous disorders are conditions of increasing prevalence in the developing world, and venous ulceration is the terminal sequel. Currently there are only limited data on all aspects of this from Southeast Asia. The aim of the present study was to assess differences in the demography and outcome between varicose vein surgery (VVS) and the relatively new endovenous laser therapy (EVT) in patients from Penang, Malaysia. A retrospective study was performed. Patients who presented to the outpatient clinic of the surgical department with saphenofemoral junction and/or saphenopopliteal junction incompetence associated with reflux of the great saphenous vein or small saphenous vein, respectively, underwent either surgery (1999-2004) or laser therapy (2004-2006). A single surgeon at a single institution performed all procedures. A total of 350 limbs were treated from 292 patients. Demographics, symptoms, outcomes and complications that arose in both groups were compared. There were significant improvements in pains, swelling, cramps and heaviness postoperatively (P popular as an elective procedure with its minimally invasive nature, cosmesis, rapid recovery and other advantages. Surgery remains an important and very cost-effective procedure, especially in a developing society such as Penang.

  19. Surgical Management of Multiple Valve Endocarditis Associated with Dialysis Catheter

    Directory of Open Access Journals (Sweden)

    R. Zea-Vera

    2016-01-01

    Full Text Available Endocarditis associated with dialysis catheter is a disease that must be suspected in every patient with hemodialysis who develops fever. Multiple valve disease is a severe complication of endocarditis that needs to be managed in a different way. There is very limited data for treatment and every case must be considered individually. We present a patient with this complication and describe the medical treatment and surgical management. We report the case of a 15-year-old patient with acute renal failure that develops trivalvular endocarditis after the hemodialysis catheter was placed, with multiple positive blood culture for Staphylococcus aureus. Transesophageal echocardiography was done and aortic and tricuspid valvular vegetations and mitral insufficiency were reported. Patient was successfully treated by surgery on the three valves, including aortic valve replacement. There is limited data about the appropriate treatment for multiple valvular endocarditis; it is important to consider this complication in the setting of hemodialysis patients that develop endocarditis and, despite the appropriate treatment, have a torpid evolution. In countries where endovenous drug abuse is uncommon, right sided endocarditis is commonly associated with vascular catheters. Aggressive surgical management should be the treatment of choice in these kinds of patients.

  20. Early and Late Retrieval of the ALN Removable Vena Cava Filter: Results from a Multicenter Study

    International Nuclear Information System (INIS)

    Pellerin, O.; Barral, F. G.; Lions, C.; Novelli, L.; Beregi, J. P.; Sapoval, M.

    2008-01-01

    Retrieval of removable inferior vena cava (IVC) filters in selected patients is widely practiced. The purpose of this multicenter study was to evaluate the feasibility and results of percutaneous removal of the ALN removable filter in a large patient cohort. Between November 2003 and June 2006, 123 consecutive patients were referred for percutaneous extraction of the ALN filter at three centers. The ALN filter is a removable filter that can be implanted through a femoral/jugular vein approach and extracted by the jugular vein approach. Filter removal was attempted after an implantation period of 93 ± 15 days (range, 6-722 days) through the right internal jugular vein approach using the dedicated extraction kit after control inferior vena cavography. Following filter removal, vena cavograms were obtained in all patients. Successful extraction was achieved in all but one case. Among these successful retrievals, additional manipulation using a femoral approach was needed when the apex of the filter was close to the IVC wall in two patients. No immediate IVC complications were observed according to the postimplantation cavography. Neither technical nor clinical differences between early and late filter retrieval were noticed. Our data confirm the safety of ALN filter retrieval up to 722 days after implantation. In infrequent cases, additional endovenous filter manipulation is needed to facilitate extraction.

  1. A randomized trial comparing treatments for varicose veins.

    Science.gov (United States)

    Brittenden, Julie; Cotton, Seonaidh C; Elders, Andrew; Ramsay, Craig R; Norrie, John; Burr, Jennifer; Campbell, Bruce; Bachoo, Paul; Chetter, Ian; Gough, Michael; Earnshaw, Jonothan; Lees, Tim; Scott, Julian; Baker, Sara A; Francis, Jill; Tassie, Emma; Scotland, Graham; Wileman, Samantha; Campbell, Marion K

    2014-09-25

    Ultrasound-guided foam sclerotherapy and endovenous laser ablation are widely used alternatives to surgery for the treatment of varicose veins, but their comparative effectiveness and safety remain uncertain. In a randomized trial involving 798 participants with primary varicose veins at 11 centers in the United Kingdom, we compared the outcomes of foam, laser, and surgical treatments. Primary outcomes at 6 months were disease-specific quality of life and generic quality of life, as measured on several scales. Secondary outcomes included complications and measures of clinical success. After adjustment for baseline scores and other covariates, the mean disease-specific quality of life was slightly worse after treatment with foam than after surgery (P=0.006) but was similar in the laser and surgery groups. There were no significant differences between the surgery group and the foam or the laser group in measures of generic quality of life. The frequency of procedural complications was similar in the foam group (6%) and the surgery group (7%) but was lower in the laser group (1%) than in the surgery group (Pdisease-specific quality of life in the foam group than in the surgery group. All treatments had similar clinical efficacy, but complications were less frequent after laser treatment and ablation rates were lower after foam treatment. (Funded by the Health Technology Assessment Programme of the National Institute for Health Research; Current Controlled Trials number, ISRCTN51995477.).

  2. Human mesenchymal stromal cell transplantation modulates neuroinflammatory milieu in a mouse model of amyotrophic lateral sclerosis.

    Science.gov (United States)

    Boido, Marina; Piras, Antonio; Valsecchi, Valeria; Spigolon, Giada; Mareschi, Katia; Ferrero, Ivana; Vizzini, Andrea; Temi, Santa; Mazzini, Letizia; Fagioli, Franca; Vercelli, Alessandro

    2014-08-01

    Mesenchymal stromal cells (MSCs), after intraparenchymal, intrathecal and endovenous administration, have been previously tested for cell therapy in amyotrophic lateral sclerosis in the SOD1 (superoxide dismutase 1) mouse. However, every administration route has specific pros and cons. We administrated human MSCs (hMSCs) in the cisterna lumbaris, which is easily accessible and could be used in outpatient surgery, in the SOD1 G93A mouse, at the earliest onset of symptoms. Control animals received saline injections. Motor behavior was checked starting from 2 months of age until the mice were killed. Animals were killed 2 weeks after transplantation; lumbar motoneurons were stereologically counted, astrocytes and microglia were analyzed and quantified after immunohistochemistry and cytokine expression was assayed by means of real-time polymerase chain reaction. We provide evidence that this route of administration can exert strongly positive effects. Motoneuron death and motor decay were delayed, astrogliosis was reduced and microglial activation was modulated. In addition, hMSC transplantation prevented the downregulation of the anti-inflammatory interleukin-10, as well as that of vascular endothelial growth factor observed in saline-treated transgenic mice compared with wild type, and resulted in a dramatic increase in the expression of the anti-inflammatory interleukin-13. Our results suggest that hMSCs, when intracisternally administered, can exert their paracrine potential, influencing the inflammatory response of the host. Copyright © 2014 International Society for Cellular Therapy. Published by Elsevier Inc. All rights reserved.

  3. [Experience with Dohlman-Doane keratoprosthesis: case reports].

    Science.gov (United States)

    Stolz, Andressa Prestes; Kwitko, Sérgio; Dal Pizzol, Melissa Manfroi; Marinho, Diane; Rymer, Samuel

    2008-01-01

    To describe 9 eyes in 8 patients who received Dohlman-Doane type 1 keratoprosthesis (KPro) with a mean follow-up of 11.2 months (2 to 25 months). A retrospective, non-comparative interventional case series. Previous corneal disease was alcaline burn in 4 eyes, multiple graft failure in 3 eyes, Stevens-Johnson syndrome in 1 eye and thermal injury in 1 eye. Best corrected visual acuity (BCVA) was hand motions or worse in all patients. Glaucoma was present preoperatively in 3 eyes and received Ahmed valve implantation. 88,9% eyes achieved BCVA of better than or equal to 20/100, and 44,4% better than or equal to 20/40. In the postoperative period, 3 eyes developed posterior capsule opacity treated with YAG laser capsulotomy; 3 retroprosthetic membrane treated with tPA injection or steroids; 2 glaucoma in clinical treatment; 1 corneal melting, treated with donor cornea bottom exchange; and 1 fungic endophthalmitis, treated with corneal transplant, anterior vitrectomy, KPro and intraocular lens explantation, and specific intravitreal and endovenous treatment. Dohlman-Doane K-Pro seems to be a good option for cases of corneal blindness with poor prognosis for traditional penetrating keratoplasty. Its main advantage is not requesting systemic immunossuppression. Best results were achieved in non-immune diseases.

  4. Cytogenetic analysis of {sup 153} Sm-EDTMP in peripheral lymphocytes from patients with bone cancer metastasis; Analise citogenetica do {sup 153} Sm-EDTMP em linfocitos perifericos de pacientes com cancer osseo matastatico

    Energy Technology Data Exchange (ETDEWEB)

    Silva, M.A. da; Suzuki, M.F.; Rogero, J.R.; Okazaki, K. [Instituto de Pesquisas Energeticas e Nucleares (IPEN), Sao Paulo, SP (Brazil); Guimaraes, M.I.C.C.; Buchpiguel, C.A. [Sao Paulo Univ., SP (Brazil). Faculdade de Medicina. Centro de Medicina Nuclear

    2002-07-01

    The {sup 153} Sm-EDTMP is a radiopharmaceutical used in nuclear medicine with promising results for the relief of metastatic pain. Therefore, there are few knowledge about the effects of {sup 153} Sm-EDTMP at cellular level. The present study was conducted with the aim of evaluating the cytogenetic effects of {sup 153} Sm-EDTMP in peripheral lymphocytes from patients with bone metastasis (with and without previous radio and/or chemotherapy) by the chromosome aberration technique. For that, the blood samples were collected before and one hour after the endovenous administrations of {sup 153} Sm-EDTMP (mean activity of 42.53 {+-} 5.31 MBq/kg body weight), taking into account the rapid blood clearance. The principal types of structural chromosome aberrations found gaps and breaks, acentric fragments centric rings, double minutes and dicentrics. The statistical analysis showed that the group submitted to previous radio and chemotherapy before{sup 153} Sm-EDTMP administration showed significant difference in chromosome aberrations frequency one hour after the treatment. The analysis of the chromosome modal number and the kinetics of cellular cycle showed no statistical difference among the groups, suggesting that the treatment with {sup 153} Sm-EDTMP, did not influence these parameters. The obtained data showed that the therapy with {sup 153} Sm-EDTMP induced a few quantity of cytogenetic damages in peripheral lymphocytes one hour after its administration in patients, although, theoretically, a long term stochastic effect cannot be disregarded. (author)

  5. Evaluation of genotoxic and cytotoxic effects of {sup 153} Sm-EDTMP in peripheral blood lymphocytes of bone metastasis patients; Avaliacao dos efeitos genotoxico e citotoxico do {sup 153} Sm-EDTMP em linfocitos perifericos de pacientes com metastase ossea

    Energy Technology Data Exchange (ETDEWEB)

    Suzuki, Miriam Fussae

    2003-07-01

    In this study the cellular damage in peripheral lymphocytes after exposure to {sup 153} Sm-EDTMP (Samarium-153 ethylene-diamine-tetramietylene-phosphonate) was determined using the technique of micronuclei analysis and differential coloration.{sup 153} Sm-EDTMP is a radiopharmaceutical used for pain relief in patients with bone metastases. The analysis of the frequency of micronuclei in patient blood samples obtained one hour after endovenous administration of radiopharmaceutical (41 MBq/kg) showed no statistical difference in relation to basal values in binucleated cells. However the analysis of damage distribution in mononucleated cells, showed that the patients without previous radiotherapy treatment presented a significant increase in the frequency of cells with one micronucleus and in those who had taken previous radiotherapy treatment, in cells with two or more micronuclei. The in vitro experiments conducted with the exposition of total blood to three radiation concentrations of {sup 153} Sm-EDTMP (0.370, 0.555 and 1.110 MBq/mL) during one hour showed an increase in the frequency of micronuclei and necrotic and apoptotic cells with increasing radiation dose. Dose-response curves for healthy donors and patients with bone metastasis without previous radiotherapy treatment were constructed. The comparison of the curves showed that patients presented higher radiosensitivity, either micronuclei or dead cell (necrotic or apoptotic) percentages, than healthy donors. (author)

  6. Surto de malária induzida entre usuários de drogas injetáveis Outbreak of malaria among injectable-drug users

    Directory of Open Access Journals (Sweden)

    Luiz Carlos Barradas Barata

    1993-02-01

    Full Text Available Em julho de 1990, foi registrado na cidade de Bauru, Estado de São Paulo, Brasil, um surto de malária envolvendo usuários de cocaína injetável. Uma ampla investigação epidemiológica, conduzida de 19 de julho a 13 de setembro, revelou que pelo menos 119 pessoas estavam envolvidas no surto, uma vez que haviam compartilhado seringas e agulhas com um ou mais casos confirmados nos 3 meses anteriores à ocorrência. Cento e duas dessas pessoas foram localizadas e entrevistadas, e destas, 99 foram submetidas a exame de gota espessa e 91 a exames sorológicos para malária. Foram confirmados por exame hemoscópico 21 casos de malária por P. vivax, e 3 outros tiveram exame sorológico positivo para P. vivax. O controle da transmissão foi obtido fornecendo-se cloroquina aos envolvidos no surto, numa dose inicial de 10 comprimidos, seguida de doses supressivas semanais de 2 comprimidos até que fosse identificado o último comunicante. Amostras de soro coletadas na ocasião revelaram, ao lado da malária, uma alta prevalência de infecções pelo HIV (58% e pelo vírus da hepatite B (40%. Foram discutidas as dificuldades para o controle do surto e a possibilidade da malária vir a se tornar uma doença endêmica entre usuários de drogas injetáveis, no Estado de São Paulo.Five cases of malaria were detected among cocaine users by the local health service in Bauru, a city with a population of 260,000, located 324 km from S. Paulo, Brazil, during the first three weeks of July 1990. Autochthonous malaria had not occurred in Bauru since 1978, and all the five cases denied having recently traveled to endemic areas. An extensive epidemiologic survey conducted from July 19 to September 13 revealed that the 5 cases were in fact part of a malaria outbreak among endovenous drug users. Moreover, at least 114 other people, who had in the last three months shared syringes and needles with one or more proved cases, were also involved in the outbreak. One

  7. Healing process of incisor teeth of diabetic rats replanted after storage in milk.

    Science.gov (United States)

    Ricieri, Camila Benez; Sonoda, Celso Koogi; Aranega, Alessandra Marcondes; Panzarini, Sônia Regina; Poi, Wilson Roberto; Sundefeld, Maria Lúcia Marçal Mazza; Okamoto, Tetuo

    2009-06-01

    Several local factors that influence the healing process of replanted teeth have been investigated. However, it remains unclear how systemic alterations, such as diabetes mellitus, affect the prognosis of these cases. The purpose of this study was to evaluate the healing process of incisors of non-controlled diabetic rats replanted after storage in bovine long shelf-life (UHT) whole milk. Thirty-two rats were randomly assigned to receive an endovenous injection of either citrate buffer solution (group I - control; n = 16) or streptozotocin dissolved in citrate buffer solution to induce diabetes (group II; n = 16). After confirmation of the diabetic status by analysis of the glycemic levels, the maxillary right incisor of each animal was extracted and immersed in milk for 60 min. The root canals of teeth were then instrumented, and were filled with a calcium hydroxide-based dressing and replanted into their sockets. All animals received systemic antibiotic and were killed by anesthetic overdose 10 and 60 days after replantation. The specimens containing the replanted teeth were removed, fixed, decalcified, and embedded in paraffin. Semi-serial 6-microm-thick sections were obtained and stained with hematoxylin and eosin for histologic and histometric analyses. The results showed that the connective tissue adjacent to the root surface was less organized in the diabetic animals than in the control animals in both periods; the root dentin was less severely affected by root resorption in the diabetic rats; there were no significant differences between the control and diabetic groups regarding the occurrence of replacement resorption and inflammatory resorption.

  8. Use of FMEA analysis to reduce risk of errors in prescribing and administering drugs in paediatric wards: a quality improvement report.

    Science.gov (United States)

    Lago, Paola; Bizzarri, Giancarlo; Scalzotto, Francesca; Parpaiola, Antonella; Amigoni, Angela; Putoto, Giovanni; Perilongo, Giorgio

    2012-01-01

    Administering medication to hospitalised infants and children is a complex process at high risk of error. Failure mode and effect analysis (FMEA) is a proactive tool used to analyse risks, identify failures before they happen and prioritise remedial measures. To examine the hazards associated with the process of drug delivery to children, we performed a proactive risk-assessment analysis. Five multidisciplinary teams, representing different divisions of the paediatric department at Padua University Hospital, were trained to analyse the drug-delivery process, to identify possible causes of failures and their potential effects, to calculate a risk priority number (RPN) for each failure and plan changes in practices. To identify higher-priority potential failure modes as defined by RPNs and planning changes in clinical practice to reduce the risk of patients harm and improve safety in the process of medication use in children. In all, 37 higher-priority potential failure modes and 71 associated causes and effects were identified. The highest RPNs related (>48) mainly to errors in calculating drug doses and concentrations. Many of these failure modes were found in all the five units, suggesting the presence of common targets for improvement, particularly in enhancing the safety of prescription and preparation of endovenous drugs. The introductions of new activities in the revised process of administering drugs allowed reducing the high-risk failure modes of 60%. FMEA is an effective proactive risk-assessment tool useful to aid multidisciplinary groups in understanding a process care and identifying errors that may occur, prioritising remedial interventions and possibly enhancing the safety of drug delivery in children.

  9. Terapêutica intravenosa com metilprednisolona e ciclofosfamida na vasculite do sistema nervoso periférico: avaliação de oito pacientes Intravenous theraphy with methylprednisolone and cyclophosphamide in vasculitis of peripheral nervous system: evaluation of eight patients

    Directory of Open Access Journals (Sweden)

    ANGELINA M.M. LINO

    1998-06-01

    Full Text Available O comprometimento do sistema nervoso periférico é frequente nas vasculites sistêmicas e contribui decisivamente para o diagnóstico. Oito pacientes foram estudados: sete do sexo feminino e um do sexo masculino; cinco brancos, dois negros, um amarelo; média de idade de 55,9 anos; quatro com poliarterite nodosa, um com lúpus eritematoso sistêmico, um com artrite reumatóide, um com vasculite isolada do sistema nervoso periférico e um com vasculite livedóide. Todos foram submetidos a terapêutica intravenosa com pulsos mensais de metilprednisolona (1 g/dia/3dias e ciclofosfamida (1 g/dia. Cinco pacientes melhoraram, dois permaneceram inalterados e um faleceu. A melhora neurológica objetiva ocorreu após o terceiro ou quarto pulso e nos pacientes com menor duração da doença.The peripheral nervous system is frequently involved in systemic vasculitis and it may be helpful in the disease diagnosis. We report on eight patients: seven women and one man; five white, two black and one yellow; age mean 55.9 years; four had polyarteritis nodosa, one had systemic lupus erythematosus, one had isolated peripheral nerve vasculitis and one had livedoid vasculitis. All of them received endovenous therapy with "pulse" of methylprednisolone (1 g/day/3days and cyclophosphamide (1 g/1day. Five patients improved, two remained unchanged and one died. The neurological improvement occurred after the third or fourth pulse and in the patients who have had a shorter time of disease.

  10. Gangrena de Fournier Fournier's gangrene

    Directory of Open Access Journals (Sweden)

    Emilio Simón Barroso de la Cruz

    2005-12-01

    Full Text Available Se realizó esta revisión relativa a la gangrena de Fournier, motivada por la presentación de una caso atendido en la Sección de Urología del Hospital General Docente de San Antonio de los Baños “Iván Portuondo,” de la provincia de La Habana en el año 2002. Se trató con antibióticos por vía endovenosa y se le practicó desbridamiento quirúrgico y orquiectomía izquierda. La aparición de esta enfermedad es poco frecuente, por lo que se recomienda ante la aparición de la sintomatología correspondiente en el nivel primario de atención ampliar los conocimientos sobre la fascitis necrotizante del periné o Síndrome de Fournier, que es nuestro objetivo final, para la atención temprana en el nivel secundario según los más avanzados criterios médicos. Se ha mantenido la confidencialidad y el consentimiento informado.A review of Fournier's gangrene was made motivated by the report of a case that received attention at the Urology Section of “Iván Portuondo” General Teaching Hospital of San Antonio de los Baños, in 2002. The patient was treated with antibiotics by endovenous route and he underwent surgical débridement and left orchidectomy. The appearance of this disease is uncommon, so when the corresponding symptomatology appears at the primary health care level it is recommended to .widen the knowledge of necrotizing fasciitis of the perineum, or Fournier's syndrome that is our final objective for the early attention at the secondary health care level, according to the most advanced medical criteria. Confidentiality and the informed consent were maintained.

  11. A 1470-nm laser combined with foam sclerotherapy in day surgery: a better choice for lower limb varicose veins.

    Science.gov (United States)

    Zhang, Xing; Wang, Xin; Gao, Cheng; Qin, Jinbao; Zhao, Haiguang; Li, Weimin; Lu, Xinwu

    2018-04-23

    Day surgery is being more and more adopted by clinicians. Higher wavelength lasers give patients better experience than lower wavelength lasers, which makes it more suitable for day surgery. This study compares the short- and mid-term efficacy, postoperative morbidity, and patient satisfaction of "1470-nm endovenous laser ablation (EVLA) combining foam sclerotherapy in day surgery" with "810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery" on great saphenous vein (GSV) insufficiency postoperatively. A single-institution historical cohort study of 194 patients was performed in Shanghai Ninth People's Hospital, China. Ninety-seven patients received 1470-nm EVLA combining foam sclerotherapy in day surgery ("1470-nm group"), and 97 patients received 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery recommended by guidelines ("810-nm group"). No significant difference was found between the 1470-nm group and the 810-nm group in terms of GSV occlusion rate (both 100%), complication rate, and recurrence rate (8.2 vs. 11.3%) during the period of 1-12 months after surgery. Serious complications in the 1470-nm group and 810-nm group were 0 and 1.0%. Minor complications in the 1470-nm group and 810-nm group were ecchymosis at 20.6 and 18.6%, edema at 69.1 and 63.9%, and paresthesia around ankle at 0 and 3.1%, respectively. Advantage of the 1470-nm group over the 810-nm group was statistically significant considering the patient perioperative comfort and economic cost. Treatment of 1470-nm EVLA combining foam sclerotherapy in day surgery has similar efficacy as the 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery in GSV insufficiency and is more comfortable with less incision, hospitalization procedure, and medical costs. It may be a new option for patients who are afraid or unable to be hospitalized.

  12. Relationships between duplex findings and quality of life in long-term follow-up of patients treated for chronic venous disease.

    Science.gov (United States)

    Huang, Ying; Gloviczki, Peter

    2016-03-01

    Relationships between duplex findings and data on health-related quality of life (QoL) to assess long-term results of treatment of varicose veins and chronic venous insufficiency (CVI) are not well known. The goal of this review was to correlate duplex findings and QoL assessments in clinical studies with long-term follow-up. A review of the English language literature on PUBMED revealed 17 clinical studies, including 9 randomized controlled trials (RCTs), 6 prospective, and 2 retrospective studies that included patients with at least 5-year follow-up after endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), and traditional superficial venous surgery. At 5 years, great saphenous vein (GSV) occlusion rate on duplex ultrasound ranged from 66% to 82% for EVLA, from 62% to 92% for RFA, from 41% to 58% for UGFS and from 54% to 85% for surgery. Freedom from GSV reflux rates were 82% and 84%, respectively for EVLA and surgery, and ranged between 84% and 95% for RFA. Significant improvements were observed in several domains of generic QoL and in most domains of venous disease-specific QoL, irrespective of the treatment. In at least one RCT, CIVIQ scores correlated well with abnormal duplex findings in patients who underwent treatment with UGFS. In another RCT, long-term AVVQ was significantly better after surgery as compared with UGFS similar to results of duplex findings. Analysis of the available literature confirmed that all four techniques were effective in the abolishment of reflux or obliteration of the GSV. Moreover, well-designed RCTs with large sample size are needed to produce robust long-term data on clinical outcome after treatment of varicose veins and CVI and to better understand the relationships between duplex-derived data and QoL assessments. © The Author(s) 2016.

  13. Evaluation of Deoxyribonucleic Acid Toxicity Induced by the Radiopharmaceutical 99mTechnetium-Methylenediphosphonic Acid and by Stannous Chloride in Wistar Rats

    Directory of Open Access Journals (Sweden)

    Adriano Caldeira-de-Araujo

    2012-11-01

    Full Text Available Radiopharmaceuticals are employed in patient diagnostics and disease treatments. Concerning the diagnosis aspect, technetium-99m (99mTc is utilized to label radiopharmaceuticals for single photon computed emission tomography (SPECT due to its physical and chemical characteristics. 99mTc fixation on pharmaceuticals depends on a reducing agent, stannous chloride (SnCl2 being the most widely-utilized. The genotoxic, clastogenic and anegenic properties of the 99mTc-MDP(methylene diphosphonate used for bone SPECT and SnCl2 were evaluated in Wistar rat blood cells using the Comet assay and micronucleus test. The experimental approach was to endovenously administer NaCl 0.9% (negative control, cyclophosphamide 50 mg/kg b.w. (positive control, SnCl2 500 μg/mL or 99mTc-MDP to animals and blood samples taken immediately before the injection, 3, and 24 h after (in the Comet assay and 36 h after, for micronucleus test. The data showed that both SnCl2 and 99mTc-MDP-induced deoxyribonucleic acid (DNA strand breaks in rat total blood cells, suggesting genotoxic potential. The 99mTc-MDP was not able to induce a significant DNA strand breaks increase in in vivo assays. Taken together, the data presented here points to the formation of a complex between SnCl2 in the radiopharmaceutical 99mTc-MDP, responsible for the decrease in cell damage, compared to both isolated chemical agents. These findings are important for the practice of nuclear medicine.

  14. Efficacy of Iralfaris shampoo in the treatment of scalp psoriasis: a videodermoscopy evaluation prospective study in 70 patients.

    Science.gov (United States)

    Rossi, A; Pranteda, G; Iorio, A; Mari, E; Milani, M

    2012-12-01

    This work has the aim to test the sensibility of VSCAPSI method in the evaluation of effectiveness of a medicated shampoo for the treatment of scalp psoriasis. Psoriasis is a chronic inflammatory skin disease histologically characterized by proliferation and loss of differentiation of keratinocytes, angiogenesis with vasodilatation and increased permeability, and inflammation. Scalp involvement is a common clinical feature of psoriasis, that is present in the 25% of patients who suffer of it. Videodermoscopy (VD) permits a magnified view of the surface components of the epidermis and papillary dermis, which are not visible to the naked eye, together with the ability to capture digitally the viewed images and to store them for later use. Moreover videodermoscopy is a non-invasive technique, used to analyze cutaneous peripheral microcirculation. Therefore VD could be an useful tool in evaluating the efficacy of treatments for scalp psoriasis. The clinical benefit of currently available medicated shampoos for the treatment of scalp psoriasis is restricted, due to their limited efficacy, low cosmetic appeal and safety and tolerability problems. Therefore effective and safe products are needed especially for the long term management of scalp psoriasis. A specific shampoo designed for the scalp hygiene in psoriatic patients has been recently developed. This shampoo contains urea, glycolic acid, salicylic acid, icthyol pale and laureth 9 (polidocanol). Aim of the study was to evaluate in a 12-week prospective monocenter, open-study the efficacy and tolerability of an emollient, keratolytic shampoo (Iralfaris shampoo ISDIN, Barcelona; Ir-S) applied three times a week in patients with scalp psoriasis. The efficacy of the shampoo has been valuated with VSCAPSI. Seventy subjects with mild to moderate/severe scalp psoriasis were enrolled in the trial, after their informed consent. Efficacy was assessed using a specific and validated videodermoscopy scalp psoriasis severity

  15. Shear Wave Elastography (SWE) for Monitoring of Treatment of Tendinopathies: A Double-blinded, Longitudinal Clinical Study.

    Science.gov (United States)

    Dirrichs, Timm; Quack, Valentin; Gatz, Matthias; Tingart, Markus; Rath, Björn; Betsch, Marcel; Kuhl, Christiane K; Schrading, Simone

    2018-03-01

    We aimed to investigate the diagnostic accuracy with which shear wave elastography (SWE) can be used to monitor response to treatment of tendinopathies, and to compare it to conventional ultrasound (US)-imaging methods (B-mode US (B-US) and power Doppler US (PD-US)). A prospective Institutional Review Board-approved longitudinal study on 35 patients with 47 symptomatic tendons (17 Achilles-, 15 patellar-, and 15 humeral-epicondylar) who underwent standardized multimodal US and standardized clinical assessment before and after 6 months of treatment (tailored stretching exercise, sport break, and local Polidocanol) was carried out. All US studies were performed by radiologists blinded to the clinical symptoms on both tendon sides to avoid biased interpretations, by B-US, PD-US, and SWE, conducted in the same order, using a high-resolution linear 15 MHz probe (Aixplorer). Orthopedic surgeons who were in turn blinded to US imaging results used established orthopedic scores (Victorian Institute of Sports Assessment questionnaire for Achilles, Victorian Institute of Sports Assessment questionnaire for patellar tendons, and Disability Arm Shoulder Hand scoring system) to rate presence, degree, and possible resolution of symptoms. We analyzed the diagnostic accuracy with which the different US imaging methods were able to detect symptomatic tendons at baseline as well as treatment effects, with orthopedic scores serving as reference standard. B-US, PD-US, and SWE detected symptomatic tendons with a sensitivity of 66% (31 of 47), 72% (34 of 47), and 87.5% (41 of 47), respectively. Positive predictive value was 0.67 for B-US, 0.87 for PD-US, and 1 for SWE. After treatment, clinical scores improved in 68% (32 of 47) of tendons. Treatment effects were observable by B-US, PD-US, and SWE with a sensitivity of 3.1% (1 of 32), 28.1% (9 of 32), and 81.3% (26 of 32), respectively. B-US was false-positive in 68.8% (20 of 32), PD-US in 46.9% (15 of 32), and SWE in 12.5% (4 of 32

  16. The incidence and characterization of deep vein thrombosis following ultrasound-guided foam sclerotherapy in 1000 legs with superficial venous reflux.

    Science.gov (United States)

    Kulkarni, Sachin R; Messenger, David E; Slim, Fiona J A; Emerson, Lorraine G; Bulbulia, Richard A; Whyman, Mark R; Poskitt, Keith R

    2013-07-01

    The incidence of deep vein thrombosis (DVT) following ultrasound-guided foam sclerotherapy (UGFS) ranges from 0% to 5.7%. The aim of this study was to assess the incidence of DVT following UGFS in a single vascular center. Patients undergoing UGFS between December 2005 and September 2011 underwent quality control duplex imaging within 2 weeks of treatment. This was performed by an independent senior vascular technologist, and data were entered on a prospectively maintained database. Deep venous segments assessed included common femoral vein, femoral vein, above- and below-knee popliteal veins, gastrocnemius, and tibial veins. DVT when present was labeled as endovenous foam-induced thrombosis (EFIT) type 1 when thrombus was lining <25% of the lumen of the deep vein; type 2 when thrombus extension was 25% to 50%; type 3 when thrombus extension was 50% to 99%; and type 4 when the deep vein was occluded. A total of 1166 UGFS treatments were performed in 1000 legs (776 patients). Complete occlusion of the treated veins was seen in 84.5% of the legs after one session of treatment. Overall, 17 DVTs were detected (1.5%) with no DVTs detected in legs undergoing multiple treatments. Of the 17 episodes of DVT, 16 legs had DVT following treatment for truncal reflux (658 legs; 2.43%). Seven DVTs were EFIT type 1, two were type 2, two were type 3, and five were type 4. One DVT was seen in the gastrocnemius vein alone. Two of 1166 treatments (0.2%) resulted in a symptomatic DVT, both of which were EFIT type 4. On regression analysis, there was an increase in the risk of DVT when ≥10 mL of foam was injected (odds ratio, 4.63; 95% confidence interval, 1.44-14.9; P = .01). The incidence of duplex-detected DVT following foam sclerotherapy is low and may be associated with the injection of ≥10 mL of foam. Copyright © 2013 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

  17. A cyclopalladated complex interacts with mitochondrial membrane thiol-groups and induces the apoptotic intrinsic pathway in murine and cisplatin-resistant human tumor cells

    International Nuclear Information System (INIS)

    Serrano, Fabiana A; Machado, Joel Jr; Santos, Edson L; Pesquero, João B; Martins, Rafael M; Travassos, Luiz R; Caires, Antonio CF; Rodrigues, Elaine G; Matsuo, Alisson L; Monteforte, Priscila T; Bechara, Alexandre; Smaili, Soraya S; Santana, Débora P; Rodrigues, Tiago; Pereira, Felipe V; Silva, Luis S

    2011-01-01

    Systemic therapy for cancer metastatic lesions is difficult and generally renders a poor clinical response. Structural analogs of cisplatin, the most widely used synthetic metal complexes, show toxic side-effects and tumor cell resistance. Recently, palladium complexes with increased stability are being investigated to circumvent these limitations, and a biphosphinic cyclopalladated complex {Pd 2 [S (-) C 2 , N-dmpa] 2 (μ-dppe)Cl 2 } named C7a efficiently controls the subcutaneous development of B16F10-Nex2 murine melanoma in syngeneic mice. Presently, we investigated the melanoma cell killing mechanism induced by C7a, and extended preclinical studies. B16F10-Nex2 cells were treated in vitro with C7a in the presence/absence of DTT, and several parameters related to apoptosis induction were evaluated. Preclinical studies were performed, and mice were endovenously inoculated with B16F10-Nex2 cells, intraperitoneally treated with C7a, and lung metastatic nodules were counted. The cytotoxic effects and the respiratory metabolism were also determined in human tumor cell lines treated in vitro with C7a. Cyclopalladated complex interacts with thiol groups on the mitochondrial membrane proteins, causes dissipation of the mitochondrial membrane potential, and induces Bax translocation from the cytosol to mitochondria, colocalizing with a mitochondrial tracker. C7a also induced an increase in cytosolic calcium concentration, mainly from intracellular compartments, and a significant decrease in the ATP levels. Activation of effector caspases, chromatin condensation and DNA degradation, suggested that C7a activates the apoptotic intrinsic pathway in murine melanoma cells. In the preclinical studies, the C7a complex protected against murine metastatic melanoma and induced death in several human tumor cell lineages in vitro, including cisplatin-resistant ones. The mitochondria-dependent cell death was also induced by C7a in human tumor cells. The cyclopalladated C7a complex is

  18. Cytogenetic effect of 153 Sm-EDTMP in peripheral lymphocytes of patients with metastatic cancer

    International Nuclear Information System (INIS)

    Silva, Marcia Augusta da

    2001-01-01

    The 153 Sm-EDTMP is a radiopharmaceutical used in nuclear medicine with promising results for the relief of metastatic pain. Therefore, there are few knowledge about the effects of 153 Sm-EDTMP at cellular level. The present study was conduced with the aim of evaluating the cytogenetic effects of 153 Sm-EDTMP in peripheral lymphocytes from patients with bone metastasis (with and without previous radio and/or chemotherapy) by the chromosome aberration technique, either in vivo or in vitro. For that, the blood samples were collected before and one hour after the endovenous administration of 153 Sm-EDTMP (mean activity of 42.53+/-5.31 MBq/kg body weight), taking into account the rapid blood clearance. The principal types of structural chromosome aberrations found gaps and breaks, acentric fragments centric rings, double minutes and dicentrics. The statistical analysis showed that the group submitted to previous radio and chemotherapy before 153 Sm-EDTMP administration showed significant difference in chromosome aberrations frequency one hour after the treatment. The analysis of the chromosome modal number and the kinetics of cellular cycle showed no statistical difference among the groups, suggesting that the treatment with 153 Sm-EDTMP, did not influence these parameters. The carrier molecule, EDTMP, did not influence the induction of chromosome aberration. In relation to the in vitro assays, the obtained data of peripheral lymphocytes of healthy donors and patients with no previous treatment exposed to different radioactive concentration of 153 Sm-EDTMP (0.046 - 1.110 MBq/mL) were better adjusted by linear regression model (Y=A+BX). The chromosome damage induced by 153 Sm-EDTMP observed in vitro was about 2 fold higher than that found in vivo for the group of patients with no previous treatment. The obtained data showed that the therapy with 153 Sm-EDTMP induced a few quantity of cytogenetic damages in peripheral lymphocytes on hour after its administration in

  19. Recent Trends in Publications of US and European Directors in Vascular Surgery.

    Science.gov (United States)

    Aurshina, Afsha; Hingorani, Anil; Hingorani, Amrit; Marks, Natalie; Ascher, Enrico

    2018-02-24

    great deal more on Endovenous Lower Extremity, Open Lower Extremity, Education, thoracic endovascular aortic repair, Open Carotid, and Endo Venous, whereas their European counterparts published more in the areas of Vascular Medicine, Replies, and Not Vascular. Copyright © 2018 Elsevier Inc. All rights reserved.

  20. Randomized controlled trial of pulse methyl prednisolone × placebo in treatment of pulmonary involvement associated with severe leptospirosis. [ISRCTN74625030

    Directory of Open Access Journals (Sweden)

    Leite Alfredo

    2011-06-01

    Full Text Available Abstract Background The lungs are involved in up to 70% of cases of leptospirosis. In the more severe forms-bleeding from the lungs and acute respiratory distress syndrome-the lethality is high. The treatment proposed for leptospirotic pneumonitis includes just care for patients in critical condition. Clinical and experimental studies point to the involvement of immunological mechanisms in the physiopathology of lung damage caused by leptospirosis. The aim of this study is to evaluate pulse treatment with methylprednisolone × placebo for leptospirotic pneumonitis. Study design This is a randomized double-blind clinical trial to test the efficacy of pulse treatment with methylprednisolone in patients with leptospirotic pneumonitis, compared with a placebo. The patients are recruited from three hospitals in the city of Recife, in the Brazilian State of Pernambuco. The exclusion criteria include patients aged under 15 years, a history of hypersensitivity to the use of corticosteroids, the presence of active infection of fungal, tuberculous or bacterial origin apart from the infection by leptospira itself, the presence of hemoconcentration or atypical lymphocyte count on admission to hospital, the presence of co-morbidities that could be responsible for the radiological and gasometric alterations used to diagnose leptospirotic pneumonitis, evidence of recent cranial trauma, neurosurgery, peptic ulcer, and participation in another clinical trial. The patients are followed until they are discharged from hospital or die. The intervention consists of endovenous pulse treatment with 1 g methylprednisolone for three consecutive days in the study group and a placebo in the control group. The primary end-point is mortality from leptospirotic pneumonitis. The secondary end-points are: evolution of lung disease; the occurrence of nosocomial respiratory infection; duration of mechanical ventilation; duration of intensive care unit (ICU stay; duration of

  1. Hipoparatireoidismo primário manifestando-se com aumento de enzimas musculares Primary hypoparathyreoidism with raised muscle enzymes

    Directory of Open Access Journals (Sweden)

    Simone Appenzeller

    2005-08-01

    Full Text Available Os autores relatam o caso de um jovem de 18 anos de idade com fraqueza muscular generalizada, cãibras e crises convulsivas, tratado com corticosteróides por oito anos em decorrência de um diagnóstico de polimiosite, sem melhora clínica. Ao exame físico apresentava força muscular normal, ausência de atrofias musculares, diminuição de reflexos tendíneos profundos e presença do sinal de Chvostek e Trousseau. A hipótese diagnóstica inicial foi de miopatia metabólica e a investigação laboratorial revelou cálcio sérico e urinário diminuídos e dosagem de paratormônio (PTH indetectável. O diagnóstico final foi de hipoparatireoidismo, tendo sido o paciente tratado com cálcio endovenoso. A tomografia de crânio demonstrou calcificações difusas, características da síndrome de Fahr. O paciente recebeu alta assintomático com carbonato de cálcio e colecalciferol.The authors report a case of an 18-year-old boy using prednisone for eight years for a misdiagnosis of polymyositis. His complains were diffuse weakness, cramps and seizures, with progressive worsening and with no improvement despite treatment with corticosteroid. On admission, the physical examination didn't show muscular weakness or atrophy. Deep tendom reflexes were absent and Chvostek and Trousseau signs were found. The diagnosis of a metabolic myopathy was considered and further laboratory findings revealed a low serum and urinary calcium, undetectable PTH. The diagnosis of hypoparathyreoidism was made and the patient was treated with endovenous calcium. Cranial tomography revealed diffuse calcifications, suggestive of Fahr's syndrome. The patient recovered completely and was discharged with oral calcium carbonate and colecalciferol.

  2. A retrospective study of a new n-butyl-2-cyanoacrylate glue ablation catheter incorporated with application guiding light for the treatment of venous insufficiency: Twelve-month results.

    Science.gov (United States)

    Yavuz, Turhan; Acar, Altay Nihat; Aydın, Huseyin; Ekingen, Evren

    2018-01-01

    Objective This study aims to present the early results of a retrospective study of the use of novel n-butyl-2-cyanoacrylate (VenaBlock)-based nontumescent endovenous ablation with a guiding light for the treatment of patients with varicose veins. Methods Patients with lower limb venous insufficiency were treated with n-butyl-2-cyanoacrylate (VenaBlock Venous Closure System) between April 2016 and July 2016. The study enrolled adults aged 21-70 years with symptomatic moderate to severe varicosities (C2-C4b) and great saphenous vein reflux lasting longer than 0.5 s with great saphenous vein diameter between 5.5 and 15 mm assessed in the standing position. No compression stockings were used after the procedure. Duplex ultrasound imaging and clinical follow-up were performed on the third day, first month, sixth month, and 12th month. Clinical, etiological, anatomical, pathophysiological classification; venous clinical severity score; and completed Aberdeen varicose vein questionnaire were recorded. Results Five hundred thirty-eight patients with great saphenous vein incompetency underwent n-butyl-2-cyanoacrylate ablation. The mean ablation length was 25.69 ± 4.8 cm, and the average amount of n-butyl-2-cyanoacrylate delivered was 0.87 ± 0.15 ml. The mean procedure time was 11.7 ± 4.9 min. Procedural success was 100%, and complete occlusion was observed after treatment and at the third-day follow-up. We observed ecchymosis in five patients (1.00%) at the entry site at the third-day follow-up. Phlebitis was encountered with six (1.20%) patients. No skin pigmentation, hematoma, paresthesia, deep vein thrombosis, or pulmonary embolism was observed. Kaplan-Meier analysis yielded an occlusion rate of 99.4% at the 12-month follow-up. All patients had significant improvement in venous clinical severity score and Aberdeen varicose vein questionnaire scores postoperatively ( p <0.0001). Venous clinical severity score scores decreased from 5.43 ± 0.87 to

  3. Cytogenetic effect of {sup 153} Sm-EDTMP in peripheral lymphocytes of patients with metastatic cancer; Efeito citogenetico do {sup 153} Sm-EDTMP em linfocitos perifericos de pacientes com cancer metastatico

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Marcia Augusta da

    2001-07-01

    The {sup 153}Sm-EDTMP is a radiopharmaceutical used in nuclear medicine with promising results for the relief of metastatic pain. Therefore, there are few knowledge about the effects of {sup 153}Sm-EDTMP at cellular level. The present study was conduced with the aim of evaluating the cytogenetic effects of {sup 153}Sm-EDTMP in peripheral lymphocytes from patients with bone metastasis (with and without previous radio and/or chemotherapy) by the chromosome aberration technique, either in vivo or in vitro. For that, the blood samples were collected before and one hour after the endovenous administration of {sup 153}Sm-EDTMP (mean activity of 42.53+/-5.31 MBq/kg body weight), taking into account the rapid blood clearance. The principal types of structural chromosome aberrations found gaps and breaks, acentric fragments centric rings, double minutes and dicentrics. The statistical analysis showed that the group submitted to previous radio and chemotherapy before {sup 153}Sm-EDTMP administration showed significant difference in chromosome aberrations frequency one hour after the treatment. The analysis of the chromosome modal number and the kinetics of cellular cycle showed no statistical difference among the groups, suggesting that the treatment with {sup 153}Sm-EDTMP, did not influence these parameters. The carrier molecule, EDTMP, did not influence the induction of chromosome aberration. In relation to the in vitro assays, the obtained data of peripheral lymphocytes of healthy donors and patients with no previous treatment exposed to different radioactive concentration of {sup 153}Sm-EDTMP (0.046 - 1.110 MBq/mL) were better adjusted by linear regression model (Y=A+BX). The chromosome damage induced by {sup 153}Sm-EDTMP observed in vitro was about 2 fold higher than that found in vivo for the group of patients with no previous treatment. The obtained data showed that the therapy with {sup 153}Sm-EDTMP induced a few quantity of cytogenetic damages in peripheral

  4. Sodium bicarbonate treatment during transient or sustained lactic acidemia in normoxic and normotensive rats.

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    Franco Valenza

    Full Text Available INTRODUCTION: Lactic acidosis is a frequent cause of poor outcome in the intensive care settings. We set up an experimental model of lactic acid infusion in normoxic and normotensive rats to investigate the systemic effects of lactic acidemia per se without the confounding factor of an underlying organic cause of acidosis. METHODOLOGY: Sprague Dawley rats underwent a primed endovenous infusion of L(+ lactic acid during general anesthesia. Normoxic and normotensive animals were then randomized to the following study groups (n = 8 per group: S sustained infusion of lactic acid, S+B sustained infusion+sodium bicarbonate, T transient infusion, T+B transient infusion+sodium bicarbonate. Hemodynamic, respiratory and acid-base parameters were measured over time. Lactate pharmacokinetics and muscle phosphofructokinase enzyme's activity were also measured. PRINCIPAL FINDINGS: Following lactic acid infusion blood lactate rose (P<0.05, pH (P<0.05 and strong ion difference (P<0.05 drop. Some rats developed hemodynamic instability during the primed infusion of lactic acid. In the normoxic and normotensive animals bicarbonate treatment normalized pH during sustained infusion of lactic acid (from 7.22 ± 0.02 to 7.36 ± 0.04, P<0.05 while overshoot to alkalemic values when the infusion was transient (from 7.24 ± 0.01 to 7.53 ± 0.03, P<0.05. When acid load was interrupted bicarbonate infusion affected lactate wash-out kinetics (P<0.05 so that blood lactate was higher (2.9 ± 1 mmol/l vs. 1.0 ± 0.2, P<0.05, group T vs. T+B respectively. The activity of phosphofructokinase enzyme was correlated with blood pH (R2 = 0.475, P<0.05. CONCLUSIONS: pH decreased with acid infusion and rose with bicarbonate administration but the effects of bicarbonate infusion on pH differed under a persistent or transient acid load. Alkalization affected the rate of lactate disposal during the transient acid load.

  5. BLEEDING PEPTIC ULCER, NONSTEROIDAL ANTIINFLAMMATORY DRUGS AND HELICOBACTER PYLORI INFECTION – A PROSPECTIVE, CONTROLLED, RANDOMIZED STUDY

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    Pavel Skok

    2002-06-01

    Full Text Available Background. The explanation of peptic ulcer etiology has changed significantly in the past decade after the clarification of the significance of Helicobacter pylori infection.Aim. To evaluate the effectiveness of Helicobacter pylori eradication in patients with hemorrhaging peptic ulcer and patients with peptic ulcer without complications.Study ethics. The study was approved in 1998 by the Medical Ethics Committee of the Republic of Slovenia (No. 90/09/98.Type of study. Prospective, controlled and randomized study, carried out between 1998–2000.Patients and methods. The study included 80 patients (50 male and 30 female, av.age 57.5 years, SD ± 17.1, range 22– 80 in which endoscopy confirmed hemorrhage from peptic ulcer of stomach or duodenum and Helicobacter pylori infection. In all cases endoscopic hemostasis was performed: injection sclerotherapy with diluted adrenalin 1:10,000 and 1% polidocanol or argon plasma coagulation. The control group was made up of 80 patients (50 male and 30 female, av.age 56.8 years, SD ± 16.8, range 19–80 with peptic ulcer of stomach or duodenum and Helicobacter pylori infection. Infection was confirmed by a rapid urease test and histologic investigation of the gastric mucosa. In all cases the recommended drug combinations were used in the treatment of the infection: a proton pump inhibitor, omeprazol (4 weeks, and combination of antibiotics, claritromycin and metronidazole or with regard to the antibiogram (1 week. The therapeutic success was ascertained endoscopically four weeks after inclusion in the study. Infection eradication was confirmed by the rapid urease test and histologic investigation of the gastric mucosa.Results. Four weeks after inclusion in the study the success of infection eradication was 92.5% in the study group, in the control group it was 91.3% (p > 0.05. In 6 patients (7.5%, 6/ 80 from the study group and in 7 (8.8%, 7/80 from the control group we introduced a replacement treatment

  6. Relevant factors affecting the outcome of ultrasound guided foam sclerotherapy of the great saphenous vein

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    Giorgio Falaschi

    2013-09-01

    Full Text Available Ultrasound guided foam sclerotherapy (UGFS constitutes a valid ablative treatment for superficial vein diseases for the great saphenous vein (GSV, but no standardized protocol for its execution has yet been defined. Different variable factors involved in this procedure influence the final outcome and clinical results. The aim of our study was to analyze the respective influence on efficacy and side effects of three variable factors (foam volume, foam concentration, and contact time between the foam and the endothelium for UGFS procedures for GSV insufficiency in order to select the best protocol for treatment. A retrospective analysis was made of UGFS procedures (190 patients, 201 legs performed for GSV insufficiency in our institute from January 2007 to January 2010. All great saphenous veins included in our study exhibited a trans-ostial reflux and caliber range was 7-11 mm. In all cases, foam was prepared according to the Tessari method, using polidocanol (POL and a gas mixture of CO2 (70% and filtered room air (30%, in a proportion of 1:4. A single injection procedure in the GSV was performed under Doppler ultrasound guidance at mid to lower third of the thigh. Legs were randomly assigned to one of three different treatment protocols: - Group A (71 legs: POL 3%, mean foam volume 4.5 cc, intermittent groin pressure 5 min, supine bed rest 10 min; - Group B (61 legs: POL 2%, mean foam volume 9 cc, intermittent groin pressure 5 min, supine bed rest 10 min; - Group C (69 legs: POL 2%, mean foam volume 9 cc, continuous groin pressure 5 min followed by intermittent groin pressure 5 min, continuous leg compression 5 min, supine bed rest 10 min. Efficacy of treatment and occurrence of side effects were evaluated in each group at two weeks and again at two years after the procedure and the cumulative results compared. Analysis of outcomes did not show any significant difference between the complete obliteration rate (P=0.825 or occurrence of local

  7. Propofol como agente anestésico en cirugía de nódulo de mama Propofol as an anesthetic agent in breast node-surgery

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    Verónica Castillo Pérez

    2004-04-01

    Full Text Available Se realizó un estudio prospectivo en 100 pacientes, intervenidos de forma electiva de nódulo de mama, en el hospital "León Cuervo Rubio" de octubre de 2002 a septiembre de 2003 divididos en 2 grupos de 50 pacientes seleccionados al azar. Grupo I (grupo control anestesia general endovenosa con ketalar (2-4 mg/Kg mas diazepan 10 mg e.v. Grupo II (grupo estudio fentanil 50-100 mcg más propofol 1,5-2,5 mg/Kg Se tomó la frecuencia cardiaca y la tensión arterial 10 min. antes de comenzar la anestesia y después cada 5 min. En el grupo I los antecedentes patológicos más frecuentemente encontrados fueron, diabetes mellitus (14%, hipertensión arterial y asma bronquial 10 % cada una, habito de fumar 24%. En el grupo (II, 16 hipertensas (32%, 7 asmáticas (14% y 3 diabéticas (6%, habito de fumar (14 %. En el grupo I a los 5 minutos (min. de iniciada la inducción aumentaron los valores medios de la FC y la TAS en un 4.7%, la TAD en un 9,9 %, comportandose de forma similar a los 20 min, En el grupo II se comprobó a los 5 min un descenso transitorio de los valores medios de la FC, TAS y TAD del 14,8%, 9,6% y 10,4% respectivamente con un ascenso gradual a la normalidad a los 20 min. El tiempo medio de recuperación anestésica en el grupo I fue de 2,5 horas y de 3,3 min. En el grupo II Los efectos adversos se encontraron con mayor frecuencia en el grupo I.A prospective study of 100 patients operated on by elective surgery from breast node was performed at Leon Cuervo Rubio Hospital between October 2002 and September 2003, they were divided into two groups of 50 patients each and selected at random. Control I (Control Group was given endovenous general anesthesia with Ketalar (2-4 mg/kg and Diazepam (10 mgiv. Group II (Study Group was given Fentanyl (50-100 mcg and Propofol (1, 5-2, 5 mg/kg. heart rate and blood pressure were taken 10 minutes before the anesthesic procedure and after 5 minute. The most frequent medical histories found in Group I

  8. Manifestações oculares do paciente infectado pelo HIV atendido no Departamento de Oftalmologia da Universidade Federal de São Paulo Ocular manifestations of the HIV infected Patients at the Ophthalmology Department of São Paulo Federal University

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    K. T. F. Matos

    1999-12-01

    Full Text Available OBJETIVO: Avaliar as manifestações oculares do paciente HIV positivo. MATERIAL E MÉTODOS: É um estudo retrospectivo em 1100 pacientes ambulatoriais HIV positivo em três anos com ficha padrão e exame oftalmológico completo, atendidos no Departamento de Oftalmologia da Escola Paulista de Medicina. RESULTADOS: Dos 1100 pacientes, 869 (79% eram do sexo masculino e 231 (21% do feminino. Os fatores de risco mais importantes foram: homossexualidade masculina em 303 (27,55%, heterossexualidade em 272 (24,73%, usuários de drogas endovenosas em 168 (15,27% e causa indeterminada ou não revelada em 246 (22,36%. As queixas oculares mais freqüentes foram: 432 (39,27% pacientes com baixa da acuidade visual; 138 (12,55% com embaçamento visual; 64 (5,82% com dor ocular, 186 (16,9% com queixas inespecíficas e 235 (21,36% pacientes não apresentavam qualquer queixa. As manifestações oculares mais freqüentes foram: retinite por CMV em 246 (22,36% dos pacientes; exsudatos algodonosos em 110 (10%, blefarite em 51(4,64% e toxoplasmose ocular em 48 (4,36%. CONCLUSÃO: Houve progressão da doença entre os heterossexuais e aumento da incidência no sexo feminino nesta população estudada. Os que apresentavam queixas oculares foram a maioria. A manifestação ocular mais freqüente foi a retinite por CMV em 246 (22,36%. Encontramos 10% de exsudatos algodonosos.PURPOSE: To evaluate ocular manifestations of HIV-infected patients MATERIAL AND METHODS: A restropective study of 1,100 HIV positive out patients in 3 years with a standard complete ophthalmological exam. RESULTS: Eigth hundred and sixty nine (79% of the 1,100 patients studied were male and 231 (21% female. The most important risk factors were: male homossexuality in 303 cases (27.55%, heterossexuality in 272 (24.73%, endovenous drugs use in 168 (15.27%, and unknown cause in 246 (26.36%. Related to ocular complains, we found 432 (39.27% patients with decreased visual acuity, 138 (12.55% with visual

  9. Effect of acetyl-L-carnitine on Vip-ergic neurons in jejunum submucous plexus of diabetic rats Efeito da acetil-L-carnitina sobre neurônios Vip-érgicos do plexo submucoso do jejuno de ratos diabéticos

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    Marli Aparecida Defani

    2003-12-01

    Full Text Available The effect of the treatment with acetyl-L-carnitine (ALC on neurons releasing the vasoactive intestinal polypeptide (VIP of the submucous plexus in the jejunum of diabetic rats was the purpose of our investigation. Diabetes (DM was induced by injecting streptozotocin endovenously (35mg/kg. After sacrificing the animals, the jejunum was collected and processed for VIP detection. Four groups were used: C (non-diabetic, CC (non-diabetic treated with ALC, D (diabetic, DC (diabetes treated with ALC. We analyzed the immunoreactivity and the cellular profile of 126 cell bodies. The treatment with ALC improved some aspects of DM. However, it promoted a small increase in the area of neurons from group CC, suggesting a possible neurotrophic effect. Neurons from groups D and DC showed a large increase in their cellular profile and immunoreactivity when compared to C and CC, suggesting a larger concentration of this neurotransmitter within the neurons that produce it. This observation constitutes a recurrent finding in diabetic animals, suggesting that ALC doesnot interfere in the pathophysiological mechanisms that unchain a higher production and/or neurotransmitter accumulation and increase the profile of the VIP-ergic neurons.Investigamos o efeito da acetil-L-carnitina (ALC sobre os neurônios que expressam o peptídeo intestinal vasoativo (VIP do plexo submucoso no jejuno de ratos diabéticos. O diabetes (DM foi induzido pela administração endovenosa de estreptozootocina (35mg/kg. Após o sacrifício dos animais, o jejuno foi coletado e processado para a detecção de VIP. Utilizou-se quatro grupos: C (não diabéticos, CC (não diabéticos suplementados com ALC, D (diabéticos e DC (diabéticos suplementados com ALC. Analisou-se a imunoreatividade e o perfil celular de 126 corpos celulares. O tratamento com ALC melhorou alguns aspectos do DM. Porém, promoveu pequeno aumento na área dos neurônios do grupo CC, indicando possível efeito neurotr

  10. Efeitos da prostaglandina E1 (PGE1 na gênese de capilares sanguíneos em músculo esquelético isquêmico de ratos: estudo histológico Effects of prostaglandin E1 (PGE1 in the genesis of blood capillaries in rat ischemic skeletal muscle: histological study

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    Dorival Moreschi Jr.

    2007-12-01

    purpose. OBJECTIVE: To study morphologic aspects in the genesis of blood capillaries in the lower limb skeletal muscle of rats submitted to ischemia under the action of intramuscular (IM or endovenous (EV PGE1. METHODS: Forty-eight Wistar-UEM rats were randomly distributed into three groups of 16, equally redistributed into two subgroups, observed at the 7th and 14th days as follows: one control group, which had only limb ischemia; one group with ischemia and IM injection of PGE1; and one group with ischemia and EV injection of PGE1. To analyze the results, hematoxylin-eosin (HE and immunohistochemical staining were used. RESULTS: There was a statistically significant increase in the number of capillaries in the subgroups using IM or EV PGE1, through counting in the samples containing HE staining. Immunostaining was not efficient for the quantification of capillaries. CONCLUSIONS: IM or EV PGE1 resulted in an increase in number of capillaries in the skeletal muscle of rats submitted to ischemia after 14 days of observation, which was histologically identifiable through HE staining. Immunostaining was not successful in establishing a correlation with the increase in vessels found in HE staining.

  11. Controle de polidrâmnio recorrente em gestante portadora do HIV-1: relato de caso Recurrent polyhydramnios management in an HIV-1 infected pregnant woman: a case report

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    Geraldo Duarte

    2004-04-01

    fluid. The patient started preterm labor with 30 weeks and 5 days resulting in vaginal delivery of a male neonate weighing 1,690g and measuring 43cm. The baby presented a post natal diagnosis of a sodium-losing nephropathy and was submitted to three negative polymerase chain reaction tests for HIV-1. The authors point out that the option to manage cases of HIV-1 infected pregnancies that could need invasive obstetric procedures should be to give the patient 2 mg//kg of ZDV endovenously before the procedure, in order to avoid MTCT of HIV-1, as it has demonstrated good results in this case.

  12. Experiência inicial com a ceratoprótese de Dohlman-Doane: relato de casos Experience with Dohlman-Doane keratoprosthesis: case reports

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    Andressa Prestes Stolz

    2008-04-01

    eye. Best corrected visual acuity (BCVA was hand motions or worse in all patients. Glaucoma was present preoperatively in 3 eyes and received Ahmed valve implantation. RESULTS: 88,9% eyes achieved BCVA of better than or equal to 20/100, and 44,4% better than or equal to 20/40. In the postoperative period, 3 eyes developed posterior capsule opacity treated with YAG laser capsulotomy; 3 retroprosthetic membrane treated with tPA injection or steroids; 2 glaucoma in clinical treatment; 1 corneal melting, treated with donor cornea bottom exchange; and 1 fungic endophthalmitis, treated with corneal transplant, anterior vitrectomy, KPro and intraocular lens explantation, and specific intravitreal and endovenous treatment. CONCLUSION: Dohlman-Doane K-Pro seems to be a good option for cases of corneal blindness with poor prognosis for traditional penetrating keratoplasty. Its main advantage is not requesting systemic immunossuppression. Best results were achieved in non-immune diseases.

  13. Effect of the period of extrinsic mechanical compression following sclerotherapy in veins in rabbit ears Efeito do tempo da compressão mecânica extrínseca após escleroterapia em veias de orelhas de coelhos

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    Cláudio Santana Ivo

    2011-06-01

    suficiente para evitar reperfusão nas veias tratadas; se há relação entre a intensidade inflamatória na parede venosa e tecidos adjacentes e o tamanho do trombo venoso; se a intensidade da inflamação pós-escleroterapia varia com o tempo de compressão; se há relação entre a presença de hemossiderina nos tecidos adjacentes ao vaso esclerosado e coágulo venoso. MÉTODOS: Utilizaram-se 28 coelhos, machos, distribuídos em quatro grupos (0, 24, 72 e 120. Em todos os animais foram administrados 0,25 ml de solução de polidocanol 1% e, como controle, 0,25 ml de solução de cloreto de sódio 0,9% na veia marginal dorsal das orelhas direita e esquerda, respectivamente. Realizou-se compressão mecânica em trecho da veia perfundida, exceto nos animais do grupo 0. O tempo de compressão variou de 0 a 120 horas nos grupos. Realizou-se exame anatomopatológico de trecho das veias marginais dorsais direita e esquerda de todos os animais. RESULTADOS: Não houve diferenças significativas nos diversos tempos de compressão, tanto no grau de trombose venosa como na intensidade inflamatória, em ambas as orelhas, nos diversos grupos. Observou-se correlação positiva e significativa entre intensidade inflamatória e tamanho do trombo e na ocorrência de trombos e hemossiderina. CONCLUSÕES: O tempo de até 120 horas de compressão não é suficiente para evitar reperfusão nos vasos esclerosados. A intensidade da inflamação nos tecidos tem relação com o tamanho do trombo, mas não com o tempo de compressão. A presença de hemossiderina nos tecidos adjacentes ao vaso submetido à esclerose está relacionada com a presença de coágulo venoso.

  14. MALT LYMPHOMA OF PALATE AND ORBIT

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    VIVIANA ANDREA CIFUENTES NAVAS

    2018-05-01

    acquires a tumour morphology of 4x4x2.2 cm, well defined that does not infiltrate adjacent tissues. It enhances intensely and homogeneously with contrast.  There are bilateral laterocervical ganglionic images ,with predominance in right side, nonspecific.Orbit MRI: It demostrates mixed orbital mass intra and extraconal on the left side, oval morfology, Its limits are partially well-defined, with transverse diameters 2.3x1.1 cm and craniocaudal 2cm approximately, it show a  moderate and diffuse enhance after endovenous contrast. The result of the biopsy of both lesions indicated infiltration of "B" lymphoma type MALT lymphoma. The patient was referred to the service of hematology, found no adenopathies or visceromegalies.  It was cataloged like a lymphoma NO HODGKIN B malt type STAGE IV-A (two extranodal sites, orbit and palate, He is currently with chemotherapy treatment, and he is followed up by this department.  CONCLUSIONS MALT lymphoma affects adults older than 60 years mainly, showing a slight female predominance, and more probably for gastric locations. The clinical characteristics and the presentation of the symptoms are mainly related to the primary location of the tomour. Approximately 6% of the non-hodgkin lymphomas that affect Waldeyer's ring are MALT lymphomas, affecting most of them to the palatine amygdala. However, according to the reviewed bibliography, the affectation of the palate is rare, being more frequent the orbital location MALT lymphomas follow a relatively indolent clinical course and generally remain localized in their primary extranodal site. Tumors are sensitive to radiation therapy and local treatment. However, dissemination at multiple sites is not infrequent, it may involve extra-ganglionic sites, such as bone marrow, spleen and liver.  Early diagnosis is the basis of a better prognosis, this allows a more adequate treatment. The role of the in-depth clinical study is emphasized and confirmed by a biopsy. It is important the