Percutaneous Sclerotherapy of Venous Malformations of the Hand: A Multicenter Analysis

Purpose To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand. Materials and Methods A retrospective multicenter trial of 29 patients with VMs primarily affecting the hand, including wrist, carpus, and/or fingers, treated by 81 percutaneous image-guided sclerotherapies using ethanol gel and/or polidocanol was performed. Clinical and imaging findings were assessed to evaluate clinical response, lesion size reduction, and complication rates. Substratification analysis was performed with respect to the Puig’s classification, the sclerosing agent, the injected volume of the sclerosant, and to previously performed treatments. Results The mean number of procedures per patient was 2.8 (± 2.2). Last follow-up (mean = 9.2 months) revealed a partial relief of symptoms in 78.9% (15/19), while three patients (15.8%) presented symptom-free and one patient (5.3%) with no improvement. Post-treatment imaging revealed an overall objective response rate of 88.9%. Early post-procedural complications occurred after 5/81 sclerotherapies (6.2%) and were entirely resolved by conservative means. Type of VM (Puig’s classification) as well as sclerosing agent had no impact on clinical response (p = 0.85, p = 0.11) or complication rates (p = 0.66, p = 0.69). The complication rates were not associated with the sclerosant volume injected (p = 0.76). In addition, no significant differences in clinical success (p = 0.11) or complication rates (p = 0.89) were detected when comparing patients with history of previous treatments compared to therapy-naive patients. Conclusion Percutaneous sclerotherapy is both safe and effective for treating VMs of the hand. Even patients with history of previous treatments benefit from further sclerotherapy showing similar low complication rates to therapy-naive patients. Level of Evidence Level 4, Retrospective study.

Success of Using Iodopovidone as a Sclerosing Agent for Chemical Pleurodesis in a Tertiary Care Center: A Descriptive Cross-Sectional Study

Introduction: Pleurodesis is a procedure to achieve symphysis between the two layers of pleura aimed at preventing the accumulation of either air or fluid in the pleural space. In Nepal, intrapleural instillation of the chemical sclerosing agent is more commonly done as thoracoscopy facility is not easily available. However, iodopovidone is rarely used for this purpose in Nepal. The study aims to find the prevalence of success using iodopovidone as the chemical sclerosing agent. Methods: The study included cases undergoing pleurodesis over a two-year period. The clinicodemographic data, diagnosis, treatment effect and treatment response were analyzed. The treatmentresponse was graded as Treatment Success (Complete Response or Partial Response) and TreatmentFailure. Results: Pleurodesis was done in a total of 54 cases. Of those, 39 cases were Secondary SpontaneousPneumothorax, 11 were Malignant Pleural Effusion, 3 were Primary Spontaneous Pneumothorax,and 1 was a case of Hepatic Hydrothorax. Among Secondary Spontaneous Pneumothorax, Pleurodesis was successful in 37 (95%) out of 39 cases, with 35 (90%) having a Complete Response and 2 (5%)having a Partial Response while 2 (5%) had Treatment failure. Among Malignant Pleural Effusion,treatment success was achieved in 6 (55%) out of 11, whereas 5 (45%) failed the treatment. The commonest complication was burning sensation, and the commonest pain scale was “distressing.” Conclusions: This study highlights the safety and ease of use of iodopovidone as an agent forchemical pleurodesis. It confirms the high rate of success of pleurodesis in cases of pneumothoraxas found in other studies. In contrast, the success rate is understandably lower in cases of MalignantPleural effusion.

Povidone Iodine as Sclerotherapy Into the Renal Pelvis for the Management of Chyluria: Our Experience

Objective: To evaluate the effectiveness and safety of 0.2% povidone iodine renal pelvic instillation as minimally invasive therapy for chyluria resistant to conservative treatment. Methods: From July 2015 to December 2016, 9 patients with chyluria were treated. There were 2 males and 7 females ranging from 30-65 years of age. Cystoscopic localization of chylous efflux was done. On a day care basis under local anesthesia a 5 Fr open ended ureteric catheter was introduced on the affected side. Freshly prepared 10 ml 0.2% Povidone iodine solution was instilled as a sclerosing agent in the renal pelvis. A total of 3 doses were given at 8-hour intervals. Unilateral instillation was done in 8 cases, and bilateral instillation was done in 1 patient. Result: Eight of 9 patients showed complete clearance. In 1 patient, recurrence was noted and a repeat injection was given after 4 weeks, with success. Conclusion: Our experience shows that povidone iodine is a safe and effective sclerosing agent in the management of chyluria Bangladesh Journal of Urology, Vol. 20, No. 2, July 2017 p.78-81

Sclerotherapy – How to Achieve a Spectacular Outcome

When performed correctly, sclerotherapy results in fibrous occlusion that is not amenable to recanalization. Paramount to success is adequate contact time of a sclerosant to the endothelial cells to cause sufficient damage to the vein while minimizing side effects. To optimize sclerotherapy results, one needs to choose the right patient and the right vein and then use the proper sclerosing agent and injection techniques. This paper will review current literature on sclerotherapy, as well as tips and tricks to optimize outcome and minimize complications.

Outcome of sclerosing agent for managing the oral pyogenic granuloma.

Objectives: Outcome sclerosing agent for managing the oral pyogenic granulomain terms of post-operative pain, post-operative healing and post-operative infection. Study Design: Cross-section study. Setting: Department of Oral & Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical & Health Sciences Jamshoro / Hyderabad. Period: October 2018 to March 2019. Material & Methods: Patients with oral pyogenic granuloma and willing to contribute in study were included. Sclerosing agent (ethanolamine oleate) was taken in 3cc disposable syringe and injected in each lesion once a week and repeated according to need. Patients were fooled for 1 to 3 weeks. Outcome was assessed in terms of post-operative pain, post-operative healing and post-operative infection. Data was recorded in proforma. Results: Total seventy four patients were included; their mean age was 40.67+4.99 years. Males were in majority 59.5%. On 1st week 32 showed mild pain which was markedly decreased on 2nd and 3rd week almost among all patients. On 1st week healing was achieved by all cases. Infection was occurred in 4 patients and fever was noted in 12 cases. On 2nd week infection was occurred in 2 patients and fever was in 04 cases. On 3rd week infection was noted in only one cases and fever not found. Conclusion: It was concluded that sclerosing agent ethanolamine oleate is better treatment option than surgical removal with lower rate of pain, best achievement of post-operative healing and lower rate of post-operative infection for the oral pyogenic granuloma management.

Establishment of an animal model of chronic osteomyelitis with Staphylococcus aureus by ligating the femoral artery of rats

Background Osteomyelitis caused by Staphylococcus aureus (S. aureus) is an important post-operation complication, especially after fracture internal fixation and artificial joint replacement. Animal models play an indispensable role in exploring the pathogenesis of osteomyelitis. Most models use internal fixation, bacterial suspension and vascular sclerosing agent to destroy blood vessels. Vascular sclerosing agents not only damage blood vessels but also lead to local inflammatory immune disorders, which is different from simple vascular disease and osteomyelitis caused by ischemia in clinical practice. Methods The experimental animals were randomly divided into three groups: femoral artery ligation group, vascular sclerosing agent group and non-infection aseptic operation group. In the femoral artery ligation group, the femoral artery was ligated to reduce the blood flow of the affected limb to simulate the clinical ischemic state and increase the susceptibility, then the Kirschner needle with S. aureus biofilm was implanted into the tibia of rats, and the bone defect was sealed with aseptic paraffin. The non-infection aseptic operation group and the infection model group caused by vascular sclerosing agent have been used as the blank and positive control group. After operation, survival rate, body temperature and incision healing were monitored. Four weeks later, radiological and pathological changes of all animals were evaluated, and the secretions from osteomyelitis experienced etiological separation and cultivation. Results The chronic osteomyelitis model was established successfully by ligating femoral artery and implanting Kirschner needle covered with S. aureus biofilm. Signs of chronic osteomyelitis were observed in all rats of femoral artery ligation infection group and positive control group. No signs of infection and chronic osteomyelitis were found in the non-infection aseptic operation control group. Conclusion The method of ligating the femoral artery and implanting Kirschner needle with S. aureus biofilm into the tibia of rats can effectively establish a stable and reproducible chronic osteomyelitis model which is closer to the clinical pathogenesis and natural route of infection. This model could be useful for the study of pathogenesis and therapeutics of chronic osteomyelitis with S. aureus.