Intralesional 3% sodium tetradecyl sulphate versus hot water in oral cavity hemangioma: a comparative study

<p class="abstract"><strong>Background:</strong> Oral cavity lesions fall among the few most common presentations in the outpatient department of ENT. Hemangioma in oral cavity though do not usually account for any life threatening or serious condition but hampers day to day activities like chewing, speaking and occasionally bleeding from oral cavity. Timely diagnosis and treatment solves the above problem. Though there are various modalities of treatment ranging from cryosurgery to surgical ablation, sclerotherapy is an evolving, effective and easy method for reduction of the size of lesion and preventing recurrence. It can be done as a day care procedure. The aim was to compare between the efficacy of 3% sodium tetradecyl sulphate and hot water in oral cavity hemangiomas.</p><p class="abstract"><strong>Methods:</strong> A total of 20 patients presenting to the OPD, department of ENT, VIMSAR, Burla, with diagnosis of hemangioma in oral cavity between January 2018 to January 2019 were selected for the study. They were divided into two groups. Group A was administered 3% sodium tetradecyl sulphate whereas group B was administered hot water, both intralesionally, at multiple sites of lesion. Injection were repeated after an interval of 2 weeks for a period of 3-4 months. The results were routinely analysed clinically and statistically and the statistical significance was set at p&lt;0.05.</p><p class="abstract"><strong>Results:</strong> There was a significant improvement (p&lt;0.05) in most of the parameters measured, in group A patients as compared to group B patients.</p><p class="abstract"><strong>Conclusions:</strong> 3% sodium tetradecyl sulphate is a better sclerosing agent than hot water in cases of oral cavity hemangiomas.</p>

Foam bubble size is significantly influenced by sclerosant concentration for polidocanol but not sodium tetradecyl sulphate

Objectives To determine the effect of liquid gas fraction (LGF), sclerosant type and concentration, and filter use on foam bubble size and count. Methods Sclerosant foam microstructure was investigated using light microscopy for a range of LGFs (1 + 2, 1 + 4 and 1 + 8), for both sodium tetradecyl sulphate (STS) and polidocanol (POL), at a range of concentrations (0.5–3%), with and without the addition of micro-filters. Foam was generated using a modified Tessari method and placed into wells for analysis by light microscopy. Foam microscopic morphology was photographically documented, and bubble diameters and counts were quantified. Results Spherical bubbles were observed at lower LGF and a trend towards polyhedral morphology was observed at the higher LGF of (1 + 8). The higher gas content in LGF led to larger but fewer bubbles. POL bubble diameters appeared to be more influenced by concentration than STS with smaller bubbles observed at higher concentrations of POL. The mean bubble diameters were slightly larger for STS than POL at the highest concentration of 3% but smaller at lower concentrations of 1% and 1.5%. Conclusions LGF is the primary determinant of bubble diameter and count. In contrast to STS, POL concentration influences the foam bubble size with smaller bubbles generated at higher concentrations of POL and larger bubbles appearing at low concentrations of this agent.

COMPARISON OF INTRALESIONAL SCLEROTHRERAPY WITH BLEOMYCIN VS SODIUM TETRA DECYL SULPHATE IN LYMPHANGIOMA

The purpose of this study is to compare between the efficacy of Bleomycin and Sodium tetra decyl sulphate as intralesional sclerotherapy for lymphangioma. Materials and methods- This prospective study was done between Jan 2018 to Jan 2020. Total of 30 patients with lymphatic malformations at head neck, axilla, chest wall and lower limb were included. Group I was given intralesional injection of bleomycin and Group II was injected with STS. All the cases were evaluated for a minimum period of one and a maximum of 2 years. Result Efficacy of bleomycin was found to be superior to STS, when used as intralesional sclerotherapic agent. Most of the vascular lesions of group I resolved after first dose giving excellent response in 60% as compared to 40% in STS group. Conclusion Intralesional bleomycin and sodium tetradecyl sulphate are safe and effective sclerosing agents in lymphangiomas of children, but bleomycin is more effective in reducing the size of the lesions.

Therapeutic vanish in pyogenic granuloma: a case series

<p class="abstract">Pyogenic granuloma (PG) is a common benign vascular tumour which affect both skin and mucous membranes, occurring commonly on the face, oral mucosa, or a site of previous injury in all ages. Though some PGs resolve spontaneously, most requires treatment to prevent bleeding, ulceration, and scarring. We presented a case report of 4 patients who developed PG on index finger, forehead and nose. Our findings demonstrated the use of sclerotherapy using 3% sodium tetradecyl sulphate which is a safe and economical therapy for adult patients.</p>

Sirolimus and propranolol inhibit endothelial proliferation while detergent sclerosants induce endothelial activation, microparticle release and apoptosis in vitro

Objectives To investigate the effects of detergent sclerosants, sodium tetradecyl sulphate and polidocanol, on endothelial cell activation and microparticle release and the effects of detergent sclerosants, sirolimus and propranolol, on apoptosis in vitro. Methods Cultured human umbilical vein endothelial cells and murine haemangioendothelioma (EOMA) cell lines were incubated with different concentrations of sodium tetradecyl sulphate and polidocanol, as well as sirolimus and propranolol. Endothelial activation was assessed using flow cytometry for CD62e (E-Selectin), CD54 (ICAM-1), CD105 (endoglin), CD144 (VE-Cadherin), CD146 (MCAM) and the release of endothelial microparticles. Cell proliferation was assessed using [3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium] and carboxyfluorescein succinimidyl ester assays. Apoptosis was assessed using flow cytometry for lactadherin/propidium iodide staining and for Caspase-3 expression. Results Sublytic concentrations of sodium tetradecyl sulphate and polidocanol (0.075%–0.3%) increased the expression of the activation markers CD62e and CD54. The expression of CD105 decreased in sclerosant treated cultured human umbilical vein endothelial cells. Both sodium tetradecyl sulphate and polidocanol induced the release of endothelial microparticles. All agents inhibited cell proliferation. Sodium tetradecyl sulphate and polidocanol-induced apoptosis as evidenced by increased phosphatidylserine exposure and caspase-3 expression, whereas sirolimus and propranolol increased caspase-3 expression only. Conclusion Sublytic concentrations of detergent sclerosants induce endothelial activation and the release of endothelial microparticles. All agents were anti-proliferative in EOMA cell lines, with sodium tetradecyl sulphate and polidocanol inducing cellular apoptosis.

Circulating blood cells influence the fibrinolytic capacity of clots generated in the presence of detergent sclerosants

Objectives To investigate the effects of sodium tetradecyl sulphate and polidocanol on fibrinolytic potential of sclerosant-incubated clots. Methods Serial dilutions of sodium tetradecyl sulphate and polidocanol were incubated with platelet poor plasma and whole blood samples. Rotational thromboelastometry was used to determine the lysis of sclerosant-incubated clots in whole blood. Fibrin generation and fibrinolysis were quantified using an overall haemostatic potential assay on platelet poor plasma. Results Rotational thromboelastometry analysis of whole blood revealed increased maximum lysis in the presence of sodium tetradecyl sulphate but decreased maximum lysis at low concentrations of polidocanol. Clots generated using platelet poor plasma in the overall haemostatic potential assay demonstrated no significant change in fibrinolysis for both sclerosants at all concentrations measured. Discussion Sodium tetradecyl sulphate and polidocanol produce differing effects on the fibrinolytic potential depending on sample type and concentration. In whole blood, sodium tetradecyl sulphate produces clots more sensitive to lysis while polidocanol produced fibrinolytic-resistant clots.

Lymphatic malformation with acquired Horner syndrome in an infant

An infant presented with right upper eyelid ptosis and was subsequently diagnosed with acquired Horner syndrome. Further evaluation revealed a right-sided cervicothoracic lymphatic malformation. At 13 weeks of age, the child underwent percutaneous intracystic sclerotherapy with a mixture of sodium tetradecyl sulphate and ethanol. Twenty-one weeks after initial treatment, ophthalmic examination showed complete resolution of the blepharoptosis and pupillary miosis. Percutaneous sclerotherapy not only effectively treated the space-occupying lymphatic malformation but also reversed the Horner syndrome that was presumably induced by neural tension (more likely) or compression.