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At least 613 records · Page 34Linked to original sources
PubMed1989

Perforation of esophagus after endoscopic variceal sclerotherapy. Incidence and clues to pathogenesis.

To determine the true incidence of endoscopic variceal sclerotherapy (EVS)-related esophageal perforation, a retrospective analysis of 900 EVS procedures using sodium tetradecyl sulfate performed on 170 patients during a five-year period (1980-1985) was carried out. Autopsy data of all patients who received EVS and who died (32 patients, 100%) during this period were available to confirm the diagnosis of perforation. Esophageal perforation was confirmed in 5 (2.9%) and was seen in patients with advanced alcoholic liver disease. Importantly, most patients did not manifest features of an esophageal leak, but presented instead as a deterioration in condition and died after a mean (+/- SD) 14 +/- 5.2 days. Analysis of the clinical and EVS data reveals that the risk of developing perforation is high when EVS is performed during active bleeding. The extravariceal location of sclerosant and microabscesses may be important predisposing factors. In our experience large-dose injection, deep ulceration, and balloon tamponade are less likely predisposing factors of this complication.

Adult↗
PubMed1989

Esophageal tamponade in the management of acute variceal hemorrhage.

Over a seven-year period, 138 patients with portal hypertension presented on 223 occasions with endoscopically proven acute variceal hemorrhage. Hemorrhage ceased spontaneously on 92 occasions (41%). On 126 occasions (57%) passage of the four-lumen modification of the Sengstaken-Blakemore tube was required, and hemorrhage was successfully controlled in 98%. Intubation was refused on five occasions (2%). Hemorrhage recurred during these 223 admissions on 47 occasions (21%); on 11 occasions a second rebleed occurred and on two occasions, a third. Tamponade was required during all of these rebleeds and arrest of hemorrhage was achieved in 87%. Hemorrhage in patients with poorer modified Child's grade was less likely to cease with intubation. The overall rate of control in the 186 episodes of hemorrhage requiring tamponade was 94%. There were 28 complications attributed to the use of tamponade in 186 episodes of hemorrhage (15%). On 12 occasions these complications proved fatal (6.4%). In four further patients failure of tamponade to control hemorrhage was fatal.

Adolescent↗
PubMed1978

[Varicose veins: sclerosing therapy (author's transl)].

Every varicosis can be treated without operation if injection therapy is correctly carried out. The patient stands upright, a thick needle (1.2 mm) is inserted into the varix. The venous blood flows out, the patient lies down. Injection is made with the leg in a high position (30 degrees), compression follows each sclerosing injection. Intraarterial injections can be avoided by using a thick needle. Retained intravaricose blood should be incised to avoid pigmentation. Rapid treatment is possible with 3-5 days. As with our ordinary treatment, we give 5-10 injections daily with Varigloban 2-8%.

Aged↗
PubMed1988

A randomised trial to compare the results of injection sclerotherapy with a bulk laxative alone in the treatment of bleeding haemorrhoids.

In a prospective randomised trial, 43 patients with bleeding haemorrhoids were allocated to receive either a bulk laxative with injection of phenol (5%) in arachis oil (20 patients) (Group 1), or a bulk laxative alone (23 patients) (Group 2). Treatment was given by one author and patients were assessed "blind" by the other at 6 weeks, 3 months and finally at 6 months. At 6 weeks 12 (48%) in Group 1 and 12 (57%) in Group 2 were still bleeding (NS; chi 2 = 0.54). At 3 months 10 (40%) in group 1 and 6 (35%) in group 2 (NS; chi 2 = 0.10), and at 6 months 10 (43%) in group 1 and 7 (47%) in group 2 were still bleeding (NS; chi 2 = 0.04). No significant difference in bleeding at 6 months after either injection sclerotherapy with bulk laxative or bulk laxatives alone was found.

Adult↗
PubMed1988

Sclerotherapy of rectal varices.

Rectal varices represent a rare condition even in cases of portal hypertension. A case of bleeding ano-rectal varices presenting as the first manifestation of portal hypertension is reported. Treatment by sclerotherapy was successful.

Aged↗
PubMedDate not supplied

Prophylactic sclerotherapy in nonalcoholic liver cirrhosis: preliminary results of a prospective controlled randomized trial.

Between June, 1984 and December, 1985, a total of 41 patients were enrolled in a prospective controlled randomized trial comparing prophylactic sclerotherapy and medical treatment for the prevention of the first esophageal variceal bleeding. All patients had nonalcoholic liver cirrhosis, fourth degree varices, and no past history of gastrointestinal bleeding. The patients were randomly assigned to the control group (20 patients) or to the sclerotherapy group (21 patients); most of the patients belonged to Child's classes A and B. After a mean follow-up of 16.8 months, there were 3 variceal bleeding episodes and a 10% mortality rate in the control group whereas neither hemorrhage nor death was observed in the sclerotherapy group. In the latter group, severe complications occurred in 9.5% of the patients; the rate of recurrence after eradication of esophageal varices was 40%. Although there were no statistically significant results, the favorable trend toward a lower bleeding risk and better survival observed in the treated patients suggests that a longer trial in a larger population of cirrhotic patients with a longer follow-up should be considered.

Aged↗
PubMedDate not supplied

Successful treatment of early hepatocellular carcinoma and concomitant esophageal varices.

Twenty-two cirrhotic patients with hepatocellular carcinoma (HCC) and concomitant esophageal varices underwent aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both (group A). To evaluate this treatment, 37 cirrhotic patients without esophageal varices who underwent hepatic resection for small HCC (2 cm or less) during the same period (group B) were studied to compare clinical data, preoperative laboratory data, pathologic findings, disease-free rates, and survival rates. The operative time, blood loss, and resected liver weight did not differ between the two groups; however, the tumor size of group A (2.7 +/- 1.6 cm, mean +/- SD) was significantly larger than that of group B (1.5 +/- 0.3 cm). The preoperative liver function of group A was also more severe than that of group B except for prothrombin time. Despite these disadvantages, the 1-, 3-, and 5-year disease-free rates of the two groups were 72% versus 94%, 48% versus 54%, and 38% versus 45%, respectively, and the 1-, 3-, and 5-year survival rates were 91% versus 97%, 79% versus 79%, and 54% versus 67% (group A versus group B), respectively, which showed no significant differences. Furthermore, there was no variceal bleeding in group A after treatment. Based on the above findings, for treatment of HCC and concomitant esophageal varices, aggressive hepatic resection accompanied by simultaneous devascularization, perioperative endoscopic injection sclerotherapy, or both is the preferred form of treatment.

Adult↗
PubMed1986

Prophylaxis of first variceal hemorrhage in patients with liver cirrhosis.

Prophylaxis of bleeding from esophageal varices is a very tempting concept at first glance, especially under the assumption of a high mortality associated with first variceal hemorrhage. Up to now four different measures have been tried for prophylaxis: portacaval shunt operation, devascularization procedures, sclerotherapy, and drugs. With the exception of portacaval shunts, ongoing controlled trials show a weak trend toward reduction of variceal bleeding and prolongation of survival in selected patients with compensated cirrhosis and large varices. However, prophylaxis of first variceal bleeding must still be regarded as experimental and should be restricted to controlled clinical studies.

Adrenergic beta-Antagonists↗
PubMed1985

[Therapy of portal hypertension in childhood].

From 1980 to 1984 fortyeight children with portal hypertension were treated, 37 out of these had a prehepatic bloc. In 19 children a sclerotherapy was performed. Seven times a bleeding recurrency occurred and an esophageal stenosis was seen in 2 cases. The distal splenorenal shunt (Warren) was performed 16 times. All children survived, one pneumonia and one slight pancreatitis were observed post-operatively. Four times a shunt obstruction was found at follow-up examinations. Bleeding recurrencies did not appear.

Child↗
PubMed1985

Transcutaneous procedures for male sterilization.

Outside the People's Republic of China transcutaneous methods of male sterilization are not widely used, even though there are advantages of these methods over surgical vasectomy procedures. Methods of transcutaneous sterilization (intratesticular, intraepididymal, and intravasal) that have been evaluated in men are reviewed.

Animals↗
PubMed1987

Effect of intravenous and intraperivenous injections of sclerosants (sodium tetradecyl sulfate and hydroxy polyethoxy dodecan) on the rat femoral vein.

The sclerosant effect of injected tetradecyl sulfate of sodium (STS) and hydroxy polyethoxy dodecan (HPD) was studied in the rat femoral vein. Intravenous (i.v.) and intravenous plus perivenous (i.v. + p.v.) injections of both sclerosants and physiologic saline were compared as to vein lumen occlusion, fibrosis, phlogosis, and damage to the artery and surrounding nervous and muscular tissues. The study was carried out in 30 rats treated by STS, in 30 treated by HPD, and 15 animals were injected with saline. The neurovascular bundle and adjacent muscle were removed at 48 h, 7 and 30 days and examined histologically. I.v. injections of STS produced a solid occlusion of the vein in a significant number of cases, after 30 days (P less than 0.01). A statistically significant number of solid occlusions of the femoral vein resulted after i.v. + p.v. injection of STS and HPD, at 48 h, 7 and 30 days (P less than 0.05; P less than 0.01). There was no significant difference between STS and HPD after i.v. + p.v. injection. After i.v. + p.v. we recorded a marked inflammation of muscle with signs of focal necrosis, at 48 h and 7 days. Our study indicated that i.v. + p.v. injection of STS and HPD provided a high degree of efficacy as regards vein occlusion. On the other hand, i.v. + p.v. injection induced a severe inflammation and necrosis of the tissues surrounding the sclerosed vein. Extrapolating our results to the endoscopic sclerotherapy for esophageal variceal bleeding, we conclude that paravariceal injection of sclerosants is a dangerous procedure, even though efficacious to reduce variceal hemorrhage, owing to the high risk of iatrogenic ulcers and esophageal perforation caused by muscular and mucosal necrosis.

Animals↗
PubMed1996

OK-432 therapy of lymphangiomas in children.

UNLABELLED: Between April 1988 and July 1995, 11 children with lymphangioma were treated with intralesional OK-432 injection. In 7 patients it was the primary therapy and total shrinkage of the lesion was obtained in 5 of them. Two patients did not respond and the children underwent surgery. Following incomplete surgical removal or recurrence of the lymphangioma, intralesional OK-432 injection was used as secondary therapy in 4 patients. Total regression was observed in 2 cases and marked regression in the 2 others. No serious side-effects except fever lasting for 2-3 days and slight tenderness with swelling of the lymphangioma for 3-4 days after the injection was noted. Local inflammatory reaction did not cause any damage to the overlying skin and did not lead to scar formation. Depending on the size, location, and anatomical relationship of the airway, intralesional injections of the lymphangiomas were performed under general anaesthesia and the children were observed for 24 h. There was no recurrence after follow up periods ranging from 2 months to 7 years. CONCLUSION: Intralesional injection OK-432 represents an alternative, safe and effective treatment for lymphangiomas. It can be used as the primary therapy, after partial surgical excision, or in recurrent lymphangiomas.

Antineoplastic Agents↗