Transient tricuspid regurgitation after endoscopic injection sclerotherapy for esophageal varices.
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Echocardiography, Doppler↗
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Splenic ablation by percutaneous injection of ethanolamine oleate in dogs: a possible therapy for hypersplenism.
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Administration, Cutaneous↗
A prognostic evaluation of endoscopic intravariceal injection sclerotherapy for esophageal varices.
Eighty cases of endoscopic injection sclerotherapy for esophageal varices were retrospectively studied to evaluate their prognoses. These cases were evaluated in terms of post-therapeutic bleeding, survival rates and causes of death. Post-therapeutic bleeding occurred in 50% of the emergency cases (26 cases), 25% of the elective cases (16 cases) and 23.7% of the prophylactic cases (38 cases). The frequency of post-therapeutic bleeding was significantly lower in cases with variceal obliteration than in cases without obliteration. An evaluation of the survival rates by the Kaplan-Meier method revealed that poor prognostic factors in sclerotherapy cases were emergency cases, Child's C group, post-therapeutic cases with unsuccessfully obliterated varices, and cases with post-therapeutic bleeding. Concerning early death within 7 days after sclerotherapy, 4 emergency cases died from initial variceal bleeding despite sclerotherapy. Three of these 4 were hepatocellular carcinoma cases, and all 3 cases had tumor thrombi of the portal vein. We recommend prophylactic sclerotherapy from the standpoint of the prognosis after sclerotherapy. However, in the bleeding cases of hepatocellular carcinoma in Child's C group complicated by tumor thrombi of the portal vein, overly enthusiastic application of the therapy should be avoided.
Actuarial Analysis↗
Extent of thrombi following sclerotherapy of esophageal varices.
Fifteen autopsy cases who died within 20 days after intravariceal endoscopic injection sclerotherapy using 5% ethanolamine oleate were examined to clarify the planar extent of thrombi. In 11 of the 15 cases, thrombi extended to part of the fundus of the stomach, as well as the lower esophagus. In addition to these cases, six autopsy cases who survived more than a month after the first injection were studied for the extent of thrombi on the basis of the angioarchitectural characteristics of esophageal varices. The extent could be divided into 3 groups: Group 1 included 5 cases with thrombosis in the main trunk of the varix alone, which connected with longitudinal veins (so-called "Venetian blind-like or sudare-like veins") running for 3-4 cm upward from the esophago-gastric junction. Group 2 included 9 cases with thrombosis in the main trunk and Venetian blind-like veins in the submucosa alone. Group 3 included 7 cases with thrombosis in the main trunk and Venetian blind-like veins in both the submucosa and lamina propria. These results obtained may provide basic information concerning this treatment. Furthermore, the mechanism of the recurrence of varices after eradication induced by treatment was discussed on the basis of the results.
Esophageal and Gastric Varices↗
A case of endoscopic injection sclerotherapy for a bleeding duodenal varix.
A case of bleeding duodenal varix which was treated successfully with endoscopic injection sclerotherapy (EIS) is reported. The patient developed a hemorrhage from a varix in the descending portion of the duodenum two months after EIS for esophageal varices, and hemostasis was achieved using EIS with an intravericeal injection of 1% polidocanol. The duodenal varix decreased in size after EIS. Two months after EIS, a splenectomy was performed. During a 14-month follow up period after the EIS for the duodenal varix, there was no recurrent bleeding.
Adult↗
A clinical controlled trial of endoscopic sclerotherapy for repeated esophageal variceal bleeding.
Thirty-seven patients with postnecrotic cirrhosis of the liver and 13 patients with primary hepatoma were proven to have repeated bleeding from ruptured esophageal varices. Clinically controlled trials were performed by assigning patients to either sclerotherapy or control arms (25 patients each). Combined intra-variceal and para-variceal injection before an upper endoscopic examination was performed in the sclerotherapy group. In all 25 sclerotherapy cases (100%) hemostasis was successful, which was a statistically significant success rate compared to the control group (52.0%) (p less than 0.01). In the sclerotherapy group 20% (5/25 cases) developed rebleeding, which was less than the 48.0% (7 cases of continuous bleeding and 5 cases of rebleeding) of the control group (p less than 0.05). Four cases (16.0%) in the sclerotherapy group died of erosive gastritis with massive bleeding, compared to 8 fatalities (32.0%) in the control group, because of uncontrolled esophageal variceal bleeding. Endoscopic sclerotherapy is a very effective method for arresting bleeding esophageal varices, and for decreasing the rebleeding rate.
Adult↗
Eradication of esophageal varices with repeated injection sclerotherapy in inoperable patients.
Esophageal varices in 50 cirrhotic patients were treated with repeated injection sclerotherapy. Eradication of varices was achieved in 27 patients (54.0%) with a mean of 4.5 injections (range 2-12) after a mean period of 3.1 months (range 1-11). There was no variceal bleeding in these 27 patients once eradication had been achieved, with a mean follow up period of 5.6 months, although bleeding occurred in 5 of the same group before eradication of the varices had been achieved, during an average of 3.1 months, and in 6 of the remaining 23 patients (10 episodes) with residual varices after a mean of 4.7 injections (range 2-12) in a mean period of 12.2 months (range 1-33). Esophageal varices can thus be eradicated with repeated injections and bleeding from recurrent esophageal varices can be prevented in many patients after eradication has been achieved.
Adult↗
The destructive effects of sclerosant ethanolamine oleate on mammalian vessel endothelium.
Ethanolamine oleate (EO) used widely in sclerotherapy against esophageal varices was studied for its pharmacological effect on blood coagulation and vascular damage in animals. Blood coagulation was completely inhibited by EO at a concentration of 0.31%. EO destroyed the endothelial cells of the vessel of dog and rat within one minute after injection into the vessels. An accumulation of fibrin and platelets on the surface of the damaged vessel was observed electron microscopically. Mural thrombus was formed in a few hours and the thrombus occluded the blood stream in the vein. From these animal experiment, intravasal injection of EO was considered to cause the disappearance of varices by the following two processes: collapse of varices because of occlusion of the blood stream and shrinking of the obstructed thrombus through organization.
Adult↗
Doppler controlled diagnosis and treatment of gastrointestinal angiodysplasia.
In 19 of 532 consecutive patients with intestinal bleeding, 47 vascular malformations were found endoscopically as the source of the hemorrhage (3.6%). Eleven angiodysplasias were located in the gastroduodenum and 36 in the colorectum. In all patients, bleeding had stopped spontaneously before endoscopy was performed. To detect superficial arterial vessels responsible for the hemorrhage all lesions were scanned by transendoscopic Doppler ultrasound. There were 41 Doppler-positive anomalies (87%) and 6 Doppler-negative anomalies without an arterial signal. All malformations with submucosal arterial blood flow were treated by prophylactic injection therapy. Control Doppler ultrasound two weeks later revealed the presence of a vessel in 4 angiodysplasias followed by a second sclerotherapy. The 6 Doppler negative lesions could not be found on control examination and corresponded probably to temporary traumatic or inflammatory mucosal changes. Within the framework of follow-up over three months, 2 patients rebled (10.5%). A second sclerotherapy resulted in no further hemorrhage. Endoscopic Doppler ultrasound may help in identification and treatment of gastrointestinal angiodysplasias. After identification of blood vessels responsible for hemorrhage, Doppler ultrasound enables monitoring of local endoscopic therapy.
Adult↗
Experimental study on the effects of sclerosants for esophageal varices on blood coagulation, fibrinolysis and systemic hemodynamics.
The effects of five sclerosants used for treating esophageal varices on blood coagulation and fibrinolysis, systemic hemodynamics, and vascular endothelial cells were studied in mongrel dogs. With each sclerosant, hemolysis and a decrease in the platelet count were observed. Changes in the blood coagulation system occurred immediately after sclerosant administration. Prolongation of the PT and APTT and decreases in fibrinogen and alpha 2-PI were seen in the thrombin (TH), sodium tetradecyl sulfate (STS), and ethanolamine oleate (EO) groups. Polidocanol (PO) and absolute ethanol (ET) had less pronounced effects on these systems. A transient decrease in the cardiac index (CI), pulmonary artery pressure (PAP) and pulmonary artery resistance (PAR) was observed with the administration of the sclerosants, especially in the TH and STS groups. Excessive vascular endothelial damage was observed in the ET group, marked damage was seen in the EO and STS groups and slight damage was recorded in the PO and TH groups.
Animals↗
Endoscopic hemostasis of bleeding peptic ulcers: 1:10000 adrenalin injection vs. 1:10000 adrenalin +1% aethoxysclerol injection vs. heater probe.
To evaluate the efficacy of three endoscopic methods which utilize different mechanisms of hemostasis to control bleeding peptic ulcers, we performed a prospective randomized study in 83 patients. Thirty-two patients were treated with 1:10000 adrenalin (Group I), 29 patients with 1:10000 adrenalin +1% aethoxysclerol (Group II), and 22 patients with the heater probe (Group III). Gastric ulcers were the source of bleeding in 14, 15 and 12 patients while duodenal ulcers were the source in 16, 13 and 10 patients in Groups I, II and III, respectively. Two stomal ulcers were noted in Group I and 1 in Group II. Two spurters were treated in Group I and 4 in Group II, while 22, 13 and 10 oozers were treated in Groups I, II and III, respectively. Definitive hemostasis was achieved in 94%, 100% and 95% in Groups I, II and III, respectively while the rebleeding rate was 6.25%, 6.9% and 9% respectively. 1:10000 adrenalin injection alone or when combined with subsequent instillation of a sclerosing agent and heater probe application have comparable efficacy in the endoscopic control of bleeding peptic ulcers.
Duodenal Ulcer↗
Effects of endoscopic variceal sclerotherapy using GT XIII on blood coagulation tests and the renal kallikrein-kinin system.
Forty-six sclerotherapy sessions were performed on liver cirrhotics with high-risk esophageal varices using GT XIII, a sclerosant composed of gelatin, thrombin and coagulation factor XIII. GT XIII was effective for the prevention of temporary symptoms and transient hypotension observed in 55 sclerotherapy sessions using thrombin. In 42 (91%) sessions, patients underwent sclerotherapy with no symptoms, and in the other four (9%) sessions, only slight symptoms of general fatigue and headache were observed. Changes in the mean arterial pressure were significantly smaller in sessions using GT XIII than in those using thrombin (-12.3 +/- 13.6 vs. -26.8 +/- 20.7 mmHg, P less than 0.01). Changes in coagulation tests, similar to those of disseminated intravascular coagulation (DIC), were also reduced in sessions using GT XIII. Urinary kallikrein and kinin excretion significantly increased after the procedure (P less than 0.01), indicating activation of the renal kallikrein-kinin system. Increases in urinary kallikrein and kinin excretion showed a significant relationship with the consumed plasma fibrinogen levels (r = -0.51, P less than 0.01 and r = -0.58, P less than 0.01, respectively), and it was suggested that activation of the glandular kallikrein-kinin system caused by abrupt DIC-like changes in the hemostatic system might play a role in manifestations of temporary complications occurring with the use of hemostatic agents containing thrombin.
Blood Coagulation↗
Prediction of the recurrence of esophageal varices based on portal vein pressure and oxygen tension in portal and peripheral blood.
In 27 variceal patients completely treated by ethanolamine oleate and polidocanol and followed for more than one year, the recurrence of varices was studied by measuring portal vein pressure and oxygen tension in the portal vein and peripheral arteries and veins before and after EIS. Frequent recurrence was observed in patients with increased PVP after EIS and lower or inverse PVO2-VO2 tension after EIS. The recurrence of varices after EIS may thus possibly be predicted based on portal vein pressure and PVO2-VO2 tension differences.
Esophageal and Gastric Varices↗
Endoscopic closure of bronchopleural fistula after pneumonectomy by submucosal injection of polidocanol.
We report two cases of a bronchopleural fistula with, and without, empyema treated by endoscopic submucosal injection of polidocanol (sclerotherapy) and application of cyanoacrylate. Case 1: A 60-year-old man underwent left pleuropneumonectomy for lung cancer. He developed bronchopleural fistula with empyema at 32 days after the operation. We performed sclerotherapy around the fistula. The air leakage stopped at 2 weeks after the sclerotherapy, and the fistula was closed. He was eventually cured of the empyema by pleural drainage. Case 2: A 61-year-old man underwent left pneumonectomy for lung cancer. He developed bronchopleural fistula without empyema at 50 days after the operation. We performed sclerotherapy and application of cyanoacrylate. After this therapy, the air leakage stopped immediately, and the bronchopleural fistula was closed. The sclerotherapy and application of cyanoacrylate are not only technically easy, but also very effective for treatment of bronchopleural fistula. Sclerotherapy and cyanoacrylate may be advocated as a first therapeutic step.
Bronchial Fistula↗
Suprapubic transvesical puncture and sclerotization of a müllerian duct cyst under US guidance.
Abdominal, ultrasonography (US) performed on a middle-aged patient who presented with partial urinary retention, long lasting lower back pain, and abdominal pain revealed a cyst in the midline of the prostate. The cyst, which protruded into the bladder, was punctured under US guidance transvesically and sclerotized with 1% Aethoxysklerol. Following this procedure, the patient became steadily free of his complaints and is voiding without retention.
Cysts↗
Povidone-iodine sclerosis of pelvic lymphoceles: a prospective study.
Twelve patients presented for percutaneous catheter drainage of 13 postoperative pelvic lymphoceles. Six patients with 7 lymphoceles were treated with povidone-iodine sclerosis prior to catheter removal. Only 1 lymphocele (which continued to drain large amounts of fluid during and after the sclerosis procedure) recurred. Six patients with 6 lymphoceles had their percutaneous catheters removed without sclerosis. Fluid collections recurred in 3 instances, necessitating repeat percutaneous drainage (2 patients) or surgery (1 patient). Percutaneous therapy is the treatment of choice for patients with postoperative lymphoceles. Povidone-iodine sclerosis is often effective in preventing reaccumulation of fluid once the lymphocele cavity is collapsed.
Adult↗
Bilateral pain relief after unilateral thoracic percutaneous sympathectomy.
PURPOSE: To present a case of unexpected bilateral pain relief following unilateral thoracic percutaneous sympathectomy. CLINICAL FINDINGS: We present a case report where severe ischemic pain due to paraneoplastic Raynaud's syndrome with distal gangrene was successfully treated by means of percutaneous thoracic sympathectomy. A unilateral T2, T3 radiofrequency sympathectomy combined with small volume phenol injection resulted in unexpected bilateral pain relief. CONCLUSION: Our observations from this case report suggest a possible crossover of sympathetic innervation at the cervical and thoracic levels. Percutanenous thoracic radiofrequency sympathectomy is a feasible option for the treatment of refractory ischemic upper limb pain.
Aged↗
Morbidity in a pediatric patient having alcohol ablation of an arteriovenous malformation.
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Acidosis↗