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At least 19 recordsLinked to original sources

PubMed2026

Gelified ethanol for percutaneous sclerotherapy of bone lesions: a systematic review of clinical applications and outcomes.

PURPOSE: To systematically review the available evidence on the feasibility, safety, and clinical effectiveness of percutaneous sclerotherapy using radiopaque gelified ethanol (RGE, Discogel®) for bone lesions. METHODS: A systematic search of MEDLINE, Embase, Web of Science, and Cochrane CENTRAL was performed. Primary studies reporting clinical, technical, and safety outcomes following RGE sclerotherapy for bone lesions were included. Data on patient characteristics, lesion type, procedural details, and outcomes were extracted and synthesized descriptively. RESULTS: Six retrospective studies involving 55 patients (mean age 22.2 ± 20.4 years; range 3-65; 26 females) with 56 lesions and 119 procedures were included (mean 2.16 procedures per patient). Aneurysmal bone cysts (80%) and aggressive vertebral hemangiomas (18%) were the main indications. Technical success was reported in 100% of procedures. Pain outcomes were available for 28 patients, with complete resolution in 64.3% (18/28), partial reduction in 32.1% (9/28), and persistence in 3.6% (1/28). Radiological follow-up (50 lesions) demonstrated complete response in 96% and partial response in 4%. No major adverse events were reported according to CIRSE (≥ 4) or CTCAE (≥ 4) criteria. One SIR grade 3 vertebral fracture occurred without confirmed causal association to RGE. Subsequent surgery was required in 3.6% of lesions. CONCLUSION: Although limited to small retrospective series, current evidence suggests that RGE sclerotherapy is a safe and effective minimally invasive option for selected benign bone lesions. Prospective comparative studies with longer follow-up are warranted.

Humans↗

PubMed2003

Sclerotherapy in aneurysmal bone cysts in children: a review of 17 cases.

OBJECTIVE: To determine the efficacy of percutaneous sclerotherapy in the treatment of aneurysmal bone cysts. MATERIALS AND METHODS: Seventeen patients (7 girls, 10 boys) with aneurysmal bone cysts were treated by the percutaneous approach with Ethibloc ( n=14) and histoacryl glue ( n=3) in our institution between January 1994 and June 2000. The cysts were located in the extremities ( n=6), pelvis ( n=2), spine ( n=2), mandible ( n=5), rib ( n=1) and sphenoid bone ( n=1). Percutaneous sclerotherapy was performed with fluoroscopic and/or computed tomographic guidance under general anesthesia. Clinical and imaging follow-up lasted from 24 months to 9 years and 6 months (mean: 57.3 months). The results were quantified as: excellent (residual cyst less than 20% of the initial involvement), satisfactory (residual cyst 30-50%), unsatisfactory (residual cyst more than 50%). RESULTS: The age of the patients ranged from 4 years and 6 months to 15 years and 8 months (mean: 11 years and 2 months). In nine patients, the therapeutic procedure was repeated 2-5 times. Excellent regression was observed in 16 (94%), satisfactory results in 1 (6%). There was no failure (unsatisfactory result or no response to treatment) in this reported series. The complications were minor and included: local inflammatory reaction ( n=2), small blister ( n=1), and leakage ( n=1). Relief of symptoms was achieved in all patients. No recurrence was noted during follow-up. CONCLUSION: Percutaneous sclerotherapy of aneurysmal bone cysts with Ethibloc is safe and effective. It is an important alternative to surgery, especially when surgery is technically impossible or not recommended in high-risk patients.

Adolescent↗

PubMed2005

Comprehensive treatment of arteriovenous malformations in the oral and maxillofacial region.

PURPOSE: Arteriovenous malformations (AVMs) in the oral and maxillofacial region are rare but potentially life-threatening vascular lesions. We report our experience in treating these lesions in the oral and maxillofacial region. PATIENTS AND METHODS: Superselective intra-arterial embolization (SIAE), sclerotherapy, bone wax packing of bone cavity and curettage, radiotherapy, and surgical resection were used alone or in combination in 28 patients with AVMs in the oral and maxillofacial region. Among them there are 13 cases involving the soft tissue, 11 cases involving bone, and 4 cases involving both the soft tissue and bone. RESULTS: Follow-up ranged from 3 to 60 months (median, 22 months) after comprehensive treatment. The rates of improvement and cure were 89.3% and 60.7%, respectively. Sclerotherapy in 6 cases of AVMs was ineffective. The rates of improvement and cure in AVMs involving soft tissue treated by surgical resection were 23.1% and 84.6%, respectively. The rates of cure for AVMs involving the jaws treated by SIAE, bone wax packing, curettage, and partial bone resection alone or in combination was 100%. CONCLUSION: Three cases of AVMs involving both soft tissue and bone treated with SIAE and radiotherapy as well as surgical resection were cured. SIAE was an adjunctive treatment for the AVMs of soft tissue and jaws and for controlling bleeding. Surgical resection was an important treatment modality for AVMs. Bone wax packing of bone cavity and curettage was a simple, safe, and effective method for the treatment of AVMs of the jaws. Radiotherapy and sclerotherapy may not be effective methods for AVMs involving the soft tissue.

Adolescent↗

PubMed2006

Treatment of aneurysmal bone cysts with percutaneous sclerotherapy using polidocanol. A review of 72 cases with long-term follow-up.

Aneurysmal bone cyst is a rare tumour-like lesion which develops during growth. Our aim was to determine the efficacy of the administration of percutaneous intralesional 3% polidocanol (hydroxypolyaethoxydodecan) as sclerotherapy. Between July 1997 and December 2004 we treated 72 patients (46 males, 26 females) with a histologically-proven diagnosis of aneurysmal bone cyst, at various skeletal sites using this method. The sclerotherapy was performed under fluoroscopic guidance and general anaesthesia or sedation and local anaesthesia. The mean follow-up period was 34 months (26.5 to 80). The patients were evaluated using the Enneking system for functional assessment and all the lesions were radiologically quantified into four grades. The mean age of patients was 15.6 years (3 to 38) and the mean number of injections was three (1 to 5). Ten patients were cured by a single injection. The mean reduction in size of the lesion (radiological healing) was found to be 76.6% (61.9% to 93.2%) with a mean clinical response of 84.5% (73.4% to 100%). Recurrence was seen in two patients (2.8%) within two years of treatment and both were treated successfully by further sclerotherapy. Percutaneous sclerotherapy with polidocanol is a safe alternative to conventional surgery for the treatment of an aneurysmal bone cyst. It can be used at surgically-inaccessible sites and treatment can be performed on an out-patient basis.

Adolescent↗

PubMed1996

Direct intraoperative sclerotherapy of an aneurysmal bone cyst of the sphenoid.

A young boy presented with a symptomatic aneurysmal bone cyst of the left great wing of the sphenoid bone. Arterial embolization had failed to produce thrombosis, and the lesion could not be resected surgically. Direct intraoperative sclerotherapy resulted in immediate thrombosis of 80% of the volume of the vascular malformation with no progression of symptoms. Two years later, the symptoms had completely resolved, and CT scans showed total ossification of the lesion.

Arteriovenous Malformations↗

PubMed2002

Coagulation abnormalities associated with extensive venous malformations of the limbs: differentiation from Kasabach-Merritt syndrome.

Confusion in the nomenclature of vascular malformations has been a major obstacle to the understanding of these conditions, so that misdiagnosis and treatment inconsistencies are common. Coagulation abnormalities occurring in combination with venous malformations (VM) have been misdiagnosed as Kasabach-Merritt syndrome (KMS), despite marked differences in clinical features, pathology and treatment. A homogenous group of 24 patients with diffuse limb VM was entered into a retrospective chart review study. The VM affected an upper limb in 12 patients, a lower limb in 10 and both in two. Localized intravascular coagulation (LIC) was characterized by a decrease in fibrinogen (0.5-1 g/l), an increase in d-dimers (2-64 micro g/ml) and presence of soluble complex of fibrin (+ to +++). Platelet counts were normal or slightly decreased. Higher VM severity scores were associated with more severe LIC. A number of events such as sclerotherapy, surgery, bone fracture, prolonged immobilization and pregnancy or menstruation triggered conversion of the LIC to disseminated intravascular coagulation (DIC), with bleeding related to factor consumption and multiorgan failure related to disseminated microvascular thrombosis. Clinical symptoms associated with worsening of LIC were pain, thrombosis and bleeding at wound sites or during surgery. None of the patients had the large ecchymotic and inflammatory tumours seen in KMS. Graded permanent elastic compression with heparin therapy was the only effective treatment. In conclusion, VM-associated LIC is a distinctive lifelong coagulopathy that must be differentiated from KMS, which is characterized by platelet trapping within a vascular tumour of infancy. The treatment of the two conditions is very different.

Adult↗

PubMedDate not supplied

[Total replacement of a middle phalanx by free non-vascularized chondral graft, after failure of sclerotherapy for treatment of an aneurysmal bone cyst].

We treated an eleven year-old boy for an aneurysmal bone cyst of the middle phalanx of the long finger. Diagnosis was established after total curettage. The tumor involved the whole phalanx and grew steadily after two attempts at sclerotherapy (with absolute alcohol and Ethibloc). After two years, en-bloc resection had to be performed, and raised the problem of reconstructing a complete finger phalanx with its proximal and distal epiphyses. A free cartilaginous graft from the non-ossified iliac crest was shaped to the exact dimensions of the phalanx and set in its place, with minimal damage to the surrounding tissues during dissection and fixation. By six months an almost normal range of motion was achieved in the PIP (10 to 90 degrees ) and DIP (5 to 30 degrees) joints and radiographs showed complete metaplasia of the chondral graft into an ossified phalanx at 20 months follow-up. The joint spaces also remodelled, and this was confirmed with MRI scanning. Reports on partial replacement of diaphysis or epiphyses in the digits are discussed, but the only valid comparison of total phalanx replacement is free toe phalanx grafting. We did not choose this solution in a normal hand because of the length discrepancy between finger and toe phalanges. This case shows that, in this particular paediatric situation, the free non-vascularised transfer of a chondral graft restored excellent function, with remodelling of the phalanx and joint spaces of the finger.

Arthroplasty↗

PubMedDate not supplied

Medical treatment of recurrent temporomandibular joint dislocation using botulinum toxin A.

This paper describes a new technique for prophylactic treatment of recurrent mandibular dislocation using injection of botulinum toxin A (BtA) into the lateral pterygoid muscles. BtA temporarily weakens muscles by blocking acetylcholine release, and thus operates through a principle different from established treatments such as joint sclerosant therapy, eminectomy or Dautry's procedure. The patient suffered recurrent mandibular dislocations caused by tardive dystonia. We injected 75 mu BtA percutaneously into each lateral pterygoid muscle under electromyographic guidance. No further dislocations occurred over the subsequent 10 months, and follow-up continues. There were no immediate or delayed side effects. More experience is required before this becomes an established treatment. BtA is usually given in outpatients, and is less invasive or destructive than previous options. It may not be suitable if dislocation is due to lax ligaments or weak muscles. Operators must be aware that other BtA preparations require a different dose.

Acetylcholine↗

PubMed1992

Maffucci's syndrome (hemangiomatosis osteolytica): a report of four cases.

Maffucci's syndrome is a congenital nonfamilial syndrome combining dyschondroplasia, (enchondromatosis) and hemangiomatosis. It is a rare disease; only 200 cases have been reported throughout the world in the past 140 years. Over the past 20 years, four patients have been admitted with signs and symptoms consistent with Maffucci's syndrome. Three were children ages 3, 7, and 9 years. The fourth was 23 years old. Two were male and two female. All had hemangiomas at birth, and all had skeletal deformities and enchondromas. All complained of pain and heaviness of the involved extremity. Three patients had the arterial inflow evaluated with arteriograms, and one had magnetic resonance imaging. Two also had venograms. Two patients had excision of their hemangiomas, and one had sclerotherapy and compression therapy. All had bone biopsies performed. None of the enchondromas or the soft tissue lesions had undergone sarcomatous transformation.

Adult↗

PubMed1997

Surgical treatment of recurrent mandibular dislocation by augmentation of the articular eminence with cranial bone.

PURPOSE: This article describes the use of calvarial bone grafts to augment the height of the articular eminence to treat recurrent mandibular dislocation. PATIENTS AND METHODS: Eight patients with mandibular recurrent dislocation were studied clinically, radiographically, and with magnetic resonance imaging (MRI) immediately before surgery, and at 1 week, 6 months, and 1 year after the operation. All the patients were treated with a modification of the Lindemann-Norman technique, performing an oblique osteotomy in the articular eminence and placing a calvarial graft into the osteotomy to augment the height of the eminence. RESULTS: During 18 months of follow-up, no cases of dislocation were noted. CONCLUSION: The results of this study indicate that the surgical technique presented has very low morbidity and predictable outcomes.

Adolescent↗

PubMed2003

Treatment of intermetatarsal Morton's neuroma with alcohol injection under US guide: 10-month follow-up.

Morton's neuroma (MN) is a frequent cause of metatarsalgia. The aim of our study was to evaluate the efficacy of neuroma alcohol-sclerosing therapy (NAST) under US guide in MN after a 10-month follow-up. Forty intermetatarsal neuromas underwent alcohol-sclerosing therapy after sonographic evaluation of their dimensions and echotexture. After subcutaneous anesthesia, a sclerosing solution composed of anesthetic (carbocaine-adrenaline 70%) and ethylic alcohol (30%) was injected inside the mass under US guidance. The procedure was repeated at intervals of 15 days until the resolution of the symptoms. A total or partial symptomatic relief was obtained in 36 cases (90%). No procedure-related complications were observed. Transitory plantar pain, due to the flogistic reaction induced by the sclerosing solution, occurred in 6 cases (15%). The 10-month follow-up revealed a 20-30% mass volume reduction and an adiposus-like change in echotexture. In the 4 cases (10%) of therapeutic failure, the preliminary sonography demonstrated a hypoechoic echotexture with a strong US beam attenuation corresponding to a highly fibrous neuroma after surgical resection. The NAST is a feasible and cost-efficient procedure with high rates of therapeutic success.

Adult↗

PubMed2004

Using silicone gel sheet for the treatment of facial telangiectasias with sclerotherapy.

BACKGROUND: Telangiectasias are superficial cutaneous vessels that are visible to human eye and are present as a dilated venule, capillary, or arteriole. They are a common cause of concern, especially when located in face. Sclerotherapy is among the treatment alternatives, but facial telangiectasias are less responsive than those located on the leg. OBJECTIVE: To show the effectiveness of silicone gel sheet in improving the results obtained by sclerotherapy in facial telangiectasias. METHODS: Between 1998 and 2003, 32 patients were treated with sclerotherapy and silicone gel sheet (group 1). Twenty-six patients were treated with sclerotherapy and cotton ball (group 2), and 30 patients were treated only sclerotherapy (group 3). Patients were evaluated for 12 weeks for the degree of improvement and side effects. All complications, side effects, and number of sessions were also recorded at each follow-up visit. The number of sessions is limited to six. After the final follow-up visit, the photographs taken of each treatment site at baseline and at final visit were reviewed in a double-blinded manner based on a 0 to 4 scale by two physicians. RESULTS: Fifty one of the 88 patients showed improvement totally. In the silicone sheet-sclerotherapy group, 22 of the 36 patients showed improvement. In the sclerotherapy-cotton ball group, 14 of the 26 patients showed improvement, and in the sclerotherapy-only group, 15 of the 30 patients showed improvement completely within the 12 weeks. The patients treated with sclerotherapy-silicone gel sheet (group 1) had more improvement than the other groups. CONCLUSION: Combining silicone gel sheeting to sclerotherapy increases the success rate in treating facial telangiectasias, especially facial subunits, which have bone support.

Adolescent↗

PubMed1995

Systemic treatment with epidermal growth factor induces anaemia in Goettingen minipigs.

1. From two independent experimental studies conducted in 48 minipigs with oesophageal sclerotherapy and concomitant treatment with epidermal growth factor, blood samples together with bone marrow biopsies were analysed for safety data. 2. Four to five weeks of systemic treatment with epidermal growth factor induced a decline in blood haemoglobin concentration in a time- and dose-dependent and reversible manner but without an effect on leucocyte or platelet counts. 3. The bone marrow expressed decreased amounts of haematopoietic tissue and reduced numbers of erythropoietic cells. 4. Four to five weeks of systemic treatment with epidermal growth factor induced reversible increases in serum concentrations of creatinine and urea, most likely reflecting renal impairment. 5. Groups in which creatinine and urea were not increased also had reduced blood haemoglobin concentrations. 6. These findings suggest that epidermal growth factor selectively impaired the erythropoiesis and stress the importance of risk-benefit analysis concerning the potential therapeutic applications of epidermal growth factor.

Anemia↗

PubMed1992

[The successful treatment of G-CSF in autoimmune neutropenia with liver cirrhosis complicated by esophageal varices].

A 72 year-old woman was admitted to our hospital for hematoemesis. After admission, endoscopic examination showed esophageal varices with a red color sign which indicated endoscopic injection sclerotherapy (EIS). Concurrently, however, laboratory findings revealed severe neutropenia in peripheral blood, while bone marrow examination showed marked reduction of mature granulocytes with mild myeloid hyperplasia. As a result of those hematological abnormalities, EIS was halted. Concerning the pathogenesis of this neutropenia, immunofluorescence technique using flow cytometry disclosed the presence of anti-neutrophil autoantibody in the serum, giving a clinical diagnosis of autoimmune neutropenia (AIN). Thereafter, a conventional regimen of corticosteroids as an initial therapy and steroid pulse therapy as a succeeding maneuver were instituted, but in vain. As a last resort, 125 micrograms/body of rhG-CSF was given daily subcutaneously. As a consequence, significant increase in granulocyte count, though transient, was attained, which made EIS possible without any episodes of infections. It seems most likely that a high dose of rhG-CSF exerts beneficial effects as a prophylactic and therapeutic regimen against infections in patients with AIN.

Aged↗

PubMed2001

New experiences with absolute ethanol sclerotherapy in the management of a complex form of congenital venous malformation.

BACKGROUND: Complex forms of congenital venous malformation have defied proper classification and confounded therapy. Through a newly designed multidisciplinary approach, these venous defects were properly diagnosed and classified according to the Hamburg classification. Absolute ethanol was adopted as a new scleroagent for this complex form of venous defects to improve overall treatment results with acceptable morbidity and recurrence rates. PATIENTS AND METHODS: Among 318 patients aged 2 months to 60 years (130 men: mean age, 24.6 years; 188 women: mean age, 24.5 years), 143 patients were confirmed as having venous defects predominantly (45%). We conducted diagnostic evaluation with magnetic resonance imaging, whole body blood pool scan, duplex scans, transarterial microalbumin lung scans, air plethysmography, bone x-ray film, and angiography. Thirty of 143 patients were indicated for the absolute ethanol sclerotherapy for the complex form of venous defects, and they completed 98 sessions of multistage therapy with direct puncture technique. Follow-up assessment (minimum, 6 months; average, 10.2 months) was made as early results after completion of therapy. RESULTS: The immediate success rate at the completion of treatment through 98 sessions on 30 patients was 92% (90/98). The reason for the failure of 8% (8/98 sessions) was mainly due to the lesion's inaccessibility to the nidus to deliver the alcohol safely. On follow-up assessment available on 28 of 30 patients, overall improvement of the lesions with good to fair response on clinical assessment was obtained in 27 (96%) of 28 patients. Similar good to fair responses were obtained on whole body blood pool scan assessment (14 [93%] of 15 patients) and also on magnetic resonance imaging assessment (12 [93%] of 13 patients). Various major to minor acute complications developed during the procedure in eight (26.7%) of 30 patients through 16 (16.3%) of 98 sessions of the therapy: ischemic bullae, tissue fibrosis, deep venous thrombosis, pulmonary embolism, peripheral nerve palsy, and temporary pulmonary hypertension. All 24 incidences of complication were successfully managed with full recovery except one case of permanent peroneal nerve palsy that was present during 18 months of follow-up. No single recurrence has been detected to date. CONCLUSION: Absolute ethanol sclerotherapy alone can deliver excellent results in complex forms of venous malformations with considerable but acceptable morbidity and may be able to reduce the morbidity involved with the conventional surgical therapy alone on complex forms of venous malformation. No recurrence or deterioration of the therapy results was observed during the follow-up period (average, 10.2 months) after the completion of multistaged therapy.

Adolescent↗

PubMed2005

Pathologic fractures in children.

Fractures through bone tumors are often difficult to treat. We reviewed our combined experience with this problem in children, as well as the existing literature, to formulate management guidelines. For this study, prospective databases (1987 to 2002) from three referral centers were screened for pathologic fractures occurring under the age of 14 years. One hundred five patients presented with fracture through unicameral bone cyst, nonossifying fibroma, fibrous dysplasia, aneurysmal bone cyst and osteosarcoma. Seventeen patients were excluded. The most common primary locations were the proximal humerus and proximal femur. Pathologic fracture through nonossifying fibroma had the best outcome; union occurred with nonsurgical treatment in all cases. Unicameral bone cyst required surgical treatment to avoid persistence of the cyst and refracture. However fracture healing was predictable without surgical treatment. Proximal femoral lesions tended to heal in malunion if not fixed surgically. Aneurysmal bone cyst required surgical treatment for the lesion to heal and to allow the fracture to heal as well. Percutaneous sclerotherapy may be the treatment of choice for many of these lesions. Fibrous dysplasia allows fracture healing with nonoperative therapy. Progressive deformity requires followup and surgical correction. Malignant lesions presenting a pathologic fracture are best managed by initial nonoperative therapy during investigation and neoadjuvant therapy when possible, followed by definitive treatment.

Adolescent↗

PubMed2003

[Superficial vascular anomalies of the face: apropos of six cases].

The classification of superficial vascular anomalies of the face recognizes two major categories: hemangiomas and vascular malformations. A multidisciplinary approach to these malformations is necessary. MRI of venous vascular malformations, pulsed Doppler and arteriography of arteriovenous malformations are key examinations in the exploration strategy for superficial vascular malformations. Hemangiomas always regress. Surgery is generally needed only for late sequelae although in some cases early surgery is beneficial. Percutaneous sclerotherapy and surgery are indicated for venous malformations in order to minimize or improve skin, muscle and bone distorsions. Arteriovenous malformations are the most dangerous vascular anomalies of the face. Superselective arterial embolization prepares the surgical excision of the nidus, complete resection is essential. We review 6 cases of superficial vascular malformations of the face treated surgically and discuss the diagnosis features and the treatment modalities of these vascular anomalies.

Adolescent↗

PubMed1990

Systemic toxicity following intracavitary administration of bleomycin.

Bleomycin administered intrapleurally has been demonstrated to be an effective sclerosing agent. The lack of morbidity associated with its use has made it an attractive alternative to other available agents. Pharmacologic data indicate that (1) intracavitary bleomycin is systemically absorbed, and (2) the plasma half-life of bleomycin increases exponentially with renal failure. We report the findings in a patient with renal failure who experienced alopecia and significant mucositis following sclerotherapy. We suspect this systemic toxicity resulted from intrapleural bleomycin and suggest that this treatment be used with caution in patients with renal dysfunction.

Adult↗