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World Journal of Orthopedics Sep 2023Aneurysmal bone cysts (ABC) are benign cystic bone tumors of an osteolytic and locally aggressive nature. As an alternative to the primary treatment of choice, which...
BACKGROUND
Aneurysmal bone cysts (ABC) are benign cystic bone tumors of an osteolytic and locally aggressive nature. As an alternative to the primary treatment of choice, which consists of curettage with bone grafting, alternative treatment methods with promising results have been described. At our department, we have, in recent years, used percutaneous sclerotherapy with polidocanol. The objective of this study was to identify the healing rate and safety of sclerotherapy with polidocanol.
AIM
To identify the efficacy and safety of sclerotherapy with polidocanol in primary and recurrent ABC.
METHODS
Twenty-two consecutive patients (median age 12.5 years; range 1-27) with 23 ABCs treated with sclerotherapy with polidocanol from 2016-2021 were included retrospectively. Eleven patients (48%) had undergone different forms of previous treatment with recurrence. Under general anesthesia and fluoroscopic guidance, repeated percutaneous injections of 4mg polidocanol/kg body weight were performed. Through review of the electronic medical records, the following were identified: healing and recurrence rate, number of treatments, gender, age, comorbidity, location of the tumor and side effects / complications, as well as any previous surgery for ABC. The median length of radiographic follow-up was 19.5 mo.
RESULTS
All ABCs except one (96%) showed healing or stable disease after a median of 4 (range 1-8) injections. Complete clinical and radiographic healing was observed in 16 cysts (70%), while partial radiographic healing with resolution of pain was seen in 6 cases (26%) and considered as stable disease. The cyst that failed to heal had previously undergone curettage twice with recurrence. One patient with a large pelvic ABC experienced, right after two injections, a sudden drop in blood pressure, which could quickly be reversed. One patient with a juxtaphyseal ABC in the femoral neck showed a minor limb length discrepancy because of deformity. Beyond that, no complications were observed.
CONCLUSION
Percutaneous sclerotherapy with polidocanol appears to be a safe alternative for treatment of aneurysmal bone cysts. In our series of both primary and recurrent cysts, it showed the ability to achieve healing or stable disease in 22 of 23 cases (96%). Further studies are needed to decide if this provides a long-lasting effect.
PubMed: 37744716
DOI: 10.5312/wjo.v14.i9.698 -
European Review For Medical and... Apr 2016Polidocanol is the most frequently used sclerosant for sclerotherapy all around the world. Our experimental research aims to find out the angiogenic effects of...
OBJECTIVE
Polidocanol is the most frequently used sclerosant for sclerotherapy all around the world. Our experimental research aims to find out the angiogenic effects of Polidocanol.
MATERIALS AND METHODS
Angiogenic activity of polidocanol was examined in vivo in the chick chorioallantoic membrane (CAM) model, cell viability assay (human umbilical vein endothelial cells - HUVECs) and in vitro tube formation assay of HUVECs.
RESULTS
In CAM assay, a significant decrease on CAM vessel growth was observed after the application of polidocanol solutions. Vessel growth inhibition was strongly dose-dependent. There was a cytotoxic effect on HUVECs in the presence of polidocanol observed with MTT assay (p < 0.05). In the tube formation assay, statistically significant decrease in tube formation was observed in polidocanol group. It was found that polidocanol had an anti-angiogenic effect (p < 0.05). The results provide evidence that polidocanol decreases angiogenesis and has a cytotoxic effect on ECs.
CONCLUSIONS
These results provide evidence that Polidocanol (lauromacrogol 400) have strong anti-angiogenic effects in vitro and in vivo. Further researches needed to reveal early and long-term effects of polidocanol in the human vascular system and new treatment approach as an anti-angiogenic therapy.
Topics: Angiogenesis Inhibitors; Animals; Cell Survival; Chickens; Chorioallantoic Membrane; Human Umbilical Vein Endothelial Cells; Humans; Neovascularization, Physiologic; Polidocanol; Polyethylene Glycols
PubMed: 27097963
DOI: No ID Found -
Frontiers in Surgery 2022In the last 2 years, anorectal surgery has been strongly affected and even surgery for urgent cases cannot be scheduled; also, patients with III- and IV-degree bleeding...
BACKGROUND
In the last 2 years, anorectal surgery has been strongly affected and even surgery for urgent cases cannot be scheduled; also, patients with III- and IV-degree bleeding hemorrhoids should be treated conservatively. The aim was to evaluate the effectiveness of sclerotherapy in patients who had to postpone surgery.
METHODS
We included all patients with III- and IV-degree bleeding hemorrhoids who underwent outpatient sclerotherapy. The visual analog scale and the hemorrhoid severity score were used at the baseline and at 4 weeks after the procedure with a telephone interview, and all patients were outpatient-evaluated 1 week, 1 month, and 1 year after the treatment. All pre- and postoperative data were recorded.
RESULTS
From October 2020 to November 2021, 19 patients with III- (12 patients; 63%) and IV-degree (7 patients; 37%) bleeding hemorrhoids were enrolled. The mean operative time was 4.5 min, and no intraoperative complications occurred. One case of tenesmus and three failures were detected. Six months after the procedure, the overall success rate was 84%, although all of the patients enrolled reported persistent bleeding at the end of the study period. Of these, 5 patients (26%) were scheduled for surgery and 11 patients (58%) refused surgery and asked to undergo a re-do sclerotherapy.
CONCLUSION
Sclerotherapy with 3% polidocanol foam is a safe and effective procedure also in III- and IV-degree bleeding hemorrhoids. The long-term data on the length of the foam remain to be evaluated in additional studies.
PubMed: 36117836
DOI: 10.3389/fsurg.2022.978574 -
Diagnostic and Interventional Imaging Jun 2020The purpose of this study was to retrospectively evaluate the efficacy and safety of a sequential treatment including percutaneous polidocanol sclerotherapy and...
PURPOSE
The purpose of this study was to retrospectively evaluate the efficacy and safety of a sequential treatment including percutaneous polidocanol sclerotherapy and radiofrequency ablation (RFA) in terms of volume reduction and complication rate in large, benign, partially cystic thyroid nodules with solid components.
MATERIALS AND METHOD
From April 2017 to April 2019, 46 patients with 47 large benign partially cystic thyroid nodules underwent sequential treatment. There were 14 men and 32 women with a mean age of 49.9±11.5 (SD) years (range: 18-75 years). The volume of initial nodules was 12.7±12.3 (SD) mL (range: 2.16-75.62mL). Volume reduction after percutaneous polidocanol sclerotherapy and further RFA was evaluated respectively. Patients had clinical and ultrasound evaluations at a follow-up time of 12.1±5.3 (SD) months (range: 1.5-23.9 months). Technical success and complications were accessed retrospectively.
RESULTS
After unsatisfying results with polidocanol sclerotherapy alone the 46 patients with 47 large benign partially cystic thyroid nodules had further RFA. Mean volume reduction of 47 nodules was 90.5±11.3 (SD) % (range: 43.9-99.3%) one month after RFA, 94.9±6.2 (SD) % (range: 66.9-99.5%) three months after RFA, and 95.8±5.5 (SD) % (range: 71.0-99.8%) six months after RFA. No recurrence or nodule enlargement after RFA was observed at the last follow-up. The complication rate of RFA was 12.5% (8/46 patients), with minor complications only.
CONCLUSIONS
The sequential treatment regimen, including percutaneous polidocanol sclerotherapy and RFA, is an appropriate and safe treatment strategy for large benign partially cystic thyroid nodules with solid components.
Topics: Adolescent; Adult; Aged; Catheter Ablation; Female; Humans; Male; Middle Aged; Neoplasm Recurrence, Local; Polidocanol; Radiofrequency Ablation; Retrospective Studies; Thyroid Nodule; Treatment Outcome; Young Adult
PubMed: 31889636
DOI: 10.1016/j.diii.2019.11.005 -
Phlebology May 2016To compare foam bubble size and bubble size distribution, stability, and degradation rate of commercially available polidocanol endovenous microfoam (Varithena®) and... (Clinical Trial)
Clinical Trial
OBJECTIVE
To compare foam bubble size and bubble size distribution, stability, and degradation rate of commercially available polidocanol endovenous microfoam (Varithena®) and physician-compounded foams using a number of laboratory tests.
METHODS
Foam properties of polidocanol endovenous microfoam and physician-compounded foams were measured and compared using a glass-plate method and a Sympatec QICPIC image analysis method to measure bubble size and bubble size distribution, Turbiscan™ LAB for foam half time and drainage and a novel biomimetic vein model to measure foam stability. Physician-compounded foams composed of polidocanol and room air, CO2, or mixtures of oxygen and carbon dioxide (O2:CO2) were generated by different methods.
RESULTS
Polidocanol endovenous microfoam was found to have a narrow bubble size distribution with no large (>500 µm) bubbles. Physician-compounded foams made with the Tessari method had broader bubble size distribution and large bubbles, which have an impact on foam stability. Polidocanol endovenous microfoam had a lower degradation rate than any physician-compounded foams, including foams made using room air (p < 0.035). The same result was obtained at different liquid to gas ratios (1:4 and 1:7) for physician-compounded foams. In all tests performed, CO2 foams were the least stable and different O2:CO2 mixtures had intermediate performance. In the biomimetic vein model, polidocanol endovenous microfoam had the slowest degradation rate and longest calculated dwell time, which represents the length of time the foam is in contact with the vein, almost twice that of physician-compounded foams using room air and eight times better than physician-compounded foams prepared using equivalent gas mixes.
CONCLUSION
Bubble size, bubble size distribution and stability of various sclerosing foam formulations show that polidocanol endovenous microfoam results in better overall performance compared with physician-compounded foams. Polidocanol endovenous microfoam offers better stability and cohesive properties in a biomimetic vein model compared to physician-compounded foams. Polidocanol endovenous microfoam, which is indicated in the United States for treatment of great saphenous vein system incompetence, provides clinicians with a consistent product with enhanced handling properties.
Topics: Female; Humans; Male; Polidocanol; Polyethylene Glycols; Sclerosing Solutions
PubMed: 26036246
DOI: 10.1177/0268355515589063 -
European Journal of Vascular and... Jun 2016The objective was to investigate the effects of the detergent sclerosants sodium tetradecyl sulfate (STS) and polidocanol (POL) on human leukocytes at sublytic...
OBJECTIVE/BACKGROUND
The objective was to investigate the effects of the detergent sclerosants sodium tetradecyl sulfate (STS) and polidocanol (POL) on human leukocytes at sublytic concentrations.
METHODS
Leukocytes were isolated and labelled with antibodies to assess for apoptosis and examined with confocal microscopy and flow cytometry. Isolated leukocyte count and viability was assessed using trypan blue, and propidium iodide staining. Phosphatidylserine (PS) exposure, a universal hallmark to measure cell apoptosis, was identified by flow cytometry using lactadherin. Caspases 3, 8, and 9, and Bax activation, as well as inhibitory assays with pan-caspase (Z-VAD-FMK) and Bax (BI-6C9) were assessed to determine apoptotic pathways. Porimin activation was used to assess cell permeability.
RESULTS
Up to 40% of leukocytes maintained membrane integrity at sublytic concentrations (≤0.15%) of sclerosants. The remaining 60% did not maintain membrane integrity but were not completely lysed. PS exposure was increased with both STS and POL exhibiting a dose- and time-dependant trend. While activation of caspases 3, 8, and 9, as well as Bax activation, were increased in leukocytes stimulated with low concentrations of STS, only caspases 3 and 9 and Bax were increased with POL. Inhibitory assays demonstrated caspases 3, 8, and 9, and Bax inhibition at low concentrations with both STS and POL. Both agents increased the leukocyte activation of porimin at all concentrations. On confocal microscopy, stains for caspases 3, 8, and 9, and Bax were increased for both STS and POL. Porimin stain was markedly positive for both STS and POL.
CONCLUSION
Both sclerosants induced leukocyte apoptosis at sublytic concentrations. STS activated both extrinsic and intrinsic pathways of apoptosis, while POL stimulated the intrinsic pathway of apoptosis only. Both agents induced oncosis. Based on these results, STS appears to have a greater effect than POL.
Topics: Apoptosis; Caspases; Detergents; Humans; Leukocytes; Necrosis; Polidocanol; Polyethylene Glycols; Sclerosing Solutions; Sodium Tetradecyl Sulfate
PubMed: 27067723
DOI: 10.1016/j.ejvs.2016.03.008 -
The Turkish Journal of Gastroenterology... May 2020Management of Haemorrhoids is suboptimal and is largely based on traditional practices in the Indian population. Though injection sclerotherapy is a well-accepted... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND/AIMS
Management of Haemorrhoids is suboptimal and is largely based on traditional practices in the Indian population. Though injection sclerotherapy is a well-accepted treatment modality in early grade haemorrhoids, there is no consensus on the effectiveness of the drugs used for sclerotherapy. The study was done to compare the safety and efficacy of a standard sclerosant (polidocanol) and the conventionally used phenol in oil in bleeding grade-1 and 2 internal haemorrhoids.
MATERIALS AND METHODS
All patients with grade-1 and 2 hemorrhoids, were selected and randomised into two groups, 3% polidocanol and 5% phenol group. All patients were followed-up for three months and observed for "free of bleeding" or "persistent bleeding." Pain, pruritus and patient satisfaction following the procedure was also assessed.
RESULTS
A total of 150 patients were enrolled, 75 in each group. At the end of the first sclerotherapy session with polidocanol, 60.6% of patients versus 38.1% in phenol group had stopped per rectal bleeding (p=0.009). After the second sclerotherapy session, 94.7% of patients in the polidocanol group and 84% of patients in the phenol group were treated successfully. Polidocanol group required significantly fewer treatment sessions than the phenol group (1.39±0.49 vs. 1.62±0.49; p=0.035), and the total volume of injected sclerosant was also less (3.30±0.96 mL vs. 4.86±1.46 mL; p=0.001). The patient satisfaction was 87% in polidocanol group versus 73% in phenol group (p=0.040).
CONCLUSION
3% polidocanol is safe and more effective than 5% phenol in oil when used as injection sclerotherapy in the treatment of first and second-degree internal hemorrhoids.
Topics: Adult; Female; Gastrointestinal Hemorrhage; Hemorrhoids; Humans; Male; Middle Aged; Phenol; Polidocanol; Sclerosing Solutions; Sclerotherapy; Treatment Outcome
PubMed: 32519957
DOI: 10.5152/tjg.2020.19276 -
Cureus Oct 2021Introduction Sclerotherapy offers an alternative to surgery to treat an aneurysmal bone cyst (ABC). The present study's main objective was to assess the radiological...
Introduction Sclerotherapy offers an alternative to surgery to treat an aneurysmal bone cyst (ABC). The present study's main objective was to assess the radiological efficacy of sclerotherapy in the healing of the cyst cavity secondary to biopsy-proven ABC on X-rays and assess clinical efficacy on pain, recurrence, and complications. Materials and methods Between 2016 and 2018, 26 patients (12 females, 14 males) with biopsy-proven ABC treated by sclerotherapy were included. All patients received an injection of polidocanol 3% intralesional as standard treatment under fluoroscopic guidance. Ossification was assessed on plain X-ray, and the pain was evaluated on a visual analog scale (VAS). Results Ossification was complete in 24 (92.3%) patients and partial in two (7.7%) patients. Eighteen patients (70%) were pain-free at the end of three months. There was an improvement in the VAS score, and clinically, there was a significant reduction in pain and swelling. Two patients developed recurrence within two years of follow-up, treated successfully by the re-application of intralesional polidocanol 3% injection. Discussion Sclerotherapy provides an effective, minimally invasive treatment for ABC and is particularly useful for deep lesions, challenging access for surgery and potentially damaging vital structures. The use of percutaneous polidocanol 3% under fluoroscopic control seems to improve the risk/benefit ratio. Its clinical and radiological efficacy makes sclerotherapy an alternative treatment option in ABC. Level of evidence IV, prospective study.
PubMed: 34754635
DOI: 10.7759/cureus.18469 -
Cardiovascular and Interventional... Oct 2021To evaluate the safety and outcome of percutaneous sclerotherapy for treating venous malformations (VMs) of the hand.
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.
Topics: Humans; Polidocanol; Retrospective Studies; Sclerosing Solutions; Sclerotherapy; Treatment Outcome
PubMed: 34286368
DOI: 10.1007/s00270-021-02926-x -
Journal of Cutaneous and Aesthetic... 2023Vascular malformations can be treated using sclerotherapy agents like alcohol, polidocanol, or sodium tetradecyl sulfate foam and embolization treatments. These...
Vascular malformations can be treated using sclerotherapy agents like alcohol, polidocanol, or sodium tetradecyl sulfate foam and embolization treatments. These endovascular treatments may cause severe complications as pulmonary embolism and thrombosis. 980-nm diode lasers (DLs) are common devices used by many specialties as plastic surgeons, dermatologists, and vascular surgeons. Laser energy is excellently absorbed in water and hemoglobin, which makes it ideal for adipose tissue and deep lesions. We treated our patient using a DL. Our surgical approach allowed total excision of the arteriovenous malformation (AVM), which decreased the size of the tumor allowing a smaller incision and eased the dissection plane. We believe that lasers will be used more frequently on AVM treatments.
PubMed: 37554679
DOI: 10.4103/JCAS.JCAS_9_22