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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 -
Biochemical and Biophysical Research... Nov 2023Venous malformations are a vascular disorder. Currently, the use of chemical sclerosing agents is a common clinical approach for the treatment of venous malformations....
Venous malformations are a vascular disorder. Currently, the use of chemical sclerosing agents is a common clinical approach for the treatment of venous malformations. However, the effectiveness of existing sclerosing agents is unsatisfactory and often accompanied by severe side effects. In this study, we have developed a novel cationic surfactant-based sclerosing agent (POL-TA) by conjugating the plasmin inhibitor tranexamic acid (TA) with a nonionic surfactant polidocanol (POL) through an ester bond. POL-TA induces endothelial cell damage, triggering the coagulation cascade and thrombus formation. Moreover, it releases TA in vivo, which inhibits plasmin activity and the activation of matrix metalloproteinase (MMPs), thereby stabilizing the fibrin network of the thrombus and promoting vascular fibrosis. We have established a cell model using venous malformation endothelial cells and assessed the cellular damage and underlying mechanisms of POL-TA. The inhibitory effects of POL-TA on the plasmin-MMPs system were evaluated using MMP-9 activity assay kit. Additionally, the mice tail vein model was employed to investigate the vascular sclerosing effects and mechanisms of POL-TA.
PubMed: 37738903
DOI: 10.1016/j.bbrc.2023.09.035 -
Laryngo- Rhino- Otologie Dec 2023Ultrasound-guided ablation techniques have been increasingly introduced into routine treatment of thyroid lesions as a complement to existing surgical therapies and...
Ultrasound-guided ablation techniques have been increasingly introduced into routine treatment of thyroid lesions as a complement to existing surgical therapies and radioiodine treatment. In cystic or predominantly cystic lesions instillation therapy (ethanol/polidocanol ablation) has yielded good results. Novel thermal ablation techniques, including radiofrequency ablation (RFA), microwave ablation (MWA), laser ablation (LA) and high intensity focused ultrasound (HIFU), induce irreversible cellular effects by locally applying temperatures ≥ 60 °C to the targeted thyroid region. Lesions causing local symptoms or focal hyperfunctionality can thus be selectively treated under continuous sonographic monitoring. While a considerable body of evidence supports the efficacy and safety of various local ablative techniques, future challenges lie in initiating comparative prospective trials and in standardizing clinical practice, training and continuous quality assessment on a regional and superregional level. In the future, it shall be indicated to include local ablative techniques - so far not known to all patients in Germany - into the informed decision-making process as a suitable alternative or supplement to existing therapies.
Topics: Humans; Thyroid Gland; Iodine Radioisotopes; Prospective Studies; Ablation Techniques; Ultrasonography, Interventional; Catheter Ablation; Treatment Outcome
PubMed: 37734389
DOI: 10.1055/a-2144-4132 -
The American Journal of Gastroenterology Jan 2024
Topics: Humans; Polidocanol; Sclerotherapy; Polyethylene Glycols; Hemangioma; Hemangioma, Cavernous; Ultrasonography, Interventional; Esophageal and Gastric Varices
PubMed: 37734340
DOI: 10.14309/ajg.0000000000002514 -
BMC Ophthalmology Sep 2023Loss of vision after topical injection of sclerosant is a rare and uncommon complication. We describe a case with vision loss following the facial injections of...
Loss of vision after topical injection of sclerosant is a rare and uncommon complication. We describe a case with vision loss following the facial injections of physician-compounded (PCP) foam sclerotherapy which was created by room air. A 3-year-old boy underwent injection of 5ml polidocanol foamed with room air to treat the venous malformation on the cheek near the left orbit. The boy experienced the whole facial swelling on day 2 after the third injection, especially involving the left side, the visual acuity in the left eye was counting fingers at 30 cm and the swelling reduced at 7 days later after referral. Fundus examination on day 15 revealed hemorrhage inferior to the optic disc and fluorescein angiography revealed blocked fluorescein. The OCT on day 15 showed the edema of the nerve fiber layer beside the fovea. The patient's hearing was also impaired. PCP foam sclerotherapy with room air produced in typical concentrations, preparations as well as volumes always causes vision loss among children. Continued evaluation on the effects of product, gas, volume, and patient age identify optimal approaches will avoid the toxicity and side-effects caused by facial foam sclerotherapy.
Topics: Male; Child; Humans; Child, Preschool; Sclerosing Solutions; Cheek; Blindness; Eye; Face
PubMed: 37726700
DOI: 10.1186/s12886-023-03128-4 -
Journal of Vascular and Interventional... Jan 2024To retrospectively evaluate sclerotherapy using consecutive polidocanol and bleomycin foam (CPBF) for large untreated venous malformations (VMs) and/or those resistant...
PURPOSE
To retrospectively evaluate sclerotherapy using consecutive polidocanol and bleomycin foam (CPBF) for large untreated venous malformations (VMs) and/or those resistant to prior treatment.
MATERIALS AND METHODS
This retrospective study included all patients treated with CPBF for untreated VMs larger than 10 mL and/or refractory to treatment between May 2016 and October 2019. Baseline and follow-up VM volumes were measured on fat-suppressed T2-weighted magnetic resonance (MR) imaging. Outcome was evaluated on postprocedural MR imaging volumetry and by a retrospective survey assessing clinical response and adverse events. Imaging response was considered good for volume reduction from 50% to 70% and excellent for volume reduction ≥70%. Symptoms and quality-of-life (QoL) scores were compared before and after CPBF sclerotherapy.
RESULTS
Forty-five patients (mean age, 16 years; range, 1-63 years; 25 males) with 57 VMs were analyzed and treated by 80 sclerotherapy. Sixty percent (27 of 45) of patients had undergone prior treatment for VM. Median VM volume was 36.7 mL (interquartile range, 84 mL) on pretherapy MR imaging. Good and excellent results after the last sclerotherapy were achieved in 36% (16 of 45) and 29% (13 of 45) of patients, respectively, corresponding to a decrease of >50% in 60% (34 of 57) of VMs. QoL score increased by at least 3 points, regardless of initial symptoms. Most patients did not desire additional sclerotherapy owing to near complete symptomatic relief, even for patients who did not achieve a good response. Swelling, pain, and motor impairment scores significantly improved after CPBF. Adverse events included fever (44%, 15 of 34) and nausea/vomiting (29%, 10 of 34).
CONCLUSIONS
CPBF sclerotherapy represents an effective therapy for large and/or refractory VMs with minimal adverse events.
Topics: Male; Humans; Adolescent; Sclerotherapy; Polidocanol; Retrospective Studies; Sclerosing Solutions; Bleomycin; Quality of Life; Veins; Magnetic Resonance Imaging; Vascular Malformations; Treatment Outcome
PubMed: 37704038
DOI: 10.1016/j.jvir.2023.09.004 -
Phlebology Dec 2023
Topics: Humans; Polidocanol; Sclerotherapy; Polyethylene Glycols; Sclerosing Solutions; Treatment Outcome
PubMed: 37644640
DOI: 10.1177/02683555231198405 -
Journal of Vascular and Interventional... Dec 2023To assess the effectiveness, safety, and predictors of outcomes and adverse events for percutaneous sclerotherapy using polidocanol for the treatment of venous...
PURPOSE
To assess the effectiveness, safety, and predictors of outcomes and adverse events for percutaneous sclerotherapy using polidocanol for the treatment of venous malformations (VMs).
METHODS
A retrospective single-center analysis was performed, including patients with VMs who were treated with sclerotherapy using polidocanol between January 2011 and November 2021 at a tertiary center. Demographic characteristics, clinical data, and radiologic features were analyzed, and the influence of patient- and VM-related factors on the subjective clinical outcome and adverse events were investigated using a multivariate logistic regression analysis.
RESULTS
In total, 167 patients who received 325 treatment sessions were included in this study. Overall symptom improvement was observed in 67.5%, stable symptoms were observed in 25.0%, and worsening was reported in 7.5% (clinical follow-up, 1.04 ± 1.67 years). The total adverse event rate was 10.2%, with an overall rate of 4.2% for permanent adverse events within the cohort. In multivariate analysis, the clinical outcome was worse in children (P = .01; 57.1% symptom improvement in children [age, <18 years] and 79.7% in adults), and adverse events were more frequently observed after the treatment of VMs located at the extremities (P < .01; 8.4% for VMs of the extremities and 1.2% for VMs in other locations).
CONCLUSIONS
Sclerotherapy using polidocanol can be an effective treatment option for VMs with an acceptable safety profile. However, it can be less effective in children, and adverse events can be more frequently expected for VMs of the extremities.
Topics: Child; Adult; Humans; Adolescent; Polidocanol; Sclerotherapy; Sclerosing Solutions; Retrospective Studies; Vascular Malformations; Treatment Outcome
PubMed: 37640102
DOI: 10.1016/j.jvir.2023.08.032 -
Journal of Clinical Medicine Aug 2023Level 2.
LEVEL OF EVIDENCE
Level 2.
PURPOSE
To compare the safety and efficacy of vascular plug (VP) and vascular plug and polidocanol foam (VPPF) treatments for embolization in pelvic congestion syndrome (PCS).
MATERIALS AND METHODS
A comparative, prospective, two-center study enrolled 50 women with PCS from January 2019 to January 2020. The patients were divided into two groups, and embolization was performed with VP (n = 25) and VPPF (n = 25) treatments. The mean age of the patients was 45.6 years ± 6.9. Three clinical parameters were assessed: abdominal pain, dyspareunia, and lower limb pain. The primary outcome (clinical success at 1 yr using a VAS), number of devices, procedure and fluoroscopy times, radiation doses, costs, and complications were compared. The participants were followed-up at 1, 3, 6, and 12 months.
RESULTS
At the 1-year follow-up, clinical success did not significantly differ between the two groups (VP vs. VPPF) regarding the improvement of the symptoms analyzed (pelvic pain, dyspareunia, lower extremity pain, and other symptoms ( < 0.05)). The mean number of devices per case was 4 ± 1.1 for the VP group and 2 ± 0.31 for the VPPF group ( < 0.001). No major complications were recorded in either group. The VPPF group had a significantly longer fluoroscopy time (42.8 min ± 14.2 vs. 25.4 min ± 7) and longer radiation dose (VPPF air kerma 839.4 ± 513 vs. VP air kerma 658.4 mGy ± 355 (all < 0.001)).
CONCLUSIONS
Embolization for PCS resulted in pain relief in 90% of patients; the use of polidocanol did not demonstrate changes in the clinical outcome. The use of a VP alone was associated with decreased fluoroscopy time and radiation dose.
PubMed: 37629450
DOI: 10.3390/jcm12165408 -
Cell Stem Cell Sep 2023Life-long reconstitution of a tissue's resident stem cell compartment with engrafted cells has the potential to durably replenish organ function. Here, we demonstrate...
Life-long reconstitution of a tissue's resident stem cell compartment with engrafted cells has the potential to durably replenish organ function. Here, we demonstrate the engraftment of the airway epithelial stem cell compartment via intra-airway transplantation of mouse or human primary and pluripotent stem cell (PSC)-derived airway basal cells (BCs). Murine primary or PSC-derived BCs transplanted into polidocanol-injured syngeneic recipients give rise for at least two years to progeny that stably display the morphologic, molecular, and functional phenotypes of airway epithelia. The engrafted basal-like cells retain extensive self-renewal potential, evident by the capacity to reconstitute the tracheal epithelium through seven generations of secondary transplantation. Using the same approach, human primary or PSC-derived BCs transplanted into NOD scid gamma (NSG) recipient mice similarly display multilineage airway epithelial differentiation in vivo. Our results may provide a step toward potential future syngeneic cell-based therapy for patients with diseases resulting from airway epithelial cell damage or dysfunction.
Topics: Humans; Animals; Mice; Pluripotent Stem Cells; Cell- and Tissue-Based Therapy; Epithelial Cells; Epithelium; Mice, Inbred NOD; Mice, SCID
PubMed: 37625411
DOI: 10.1016/j.stem.2023.07.014