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Suh PS, Lee JH, Roh YH, Moon HH, Chung SR, Kwon MS, Choi YJ, Lee YS, Baek JH, Choi SH. Ethanol Ablation of Ranulas and Risk Factor Analysis for Recurrence. JAMA Otolaryngol Head Neck Surg 2024:2818466. [PMID: 38696210 PMCID: PMC11066768 DOI: 10.1001/jamaoto.2024.0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 03/09/2024] [Indexed: 05/05/2024]
Abstract
Importance Ethanol ablation (EA) was shown to be safe and effective for treating ranula, but few studies have assessed long-term outcomes and recurrence of ranula after EA. Objective To evaluate the long-term outcomes and the risk factors for recurrence and receipt of subsequent surgery in patients who underwent treatment with EA for ranula. Design, Setting, and Participants This case-series study was conducted at a single tertiary hospital and assessed patients who were treated with EA between July 2009 and March 2021. Among 70 consecutive patients, those with follow-up loss or who were followed up for less than 24 months were excluded. Exposures EA for ranula. Main Outcomes and Measures The primary outcome was recurrence at last follow-up after single or multiple EA sessions. Secondary outcomes included receipt of subsequent surgery and the recurrence-free survival (RFS) rate after initial EA. Factors possibly associated with outcomes included patient age and sex; ranula site, type, diameter, volume, and echogenicity; the presentation-to-EA interval; parapharyngeal space extension; and sublingual gland herniation. Risk factors were identified on logistic regression analyses. Two-year RFS rates were analyzed for the initial cohort using the Kaplan-Meier method and compared by log-rank tests. Results A total of 57 patients (mean [SD] age, 26.4 [12.1] years; 24 female individuals [42%]) who were followed up for a median of 57 months (range, 24-167 months) were included. The recurrence rate was 33% (n = 19), and 11 (19%) underwent subsequent surgery. Among patients with recurrence, 86% (31 of 36) experienced first recurrence within 12 months after initial EA. A presentation-to-EA interval of 12 months or longer was associated with an increased risk of recurrence (adjusted odds ratio [OR], 3.74; 95% CI, 1.01-13.82). No risk factors were significantly associated with subsequent surgery (highest OR in parapharyngeal space extension: adjusted OR, 4.96; 95% CI, 0.94-26.35). Among the initial cohort of 70 patients, 2-year RFS was lower in a maximum diameter of ranula of 5 cm or greater than less than 5 cm (24% [95% CI, 7%-41%] vs 50% [95% CI, 34%-66%]; difference, 26% [95% CI, -4% to 56%]; log-rank test, P = .02). Conclusions and Relevance This case-series study found that the recurrence rate of ranula after EA was 33%. A presentation-to-EA interval of 12 months or longer may be a risk factor for recurrence, suggesting that early intervention with EA might minimize recurrence. Most first recurrences occurred within 12 months after EA, with a maximum diameter of ranula of 5 cm or greater being a possible risk factor.
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Affiliation(s)
- Pae Sun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yun Hwa Roh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hye Hyun Moon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Min Su Kwon
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Yoon Se Lee
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung-Ho Choi
- Department of Otolaryngology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Geng Y, Zou H, Li Z, Wu H. Recent advances in nanomaterial-driven strategies for diagnosis and therapy of vascular anomalies. J Nanobiotechnology 2024; 22:120. [PMID: 38500178 PMCID: PMC10949774 DOI: 10.1186/s12951-024-02370-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/23/2024] [Indexed: 03/20/2024] Open
Abstract
Nanotechnology has demonstrated immense potential in various fields, especially in biomedical field. Among these domains, the development of nanotechnology for diagnosing and treating vascular anomalies has garnered significant attention. Vascular anomalies refer to structural and functional anomalies within the vascular system, which can result in conditions such as vascular malformations and tumors. These anomalies can significantly impact the quality of life of patients and pose significant health concerns. Nanoscale contrast agents have been developed for targeted imaging of blood vessels, enabling more precise identification and characterization of vascular anomalies. These contrast agents can be designed to bind specifically to abnormal blood vessels, providing healthcare professionals with a clearer view of the affected areas. More importantly, nanotechnology also offers promising solutions for targeted therapeutic interventions. Nanoparticles can be engineered to deliver drugs directly to the site of vascular anomalies, maximizing therapeutic effects while minimizing side effects on healthy tissues. Meanwhile, by incorporating functional components into nanoparticles, such as photosensitizers, nanotechnology enables innovative treatment modalities such as photothermal therapy and photodynamic therapy. This review focuses on the applications and potential of nanotechnology in the imaging and therapy of vascular anomalies, as well as discusses the present challenges and future directions.
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Affiliation(s)
- Yiming Geng
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, China
| | - Huwei Zou
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, China
| | - Zhaowei Li
- School of Radiology, Shandong First Medical University and Shandong Academy of Medical Sciences, 619 Changcheng Road, Tai'an, 271000, China.
| | - Haiwei Wu
- Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, 324 Jingwu Road, Jinan, 250021, China.
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Hashimoto M, Ouchi Y, Yata S, Yamamoto A, Suzuki K, Kobayashi A. The Guidelines for Percutaneous Transhepatic Portal Vein Embolization: English Version. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2024; 9:41-48. [PMID: 38525000 PMCID: PMC10955465 DOI: 10.22575/interventionalradiology.2022-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/26/2023] [Indexed: 03/26/2024]
Abstract
Preoperative portal vein embolization is a beneficial option to reduce the risk of postoperative liver failure by promoting the growth of the future liver remnant. In particular, a percutaneous transhepatic procedure (percutaneous transhepatic portal vein embolization) has been developed as a less-invasive approach. Although percutaneous transhepatic portal vein embolization is widely recognized as a safe procedure, various complications, including rare but fatal adverse events, have been reported. Currently, there are no prospective clinical trials regarding percutaneous transhepatic portal vein embolization procedures and no standard guidelines for the PTPE procedure in Japan. As a result, various methods and various embolic materials are used in each hospital according to each physician's policy. The purpose of these guidelines is to propose appropriate techniques at present and to identify issues that should be addressed in the future for safer and more reliable percutaneous transhepatic portal vein embolization techniques.
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Affiliation(s)
| | - Yasufumi Ouchi
- Department of Radiology, Faculty of Medicine, Tottori University
| | - Shinsaku Yata
- Department of Radiology, Faculty of Medicine, Tottori University
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Sharma R, Goyal S, Laythalling RK. Adjunct role of liquid absolute alcohol intralesional sclerotherapy during the surgical management of spinal primary aneurysmal bone cyst in a child: a technical case report. Childs Nerv Syst 2024; 40:569-573. [PMID: 37778002 DOI: 10.1007/s00381-023-06149-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 09/05/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Aneurysmal bone cyst is composed of variable -sized cystic blood-filled spaces separated by connective tissue septae. First-line surgical resection of spinal aneurysmal bone cyst in a child with limited total blood volume can lead to massive intraoperative bleeding, thus limiting extent of resection. Our Centre's has good experience of using absolute alcohol as an effective immediate devascularizing agent during vertebral hemangioma surgery in children. MATERIAL AND METHODS We report the first case of pediatric lumbar primary aneurysmal bone cyst in which completely blood-less piecemeal total resection of the lesion was performed after intraoperative absolute alcohol intralesional sclerotherapy. RESULTS Completely blood-less piecemeal total resection of the lumbar aneurysmal bone cyst was performed after intraoperative absolute alcohol intralesional sclerotherapy. CONCLUSION Intraoperative absolute alcohol intralesional sclerotherapy is a very effective devascularizing adjunct for complete piecemeal resection of spinal aneurysmal bone cyst in children with limited blood volume.
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Affiliation(s)
- Rajeev Sharma
- Department of Neurosurgery, AIIMS, New Delhi, 110029, India.
| | - Sarvesh Goyal
- Department of Neurosurgery, AIIMS, New Delhi, 110029, India
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Malik MH, Jabal MS, Kobeissi H, Gupta R, Bilgin C, Brinjikji W. Embolization of arteriovenous malformations of head and neck: A systematic review. Interv Neuroradiol 2023:15910199231219823. [PMID: 38105437 DOI: 10.1177/15910199231219823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Cervicofacial arteriovenous malformations (AVMs) are a significant source of morbidity. Endovascular embolization has emerged as a promising treatment technique for these lesions. However, current literature on cervicofacial AVM embolization mostly consists of single-agent oriented case series, and to date, no comprehensive study has compared the outcomes of available embolic agents. PURPOSE To investigate the performance of different embolic agents in the management of cervicofacial AVMs. METHODS We systematically searched Ovid MEDLINE, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials Scopus, and Web of Science. Studies providing data for the endovascular treatment of cervicofacial AVMs were included. The data regarding complication and cure rates were collected for each embolic agent. Pooled event rates were presented as descriptive statistics. RESULTS Eleven studies comprising 204 patients were included in the review. The overall complete and partial cure rates were 62.2% (127/204) and 36.2% (74/204), respectively. Embolization failed to achieve significant improvement in only 1.6% (3/204) of the patients. The complete cure rates were 87.5% (75-100%) for n-Butyl cyanoacrylate (NBCA, glue), 80.5% (61-100%) for Onyx (Medtronic, MN, USA), and 51.5% (18-85%) for ethanol. The overall complication rate was 30% (61/204). The complication rates were 33% (12.5-53%) for ethanol, 14% (0-28%) for Onyx, and 0% for NBCA. CONCLUSIONS Our systematic review supports that endovascular embolization is an effective treatment option for cervicofacial AVMs. In our review, the use of Onyx and NBCA was associated with consistently high complete cure rates and a promising safety profile. However, more research is needed to investigate the use of different embolic agents in the treatment of cervicofacial AVMs.
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Affiliation(s)
| | | | | | - Rishabh Gupta
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Huang YH, Chen YC, Lai HC. Acute cardiopulmonary decompensation following ethanol sclerotherapy under general anesthesia. JOURNAL OF MEDICAL SCIENCES 2023. [DOI: 10.4103/jmedsci.jmedsci_369_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
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Inhibition of angiotensin II type 1 receptor partially prevents acute elevation of pulmonary arterial pressure induced by endovascular ethanol injection. Hypertens Res 2022; 46:972-983. [PMID: 36539462 DOI: 10.1038/s41440-022-01132-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/05/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to examine whether the administration of losartan can prevent acute elevation of pulmonary arterial pressure (AEPAP) induced by endovascular ethanol injection and to assess its related mechanisms. Male swine were selected and performed with absolute ethanol endovascular injection. Saline was used as the negative control. Losartan was administered preoperatively. Pulmonary arterial pressure (PAP), femoral arterial pressure (FAP) and heart rate (HR) were monitored during operations. Venous plasma and pulmonary artery (PA) tissue were harvested for analyses. Protein level was detected by Western blotting and ELISA, whereas qRT-PCR was used in mRNA detection. H & E staining and immunohistochemistry were conducted to evaluate histopathology. Ethanol injection elevated PAP in swine. The concentration of RAS ligands was elevated in plasma (all P < 0.0001) but not in PA. The level of oxidative stress increased in both plasma and PA. MRNA level of AT1R (P < 0.01, 95% CI: 0.251-1.006), not AT2R increased in PA. Losartan failed to inhibit AEPAP after all sessions of ethanol injection, and partially reversed the ethanol-induced PA remodeling. The P38 MAPK was activated after ethanol injection and could be inhibited by losartan (P < 0.01, 95% CI: -0.391 to -0.164). Ethanol also promoted the translocation of the P40-PHOX/P47-PHOX/P67-PHOX complex and the activation of NOX, which was independent from RAS. Endovascular ethanol injection can induce AEPAP mainly by activating RAS and P38 MAPK signaling. Losartan can partially prevent AEPAP and vascular remodeling owing to the promotion of NOX activity by ethanol. Mechanism diagram of endovascular ethanol injection-induced acute elevation of pulmonary arterial pressure (AEPAP) partially prevented by losartan. RAS: Renin-angiotensin system; AGT: angiotensinogen; Ang I: angiotensin I; ACE: angiotensin I converting enzyme; Ang II: angiotensin II. AT1R: angiotensin II type 1 receptor. NOX2: NADPH oxidase 2. PA: pulmonary artery.
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Waters MJ, Hinshelwood J, Chaudry MI. Interventional Treatment of Vascular Anomalies. Dermatol Clin 2022; 40:489-497. [DOI: 10.1016/j.det.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lilje D, Wiesmann M, Hasan D, Riabikin A, Ridwan H, Hölzle F, Nikoubashman O. Interventional therapy of extracranial arteriovenous malformations of the head and neck—A systematic review. PLoS One 2022; 17:e0268809. [PMID: 35839171 PMCID: PMC9286278 DOI: 10.1371/journal.pone.0268809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/06/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives The primary aim of this study was to conduct a meta-analysis of the literature on interventional treatment for patients with extracranial AVM of the head and neck to identify a superior treatment. The secondary aim was to evaluate the methodological quality of associated articles published between 2000–2020. Methods The literature search was conducted on PubMed, Embase, the Cochrane Library, and scholar.google.com. Studies, meeting the acceptable reference standard underwent meta-analysis. All identified literature underwent methodological quality analysis. Results Of 1560 screened articles, 56 were included in the literature review. Appropriate diagnostic tests were reported in 98% of included articles. 13% of included articles did not specify the embolization agent. Outcome analysis varied throughout. 45% of the authors used radiographic imaging for follow-up. 77% specified the span of follow-up of their entire patient collective. Two articles met the inclusion criteria for meta-analysis. Curing rate of transarterial ethanol embolization for intraosseous AVM was 83% with a complication rate of 58%. Curing rate of ethanol combined with NBCA or Onyx in soft tissue AVM was 18% with a complication rate of 87%. Conclusion Our literature review revealed an absence of treatment or reporting standards for extracranial AVM of the head and neck. The meta-analysis is comprised of two articles and methodological quality is heterogeneous. We recommend implementing consistent reporting standards to facilitate comparability of studies and to provide robust data for the development of an evidence-based treatment strategy. Advances in knowledge Meta-analysis showed a favorable radiological outcome for intraosseous AVM when treated with intraarterial ethanol embolization. Our analysis demonstrated that the published data on extracranial AVMs of the head and neck is lacking in consistency and quality, prompting agreement for the need of standardized reporting on AVM treatments.
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Affiliation(s)
- Daniel Lilje
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Martin Wiesmann
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Dimah Hasan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Alexander Riabikin
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Hani Ridwan
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Frank Hölzle
- Department of Oral, Maxillofacial and Facial Plastic Surgery University Hospital RWTH Aachen, Aachen, Germany
| | - Omid Nikoubashman
- Department of Neuroradiology, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
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Lee E, Badger C, Mamidi IS, Benito DA, Li L, Goodman JF, Thakkar PG, Joshi A. Ultrasound-guided ethanol sclerotherapy for multifocal unilateral Warthin's tumor after partial parotidectomy. ULTRASOUND (LEEDS, ENGLAND) 2022; 30:158-161. [PMID: 35509301 PMCID: PMC9058389 DOI: 10.1177/1742271x211030302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/12/2021] [Indexed: 05/03/2023]
Abstract
Introduction Warthin's tumor, also known as papillary cystadenoma lymphomatosum, is one of the most common benign salivary gland neoplasms. The current first-line treatment for Warthin's tumor is parotidectomy. However, surgical resection has the risk of complications including facial nerve weakness and Frey's syndrome. Recently, ultrasound-guided ethanol sclerotherapy (UGES) has been found to be efficacious in the treatment of a variety of head and neck lesions. Case report We present a patient with multifocal Warthin's tumor who was managed with partial parotidectomy and two cycles of ultrasound-guided ethanol sclerotherapy. Discussion Ethanol sclerotherapy has been used as a minimally invasive alternative to surgical excision or observation alone for a variety of head and neck masses. To our knowledge, this is the first case presented in the literature where sclerotherapy was used in conjunction with a partial parotidectomy. Minimizing the extent of surgical resection can reduce the risk of facial nerve weakness and Frey's syndrome and negate the need for fat grafting for defect reconstruction. Conclusion UGES may serve as a safe and reliable procedure that can be performed in conjunction with partial parotidectomy for patients who wish to achieve definitive diagnosis while also minimizing the risk of complications associated with extensive parotidectomy.
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Affiliation(s)
- Esther Lee
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC and Western University of Health Sciences, Pomona, CA, USA
- Esther Lee, Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Western University of Health Sciences, Pomona, CA, USA.
| | - Christopher Badger
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Ishwarya S Mamidi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Daniel A Benito
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Lilun Li
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Joseph F Goodman
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Punam G Thakkar
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Arjun Joshi
- Division of Otolaryngology-Head and Neck Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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Cao J, Huang J, Gui S, Chu X. Preparation, Synergism, and Biocompatibility of in situ Liquid Crystals Loaded with Sinomenine and 5-Fluorouracil for Treatment of Liver Cancer. Int J Nanomedicine 2021; 16:3725-3739. [PMID: 34103913 PMCID: PMC8178703 DOI: 10.2147/ijn.s207607] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Transarterial chemoembolization is the preferred treatment for patients with middle and advanced-stage hepatocellular carcinoma (HCC); however, most hepatic artery embolization agents have various disadvantages. The purpose of this study was to evaluate phytantriol-based liquid crystal injections for potential use in treatment of HCC. METHODS Using sinomenine (SN) and 5-fluorouracil (5-FU) as model drugs, three precursor in situ liquid crystal injections based on phytantriol (P1, P2, and P3) were prepared, and their in vitro biocompatibility, anticancer activity, and drug release investigated, to evaluate their feasibility for use in treatment of HCC. The properties of the precursor injections and subsequent cubic liquid crystal gels were observed by visual and polarizing microscopy, in an in vitro gelation experiment. Biocompatibility was evaluated by in vitro hemolysis, histocompatibility, and cytotoxicity assays. RESULTS Precursor injections were colorless liquids that formed transparent cubic liquid crystal gels on addition of excess water. The three precursor injections all caused slight hemolysis, without agglutination, and were mildly cytotoxic. Histocompatibility experiments showed that P1 had good histocompatibility, while P2 and P3 resulted in strong inflammatory responses, which subsequently resolved spontaneously. In vitro anti-cancer testing showed that SN and 5-FU inhibited HepG2 cells in a time- and concentration-dependent manner and had synergistic effects. Further, in vitro release assays indicated that all three preparations had sustained release effects, with cumulative release of >80% within 48 h. CONCLUSION These results indicate that SN and 5-FU have synergistic inhibitory effects on HepG2 cells, which has not previously been reported. Moreover, we describe a biocompatible precursor injection, useful as a drug carrier for the treatment of liver cancer, which can achieve targeting, sustained release, synergistic chemotherapy, and embolization. These data indicate that precursor injections containing SN and 5-FU have great potential for use in therapy for liver cancer.
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Affiliation(s)
- Jiaojiao Cao
- Department of Pharmaceutics, Anhui University of Chinese Medicine, Hefei, 230012, People’s Republic of China
| | - Jie Huang
- Department of Pharmaceutics, Anhui University of Chinese Medicine, Hefei, 230012, People’s Republic of China
| | - Shuangying Gui
- Department of Pharmaceutics, Anhui University of Chinese Medicine, Hefei, 230012, People’s Republic of China
- Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei, 230012, People’s Republic of China
| | - Xiaoqin Chu
- Department of Pharmaceutics, Anhui University of Chinese Medicine, Hefei, 230012, People’s Republic of China
- Institute of Pharmaceutics, Anhui Academy of Chinese Medicine, Hefei, 230012, People’s Republic of China
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Bozzato A, Neubert C, Yeter Y. [Ultrasound-guided minimally invasive diagnostics and treatment in the head and neck area]. HNO 2021; 69:157-168. [PMID: 33416910 DOI: 10.1007/s00106-020-00981-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Tumoral lesions in the head and neck region represent a diagnostic and therapeutic challenge in otorhinolaryngologic routine. High-resolution ultrasound is usually able to guide diagnosis. Nevertheless, a definite differentiation between benign and malignant lesions can only be achieved by tissue biopsy. The various options for obtaining samples for histopathological or cytological examination-from minimally invasive ultrasound-guided fine-needle biopsy to punch biopsy and open surgical biopsy-will be discussed in the first part along with the associated advantages and disadvantages. In the second part of this CME article, minimally invasive ultrasound-guided therapeutic options in the head and neck region which can be performed on an outpatient basis are depicted.
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Affiliation(s)
- A Bozzato
- UKS - Universitätsklinikum des Saarlandes, Kirrbergerstraße, Gebäude 6, 66421, Homburg, Deutschland.
| | - C Neubert
- UKS - Universitätsklinikum des Saarlandes, Kirrbergerstraße, Gebäude 6, 66421, Homburg, Deutschland
| | - Y Yeter
- UKS - Universitätsklinikum des Saarlandes, Kirrbergerstraße, Gebäude 6, 66421, Homburg, Deutschland
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Nundlall N, Playford D, Davis TME, Davis WA. Relative incidence and predictors of pulmonary arterial hypertension complicating type 2 diabetes: The Fremantle Diabetes Study Phase I. J Diabetes Complications 2021; 35:107773. [PMID: 33144028 DOI: 10.1016/j.jdiacomp.2020.107773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 11/19/2022]
Abstract
AIMS To determine the relative incidence and predictors of pulmonary arterial hypertension (PAH) in type 2 diabetes. METHODS Hospitalizations for/with and death from/with PAH, and all-cause mortality, were ascertained from validated databases for participants from the longitudinal, community-based Fremantle Diabetes Study Phase I (FDS1; n = 1287) and age-, sex- and zip code-matched people without diabetes (n = 5153) between entry (1993-1996) and end-2017. Incidence rates (IRs) and IR ratios (IRRs) were calculated. Cox proportional hazards and competing risk models generated cause-specific (cs) and subdistribution (sd) hazard ratios (HRs) for incident PAH. RESULTS In the pooled cohort (mean age 64.0 years, 49% males), 49 (3.8%) of the type 2 diabetes participants and 133 (2.6%) of those without diabetes developed PAH during 106,556 person-years of follow-up (IRs (95% CI) 262 (194-346) and 151 (127-179) /100,000 person-years, respectively; IRR 1.73 (1.22-2.42), P = 0.001). Type 2 diabetes was associated with an unadjusted csHR of 1.97 (1.42-2.74) and sdHR of 1.44 (1.04-2.00) (P ≤ 0.03); after adjustment for age, sex, and co-morbidities, these were 1.43 (0.83-2.47) and 1.36 (0.97-1.91), respectively (P ≥ 0.07). CONCLUSIONS Type 2 diabetes is associated with an increased risk of PAH but this is no longer significant after adjustment for other explanatory variables and the competing risk of death.
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Affiliation(s)
| | - David Playford
- School of Medicine, The University of Notre Dame, Australia
| | - Timothy M E Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Wendy A Davis
- Medical School, The University of Western Australia, Fremantle Hospital, Fremantle, Western Australia, Australia.
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Ultrasound Evaluation of Pediatric Slow-Flow Vascular Malformations: Practical Diagnostic Reporting to Guide Interventional Management. AJR Am J Roentgenol 2020; 216:494-506. [PMID: 33356433 DOI: 10.2214/ajr.20.23338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE. This article reviews the ultrasound characteristics of pediatric slow-flow vascular malformations and underscores findings that significantly impact diagnosis and treatment. Key imaging features are discussed including lesion size, malformation location, morphology, and mimics. CONCLUSION. Ultrasound findings affect the management of slow-flow vascular malformations and should be emphasized in lesion diagnosis. Superficial, focal lesions with well-defined margins are ideal for ultrasound evaluation.
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Yang F, Yang B, Qu Z, Tan Y, Lu F, Liao Z. Percutaneous ethanol sclerotherapy for auricular arteriovenous malformation: Our experience with 11 patients. Clin Otolaryngol 2020; 45:811-817. [PMID: 32385948 DOI: 10.1111/coa.13567] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 04/29/2020] [Accepted: 05/03/2020] [Indexed: 02/05/2023]
Affiliation(s)
- FangYun Yang
- Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - Biao Yang
- Department of Gastroenterology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - ZiYu Qu
- Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - YuPing Tan
- Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - FaCheng Lu
- Department of Radiology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
| | - ZhengYin Liao
- Department of Abdominal Oncology, West China Hospital, West China Medical School, Sichuan University, Chengdu, China
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16
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Anson A, Soler M, Martinez M, Murciano J, Agut A. Sclerotherapy treatment of an assumed aneurysmal bone cyst in a dog. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2019-000975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Agustina Anson
- Veterinary Teaching HospitalUniversity of MurciaMurciaSpain
| | - Marta Soler
- Department of Medicine and SurgeryUniversity of MurciaMurciaSpain
| | | | - Jose Murciano
- Department of Medicine and SurgeryUniversity of MurciaMurciaSpain
| | - Amalia Agut
- Department of Medicine and SurgeryUniversity of MurciaMurciaSpain
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Fernández-Alvarez V, Suárez C, de Bree R, Nixon IJ, Mäkitie AA, Rinaldo A, Downer J, Ferlito A. Management of extracranial arteriovenous malformations of the head and neck. Auris Nasus Larynx 2019; 47:181-190. [PMID: 31862283 DOI: 10.1016/j.anl.2019.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/09/2019] [Accepted: 12/02/2019] [Indexed: 12/16/2022]
Abstract
The purpose of this study was to review the outcomes of the different therapies for extracranial head and neck arteriovenous malformations (AVMs). AVMs are high-flow congenital vascular anomalies. They are composed of a complex system of vessels directly connecting feeding arteries to draining veins forming a nidus. They may be potentially life-threatening due to progressive symptoms and infiltrative disease. Extracranial AVMs most commonly affect the head and neck area (47.4%) followed by the extremities (28.5%). AVMs are best characterized as being either focal or diffuse. Focal AVMs have good outcomes following adequate treatment. Diffuse lesions have multiple feeding vessel, which results in high rates of recurrence despite treatment. The management of AVMs includes conventional surgery and endovascular techniques. A combination of embolization and surgical resection has become the treatment of choice over the last years. The main goal of both forms of treatment being the complete blockage or resection of the nidus. Transcatheter embolization of vessels has evolved over the years and new embolic agents have emerged. The types of materials available for embolization are classified into mechanical devices, liquid agents and particulates. Efficacy, rate of recurrence and most common complications were evaluated. AVMs recurrence after embolization or resection is reported in up to 80% of cases. Incomplete resection and embolization can induce aggressive growth of the remaining nidus and the risk of progression is up to 50% within the first 5 years and recurrences can occur up to 10 years later. Although ethanol seems to be associated with the highest degree of cure and permanent occlusion, the overall complication rate reported was 48%. Other materials, such as cyanoacrylate, have obtained modest rates of complete remission, while the reported rates of complete regression of AVMs with Fibrin glue and Polyvinyl alcohol are above 50%. At present, there are no unified agreement on the ideal embolic agent. Therefore, a multidisciplinary approach is recommended to support decision making about the best therapeutic approach and to achieve optimal outcome. A long-term post-treatment follow-up is recommended to recognize early recurrence.
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Affiliation(s)
| | - Carlos Suárez
- Instituto de Investigación Sanitaria del Principado de Asturias and CIBERONC, ISCIII, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - Remco de Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Iain J Nixon
- Departments of Surgery and Otolaryngology, Head and Neck Surgery, Edinburgh University, Edinburgh, UK
| | - Antti A Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programme in Systems Oncology, Faculty of Medicine, University of Helsinki, Helsinki, Finland; Division of Ear, Nose and Throat Diseases, Department of Clinical Sciences, Intervention and Technology, Karolinska Institutet and Karolinska Hospital, Stockholm, Sweden
| | | | - Jonathan Downer
- Department of Clinical Neurosciences, Edinburgh University, UK
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Italy
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Abstract
Ethanol intoxication of infants and young children can be a challenging diagnosis in the pediatric emergency department, and features of the poisoning may differ in comparison with adolescents. The sources of ethanol exposures in this age are varied and include unintentional, malicious, and iatrogenic etiologies. Young children exposed to ethanol often present with mixed clinical signs and symptoms that may not fit the traditional ethanol or sedative-hypnotic toxidrome. Pediatric ethanol intoxications are often managed supportively, and recovery is usually rapid. The purpose of this review is to describe the sources of ethanol poisoning among children 6 years and younger, highlight presenting symptoms and pharmacokinetic considerations unique to this age group, and review management strategies. In addition, published cases of ethanol poisoning due to ingestion among young infants are compiled for presentation.
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Abstract
The approach to treating common (cystic) lymphatic malformations (LMs) has evolved significantly over the last decade due to clinical research and recent developments in molecular biology. Surgery, sclerosing agents, and medical drugs with specific targets for biological therapy have been reported for the management of LMs. We will discuss the importance to standardize the location and imaging characterization of LMs to improve the knowledge about the outcome of the different therapeutic options. Our goal is to help the reader understand the different options for the management of LMs with the balance between risk and benefit for the patients.
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Hu J, Albadawi H, Oklu R, Chong BW, Deipolyi AR, Sheth RA, Khademhosseini A. Advances in Biomaterials and Technologies for Vascular Embolization. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2019; 31:e1901071. [PMID: 31168915 PMCID: PMC7014563 DOI: 10.1002/adma.201901071] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/24/2019] [Indexed: 05/03/2023]
Abstract
Minimally invasive transcatheter embolization is a common nonsurgical procedure in interventional radiology used for the deliberate occlusion of blood vessels for the treatment of diseased or injured vasculature. A wide variety of embolic agents including metallic coils, calibrated microspheres, and liquids are available for clinical practice. Additionally, advances in biomaterials, such as shape-memory foams, biodegradable polymers, and in situ gelling solutions have led to the development of novel preclinical embolic agents. The aim here is to provide a comprehensive overview of current and emerging technologies in endovascular embolization with respect to devices, materials, mechanisms, and design guidelines. Limitations and challenges in embolic materials are also discussed to promote advancement in the field.
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Affiliation(s)
- Jingjie Hu
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Hassan Albadawi
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Rahmi Oklu
- Division of Vascular & Interventional Radiology, Minimally Invasive Therapeutics Laboratory, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Brian W Chong
- Departments of Radiology and Neurological Surgery, Mayo Clinic, 13400 East Shea Blvd., Scottsdale, Arizona 85259, USA
| | - Amy R. Deipolyi
- Department of Interventional Radiology, Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, 1275 York Avenue, New York, New York 10065, USA
| | - Rahul A. Sheth
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, Texas 77054, USA
| | - Ali Khademhosseini
- Department of Bioengineering, Department of Radiological Sciences, Department of Chemical and Biomolecular Engineering, Center for Minimally Invasive Therapeutics, California Nanosystems Institute, University of California, 410 Westwood Plaza, Los Angeles, California 90095, USA
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21
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Sindel A, Sayan A, Özgür Ö, Sindel T, Ilankovan V. Percutaneous treatment of orofacial vascular malformations. Br J Oral Maxillofac Surg 2019; 56:206-211. [PMID: 29422307 DOI: 10.1016/j.bjoms.2018.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Accepted: 01/18/2018] [Indexed: 11/17/2022]
Abstract
The aim of this study was to evaluate the efficacy of fluoroscopy-guided percutaneous injection of bleomycin as the primary treatment for low-flow vascular malformations. A total of 34 patients (mean (range) age 24 (8-51) years) with orofacial vascular lesions were treated in the Department of Interventional Radiology and Maxillofacial Surgery. There were 20 low-flow venous malformations, 11 lymphatic malformations, and three of mixed type. All patients were treated by fluoroscopy-guided percutaneous injection of a mixture of bleomycin (mean (range) 15 (5-15)mg) and a radio-opaque agent (Ultravist® (iopromide), Bayer)/session. The number of sessions ranged from one to six. The clinical response was complete in 21 patients, obvious in nine, and of clinical benefit in four. Patients were reviewed within the first week, third week, and at three-month periods until 24 months. There were no serious complications such as pulmonary fibrosis. Fluoroscopy-guided intralesional injection of bleomycin should be considered as the first-line treatment for lymphatic malformations because it is effective and reliable with few complications.
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Affiliation(s)
- A Sindel
- Department of Oral and Maxillofacial Surgery, Akdeniz University, Antalya, Turkey
| | - A Sayan
- Department of Oral and Maxillofacial surgery, Poole Hospital NHS Foundation Trust.
| | - Ö Özgür
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - T Sindel
- Department of Radiology, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - V Ilankovan
- Department of Oral and Maxillofacial surgery, Poole Hospital NHS Foundation Trust
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22
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Midterm and long-term results of ethanol embolization of auricular arteriovenous malformations as first-line therapy. J Vasc Surg Venous Lymphat Disord 2018; 6:626-635. [DOI: 10.1016/j.jvsv.2018.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 01/25/2018] [Indexed: 12/26/2022]
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Abstract
Anesthesiologists are increasingly called on to care for pediatric patients undergoing diagnostic imaging and invasive procedures in interventional radiology. These procedures are typically classified as either nonvascular or vascular, and can range from short diagnostic imaging studies or biopsies to significantly longer and more invasive intravascular procedures. Anesthesia providers must consider each child's ability to cooperate reliably during the procedure, their age, and any cognitive impairment to define the best anesthetic plan. Several unique pediatric patient populations with specific procedural implications and anesthetic considerations who will benefit from additional periprocedural planning are discussed.
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Affiliation(s)
- Olivia Nelson
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, 9th Floor, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Philip D Bailey
- Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, The University of Pennsylvania, The Children's Hospital of Philadelphia, 9th Floor, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Seront E, Vikkula M, Boon LM. Venous Malformations of the Head and Neck. Otolaryngol Clin North Am 2018; 51:173-184. [DOI: 10.1016/j.otc.2017.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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25
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Ethanol Embolotherapy for the Management of Refractory Chronic Skin Ulcers Caused by Arteriovenous Malformations. J Vasc Interv Radiol 2018; 29:107-113. [DOI: 10.1016/j.jvir.2017.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 01/20/2023] Open
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Kumar S, Bhavana K, Kumar S, Kumar P. Ultrasound-guided polidocanol foam sclerotherapy for treating venous malformations. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:23-31. [PMID: 29080330 DOI: 10.1002/jcu.22546] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 05/22/2017] [Accepted: 05/22/2017] [Indexed: 06/07/2023]
Abstract
AIM To evaluate clinical and imaging outcomes after ultrasound (US)-guided 3% polidocanol (POL) foam-sclerotherapy of venous malformations (VMs). METHODS We retrospectively evaluated consecutive VM cases over 1.5 years, with 6-month follow-up. US findings were used to classify VMs into four types depending upon extent of anechoic channels, connections to adjacent veins, and dysmorphism. Single or multiple needles were inserted depending upon lesion size, and used to inject up to 8 mL POL per session, every 2 to 4 weeks. We evaluated reduction in pain and swelling, lesion resolution on imaging, and patient satisfaction. RESULTS There were 15, 24, 9, and 5 patients (total 53) with type I, II, III, and IV VMs, respectively. The average number of sessions was 5.3, 4.3, and 4, and the average amount of POL injected was 14.24 mL, 16.1 mL, and 23.2 mL for type I, II, III VMs, respectively. The number of sessions correlated with lesion volume (P < .0001). Imaging showed good resolution in 4/15, 18/24, 6/9, and 4/5 patients respectively with type I, II, III, and IV VMs. Patient satisfaction was not related to lesion type (P = .1). ROC analyses showed cut-off values of 4.9 mL lesion volume, three sessions, and 12 mL POL volume for patient satisfaction. At 6 months, 23 patients having pain had significant improvement (P < .00001). Local (n = 30) and chest pain (n = 2) were the only complications. CONCLUSIONS US-guided sclerotherapy with 3% POL foam is safe and effective. Lesions with up to 50% anechoic areas had better resolution, without correlation with patient satisfaction.
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Affiliation(s)
- Subhash Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Kranti Bhavana
- Department of ENT, All India Institute of Medical Sciences, Patna, Bihar, India
| | - Sanjeev Kumar
- Department of Trauma and Emergency (CTVS), All India Institute of Medical Sciences, Patna, Bihar, India
| | - Prem Kumar
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna, Bihar, India
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27
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Wong W, Loya MF, Martynov A, Shah SS, Berman D. Successful sclerotherapy of a recurrent, benign parotid cyst. Radiol Case Rep 2017; 13:146-149. [PMID: 29552253 PMCID: PMC5850872 DOI: 10.1016/j.radcr.2017.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/26/2017] [Accepted: 09/05/2017] [Indexed: 02/02/2023] Open
Abstract
Benign parotid lesions can grow to be a cosmetic deformation with psychological sequelae for a patient. Although surgical resection is the treatment of choice, cyst aspiration has also been attempted. This, however, has been shown to recur, requiring repeat intervention. An alternative therapeutic method not as widely recognized, but which has been reported to be both effective and less invasive than surgery for treating parotid cyst lesions, is sclerotherapy. Here we describe a report of a patient with a benign, localized, cystic neck mass refractory to 2 trials of fine needle aspiration. After the patient refused surgical resection, a trial of sterile ethanol sclerotherapy was performed. Our patient tolerated the procedure well with a significant reduction in the size of the lesion.
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28
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Lee JY, Suh DC. Visualization of Soft Tissue Venous Malformations of Head and Neck with 4D Flow Magnetic Resonance Imaging. Neurointervention 2017; 12:110-115. [PMID: 28955513 PMCID: PMC5613042 DOI: 10.5469/neuroint.2017.12.2.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/18/2017] [Accepted: 07/20/2017] [Indexed: 11/24/2022] Open
Abstract
Evaluation of hemodynamics in venous malformation (VM) in the head and neck area is done by direct puncture venography before alcohol sclerotherapy, but it is difficult due to a variable degree of filling in from the artery and filling out into the draining vein. We present our preliminary experience of 4D MRI to evaluate VM hemodynamics. Four patients with venous malformation in the maxillofacial area underwent both 4D MRI and direct puncture venography before alcohol sclerotherapy. To find out appropriate velocity encoding (VENC) for VM, we applied 5-50 cm/sec VENC. Significant high-flow foci demonstrated by phase changes in magnitude images were compared with lesion types shown on a direct puncture venogram. Detection of flow in VM was possible in magnitude images or phase-difference images when VENC was set to less than 30 cm/sec. Appropriate VENC for VM was regarded as less than 5 cm/sec. High-flow areas in the dilated venous sac demonstrated focal spots or linear band-like areas on phase changes of 4D MRI. Appropriate VENC application was mandatory to detect flow in VM. Flow information on 4D MRI provided flow information in VM which was not detected on a direct puncture venogram in the compartmentalized lesion and thus can make alcohol sclerotherapy safer.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Dae Chul Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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29
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Ryu KH, Lee JH, Lee JY, Chung SR, Chung MS, Kim HW, Choi YJ, Baek JH. Ethanol Ablation of Ranulas: Short-Term Follow-Up Results and Clinicoradiologic Factors for Successful Outcome. AJNR Am J Neuroradiol 2017; 38:1794-1798. [PMID: 28663262 DOI: 10.3174/ajnr.a5292] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 05/09/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Surgical excision of an affected sublingual gland for treatment of a ranula can carry a potential of a nerve damage or postoperative complications. However, there have been little studies about effective minimally invasive therapeutic method, yet. Our aim was to evaluate the efficacy and safety of ethanol ablation of ranulas and the clinicoradiologic factors that can predict outcome. MATERIALS AND METHODS This retrospective study evaluated 23 patients with ranulas treated by percutaneous ethanol ablation. Treatment outcome was assessed in 20 patients followed for at least 6 months. The duration of symptoms before ethanol ablation, pretreatment volume, and parapharyngeal extension on sonography and/or CT were correlated with the outcome. The Mann-Whitney U test and Fisher exact test were used for comparison of the factors according to the outcome. RESULTS The study evaluated 14 males and 9 females with a median age of 26 years (range, 3-41 years). Among 20 patients who were followed for at least 6 months (median, 20 months; range, 6-73 months), 9 patients (45%) demonstrated complete disappearance of the ranulas and 11 (55%) showed an incomplete response. When the patients were divided according to the duration of symptoms before ethanol ablation, the complete response rate was significantly higher in patients with ≤12 months of symptoms (73%, 8/11) than that in others (11%, 1/9) (P = .010). Pretreatment volume and parapharyngeal extension were not significantly different between the 2 groups. CONCLUSIONS Ethanol ablation is a safe and noninvasive treatment technique for ranulas with a significantly better outcome in patients with ≤12 months of symptoms. Therefore, it could be considered an alternative nonsurgical approach for ranulas with recent onset of symptoms.
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Affiliation(s)
- K H Ryu
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Radiology (K.H.R.), Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - J H Lee
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - J Y Lee
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Radiology (J.Y.L.), Soonchunhyang University College of Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea
| | - S R Chung
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - M S Chung
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.,Department of Radiology (M.S.C.), Chung-Ang University College of Medicine, Chung-Ang University Medical Center, Seoul, Republic of Korea
| | - H W Kim
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Y J Choi
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - J H Baek
- From the Department of Radiology and Research Institute of Radiology (K.H.R., J.H.L., J.Y.L., S.R.C., M.S.C., H.W.K., Y.J.C., J.H.B.), University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Abstract
Venous malformations are the most common vascular anomalies. When they are superficial and large, they are easily recognized. However, when the malformation is deep or involves normally occurring veins, the diagnosis can be challenging. Extremity varicosities may be the only visible signs of the problem. Unfortunately, varicosities are often presumed to be the result of superficial venous insufficiency and the underlying venous malformation is overlooked. The phlebologist must be cognizant of the possibility that a venous malformation may be the cause of the patient's symptoms and varicosities. Ultrasound and magnetic resonance imaging can help to confirm the correct diagnosis. Treatment involves image-guided endovenous occlusion of the malformation, most commonly with potent liquid sclerosing agents. Some of these agents can cause severe complications. A thorough knowledge of the sclerosing solutions and the endovascular techniques to properly deliver them to the malformation is essential. This article will review the basic principle surrounding endovascular management of venous malformations.
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Affiliation(s)
- M Rosenblatt
- Connecticut Image Guided Surgery, Fairfield, CT, USA
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31
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Treatment of glomus tympanicum tumors by preoperative embolization and total surgical resection. Am J Otolaryngol 2016; 37:544-551. [PMID: 27650391 DOI: 10.1016/j.amjoto.2016.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 08/29/2016] [Indexed: 11/23/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness on function preservation and tumor control of the treatment of glomus tympanicum tumors with pre-operative embolization followed by total surgical resection. MATERIAL AND METHODS We describe a series of 6 patients with a glomus tympanicum tumor who were treated in our hospital using the same technique: the day before surgery selective tumor embolization due to denaturation with 96% ethanol. Following parameters were considered: tumor classification, tumor control, clinical and audiological outcome, effectiveness of embolization, percentage of tumor necrosis and treatment complications. RESULTS There were no severe complications due to embolization or surgery. Tumor blush disappeared completely in 5 patients on DSA post embolization and histologic evaluation of the resected tissue showed a median of 69.2% of tumor necrosis. Pulsatile tinnitus disappeared in all patients and 3 patients had no symptoms at all. Hearing ameliorated in 4 patients, 1 patient without hearing loss pre- treatment still had normal hearing after treatment and 1 patient's hearing was worse after treatment. Average follow-up was 21.3months. CONCLUSIONS Treatment of glomus tympanicum tumors by pre-operative embolization with ethanol and surgical resection has not been described before. Our results show that it is a safe procedure with a good long term tumor control, good clinical and audiological outcome.
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Frenk NE, Sebastianes F, Lerario AM, Fragoso MCBV, Mendonca BB, de Menezes MR. Long-term Results after CT-Guided Percutaneous Ethanol Ablation for the Treatment of Hyperfunctioning Adrenal Disorders. Clinics (Sao Paulo) 2016; 71:600-605. [PMID: 27759849 PMCID: PMC5054768 DOI: 10.6061/clinics/2016(10)08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 07/27/2016] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES: To evaluate the safety and long-term efficacy of computed tomography-guided percutaneous ethanol ablation for benign primary and secondary hyperfunctioning adrenal disorders. METHOD: We retrospectively evaluated the long-term results of nine patients treated with computed tomography-guided percutaneous ethanol ablation: eight subjects who presented with primary adrenal disorders, such as pheochromocytoma, primary macronodular adrenal hyperplasia and aldosterone-producing adenoma, and one subject with Cushing disease refractory to conventional treatment. Eleven sessions were performed for the nine patients. The patient data were reviewed for the clinical outcome and procedure-related complications over ten years. RESULTS: Patients with aldosterone-producing adenoma had clinical improvement: symptoms recurred in one case 96 months after ethanol ablation, and the other patient was still in remission 110 months later. All patients with pheochromocytoma had clinical improvement but were eventually submitted to surgery for complete remission. No significant clinical improvement was seen in patients with hypercortisolism due to primary macronodular adrenal hyperplasia or Cushing disease. Major complications were seen in five of the eleven procedures and included cardiovascular instability and myocardial infarction. Minor complications attributed to sedation were seen in two patients. CONCLUSION: Computed tomography-guided ethanol ablation does not appear to be suitable for the long-term treatment of hyperfunctioning adrenal disorders and is not without risks.
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Affiliation(s)
- Nathan Elie Frenk
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, Serviço de Intervenção Guiada por Imagem, São Paulo/SP, Brazil
| | - Fernando Sebastianes
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Endocrinologia, Departamento de Medicina Interna, São Paulo/SP, Brazil
| | - Antonio Marcondes Lerario
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Endocrinologia, Departamento de Medicina Interna, São Paulo/SP, Brazil
| | | | - Berenice Bilharinho Mendonca
- Faculdade de Medicina da Universidade de São Paulo, Disciplina de Endocrinologia, Departamento de Medicina Interna, São Paulo/SP, Brazil
| | - Marcos Roberto de Menezes
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, Serviço de Intervenção Guiada por Imagem, São Paulo/SP, Brazil
- Instituto do Câncer do Estado de São Paulo, Serviço de Radiologia e Intervenção Guiada por Imagem, São Paulo/SP, Brazil
- E-mail:
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Settecase F, Hetts SW, Nicholson AD, Amans MR, Cooke DL, Dowd CF, Higashida RT, Halbach VV. Superselective Intra-Arterial Ethanol Sclerotherapy of Feeding Artery and Nidal Aneurysms in Ruptured Cerebral Arteriovenous Malformations. AJNR Am J Neuroradiol 2016; 37:692-7. [PMID: 26564434 DOI: 10.3174/ajnr.a4584] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 08/10/2015] [Indexed: 01/19/2023]
Abstract
In the endovascular treatment of cerebral arteriovenous malformations, ethanol sclerotherapy is seldom used due to safety concerns. However, when limited reflux of an embolic agent is permissible or when there is a long distance to the target, ethanol may be preferable. We reviewed 10 patients with 14 cerebral AVM feeding artery aneurysms or intranidal aneurysms treated with intra-arterial ethanol sclerotherapy at our institution between 2005 and 2014. All patients presented with acute intracranial hemorrhage. Thirteen of 14 aneurysms were treated primarily with 60%-80% ethanol into the feeding artery. Complete target feeding artery and aneurysm occlusion was seen in all cases; 8/13 (62%) were occluded by using ethanol alone. No retreatments or recurrences were seen. One permanent neurologic deficit (1/13, 7.7%) and no deaths occurred. In a subset of ruptured cerebral AVMs, ethanol sclerotherapy of feeding artery aneurysms and intranidal aneurysms can be performed with a high degree of technical success and a low rate of complication.
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Affiliation(s)
- F Settecase
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California.
| | - S W Hetts
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - A D Nicholson
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - M R Amans
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - D L Cooke
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - C F Dowd
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - R T Higashida
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
| | - V V Halbach
- From the Division of Interventional Neuroradiology, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California
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Yu SCH, Hui EP, Tang P, Chan SKC, Chu CCM, Hui JWY, Chan SL, Lee KF, Lai PBS, Yeo W. Transarterial Ethanol Ablation for Unresectable Hepatocellular Carcinoma: Analysis of Clinical and Tumor Outcomes. J Vasc Interv Radiol 2016; 27:639-49. [PMID: 26803574 DOI: 10.1016/j.jvir.2015.11.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 11/05/2015] [Accepted: 11/07/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To evaluate survival, tumor response, and treatment toxicity of transarterial ethanol ablation (TEA) in patients with unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS This prospective study involved 186 patients (146 men and 40 women; median age, 65 y [interquartile range, 57-72.3 y]). Of 186 patients, 146 (78.5%) were hepatitis B virus carriers, 18 (9.7%) were hepatitis C virus carriers, 82 (44.1%) had tumors ≥ 5 cm, and 43 (23.1%) had multifocal tumors. Overall survival (OS), complete response (CR) by European Association for the Study of the Liver criteria, time to progression (TTP), progression-free survival (PFS), and treatment toxicities were evaluated. Univariate and multivariate analyses for prognostic factors of OS were performed. RESULTS Median OS was 25.7 months (95% confidence interval [CI], 20.9-30.5) and varied significantly between Child-Pugh A and B (28.7 mo vs 13.4 mo, P < .001), and Barcelona Clinic Liver Cancer A and B or C (37.1 mo vs 17.7 mo, P = .001). Prognostic factors for longer OS were solitary tumor, tumor size < 5 cm, > 1 treatments, and CR of all tumors at 6 months. TTP was 9.1 months (95% CI, 6.9-11.3). PFS was 8.4 months (95% CI, 7.1-9.7). CR occurred in 69.1% (159/230) of lesions and 48.9% (88/180) of patients at 6 months. Any one symptom of the postembolization syndrome of grade 2 severity occurred in < 22% (41/186) of patients. No treatment-related hepatitis or death occurred within 30 days. Transient respiratory decompensation occurred in three patients (1.6% [3/186]), and alcoholic intoxication occurred in one patient (0.5% [1/186]). CONCLUSIONS TEA appears to be safe and effective for local control of HCC.
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Affiliation(s)
- Simon Chun Ho Yu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR; Department of Vascular and Interventional Radiology Foundation Clinical Science Center, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR.
| | - Edwin Pun Hui
- Department of Clinical Oncology, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR
| | - Peggy Tang
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR
| | - Stephen Ka Chi Chan
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR
| | - Charmant Cheuk Man Chu
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR
| | - Joyce Wai Yi Hui
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR
| | - Stephen Lam Chan
- Department of Clinical Oncology, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR
| | - Kit Fai Lee
- Department of Surgery, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR
| | - Paul Bo San Lai
- Department of Surgery, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR
| | - Winnie Yeo
- Department of Clinical Oncology, The Chinese University of Hong Kong, Room 2A061, 2/F, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, 30-32 Ngan Shing Street, Sha Tin, New Territories, Hong Kong SAR
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Management of Low-Flow Vascular Malformations: Clinical Presentation, Classification, Patient Selection, Imaging and Treatment. Cardiovasc Intervent Radiol 2015; 38:1082-104. [DOI: 10.1007/s00270-015-1085-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 02/02/2015] [Indexed: 01/19/2023]
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36
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Kim CG, Kweon SH. Primary Aneurysmal Bone Cyst in the Iliac Bone: A Case Report. Hip Pelvis 2014; 26:202-5. [PMID: 27536582 PMCID: PMC4971149 DOI: 10.5371/hp.2014.26.3.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/16/2014] [Accepted: 07/09/2014] [Indexed: 11/24/2022] Open
Abstract
Symptomatic aneurysmal bone cysts with expansible lesions in the pelvis are rare in children. The management of an aggressive vascular lesion in a female child is challenging. The standard treatment for aneurysmal bone cysts is accompanied by a high risk of local recurrence. A 12-year-old female presented with a history of pelvic pain for 5 months. Plain radiographs and magnetic resonance imaging showed a very large expansile lytic lesion arising from the right iliac bone. Intralesional curettage, electric cauterization, chemical sclerotherapy and allogeneic bone graft were performed through the window of the iliac crest. At a follow-up consultation 3.5 years post-surgery, the child had painless full-range movement in the hip joint with no recurrence. Although many treatment options are described, our patient was treated successfully using curettage and allogeneic bone graft without recurrence.
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Affiliation(s)
- Chae Geun Kim
- Department of Orthopaedic Surgery, St. Carollo Hospital, Suncheon, Korea
| | - Seok Hyun Kweon
- Department of Orthopaedic Surgery, Wonkwang University College of Medicine, Iksan, Korea
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37
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Du LR, Lu XJ, Guan HT, Yang YJ, Gu MJ, Zheng ZZ, Lv TS, Yan ZG, Song L, Zou YH, Fu NQ, Qi XR, Fan TY. Development and evaluation of liquid embolic agents based on liquid crystalline material of glyceryl monooleate. Int J Pharm 2014; 471:285-96. [DOI: 10.1016/j.ijpharm.2014.05.036] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Revised: 05/07/2014] [Accepted: 05/19/2014] [Indexed: 11/16/2022]
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38
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Pulmonary arterial hypertension secondary to ethanol sclerotherapy for renal artery embolization. Case Rep Crit Care 2014; 2014:452452. [PMID: 25024851 PMCID: PMC4082933 DOI: 10.1155/2014/452452] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 06/04/2014] [Indexed: 11/17/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) has been reported as a major complication to consider and promptly manage in the use of ethanol sclerotherapy. Most of the available data on the development of PAH is derived from the use of ethanol for embolization of arteriovenous malformation, but it has been rarely reported in its other fields of application. We describe a case of outpatient renal artery embolization using ethanol, in which respiratory failure develops secondary to PAH despite adhering to safe practice protocols. We highlight the importance of pulmonary arterial pressure monitoring and the treatment steps to follow in order to avoid irreversible fatal outcomes.
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40
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Mulligan PR, Prajapati HJS, Martin LG, Patel TH. Vascular anomalies: classification, imaging characteristics and implications for interventional radiology treatment approaches. Br J Radiol 2014; 87:20130392. [PMID: 24588666 DOI: 10.1259/bjr.20130392] [Citation(s) in RCA: 111] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The term vascular anomaly represents a broad spectrum of vascular pathology, including proliferating vascular tumours and vascular malformations. While the treatment of most vascular anomalies is multifactorial, interventional radiology procedures, including embolic therapy, sclerotherapy and laser coagulation among others, are playing an increasingly important role in vascular anomaly management. This review discusses the diagnosis and treatment of common vascular malformations, with emphasis on the technique, efficacy and complications of different interventional radiology procedures.
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Affiliation(s)
- P R Mulligan
- Division of Interventional Radiology & Image Guided Medicine, Department of Radiology, Emory University School of Medicine, Atlanta, GA, USA
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41
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Tachibana K, Sasaki S, Nakamura T, Dozaki S. Bronchospasm Induced by Ethanol Injection for a Craniofacial Venous Malformation. ACTA ACUST UNITED AC 2014; 2:149-51. [DOI: 10.1213/xaa.0000000000000032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
The volume of pediatric invasive and noninvasive procedures outside the operating room continues to increase. The acuity and complexity of patient clinical condition has resulted in the expansion of the anesthesiologist's role in remote sites. The anesthesia provider must ensure patient safety by assuring appropriate patient preparation, having available required equipment for monitoring and rescue, planning careful sedation/anesthesia management, continuing vigilance and observation into the recovery phase, and requiring strict discharge criteria. A quality improvement program for the department of anesthesiology should review anesthetic and sedation outcomes of patients both inside and outside the operating room.
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Affiliation(s)
- Katrin Campbell
- Division of Sedation, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Suite A300, Houston, TX 77030, USA
| | - Laura Torres
- Department of Pediatrics, Sedation Oversight Committee, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Suite A300, Houston, TX 77030, USA
| | - Stephen Stayer
- Pediatric Anesthesiology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Suite A300, Houston, TX 77030, USA.
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Kim JH. Ultrasound-guided sclerotherapy for benign non-thyroid cystic mass in the neck. Ultrasonography 2014; 33:83-90. [PMID: 24936500 PMCID: PMC4058977 DOI: 10.14366/usg.13026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 01/28/2014] [Indexed: 11/03/2022] Open
Abstract
Surgical excision has traditionally been the treatment of choice for benign non-thyroid cystic neck masses, including lymphatic malformation, ranula, branchial cleft cyst, thyroglossal duct cyst, and parathyroid cyst. However, there is a tendency toward recurrence after surgery, and surgery may be accompanied by complications, including nerve injuries, vascular injuries, and scar formation. Ultrasound-guided sclerotherapy using various agents has been challenged and successfully applied as an alternative treatment for benign non-thyroid cystic neck masses. This report reviews the available sclerosing agents and describes the applications of sclerotherapy to the treatment of benign cystic masses in the neck.
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Affiliation(s)
- Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
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45
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Talens Ferrando A, Ferrer Mengual S, González-Cruz Soler A, Martínez Sanjuán V, Poveda Roda R, Sanchis Bielsa J, Bagán Sebastián J. Alcohol sclerotherapy to treat vascular malformations in the oral cavity. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2011.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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46
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Balloon-occluded retrograde transvenous obliteration for intractable gastric variceal bleeding. J Formos Med Assoc 2013; 112:426-9. [DOI: 10.1016/j.jfma.2012.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2009] [Revised: 12/04/2009] [Accepted: 03/10/2010] [Indexed: 11/23/2022] Open
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47
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Kishi K, Morita N, Terada T, Sato M. Dose-saving isolation procedure in percutaneous ethanol sclerotherapy for venous malformations. Phlebology 2013; 29:276-86. [PMID: 23508004 DOI: 10.1177/0268355513475604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the feasibility and effectiveness of an isolation technique during ethanol injection sclerotherapy for venous malformations (VMs) in the head and neck region. METHODS The subjects were 23 patients with 35 VM lesions in the head and neck, treated between 1999 and 2012. The mean lesion area was 3.75 ± 3.09 cm(2) (±standard deviation). We confirmed the contour of the lesions to be treated on a fully filled image on direct injection cisternography, and observed patterns of communicating drainage to systemic veins. The cisterns were evacuated by squeezing and were isolated by manual compression of the communicators. Ethanol (94.5%) with a contrast agent was then injected into both isolable and unisolable lesions, up to a total volume of 1 mL/cm(2), avoiding complications. We investigated the relationship between lesion size and injected ethanol dose, and also dose per unit area. RESULTS Both manual evacuation by compression and isolation were performed in 20 (57.1%) isolable lesions, but not in 15 unisolable lesions. The mean injected ethanol dose was 0.65 ± 0.31 mL/cm(2) overall, 0.70 ± 0.32 in isolable and 0.59 ± 0.30 in unisolable lesions (NS). However, the injected ethanol dose was significantly lower for lesions sized >6 cm. Complete to near-complete shrinkage was observed in all isolable lesions, and in 60% of unisolable lesions (P < 0.05). Clinical outcome seemed unrelated to the injected ethanol dose or the dose per unit area. There was one case of recurrence and one complication in the unisolable lesions. No further relapses or complications were observed during the follow-up period of 38.6 ± 12.3 months. CONCLUSIONS Clinical outcome was related to the isolability not to the injected dose. The isolation appears useful for improving the safety and effectiveness of ethanol sclerotherapy for VM.
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Affiliation(s)
- K Kishi
- Department of Radiology, Wakayama Medical University Hospital, Wakayama City, Japan
| | - N Morita
- Department of Oral and Maxillary Surgery, Wakayama Rosai Hospital, Wakayama City, Japan
| | - T Terada
- Department of Neurosurgery, Wakayama Rosai Hospital, Wakayama City, Japan
| | - M Sato
- Department of Radiology, Wakayama Medical University Hospital, Wakayama City, Japan
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Odeyinde S, Kangesu L, Badran M. Sclerotherapy for vascular malformations: Complications and a review of techniques to avoid them. J Plast Reconstr Aesthet Surg 2013; 66:215-23. [DOI: 10.1016/j.bjps.2012.09.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 05/20/2012] [Accepted: 09/10/2012] [Indexed: 02/06/2023]
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49
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Pekkola J, Lappalainen K, Vuola P, Klockars T, Salminen P, Pitkäranta A. Head and neck arteriovenous malformations: results of ethanol sclerotherapy. AJNR Am J Neuroradiol 2012; 34:198-204. [PMID: 22766677 DOI: 10.3174/ajnr.a3180] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Peripheral AVM is a locally aggressive disease with a high tendency to recur; its treatment is complex, especially in the anatomically delicate head and neck area. Here, we report results of ethanol sclerotherapy for head and neck AVM and discuss its potential use for peripheral AVM. MATERIALS AND METHODS We retrospectively assessed degree of AVM eradication, complications, and clinical or imaging signs of recurrence for 19 patients treated with ethanol sclerotherapy for head and neck AVM (1 intraosseous, 18 soft-tissue AVMs). RESULTS Of the 19 patients, 11 had complete eradication of arteriovenous shunting at DSA, with 1 recurrence (mean follow-up 15 months), and for 7 patients, treatment is ongoing. During 59 treatment sessions, 12 patients experienced 14 complications, 1 leading to permanent functional damage. CONCLUSIONS Ethanol sclerotherapy has potential for complete eradication of head and neck AVM with low recurrence within the first year after completion of treatment. Complete eradication may require several treatment sessions during which complications should be minimized with careful techniques.
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Affiliation(s)
- J Pekkola
- Department of Radiology, University of Helsinki and HUS Radiology, Helsinki, Finland.
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50
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Lambot-Juhan K, Pannier S, Grévent D, Péjin Z, Breton S, Berteloot L, Emond-Gonsard S, Boddaert N, Glorion C, Brunelle F. Primary aneurysmal bone cysts in children: percutaneous sclerotherapy with absolute alcohol and proposal of a vascular classification. Pediatr Radiol 2012; 42:599-605. [PMID: 22237479 DOI: 10.1007/s00247-011-2312-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 10/04/2011] [Accepted: 10/04/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Percutaneous sclerotherapy is an effective treatment for aneurysmal bone cysts (ABCs). OBJECTIVE The purpose of this study was to demonstrate the safety and efficacy of sclerotherapy with absolute alcohol and to propose a vascular classification of ABCs based on a retrospective review. MATERIALS AND METHODS This was a review of children treated with absolute alcohol sclerotherapy for ABC at a single institution from January 1995 until November 2009. Treatment response was evaluated radiographically and clinically. Cyst fluid was classified as clear, partially bloody, or bloody. Presence of any venous drainage of the cyst was assessed by injection of contrast medium into the cyst cavity. RESULTS Twenty-nine children with ages ranging from 2 to 16 years were included. Treatment response was good in 17 (59%), partial in 9 (31%), and poor in 3 (10%) children. Venous drainage was absent in six out of seven clear-fluid cysts, which we classified as lymphatic. Drainage was present in all seven bloody-fluid cysts, which we classified as venous. In seven partially bloody-fluid cysts, venous drainage was seen in three. CONCLUSION Sclerotherapy with absolute alcohol is a safe and effective treatment of ABC. We propose classifying ABC as lymphatic or venous and suggest considering ABC intraosseous slow-flow vascular malformations.
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Affiliation(s)
- K Lambot-Juhan
- Pediatric Radiology, Hôpital Necker Enfants Malades, 149-161 rue de Sèvres, Paris, 75015, France.
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