Ethanol Sclerosis Research Articles

Ethanol Sclerosis Therapy for Aggressive Vertebral Hemangioma of the Spine: A Narrative Review.

Vertebral hemangiomas of the spine are rare benign tumors. They occur primarily in the thoracic region and are often asymptomatic and found incidentally on radiological examination; however, some are symptomatic, aggressive, and gradually increase in size. Various therapeutic approaches have been proposed for their management. This study aimed to review the therapeutic management, focusing on ethanol sclerosis therapy. The PubMed database was searched from inception to January 2023 using the keywords "hemangioma", "spine OR vertebra", and "ethanol". Twenty studies were retrieved, including two letters. The first report of spinal therapy was published in 1994. Ethanol sclerosis therapy is effective in treating vertebral hemangiomas. It is performed independently or in combination with other techniques, such as vertebroplasty using cement and surgery. The therapy is performed under local or general anesthesia with fluoroscopic or computed tomography guidance. A total of 10-15 mL of ethanol is slowly injected via unilateral or bilateral pedicles. Complications of the therapy include hypotension and arrhythmia during the procedure, paralysis immediately after the procedure, and delayed compression fractures. This review could enable the refinement of knowledge regarding ethanol sclerosis therapy, which is a treatment option that could be adopted.

Abstract #1394898: Ethanol Sclerosis of Recurrent Intrathyroidal Parathyroid Cyst

The incidence of parathyroid cyst varies between 0.08 % and 3.4 %. To date about 300 cases have been reported in the worlds’ literature. Parathyroid cysts may be functional or not, with functionating cysts tending to occur in men and at more advanced ages. Non-functionating parathyroid cysts are typically pure cysts that are usually asymptomatic unless they are large enough to cause compressive type symptoms. The treatment for a functionating parathyroid cyst is primarily surgical. We present the case of a 58-year-old Caucasian female who presented with a recurrent parathyroid cyst first being noted in 1993. Initial FNA drainage was reported to have yielded acellular, clear fluid (amount unknown) and fluid PTH was not assessed. A cycle of cyst re-accumulation and repeat FNA drainage occurred. Subsequent FNA drainage in 2008 yielded 20cc of clear fluid and 16.5 cc in 2013. The incidence of parathyroid cyst varies between 0.08 % and 3.4 %. To date about 300 cases have been reported in the world’s literature (1, 2). Parathyroid cysts may be functional or not, with functionating cysts tending to occur in men and at more advanced ages Non-functionating parathyroid cysts are typically pure cysts that are usually asymptomatic unless they are large enough to cause compressive type symptoms (1). The treatment for a functionating parathyroid cyst is primarily surgical. We present the case of a 58-year-old Caucasian female who presented with a recurrent parathyroid cyst first being noted in 1993. Initial FNA drainage was reported to have yielded acellular, clear fluid. A cycle of cyst reaccumulation and repeat FNA drainage occurred. In 2008, cyst fluid PTH was assessed to be 372 pg/ml. Serum calcium levels were consistently normal between 9.2 – 9.4 mg/dl and serum PTH 23.8 – 34 pg/ml from Oct 2012 through Dec 2017. In June 2017, patient returned with a sensation of left neck pressure. Ultrasound revealed a simple cyst encompassing most of the left thyroid lobe measuring 5.1 x 2.1 x 1.7 cm. To prevent recurrence, ethanol sclerosis of the cyst was performed. Follow up evaluation in 2020 revealed patient to feel well, having normal calcium and thyroid blood tests with US documenting resolution of the left intrathyroidal cyst. While treatment of the functionating parathyroid cysts typically remains surgical, there are additional options for non-functionating parathyroid cysts management to include non-surgical options such as sclerosis with ethanol or possibly tetracycline.

A Clinical Study of Post-treatment Nursing Strategy for Venous Malformations in the Pharynx Region

Background: Post-treatment nursing care is essential for patients with venous malformations (VMs) after they have undergone treatment. Effective post-treatment nursing care requires adequate resources, effective communication, patient compliance, and addressing psychological distress. However, the clinical care plan for VMs in the pharyngeal isthmus is not clear. Objectives: The present study aims to explore the clinical nursing strategy after the treatment of VMs in the pharynx area. Methods: In this study, the patients with VM in the pharynx region who received anhydrous ethanol sclerosis injection and/or surgical treatment in our Hospital from January 2013 to November 2018 were recruited. A total of 143 patients who had completed medical records were included in this prospective cohort study. The patients' post-operative vital signs were closely observed, the respiratory tract was maintained, the oral cavity was cleaned, and the nursing care of indwelling endotracheal intubation or tracheotomy was performed. After the clinical follow-ups of one to five years, long-term efficacy was also observed. We summarized their nursing care treatments. Results: The results showed that there were 0 patients rated as grade I, 3 patients rated as grade II, 17 patients rated as grade III, and 123 patients rated as grade IV after long-term efficacy. Conclusion: Appropriate anhydrous ethanol sclerotherapy can be selected for patients with pharyngeal venous malformation, and this method combined with the clinical nursing strategy after treatment concluded in this study can effectively reduce the volume of VM, with fewer side effects, and can effectively improve breathing, swallowing, and vocal function.

Overexpression of Argonaute HIWI Gene in Colorectal Cancer Stem Cells and Colorectal Cancerous Tissue

Background: Post-treatment nursing care is essential for patients with venous malformations (VMs) after they have undergone treatment. Effective post-treatment nursing care requires adequate resources, effective communication, patient compliance, and addressing psychological distress. However, the clinical care plan for VMs in the pharyngeal isthmus is not clear. Objectives: The present study aims to explore the clinical nursing strategy after the treatment of VMs in the pharynx area. Methods: In this study, the patients with VM in the pharynx region who received anhydrous ethanol sclerosis injection and/or surgical treatment in our Hospital from January 2013 to November 2018 were recruited. A total of 143 patients who had completed medical records were included in this prospective cohort study. The patients' post-operative vital signs were closely observed, the respiratory tract was maintained, the oral cavity was cleaned, and the nursing care of indwelling endotracheal intubation or tracheotomy was performed. After the clinical follow-ups of one to five years, long-term efficacy was also observed. We summarized their nursing care treatments. Results: The results showed that there were 0 patients rated as grade I, 3 patients rated as grade II, 17 patients rated as grade III, and 123 patients rated as grade IV after long-term efficacy. Conclusion: Appropriate anhydrous ethanol sclerotherapy can be selected for patients with pharyngeal venous malformation, and this method combined with the clinical nursing strategy after treatment concluded in this study can effectively reduce the volume of VM, with fewer side effects, and can effectively improve breathing, swallowing, and vocal function.

Transvaginal Ethanol Sclerosis versus Saline Aspiration of Endometriomas Prior to IVF: A Randomized Controlled Trial

Transvaginal Ethanol Sclerosis versus Saline Aspiration of Endometriomas Prior to IVF: A Randomized Controlled Trial

Ethanol sclerotherapy of ovarian endometrioma: a safe and effective minimal invasive procedure. Preliminary results

ObjectiveTo study if ultrasound-guided aspiration with ethanol sclerosis is a safe and effective treatment for endometriomas. Study designWe conducted a prospective study of 25 women with 27 endometriomas (two bilateral) measuring 4–10cm in diameter with no suspected malignancy, who underwent ultrasound-guided aspiration and ethanol sclerosis between August 2010 and July 2014. Patients were followed up by ultrasound at 6, 12, 24, and 36 months to identify rates of complication and recurrence. Clinical characteristics of the patients (age, history of infertility, previous surgery, and abdominal pain), the cysts (location, diameter, and volume) and the procedure (duration and complications) were recorded. Kaplan–Meier survival curves were used to analyze the recurrence rates by SPSS statistical software. ResultsThe recurrence rate after sclerosis was 12%. The mean length of follow-up was 17 (SD 9.9) months. Although no major procedure-related complications were recorded, minor complications included three cases of low abdominal pain during the procedure (10.7%) and two cases of abdominal ethanol extravasation (7.1%). ConclusionUltrasound-guided aspiration and ethanol sclerotherapy are a safe and effective treatment for endometriomas measuring 4–10cm in diameter with no evidence of malignancy. This conservative treatment could possibly achieve a symptomatic cure while preserving healthy ovarian tissue, thereby improving fertility outcomes and avoiding early menopause.

Pericardial Cyst: A Review of Historical Perspective and Current Concept of Diagnosis and Management

Pericardial cysts are very rare disorder with an incidence of about 1 in 1, 00,000. Pericardial cyst and diverticulum share similar developmental origin and may appear as an incidental finding in chest x ray in an asymptomatic patient. CT scan is considered as best modality for diagnosis and delineation of surrounding anatomy. Cardiac MRI is another excellent tool in diagnosis and evaluation of compressive effect and diffusion weighted cardiac MRI are very helpful for cases with diagnostic confusion. Echocardiography is best modality for follow up and image guided aspiration of the cyst. Conservative management with regular follow up may be considered if the cyst is small, patient is asymptomatic and probability of subsequent complication is low. Surgical resection should be considered in symptomatic patients, large cysts and with high probability of complications. Percutaneous aspiration and ethanol sclerosis is another attractive option.

Percutaneous Aspiration and Ethanolamine Oleate Sclerotherapy for Sustained Resolution of Symptomatic Polycystic Liver Disease: An Initial Experience

Surgical therapy for symptomatic polycystic liver disease is effective but has substantial mortality and morbidity. Minimally invasive options such as percutaneous aspiration with or without ethanol sclerosis have had disappointing results. The purpose of this study was to evaluate percutaneous aspiration with ethanolamine oleate sclerosis in the management of symptomatic polycystic liver disease. The study included 13 patients (11 with polycystic liver disease, two with simple cysts) with 17 cysts. All patients underwent percutaneous aspiration of the liver cyst under ultrasound guidance followed by insertion of a 7-French pigtail catheter, instillation of ethanolamine oleate (10% of cyst volume), and aspiration of the ethanolamine oleate. The catheter was kept in place for 24 hours of open drainage and then removed. All but one of the cysts resolved with one instillation. The one cyst, in a patient with polycystic liver disease, required two instillations 3 months apart. The mean initial volume of cysts was 589.8 mL, and the mean reduction in volume was 88.8%. Both the simple cysts resolved completely. In the cases of polycystic disease, the volume of cysts larger than 10 cm in diameter was reduced by 92.8%. Cyst resolution was gradual, and clinically significant cyst reduction was achieved within 1 year of therapy. None of the patients needed surgery. The median follow-up period was 54 months (range, 1 week-95 months). There were no significant adverse effects, and all patients had relief of symptoms after therapy. This initial experience with a single session of percutaneous aspiration and ethanolamine oleate sclerosis resulted in sustained resolution of symptomatic polycystic liver disease with minimal morbidity, avoidance of surgery, and improvement in quality of life.

Percutaneous Image-Guided Aspiration and Sclerosis of Adventitial Cystic Disease of the Femoral Vein

Adventitial cystic disease (ACD), also known as cystic mucoid or myxomatous degeneration, is a rare vascular disease mainly seen in arteries. Seventeen cases have been reported in the world literature. We report the first known case of ACD successfully treated with percutaneous image-guided ethanol sclerosis. Computed tomography showed a cystic mass adherent to the wall of the common femoral vein. An ultrasound examination revealed a deep venous thrombosis of the leg, secondary to extrinsic compression of the common femoral vein. Three years prior to our procedure, the cyst was aspirated, which partially relieved the patient's symptoms. Over the following 3 years the patient's symptoms worsened and a 10-cm discrepancy in thigh size developed, in addition to the deep venous thrombosis associated with lower-extremity edema. Using ultrasound guidance and fluoroscopic control, the cyst was drained and then sclerosed with absolute ethanol. The patient's symptoms and leg swelling resolved completely within several weeks. Follow-up physical examination and duplex ultrasound 6 months following sclerosis demonstrated resolution of the symptoms and elimination of the extrinsic compression effect of the ACD on the common femoral vein.

Ethanol-induced Coma after Therapeutic Ethanol Injection of a Hepatic Cyst

Ethanol-induced Coma after Therapeutic Ethanol Injection of a Hepatic Cyst

Successful aspiration and ethanol sclerosis of a large, symptomatic, simple liver cyst: Case presentation and review of the literature

Simple liver cysts are congenital with a prevalence of 2.5%-4.25%. Imaging, whether by US, CT or MRI, is accurate in distinguishing simple cysts from other etiologies, including parasitic, neoplastic, duct-related, and traumatic cysts. Symptomatic simple liver cysts are rare, and the true frequency of symptoms is not known. Symptomatic simple liver cysts are predominantly large (> 4 cm), right-sided, and more common in women and older patients. The vast majority of simple hepatic cysts require no treatment or follow-up, though large cysts (> 4 cm) may be followed initially with serial imaging to ensure stability. Attribution of symptoms to a large simple cyst should be undertaken with caution, after alternative diagnoses have been excluded. Aspiration may be performed to test whether symptoms are due to the cyst; however, cyst recurrence should be expected. Limited experience with both laparoscopic deroofing and aspiration, followed by instillation of a sclerosing agent has demonstrated promising results for the treatment of symptomatic cysts. Here, we describe a patient with a large, symptomatic, simple liver cyst who experienced complete resolution of symptoms following cyst drainage and alcohol ablation, and we present a comprehensive review of the literature.

Orbital Hemangioma Requiring Enucleation in a Premature Infant

A preterm male infant developed a rapidly growing, treatment-resistant orbital hemangioma. Despite aggressive management, the patient required enucleation of his right eye and image-guided ethanol sclerosis to limit tumor progression intracranially.

Posttransplant symptomatic lymphocele treatment with percutaneous drainage and ethanol sclerosis: Long-term follow-up

Purpose Lymphocele following kidney transplantation is a well-known complication. We present here the long-term results of percutaneous drainage and ethanol sclerosis in posttransplant lymphoceles. Patients and methods Between October 1988 and September 2003, 18 patients with symptomatic lymphoceles were treated with percutaneous transcatheter ethanol sclerosis among 300 renal transplants followed up. Catheters were positioned under ultrasonography (US) guidance. Cavity dimensions and extravasation were evaluated by pouch graph. The day after catheter insertion, sclerotherapy with ethanol was applied. Daily output and probable complications were followed up on periodic controls, and the alcohol was instilled when required. Result The mean initial size of the lymphoceles was 6×8×10 cm (range 3×4×6 to 7×12×21 cm), with a mean initial volume of 230 ml (range 40–1340 ml). Incomplete resolution was achieved in all patients after sclerotherapy in the first week (100%). The mean duration of therapy was 17 days (range 4–45 days). The mean therapy sitting was 12 (4–21), and the average alcohol volume in one sitting was 30 ml. One recurrence and one graft lost were seen in this series. Minor complications like discomfort and mild temperature elevation were determined in 10 patients. In one case, temporary double-J stent was required to alleviate the increased pressure in collecting system of transplanted kidney. No late complication was occurred. Conclusion As a less invasive method, percutaneous transcatheter ethanol sclerosis and drainage in the treatment of symptomatic lymphocele is a simple, safe and cost-effective method. Other treatment choices, like open or laparoscopic fenestration, can be used in case of failure.

Marked acute tissue swelling following percutaneous sclerosis of low-flow vascular malformations: a predictor of both prolonged recovery and therapeutic effect.

To evaluate the significance of marked, acute swelling in patients after percutaneous sclerosis of low-flow vascular malformations, as a predictor of both prolonged recovery and likelihood of therapeutic effect. In 22 patients who underwent percutaneous ethanol sclerosis of low-flow vascular malformations, we compared the incidence of prolonged recovery and lasting therapeutic effect between those patients with and without marked soft-tissue swelling following the procedure. Five patients exhibited marked swelling after sclerosis. Four of these five had causes of prolonged recovery. These four recovered and all five eventually had marked therapeutic effect. Seventeen patients did not meet criteria for severe swelling. Only one of these patients had prolonged recovery. Eighteen of the 22 total patients had therapeutic effect. All 4 of the 22 total patients who had no therapeutic effect were in the group without marked swelling. Marked soft-tissue swelling, which occurs after percutaneous sclerosis of vascular malformations, is both a predictor of prolonged recovery and high likelihood of therapeutic effect.

Treatment of venous malformations by direct injection with ethanol

Purpose: Venous malformations (VMs) may be discrete or extensive, and larger lesions may be difficult to remove with surgery. Incompletely removed lesions have a tendency to recur. We report our experience with ethanol ablation of VMs. Methods: All 12 patients (seven women; mean age, 37 years) were evaluated with magnetic resonance imaging before treatment. A total of 19 prior surgical excisions had been performed for seven of the patients. Symptoms were present in all 12 patients and included bleeding, pain, swelling, and limitation of exercise. The VMs were present in the lower extremities of seven patients, in the upper extremities of three patients, and in the flank and buttocks in two patients. Results: The 12 patients have undergone 30 injection procedures, with six patients requiring one, three patients requiring two, two patients requiring three, and one patient having undergone 12 treatments. General anesthesia was used in 11 patients. Blood loss was minimal for all procedures, and 28 of the 30 procedures were technically successful. Skin ulceration was seen in approximately half of the treated VMs, all of which healed with local wound care. Focal VMs were injected in six patients and resolved with a single treatment in five patients. Patients were free of symptoms at a mean follow-up of 10 months. Extensive VMs were injected for discrete, symptomatic areas in five patients. These lesions all regressed and were asymptomatic at a mean follow-up of 23 months in all but one patient. However, these lesions required multiple treatments as additional areas became problematic. Conclusions: Ethanol sclerosis is a well-tolerated, safe, and effective adjunct to the management of VMs. Advantages of ethanol injection include the ability to treat a very localized area without an incision. Conversely, extensive lesions may be palliated as symptoms occur. (J Vasc Surg 1997;26:838-44.)

Treatment of Symptomatic Congenital Hepatic Cysts with Single-Session Percutaneous Drainage and Ethanol Sclerosis: Technique and Outcome

To evaluate the safety and efficacy of percutaneous aspiration and ethanol sclerotherapy as the sole treatment for symptomatic, nonneoplastic, congenital hepatic cysts. In a prospective study, 59 symptomatic, congenital hepatic cysts in 25 patients were treated with ultrasound-guided percutaneous aspiration and ethanol sclerotherapy. Eleven patients had a solitary cyst, and 14 patients had polycystic liver disease. Mean follow-up was 4 years. Fifty-seven (97%) of 59 sclerotherapy procedures were technically successful, and there were no recurrences. Eight cysts in six patients disappeared totally. The mean diameter of the remaining 49 cysts decreased from 9 cm to 3 cm. At the last follow-up visit, 14 patients were asymptomatic, four had milder epigastric pain than before the treatment, and seven with polycystic liver disease had recurrent symptoms due to growth of nontreated cysts. No major complications occurred. Percutaneous aspiration with ethanol sclerotherapy is a safe, effective, and minimally invasive treatment method for symptomatic congenital cysts. It is the initial treatment of choice for all patients with symptomatic congenital hepatic cysts.

Endoscopic ethanol sclerotherapy in non‐variceal gastrointestinal bleeding

Upper gastrointestinal bleeding still causes significant morbidity and mortality in spite of an aggressive medical and surgical approach. Endoscopic methods of treatment promise early and effective non‐surgical control of bleeding. Endoscopic injection of ethanol has been used to control gastrointestinal bleeding in a prospective study of 28 high risk patients. Twenty‐two had chronic ulcers (12 duodenal, 10 gastric) and six had angiodysplastic lesions (three gastric, three caecal). The 22 patients with chronic peptic ulcers were either elderly (median age 69 years) or had serious associated medical disorders (73%); 64% presented with shock. Primary haemostasis was achieved in all, but two re‐bled from their ulcer. Surgery was required in one patient who re‐bled 48 h after treatment and in one patient with an ulcer which perforated 45 days after injection; three patients with chronic ulcers refractory to medical therapy also underwent surgery. One patient developed a closed perforation of an antral ulcer after treatment which settled with conservative management; two patients died from causes unrelated to their ulcer. It is concluded that ethanol sclerosis is a safe, effective method for controlling bleeding from chronic peptic ulcers and angiomatous malformations.