Injection Of Sclerosing Agent Research Articles

Lymphangioma in nasal tip and vestibulum: Case report

A ‘Pinocchio’ or ‘Cyrano’ nose is a condition with a deformity at the tip of the nose caused by an underlying soft tissue tumor. The deformity of the nose with secondary involvement in the form of lymphangioma is a sporadic case, and few studies have reported it. Lymphangioma itself is a benign tumor that originates from the lymph vessels. The diagnosis of lymphangiomas can be made based on the clinical picture and computed tomography (CT) or magnetic resonance imaging (MRI) scans. Treatment options for nasal tip lymphangioma and nasal vestibule are radiotherapy, cryotherapy, and sclerosant injection.

SAT197 A Rare Case Of Infected Parathyroid Cyst Associated With Hyperparathyroidism

Abstract Disclosure: B. Ataallah: None. M. Al Tameemi: None. P.R. Orlander: None. Introduction: Parathyroid cysts are considered rare lesions compromising 1-5 % of neck masses. Clinical pictures can range from asymptomatic to symptoms and signs of hyperparathyroidism, and it may lead to compressive symptoms as well. Infection of the parathyroid cyst is not reported in literature. We are presenting a patient with parathyroid cyst and was found to be infected with E-coli. Case presentation: A 59-year-old woman presented with neck swelling and ear pain. She was initially diagnosed with otitis externa and was treated with antibiotics. Her neck swelling worsens over a brief period with associated ear drainage and shortness of breath. Computed tomography (CT) scan of the neck revealed a large cystic lesion up to 10 cm in largest diameter in the region of the thyroid gland with inflammatory changes extending to the prevertebral soft tissues. CT scan of the chest showed a mass effect on the trachea and adjacent structures with possible hemorrhage. Eventually the patient was intubated. Laboratory evaluation revealed parathyroid hormone (PTH) at 455 pg/ml, corrected calcium of 11.3 mg/dl, Ionized calcium of 1.41 mMol/L, and phosphorus at 3.0 mg/dl. Aspiration of the cyst was done prior to surgery and the culture grew E-coli. She started on antibiotics, and eventually underwent a total thyroidectomy with excision of the parathyroid cyst and adenoma. Pathology showed a ruptured cyst with marked inflammation and granulation tissue with hypercellular left superior parathyroid gland. Postoperatively, corrected calcium dropped to 10.1mg/dl and PTH to 38.5 pg/ml. Discussion: Parathyroid cyst (PC) is a relatively rare neck or mediastinal lesion, representing less than 0.5% of parathyroid gland disorders. Most PCs are nonfunctional, but some may produce excess parathyroid hormone or can cause local compressive symptoms like dyspnea, dysphagia, or hoarseness of voice, depending on the size and location of the lesion. There are no distinct clinical or radiological features to differentiate parathyroid cysts, and that makes preoperative diagnosis challenging, and most cases are diagnosed during surgery or postoperatively. Aspiration and fluid analysis can confirm the diagnosis preoperatively, and the treatment can be achieved either by cyst aspiration for small lesions with less than 2.5 cm in diameter, through sclerosing agent injection, or by surgical resection. In this patient, the culture of the aspirated parathyroid cyst surprisingly grew E coli. It is unusual to have an infection with E coli in the neck tissues or the surrounding structures, and it is unknown whether the cyst infection is related to the ear infection that our patient has. Parathyroid cyst infection is not reported in literature reviews, and it is important to consider fluid analysis and culture to confirm the diagnosis preoperatively and to rule out cyst infection Presentation: Saturday, June 17, 2023

Topical injection of sclerosant to treat cheek subcutaneous venous malformation resulting in blindness: a case report

Loss of vision after topical injection of sclerosant is a rare and uncommon complication. We describe a case with vision loss following the facial injections of physician-compounded (PCP) foam sclerotherapy which was created by room air. A 3-year-old boy underwent injection of 5ml polidocanol foamed with room air to treat the venous malformation on the cheek near the left orbit. The boy experienced the whole facial swelling on day 2 after the third injection, especially involving the left side, the visual acuity in the left eye was counting fingers at 30 cm and the swelling reduced at 7 days later after referral. Fundus examination on day 15 revealed hemorrhage inferior to the optic disc and fluorescein angiography revealed blocked fluorescein. The OCT on day 15 showed the edema of the nerve fiber layer beside the fovea. The patient’s hearing was also impaired. PCP foam sclerotherapy with room air produced in typical concentrations, preparations as well as volumes always causes vision loss among children. Continued evaluation on the effects of product, gas, volume, and patient age identify optimal approaches will avoid the toxicity and side-effects caused by facial foam sclerotherapy.

Efficiency and clinical results of bleomycin injection in the treatment of lymphatic malformations.

Lymphatic malformations (LMs) are rare congenital anomalies. The traditional treatment is surgical excision, but intralesional sclerosing agent injection is also preferred as the first-choice treatment because of postoperative frequent recurrences, poor cosmetic results, and high complication rate. We aimed to evaluate the efficacy of sclerosing agent injection used in the treatment of LMs in children. We retrospectively analyzed the children who were treated for LM between January 2011 and January 2022. The lesion sizes of the patients who were injected with sclerosant (Bleomycin) under sedation anesthesia, measured by ultrasound before and after the treatment, were recorded, and the difference between them was statistically evaluated. Fifteen patients were retrospectively analyzed. The mean age was 45.2 ± 14.1 months. Of these, ten (66.6%) were male and five (33.3%) were female (F/M = 1/2). The mean age of male patients was 55 ± 20.1 months; the mean age of female patients was 25.8 ± 11. Seven patients had a single dose, two had twice, and six had three and more. The mean measurable size of macrocystic lesions before treatment was 55.2 ± 28.4 mm; after treatment, it was 23.8 ± 18.2 mm. Although no measurable shrinkage was detected in microcystic lesions, it was observed that the lesion shrank to allow surgical resection. With the statistical analysis, it was seen that there was a statistically significant difference between the dimensions before and after the treatment (P < 0.05) and the sclerosant injection had a great effect on the treatment (R: 0.89). Intralesional injection of bleomycin is less effective for microcystic or mixed-type LMs, but provides an effective reduction for a safe surgical procedure. It is an effective treatment for macrocystic lesions.

A Retrospective Follow-Up Study To Show The Effectiveness Of Booster Dose Of Foam Sclerotherapy Session At 3rd And 6th Months In Preventing The Recurrence Of Varicose Veins.

Injection sclerotherapy administration is known to cause a decreased recurrence of varicose vein disease. This research aimed to investigate the recurrence of varicose vein disease after giving booster doses of injection sclerotherapy. The booster doses were given at 3rd and 6th months. One hundred and fifty patients participated and all patient's included ages 30-70 in the category of 'low risk' patients. The patients were both males and females. Patients participating in the study were counselled appropriately and written consent was taken from them. Moreover, the patients selected were volunteers and agreed to be part of the study. Patients who were above 70 years of age, those who were at a high-risk due to some co-morbidities (high-risk patients), patients not willing to be part of the study, those allergic to drugs being used including sclerosant and people with any known psychiatric illness or cardiac arrhythmias, deep venous thrombosis patients, patients having arteriovenous malformation/venous ulcers were all excluded. If the patient was pregnant, the gynaecology team was taken on board and the procedure was carried out. Every procedure was carried out under the direct supervision of the supervisor. Booster dose sessions of Foam Sclerotherapy were held at 3rd and 6th months of the study time. Their effectiveness was observed and documentation was carried out. Since it was a procedure that could be done in the OPD, there was no need for specialized anaesthesia care. It is of significant notice that when a patient of varicose veins was given a booster intravenous sclerosant injection at 3rd and 6th month of treatment, chances of recurrence decreased to 50%.

Regional differences of the sclera in the ocular hypertensive rat model induced by circumlimbal suture

PurposeTo describe the regional differences of the sclera in ocular hypertension (OHT) models with the inappropriate extension of the ocular axis.MethodsTo discover the regional differences of the sclera at the early stage, OHT models were established using circumlimbal suture (CS) or sclerosant injection (SI). Axial length (AL) was measured by ultrasound and magnetic resonance imaging. The glaucoma-associated distinction was determined by intraocular pressure (IOP) and retrograde tracing of retinal ganglion cells (RGCs). The central thickness of the ganglion cell complex (GCC) was measured by optical coherence tomography. RGCs and collagen fibrils were detected using a transmission electron microscope, furthermore, anti-alpha smooth muscle actin (αSMA) was determined in the early stage after the operation.ResultsCompared with the control group, the eyes in OHT models showed an increased IOP (P < 0.001 in the CS group, P = 0.001 in the SI group), growing AL (P = 0.026 in the CS group, P = 0.043 in the SI group), reduction of central RGCs (P < 0.001 in the CS group, P = 0.017 in the SI group), thinning central GCC (P < 0.001 in the CS group), and a distinctive expression of αSMA in the central sclera in the early 4-week stage after the operation (P = 0.002 in the CS group). Compared with the SI group, the eye in the CS group showed a significantly increased AL (7.1 ± 0.4 mm, P = 0.031), reduction of central RGCs (2121.1 ± 87.2 cells/mm2, P = 0.001), thinning central GCC (71.4 ± 0.8 pixels, P = 0.015), and a distinctive expression of αSMA (P = 0.005). Additionally, ultrastructural changes in RGCs, scleral collagen fibers, and collagen crimp were observed in the different regions. Increased collagen volume fraction in the posterior segment of the eyeball wall (30.2 ± 3.1%, P = 0.022) was observed by MASSON staining in the CS group.ConclusionRegional differences of the sclera in the ocular hypertensive rat model induced by CS may provide a reference for further treatment of scleral-related eye disorders.

–Inadvertent intravitreal injection of microdroplet of sclerosant during lower lid inclusion cyst management

Globe perforation during oculoplastic procedures is uncommon. Inclusion cysts of the conjunctiva are amenable to complete excision but tend to recur if a part of the cyst wall remains. Sclerosant injections have been tried successfully to collapse inclusion cysts of the conjunctiva. Our case presented with signs of globe perforation two days after the second cyst aspiration and sclerosant injection procedure. The case was managed with a laser barrage of the suspected perforation site, systemic antibiotics, and steroids, resulting in complete visual and functional recovery at the 1-month follow-up. This is the first such case reported in the literature.

Prospective Randomized Controlled Trial Comparing Laparoscopic Palomo Surgery versus Scrotal Antegrade Sclerotherapy in Adolescent Varicocele.

Varicocele is a common condition in adolescence and the most common correctable cause of infertility. This study aimed to analyze and compare the outcomes of scrotal antegrade sclerotherapy (SAS) and laparoscopic Palomo surgery (LPS) in a tertiary referral centre. Patients with left grade 3 varicocele indicated for surgery were prospectively enrolled and randomly allocated to the SAS and LPS groups, with their respective contralateral normal testes taken as controls. The primary outcome measures were clinical varicocele recurrence, testicular catch-up growth, and post-operative hydrocele. All patients were evaluated clinically and using Doppler ultrasound by radiologists. From 2015 to 2020, 113 patients completed the study and were statistically analyzed (SAS, n = 57; LPS, n = 56). All patients had significantly smaller testes pre-operatively that the testicular volume differences with control testes were -23% in SAS and -19% in LPS. At 12-month follow-up, there were no statistical significant difference in clinical recurrences between the 2 groups (SAS = 5.3% vs LPS = 5.4%, P>.05, non-inferiority test). Testicular catch-up growths were observed in both groups, the mean testicular volume difference between the treatment and control testes reduced from -23% to -8.1% in SAS (P<.001) and -19% to -9.3% in LPS (P<.001) at 12-month follow-up. There was no post-operative hydrocele in SAS compared to 7 in LPS (0% vs 13%, P = .006). Both SAS and LPS are safe and effective procedures for treatment of adolescent varicocele with significant positive effect on testicular catch-up growth. SAS is not inferior to LPS in terms of clinical recurrence rate and with significantly less post-operative hydrocele.

OUTCOME OF ULTRASOUND GUIDED FOAM SCLEROTHERAPY IN THE TREATMENT OF VARICOSE VEINS

Varicose veins are one associated aspect of evolution that humans could have happily lived without. It's almost certainly the price we pay for the two-legged erect posture. Though we have achieved cure for various diseases, till now no reliable cure has been found for venous insufciency.The gold standard for treating chronic venous insufciency has been surgery. The surgeon dealing with varicose veins has always had to strike a balance between an aesthetically pleasing outcome and a low rate of recurrence and complications. Sclerotherapy, which was rst used over 150 years ago, is still the most efcient method for permanently removing pathologically swollen as well as cosmetically unpleasant but otherwise normal veins.Foam sclerotherapy, in which the sclerosant is mixed with air or physiological gases, is more effective than direct injection of sclerosants, because the agent's contact with the endothelium is prolonged by the air in the foam. The use of foam sclerotherapy for big veins has reduced recurrence rates. Large-scale researches have demonstrated the safety of foam sclerotherapy. Foam sclerotherapy has a recurrence rate that is comparable to surgery. The efcacy of foam sclerotherapy has been variable as per different studies across different institutions.

Balloon-Occluded Esophageal Variceal Obliteration Procedure: A Novel Technique Report from Three Centers.

Introduction: Esophageal variceal bleeding (EVB) is a potentially fatal complication of cirrhosis. The purpose of the present study was to evaluate the safety and efficacy of a novel technique of balloon-occluded esophageal varices (EVs) obliteration (BEVO) for EVs classified as F2 (medium size, F2-EVs) and F3 (large size, F3-EVs). Materials and Methods: Between December 2020 and December 2021, a total of 73 consecutive patients with EVs were treated using BEVO. An injection of sclerosant was administered via direct puncture of the varices during balloon occlusion. Immediate postprocedural Doppler endoscopic ultrasonography (EUS) was conducted to evaluate the blood flow in the EVs. Several factors, including the technical success, controlling of acute bleeding, intraoperative bleeding at the injection site, variceal eradication, variceal recurrence, and BEVO-related complications, were assessed. Results: BEVO was successfully performed in all patients. Immediate hemostasis was achieved in 100% (25/25) of patients with active EVB. The incidence of injection site intraoperative bleeding presenting as oozing and spurting bleeding was 76.71% (56/73) and 8.22% (6/73), respectively. Based on Doppler EUS and endoscopic examination, EVs were completely eradicated in 71 out of 73 patients (97.26%) after three sessions. A total of 3 (4.11%) patients were diagnosed with EV recurrence during follow-up after complete EV eradication. Retrosternal chest discomfort (13.70%; 10/73) and abdominal bloating (2.74%; 2/73) were spontaneously relieved after a few days. No serious BEVO-related complications were observed. Discussion: BEVO is a convenient and effective treatment for obliterating F2 and F3 EVs. Clinical Trial Registration No. ChiCTR2000039974.

S2883 Hemorrhagic Shock After TRUS-guided Prostate Biopsy Successfully Treated With Endoscopic Therapy

Introduction: Prostate cancer is the leading cause of malignancy and the 2nd overall cause of cancer-related deaths for men in the US today. Diagnosis involves transrectal ultrasound-guided prostate biopsy (TRUS-guided prostate biopsy), which has remained the gold standard. It provides a rapid diagnosis with a relatively low complication profile. Post biopsy, patients may commonly experience mild rectal bleeding, prostatitis, hematospermia or hematuria. However, one of the rarest complications of TRUS-guided prostate biopsy is massive rectal bleeding requiring angiographic or endoscopic therapy. In literature to date, only a few case reports exist describing this. We present a case of hemorrhagic shock after TRUS-guided prostate biopsy that was successfully treated with endoscopic hemoclipping and epinephrine injection. Case Description/Methods: A 64-year-old male presented with 6 episodes of small-volume hematochezia six days after he underwent a TRUS- guided prostate biopsy. Initially, he had normal vitals with a hemoglobin of 8.2 g/dL, compared to a baseline of 13.0 g/dL. On day two, he developed four large episodes of hematochezia, profound hypotension, and had an episode of syncope. The hemoglobin had dropped to 5 g/dL. CT angiogram showed no active bleeding. Massive transfusion protocol was initiated. Emergent flexible sigmoidoscopy showed a raised arterial-appearing lesion with active oozing in the rectum (Figure). Four hemoclips and 4cc of epinephrine were injected into the lesion, achieving hemostasis (Figure). Post endoscopy, the patient's hematochezia resolved and his hemoglobin stabilized. Patient suffered no further complications and was discharged home 48 hours after the endoscopy. Discussion: Mild rectal bleeding after TRUS-guided Prostate biopsy is common, the management is usually supportive care. Rectal gauze for tamponade can be used to control most cases of rectal bleeding. Uncommonly, these patients can progress to massive bleeding or hemorrhagic shock requiring radiologic or endoscopic therapy. Endoscopic options consist of local epinephrine, sclerosant injections, thermocoagulation, banding, or hemoclips. Recognizing the potential of severe bleeding after TRUS-guided prostate biopsy is integral in deeming who may benefit from early endoscopic therapy.Figure 1.: Active oozing from the biopsy site (top). Status post epinephrine and hemoclip placement (bottom).

Temporary hypotension and ventilation difficulty during endoscopic injection sclerotherapy for esophageal varices in a child with Fontan circulation: a case report

BackgroundEndoscopic procedures are rarely performed in children with congenital heart disease (CHD); therefore, the associated complications are unknown. We report an abrupt change in circulatory and respiratory condition during endoscopic injection sclerotherapy for esophageal varices.Case presentationA 9-year-old boy with a history of total anomalous pulmonary venous connection (TAPVC) repair and Fontan procedure for asplenia and a single ventricle with TAPVC underwent endoscopic injection sclerotherapy under general anesthesia for esophageal varices. Systolic blood pressure decreased from 70 to 50 mmHg following a sclerosant injection; a second injection reduced his peripheral oxygen saturation from 93 to 79% secondary to ventilation difficulty. Although we suspected anaphylaxis intraoperatively, postoperative imaging suggested that balloon dilation performed to prevent sclerosing agent leakage caused compression of the pulmonary venous chamber and trachea owing to the anomalous intrathoracic organ anatomy.ConclusionThorough understanding of the complex anatomy is important before performing endoscopic procedures in children with CHD to preoperatively anticipate possible intraoperative complications and select the optimal therapeutic approach and anesthesia management.

Clinical Observation of RPH Combined with Sclerosing Agent Injection in Treating Mixed Hemorrhoids

Clinical Observation of RPH Combined with Sclerosing Agent Injection in Treating Mixed Hemorrhoids

Management Options for Fetal Bronchopulmonary Sequestration.

To evaluate the prenatal course and perinatal outcome of fetuses with bronchopulmonary sequestration (BPS) managed expectantly or using minimally invasive methods. This was a retrospective study of 29 fetuses with suspected BPS managed between 2010 and 2021 in three fetal medicine centers in Poland. Medline was searched to identify cases of BPS managed expectantly or through minimally-invasive methods. In 16 fetuses with BPS, there was no evidence of cardiac compromise. These fetuses were managed expectantly. Thirteen hydropic fetuses with BPS qualified for intrauterine intervention: a thoraco-amniotic shunt (TAS) was inserted in five fetuses, laser coagulation of the feeding vessel was performed in seven cases, and one fetus had combined treatment. In the combined data from the previous and the current study of various percutaneous interventions for BPS associated with hydrops, the survival rate was 91.2% (31/34) for TAS, 98.1% (53/54) for laser coagulation, and 75% (3/4) for intratumor injection of sclerosant. After taking into account cases with available data, the rate of preterm birth before 37 weeks in the group treated with laser coagulation was 14.3% (7/49) compared to 84.6% (22/26) in the group treated with TAS. The need for postnatal sequestrectomy was lower in the group of fetuses treated with laser coagulation 23.5% (12/51) in comparison to fetuses treated with TAS 84% (21/26). In fetuses with BPS without hydrops, progression of the lesion’s volume, leading to cardiac compromise, is unlikely. In hydropic fetuses with BPS, intrauterine therapy using minimally invasive methods prevents fetal demise. Both, the rate of preterm birth and the need for postnatal surgery is significantly lower in the group treated with laser coagulation compared to the group treated with TAS.

Aminolevulinate photodynamic therapy (ALA-PDT) combined with fire needle for vulva lymphangioma circumscriptum

Lymphangioma is a rare benign lymphatic system proliferation, especially in the vulva. The general treatment principle is determined by clinical manifestations, lesion size, anatomic location, and complications. Treatment options include surgical excision, carbon dioxide laser, cryotherapy, electrocoagulation, and sclerosing agent injection. In the absence of evidence to guide the choice of significant treatment modalities, treatment options are often based on the experience of the treatment team and the patient's preferences.This study presents a case of primary vulva lymphangioma circumscriptum treated with fire needle therapy, photodynamic therapy, and cryotherapy. Furthermore, the combination of fire needle and photodynamic therapy demonstrated exceptional comprehensive effects in pain, wound healing and cosmetic.

The novel use of lauromacrogol: A respective study of ultrasound‐guided sclerosant injection for cesarean scar pregnancy

To introduce the novel use of lauromacrogol for cesarean scar pregnancy (CSP), and to compare the clinical efficacy and safety of curettage combined with ultrasound-guided sclerosant injection (USI) and curettage following uterine artery embolization (UAE) in the treatment of CSP. CSP patients undergoing curettage combined with USI (n=72) from December 2014 to May 2020 were compared to patient with curettage following UAE (n=72).The basic clinical findings and clinical outcomes were reviewed between the two groups. For USI group, 69 patients underwent successful treatment (95.8% success rate), while the number of cured patients for the UAE group was 70 (97.2% success rate). Differences between USI group and UAE group in intraoperative blood loss (10.0 [10.0-20.0] vs. 10.0 [10.0-20.0] mL) and time for serum β human chorionic gonadotropin (β-hCG) to reduce to normal (28.0 [21.0-40.0] vs. 28.0 [21.0-35.0] days) were not statistically significant. The hospital stay for USI group was significantly shorter than that for UAE group (4.0 [4.0-6.0] vs. 6.0 [5.0-7.0] days, respectively). Statistically significant decreases were noted in hospitalization expenses and adverse events in USI group, compared to UAE group. There was no difference in live birth rate between the two groups with fertility intentions during the follow-up. For treatment of CSP, curettage combined with USI yielded clinical results comparable to those of curettage following UAE. Curettage combined with USI was associated with lower hospitalization expenses, shorter hospital stay and less complications, and it merited an effective and safe treatment for CSP.

Balloon-compression endoscopic injection sclerotherapy for the treatment of esophageal varices.

Video 1Balloon-compression endoscopic injection sclerotherapy for the treatment of esophageal varices. A 50-year-old man with schistosomiasis-induced liver fibrosis presented with melena and hematemesis. The bleeding stopped after intravenous administration of somatostatin and ceftriaxone for 4 days. Balloon-compression endoscopic injection sclerotherapy (bc-EIS) was performed with the patient under general anesthesia to prevent rebleeding. The novel device for bc-EIS is composed of a syringe, a stopcock, a catheter, and an inflatable balloon. In the majority of patients with cirrhosis, the blood flow from the coronary vein drains into the azygos and hemiazygos venous system through esophageal and para-esophageal varices, and eventually back to the inferior vena cava. With compression of proximal esophageal and para-esophageal varices via an inflated balloon, sclerosant can be retained at the injection site, rather than flowing back to the inferior vena cava. Endoscopy revealed the presence of moderately enlarged, beady esophageal varices with red wale signs in the middle and lower esophagus. An inflatable balloon was fixed to an endoscope at a distance of 3 cm from its distal end. When the end of the endoscope was introduced to the target varices, 20 mL of air was injected into the balloon through a thin catheter, making its outer diameter expand to 3.5 cm. A disposable endoscopic injection needle then entered the base of the variceal columns near the cardia. When blood flowed back into the needle, a mixture of Lauromacrogol and methylene blue was intravariceally administered. Minor bleeding at the injection site was stopped through brief compression with the needle sheath. The second injection was performed following the aforementioned procedure. Follow-up endoscopy at 1 month, 4 months, and 7 months revealed the progression from thrombosed blue varices to complete eradication of esophageal varices. Endoscopic ultrasonography also showed the absence of blood flow in the varices after treatment. To date, bc-EIS has been performed successfully on 28 patients with esophageal varices. Variceal eradication was obtained in 17 patients with 1 session, 10 patients with 2 sessions, and 1 patient with 3 sessions. Two patients showed recurrence of esophageal varices on routine follow-up endoscopy and were re-treated with bc-EIS successfully. There were no severe complications during the follow-up period. With the sclerosant retained at injection sites after balloon compression, bc-EIS enables complete eradication of esophageal varices and lowers the risk of recurrence. The blockade of sclerosant also decreases the incidence of complications related to large-volume injection of sclerosant, such as embolization, ulceration, and perforation. In conclusion, bc-EIS appears to be an effective and safe approach for the treatment of esophaeal varices. Further research is underway to determine its suitability for large-scale clinical application.

Transanal rectopexy for external rectal prolapse.

The surgical management of patients with full-thickness rectal prolapse (FTRP) continues to remain a challenge in the laparoscopic era. This study retrospectively assesses a cohort of patients undergoing a transanal suture sacro rectopexy supported by sclerosant injection into the presacral space under ultrasound guidance. Patients with FTRP underwent a sutured transrectal presacral fixation of 2/3 of the circumference of the rectum from the third sacral vertebra to the sacrococcygeal junction through a side-viewing operating proctoscope. The procedure was supplemented by ultrasound-guided injection into the retrorectal space of a 2 mL solution of sodium tetradecyl sulfate/polidocanol mixed with air. Patients were functionally assessed before and 6 months after surgery with the Agachan constipation score and the Pescatori incontinence score. There were 36 adult patients (26 males; the range of age, 23-92 years). The mean operative time was 27 minutes (range, 23-50 minutes) with no recorded perioperative morbidity. The median follow-up was 66 months (range, 48-84 months) with 1 (2.8%) recurrence presenting 18 months after surgery. There were 19 patients (52.8%) who presented with incontinence before surgery with 17 out of 19 (89.5%) reporting improvement in their Pescatori score (P<0.001). No patient had worsening incontinence and there were no de novo incontinence cases. Constipation scores improved in 23 out of 36 patients (63.9%) with a mean score reduction difference of 7.91 (P=0.001). Transanal sutured sacral rectopexy with supplemental presacral sclerosant injection is safe and effective in the management of FTRP with sustained improvement in bowel function.

Percutaneous Drainage with Injection of Ethanol as the Sclerosing Agent for Treatment of Simple Kidney Cysts: A New Modification

Introduction: The simple kidney cyst is the most common type of benign kidney tumor in adults and it is usually asymptomatic. Symptomatic cysts are treated with percutaneous aspiration with or without sclerosing agent injection, laparoscopic decortication, or open surgery in rare cases. Considering the probable complications of anesthesia in open surgery and laparoscopic methods, we used an innovative method of percutaneous aspiration, insertion of a single J draining catheter for 24 hours, and injection of sclerosing agents, leaving the agent inside the cyst, while the catheter was removed immediately. Long-term results of this method were evaluated using sonography. Materials and Methods: Twenty-eight patients with symptomatic kidney cysts underwent the process of insertion of the percutaneous catheter and aspiration of its contents in two steps and a one-time injection of 95% ethanol. After the first aspiration, patients stayed admitted for 24 hours. Then, the second aspiration was performed and the total fluid volume was measured. Patients were then followed for a mean follow-up period of 14 months. The procedure was considered effective with no signs of relapse (consistent with reduced size of cysts) in a sonographic evaluation of long-term results. Results: Among all the patients, 23 (82.14%) showed positive results in the sonographic evaluation after 14 months. Death occurred in one patient (3.6%), not attributable to the procedure, and recurrence was observed in five patients (17.9%). Conclusions: Our study showed that this method is safe, effective, and minimally invasive in treating simple kidney cysts and can be a proper substitute for the other current methods.

Chronic Glaucoma Using Biodegradable Microspheres to Induce Intraocular Pressure Elevation. Six-Month Follow-Up.

Background: To compare two prolonged animal models of glaucoma over 24 weeks of follow-up. A novel pre-trabecular model of chronic glaucoma was achieved by injection of biodegradable poly lactic-co-glycolic acid (PLGA) microspheres (10–20 µm) (Ms20/10) into the ocular anterior chamber to progressively increase ocular hypertension (OHT). Methods: Rat right eyes were injected to induce OHT: 50% received a suspension of Ms20/10 in the anterior chamber at 0, 2, 4, 8, 12, 16 and 20 weeks, and the other 50% received a sclerosing episcleral vein injection biweekly (EPIm). Ophthalmological clinical signs, intraocular pressure (IOP), neuroretinal functionality measured by electroretinography (ERG), and structural analysis of the retina, retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL) protocols using optical coherence tomography (OCT) and histological exams were performed. Results: Both models showed progressive neuroretinal degeneration (p < 0.05), and contralateral eye affectation. The Ms20/10 model showed a more progressive increase in IOP and better preservation of ocular surface. Although no statistical differences were found between models, the EPIm showed a tendency to produce thicker retinal and thinner GCL thicknesses, slower latency and smaller amplitude as measured using ERG, and more aggressive disturbances in retinal histology. In both models, while the GCL showed the greatest percentage loss of thickness, the RNFL showed the greatest and earliest rate of thickness loss. Conclusions: The intracameral model with biodegradable microspheres resulted more like the conditions observed in humans. It was obtained by a less-aggressive mechanism, which allows for adequate study of the pathology over longer periods.