Sodium Tetradecyl Research Articles

Dual Effect of Anionic Surfactants in the Electrodeposited MnO2 Trafficking Redox Ions for Energy Storage

The dual effect of in-situ addition of anionic surfactants, sodium octyl sulfate (SOS), sodium dodecyl sulfate (SDS) and sodium tetradecyl sulfate (STS) on the microstructure and electrochemical properties of electrolytic manganese dioxide (EMD) produced from waste low grade manganese residue is discussed. X-ray diffraction (XRD), field emission scanning electron microscopy (FESEM), BET-surface area studies, thermogravimetry-differential thermal analysis (TG-DTA) and Fourier transform infrared spectroscopy (FTIR) were used to determine the structure and chemistry of the EMD. All EMD samples were found to contain predominantly γ-phase MnO2, which is electrochemically active for energy storage applications. FESEM images showed that needle, rod and flower shaped nano-particles with a porous surface and platy nano-particles were obtained in the case of EMD deposited with and without surfactant respectively. Thermal studies showed loss of structural water and formation of lower manganese oxides indicating high stability of the EMD samples. The cyclic voltammetry and charge – discharge characteristics implied the presence of surfactants enhances the energy storage within the MnO2 structure. Addition of the surfactant at its optimum concentration greatly increased the EMD surface area, which in turn improved the cycle life of the EMD cathode. EMD obtained in the presence of 25, 50, 25 ppm of SOS, SDS, and STS respectively showed an improved cycle life relative to the EMD obtained in the absence of surfactant. EMD obtained without surfactant showed a capacity fade of 20 mAh g−1 within 15 discharge-charge cycles, while surfactant modified samples showed stable cyclic behavior of capacity 95 mAh g−1 even after 15 cycles.

Scintigraphy-based analysis of possible pulmonary lesions after foam sclerotherapy: a pilot study

The aims of this study were to assess extemporaneous in vivo binding between 99mTcO4- and two sclerosant detergents in foam sclerotherapy, and subsequently to control any possible damage in lungs and other organs related to sclerosant foam passage. A prospective comparative pilot study was performed on two male patients (62 and 56 years old) affected by varicose veins; each of them underwent scintigraphy investigations with free radiotracer and a scintigraphy investigation after each of the four sessions of sclerotherapy of varicose tributaries of the lower limbs with labeled sclerosant foam. One of the two patients underwent two further scintigraphic investigations, with free radiotracer and with labeled sclerosant foam, at a later stage. Four mL of 2% polidocanol (POL) foam, or four mL of 1% sodiumtetradecylsulfate (STS) foam for session were injected. The sclerosant foam was labeled with the radioactive tracer technetium pertechnetate, 99mTcO4- (120 MBq per exam). Two scintigraphy assessments for free tracer (basal) and five scintigraphy investigations of bound-tosclerosant tracer uptake/transit were obtained. No relevant variations in time/activity curves of the lungs and other organs were documented between the basal and post-sclerotherapy findings, also at the later stage. Free radiotracer mean region-of-interest data were: 336 counts (heart), 208 counts (lungs) and 371 counts (thyroid). Mean values extrapolated from each curve at each step for labeled CO2O2-based sclerosant foam were respectively: 351 counts (POL) and 328 counts (STS) for heart, 202 counts (POL) and 188 counts (STS) for lungs, 335 (POL) and 263 (STS) for thyroid. No pulmonary damage by sclerosant foam was caused. Neither immediately after treatments, nor at short-term follow-up.

Treatment of Digital Mucous Cysts With Intralesional Sodium Tetradecyl Sulfate Injection

Digital mucous cysts (DMCs) are benign myxoid cysts typically involving the distal interphalangeal joint or over the proximal nail fold. There are various treatment modalities for DMCs, and intralesional sodium tetradecyl sulfate injection has been reported as an alternative treatment. To assess the efficacy and safety of intralesional sodium tetradecyl sulfate injection in treating DMCs. We performed intralesional injection of sodium tetradecyl sulfate in 17 patients (6 men and 11 women) with 20 DMCs. At each session, 1% to 3% sodium tetradecyl sulfate of 0.2 to 0.5 mL was injected into a lesion and repeated every 4 weeks if the cyst persisted. Changes in lesions and adverse reactions were recorded, and therapeutic efficacy was evaluated. Of the 20 lesions treated with intralesional sodium tetradecyl sulfate injection, 80% responded. Recurrences were observed in 2 patients, and 2 patients did not respond well to the treatment. No patient reported any major adverse effects. Intralesional sodium tetradecyl sulfate injection is a simple, safe, and effective modality for distal mucous cyst. Treatment was well tolerated with few side effects and favorable cure rate. Therefore, we believe that intralesional sodium tetradecyl sulfate injection should be considered an alternative treatment of DMCs.

Modified Tessari Tourbillon technique for making foam sclerotherapy with silicone-free syringes.

The longevity of foam made using sodium tetradecyl sulphate and gas (air or a CO2:O2 mixture) is increased significantly if silicone-free syringes are used over the normal syringes containing silicone oil lubrication. However, the plungers in silicone-free syringes start sticking after several passages when making foam for sclerotherapy, preventing the smooth injection of the resulting foam. We describe a three syringe technique which allows foam to be made using the Tessari Tourbillon 'three-way stopcock' principle between two syringes, but with the foam ending up in a third syringe which has not undergone multiple passages of the plunger. This allows a smoother injection of the resultant foam, which is particularly useful when injecting small diameter veins under ultrasound control.

Neuropathy after sodium tetradecyl sulfate sclerotherapy of venous malformations in children.

To estimate the risk of nerve injuries and assess outcomes after sodium tetradecyl sulfate (STS) sclerotherapy of venous malformations (VMs) in children. Sclerotherapy is the treatment of choice for most VMs, but all sclerotherapy agents are associated with the risk of complications. Neuropathy is considered a rare but potentially serious complication of venous sclerotherapy. The institutional review board waived ethical approval for this retrospective review, in which 647 sclerotherapy procedures were performed in 204 patients (104 female and 100 male patients; mean age, 9 years 6 months [range, 6 months to 17 years 11 months]) as treatment for symptomatic VMs. Technical and clinical success of the treatment was evaluated. Complications were reviewed with a particular focus on nerve injury. Informed consent, specifying the risk of neuropathy, as well as pain, swelling, infection, risks of anesthesia, skin injury, nonresolution or worsening of symptoms, and possible need for further or multiple procedures, was obtained for all patients. Standard sclerotherapy techniques were used. Technical details of all procedures were recorded prospectively. Follow-up included immediate postprocedural assessment and outpatient clinic review. All nerve injuries were recorded. Patients were monitored and treated according to clinical need. Confidence intervals were calculated by using the Wilson method, without correction for continuity. Treatment was technically successful in 197 of 204 patients (96.6%), and clinical success was achieved in 174 of 204 (85.3%). Thirty-seven of the 647 procedures (5.7%) resulted in a complication, including 11 cases of excessive swelling, nine cases of skin injury, two patients with infection, and two with pain. Motor and/or sensory nerve injuries occurred after seven procedures (1.1%). Five of the seven children had undergone at least one previous sclerotherapy procedure. Neuropathy resolved spontaneously in four patients and partially recovered in three, of whom two underwent surgery. Surgery included debridement of necrotic tissue, carpal tunnel decompression, and external neurolysis. Nerve injury is an unusual but not rare complication of STS sclerotherapy. A degree of recovery, which may be complete, can be expected in most patients.

Is sclerotherapy useful for cherry angiomas?

Sclerotherapy is a safe, effective, and easily available treatment modality, its role in cherry hemangioma is still unexplored. This study aims at establishing the role and efficacy of sclerotherapy in treating cherry angiomas and its dermatological complications. This prospective study included 20 patients with 100 lesions of cherry hemangiomas of size >0.2 mm. Intralesional injection of 0.1 mL of 3% sodium tetradecyl sulfate was used. Scarring, if any, was evaluated using "The Stony Brook Scar Evaluation Scale." Patients were called for weekly sessions for a maximum of 4 weeks. Of 100 lesions treated, 42 lesions responded with a single dose of sclerosant, 44 lesions required a second setting. Remaining lesions were injected for 3 weeks, of which 14 lesions did not remit completely and required a fourth sitting. Depending on response to sclerotherapy, patients were divided into 2 groups (Group A and Group B). On comparing these groups, no statistically significant (χ test) difference in the rate of healing was observed. Sclerotherapy with sodium tetradecyl sulfate 3% is effective in the treatment of cherry hemangiomas. It offers an economical alternative to other available conventional methods.

A Step‐Ladder Protocol to Treat Cervico‐facial Venous Malformations

Objectives: Venous malformations (VMs) are the most commonly encountered vascular malformation of the cervico-facial region. Their clinical spectrum is extremely variable as they can present as single small lesions (often confined within muscle fasciae) or huge infiltrating ones. They can be part of a syndrome, as with Bean Syndrome, or in cutaneous mucosal venous malformation syndrome, among others. The aims of the study were: (1) Diagnose and stage a cervico-facial VM. (2) Describe the available treatment for head and neck VMs. (3) Propose the most appropriate treatment based on the staging of the VM. Methods: A review of the pertinent literature was performed to provide the common indications and techniques to treat head and neck VMs. Thirty-four consecutive cases of VMs have been treated by the authors by means of endovascular sclerotherapy with sodium tetradecyl sulphate, surgery, or both. Only patients with intraosseous VMs (8 total) were treated by surgery alone. Three large, unresectable cervicofacial VMs were treated by means of the “strangling technique.” Results: Good to very good aesthetic and functional results were obtained in all 34 patients. All 26 patients who underwent sclerotherapy experienced significant swelling. Six cases of skin or mucosal ulcerations were noted. No damage to the facial nerve was observed. Five patients affected by larger VMs showed partial recanalization/recurrence of the malformation. Conclusions: Cervicofacial VMs have to be managed by an experienced, multidisciplinary team. A protocol with increasing invasiveness is proposed to maximize results after their treatment.

Histologic findings after mechanochemical ablation in a caprine model with use of ClariVein.

The use of foam and liquid sclerotherapy for the treatment of varicose veins and underlying venous reflux is widespread. A novel device, the ClariVein Occlusion Catheter (Vascular Insights LLC, Madison, Conn), has been the subject of several clinical trials in humans. We report the initial histologic results obtained with use of the device in a caprine vein model. A total of 11 male goats (12 veins) underwent minimally invasive procedures. Unilateral mechanochemical ablation of the lateral saphenous vein by the ClariVein Occlusion Catheter with an E-140° tip was performed under fluoroscopic guidance in five veins with 5 mL of 1.5% sodium tetradecyl sulfate (STS) and in one vein with 5 mL of 0.9% saline. The remaining six received injection sclerotherapy with 5 mL of 1.5% STS or 0.9% saline. All subjects were assessed with ultrasound before the procedure and intermittently afterward during a period of 12 weeks. Subsequent termination was immediately followed by necropsy and histologic examination of the treated veins. Complete occlusion of the lateral saphenous vein was observed in all subjects treated with ClariVein and STS, whereas complete patency was noted in all other treatment modalities. Histologic staining with hematoxylin and eosin and Masson trichrome stain revealed total fibrotic sealing with extensive collagen production in all ClariVein/STS veins. A statistical significance was observed in the difference in the number of occluded veins between subjects treated with ClariVein/STS and those treated by injection sclerotherapy (Fisher exact test, P < .01). The ClariVein Occlusion Catheter with 1.5% STS can be used to achieve complete mechanochemical ablation of the lateral saphenous vein in a caprine model. The evidence in this report can be used to justify the device's use for the treatment of the great saphenous vein in subsequent human clinical trials.

Foam sclerotherapy for reticular veins of the dorsal hands: a retrospective review.

Despite being the gold standard for lower extremity reticular vein treatment, few studies have yet evaluated foam sclerotherapy for hand veins. This retrospective study evaluates the safety and efficacy of foam sclerotherapy for reticular veins of the dorsal hands. A telephone-based questionnaire was used for patient self-assessment of overall improvement, satisfaction, prevalence of adverse events, and willingness for repeat treatment after foam sclerotherapy with sodium tetradecyl sulfate (STS). All patients had been treated with foam STS of 0.25% to 1.0% concentration using room air. Twenty-one of 45 patients were successfully contacted, with a total of 54 treatment sessions performed on 38 hands. Overall, patients reported scores of 2.55 ± 0.56 for overall improvement (0 = none, 1= mild, 2 = moderate, and 3 = complete resolution) and 1.79 ± 0.41 for satisfaction with results (0 = not satisfied at all, 1 = mildly satisfied, and 2 = very satisfied), with few significant treatment-related adverse events. Most patients stated they would undergo another treatment if needed. This single-center experience found that foam sclerotherapy with STS is a safe and effective treatment for reticular veins of the dorsal hands with excellent long-term patient satisfaction.

Accelerated balloon-occluded retrograde transvenous obliteration without indwelling balloon occlusion for gastric varices with small gastrorenal shunts using a terminal gelfoam plug.

We performed balloon-occluded retrograde transvenous obliteration in three consecutive patients with small gastric varices without indwelling balloon catheter occlusion. Foam of 3% sodium tetradecyl sulfate mixed with iodized oil and room air was injected retrograde through the gastrorenal shunt, followed by a thick absorbable gelatin sponge (Gelfoam, Pfizer) plug under only 10-minute balloon occlusion. Because complete obliteration of gastric varices was achieved in all patients without any complications, our technique is considered to be safe and effective for small gastric varices.

Timing and modality of the sclerosing agents binding to the human proteins: laboratory analysis and clinical evidences

Sclerosing agents (SA) are blood inactivated. Nevertheless, investigations concerning the interaction among SA and blood components have never been deeply investigated. Aim of the study is to precisely identify SA blood ligands, to determine their binding time and to highlight the clinical consequences. Thirty-one blood samples were collected from chronic venous disease patients and tested by capillary and agarose gel (AGE) electrophoresis before and after adding polidocanol (POL) and sodiumtetradecylsulphate (STS). The two different types of electrophoresis allowed an evaluation of the blood proteins binding with the sclerosing agents, with a reaction time lower than 8 seconds for the AGE. Subsequently six patients underwent foam sclerotherapy and then were subdivided in group A (4 patients) and B (2 patients). In group A blood sample was obtained from the ipsilateral brachial vein immediately before (T0) and repeated 1, 3, 5, and 10 minutes after injection of STS 3% injection into the GSV. In group B, the same procedure was performed with the same timing from the ipsilateral femoral vein. Free STS (fSTS) and total proteinbound STS (bSTS) were measured. POL mainly binds to β-globulins (11%), while STS to albumin and α-globulins (62.6% and 30.7%) on the protidogram, respectively. Both in the brachial and in the femoral vein, the average fSTS was always 0. STS binds to albumin (62.6%) and α-globulins (30.7%), while POL is bound mainly by the b-globulins (11%). The present paper demonstrates how the vast majority of the sclerosing agent is bound to the blood proteins, suggesting the need to look for possible sclerotherapy complications factors also in the used gas and/or in the subsequent cathabolites release.

Feeding and Draining Vessel Ligation with Sclerotherapy of High Flow Arteriovenous Malformations in the Head and Neck

Feeding and Draining Vessel Ligation with Sclerotherapy of High Flow Arteriovenous Malformations in the Head and Neck

Comparison of Sonographically Guided Percutaneous Sodium Tetradecyl Sulfate Injection with Ethanol Injection in the Treatment of Benign Nonfunctioning Thyroid Nodules

PurposeTo compare the efficacy of percutaneous sodium tetradecyl sulfate (STS) injection with ethanol injection in the treatment of benign nonfunctioning thyroid nodules. Materials and MethodsThis prospective study included 47 patients with 50 benign thyroid nodules. The lesions were randomly assigned into two groups: 20 in the ethanol arm and 30 in the STS arm. The mean lesion volume was 25.6 mL ± 28.5 (range, 4–122.1 mL) in the ethanol arm and 25.4 mL ± 27 (range, 0.72–129 mL) in the STS arm. One sitting of sclerosant injection was done in 20 lesions, and two injections, three injections, four injections, five injections, six injections, seven injections, and eight sittings of injections were done in 9 lesions, 4 lesions, 8 lesions, 4 lesions, 2 lesions, 2 lesions, and 1 lesion. The mean volumes of the instilled ethanol and STS were 5.3 mL and 7.8 mL, respectively, per sitting. Follow-up sonography was performed at 1, 3, 6, and 12 months after the procedure. ResultsThe final 12-month follow-up lesion volumes were 4.1 mL ± 3.7 (range, 0.3–15.2 mL) in the ethanol group and 4.4 mL ± 5.8 (range, 0.01–29.6 mL) in the STS group (P = .85). The mean volume reduction was 84% and 82.8% in the two groups. No significant adverse effects were seen in either of the two groups. ConclusionsSonographically guided percutaneous ethanol and STS injections are not significantly different from each other in terms of the volume reduction achieved in benign nonfunctioning thyroid nodules.

Percutaneous sclerotherapy of foot venous malformations: Evaluation of clinical response

To evaluate a single institutional experience with percutaneous sclerotherapy of venous malformations (VM) of the foot. Sixteen patients (mean age 14.6 years; range 6-27.3 years), who underwent 34 sclerotherapy procedures were retrospectively analysed. Technical success, Puig classification, VM size reduction, and the complication rate were evaluated. In procedures in which C-arm computed tomography (CT) was performed, the VM-to-skin surface distance was measured. Additionally, an e-mail-based questionnaire to evaluate the response to sclerotherapy was answered by the patients. Technical success was 97%. The mean number of procedures per patient was 2.1 (range 1-5). In all procedures, sodium tetradecyl sulphate foam was used. Appropriate follow-up was available for 29/33 procedures (88%). Post-procedural complications occurred after 6/29 procedures (21%), all of which were self-limited skin complications. C-arm CT was performed in 19/33 procedures (58%). The lesion-to-skin surface distance was significantly shorter in patients with skin post-procedural complications (p < 0.001). The e-mail-based questionnaire was completed by 13/16 patients (81%). Decrease in swelling, improvement of foot function and a significant decrease in pain (p = 0.003) was reported. No patient reported dis-improvement after sclerotherapy. Percutaneous sclerotherapy is an effective option for treating foot VMs. Skin complication rates are higher with shorter VM-to-skin surface distance.

Interaction of detergent sclerosants with cell membranes.

Commonly used detergent sclerosants including sodium tetradecyl sulphate (STS) and polidocanol (POL) are clinically used to induce endovascular fibrosis and vessel occlusion. They achieve this by lysing the endothelial lining of target vessels. These agents are surface active (surfactant) molecules that interfere with cell membranes. Surfactants have a striking similarity to the phospholipid molecules of the membrane lipid bilayer. By adsorbing at the cell membrane, surfactants disrupt the normal architecture of the lipid bilayer and reduce the surface tension. The outcome of this interaction is concentration dependent. At high enough concentrations, surfactants solubilise cell membranes resulting in cell lysis. At lower concentrations, these agents can induce a procoagulant negatively charged surface on the external aspect of the cell membrane. The interaction is also influenced by the ionic charge, molecular structure, pH and the chemical nature of the diluent (e.g. saline vs. water). The ionic charge of the surfactant molecule can influence the effect on plasma proteins and the protein contents of cell membranes. STS, an anionic detergent, denatures the tertiary complex of most proteins and in particular the clinically relevant clotting factors. By contrast, POL has no effect on proteins due to its non-ionic structure. These agents therefore exhibit remarkable differences in their interaction with lipid membranes, target cells and circulating proteins with potential implications in a range of clinical applications.

Low-concentration detergent sclerosants stimulate white blood cells and release proinflammatory and proangiogenic cytokines invitro.

The objective of this study was to investigate the effects of the detergent sclerosants sodium tetradecyl sulfate (STS) and polidocanol (POL) on the release of proinflammatory and angiogenic mediators from circulating bloodcells. Whole blood, platelet-rich plasma, platelet-poor plasma, and suspensions of polymorphonuclear cells (PMNCs) and mononuclear cells (MNCs) were incubated with varying concentrations of sclerosants. Enzyme-linked immunosorbent assay was used to detect the release of interferon-γ (IFN-γ); tumor necrosis factor-α (TNF-α); interleukins (IL) 1α, 1β, 6, 8, and 17; vascular endothelial growth factor (VEGF); and basic fibroblast growth factor. Leukocyte activation was assessed by flow cytometry. IFN-γ and TNF-α were released from STS-stimulated PMNCs at high (387ng/mL; P< .01) and modest (232ng/mL; P< .05) quantities, respectively. Both sclerosants induced a weak response in MNCs, releasing minor quantities of IL-1α (STS, 18.2ng/mL; POL, 14.0ng/mL), IFN-γ (STS, 41.7ng/mL; POL, 27.7ng/mL), and TNF-α (STS, 29.7ng/mL; POL, 14.0ng/mL). POL at a wide range of concentrations and in all sample types tested stimulated the release of VEGF, whereas the effect of STS was limited to lowconcentrations and not detected in MNCs. Both agents stimulated moderate release of IL-8 from PMNCs (STS, 223.3ng/mL, P< .001; POL, 84.23ng/mL, P< .05). Neither agent induced a significant rise in basic fibroblast growth factor, IL-6, or IL-17. STS at low concentrations increased the expression of CD11b in both PMNCs and MNCs, suggestive of cellular activation. The activating effect of POL was limited to MNCs. STS demonstrated proinflammatory activity mediated primarily by IFN-γ released from PMNCs and MNCs. POL had a weak proinflammatory effect limited to MNCs. Both sclerosants (POL > STS) induced a proangiogenic response mediated by VEGF.

Foam sclerotherapy for periorbital dermoid cysts.

To report nonsurgical treatment of periorbital dermoid cysts with foam sclerotherapy using sodium tetradecyl sulfate (STS). Single-center, retrospective, interventional case series. Clinical records of all patients diagnosed to have congenital orbital dermoid cyst and treated with STS foam sclerotherapy between 2012 and 2013 were reviewed. The ectodermal contents of the dermoid cyst were aspirated through a stab incision with 18G needle, followed by saline lavage. Intraluminal foam sclerotherapy was then performed using STS (30 mg/ml) in a proportion of 10% of the total aspirate volume. Retrospective data analysis included demographic profile, clinicoradiologic findings, and treatment outcomes of foam sclerotherapy. Four patients were treated in the given period. Average age at presentation was 20.2 years. All cysts were reported to be congenital in nature, and the location was medial angular in 2 cases, lateral angular in 1 case, and lateral orbitotemporal in 1 case. The average aspirate of the pultaceous cyst content was 3.75 ml (range, 2-5 ml). Of the 4 patients, 2 dermoid cysts resolved completely within 8 weeks. Two cysts showed partial response and required a second foam sclerotherapy to achieve complete resolution. At an average follow up of 13.25 months (range, 11-16 months), complete cyst resolution was noted. No sclerotherapy-related complications were observed. Foam sclerotherapy is successful in obliterating periorbital dermoid cysts and provides a minimally invasive nonsurgical approach to achieve an aesthetic result.

Indications, contraindications and performance: European Guidelines for Sclerotherapy in Chronic Venous Disorders

Sclerotherapy is the targeted chemical ablation of varicose veins by intravenous injection of a liquid or foamed sclerosing drug. The treated veins may be intradermal, subcutaneous, and/or transfascial as well as superficial and deep in venous malformations. The aim of this guideline is to give evidence-based recommendations for liquid and foam sclerotherapy. This guideline was drafted on behalf of 23 European Phlebological Societies during a Guideline Conference on 7th - 10th May 2012 in Mainz. The conference was organized by the German Society of Phlebology. This guideline focuses on the two sclerosing drugs which are licensed in the majority of the European countries, Polidocanol (POL) and Sodium tetradecyl sulphate (STS). Other sclerosants are not discussed in detail. In this paper the recommendations concerning indications, contraindications, concentrations, volumes and technique of liquid and foam sclerotherapy of varicose veins and venous malformations are reviewed.

Thrombocytopenia in Patients with Gastric Varices and the Effect of Balloon-occluded Retrograde Transvenous Obliteration on the Platelet Count.

Objectives:Gastric varices primarily occur in cirrhotic patients with portal hypertension and splenomegaly and thus are probably associated with thrombocytopenia. However, the prevalence and severity of thrombocytopenia are unknown in this clinical setting. Moreover, one-third of patients after balloon-occluded retrograde transvenous obliteration (BRTO) have aggravated splenomegaly, which potentially may cause worsening thrombocytopenia. The aim of the study is to determine the prevalence and degree of thrombocytopenia in patients with gastric varices associated with gastrorenal shunts undergoing BRTO, to determine the prognostic factors of survival after BRTO (platelet count included), and to assess the effect of BRTO on platelet count over a 1-year period.Materials and Methods:This is a retrospective review of 35 patients who underwent BRTO (March 2008–August 2011). Pre- and post-BRTO platelet counts were noted. Potential predictors of bleeding and survival (age, gender, liver disease etiology, platelet count, model for end stage liver disease [MELD]-score, presence of ascites or hepatocellular carcinoma) were analyzed (multivariate analysis). A total of 91% (n = 32/35) of patients had thrombocytopenia (<150,000 platelet/cm3) pre-BRTO. Platelet counts at within 48-h, within 2 weeks and at 30-60 days intervals (up to 6 months) after BRTO were compared with the baseline pre-BRTO values.Results:35 Patients with adequate platelet follow-up were found. A total of 92% and 17% of patients had a platelet count of <150,000/cm3 and <50,000/cm3, respectively. There was a trend for transient worsening of thrombocytopenia immediately (<48 h) after BRTO, however, this was not statistically significant. Platelet count was not a predictor of post-BRTO rebleeding or patient survival. However, MELD-score, albumin, international normalized ratio (INR), and etiology were predictors of rebleeding.Conclusion:Thrombocytopenia is very common (>90% of patients) in patients undergoing BRTO. However, BRTO (with occlusion of the gastrorenal shunt) has little effect on the platelet count. Long-term outcomes of BRTO for bleeding gastric varices using sodium tetradecyl sulfate in the USA are impressive with a 4-year variceal rebleed rate and transplant-free survival rate of 9% and 76%, respectively. Platelet count is not a predictor of higher rebleeding or patient survival after BRTO.

Percutaneous Sclerotherapy for Treatment of Tumoral Calcinosis

Massive tumoral calcinosis developed in a 29-year-old woman with type 1 diabetes and failed pancreas and kidney transplant on peritoneal dialysis. The patient had a symptomatic calcified, fluid-filled posterior thigh mass. After percutaneous drainage of 260 mL of milky fluid, she had rapid recurrence of the collection. She underwent catheter-based sclerotherapy first with 110 mL of povidone-iodine followed 2 days later by 40 mL of 3% sodium tetradecyl sulfate foam. At 5.5 months after the procedure, the patient remained asymptomatic, and computed tomography imaging showed complete resolution of the collection.