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At least 37 records · Page 2Linked to original sources
PubMed2002

Endoscopic sclerotherapy of gastric variceal bleeding with N-butyl-2-cyanoacrylate.

BACKGROUND: bleeding from gastric varices is a life-threatening complication of portal hypertension. Fundal and isolated gastric varices are at high risk for variceal bleeding. In this study, we report our experience with n-butyl-2-cyanoacrylate (BC) in patients with large gastric varices. STUDY: twenty-nine patients (15 male, 14 female) with large fundal varices (active bleed, 5; passive bleed after eradication of esophageal varices, 13; unbled fundal varices with red color sign, 11) underwent endoscopic sclerotherapy with BC. Cirrhosis was present in 13 patients; extrahepatic portal venous obstruction, in 13; and noncirrhotic portal fibrosis, in 3. N-Butyl-2-cyanoacrylate after mixing with lipiodol (1:1) was given to the initial 10 patients and was given in undiluted form to the remaining patients, followed by injection of 0.7 mL of distilled water to rinse the injection catheter. One to three injections (0.5-1 mL) were given until all gastric varices became hard. All patients were on long-term endoscopic sclerotherapy or variceal ligation programs for eradication of esophageal varices. RESULTS: acute variceal bleeding was controlled in all five patients with BC injections. Eradication of gastric varices was achieved in 27 (93.1%) patients (20 patients in 1 session, 4 patients in 2, and 3 patients in 3-6). Rebleeding occurred in three (10.3%) patients who responded to repeat BC injections. Complications related to the procedure occurred in two (6.9%) patients. In one patient, the needle became impacted into the tissue adhesive. This patient died 5 days later because of massive upper gastrointestinal bleeding. In the other patient, there was distal embolization. CONCLUSIONS: sclerotherapy of gastric varices with BC is a safe and an effective treatment for control of bleeding and eradication. The needle should be withdrawn immediately after the BC injection to prevent its impaction into the tissue adhesive.

Adolescent↗
PubMed1996

Submucosal bladder neck injection of bovine dermal collagen for stress urinary incontinence in the pediatric population.

PURPOSE: The surgical management of stress urinary incontinence in the pediatric population includes various surgical techniques of which the simplest is outpatient transurethral or periurethral injection of a bulking agent. Currently purified bovine dermal collagen cross-linked with glutaraldehyde (Contigen) is the only Food and Drug Administration approved bulking agent available. Patients with stable detrusor function are ideal candidates. We review our initial experience with children. MATERIALS AND METHODS: Between January 1994 and June 1995, 23 boys and 9 girls 4 to 17 years old (mean age 9) consecutively underwent submucosal bladder neck injection with cross-linked bovine dermal collagen. Incontinence was secondary to spinal dysraphism in 24 patients, complete epispadias in 4, classic bladder exstrophy in 3 and neurogenic bladder secondary to a sacral teratoma in 1. Preoperative video urodynamics documented intrinsic sphincteric deficiency in all patients with leak point pressure of 15 to 60 cm. water (mean 37). Injection volumes ranged from 2.5 to 17 cc (mean 10). Continence results were defined as dry-requiring no protection while on a 4-hour clean intermittent catheterization program, good-improved but requiring 1 to 5 pads daily and failure-no postoperative improvement or still requiring diapers. RESULTS: Of the children with neurogenic bladder 20% became dry following the first injection and an additional 28% had a good result. Furthermore, of the 6 children with exstrophy or epispadias who underwent a Young-Dees-Leadbetter procedure 50% were dry and 17% had a good result after the first injection. Complications were limited to a febrile urinary tract infection associated with urinary retention in 1 patient and transiently worse continence in 2. CONCLUSIONS: Despite the limited success rate, we believe that transurethral collagen injection therapy has a viable role in the treatment of intrinsic sphincteric deficiency in select pediatric patients, particularly since the procedure has low morbidity and can be performed on an outpatient basis. Preoperative counseling should be given with realistic expectations.

Administration, Intravesical↗
PubMedDate not supplied

Sectional neuroanatomy of the middle thoracic spine (t5-t8) and chest.

This is the third in a series of articles on the spine. The first reviewed the anatomy of the neck. The second reviewed the upper thoracic spine and chest (T1-T4). A fourth article is planned for the lower thoracic spine. Procedures in the midthoracic spine include chest tube placement, trigger point injections, chemodenervation with botulinum toxin, video-assisted thoroscopic surgery, and spinal injections. Complications include pneumothorax, hemothorax, diaphragmatic irritation, sympathetic trunk irritation, postthoracotomy pain, and intradural abscesses. This article provides anatomically accurate schematics of innervations of the middle thoracic chest and spine (T5-T8) that can be used to interpret magnetic resonance images of the muscles and nerves. Cross-sectional schematics of the middle thoracic chest and spine were drawn as they appear on imaging projections. The relevant nerves were color coded. The muscles and skin surfaces were labeled and assigned the color of the appropriate nerves. An organized comprehensive map of the motor innervation of the middle thoracic chest and spine allows the physician to increase the accuracy and efficacy of interventional procedures. This could also assist the electromyographer in correlating the clinical and electrophysiologic findings with magnetic resonance images.

Anatomy, Cross-Sectional↗
PubMed2006

Intravitreal bevacizumab (Avastin) as treatment for subfoveal choroidal neovascularisation secondary to pathological myopia.

OBJECTIVE: To evaluate the safety and efficacy of intravitreal bevacizumab (Avastin) as treatment for subfoveal choroidal neovascularisation (CNV) due to pathological myopia. METHODS: Consecutive series of primary or recurrent subfoveal CNV secondary to myopia treated with intravitreal bevacizumab 1.25 mg between August 2005 and January 2006 at the New England Eye Center, Boston, Massachusetts, USA, were reviewed retrospectively. Data from clinical examination, fundus photography, fluorescein angiography, optical coherence tomography and visual acuity were collected. RESULTS: There were 11 eyes of 9 patients. 5 of 11 eyes had been treated previously with photodynamic therapy. Pre-injection visual acuity measured 20/50 to 20/100 in 6 eyes and 20/200 or worse in 5 eyes. After a mean follow-up of 153 (range 35-224) days, post-injection visual acuity measured 20/20 to 20/40 in 7 eyes, 20/50 to 20/100 in 1 eye and 20/200 or worse in 3 eyes. Three eyes received two bevacizumab injections and eight eyes received one injection. Visual acuity improved by a mean of +3.5 (range -1 to +8 lines) lines, and 8 of 11 eyes achieved 20/50 or better at the last follow-up. Central foveal thickness improved from 340 (range 253-664) microm to 234 (range 142-308) microm, representing an average reduction of 103 (range +4 to -356) microm. No injection complications or drug-related side effects were observed. CONCLUSIONS: In this small series of eyes with limited follow-up, intravitreal bevacizumab seems to be safe and potentially efficacious in eyes with subfoveal CNV secondary to pathological myopia.

Adult↗
PubMed1991

Percutaneous transpenile and retrograde venous occlusion for the treatment of venous leak impotence.

In 17 patients percutaneous transpenile venous occlusion was performed for the treatment of so-called venous leak impotence. Because of primary failure, the procedure was repeated in 5 patients. On four occasions, it was combined with a retrograde venous occlusion via the internal iliac vein. Within a rather short follow-up period of 23 months maximum, the overall success rate is 65%. Six patients are able to have intercourse and 5 others need additional intracavernous injections. Complications of the procedure were not observed.

Adult↗
PubMedDate not supplied

High-dose (5000-microg) intravitreal ganciclovir combined with highly active antiretroviral therapy for cytomegalovirus retinitis in HIV-infected patients in Venezuela.

PURPOSE: To describe the use of high doses of intravitreal ganciclovir combined with highly active antiretroviral therapy (HAART) for the treatment of cytomegalovirus (CMV) retinitis in human immunodeficiency virus (HIV)-infected patients. METHODS: Thirteen HIV-infected patients (18 eyes) with active CMV retinitis (83.3% in zone 1 and 38.4% resistant) participated in this prospective interventional case series. Patients were treated with high dose intravitreal ganciclovir (5.0 mg/0.1 mL once a week) in combination with HAART therapy. Intravitreal injections were discontinued once CMV retinitis healed if there was a significant increase in CD4+ count (any increase of > or 50 cells/microL to levels over 100 cells/microL sustained for at least 3 months). Mean follow-up was 15.6 months. Main outcome measures included assessment of visual acuity and retinal inflammation (CMV retinitis activity). A matched historical control group of 20 eyes (15 patients) with CMV retinitis treated with systemic ganciclovir (intravenous [induction] and oral [maintenance]) was included. RESULTS: Complete regression of the retinitis was obtained with high doses of intravitreal ganciclovir in 88.8% of eyes (two patients died during follow-up) at a mean of 4.5 weeks (2 to 8 weeks). Visual acuity improved two or more lines in 61.1% of eyes. No ganciclovir retinal toxicity was identified. Three eyes presented CMV retinitis reactivation at a mean of 25.6 days after their last injection. Complications (33.3%) included retinal detachment (RD; 3 eyes), immune recovery uveitis (IRU; 2 eyes), and endophthalmitis (1 eye). In our control group complete regression of the retinitis was obtained in 100% of eyes at a mean of 4 weeks (3 to 7 weeks). However, 12 eyes (60%) presented with CMV retinitis relapse at a mean of 29 days (21 to 32 days) after initiating oral ganciclovir (maintenance). Complications included RD (7 eyes, 35%) and IRU (3 eyes, 15%). Severe neutropenia occurred in 2 patients (13%). CONCLUSIONS: High doses of intravitreal ganciclovir (5.0 mg) once a week in combination with HAART therapy is effective to control CMV retinitis, and may be discontinued after CMV retinitis has healed if immune reconstitution with a significant increase in CD4+ count has occurred.

AIDS-Related Opportunistic Infections↗
PubMed2002

Principles of office anesthesia: part I. Infiltrative anesthesia.

The use of effective analgesia is vital for any office procedure in which pain may be inflicted. The ideal anesthetic achieves 100 percent analgesia in a short period of time, works on intact or nonintact skin without systemic side effects, and invokes neither pain nor toxicity. Because no single agent meets all of these criteria, the physician must choose from the available armamentarium based on the anesthetic properties that are most desired. Infiltrative anesthetics are frequently chosen because of their proven safety record, low cost, ease of storage, widespread availability, and rapid onset of action. Allergy to local injectable anesthetics is rare, and when it occurs it is often secondary to the preservative in multidose vials. Anesthesia can be prolonged with the addition of epinephrine or the use of longer-acting agents. Buffering the local anesthetic with bicarbonate, warming the solution, and injecting slowly can minimize the pain of anesthetic injection. Complications are rare but include central nervous system and cardiovascular toxicity, or extreme vasoconstriction in an end organ, if epinephrine is used.

Ambulatory Surgical Procedures↗
PubMedDate not supplied

The triangle of safety: a modified posterior superior alveolar injection technique based on the anatomy of the PSA artery.

The posterior superior alveolar (PSA) injection technique is commonly used to anesthetize soft and hard tissues of the posterior maxilla. As with all injections, complications arise, including hematoma formation secondary to needle-induced vascular trauma. In an attempt to develop a hemorrhage-free PSA injection technique, 361 infratemporal dissections were completed on human cadaver specimens. Three distribution patterns were identified for the external branch of the PSA artery. Regardless of distribution pattern, an anatomical Triangle of Safety was found superior to the maxillary second molar that was free of neurovascular tissues in more than 99% of individuals. Injection into this area appears to meet anesthetic needs while reducing the risk of hematoma formation. The combination of this anatomical triangle with newer anesthetic agents and computerized delivery systems holds promise for continued improvement of the PSA injection technique.

Adult↗
PubMed1991

Rhegmatogenous retinal detachments in patients with AIDS and necrotizing retinal infections.

Rhegmatogenous retinal detachments can occur in patients with acquired immune deficiency syndrome (AIDS) and necrotizing retinal infections. Of 68 patients with AIDS and necrotizing retinal infections seen between 1983 and 1987, rhegmatogenous retinal detachments developed in 16 patients (27 eyes). In this group, cytomegalovirus retinopathy was present in 75% (12 of 16) of patients, 18.8% (3 of 16) had probable herpes simplex virus retinopathy, and 6.2% (1 of 16) had toxoplasmic retinochoroiditis. Retinal detachment was bilateral in 68.8% (11 of 16) of patients. The retina was reattached successfully in 91% (10 of 11) of operated eyes. Proliferative vitreoretinopathy was present preoperatively in 95% of these eyes. Seven of 11 operated eyes had initial improvement in visual acuity. However, 5 of 11 continued to lose vision despite successful reattachment. Techniques included pneumatic reattachment, scleral buckle, vitrectomy, and silicone oil injection. Complicated retinal detachments in AIDS patients with rhegmatogenous retinal detachments and necrotizing retinal infections are common and can be repaired, but the prognosis is guarded in many patients.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Botulinum toxin for the treatment of essential blepharospasm.

Twenty-six patients with essential blepharospasm were treated with botulinum toxin by injection. The onset of protractor weakness in all patients ranged from one to five days following treatment. Maximal weakness developed within 12 days. There was a variable and gradual return of protractor strength over eight to 29 weeks in most patients and, with it, a return of spasm. Twenty-five patients received some degree of functional relief following initial injection. In most patients, however, the post-injection result could not be stabilized and repeat injections have been necessary to control recurrent spasms. There was one treatment failure. Three patients treated by injection following previous neurectomy and myectomy appeared to have a reduced requirement for subsequent injections. Complications included transient ptosis in six patients and mild exposure symptoms in four patients. Extraocular muscle paresis did not occur. There were no systemic side effects from the botulinum toxin injections.

Aged↗
PubMed1985

Varicose veins: optimum compression following sclerotherapy.

There is uncertainty regarding the most satisfactory technique of lower limb compression following sclerotherapy for varicose veins. We have compared a standard bandaging technique with a high pressure compression stocking in a randomised trial. Efficacy was judged on the success of injections, complications of the treatment and patient satisfaction. In the stockinged legs 144 of 156 injections were successful, compared with 117 of 147 in the bandaged group (P less than 0.001) (Chi squared). The incidence of superficial thrombophlebitis was also reduced in the stocking group. In addition, the stocking technique costs less in materials than conventional bandaging. We would recommend compression stockings for evaluation in sclerotherapy of varicose veins.

Adult↗
PubMed1985

[Glycerol injection method for trigeminal neuralgia].

Twenty nine patients with trigeminal neuralgia were treated by retrogasserian glycerol injection method. Two of 29 were postherpetic and 27 were idiopathic trigeminal neuralgia. The mean age of these 27 was 65.2 years old ranging from 35 to 83 and the mean duration of symptoms was 7.6 years ranging from 6 months to 25 years. As previous surgical treatment there were 9 alcohol block, 5 thermorhizotomy of the Gasserian ganglion and one microvascular decompression. Twenty-two gauge needle was introduced into the trigeminal cistern via foramen ovale under the fluoroscopic control. Before injection of glycerol trigeminal cisternography using metrizamide of 300 mgI/dl was done to ascertain whether or not the needle tip was properly placed in the cistern. Patients' neck being flexed anteriorly, pure glycerol, amounting from 0.15 to 0.6 ml, was injected into the cistern with small increments through the needle. If the needle was inserted too deeply in the cistern, it is more probable that glycerol should escape from the cistern into the posterior fossa. So it was advisable that needle tip should be placed in the bottom of the cistern. When there was no pain relief, second injection was performed usually 7 days after the first injection. Complications were as follows; dysesthesia (81%), hypertension (70%), hypalgesia and hypesthesia (48%) headache (22%), ocular dysesthesia (11%), masseter weakness (7%), hyperalgesia (7%), attack of paroxysmal pain (7%). Most of these complications subsided within 8 weeks. Dysesthesia and hypalgesia that had persisted over 8 weeks were recognized in 30% of the cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Female↗
PubMed1995

Posterior sub-Tenon injections of repository corticosteroids in uveitis patients with cystoid macular edema.

Repository corticosteroid was injected into the posterior sub-Tenon space in 29 cases (39 eyes) of cystoid macular edema (CME) secondary to uveitis. There were 12 cases of Behçet's disease, 7 cases of sarcoidosis, one case of tuberculous uveitis, and 9 cases of etiology unknown uveitis. In some of the patients injections were repeated 2 to 7 times at intervals of more than 2 weeks. Twenty-two of the 39 treated eyes (56.4%) showed visual improvement in at least two lines of visual acuity. Fifteen of the 22 eyes had maintained improved visual acuity over 6 months. Eleven eyes showed no improvement in vision. Most of them already had poor visual acuity (0.2 or less) before the injections. Complications of the treatment included cataract in 6 eyes, glaucoma in one, and blepharoptosis in one. Injection of repository corticosteroids into the posterior sub-Tenon space is of value in the treatment of CME secondary to uveitis. However, we have to beware of the complications of treatment.

Adolescent↗
PubMed1993

[Posterior sub-Tenon's injections of repository corticosteroids in uveitis patients with cystoid macular edema].

Repository corticosteroid was injected into the posterior sub-Tenon's space in 29 cases (39 eyes) of cystoid macular edema (CME) secondary to uveitis. They included 12 cases of Behçet's disease, 7 cases of Sarcoidosis, one case of tuberculous uveitis and 9 cases of etiology unknown uveitis. In some of the patients injections were repeated twice to seven times at intervals of more than 2 weeks. Twenty two of the 39 treated eyes (56.4%) showed visual improvement in at least two lines of visual acuity. Eleven eyes showed no improvement in vision. Most of them had already had bad visual acuity (0.2 or less) before the injections. Complications of the treatment included cataract in 6 eyes, glaucoma in one, and blepharoptosis in one. Injection of repository corticosteroids into the posterior sub-Tenon's space was effective in the treatment of CME secondary to uveitis. However, we have to beware of the complications of this treatment.

Adolescent↗
PubMed1997

[The prolapse of the rectum. Treatment with fibrin adhesive].

Injection of sclerosing solutions into the rectal submucosa or into the perirectal space is one of the many therapies designed to correct rectal prolapse. Since 1994, four patients affected with this condition have been treated with fibrin adhesive percutaneous injection. Up to now, this product had not been used to this aim. Age range was from 1 month to 8 years. The medium duration of prolapse prior to therapy was 19 months and three of them had an associated pathology (myelomeningocele, cystic fibrosis and severe psychomotor retardation). There were no post-injection complications. In one patient with an irreducible prolapse an anus encirclement with a rectal tube was associated. Except for this patient, the whole process take less than 24 hours. With a medium follow up of 11 months this therapy has resulted effective in three of our four patients. It has failed in a girl with severe psychomotor retardation.

Child↗
PubMed1997

[Iatrogenic intra-arterial injection during sclerotherapy of the external saphenous vein].

Inadvertant intra-arterial injection is a rare complication of sclerotherapy of varicose veins. We report one case of accidental popliteal injection complicated by acute ischemiae of the posterior compartment of the leg who needed fasciotomy and Achillus tendum elongation. There is no practical "step-by-step" guide of these complications and the best treatment is the prevention by respect of contraindications and the injection of sclerosing agent under ultrasonographic control.

Adult↗