polidocanol and Acute-Disease

392 patients were examined by endoscopy for acute upper gastrointestinal bleeding; 140 had ulcers containing an actively bleeding visible vessel or a non-bleeding visible vessel and were enrolled in a randomised trial of three endoscopic methods of haemostasis--adrenaline (1/10(4] alone, adrenaline plus polidocanol 1%, and adrenaline followed by yttrium-aluminium-garnet (YAG) laser photocoagulation. For patients with non-bleeding visible vessels sham treatment was significantly less effective in achieving haemostasis (8 of 20 patients) than were adrenaline plus polidocanol (18 of 20; p = 0.002) and adrenaline plus laser (16 of 20; p = 0.012). All three treatments significantly reduced total transfusion needs compared with sham treatment. For the whole group of patients, adrenaline plus polidocanol was significantly more effective than adrenaline alone in achieving permanent haemostasis; adrenaline plus laser was also more effective than adrenaline alone, but not significantly so. The efficacy of the three treatments was enhanced by repeated application on recurrence of bleeding. Since injection therapy with adrenaline and polidocanol was at least as effective as adrenaline plus laser therapy, it should be preferred over laser therapy because it is cheaper, easier to use, and perhaps also safer.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Child; Combined Modality Therapy; Drug Therapy, Combination; Endoscopy; Epinephrine; Evaluation Studies as Topic; Female; Follow-Up Studies; Hemostatic Techniques; Humans; Laser Therapy; Light Coagulation; Male; Middle Aged; Peptic Ulcer; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Random Allocation; Recurrence

To assess the presence of pulmonary embolism and inflammation after polidocanol foam injection into the peripheral veins of rabbits.. The animals were treated with polidocanol foam (1 or 3 mg/kg) or vehicle. Early (15 minutes) and late (30 days) animals were evaluated by perfusional lung scintigraphy and histopathological examination.. In the control group no alterations were found. After polidocanol foam injection it was observed that an important reduction of pulmonary perfusion in the early periods, was mainly in the left lung (P < 0.001), with consequent embolism in the histological evaluation. In late periods it was observed that the presence of thrombus was with fibrin in small veins, compatible with chronic thrombus and the presence of chronic pulmonary inflammation.. The injection of polidocanol foam in experimental animals can induce venous embolism and chronic inflammatory infiltration.

Topics: Acute Disease; Animals; Chronic Disease; Female; Lung; Male; Polidocanol; Polyethylene Glycols; Pulmonary Embolism; Rabbits; Sclerosing Solutions; Time Factors

The aim of this study was to investigate the efficacy of endoscopic injection therapy on the clinical outcome of elderly patients with peptic ulcer bleeding.. From January 1995 to December 1998, 738 patients with acute peptic ulcer bleeding were observed in the First Division of General Surgery, University of Verona: 359 aged <70 years and 379 =/>70 years. History, clinical and endoscopic findings and outcome were prospectively collected and analyzed comparing old (=/>70 yrs) and young (<70 yrs) patients. Ulcers with active or sign of recent bleeding were submitted to injection therapy using epinephrine and 1% polidocanol.. Coexisting diseases were significantly more present in the elderly group except for liver cirrhosis that affected preferentially young patients (12.3 versus 4.0%; p<0.001). Endoscopic treatment was performed in a similar percentage between young and elderly patients (respectively 64.9 e 61.5%) and also the rebleeding rate (14.2 versus 13.2) and the mean duration of hospitalisation were not different. The overall mortality was 12.7% in the elderly group and 8.3% in the young group (p=0.04), whereas mortality after surgery was significantly higher in the young group (respectively 57.1 versus 8.3%; p=0.037).. The clinical and endoscopic features and reebleeding rate were not different between elderly and young patients. Patients aged 70 years or older have a higher number of associated medical diseases except for liver cirrhosis conditions and a highest overall mortality whereas the risk of death after surgery is lower than in the younger group.

Topics: Acute Disease; Aged; Duodenal Ulcer; Epinephrine; Female; Humans; Male; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Sclerosing Solutions; Stomach Ulcer

In a prospective study, all patients with peptic ulcer bleeding were documented between February 1984 and April 1992. A total of 227 patients were treated by local injection of epinephrine followed by laser application and injection of polidocanol or fibrin tissue adhesive. In five of these patients, intramural hematomas developing at the former bleeding site one to three days after endoscopic treatment were observed. The presenting symptoms were abdominal pain, nausea, and vomiting. The diagnosis was established by endoscopy, abdominal ultrasound, computed tomography, or laparotomy. In four of our five patients, the bleeding site and hematoma were located in the duodenum. All patients suffered from severe underlying diseases, and showed a clear disturbance of coagulation parameters. In three patients, acute pancreatitis occurred concurrently with the hematoma, probably due to obstruction of the papilla of Vater or compression of the pancreas caused by the hematoma.

Topics: Acute Disease; Adult; Aged; Duodenal Diseases; Endoscopy, Gastrointestinal; Epinephrine; Female; Fibrin; Hematoma; Humans; Injections, Intralesional; Male; Middle Aged; Pancreatitis; Peptic Ulcer Hemorrhage; Polidocanol; Polyethylene Glycols; Prospective Studies; Tissue Adhesives