sodium-morrhuate and Thrombosis

Esophageal and gastric varices are associated with significant morbidity and mortality for cirrhotic patients. The current modalities available for treating bleeding esophageal and gastric varices, namely endoscopic band ligation and sclerotherapy, require frequent sessions to obtain effective thrombosis and are associated with significant adverse effects. A more effective therapy that results in long-term vascular occlusion has the potential to improve patient outcomes. In this study, we investigated a new potential method for inducing long-term vascular occlusion by targeting segments of a rabbit's auricular vein in vivo with low-duty-cycle, high-peak-rarefaction pressure (9 MPa), pulsed high-intensity focused ultrasound in the presence of intravenously administered ultrasound microbubbles followed by local injection of fibrinogen and a pro-inflammatory agent (ethanol, cyanoacrylate or morrhuate sodium). The novel method introduced in this study resulted in acute and long-term complete vascular occlusions when injecting a pro-inflammatory agent with fibrinogen. Future investigation and translational studies are needed to assess its clinical applicability.

Topics: Animals; Aprotinin; Cyanoacrylates; Esophageal and Gastric Varices; Ethanol; Fibrinogen; Fluorocarbons; High-Intensity Focused Ultrasound Ablation; Rabbits; Sodium Morrhuate; Thrombosis; Ultrasonography

Of the congenital vascular abnormalities, venous malformations receive little attention and essentially no discussion of treatment. The author describes a 30-year experience with sclerotherapy, which was used for 34 venous malformations. In some cases, these lesions are localized and can be excised, but all the patients in this series had such extensive involvement of adjacent organ systems that no other treatment than sclerotherapy was tenable. Five patients had Klippel-Trenaunay Syndrome, five had head and neck involvement, two had involvement of the entire left side and the remainder had other areas affected. Sodium morrhuate, ethanolamine, sotradecol, and absolute ethyl alcohol were the sclerosing agents used. A butterfly needle was inserted into an anomalous vein, and a three-way stopcock connected to saline and the sclerosing solution was used to ensure intraluminal injection. When rapid runoff into normal venous tributaries could be a concern, a venogram on the operating table preceded injection of the sclerosing solution. Small lesions required only one treatment; widespread bulky lesions required more than 30 injections. The volume of sclerosing solution varied from 5 to 90 mL per injection course. Because of pain, general anesthesia and an overnight hospital stay were necessary. Patients with pharyngeal and/or laryngeal involvement required preliminary tracheostomy or endotracheal ventilatory support for 3 days. Complications included skin necrosis, transient nerve palsy, hemoglobinuria, and one case of anaphylaxis. Repeated aggressive treatment was required for the very large malformations because recanalization occurred. All the patients have been very satisfied with the results.

Topics: Adolescent; Adult; Child; Child, Preschool; Female; Hemangioma; Humans; Male; Phlebography; Sclerotherapy; Sodium Morrhuate; Thrombophlebitis; Thrombosis; Veins

The rabbit model of osteomyelitis introduced by C.W. Norden, based on injection of an infecting solution (Staphylococcus aureus, sodium morrhuate) into the tibia, was studied at 4.7 Tesla with a time-efficient chemical shift selective imaging technique, Chemical Shift Specific Slice Selection (C4S). The evolution of the disease over several weeks was followed on water-selective, fat-selective, and sum images obtained simultaneously with this imaging sequence. Experiments were performed either on different groups of rabbits at different times after infection with subsequent sacrifice of the animal and microbiological analysis of the infected tibia or on the same group of animals imaged several times after infection. Associated analysis of the water and fat selective images revealed marrow modifications very early (Day 5 after inoculation) demonstrating the high sensitivity of the employed imaging technique. Later on, bone modifications were best identified on the sum images. Additional experiments performed on animals injected with a noninfecting solution containing only sodium morrhuate showed however that the sclerosing agent alone can yield images similar to those produced by infection at early stages after inoculation. Therefore, the Norden model would not be suitable for monitoring quantitatively outcome of therapy by magnetic resonance imaging. It is however well adapted for the evaluation and optimization of MRI techniques or protocols intended to detect early changes of bone marrow produced by septic or aseptic infarct.

Topics: Adipose Tissue; Animals; Body Water; Bone Marrow; Disease Models, Animal; Evaluation Studies as Topic; Female; Image Enhancement; Image Processing, Computer-Assisted; Infarction; Magnetic Resonance Imaging; Muscle, Skeletal; Osteomyelitis; Rabbits; Reproducibility of Results; Sodium Morrhuate; Staphylococcal Infections; Staphylococcus aureus; Thrombosis; Tibia; Time Factors

During the past 3 2/3 yr, 6 children with portal vein thrombosis were treated for esophageal hemorrhage by direct injection of esophageal varices with sodium morrhuate (endosclerosis). Four children were actively hemorrhaging at the time of initial endosclerosis; 2 patients were treated electively. Endosclerosis was performed by (1) employment of an especially slotted rigid esophagoscope, (2) direct intravariceal injection, (3) injection of varices at the gastroesophageal junction only. In patients actively hemorrhaging, endosclerosis was repeated every 3 to 4 days until the bleeding ceased. Once bleeding was controlled the procedure was done at 6-wk intervals until esophageal varices were obliterated. In the four patients actively hemorrhaging, bleeding was controlled by 2 to 3 separate injection sessions. Four patients have completed treatment and varices are absent radiographically and endoscopically. No patient has rebled during or after treatment in follow-up from 1/6 to 3 2/3 yr. Esophageal endosclerosis is advocated as a legitimate alternative to portosystemic shunt operations and nonoperative management of esophageal variceal hemorrhage in children with portal vein thrombosis.

Topics: Adolescent; Child; Child, Preschool; Esophageal and Gastric Varices; Esophagoscopy; Fatty Acids; Female; Gastrointestinal Hemorrhage; Humans; Infant; Male; Portal Vein; Sodium Morrhuate; Thrombosis

Topics: Animals; Dogs; Femoral Vein; Fibrinolysin; Humans; Sodium Morrhuate; Thrombophlebitis; Thrombosis