Percutaneous sclerotherapy for venous malformations in the extremities: clinical outcomes and predictors of patient satisfaction

The purpose of this study is to retrospectively evaluate the clinical outcomes and to identify the predictors ofpatient satisfaction after percutaneous sclerotherapy for venous malformations (VMs) in the extremities. A totalof 48 patients with VMs in the extremities over 10 years of age underwent sclerotherapy to relieve symptoms, such as pain, swelling, functional limitations, and cosmetic problems. Self-assessment questionnaires were sentto rate the degree of symptom improvement and level of satisfaction. Clinical and imaging data from medicalrecords were analyzed to obtain information about VMs and sclerotherapy. The predictors for patientsatisfaction were determined by univariate and multivariate analysis of clinical variables. Forty patients (meanage, 28.2 years; range, 11-69 years) responded to the survey. Sixteen patients had VMs in the upper extremities, and 24 patients had VMs in the lower extremities. In 12 patients (30%), adjacent bone change was seen. After amean of 2.6 (range 1-10) sclerotherapy sessions, good response to pain, swelling, dysfunction, and cosmeticproblems was obtained in 83%, 74%, 79%, and 50% of patients, respectively. Thirty-two patients (80%) weresatisfied with their outcomes. On univariate analysis, absence of adjacent bone change, maximum diameter (<6.7 cm), and number of sclerotherapy sessions (<3) were significantly associated with patient satisfaction.Multivariate analysis revealed absence of adjacent bone change (odds ratio, 7.56; 95% confidence interval, 1.02-55.8) as an independent predictor for satisfaction. Thus, adjacent bone change significantly portended adissatisfied patient. In conclusion, percutaneous sclerotherapy was effective to relieve symptoms of VMs in theextremities, and most patients were satisfied with the outcomes. However, adjacent bone change was asignificant predictor of patient dissatisfaction

Sequential Washing with Electrolyzed Alkaline and Acidic Water Effectively Removes Pathogens from Metal Surfaces.

Removal of pathogenic organisms from reprocessed surgical instruments is essential to prevent iatrogenic infections. Some bacteria can make persistent biofilms on medical devices. Contamination of non-disposable equipment with prions also represents a serious risk to surgical patients. Efficient disinfection of prions from endoscopes and other instruments such as high-resolution cameras remains problematic because these instruments do not tolerate aggressive chemical or heat treatments. Herein, we develop a new washing system that uses both the alkaline and acidic water produced by electrolysis. Electrolyzed acidic water, containing HCl and HOCl as active substances, has been reported to be an effective disinfectant. A 0.15% NaCl solution was electrolyzed and used immediately to wash bio-contaminated stainless steel model systems with alkaline water (pH 11.9) with sonication, and then with acidic water (pH 2.7) without sonication. Two bacterial species (Staphylococcus aureus and Pseudomonas aeruginosa) and a fungus (Candida albicans) were effectively removed or inactivated by the washing process. In addition, this process effectively removed or inactivated prions from the stainless steel surfaces. This washing system will be potentially useful for the disinfection of clinical devices such as neuroendoscopes because electrolyzed water is gentle to both patients and equipment and is environmentally sound

Electrolysis apparatus and washing procedures.

<p>(A) A schematic of the electrolysis apparatus: The apparatus consists of two wells separated by an electrolytic diaphragm. Anode and cathode plates were installed in the separate wells. Electrolyzed acidic and alkaline water were obtained from the anode and cathode wells, respectively. (B) Time schedules of washing procedures: Procedure 1 was used to determine the removal efficacy of bacteria, fungus and prions. Procedure 2 was used to evaluate the bacterial and fungal removal efficacy of procedure 1. Alkaline and acidic water steps were performed sequentially for 3 (Procedure 1), or 6 min (Procedure 2) each. The black box represents sonication. W: water. (C) Photographs of a rigid endoscope (502-457-030, Stryker, Kalamazoo, MI, USA) washed 10 (upper), 150 (middle) and 300 times (bottom) using procedure 1. The photographs are of the distal end of endoscopes before (left) and after washing (right).</p

Number of cylinders still harboring culturable bacteria following treatments with unelectrolyzed water control.

<p>Number of cylinders still harboring culturable bacteria following treatments with unelectrolyzed water control.</p

Existence of PrP^Sc in brain homogenates.

<p>PK-treated (PK+) and–untreated (PK-) brain homogenates from sCJD patient were loaded at concentrations of 40 and 20 μg of protein per lane onto a 15% polyacrylamide gel and subjected to SDS-PAGE. The proteins were detected by western blotting using anti-PrP antibody, SAF61.</p

Evaluation of wash procedure efficacy by PrP^Sc detection in mice study.

<p>The proteins of PK-treated (PK+) and–untreated (PK-) brain homogenates from mice were detected by western blotting using anti-PrP (SAF61) and β-actin antibodies. The numbers above indicate the survival times or the dates when the mice were killed in days post-inoculation with prion or implants with wires.</p

Number of cylinders still harboring culturable bacteria following treatments with electrolyzed alkaline and/or acidic water.

<p>Number of cylinders still harboring culturable bacteria following treatments with electrolyzed alkaline and/or acidic water.</p

The new washing procedure can inactivate prions.

<p>Kaplan–Meier survival analysis of wire-implanted Ki-ChM mice. The statistical significances were evaluated using log-rank test.</p