RESUMO
BACKGROUND: Telangiectasias (spider veins) and reticular veins on the lower limbs are very common, increase with age, and have been found in 41% of women. The cause is unknown and the patients may be asymptomatic or can report pain, burning or itching. Treatments include sclerotherapy, laser, intense pulsed light, microphlebectomy and thermoablation, but none is established as preferable. OBJECTIVES: To assess the effects of sclerotherapy, laser therapy, intensive pulsed light, thermocoagulation, and microphlebectomy treatments for telangiectasias and reticular veins. SEARCH METHODS: The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, AMED and CINAHL databases, and the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 16 March 2021. We undertook additional searches in LILACS and IBECS databases, reference checking, and contacted specialists in the field, manufacturers and study authors to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that compared treatment methods such as sclerotherapy, laser therapy, intensive pulsed light, thermocoagulation, and microphlebectomy for telangiectasias and reticular veins in the lower limb. We included studies that compared individual treatment methods against placebo, or that compared different sclerosing agents, foam or laser treatment, or that used a combination of treatment methods. DATA COLLECTION AND ANALYSIS: Three review authors independently performed study selection, extracted data, assessed risks of bias and assessed the certainty of evidence using GRADE. The outcomes of interest were resolution or improvement (or both) of telangiectasias, adverse events (including hyperpigmentation, matting), pain, recurrence, time to resolution, and quality of life. MAIN RESULTS: We included 3632 participants from 35 RCTs. Studies compared a variety of sclerosing agents, laser treatment and compression. No studies investigated intensive pulsed light, thermocoagulation or microphlebectomy. None of the included studies assessed recurrence or time to resolution. Overall the risk of bias of the included studies was moderate. We downgraded the certainty of evidence to moderate or low because of clinical heterogeneity and imprecision due to the wide confidence intervals (CIs) and few participants for each comparison. Any sclerosing agent versus placebo There was moderate-certainty evidence that sclerosing agents showed more resolution or improvement of telangiectasias compared to placebo (standard mean difference (SMD) 3.08, 95% CI 2.68 to 3.48; 4 studies, 613 participants/procedures), and more frequent adverse events: hyperpigmentation (risk ratio (RR) 11.88, 95% CI 4.54 to 31.09; 3 studies, 528 participants/procedures); matting (RR 4.06, 95% CI 1.28 to 12.84; 3 studies, 528 participants/procedures). There may be more pain experienced in the sclerosing-agents group compared to placebo (SMD 0.70, 95% CI 0.06 to 1.34; 1 study, 40 participants; low-certainty evidence). Polidocanol versus any sclerosing agent There was no clear difference in resolution or improvement (or both) of telangiectasias (SMD 0.01, 95% CI -0.13 to 0.14; 7 studies, 852 participants/procedures), hyperpigmentation (RR 0.94, 95% CI 0.62 to 1.43; 6 studies, 819 participants/procedures), or matting (RR 0.82, 95% CI 0.52 to 1.27; 7 studies, 859 participants/procedures), but there were fewer cases of pain (SMD -0.26, 95% CI -0.44 to -0.08; 5 studies, 480 participants/procedures) in the polidocanol group. All moderate-certainty evidence. Sodium tetradecyl sulphate (STS) versus any sclerosing agent There was no clear difference in resolution or improvement (or both) of telangiectasias (SMD -0.07, 95% CI -0.25 to 0.11; 4 studies, 473 participants/procedures). There was more hyperpigmentation (RR 1.71, 95% CI 1.10 to 2.64; 4 studies, 478 participants/procedures), matting (RR 2.10, 95% CI 1.14 to 3.85; 2 studies, 323 participants/procedures) and probably more pain (RR 1.49, 95% CI 0.99 to 2.25; 4 studies, 409 participants/procedures). All moderate-certainty evidence. Foam versus any sclerosing agent There was no clear difference in resolution or improvement (or both) of telangiectasias (SMD 0.04, 95% CI -0.26 to 0.34; 2 studies, 187 participants/procedures); hyperpigmentation (RR 2.12, 95% CI 0.44 to 10.23; 2 studies, 187 participants/procedures) or pain (SMD -0.10, 95% CI -0.44 to 0.24; 1 study, 147 participants/procedures). There may be more matting using foam (RR 6.12, 95% CI 1.04 to 35.98; 2 studies, 187 participants/procedures). All low-certainty evidence. Laser versus any sclerosing agent There was no clear difference in resolution or improvement (or both) of telangiectasias (SMD -0.09, 95% CI -0.25 to 0.07; 5 studies, 593 participants/procedures), or matting (RR 1.00, 95% CI 0.46 to 2.19; 2 studies, 162 participants/procedures), and maybe less hyperpigmentation (RR 0.57, 95% CI 0.40 to 0.80; 4 studies, 262 participants/procedures) in the laser group. All moderate-certainty evidence. High heterogeneity of the studies reporting on pain prevented pooling, and results were inconsistent (low-certainty evidence). Laser plus sclerotherapy (polidocanol) versus sclerotherapy (polidocanol) Low-certainty evidence suggests there may be more resolution or improvement (or both) of telangiectasias in the combined group (SMD 5.68, 95% CI 5.14 to 6.23; 2 studies, 710 participants), and no clear difference in hyperpigmentation (RR 0.83, 95% CI 0.35 to 1.99; 2 studies, 656 participants) or matting (RR 0.83, 95% CI 0.21 to 3.28; 2 studies, 656 participants). There may be more pain in the combined group (RR 2.44, 95% CI 1.69 to 3.55; 1 study, 596 participants; low-certainty evidence). AUTHORS' CONCLUSIONS: Small numbers of studies and participants in each comparison limited our confidence in the evidence. Sclerosing agents were more effective than placebo for resolution or improvement of telangiectasias but also caused more adverse events (moderate-certainty evidence), and may result in more pain (low-certainty evidence). There was no evidence of a benefit in resolution or improvement for any sclerosant compared to another or to laser. There may be more resolution or improvement of telangiectasias in the combined laser and polidocanol group compared to polidocanol alone (low-certainty evidence). There may be differences between treatments in adverse events and pain. Compared to other sclerosing agents polidocanol probably causes less pain; STS resulted in more hyperpigmentation, matting and probably pain; foam may cause more matting (low-certainty evidence); laser treatment may result in less hyperpigmentation (moderate-certainty evidence). Further well-designed studies are required to provide evidence for other available treatments and important outcomes (such as recurrence, time to resolution and delayed adverse events); and to improve our confidence in the identified comparisons.
Assuntos
Telangiectasia , Veias , Feminino , Humanos , Prurido/tratamento farmacológico , Escleroterapia , Telangiectasia/terapiaRESUMO
Telangiectases of the nose are of esthetic concern and treatment is warranted. The study provides the results of 5 years of treatment of telangiectases of the nose region with the long-pulsed Nd:YAG 1,064 nm laser. A retrospective analysis was conducted in patients of Fitzpatrick skin type II-V. Exclusion criteria were patients with a previous history of treatment of the nose region, pregnant or lactating patients or patients with unrealistic expectations regarding the treatment risks, limitations and results. Standardized photographs were obtained before each session and at least 2 months after the last treatment session. A long-pulsed Nd:YAG 1,064 nm laser was used with a spot size of 2.5mm, fluence of 100 - 175 J/cm2, pulse duration of up to 135ms and repetition rate of 2-4 Hz. The follow-up ranged from 2 months to 5 years. The number of laser sessions varied from 1 to 5 monthly. Assessment was made by comparing pre-treatment and post-treatment photographs by two independent specialists and also by the patients' own assessment. All patients presented improvement of the vascular alterations. Evaluation of independent specialists as well as the evaluation of the patients themselves showed a high degree of satisfaction with the treatment. The treatment presented only few transitory side effects. Treatment of telangiectasia on the nose skin with the long-pulsed Nd:YAG 1,064 nm laser demonstrated to be safe and effective even in darker pigmented skin. The major limitation of this study is its retrospective nature.
Assuntos
Terapia a Laser , Lasers de Estado Sólido , Terapia com Luz de Baixa Intensidade , Telangiectasia , Feminino , Humanos , Lactação , Lasers de Estado Sólido/uso terapêutico , Estudos Retrospectivos , Telangiectasia/terapia , Resultado do TratamentoRESUMO
OBJECTIVE: Sclerotherapy for the treatment of varicose veins is one of the most common medical procedures performed in the Western world, and hyperpigmentation is one of the most frequent, dreaded, minor adverse events. There has recently been some interest in investigating the inflammatory response of the local endothelium after sclerotherapy and the possible benefits of venoactive drugs because of their pleiotropic properties. The aim of this study was to evaluate whether adding a venoactive drug (sulodexide) to the standard sclerotherapy treatment protocol for patients with varicose veins can reduce the occurrence of postsclerotherapy hyperpigmentation. METHODS: We carried out a prospective, multicenter, randomized controlled trial with a parallel group design. It included 720 patients with telangiectasia, reticular veins, or varicose veins who were candidates for sclerotherapy. Patients with reflux in deep system or saphenous veins were excluded. Group A consisted of 354 patients who received an oral dose of sulodexide twice a day for 7 days before scheduled sclerotherapy; the treatment then continued for 3 months. Group B consisted of 366 patients who received the standard sclerotherapy protocol. Polidocanol was used as the sclerosing agent, and 20 to 30 mm Hg compression stockings were used in both groups for 7 days. Control photographs were taken, and a follow-up examination took place after 1 month and 3 months. Computer software was used to analyze the treated area for incidence of hyperpigmentation, total area of hyperpigmentation, skin tone increase in the hyperpigmented area, vein disappearance, and incidence of major bleeding. The sample size was calculated to give a statistical power of 80%. Student t-test and the χ2 test were used for comparative analyses, as appropriate. The level of significance was set at P < .05. RESULTS: A total of 609 patients completed the 3-month follow-up: 312 in group A and 297 in group B. After 1 month, the incidence of hyperpigmentation was 8.7% in group A and 14.8% in group B (P = .01). Group A developed an average area of hyperpigmentation of 10.7% compared with 18.2% in group B (P = .01), and the skin tone of the hyperpigmented area was lower in group A than in group B (P = .02). However, the latter difference was not significant after 3 months. The overall vein disappearance rate was similar in both groups. CONCLUSIONS: Our analysis shows that by adding a venoactive drug (sulodexide) to the standard sclerotherapy protocol, the occurrence of hyperpigmentation is reduced without affecting the desired therapeutic vein elimination response.
Assuntos
Glicosaminoglicanos/uso terapêutico , Hiperpigmentação/prevenção & controle , Polidocanol/efeitos adversos , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Pigmentação da Pele/efeitos dos fármacos , Telangiectasia/terapia , Varizes/terapia , Adulto , Feminino , Glicosaminoglicanos/efeitos adversos , Humanos , Hiperpigmentação/diagnóstico , Hiperpigmentação/etiologia , Masculino , México , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do TratamentoRESUMO
The aim of the case report was to discuss generalised oedema in a patient with lipoedema and obesity, describing a novel concept of a stage 0 lymphoedema that was denominated as subclinical systemic lymphoedema. A 35-year-old female patient reported to the clinic due to telangiectasia of the lower limbs and leg pain that increased in the heat and when she spend a lot of time in a standing position. The patient had a physical appearance of lipoedema involving the upper and lower limbs associated with a family history of lipoedema, Body Mass Index (BMI) of 33.9 kg/m2 . Bioelectrical impedance analysis demonstrated important changes in intracellular and extracellular water as well as in all limbs and the thorax beyond the limits of normality. The telangiectasia was treated with sclerotherapy and pateint was instructed to lose weight and perform physical activity.
Assuntos
Humanos , Feminino , Adulto , Escleroterapia , Linfedema/terapia , Telangiectasia/terapia , ObesidadeRESUMO
BACKGROUND: Liquid sclerotherapy is the treatment of choice for telangiectasias. However, pain caused by the procedure is a barrier to treatment adherence by patients. OBJECTIVE: To evaluate the use of skin cooling for the management of pain in patients undergoing liquid sclerotherapy. METHODS AND MATERIALS: A total of 230 lower limbs from 115 patients with telangiectasias classified as C1 according to the Clinical-Etiological-Anatomical-Pathophysiological classification were included. Patients underwent liquid sclerotherapy with and without skin cooling during the procedure. Pain was assessed using a visual analog scale, applied immediately after the procedure, according to each lower limb area treated. RESULTS: Visual analog scale pain scores were significantly lower for sclerotherapy with the use of cooling for pain management during the procedure than for sclerotherapy without cooling both in the thigh and leg (p < .0001). CONCLUSION: The use of a cooling system is effective in reducing pain in patients undergoing liquid sclerotherapy of telangiectasias, providing more comfort to patients.
Assuntos
Crioterapia , Dor Processual/terapia , Soluções Esclerosantes/administração & dosagem , Escleroterapia/efeitos adversos , Telangiectasia/terapia , Adulto , Idoso , Feminino , Humanos , Perna (Membro) , Pessoa de Meia-Idade , Manejo da Dor/métodos , Medição da Dor , Limiar da Dor/fisiologia , Dor Processual/diagnóstico , Dor Processual/fisiopatologia , Soluções Esclerosantes/efeitos adversos , Escleroterapia/métodos , Coxa da Perna , Resultado do Tratamento , Adulto JovemRESUMO
A 78-year-old woman with a history of bilateral hip replacements presented with an ill-defined erythematous plaque with foci of reticulated and indurated areas on the left thigh. Initially, a few weeks after her surgery, a small area of erythema appeared overlying the incision site. Over a 6-month period, the erythema slowly expanded before stabilizing in size (Figure 1). There was no pruritus, pain, or warmth. Orthopedic evaluation found no evidence of infection or malfunction of the hip prosthesis. A skin biopsy revealed telangiectasia of the superficial vessels. Based on the clinical and histopathologic findings, a diagnosis of reticular telangiectatic erythema (RTE) was established. An ultrasound scan revealed a greater trochanteric bursa distended by a chronic, organized hematoma measuring 12 cm at greatest dimension, secondary to a full-thickness tear of the left gluteus minimus (Figure 2), establishing the underlying cause of the RTE in this patient.
Assuntos
Artroplastia de Quadril/efeitos adversos , Eritema/etiologia , Hematoma/etiologia , Complicações Pós-Operatórias/etiologia , Telangiectasia/etiologia , Idoso , Doença Crônica , Eritema/diagnóstico , Eritema/terapia , Feminino , Hematoma/diagnóstico , Hematoma/terapia , Humanos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Telangiectasia/diagnóstico , Telangiectasia/terapiaRESUMO
BACKGROUND: Telangiectasias are defined as small venules abnormally dilated, located in the intradermal portion of the skin, of reddish or bluish tinge, their diameter not exceeding 1âmm; they are classified by the American Venous Forum as mild venous disease CEAP C1. Conventional treatment consists of chemical sclerotherapy, considered a minimally invasive technique with rapid clinical recovery. A wide variety of sclerosing solutions can be used for this purpose. METHODS/DESIGN: This project intends to include 96 patients that will be randomized to a triple-blind study. Inclusion criteria are women between 18 and 65 years, with telangiectasia on the lateral thigh. Male patients, female patients with chronic venous disease CEAP 2 to 6, women with allergies, pregnant, breastfeeding, with any type of skin problems or any decompensated clinical disease will be excluded. All patients included will be submitted to venous ultrasound mapping in order to rule out venous disease not clinically visible, deep venous system insufficiency, and insufficiency of the ostial valve of the great saphenous vein. One group will be treated with glucose 75% solution and the other will receive polidocanol 0.2% diluted in glucose 70%. Each patient will receive only 1 treatment session in 1 single member. The volume of sclerosing solution will not exceed 5âmL and the treatment area will be limited to a region of 150âcm on the lateral thigh. Clinical follow-up will be: 1 initial visit, when the clinical report will be filled; photographic record and treatment with sclerotherapy (D0); follow-up visits after 7 and 60 days (D7 and D60, respectively), always with clinical and photographic documentation. DISCUSSION: The project intends to evaluate the efficacy and safety of sclerotherapy in eliminating telangiectasia in a predetermined area in order to establish efficacy and safety parameters for the treatments presented. CONCLUSION: This protocol for clinical trial will provide date to determine the efficacy and safety of sclerotherapy with the solutions presented. TRIAL REGISTRATION IDENTIFIER: ClinicalTrial.gov NCT02657252 Date: 01/12/2016 (retrospectively registered).
Assuntos
Glucose/uso terapêutico , Polietilenoglicóis/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Telangiectasia/terapia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polidocanol , Projetos de Pesquisa , Coxa da Perna , Adulto JovemRESUMO
BACKGROUND: The prevalence of chronic venous disease is high and occurs more frequently in females. According to the clinical, etiological, anatomical, and pathological classification (CEAP) definition, the reticular veins are included in the C1 class and are mainly associated with aesthetic complaints. Several invasive techniques are used for treatment, including mini phlebectomy, laser ablation, and radiofrequency ablation. However, a wide range of sclerosing agents may serve as minimally invasive alternatives, promoting chemical sclerosis of the vein wall. Although this technique is routinely performed around the world, there is no consensus on the most efficacious and safe chemical agent to be used. METHODS/DESIGN: Inclusion criteria are women between 18 and 69 years old with at least 10 cm long reticular veins in the lower limbs, on the outer side of the leg/thigh. Patients with CEAP 2 to 6, or with allergies, pregnancy, performing breastfeeding, or with any dermatologic or clinical problems will be excluded. Patients with venous ultrasound mapping showing involvement of saphenous trunks and/or a deep venous system will also be excluded. Patients will be randomized into two groups, one receiving 75% pure glucose and the other group receiving 0.2% polidocanol diluted in 70% glucose. Just one limb and one session per patient will be performed. The sclerosing agent volume will not exceed 5 mL. Clinical follow-up will include visits on days 7 and 60, always with photographic documentation. DISCUSSION: This project aims to enroll 96 patients and subject them to a double-blind treatment after the randomization process. The design is intended to evaluate efficacy through a primary end point and safety through a secondary end point. Forty-eight patients have currently been enrolled. Preliminary results for these patients showed that 25 received treatment, 2 were excluded, and 22 returned after 7 days and showed no greater adverse events. To date, establishing efficacy criteria has not been possible, and no patients have reached the 60-day return point. These data may help doctors choose the best chemical agent for the treatment of reticular veins. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02054325, 3/02/2014.
Assuntos
Solução Hipertônica de Glucose/administração & dosagem , Extremidade Inferior/irrigação sanguínea , Polietilenoglicóis/administração & dosagem , Projetos de Pesquisa , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Telangiectasia/terapia , Varizes/terapia , Adolescente , Adulto , Idoso , Brasil , Doença Crônica , Protocolos Clínicos , Método Duplo-Cego , Feminino , Solução Hipertônica de Glucose/efeitos adversos , Humanos , Pessoa de Meia-Idade , Polidocanol , Polietilenoglicóis/efeitos adversos , Estudos Prospectivos , Soluções Esclerosantes/efeitos adversos , Escleroterapia/efeitos adversos , Telangiectasia/diagnóstico , Fatores de Tempo , Resultado do Tratamento , Varizes/diagnóstico , Adulto JovemRESUMO
BACKGROUND: Lower extremity telangiectasia affects approximately 40% of women. The demand for aesthetic treatment of these veins continues to grow. Few studies have compared laser and sclerotherapy to treat leg telangiectasias. OBJECTIVE: To compare the efficacy of conventional sclerotherapy and neodymium-doped yttrium aluminum garnet (Nd:YAG) laser in the treatment of leg telangiectasias. METHODS AND MATERIALS: Thirty women were enrolled in the study. One leg was randomly assigned laser treatment and the other sclerotherapy with 75% glucose solution. All patients were photographed before and after treatment. The applying physician and two independent observers rated photographic improvement of the treated areas. Complications and adverse effects were noted during follow-up. Patients answered a questionnaire that addressed pain, clearing of the vessels, and satisfaction with the results. RESULTS: There was a significant difference between the modes of treatment regarding pain. Twelve patients using laser and 16 using sclerotherapy considered the clearing of the vessels to be good to excellent after three sessions of both laser and scleratherapy. Mean scores after photographic assessment were 7.9 for laser and 7.0 for sclerotherapy. CONCLUSION: Lower extremity telangiectases may be treated equally well using Nd:YAG 1064-nm laser or conventional sclerotherapy.
Assuntos
Lasers de Estado Sólido/uso terapêutico , Perna (Membro)/irrigação sanguínea , Escleroterapia , Telangiectasia/terapia , Adulto , Idoso , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Método Simples-CegoRESUMO
Congenital Cutis Marmorata Telangiectasia (CCMT) is a skin vascular malformation of low flow compromi-sing venous and capillary vessels. Of unknown origin, it shows in an estimated 1/3 000 births. In over 90 percent of cases it can be seen since birth, although it can appear on the first few days after. Clinical manisfestation includes poorly defined reticular erythematopurpureal maculae, frequently associated to ßreas of segmental, asymetric skin atrophy, most often seen in the lower extremitie. The diagnosis is mostly clinical, important to make as it is associated in 30 percent) of cases to other congenital abnormalities. No specific treatment is required, with spontaneous resolution. Prognosis is good, depending on the associated malformations. Four patients are described in this paper, as a reminder of the clinical entity.
El Cutis Marmorata Telangiectático Congénito (CMTC) es un tipo de malformación vascular cutánea de bajo flujo que compromete vasos capilares y venosos. Su causa es desconocida y tiene una incidencia estimada de 1/3 000 recién nacidos. En más del 90 por ciento> de los casos se presenta desde el nacimiento. Sin embargo, también puede aparecer en los primeros días de vida. Clínicamente se observan máculas eritematovioláceas, de aspecto reticulado, de bordes mal definidos, asociado frecuentemente a zonas de atrofia cutánea, de distribución segmentaria, asimétricas. Se ubican de preferencia en las extremidades, siendo las inferiores las más afectadas. El diagnóstico es fundamentalmente clínico y su importancia radica en que aproximadamente el 30 por ciento> de los casos se asocia a otras anomalías congénitas, la mayoría de carácter leve. No tiene un tratamiento específico, ya que evoluciona en poco tiempo a la resolución en forma espontánea. El pronóstico es generalmente bueno, aunque depende de las anomalías asociadas. En este artículo se presentan cuatro pacientes cuya historia clínica es compatible con este diagnóstico, para dar a conocer esta entidad clínica a los pediatras.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Dermatopatias Vasculares/congênito , Dermatopatias Vasculares/diagnóstico , Telangiectasia/congênito , Telangiectasia/diagnóstico , Diagnóstico Diferencial , Dermatopatias Vasculares/terapia , Prognóstico , Estudos Retrospectivos , Telangiectasia/terapiaRESUMO
Relato de caso de um paciente com telangiectasia justafoveal idiopática (TJI) tipo 1A, no olho direito, submetido a 4 mg de triancinolona intravítrea. O resultado foi avaliado por meio da acuidade visual e da tomografia de coerência óptica. A acuidade visual e a espessura retiniana macular medida na tomografia de coerência óptica, antes da injeção intravítrea de triancinolona, foram respectivamente de 20/100 e 569 æm e, após três semanas do tratamento foram de 20/60 e 371 æm e na sexta semana de 20/100 e 614 æm. A estabilização da parede vascular obtida com injeção intravítrea de triancinolona proporciona melhora transitória da visão e do edema macular em olhos com TJI-1A. Não foi demonstrada nenhuma ajuda permanente à fotocoagulação prévia.
Case report of one idiopathic juxtafoveal telangiectasis (IJT) 1A patient whose right eye was treated with a 4 mg intravitreal triamcinolone acetonide injection. The outcome was evaluated by visual acuity and optic coherence tomography. The visual acuity and the caliper retinal thickness before triamcinolone injection were respectively 20/100 and 569 æm, and 20/60 and 371 æm after three weeks and 20/100 and 614 æm after six week of follow-up. The stabilization of the vascular wall due to the intravitreal triamcinolone injection leads to a transitory improvement in vision and reduction in macular edema in the TJI 1A eyes. No permanent help by the photocoagulation could be shown.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Glucocorticoides/administração & dosagem , Doenças Retinianas/tratamento farmacológico , Vasos Retinianos/efeitos dos fármacos , Telangiectasia/terapia , Triancinolona Acetonida/administração & dosagem , Injeções , Edema Macular/tratamento farmacológico , Vasos Retinianos/patologia , Fatores de Tempo , Acuidade Visual , Corpo Vítreo/efeitos dos fármacosRESUMO
BACKGROUND: A new noninvasive vein imaging device initially developed for phlebotomy has been tested for the first time for vein treatment. This unique device captures a near infrared vein image, processes it, and projects it onto the skin using green light. OBJECTIVE: To perform the first clinical tests of the device in phlebology. MATERIALS AND METHODS: A pilot study on 23 subjects with varicose veins and telangiectasias was performed. The VeinViewer prototype (V-V-P; Luminetx Corp., Memphis, TN) was tested in five situations: diagnosing feeder veins with the V-V-P, comparison between the V-V-P and ultrasound, marking varicose veins with or without the device, phlebectomy using the V-V-P, and the use of laser and sclerotherapy guided by the V-V-P. RESULTS: One hundred percent of subjects had feeder veins identified by the V-V-P. The ultrasound machine detected fewer feeder veins than the V-V-P, and the device identified more veins than the naked eye in all subjects. The V-V-P could help in finding feeder veins during phlebectomy and in guiding laser and sclerotherapy treatments. CONCLUSION: The device could identify veins that were invisible to the naked eye and too shallow for ultrasound detection. The V-V-P may help find feeder veins and may also help various types of vein treatments.
Assuntos
Raios Infravermelhos , Telangiectasia/diagnóstico , Transiluminação/instrumentação , Varizes/diagnóstico , Humanos , Terapia a Laser , Projetos Piloto , Escleroterapia , Telangiectasia/diagnóstico por imagem , Telangiectasia/terapia , Ultrassonografia , Varizes/diagnóstico por imagem , Varizes/terapiaRESUMO
BACKGROUND: Despite different telangiectasia treatments in the lower limbs, there is no method standardization for results assessment, making comparison between the existing treatments conflicting. OBJECTIVE: To compare the assessment carried out by a group of specialists with the assessment carried out by a computer program, according to clearance degree of telangiectasias during treatment by sclerotherapy. MATERIALS AND METHODS: Nineteen patients (21 studied areas) with telangiectasias of thighs and popliteal fossa were assessed, with a mean age of 37.5 (21-59) years old, all female. The pre- and posttreatment photos were standardized as per distance, light exposure, and aperture time. The sclerotherapy sessions were performed with 75% glucose. The clearance degree of telangiectasias was judged by a group of six doctors and by a computer program that analyzed the initial and final photos. The results of such assessment were compared according to concordance and correlation. RESULTS: There was no statistical difference between the assessments carried out by the specialists and the assessments carried out by the computer program according to the sclerotherapy results. CONCLUSION: The assessment carried out by the computer program was equivalent to the assessment carried out by the specialists in the judgment of clearance degree of telangiectasias of the lower limbs.
Assuntos
Fotografação , Escleroterapia , Telangiectasia/terapia , Adulto , Feminino , Humanos , Aumento da Imagem , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Processamento de Sinais Assistido por Computador , Telangiectasia/patologiaRESUMO
OBJETIVOS: A escleroterapia por método químico é o tratamento mais tradicional para eliminar as telangiectasias. Há varias décadas, é realizada em consultório, mas com alto índice de abandono devido ao seu caráter prolongado, doloroso e, por isso, pouco eficaz. Uma grande proporção destes pacientes apresenta também insuficiência de tributárias, ou seja, veias varicosas com indicação de fleboextração e que serão submetidas à cirurgia. O objetivo deste trabalho é descrever a opção de tratamento combinado da cirurgia de varizes com a escleroterapia das telangiectasias no mesmo ato. MÉTODOS: De janeiro de 1998 a março de 2002, 213 pacientes (426 membros inferiores) foram submetidos ao tratamento das telangiectasias por meio de injeção de glicose hipertônica durante a cirurgia de varizes. RESULTADOS: Mais de 90 por cento dos pacientes relataram altos índices de satisfação estética. A escleroterapia complementar foi necessária em 165 pacientes, para atingir plena satisfação estética durante o seguimento. Não foram constatados casos de tromboflebites superficiais, nem de trombose venosa profunda. Também não houve relatos de complicações graves. Em 10 por cento dos casos, foram necessárias pequenas drenagens de microtrombos residuais. O índice de manchas hipercrômicas não ultrapassou 3 por cento. Apenas um paciente desenvolveu uma pequena úlcera no dorso do pé (0,2 por cento), que cicatrizou espontaneamente. CONCLUSÕES: O tratamento combinado da cirurgia de varizes com a escleroterapia das telangiectasias dos membros inferiores é uma alternativa para os pacientes que desejam um resultado mais rápido e indolor. As sessões múltiplas com injeção de glicose hipertônica são uma opção segura e eficaz.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Telangiectasia/terapia , Varizes/cirurgia , Escleroterapia/métodos , Técnicas Cosméticas , Procedimentos Cirúrgicos Ambulatórios/métodos , Glucose/uso terapêuticoRESUMO
Case report of one idiopathic juxtafoveal telangiectasis (IJT) 1A patient whose right eye was treated with a 4 mg intravitreal triamcinolone acetonide injection. The outcome was evaluated by visual acuity and optic coherence tomography. The visual acuity and the caliper retinal thickness before triamcinolone injection were respectively 20/100 and 569 microm, and 20/60 and 371 microm after three weeks and 20/100 and 614 microm after six week of follow-up. The stabilization of the vascular wall due to the intravitreal triamcinolone injection leads to a transitory improvement in vision and reduction in macular edema in the TJI 1A eyes. No permanent help by the photocoagulation could be shown.
Assuntos
Glucocorticoides/administração & dosagem , Doenças Retinianas/tratamento farmacológico , Vasos Retinianos/efeitos dos fármacos , Telangiectasia/terapia , Triancinolona Acetonida/administração & dosagem , Humanos , Injeções , Edema Macular/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Vasos Retinianos/patologia , Fatores de Tempo , Acuidade Visual , Corpo Vítreo/efeitos dos fármacosRESUMO
La trelangiectasia Macularis Eruptiva Perstans (TMEP) es una rara forma de mastocitosis cutánea que se presenta casi con exclusividad en la población adulta. Es una enfermedad crónica causada por el incremento de mastocitos en distintos tejidos. Los signos y síntomas de la enfermedad son secundarios a la liberación de histamina los diferentes óghanos, siendo la piel el más frecuente afectado. Presentamos 11 casos clínicos de TMEP y realizamos una revisión bibliográfica(AU)
Assuntos
Humanos , Masculino , Feminino , Telangiectasia/diagnóstico , Telangiectasia/terapia , Mastocitose/diagnóstico , Mastocitose/terapia , Estudos Retrospectivos , RevisãoRESUMO
BACKGROUND: Cutaneous hyperpigmentation after venous sclerotherapy is an adverse sequelae of difficult management. OBJECTIVE: To evaluate the degree of depigmentation with the use of deferoxamine mesylate (DM) in patients with postsclerotherapy hyperpigmentation treated with polydocanol (POL) for telangiectasias and reticular veins (0.2-5 mm diameter) and varicose veins (5-8 mm diameter). METHODS: The experimental group of 36 female patients (mean age 37 years) was divided in two groups. Group I consisted of 30 patients who were treated with POL at 0.25-0.50% concentration for telangiectasias and reticular veins. Group II consisted of six patients with prolonged postsclerotherapy hyperpigmentation (more than 6 months after treatment) in varicose veins that had been treated with POL at 1.5% concentration each week. Groups I and II were injected with DM 500 mg subcutaneously once a week until 81-100% depigmentation was reached. In group I, DM was injected at the time of sclerotherapy. These groups were compared to their respective control groups with similar conditions but allowing spontaneous depigmentation without DM. Evaluation was undertaken clinically and photographically, and the number of days required to reach the desired depigmentation of 81-100% was determined. RESULTS: When DM was used, depigmentation of 81-100% was observed in group I at 27 days, and for group II in 46 days. In each control group, similar depigmentation was seen at 150 +/- 19 and 255 +/- 11 days, respectively. Comparing results, there was a reduction in the time to depigmentation of 82% for each group (P <.0001). CONCLUSION: The weekly subcutaneous administration of DM 500 mg reduces the time to depigmentation by 82% in patients with postsclerotherapy cutaneous hyperpigmentation treated for telangiectasias and reticular veins and prolonged postsclerotherapy hyperpigmentation in varicose veins. In this study we could not explain why such variability exists in the length of time to spontaneous depigmentation.
Assuntos
Desferroxamina/administração & dosagem , Hiperpigmentação/induzido quimicamente , Escleroterapia/efeitos adversos , Telangiectasia/terapia , Varizes/terapia , Adulto , Esquema de Medicação , Feminino , Seguimentos , Humanos , Hiperpigmentação/tratamento farmacológico , Injeções Subcutâneas , Estudos RetrospectivosAssuntos
Humanos , Adolescente , Adulto , Pré-Escolar , Criança , Pessoa de Meia-Idade , Idoso , Hemorragia Gastrointestinal/classificação , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/fisiopatologia , Hemorragia Gastrointestinal/diagnóstico , Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/epidemiologia , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/fisiopatologia , Doença Diverticular do Colo/sangue , Ectasia Vascular Gástrica Antral/etiologia , Ectasia Vascular Gástrica Antral/diagnóstico por imagem , Ectasia Vascular Gástrica Antral/complicações , Ectasia Vascular Gástrica Antral/fisiopatologia , Ectasia Vascular Gástrica Antral/terapia , Ectasia Vascular Gástrica Antral/sangue , Telangiectasia/etiologia , Telangiectasia/fisiopatologia , Telangiectasia/genética , Telangiectasia/sangue , Telangiectasia/terapia , Telangiectasia/cirurgia , Hemangioma/fisiopatologiaRESUMO
El reconocimiento del cáncer como un factor que puede provocar un trastorno por estrés. La última sección analiza la influencia del estrés en el grupo de profesionales dedicados a proporcionar atención al paciente oncológico haciendo alusión a distintas estrategias para mejorar su capacidad postraumático ha permitido la exploración de dicho padecimiento en pacientes oncológicos y en sus familias, mostrando una prevalencia que va de 1.4 por ciento hasta 54 por ciento. El presente trabajo realiza una breve revisión general del trastorno y se enfoca a describir los hallazgos más recientes en torno al paciente con cáncer. Se delinean los aspectos básicos de su detección en el setting oncológico, se describen algunos casos clínicos, y se discute su manejo farmacológico y psicoterapéuticode coping y prevenir el síndrome de burnout en el equipo médico. Finalmente se discuten las aplicaciones futuras de esta área de estudio.