식도 정맥류 출혈에 대한 내시경적 경화요법의 장기관찰 결과

정정명,박정현,구대식,김규환,이상혁,최하진 인제대학교 1992 仁濟醫學 Vol.13 No.4

In 1939, Crafoord and Frenckner originally reported the sucessful use of endoscopic sclerotherapy by paravasal injection of quinine as a sclerosant to control acute variceal bleeding of a 16-year-old girl. After the introduction of shunt operation as a treatment of acute variceal bleeding, the endoscopic sclerotherapy became less adoptable for a while. But since 1970, with the development of the technique, equipments and newer sclerosants, endoscopic sclerotherapy became favorable as a treatment of acute variceal bleeding. Since 1980 in Korea, endoscopic sclerotherapy as a treatment of acute variceal bleeding has been practiced in many clinics. However, there are few reports of the prognosis and survival rates of the patients who received endoscopic sclerotherapy, and there are many differences among those reports. Now we report the results of the clinical observation and the survival rates of 125 patients who have been followed for several years(from June 1985 to June 1991) by the Department of Internal Medicine, Paik Hospital, Inje University, Pusan. The results are as follows. 1.125 patients(103 male and 22 female) with bleeding esophageal varices were treated by endoscopic sclerotherapy and followed over a period ranging 3∼6 years. Among them, 24 patients were Child class A, 43 Child class B and 58 Child class C. In the degrees of varices, 65 patients showed grade III and 56 patients grade IV respectively, accounting for 97% of all patients. 2.The most prevalent underlying disease was post-necrotic liver cirrhosis in 84 patients, alcoholic liver cirrhosis in 12 patients, chronic active hepatitls in 4, idiopathic portal hypertension in 4 and unknown in 10 patients. 3.Variceal rebleeding after sclerotherapy occorred in 51 patients(40.8%) ; rebleeding occurred within 6 months in 20 patients(16.0%), and after 6 months in 31 patients(24.8%). 4.Complications after slcerotherapy occurred in 16 patients(12.8%) ; pneumonia 6 patients, esophageal ulcer 4, esophageal stricture 3, and mediastinitis 3 patients. 5.Fifty-four patients(43.2%) were dead during the clinical observation period : 24 patients(19.2%) were died within 1 month after sclerotherapy, and 30 patients(24.0%) after 1 month. The most prevalent cause of death was hepatic failure accounting for half of all deaths. 6.The survival rate of the patients who were treated with sclerotherapy was calculated by Kaplan-Meier method. One year survival rate was 75%, 5 year survival rate was 40%. Patients in he Child grade A and B showed much higher survival rate than the patients in the Child grade C. With our experience, one third of the patients died within 2 years after sclerotherapy and another one third died 2-5 years after sclerotherapy, but the rest one third survived mostly over 5 years after sclerotherapy. In conclusion, endoscopic sclerotherapy of the aucte variceal bleeding shows still higher frequency of variceal rebleeding and does not affect the overall mortality rate, but endoscopic sclerotherapy is estimated to be an excellent method of choice in treatment of acute variceal bleeding with its excellent hemostatic effect and less side effects.

Comparison of Alcohol-Retention Sclerotherapy for Simple Cysts: Single-Session Prolonged and Multi-Session Techniques

박소희,양희철,신석균,김도중,박수미 대한영상의학회 2009 대한영상의학회지 Vol.61 No.4

Purpose: To compare the therapeutic results of single-session prolonged sclerotherapy to a multi-session technique in patients with renal cysts. Materials and Methods: We reviewed 47 renal cysts of 47 patients treated by sclerotherapy. All cysts were diagnosed by ultrasonography or CT. Twenty-seven cysts (group 1) were treated by multi-session sclerotherapy, which consisted of 95% alcohol retention (20-30% of the cyst volume) for 20 minutes after aspiration of the cyst fluid, which was repeated at a 24 hour interval until the daily drained fluid decreased to 10 mL. In addition, 20 cysts (group 2) were treated by single-session prolonged sclerotherapy, which consisted of one treatment session with alcohol retention (30-50% of cyst volume) for 2 hours. All patients had a follow-up ultrasonography at 3 to 6 month intervals for at least 6 months after the procedure. The therapeutic response of the treatment was classified as either a complete success (no residual cyst), partial success (diameter reduction, >50%), or failure (diameter reduction, <50%). Results: The complete success rates in each group were 41% and 40%, along with partial success rates of 59% and 60%. No cases of treatment failure were observed in either group. In addition, no statistical difference in the therapeutic success rate was observed between two groups (p = 0.317). Conclusion: Of the two sclerotherapy techniques, we recommend the single-session prolonged sclerotherapy, considering its comparable therapeutic outcome, patient comfort and reasonable cost-effectiveness.

난소의 가성 낭종의 보존적 치료로서 경화술의 효용성

안성희,유승철,조미영,김미란,황경주,유희석,Ahn, Sung-Hee,Yoo, Seung-Chul,Jo, Mi-Yeong,Kim, Mi-Ran,Hwang, Kyung-Joo,Ryu, Hee-Suk 대한생식의학회 2002 Clinical and Experimental Reproductive Medicine Vol.29 No.4

Objective: To evaluate the efficacy of sclerotherapy for conservative treatment of ovarian pseudocyst. Methods: Patients with ovarian pseudocyst who had undergone sclerotherapy at Ajou University Hospital from February, 1997 to March, 2002 were included in this study. Sclerotherapy was performed as follows: Under intravenous analgesia, the cyst was irrigated with dehydrated alcohol after aspiration under transvaginal sonography. The aspirated contents and alcohol irrigated contents were sent for cytologic examination. Results: 71 patients with ovarian pseudocyst were performed sclerotherapy. All but 2 patients were followed up for 0.5 to 33 months with transvaginal sonography and pelvic examination. Mean age of the patients was 40 years old. Mean size of the pseudocyst was 8.0 cm, mean amount of aspiration fluid was 179.8 ml, and average follow-up duration was 6.0 months. All had abdominal or pelvic surgical history and 38 patients (58.9%) of them had undergone hysterectomy. 44 of 71 patients (62.0%) were performed sclerotherapy only one time. 27 patients (38.0%) recurred and were undergone more than one time. Complication was not occurred in all cases. Conclusions: We concluded that although pseudocyst after sclerotherapy has high recurrence rate, sclerotherapy was an safe and effective method for conservative treatment of ovarian pseudocyst.

OK-432와 99% Alcohol을 이용한 양성 경부 낭종의 경화치료 효과

김명구 대한이비인후과학회 2005 대한이비인후과학회지 두경부외과학 Vol.48 No.9

Background and Objectives:In most cases of benign neck cysts, surgical excision has been considered the definite treatment.However, it is difficult to excise cysts completely in some cases. In view of this, non-surgical treatment for these lesions has been attempted with sclerosing agents. Some authors presented case reports on using OK-432 or 99% Alcohol sclerotherapy. In this study, we compared OK-432 and 99% Alcohol sclerotherapy with regards to effectiveness and complications associated in treating benign neck cyst. Subjects and Method:We retrospectively reviewed 29 patients who had undergone sclerotherapy with OK- 432 or 99% Alcohol for benign neck cyst, such as ranula, lymphangioma, thyroglossal duct cyst and branchial cleft cyst. Information was gathered with respect to age, sex, number of injections, post-sclerotherapy side effects and outcome of treatments. Result:In the OK-432 sclerotherapy, 16 patients (69.6%) showed complete response, and 5 patients (20.7%) showed intermediate response. No response was seen in 2 patients (9.7%). In the 99% Alcohol sclerotherapy, 5 patients (83.3%) showed complete response, and 1 patient (16.7%) showed intermediate response. The side effects observed from intracystic injection therapy with OK-432 and 99% Alcohol were fever (55.2%) and localized pain (44.8%). In the OK-432 sclerotherapy, 18 patients (78.3%) had complications, In the 99% Alcohol, 3 patients (50%) had complications. However, these complications spontaneously disappeared after several days in all the cases. Conclusion:The results showed that OK-432 and 99% Alcohol injection is an effective and safe treatment for benign neck cyst. The effectiveness of OK-432 and 99% Alcohol injection is very similar.

식도 정맥류출혈의 최신치료

정정명 인제대학교 1982 仁濟醫學 Vol.3 No.1

급성 식도 정맥류출혈의 치료법을 다음과 같이 요약해서 기술할 수 있다. 첫째 환자가 병원에 내원시 환자를 내과적 치료로써 Vasopressin을 주입하고, 또 Balloon Tam ponade을 사용하여 혈액손실을 최소한으로 방지해야 한다. 그리고, 병원에 입원중 곧 내시경으로 진단을 확인하고 동시에 Sclerotherapy가 요망되며 이것이 불가능할 경우 24시간동안 Balloon Tamponade을 재차 시행하고, 24시간후 Sclerotherapy를 시행하여 나머지 출혈을 조절해야 하는 것이다. 재 출혈 방지를 위한 방법으로서는 처음 Sclerotherapy를 한 6개월후 다시 Sclerotherapy를 해주거나 외과적으로 Warren과 Zeppa의 distal splenorenal Shunt를 해줌이 가장 좋은 예방법으로 사료된다. Various therapeutic methods in esophagus varices bleeding, surgical or non-surgical methods are tried with rather unfavorable results. Among these therapeutic procedures, the sclerotherapy of esophagus varices seems to be the most promising method at present moment. Immediately, after the esophageal varix begin to bleed, the vasopressin infusioon and the ballon tamponade should be intr oduced and let the tamponade be kept for 8 hours. After 8 hours'observation, the endoscopic sclerotherapy has to be performed. Soehendra has reported sclerotherapy in 170 cases of varices bleeding with 83% success rate during 11.2 months. Key Words : Esophagus Varices Bleeding Shunt Operation Vasopressin Balloon Tamponade Transhepatic Obliteration of Gastric Coronary Veim Laser Coagulation Endoscopic Sclerotherapy Warren and Zeppa's Distal Splenorenal Shunt

갑상선 낭종에서 Viscum Album을 이용한 경화치료 증례

이재하,이승원,박기남 대한갑상선학회 2023 International Journal of Thyroidology Vol.16 No.1

We report two cases of successful treatment of thyroid cystic nodules using Viscum Album extract as a sclerotherapy material. Both cases showed volume reduction of more than 50%, and it is possible that a higher dose injection resulted in a larger volume reduction. In terms of side effects, pain, hematoma, and dyspnea, which can occur in sclerotherapy, were not observed. Since sclerotherapy is a procedure that can be performed repeatedly, we expect that the procedure can be performed with less concern in terms of side effects, and there is a possibility as another alternative material that can be used for sclerotherapy.

출혈성 치핵에 대한 경화 요법의 효과

임석원,이광렬,유정준,박세영,김현식,이종균 대한대장항문학회 1995 Annals of Coloproctolgy Vol.11 No.3

식도정맥류 출혈에 내시경적 경화요법 후 합병된 상 장간막 정맥 혈전증 1예

김원덕,최광해,하정옥 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.2

The efficacy of injection sclerotherapy for treatment of acute esophageal variceal bleeding is well established. But several complications of endoscopic sclerotherapy have been reported. One of the complications is mesenteric venous thrombosis which develops when vasopressin is used for the sclerotherapy. We report a case of superior mesenteric venous thrombosis which developed after endoscopic sclerotherapy for control of esophageal variceal bleeding.

수지점액낭종 환자에서 유형 및 치료 반응에 대한 후향적 연구

정준우 ( Joon Woo Jung ),홍은혜 ( Eun Hye Hong ),백은주 ( Eun Joo Baek ),박은주 ( Eun Joo Park ),김광중 ( Kwang Joong Kim ),김광호 ( Kwang Ho Kim ) 대한피부과학회 2021 대한피부과학회지 Vol.59 No.10

Background: Digital mucous cysts (DMCs) are benign, occurring mainly on the fingers but rarely on the toes. Although the exact cause of DMC has not been identified, it is classified into two different types based on its pathogenesis and location. Surgical and nonsurgical procedures, including aspiration, sclerotherapy, steroid injection, cryotherapy, and CO2 laser, can be used to treat DMC. Objective: This study aimed to compare treatment response based on DMC type and evaluate its efficacy in surgical and nonsurgical (sclerotherapy) treatments. Methods: We retrospectively reviewed the electronic medical records of patients with DMC who visited our dermatology department between January 2010 and November 2020. Results: This study enrolled 39 patients having a mean age of 59.2 years. The proportion of female patients (21/39, 53.8%) was more than male (18/39, 46.2%). The DMC occurrence was more frequent in the fingers (32/39, 82.1%), especially in the index and middle fingers than in the toes (7/39, 17.9%). In sclerotherapy, DMC in the distal interphalangeal joint (DIPJ) required more treatment than that in the proximal nail fold (PNF) (p<0.05). The number of treatments using sclerotherapy was higher compared to that of surgical treatments (p<0.05). Conclusion: The DIPJ type of DMC patients was more difficult to treat using sclerotherapy than the PNF type. Moreover, surgical treatment has a better response than sclerotherapy. (Korean J Dermatol 2021;59(10):742∼748)

CT-Guided Sclerotherapy for Simple Renal Cysts: Value of Ethanol Concentration Monitoring

Jin Hong Yu,Yong Du,Yang Li,Han Feng Yang,Xiao Xue Xu,Hou Jun Zheng 대한영상의학회 2014 Korean Journal of Radiology Vol.15 No.1

Objective: The aim of our study was to evaluate the differences between sclerotherapy with and without ethanol concentration monitoring for the treatment of simple renal cysts. Materials and Methods: Sixty-seven patients with 70 simple renal cysts were randomly assigned to two groups in a 12-month prospective controlled trial. One group (group A) was treated with computed tomography (CT)-guided sclerotherapy without ethanol concentration monitoring (33 patients with 35 cysts), whereas the other group (group B) had ethanol concentration monitoring (34 patients with 35 cysts) during the procedure. Treatment outcomes between the two groups were compared 12 months later with follow-up ultrasound examination. Results: After the 12-month follow-up period, the overall success rate was 74.3% in group A and 94.3% in group B (p = 0.022). The mean cyst size before and after treatment was 8.6 ± 2.0 cm and 2.3 ± 2.9 cm, respectively, in group A, and 8.4 ± 1.7 cm and 0.8 ± 1.9 cm, respectively, in group B. The final size of the cysts in group B was significantly smaller than that in group A (p = 0.015). The likelihood of treatment with ethanol concentration monitoring being successful was approximately 16 times higher than without ethanol concentration monitoring (p = 0.026; odds ratio = 15.7; 95% confidence interval: 1.38-179.49). There were no major complications in either group. Conclusion: Monitoring of Hounsfield units (HU) of ethanol by CT is an effective method in the treatment of simple renal cysts with ethanol sclerotherapy. The ethanol sclerotherapy procedure can be terminated at the point of clear fluid aspiration because the HU (-190) of CT scan corresponds to it.