| BackgroundMcAusland firstly reported the use of foam sclerotherapy in the treatment of telangiectasia in 1939, the sclerosing foam was made by shaking the reagent bottle which full filled with the sodium morrhuate in his article.. This is the earliest concept of foam sclerotherapy. After few years of development, the foam sclerotherapy has been widely used in the treatment for varicose veins, telangiectasia and arteriovenous malformations. In addition, sclerosing foam may also be used to treat blue rubber-bleb nevus syndrome, lymphatic cyst and fistula after surgery, branchial cleft fistula, varicocele, ovarian and pelvic varicose veins and other diseases.Currently, lauromacrogol (foreign aka:polidocanol), tetradecyl sulfate, sodium morrhuate are the three kinds of sclerosing foam which being often used. Among of them, the sodium morrhuate is the most earliest applied by literature. In 1930s, Higgins et al reported the first application of sodium morrhuate as a sclerosing foam. After 80 years of development, sodium morrhuate has been widly used in the treatment of vascular tumors, varicose veins and hemorrhoids cysts and other diseases. Even sodium morrhuate has been widely used in clinical, but there has no studies about the physicochemical properties of sodium morrhuate sclerosing foam both at domestic and at abroad. Physical and chemical properties of the foam are closely related to the efficacy of the sclerosing foam. The effects of sclerosing foam become better when foam stability become better. Therefore, the study on the physicochemical properties of the sodium morrhuate sclerosing foam is necessary.Currently, liquid injections is the more often applied on studies which focus on the mechanism of sodium morrhuate on vessels. However, few research can be found by using sodium morrhuate sclerosing foam on vessels in literature.Objectives(1) The sodium morrhuate sclerosing foam were made in several different concentration(1%,3% and 5%), the best concentration was choosed by observing the precipitation time of hardening agent (2) The sodium morrhuate sclerosing foam in different concentration were injected into rabbit’s auricular vein, then the rabbits were sacrificed on several definited days (1,3,5,7 and 15 days). The pathological changes of auricular vein tissue were observed. The aim of this study was to lay some theorical foundation for the use of sodium morrhuate sclerosing foam to treat abnormal blood vessels in clinical.Materials and methodsTheThe 1%,3% and 5% sodium morrhuate were diluted according to different liquid-gas ratio(1:1,1:2,1:3,1:4,1:5,1:6,1:7 and 1:8). The 50% precipitation time of sodium morrhuate were recorded. A best liquid-gas ratio of sodium morrhuate sclerosing foam was selected from the study. (2) 45 New Zealand white rabbits, (weighing 2.35±0.21kg) were randomly divided into three groups (each 15 cases). The 1%,3% and 5% sodium morrhuate injection group. The different concentration were made by the mixture of 5% sodium morrhuate injection and normal saline. Then the sclerosing foam was made by liquid-gas ratio which determined in previous experiments.0.2ml sclerosing foam was injected into rabbit auricular vein. Then the animals were respectively sacrificed in the first day and 3,5,7,15 days after injection. HE and Immunohistochemistry stain of vascular pathology specimens were derived from rabbits. Then the pathological changes and the expression of VEGF were observed.Results1. Comparison of precipitation timeBy detecting the 50% precipitation time of the different solubility (1%,3% and 5%) sodium morrhuate which mixed with gas(different liquid-gas ratio), it is found that the precipitation time were all being the longest time when the liquid-gas ratio is 1:4 in the all three groups. When compare with different liquid-ratio, the difference was statistically significant (p<0.05).2. The pathological changes of specimens on light microscopy and score comparisonAn acute inflammatory response was generated after the sclerosing foam injection to the rabbit auricular vein through the observation of the different groups of animals vascular specimens. The vascular endothelial cell injury of the three group was started from the first day, then gradually aggravated in the third day, the most serious vascular endothelial cell injury was found in the fifth days. The injury then gradually reduced after the fifth day. The vascular embolism of the three group was started from the first day, gradually increased in the third day, the most serious vascular embolism was in the fifth day. The embolism of 1% group gradually reduced, while 3% and 5% group still being heavy after five days. Thrombus organization was partially observed in the 1% group on the third day, and totally in the fifteen day. And thrombus organization in the 3% and 5% group was partially appeared from the first day, totally in the fifteenth days. The observation of tissue inflammation around vessels found that perivascular tissue inflammation were increased from the first day, then reached to a peak in the fifth day. Perivascular tissue inflammation of the 1% group was weaker than the 3% group, and perivascular tissue inflammation of the 3% group was weaker than 5% group. The comparison of VEGF expression was also illustrates this point. The scores of vascular embolism and vascular endothelial injury in the 3% and 5% group were greater than the 1% group at the same time, and the difference was statistically significant (p<0.05), However, the comparison of the 3% and 5% group had no statistically significant at the same time. In the first day, third day, fifth day and seventh day, thrombus organization score of the 3% and 5% group were higher than 1% group at the same time, the difference was statistically significance (p<0.05). But on the fifteenth day, the comparison of the 1% group with the 3% and 5% group had no statistically significance at the same time.Conclusion(1) When the liquid-gas ratio is 1:4, whatever in the 1%,3% or 5% smodium morrhuate sclerosing foam, the sclerosing foam stability is best in the all different ratios.(2) An acute imflammation will occur when smodium morrhuate sclerosing foam was injected into rabbit auricular vein, the pathological changes is similar with the liquid hardener (3) The vascular pathology injury, the vaucular embolization and the thrombus organization were similar in the 3% and 5% group on different time. But both of the two groups are more serious than the 1% group. Perivascular tissue inflammation of the 3% group is weaker than 5% group, and perivascular tissue inflammation of the 1% group is weaker than 3% group. VGEF expression of perivascular tissue in the three groups in different time were same as the gross pathological changes. |
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