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Hakan Alfredson - One of the best experts on this subject based on the ideXlab platform.
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sclerosing injections to treat midportion achilles tendinosis a randomised controlled study evaluating two different concentrations of Polidocanol
Knee Surgery Sports Traumatology Arthroscopy, 2008Co-Authors: Lotta Willberg, Kerstin Sunding, Lars Ohberg, Magnus Forssblad, Martin Fahlstrom, Hakan AlfredsonAbstract:Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6–8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.
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Nerve-related characteristics of ventral paratendinous tissue in chronic Achilles tendinosis
Knee Surgery Sports Traumatology Arthroscopy, 2007Co-Authors: Gustav Andersson, Hakan Alfredson, Patrik Danielson, Sture ForsgrenAbstract:Ultrasound and Doppler examination has shown high blood flow-neovascularisation inside and outside the ventral Achilles tendon in chronic painful tendinosis, but not in pain-free normal Achilles tendons. In patients with Achilles tendinosis, injections with the sclerosing substance Polidocanol, targeting the areas with increased blood flow, have been demonstrated to give pain relief. A drawback when interpreting these findings is the fact that the pattern of nerve supply in the target area, i.e. the ventral area of the tendon, is so far unknown. In this study, therefore, tissue specimens from this area, obtained during surgical treatment of patients with chronic painful midportion Achilles tendinosis, were examined. In the examined area, containing loose connective tissue, the general finding was a presence of large and small arteries and nerve fascicles. The nerve fascicles were distinguished in sections processed for the pan-neural marker protein gene-product 9.5. The nerve fascicles contain sensory nerve fibers, as shown via staining for the sensory markers substance P (SP) and calcitonin gene-related peptide, and sympathetic nerve fibers as seen via processing for tyrosine hydroxylase. In addition, there were immunoreactions for the SP-preferred receptor, the neurokinin-1 receptor, in blood vessel walls and nerve fascicles. Some of the blood vessels were supplied by an extensive peri-vascular innervation, sympathetic nerve fibers being a distinct component of this innervation. There was also a marked occurrence of immunoreactions for the α_1-adrenoreceptor in arterial walls as well as in the nerve fascicles. Altogether, these findings suggest that the area investigated is under marked influence by the nervous system, including sympathetic and sensory components. Thus, sympathetic/sensory influences may be involved in the pain mechanisms from this area. In conclusion, the nerve-related characteristics of the area targeted by the polidicanol injection treatment for Achilles tendinosis, are shown here for the first time.
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treatment of midportion achilles tendinosis similar clinical results with us and cd guided surgery outside the tendon and sclerosing Polidocanol injections
Knee Surgery Sports Traumatology Arthroscopy, 2007Co-Authors: Hakan Alfredson, Lars Ohberg, Ewa Zeisig, Ronny LorentzonAbstract:Treatment of midportion Achilles tendinosis: similar clinical results with US and CD-guided surgery outside the tendon and sclerosing Polidocanol injections.
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sclerosing Polidocanol injections of small vessels to treat the chronic painful tendon
Cardiovascular and Hematological Agents in Medicinal Chemistry, 2007Co-Authors: Hakan Alfredson, Ronny LorentzonAbstract:The chronic painful tendon (tendinopathy, tendinosis) is generally considered difficult to treat, not seldom causing long-term disability and sometimes ending the sports or work carreer. Most common sites for tendinopathy are the Achilles-, patellar-, extensor carpi radialis brevis (ERCB)-, and supraspinatus tendons. The origin of pain has for many years been unknown, but recently, by using ultrasound (US) + colour Doppler (CD), immunohistochemical analyses of tendon biopsies, and diagnostic injections of local anaestesia, we found a close relationship between areas with vasculo-neural ingrowth and tendon pain. Sensory nerves (Substance-P-SP and Calcitonin Gene Related Peptide-CGRP) were found inside and outside the vascular wall. In following clinical studies we have demonstrated good short-and mid-term clinical results using treatment with US+CD-guided sclerosing Polidocanol injections, targeting the area with neovessels outside the tendon. Two-year follow ups have showed remaining good clinical results, and sonographically signs of remodelling with a significantly thinner tendon with a more normal structure. Whether the effects of Polidocanol are mediated through destruction of neovessels, activity on nerves or a combination, is under evaluation.
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sclerosing Polidocanol injections to treat chronic painful shoulder impingement syndrome results of a two centre collaborative pilot study
Knee Surgery Sports Traumatology Arthroscopy, 2006Co-Authors: Hakan Alfredson, S Haugen, Herlof Harstad, Lars OhbergAbstract:Sclerosing Polidocanol injections to treat chronic painful shoulder impingement syndrome-results of a two-centre collaborative pilot study.
Lars Ohberg - One of the best experts on this subject based on the ideXlab platform.
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sclerosing injections to treat midportion achilles tendinosis a randomised controlled study evaluating two different concentrations of Polidocanol
Knee Surgery Sports Traumatology Arthroscopy, 2008Co-Authors: Lotta Willberg, Kerstin Sunding, Lars Ohberg, Magnus Forssblad, Martin Fahlstrom, Hakan AlfredsonAbstract:Two to three ultrasound (US) and colour Doppler (CD)-guided injections of the sclerosing substance Polidocanol (5 mg/ml) have been demonstrated to give good clinical results in patients with chronic midportion Achilles tendinopathy. This study aimed to investigate if a higher concentration of Polidocanol (10 mg/ml) would lead to a less number of treatments, and lower volumes, needed for good clinical results. Fifty-two consecutive Achilles tendons (48 patients, mean age 49.6 years) with chronic painful midportion Achilles tendinopathy, were randomised to treatment with Polidocanol 5 mg/ml (group A) or 10 mg/ml (group B). The patients and treating physician were blinded to the concentration of Polidocanol injected. All patients had structural tendon changes and neovascularisation in the Achilles midportion. Treatment was US + CD-guided injections targeting the region with neovascularisation (outside ventral tendon). A maximum of three treatments (6–8 weeks in between) were given before evaluation. Patients not satisfied after three treatments were given additional treatment with Polidocanol 10 mg/ml, up to five treatments. For evaluation, the patients recorded the severity of Achilles tendon pain during activity on a visual analogue scale (VAS), before and after treatment. Patient satisfaction with treatment was also assessed. At follow-up (mean 14 months) after three treatments, 18/26 patients in group A and 19/26 patients in group B were satisfied with the treatment and had a significantly reduced level of tendon pain (P < 0.05). After completion of the study, additional treatments with Polidocanol 10 mg/ml in the not satisfied patients resulted in 26/26 satisfied patients in both groups A and B. In summary, we found no significant differences in the number of satisfied patients, number of injections or volumes given, between patients treated with 5 or 10 mg/ml Polidocanol.
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treatment of midportion achilles tendinosis similar clinical results with us and cd guided surgery outside the tendon and sclerosing Polidocanol injections
Knee Surgery Sports Traumatology Arthroscopy, 2007Co-Authors: Hakan Alfredson, Lars Ohberg, Ewa Zeisig, Ronny LorentzonAbstract:Treatment of midportion Achilles tendinosis: similar clinical results with US and CD-guided surgery outside the tendon and sclerosing Polidocanol injections.
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sclerosing Polidocanol injections to treat chronic painful shoulder impingement syndrome results of a two centre collaborative pilot study
Knee Surgery Sports Traumatology Arthroscopy, 2006Co-Authors: Hakan Alfredson, S Haugen, Herlof Harstad, Lars OhbergAbstract:Sclerosing Polidocanol injections to treat chronic painful shoulder impingement syndrome-results of a two-centre collaborative pilot study.
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sclerosing Polidocanol injections in mid portion achilles tendinosis remaining good clinical results and decreased tendon thickness at 2 year follow up
Knee Surgery Sports Traumatology Arthroscopy, 2006Co-Authors: Bengt Lind, Lars Ohberg, Hakan AlfredsonAbstract:The short-term results after treatment with sclerosing Polidocanol injections have been shown to be good in patients with chronic painful mid-portion Achilles tendinosis. This study aimed to evaluate the longer-term effects on tendon thickness, structure and vascularity, patient satisfaction with treatment, and pain during tendon loading activity. Ultrasonography (US) + colour Doppler (CD) was used for evaluation of the tendon, and the patients graded the amount of pain during tendon loading activity on a VAS. Forty-two patient’s tendons (23 men and 19 women, mean age 53 years) with a long duration (mean 32 months) of pain symptoms from mid-portion Achilles tendinosis (US + CD showed a localised thickening, structural changes and neovascularisation), were at three (mean) occasions (6–8 weeks in between) treated with US and CD guided injections of the sclerosing substance Polidocanol, targeting the area with neovessels ventral to the tendon. After treatment, 37 patients were satisfied with the results of the treatment and back to previous (before injury) activity level. At the 2-year follow-up (mean 23 months), 38 patients were satisfied with the results of the treatment, and there was a significant reduction in VAS (from 75 to 7; P < 0.05). US showed a significant reduction in the mean mid-portion tendon thickness (from 10 to 8 mm, P < 0.05) and a “more normal” structure. CD showed no, or a few, remaining neovessels in the majority of the successfully treated tendons. In conclusion, treatment with sclerosing Polidocanol injections in patients with chronic painful mid-portion Achilles tendinosis showed remaining good clinical results at a 2-year follow-up. Decreased tendon thickness and improved structure after treatment, might indicate a remodelling potential?
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sclerosing Polidocanol injections in chronic painful tennis elbow promising results in a pilot study
Knee Surgery Sports Traumatology Arthroscopy, 2006Co-Authors: Eva Zeisig, Lars Ohberg, Hakan AlfredsonAbstract:Sclerosing Polidocanol injections targeting the area with neovessels (vascularity) have been demonstrated to give promising clinical results in patients with chronic painful Achilles and patellar tendinosis. Recently, we demonstrated vascularity in the extensor origin in patients with chronic painful tennis elbow, but not in controls with pain-free elbows. In this pilot study, 11 patients (four men and seven women, mean age 46 years) with the diagnosis of tennis elbow in altogether 13 elbows, were included. All patients had a long duration of pain symptoms (mean 23 months), and ultrasonography (US) + colour Doppler (CD) examination showed structural tendon changes with hypo-echoic areas, and a vascularity, corresponding to the painful area in the extensor origin. All patients were treated with US- and CD-guided injections of the sclerosing substance Polidocanol, targeting the area with vascularity. At 8-month follow-up after treatment, there was a good clinical result in 11/13 elbows. Extensor origin pain during wrist loading activities (recorded on a VAS-scale) was significantly reduced (mean VAS from 75 to 34; P < 0.003), and maximal grip strength was significantly increased (from 29 to 40 kg; P < 0.025). Our findings indicate that one treatment with sclerosing Polidocanol injections, targeting the area with vascularity in the extensor origin, has a potential to reduce the tendon pain and increase grip strength, in patients with chronic painful tennis elbow.
Jeffrey T Jensen - One of the best experts on this subject based on the ideXlab platform.
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transcervical administration of Polidocanol foam prevents pregnancy in female baboons
Contraception, 2016Co-Authors: Jeffrey T Jensen, Carol B Hanna, S Yao, Ov D Slayden, Emily Thompson, Cassondra BauerAbstract:Background Our objective was to conduct a pilot study to determine if transcervical administration of Polidocanol foam (PF) with or without doxycycline or benzalkonium chloride (BZK) would prevent pregnancy in baboons.
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Polidocanol induced tubal occlusion in nonhuman primates immunohistochemical detection of collagen i v
Contraception, 2016Co-Authors: Jeffrey T Jensen, S Yao, Ov D Slayden, Dong Ock LeeAbstract:Objective Intrauterine administration of Polidocanol foam (PF) can create fallopian tube occlusion in nonhuman primates. The objective of this study was to determine if PF-induced tubal obstructions contain collagen in the extracellular matrix.
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blockade of tubal patency following transcervical administration of Polidocanol foam initial studies in rhesus macaques
Contraception, 2014Co-Authors: Jeffrey T Jensen, Carol B Hanna, S Yao, Elizabeth Micks, Alison Edelman, Lindsay A Holden, Ov D SlaydenAbstract:Objective To demonstrate the feasibility of Polidocanol foam (PF) as a nonsurgical method of female permanent contraception using a nonhuman primate model.
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transcervical Polidocanol as a nonsurgical method of female sterilization a pilot study
Contraception, 2004Co-Authors: Jeffrey T Jensen, Maria I Rodriguez, J Liechtensteinzabrak, S ZalanyiAbstract:We have studied the effects of transcervically administered Polidocanol on uterine and fallopian tube morphology in Wistar rats and Rhesus monkeys. Polidocanol is a synthetic, long-chain fatty acid that is widely used as a sclerosing agent in Europe. The goal of the study was to determine whether Polidocanol would safely cause tubal occlusion in an animal model. Twenty female Wistar rats and three female Rhesus monkeys underwent transcervical injection of Polidocanol or physiological saline. The animals were followed for 30 days and then a lower laparotomy was performed, with excision of the entire upper reproductive tract. Specimens were subsequently examined for macroscopic and microscopic changes. Only cyclic changes were observed in the control animals of both species. Fifteen macroscopic and 37 microscopic changes were observed in the uterine horns of the 10 rats treated with Polidocanol. There was no observed effect in the monkey fallopian tube. These results suggest that species differences that exist between rodents and primates may influence the effects of transcervical Polidocanol. Experiments using a primate model are needed as proof of concept prior to human studies of candidate agents for transcervical tubal sterilization.
Ov D Slayden - One of the best experts on this subject based on the ideXlab platform.
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Polidocanol induced tubal occlusion in nonhuman primates immunohistochemical detection of collagen i v
Contraception, 2016Co-Authors: Jeffrey T Jensen, S Yao, Ov D Slayden, Dong Ock LeeAbstract:Objective Intrauterine administration of Polidocanol foam (PF) can create fallopian tube occlusion in nonhuman primates. The objective of this study was to determine if PF-induced tubal obstructions contain collagen in the extracellular matrix.
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transcervical administration of Polidocanol foam prevents pregnancy in female baboons
Contraception, 2016Co-Authors: Jeffrey T Jensen, Carol B Hanna, S Yao, Ov D Slayden, Emily Thompson, Cassondra BauerAbstract:Background Our objective was to conduct a pilot study to determine if transcervical administration of Polidocanol foam (PF) with or without doxycycline or benzalkonium chloride (BZK) would prevent pregnancy in baboons.
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blockade of tubal patency following transcervical administration of Polidocanol foam initial studies in rhesus macaques
Contraception, 2014Co-Authors: Jeffrey T Jensen, Carol B Hanna, S Yao, Elizabeth Micks, Alison Edelman, Lindsay A Holden, Ov D SlaydenAbstract:Objective To demonstrate the feasibility of Polidocanol foam (PF) as a nonsurgical method of female permanent contraception using a nonhuman primate model.
David M. Eckmann - One of the best experts on this subject based on the ideXlab platform.
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Polidocanol for endovenous microfoam sclerosant therapy
Expert opinion on investigational drugs, 2009Co-Authors: David M. EckmannAbstract:Background: Polidocanol is a liquid surfactant having endothelial cell lytic properties. In the form of a controlled, dispensed microfoam it is administered endovenously as a sclerosing agent in the treatment of varicose veins. Objective: This review summarizes efficacy of Polidocanol endovenous microfoam sclerotherapy using a proprietary dispensing system to control foam characteristics and gas content for treating varicose veins. Methods: We reviewed in vitro, Phase I, Phase II and limited Phase III data for Polidocanol microfoam with a focus on controlled foam formulation in therapy. Results/conclusions: Clinical trials of controlled dispensing of Polidocanol microfoam provide evidence of effective treatment of chronic venous insufficiency with low toxicity, minimal risk and few complications.
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microvascular embolization following Polidocanol microfoam sclerosant administration
Dermatologic Surgery, 2005Co-Authors: David M. Eckmann, Shunji KobayashiAbstract:Background. Intravenous microfoam sclerotherapy solutions can potentially cause cerebrovascular arterial embolization. Objective. To determine the relationship between Polidocanol microfoam formulation and arteriolar embolization bubble lodging and clearance in vivo. Methods. Three Polidocanol microfoams (one made by the double-syringe method using air and two Varisolve (Provensis, Inc., West Conshohocken, PA, USA) formulations using different physiologic gas mixtures composed primarily of oxygen and carbon dioxide and dispensed from a proprietary canister mechanism) were mixed with venous blood and injected into the rat cremaster arterial microcirculation. Bubble dimensions and dynamics were recorded using intravital microscopy. Results. Bubble entry frequency, size, and dynamics depended on microfoam formulation. Air-based bubbles (2.72 1.38 nL; n = 21) lodged, obliterating blood flow. Varisolve bubbles (0.20 0.02 nL; n = 2 and 0.53 0.27 nL; n = 27 for the two gas compositions) entered but either did not lodge or cleared within seconds. Bubble size and number were different among these microfoams. Conclusions. Both Varisolve formulations produced smaller embolism bubbles than occurred with air-based microfoam. Rapid clearance of Varisolve bubbles suggests that they are so small that they do not have adequate surface area available for significant binding interactions with arteriolar endothelium. Larger air-based bubbles obstruct arteriolar vessels and block blood flow.