Alcoholism in marriage is a great recipe for disaster. There are only a very few things that can tear a marriage apart like alcoholism. And if your spouse has developed a drinking habit only after you got married then the problem can have significant implications in your married life.

The effect alcoholism in marriage can’t be hidden. If you partner drinks excessively during social events when they are not supposed to or they begin to lie about how much they drink, then you should realize that your spouse has become an alcoholic and it’s time for drastic measures. It’s imperative that you accept your situation and work towards getting proper help for your partner and yourself.

The simple truth is that unless your spouse admits they have a problem, you’ll not be able to do much about it. If you stop them from drinking or nag them about their habit, they will only become angrier and more deceitful. You must also understand that shouting, screaming, pleading, or threatening will worsen the situation further and bring only short-term changes. And soon your spouse may begin to drink again, because they have become addicted to alcohol.

Alcoholism in marriage does cause many problems for everyone involved. However, as a partner of an alcoholic, the most important thing for you to do is learn to take care of yourself. There are many programs that help you get a grip on your situation and empower you to stop lying, manipulating or making excuses for your love one who is an alcoholic. Program like Ala-non teaches you to understand what you do have control over and what you don’t. As a support group they help you by guiding you to have more control over your life and your marriage. Just key in Ala-non in any search engine with you city or town name or look for them in the telephone book.

Author: Angel CH

Had enough with alcoholism in teenager of yours? Discover more by visiting http://www.alcoholism-detox.com, a popular website that offers valuable alternative alcoholism treatment tips.

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Information on Alcoholism Cure and Alcoholism Jealousy Midlife.

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If you struggle with jealousy in your love relationship or marriage, it might seem to you as if your emotions take over at times. It’s kind of like jealousy rears its ugly head and dominates you– and your relationship.

As much as you want to trust your partner and connect with him or her, jealous fears or anger get in the way. You probably find yourself saying and even doing things that you might not otherwise do.

We all have had "demons" at one time or another.

These are the habits and tendencies that hold us back and often cause pain and hurt. Addictions such as alcoholism or drug abuse are sometimes considered to be "demons" that a person can, hopefully, identify and overcome.

Jealousy might not be classified as an addiction, but it certainly can feel like a "demon." The powerful emotions that accompany jealousy can rise up and seem to control you.

The fact of the matter is, you are the one who gets to decide how you respond to the situations and people in your life.

You can take back the control and overcome your jealousy demons with awareness and conscious decisions.

Patrick feels like he’s moved from one demon to another. He’s been sober for 5 years now with the help of good friends and a great therapist. It was a struggle, at times, for Patrick to give up alcohol, but he could no longer deny the toll it was taking on his life.

Not only was Patrick blacking out and suffering other physical consequences of alcoholism, he also experienced the destruction of a love relationship due, in large part, to his drinking.

Patrick feels blessed to have found Julia. She is a wonderful partner for him and has been so supportive of his journey giving up alcohol. Unfortunately, however, Patrick has realized another demon in his life– jealousy.

Whenever Patrick is out with Julia, he is constantly "on guard." He feels like he has to watch out for other men and is frequently worried that Julia will find a "better" man and leave him.

Patrick realizes that his jealousy demon is causing distance between he and Julia. He would like to put an end to his jealousy, just like he stopped drinking.

The challenge is, he feels helpless and unable to do so.

Acknowledge your power.
When a habit or tendency feels overwhelming and like a demon in your life, you might also feel powerless to do anything about it. It may seem to you as if the jealousy has a force of its own and you are at its mercy.

We understand. Jealous emotions can be that intense and overwhelming.

A vital first step in overcoming jealousy is to acknowledge that you are the one in control. You have the power and the choice.

Sometimes it can help you to acknowledge your power to step back and really observe yourself. Watch your thoughts and the ways you respond to life.

For example, Patrick is able to see that he makes choices all the time. He chooses to get up early each morning so that he can go for a run. He chooses to eat a particular cereal for breakfast. He chooses to show up and give his all at work each day. He chooses to drink non-alcoholic beverages– even when he gets stressed out.

As mundane as many of these things are, it bolsters Patrick to realize how many choices he makes in the course of a day, or even a few hours.

Just as you get to control what you eat and where you’ll eat or whether or not you’ll brush your teeth or go straight to bed, you also get to choose how to meet particular situations that crop up in your relationship.

Get to know your habitual reactions.
Now that you know how potentially powerful you are, you can make more conscious choices about how to respond to situations.

Just as you took a step back and observed how much choice you have in your day-to-day life, do the same when looking at your habitual reactions– especially those that link to jealousy.

When you get triggered because your partner doesn’t call when working late at the office or when he or she is out of town alone, how do you often react?

It is in these triggering situations that a jealousy demon can rise up and seem to take you over.

Learn the signs that jealousy is coming up for you and then remind yourself of how powerful you actually are.

Again, this can take practice. Be gentle with yourself. Know that you can always pause mid-jealousy stream and make a shift.

Remembering your capacity to make a choice about how you will respond to a situation that previously made you feel jealous can make a big difference. Next, it is up to you to follow through with that desired, alternate choice.

How does it feel when you first question your fearful thoughts and calm yourself before taking any action? What differences do you notice when you interact with your partner from a place of curiosity and a sense of openness instead of making jealous assumptions?

The choice is truly up to you. If you like the way these different approaches feel, then continue in this direction. A closer connection with your partner is just around the corner.

Author: Susie Collins

Start today to heal your jealous behavior by signing up for Relationship Coaches Susie and Otto Collins’ free course on how to stop jealousy at http://www.NoMoreJealousy.com

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Information on Alcoholism Cure and Treating Alcoholism.

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Alcoholism is a disorder that has made million of individuals dependent on alcohol. It starts with the feel-good effect after losing your inhibitions to alcohol, then next thing you know, one is addicted to this surreal state of euphoria. Alcoholism should stop for its obvious effects to the body. Yes, it can be treated. No one ever said it was easy, but it can be done.

Fundamental to the treatment of alcoholism is managing the body’s withdrawal from this substance abuse. Since this is a feat not meant for overnight success, small changes can make a big difference in reducing your chances of having alcohol-related problems. Here are some strategies to try:

Getting help: It starts by admitting you have a problem and you need help. Talk to someone about it, be it a family member or a friend. You shouldn’t be alone with this because then it will be easier to slip back to depression when you do not have a support system. There are organizations that specially facilitate alcoholism therapies.

Talk to an expert: An expert can be a doctor or a counselor. He or she may be able to give you sound advice about treatments. There might be a prescription medicine that will work for you. Check your local health department or social services agencies as they are likely to offer help. They have resources to trained counselors who know about alcoholism and support groups with similar problems.

Cut back: In severe cases, complete withdrawal can do more harm than good. Most experts’ advice is to gradually allow the body to retreat from alcohol. Cutting back on alcohol intake is the first step on quitting drinking. Keep track of your alcohol intake: quantity and frequency. Then set a goal of slowly reducing your intakes. Pace yourself when you drink and never drink with an empty stomach. Alcohol is slowly absorbed by your system when you have had something to eat.

Plan ahead: Don’t let your mind remain idle. Develop interests that don’t involve alcohol like a new hobby or sports. Avoid people, places, and occasions that will obviously serve alcohol and may trigger your drinking. Learn to say "no, thanks" when you’re offered an alcoholic drink. And should the inevitable happen, always have an intervention plan on what you will do if you have an urge to drink.

Remember that it is important to stay healthy for the fun things in life: birth of a child, a long awaited trip or a holiday party. While alcoholics can be a nuisance, they are actually crying for help.

Author: Evelyn Kiarra

They are our friends and loved ones who got lost in the path. Treatment for alcoholism is available, so consider one you miss out on the best things in life.

If you notice symptoms of alcoholism, start by admitting that you have a problem and get help, visit http://www.treatmentforalcohol.net

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Information on Alcoholism Cure and Relapse Prevention Plan For Alcoholism.

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A very common reason drug and alcohol relapses happen so frequently is that there is no relapse prevention plan in place.

Here are 3 major areas to be thinking about when constructing a relapse prevention plan, food for thought, if you will. These are broad concepts. It may be wise to develop a muck more detailed plan. Let’s get started:

1. Maintain awareness of addiction.

Complacency sets the stage for more relapses than any other factor. With a lowered level of awareness the door is open for a return of denial. Examples are "I’m doing great now, no problem", "It wasn’t as bad as everyone made out", "I’ve been good for so long, I deserve just one". If denial creeps in, the door is open to rationalizing a return to use, as well as, engaging in risky behaviors. Risky behaviors increase the chance of relapse.

2. Identify your high-risk factors and triggers.

A trigger or high risk factor can be anything that was associated with drug or alcohol use and brings back those memories. It can be a person, place or thing, as well as things like rituals, smells or sounds. Some examples might be the smell of stale beer, seeing your dealer, or getting very emotional.

Basically there are 2 types of risk factors, those that can be easily avoided, and those that cannot. If a situation is known to be risky and can be avoided, do so.

On the other hand there are situations that cannot be avoided. Just about every supermarket has a beer and wine aisle, there may be events where alcohol is served and your attendance is required. In these cases, forethought and planning is needed.

3. Have plans in place before the temptation.

Awareness is an extremely powerful relapse prevention tool It is suggested to identify situations that can be avoided ahead of time, make a list. For example: it is not a good idea to hang out in a bar drinking soda, or to continue to hang out with people you used to use with. Identify these dangerous situations and plan to minimize exposure to them.

The same planning concept applies to possibly dangerous situations that may be unforeseen or unavoidable. For example: you have to shop for groceries, but can avoid going down the alcohol aisle. You can go to a wedding, perhaps go with a non-drinker, request ginger ale for the toast, etc.

And we have just exposed the tip of the iceberg when it comes to relapse prevention. There is much more detailed and information available on creating a relapse prevention plan.

Author: Bill Urell

Of course we have just uncovered the tip of the iceberg when it comes to addiction and addiction treatment. For even more information please visit http://AddictionTreatmentChallenges.com.

Thank You from Bill Urell and the Addiction Recovery Basics Network

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Information on Alcoholism Cure and Facts About Alcoholism.

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Some of these symptoms include, a higher tolerance to alcoholic beverages, cravings for alcohol throughout the day, shakes, chills, sweating profusely, not being able to set a small limit and follow through with it, overdoing it every time. If a persons drinking is not controlled some, over a period of time it could lead to life threatening illnesses and destroy your entire life. This is why it is so very important for anyone struggling with alcoholism or if you know someone who is struggling with it, to quickly find the help that is needed to help gain back control of your life, before it might be too late. There are so many disadvantages to losing control over your drinking habits, you could lose many friends and family because of your erratic behavior, that is caused by alcoholism. You could say things or do thing that you do not mean but others may just get tired of all of your excuses.

Alcoholism can destroy a persons social image, most people look down at alcoholics, not truly understanding why they have allowed themselves to become an alcoholic in the first place. It could cause you to not be able to hold down a job also, which could lead to financial strains that you can not dig your way out of, along with depression, not being able to get a grip on things in your life, that are spiraling out of control before your very eyes. Alcoholism can and will change your life for the worst, if you do not recognize it and choose to do something positive about it. Do not expect to recover quickly from alcoholism, it will be a life long challenge, to say the least.

If you have plenty of support from family and friends, it is possible to get through this extremely difficult time in your life. You will also need a great deal of strength and will power, within yourself, to fight that urge constantly, for wanting just one more drink. If you are a recovering alcoholic, you will never stop wanting that taste, but you can not allow yourself to go back on that path, it is a self destructive path, that never has a happy ending, for anyone involved.

Author: Dennis Isong Dennis Isong is an Author and Publisher of various health related websites. He has some great related articles that you can’t wait to read visit [http://www.greatalcoholismhelp.com] for more … Article Source: http://EzineArticles.com/?expert=Dennis_Isong Information on Alcoholism Cure and Alcohol For Healthy Diet.

Alcoholism Facts – Facts Of Alcoholism That You Should Know

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Evidence suggesting that alcohol is "cardio-protective" first appeared in the literature about 30 years ago. The Framingham Heart Study [the longest running population study of heart disease which began in 1948] provided the first solid evidence of this association. The relationship has now been confirmed by dozens of large population ["epidemiological"] studies. However, physicians have been reluctant to recommend alcohol consumption to patients because of the well-known health consequences of excessive drinking [hypertension, liver disease, increased rates of cancer, violent or accidental death] and the horrors that are associated with "drinking and driving".

Moderation is the key. Many large studies have found that men and women who consume light to moderate amounts of alcohol per day live longer than those who abstain completely. The Physicians’ Health Study involved long term follow-up of 89,300 men. The study found that men who drank five or six alcoholic drinks per week had a 20% lower risk of all-cause mortality than those who drank no alcohol. On the other hand, the same study showed that men who had more than two alcoholic drinks per day had a higher risk of death than nondrinkers. That means that, when drinking moderately, it appears to be quite beneficial; however, higher alcohol intake increases the risks of cancer and motor vehicle accidents so much as to overwhelm any cardiovascular benefits.

How does alcohol protect the heart? A large portion of the benefit may be attributable to increased levels of HDL ["good] cholesterol. Alcohol also has "antiplatelet" effects [making these natural blood elements less sticky and then less likely to clog arteries during plaque rupture] in much the same way as aspirin.

Moderate alcohol consumption may also help improve insulin resistance, which is just about one step below true diabetes and recognized as another independent predictor for cardiac risk. The Physicians’ Health Study also showed that in subjects who consumed alcohol daily, the risk for heart disease was reduced by 60% in diabetic patients, compared to a 40% decrease in persons who did not have diabetes. Moderate alcohol intake also decreases blood values for CRP [C-reactive protein], a metabolic marker for inflammation (elevated when you are in an increased state of oxidative stress).

The jury is still out as to whether or not wine provides a better protective effect compared to other forms of alcohol. Red wine is rich in flavonoids, which slow down oxidation of LDL ["bad"] cholesterol [which is one of the last steps before it is deposited in your artery wall]. One recent study suggested that light drinkers who avoided wine reduce their risk of all-cause mortality by 10%, while light drinkers who preferred wine had more than a 30% decrease in this risk. However, other studies have found that all forms of alcohol [beer, whiskey, etc.] were equally protective.

It is important to emphasize that alcohol [of ANY kind!] should be limited to one drink daily for women and at most two drinks daily for men [this is based merely on general body size and nothing else]. One drink is defined as 1.5 oz of distilled spirits (such as whisky, gin, and vodka), 5 oz of wine, or 12 oz of beer. Patients who have liver disease, who have a personal or family history of alcohol abuse, or who cannot limit their intake in a responsible manner should NOT start! However, since "all things in moderation" is a good adage for much of life, others can enjoy a daily alcoholic drink as part of a generally healthy diet.

Author: John Rumberger, PhD, MD

Disclaimer: If you are under 18, pregnant, nursing or have health problems, consult your physician before starting any weight loss plan. The information here is not intended as a substitute for medical advice. Please consult your physician before beginning any course of treatment.

Dr. John Rumberger is the Author of The WAY Diet, The complete lifestyle plan to live longer, reduce stress, and lose weight the healthy way. To purchase The Way Diet simply go to http://www.amazon.com/exec/obidos/redirect?path=
ASIN/0974993387&link_code=as2&camp=1789&tag=icobweb-20&creative=9325 or go to Empty Canoe Publishing http://www.emptycanoe.com and order your copy of The Way.

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Information on Alcoholism Cure and Cure Alcoholism Naturally.

Confirmed Again: Healthy Diet and Lifestyle Cuts Risk of Heart

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Many men throughout the world suffer from impotence or erectile dysfunction, the inability to achieve or sustain an erection for satisfactory sexual relations.

There are many different reasons why men suffer from erectile dysfunction but one major embarrassing situation that can strip a man of his manhood is alcohol impotence. Many heavy drinkers are quite likely to suffer erectile dysfunction.

William Shakespeare was aware of the problem when he wrote, "alcohol provokes the desire but takes away the performance." "Brewer’s droop" is a well known humorous term used to describe alcohol impotence but it is not amusing to those who become lustful whilst under the influence only to experience frustration when they are unable to fulfill their sexual desires.

Many doctors recommend a small quantity of alcohol, expounding on its numerous health benefits. Research suggests that consuming a moderate amount of alcoholic beverages a day, especially a few glasses of red wine, will lower stress levels, thin the blood, and benefit the heart. Small amounts of alcohol help to dissipate inhibition, improve libido, and increase sex drive. Excessive alcohol consumption can have the opposite effect, destroying sexual activity.

Some men, whilst under the influence of alcohol, are unable to achieve an erection whilst others are able to sustain an erection but are unable to reach the point of orgasm. If alcohol is abused indefinitely, the difficulty in achieving an erection can increase. Excessive alcohol abuse by men can reduce testosterone levels, increase breast size, shrink testicles, and lead to alcohol impotence.

When the body’s nervous system is affected by heavy alcohol intake, the ability to achieve an erection can be destroyed through the inability of the nervous system to dilate the blood vessels within the penis. When the blood vessels dilate, blood flows into the penis causing an erection.

With long-term alcohol abuse the nervous system can become permanently damaged. Ultimately the inability to achieve an erection may continue even when the sufferer is sober. Excess alcohol can cause chronic sexual under-performance, and may lead to chronic alcohol impotence.

Many men suffering from alcohol impotence have benefited from medications such as Viagra, Cialis and Levitra. These drugs are designed to relax the blood vessels in the penis allowing the penis to become erect. Viagra is effective in dilating blood vessels but unlike its herbal equivalent it is not designed to increase libido or enhance sexual activity. Viagra takes much longer than herbal remedies to take effect, and many users suffer side effects such as flushes, nasal congestion, nausea, headache, chest pain, and visual disturbances.

Chemical-free, herbal cures for alcohol impotence are the only natural way to increase blood flow to the penis, resulting in a harder and longer erection. Herbal remedies boost libido, increase semen production, eliminate impotence, increase sexual energy, stamina, endurance, virility, and vitality.

Herbal remedies benefit men by prolonging sexual activity, sustaining hard erections even after ejaculation, increasing energy levels for extended activity, enlarging the length and thickness of the penis for fuller penetration, and enhancing sexual desire.

Author: Russ Cawara

Natural cures are not only effective for the treatment of alcohol impotence or erectile dysfunction but are for anyone who desires a more fulfilling and explosive sex life.

Russ Cawara is a restaurateur, writer, artist, and purveyor of http://www.balimojoworldwide.com/ herbal remedies: http://www.balimojoworldwide.com

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Information on Alcoholism Cure and Disease Theory of Alcoholism.

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During the past generation, a great deal of effort has been placed on examining the alcoholism disease concept. As a result, many researchers have concluded that alcoholism is a disease, that alcoholism disease does indeed have a biological basis. Because of this research, variety of treatment options has been developed to aid people with alcoholism disease. In addition, the stigma that traditionally has associated with alcoholism has retreated to some degree as a result of the determination that there is an alcoholism disease.

In considering the alcoholism disease theory, there are three schools of thought in regard to how alcoholism disease can develop. There are experts who have concluded that there is a biological and genetic foundation to alcoholism disease. These scientists and doctors concluded that alcoholism is inherited and is past down from generation to generation.

Additionally, there is another group of experts who argue that although the alcoholism disease is not genetic, certain individuals do have a greater likelihood to suffer from addictive behaviors, including alcoholism, throughout their lives. These researchers have concluded that there is some sort of biological basis for this propensity in certain people.

Finally, an increasing number of experts concluded that both of these concepts about the alcoholism disease are accurate. For some people, alcoholism does have a genetic element. Meanwhile, for other people, while there might not actually be a direct genetic link to the alcoholism disease, these individuals are biologically susceptible to addiction, including alcoholism.

Because there appears to be good evidence suggesting a biological foundation to alcoholism, an individual suffering from alcoholism really cannot be blamed for actually having the disease. Nonetheless, as with any other chronic disease, an individual with alcoholism disease must try to take steps to control his or her alcoholism disease in order to life a productive and happy life.

Author: Angel CH

Had enough with the alcoholism disease of yours or your partner? Discover more by visiting http://www.alcoholism-detox.com, a popular website that offers valuable alternative alcoholism treatment tips.

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Information on Alcoholism Cure and Test For Alcoholism.

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In modern times, the focal point of almost all social events is a few crates of beer. A party without any alcohol is perceived as boring. Public drinking joints are filled to the brim after working hours and during weekends, when people get together to catch up. However, excessive and irresponsible drinking is causing problems in our homes, workplaces and even in schools. Self test for alcoholism helps you know if you drink too much without realizing it.

Alcoholics tend to drink heavily when frustrated or under pressure. They are irritable when confronted by family members or friends about their drinking, or when they have limited or no access to alcohol. Some have frequent memory blackouts after drinking and forget their commitments and promises. They drink more than their friends do when in groups, and even drink in secret. They are always on the lookout for occasions to drink heavily.

To detect alcoholism, you can use self test for the same, which involves analyzing behavior. Think of whether you often miss class or work after drinking, have tried to quit drinking in vain, been involved in squabbles after drinking or even been arrested. Also, reflect on whether you have had sex when drunk and regretted it, regularly drink when stressed and lie to your family and friends about the amount you drink. If these characteristics describe you, then you are evidently an alcoholic.

After the self test for alcohol addiction, you should not panic if you find out you are an alcoholic. In the early stages, this is curable. You should be open to family members and close friends who can provide support. However, your goal should be to quit drinking completely because you remain vulnerable and the problem is likely to recur. As it is said, ‘Old habits die hard!’

Author: Peter Gitundu Peter Gitundu Creates Interesting And Thought Provoking Content on Alcoholism For More Information, Read More Of His Articles Here ALCOHOLISM If You Enjoyed This Article, Make Sure You SUBSCRIBE TO MY RSS FEED! Article Source: http://EzineArticles.com/?expert=Peter_Gitundu

Information on Alcoholism Cure and Alcohol Treatment of Venous Disorder.

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Introduction

Vascular malformations are not rare, but finding an experienced physician to care for them may be difficult. This is because surgical removal may be demanding or impossible, embolization with coils requires an adequate arterial inflow, and closure with ethanol is complex and fraught with complications. Fortunately, a number of specialized multidisciplinary clinics have been formed in the United States and abroad to take care of the small number of under-served patients who harbor vascular anomalies.

Venous malformations are the most common of all vascular anomalies. They comprised 37% of BB Lee’s experience at the Sungkyunkwan Vascular Malformation Clinic at the Samsung Hospital in Seoul. Of the 294 cases, 128 were in the extremities (98 in the lower). In the Vascular Anomalies Clinic of the University of California at San Francisco, 62% of patients diagnosed over 10 years of age had venous malformations.

Yakes described 36 such patients in 1994. He called attention to high-flow and low-flow malformations and pointed out that incorrect terms included hemangioma, cavernous hemangioma, venous angioma, phlebectasias, and cavernoma. Yakes used the classification system of Mulliken and Glowacki. In 1982, that system was a step forward away from the chaos of disordered terminology that dominated the 20th century. Mulliken noted that hemangiomas were true endothelial tumors that exhibited a distinct proliferative phase, which was followed by slow involution.

In 1988, a consensus conference was held in Hamburg, Germany under the direction of Stefan Belov of Sofia, Bulgaria. The conference was attended by many of the world’s experts on congenital vascular malformations (CVMs), founding members of the International Society for Studies of Vascular Anomalies (ISSVA). Ultimately, this conference proposed an acceptable classification and terminology of CVMs that was properly based on embryologic information that had been accumulating over many years.

The Hamburg classification defined CVMs according to developmental arrest at various stages of embryonic life. This was somewhat modified by consensus at a meeting of these same experts in Denver in 1992. The classification singled out predominantly arterial, venous, arteriovenous shunting and lymphatic lesions in their truncular or extratruncular forms and added the anatomical forms of aplasia or obstruction, dilation, and infiltrating or limited forms. Arterial and venous forms with and without shunts were acknowledged, as were hemolymphatic types.

Extratruncular forms develop from the earliest stages of embryonic life, at the reticular stage. They have embryonic characteristics of developmental potential. This means that, when stimulated by trauma, pregnancy or surgery, they can begin to grow. They are further classified as diffuse and infiltrating, or as limited and localized.

Truncular forms develop from later stages of embryonic life and their hemodynamic impact may be severe. They are further classified as an aplasia type (obstruc tion, hypoplasia, stenosis, spur or membrane) or a dilation type (localized aneurysm, diffuse ectasia). The Hamburg classification separates vascular malformations from vascular tumors and can decrease confusion regarding these different entities.

Although the Hamburg classification provided a path away from the name-based terminology, some of these eponyms persist even though they remain imprecisely defined. As originally described, the Klippel-Trenaunay syndrome was a triad. This included a cutaneous hemangioma, varicose veins since childhood and limb hypertrophy

Gradually, as various quantities of arteriovenous shunting in these limbs were recognized, the eponym became corrupted into the Klippel-Trenaunay-Weber syndrome. Parkes Weber described "hemangiectatic hypertrophy" and included all hypertrophies of the lower limb. He included limbs not only with varices but also true arteriovenous fistulas. This introduced confusion because congenital arteriovenous fistulas and the Klippel-Trenaunay syndrome are distinctly different entities. Several authorities have described the Klippel-Trenaunay syndrome variously. At the Mayo Clinic, it was described as a limb hemangioma with over growth of bone and soft tissues in a limb with varicose veins. We favor this definition, thus separating the Klippel-Trenaunay syndrome from high-flow vascular malformations and leaving the syndrome as a venous angiodysplasia.

Probably, the Hamburg classification terminology should be used and the name-based eponyms dropped. But there is a certain historic charm in the use of eponyms, and our interpretation of the Klippel-Trenaunay syndrome is a limb with capillary vascular malformations, soft tissue and/or bony hypertrophy, and varicose veins without gross arteriovenous shunting or lymphatic/soft tissue abnormalities. Some, but not all, of these limbs have abnormal development of deep and superficial veins.

Venous malformations (angiomas) are often present at birth, although they may not be evident until later. They consist of a spongy tangle of veins, and these lesions usually vary in size (Figure 20.2). Treatment of these venous malformations is often requested for cosmetic reasons, but painful ulcerations, nerve compression and functional disability can command care.

Investigations

Following a focused physical examination, a duplex ultrasound examination can add information about blood flow, volume and velocity of a vascular malformation. If carefully done, it can identify feeding arteries and

draining veins. Magnetic resonance imaging has replaced conventional arteriography and phlebography in the initial evaluation of vascular malformations. It provides hemodynamic and anatomic information, as well as relationships with surrounding tissues and organs. Lee has found a sensitivity in excess of 97% and a specificity of 91%. It is also useful in assessment of the results of treatment. T1- and T2-weighted images have shown excellent ability to differentiate low-flow shunting from high-flow lesions. Angiography, especially catheter-directed and superselective arteriography, remains useful in pretreatment planning. Magnetic resonance imaging has a distinct limitation in differentiating between lymphatic and vascular malformations.

Personal experience

During a 30-month period, 1321 patients were investigated for venous disorders at the Vein Institute of La Jolla, CA. Fourteen (incidence: 1%) were found to have venous malformations (5 men, 9 women). The age range was 15-76 years (mean: 30.8 ± 18.6). Lesions were classified by the Hamburg system and were primarily venous, extratruncular in 12 patients and combined extratruncular and truncular in 2 patients.

Eight patients, three of them males, had manifestations of lower extremity Klippel-Trenaunay syndrome; six had only venous malformations. Eighteen of the 22 patients were treated.

All patients were studied by Doppler duplex examination. Selected lesions were chosen for helical computed tomographic studies. Magnetic resonance venography was also used to image the lesions, define the deep circulation, note connections with normal circulation, identify vessels for therapeutic access, and determine infiltration of the lesion into adjacent soft tissue.

Foam was produced by the technique of Tessari, using two syringes connected by a three-way stopcock, with the air-to-polidocanol ratio being 4 or 5 to 1. This was used at 1% or 2% concentration, specific for each patient.

The SonoSite 190 Plus duplex Doppler was used for ultrasound guidance whenever deep access was required, and to monitor progress and effects of treatment. A goal was set for each patient before treatment was begun.

The mean number of treatments was 3.6 ± 2.8 (range: 1-10). A primary goal of pain-free healing was set in patients with nonhealing, painful ulcerations or sympto matic varicose veins. This was achieved in all treated patients. Cosmetically, all of the patients were improved, and symptomatic patients were relieved of ulcers and pain.

Sclerosant foam is a satisfactory tool to use in treating venous malformations and the Klippel-Trenaunay syndrome. Use of foam sclerotherapy in this experience has proven the technique to be effective, essentially pain-free, and durable in the short term.

Discussion

Absolute ethanol sclerotherapy has been used in the treatment of vascular malformations. Its action is to denature tissue protein, precipitating protoplasm with subsequent obliteration of the vessel lumen. Its use is fraught with complications. The procedures require general anesthesia but are effective. In the Boston Children’s Hospital experience, 13% of 40 patients experienced deep ulcerations, 50% had blistering and 28% had hemoglobinuria.

In order to minimize complications, sclerotherapy with liquid sclerosants has been used in the treatment of venous, lymphatic and low-flow vascular malformations. It finds a place in the treatment of small vascular malformations. Over a 20-year period ending in 1995, 157 patients were treated with liquid sclerotherapy in the Dermatology Department of the Humboldt University in Berlin, Germany. The majority of the lesions were hemangiomas and vascular malformations located in the head and neck, and 55% were in children and adolescents. One to three treatments sufficed and the results appeared durable.

Liquid sclerosants, unfortunately, become diluted and inactivated by intralesional blood. Alternatively, the use of sclerosants in microfoam form significantly improves the procedure. The foam displaces blood instead of becoming diluted, and the echogenicity of the bubbles makes them visible on ultrasound surveillance. Foam treatments, in contrast to those using ethanol, can be given on a strictly ambulatory basis.

Yamaki described the use of sclerosant foam in treating a facial vascular malformation of the cheek in a patient with a failed attempt at surgical removal.

Duplex guidance and general anesthesia were used, with the foam being produced by the Tessari technique using 1% polidocanol.

The first report of a large group of patients treated by foam sclerotherapy was that of Cabrera from Granada, Spain. The report included 50 patients, 19 with limited venous malformations, 16 with infiltrating venous malformations and 15 with Klippel-Trenaunay syndrome. Sclerotherapy was by direct injection of 0.25-4% polidocanol microfoam using ultrasound guidance. The therapy was judged to be beneficial in 92% of the patients. Amongst the 46 responders, 18 showed disappearance of treated lesions, 15 had a reduction in malformation size of more than 50% and 13 showed a reduction in malformation size of 50% or less. Of those with severe pain, 25 of 39 patients experienced total relief, and in the other 14, the pain was significantly reduced. No patient reported a major adverse event. There were 4 cases of transient skin pigmentation and 3 cases of skin necrosis.

Cabrera’s group has also taken the lead in the evaluation of Klippel-Trenaunay syndrome. Their conclusion was that multidetector computed tomography and three-dimensional magnetic resonance venography are extremely helpful for the global evaluation of patients with Klippel-Trenaunay syndrome. Information regarding soft tissue and bony anatomy, as well as information about superficial and deep venous systems, may be obtained with a single examination (Figure 20.3). In examining 16 patients, persistent embryonic veins were seen in all patients. In one patient, aplasia/atresia of the whole deep venous system was revealed. Half of the patients had popliteal venous abnormalities, including aplasia (6 patients) and an aneurysm (1 patient). Other abnormalities in this group of patients included femoral vein hypoplasia in 4 patients, duplication of the femoral vein in 1 patient, and aplasia of the femoral vein in 3 patients.

Conclusions

Foam sclerotherapy holds several advantages over absolute ethanol and liquid sclerosants although, admittedly, it is nowhere near as powerful as ethanol. Neither does it carry the need for general anesthesthia or have the rate of complications of alcohol. The efficacy of a given concentration of sclerosant is greatly increased when used as foam instead of liquid. Also, a small amount of liquid can produce four to five times its volume when made into foam. It is echogenic, a significant benefit that allows foam sclerotherapy of vascular malformations to be moved into an outpatient office.

Author: Van Cheng, M.D. For more information, please visit http://www.SDVeinInstitute.com Van Cheng, MD Medical Director, San Diego Vein Institute 1011 Devonshire Dr. Ste B Encinitas, CA 92024 760.944.9263 http://www.SDVeinInstitute.com Article Source: http://EzineArticles.com/?expert=Van_Cheng,_M.D.

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