Less-invasive alternative to tackle the Sagging neck

But it turns out that is not true. These days, less-invasive alternative to enhance the appearance of neck, provided that there is a full-scale Turkey wood. As a Romance, a neck go wrong in many ways. Weight gain or genetics may lead to a double chin. Loose skin can worsen underlying lax muscles. A neck-lift (on your own or with a face lift) remains the best basis for a striking, lasting correction.

But cautious liposuctioning superfluous fat can also help streamline full throat, especially those who have still relatively youthful elastic skin that can bounce back after the procedure. The trick is not to be suctioned to point see skeleton (it should look at the underlying Loose bands of muscle, which become more obvious after).

If the problem is these isolated bands, inject Botox in your neck muscle can make them less conspicuous in a patient with large colour, "said Dr. Rod j. Rohrich, Chairman of the Department of plastic surgery at the University of Texas Southwestern Medical Center in Dallas. But patch lasts only three to four months.

Promoted in the last year of "The Rachael Ray Show", Ulthera is a new lifting skin procedure using focused ultrasound to trigger collagen growth depth beneath the epidermis. A single treatment can improve the outlines of the under-chin laxity in patients about 40-55 years old who believe that they are not ready for surgery or placed, several doctors said, including Dr. Matthew White, facial plastic surgeon at NYU Langone Medical Center. Ulthera handpiece pressed to the skin can doctors to see underlying layers onto a screen (as with gynaecological ultrasound) before entering treatment, a first noninvasive Dermatological procedures. "We deposit energy into an exact depth below the surface of the skin without prejudice to the intermediate tissue," said Matthew Likens, CEO of Ulthera, Mesa, Ariz., the company behind it.

Patients may feel pain during treatment. Potential candidates should also be aware that peer-reviewed published studies have yet to quantify just how much sharpening can be expected in the neck and lower face. "It is true," confirmed Mr. Likens. (Research continues, "he says.)

Not to stop Dr. Mehmet Oz, a cardiologist, from proclaiming his television show last month that Ulthera was a "revolutionary nonsurgical facelift" and promises to get rid of a viewer sagging necks live scene. In the segment, said Dr. Haideh Hirmand, plastic surgeon in Manhattan, it was the first time she was "really excited" about a noninvasive technique for lifting of tissue. She stressed that Ulthera is no substitute for surgery, neck skin is too loose. (In a later interview she recommended a pain medication such as Percocet and antianxiety drugs Valium before treatment, which she said was worth for minimal cervical rotating.)

"The company will tell you to do this," said Dr. Tina Alster, a dermatologist in Washington, which has left a pain and an antianxiety medicines mandatory for her Ulthera patients. As I said, Dr. Alster, who will receive a scholarship for research from Ulthera to study its effect on off-face areas, is to see the results in the area of eyebrows, Cheeks and neck of middle-aged patients.

The segment "Dr. Oz" left the impression that the Ulthera device has been cleared by the Food and Drug Administration for the neck and lower face and eyebrow area.

Not so. "The company can only promote device for eyebrows-lift," Although treatment schedule includes the Cheeks and throat, too, Karen Riley, a spokeswoman for the Agency, wrote in an e-mail message. -But they can make any claims with respect to these areas and not promote their device for treating specific conditions in these areas. (As with other procedures, but the doctors can treat other body parts fit.)

Nina Fritz Meyerhof, carrying children on Earth, an organization for peace, was willing to chance it when she met Dr. White this month for Ulthera fixed up her throat and jawline. "I wanted everything to look fresh and tight," she said.

68 Is Ms. Fritz Meyerhof, of South Burlington, Vt., a decade or two older than Dr. White typical candidate, someone who is just starting to Notice during the chin skin laxity. But Dr. White, who has studied the focused ultrasound, knew his skin was still so elastic that it would tighten. (How fast the skin ages vary with factors such as sun exposure, genetics and smoking – which may be why your older pal neck skin is taut while your gave way at 47.)

View the original article here

Less-invasive alternative to tackle the Sagging neck

But it turns out that is not true. These days, less-invasive alternative to enhance the appearance of his neck, provided that there is a full-scale Turkey wood. As a Romance, a neck go wrong in many ways. Weight gain or genetics may lead to a double chin. Loose skin can worsen underlying lax muscles. Neck-lift (on your own or with appearance) remains the best basis for a striking, lasting correction.

But cautious liposuctioning superfluous fat can also help streamline full throat, especially those who have still relatively youthful elastic skin that can bounce back after the procedure. The trick is not to be suctioned to point see skeleton (it should look at the underlying Loose the bands of muscle, which become more obvious after).

If the problem is these isolated bands, inject Botox in your neck muscle can make them less conspicuous in a patient with large colour, "said Dr. Rod Rohrich j., Chair of the Department of plastic surgery at the University of Texas Southwestern Medical Center in Dallas. But patch lasts only three to four months.

Promoted over the past year "the Rachael Ray Show", Ulthera is a new lifting skin procedure with focused ultrasound to trigger collagen growth depth under the epidermis. A single treatment can improve the outlines of the under-chin laxity in patients around 40-55 years old who believe that they are not ready for surgery or amenable to it, several doctors said, including Dr. Matthew White, photo by plastic surgeon at NYU Langone Medical Center. Ulthera handpiece printed on the skin can doctors to see underlying layers onto a screen (as with gynaecological ultrasound) before entering treatment, a first noninvasive dermatological procedures. "We deposit energy into an exact depth below the surface of the skin, without interfering with the intermediate tissue," said Matthew Likens, CEO of Ulthera, Mesa, Ariz., the company behind it.

Patients may feel pain during treatment. Potential candidates should also be aware that peer-reviewed published studies have yet to quantify just how much sharpening can be expected in the neck and lower face. -It is true, confirmed Mr. Likens. (Research continues, "he says.)

Not to stop Dr. Mehmet Oz, a cardiologist, from proclaiming his television show last month that Ulthera was a "revolutionary nonsurgical facelift" and promises to get rid of a viewer sagging necks live scene. In the segment, "said Dr. Haideh Hirmand, plastic surgeon in Manhattan, it was the first time she was" really excited "about a noninvasive technique for lifting of tissue. She stressed that there is no substitute for Ulthera surgery, neck skin is too loose. (In a later interview she recommended a pain medication such as Percocet and antianxiety drugs Valium before treatment, which she said was worth for minimal neck looseness.)

"The company will tell you it's easier to do," said Dr. Tina Alster, a dermatologist in Washington, which has left a pain and an antianxiety medicines mandatory for her Ulthera patients. As I said, Dr. Alster, who will receive a scholarship for research from Ulthera to study its effect on the outside face areas, is to see the results in the area of eyebrows, Cheeks and neck of middle-aged patients.

The segment "Dr. Oz" left the impression that the device has been cleared of Ulthera Food and Drug Administration used for the neck and lower face and eyebrow area.

Not so. "The company can only promote device for eyebrows-lift," Although treatment schedule includes the Cheeks and throat, also Karen Riley, a spokeswoman for the Agency, wrote in an e-mail message. -But they can make any claims with respect to these areas and cannot promote their device for treating specific conditions in these areas. (As with other procedures, but the doctors can treat other body parts at our own discretion.)

Nina Fritz Meyerhof, who runs the children on Earth, an organization for peace, was willing to chance it when she met Dr. White this month to firm up for Ulthera her neck and jawline. "I wanted everything to look fresh and tight," she said.

68 Is Ms. Fritz Meyerhof, of South Burlington, Vt., a decade or two older than Dr. White typical candidate, someone who is just starting to Notice during the chin skin laxity. But Dr. White, who has studied the focused ultrasound, knew his skin was still so elastic that it would tighten. (How fast the skin ages vary with factors such as sun exposure, genetics and smoking – which may be why your older pal neck skin is taut while your gave way at 47.)

View the original article here

Less-invasive alternative to tackle the Sagging neck

But it turns out that is not true. These days, less-invasive alternative to enhance the appearance of his neck, provided that there is a full-scale Turkey wood. As a Romance, a neck go wrong in many ways. Weight gain or genetics may lead to a double chin. Loose skin can worsen underlying lax muscles. Neck-lift (on your own or with appearance) remains the best basis for a striking, lasting correction.

But cautious liposuctioning superfluous fat can also help streamline full throat, especially those who have still relatively youthful elastic skin that can bounce back after the procedure. The trick is not to be suctioned to point see skeleton (it should look at the underlying Loose the bands of muscle, which become more obvious after).

If the problem is these isolated bands, inject Botox in your neck muscle can make them less conspicuous in a patient with large colour, "said Dr. Rod Rohrich j., Chair of the Department of plastic surgery at the University of Texas Southwestern Medical Center in Dallas. But patch lasts only three to four months.

Promoted over the past year "the Rachael Ray Show", Ulthera is a new lifting skin procedure with focused ultrasound to trigger collagen growth depth under the epidermis. A single treatment can improve the outlines of the under-chin laxity in patients around 40-55 years old who believe that they are not ready for surgery or amenable to it, several doctors said, including Dr. Matthew White, photo by plastic surgeon at NYU Langone Medical Center. Ulthera handpiece printed on the skin can doctors to see underlying layers onto a screen (as with gynaecological ultrasound) before entering treatment, a first noninvasive dermatological procedures. "We deposit energy into an exact depth below the surface of the skin, without interfering with the intermediate tissue," said Matthew Likens, CEO of Ulthera, Mesa, Ariz., the company behind it.

Patients may feel pain during treatment. Potential candidates should also be aware that peer-reviewed published studies have yet to quantify just how much sharpening can be expected in the neck and lower face. -It is true, confirmed Mr. Likens. (Research continues, "he says.)

Not to stop Dr. Mehmet Oz, a cardiologist, from proclaiming his television show last month that Ulthera was a "revolutionary nonsurgical facelift" and promises to get rid of a viewer sagging necks live scene. In the segment, "said Dr. Haideh Hirmand, plastic surgeon in Manhattan, it was the first time she was" really excited "about a noninvasive technique for lifting of tissue. She stressed that there is no substitute for Ulthera surgery, neck skin is too loose. (In a later interview she recommended a pain medication such as Percocet and antianxiety drugs Valium before treatment, which she said was worth for minimal neck looseness.)

"The company will tell you it's easier to do," said Dr. Tina Alster, a dermatologist in Washington, which has left a pain and an antianxiety medicines mandatory for her Ulthera patients. As I said, Dr. Alster, who will receive a scholarship for research from Ulthera to study its effect on the outside face areas, is to see the results in the area of eyebrows, Cheeks and neck of middle-aged patients.

The segment "Dr. Oz" left the impression that the device has been cleared of Ulthera Food and Drug Administration used for the neck and lower face and eyebrow area.

Not so. "The company can only promote device for eyebrows-lift," Although treatment schedule includes the Cheeks and throat, also Karen Riley, a spokeswoman for the Agency, wrote in an e-mail message. -But they can make any claims with respect to these areas and cannot promote their device for treating specific conditions in these areas. (As with other procedures, but the doctors can treat other body parts at our own discretion.)

Nina Fritz Meyerhof, who runs the children on Earth, an organization for peace, was willing to chance it when she met Dr. White this month to firm up for Ulthera her neck and jawline. "I wanted everything to look fresh and tight," she said.

68 Is Ms. Fritz Meyerhof, of South Burlington, Vt., a decade or two older than Dr. White typical candidate, someone who is just starting to Notice during the chin skin laxity. But Dr. White, who has studied the focused ultrasound, knew his skin was still so elastic that it would tighten. (How fast the skin ages vary with factors such as sun exposure, genetics and smoking – which may be why your older pal neck skin is taut while your gave way at 47.)

View the original article here

Bleomycin: A worthy alternative

Bleomycin: A worthy alternative

Gursev Sandlas, Paras Kothari, Parag Karkera, Abhaya Gupta
Department of Pediatric Surgery, Lokmanya Tilak Muncipal Medical College and General Hospital, Sion, Mumbai, India

Correspondence Address:
Gursev Sandlas
Department of Paediatric Surgery, Lokmanya Tilak Muncipal Medical College and General Hospital, Sion, Mumbai - 400 022
India

DOI: 10.4103/0970-0358.81443

Context : Lymphangiomas are developmental anomalies presenting mainly in the first two years of life. Surgical excision has been the mainstay of treatment; however a potentially disfiguring surgery along with presence of important structures in the vicinity and infiltration into surrounding structures makes the dissection difficult. Aims : To study the safety and efficacy of Bleomycin as a sclerosing agent for lymphatic malformations in children. Settings and Design : Prospective non comparative nonrandomized trial. Materials and Methods: The study was carried out in 15 children between Day 5 of life to 12 years of age who presented between May2008 to May 2009. Bleomycin aqueous solution was injected intralesionally at a dose not exceeding 0.6 to 0.8 mg. /kg Body wt. The response to therapy was monitored clinically by measuring the length, breadth and area as well as by measuring the two largest perpendicular dimensions. The response was graded as excellent [total disappearance], good [>50% reduction] and poor [<50% decrease]. Those patients with diffuse lymphangiomas associated predominantly with hemangiomatous malformations, mediastinal, spinal or retroperitoneal extensions, visceral lymphangiomas, those with infections were excluded from the study. Statistical analysis used: None applicable. Results: The reduction in the size of the mass usually took between two weeks to ten months. The average duration of follow up has been ten months. A significant response was seen in 8 out of the fifteen [53.33%] patients. 5 patients [33.33%] patients showed a good response to therapy and achieved >50% reduction in the size of their swellings. 2 patients [13.33%] showed a poor response to therapy and achieved less than 50% reduction in the size of the swelling. Complications of the therapy were few and far between. 2 patients developed fever after injection, one patients reported a transient increase in size of swelling, 2 patients have developed discoloration of the overlying skin and are currently being followed up for final outcome. None of the patients developed leucopenia or leukocytosis. All of the complications were managed with conservatively. Patients are on long term follow up to evaluate long term effects, if any.

Keywords: Bleomycin; sclerotherapy; lympangimatous malformations

How to cite this article:
Sandlas G, Kothari P, Karkera P, Gupta A. Bleomycin: A worthy alternative. Indian J Plast Surg 2011;44:50-3

Lymphatic malformations are developmental anomalies presenting mainly in the first 2 years of life. [1] They have been classified into three major groups, although different varieties coexist. The cysts can vary from a few millimeters to several centimeters in diameter. [2] Surgical excision has been the mainstay of treatment; however, problems remain because of a potentially disfiguring nature of surgery, the presence of important anatomical structures in the vicinity which need to be protected and infiltration of the lesion into these structures making the dissection difficult. [1],[3]

Coupled with a high-recurrence rate, there is a search for effective and safe alternative or adjuvant methods of treatment. This study was conducted to examine the efficacy of bleomycin aqueous solution as a sclerosing agent. And, although other alternatives are available, the concerned agent was used to evaluate its safety and efficacy in children.

The study was conducted to evaluate the efficacy of intralesional bleomycin in cystic hygroma, lymphangiomas and haemangioma. It was a prospective study conducted at a tertiary care paediatric surgical centre in Mumbai.

The study was carried out in 15 children between Day 5 of life to 12 years of age who presented between May 2008 and May 2009. Those patients with diffuse lymphatic malformations with associated predominant haemangiomatous components, mediastinal, spinal or retroperitoneal extensions, visceral lymphatic malformations and those with infections were excluded from the study. An informed consent was obtained from the parents of the children subjected to intralesional bleomycin therapy in the out-patient department. After preliminary clinical examination and blood investigations, an imaging study that included ultrasound and magnetic resonance imaging in some cases was carried out where the extent was not clearly defined. Under complete aseptic precautions and necessary sedation, the lesions were aspirated as much as possible. The aspirating needle was kept in situ and bleomycin aqueous solution was injected intralesionally at a dose not exceeding 0.6-0.8 mg/kg body weight. [1]

The multilocular lesions were aspirated and injected at multiple sites. The bleomycin was reconstituted in such a way as to deliver a dose of 0.5 mg/ml. The injection was repeated at an interval of 4 weeks and the cumulative dose of bleomycin was restricted to less than 5 mg/kg.

The response to therapy was monitored clinically by measuring the length, breadth and area as well as by measuring the two largest perpendicular dimensions. Imaging for follow-up was restricted to cases that needed accurate assessment. The response was graded as excellent (total disappearance), good (>50% reduction) and poor (<50% decrease). The average follow-up period till now is 18 months, and patients are being followed-up regularly, and this is an ongoing process.

Of the 15 patients treated, nine patients (60%) were less than 1 year of age. The youngest patient treated, a Day 5 neonate [Figure 1], [Table 1] had a huge lymphatic malformation in the neck. Nine patients were male and six patients were female. The most common site was the face and the neck region (10 patients); there was one patient with scalp haemangioma, one patient with inguinal region lymphatic malformation, one patient with suprascapular lymphatic malformation, one patient with a lip haemangioma and one patient with lymphatic malformation in the floor of the mouth.

The reduction in the size of the mass usually took between 2 weeks to 10 months. The number of sittings varied from one to a maximum of four per patient. The average duration of follow-up has been 18 months.

A significant response was seen in eight of the 15 (53.33%) patients. They showed an excellent response to therapy resulting in complete disappearance of the lesion [Figure 2].

Five patients (33.33%) showed a good response to therapy and achieved >50% reduction in the size of their swellings [Figure 3] and [Figure 4]. Figure 4: Greater than 50% reduction in swelling after three sittings of bleomycin

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Two patients (13.33%) showed a poor response to therapy and achieved less than 50% reduction in the size of the swelling. Both these patients had their swellings excised surgically.

The patients showing a good response are currently under active follow-up. All of them have been given an option of surgical removal of the residual swelling, but they have opted for a wait and watch policy.

The patients with excellent response have shown a good final cosmetic outcome with no signs of recurrence in any of them.

Complications of the therapy were few and far between. Two patients developed fever after injection, one patient reported a transient increase in the size of the swelling and two patients had discolouration of the overlying skin and are currently being followed-up for final outcome [Figure 5]. None of the patients developed leucopenia or leukocytosis. All the complications were managed conservatively and do not seem to have any lasting effects.

Intralesional bleomycin as a sclerosing agent was used for the first time by Yura et al.[4] Bleomycin aqueous solution as a sclerosing agent has been used by many workers, and some of them found that it is not as effective as the bleomycin emulsion. Bleomycin has been shown to be more effective for cystic-type as compared with capillary or cavernous lymphangiomas. [1],[3],[5] Cervical, facial and axillary lymphatic malformations are more commonly composed of the cystic type.

Pulmonary toxicity is a potential side-effect of bleomycin therapy. This risk is related to the dose, an increasing incidence being associated with a total dose of more than 400 units or a single dose exceeding 30 mg/m 2 of the body surface area. Elderly patients and those with underlying pulmonary disease are at an increased risk. [6] Because of the potential for airway compromise after bleomycin injection of some cervical lymphatic malformations, close monitoring is required for such lesions. [1],[3] We have not encountered any pulmonary complications in our study. The subjects are being screened with X-ray chest annually to look for early changes of pulmonary fibrosis.

Intralesional bleomycin has been effective in complete resolution of the lesions in 60% of the patients, which is comparable, favourably, with the other studies carried out on this subject. [1],[2],[3],[5]

A minimum dose of 1 mg/kg of bleomycin has been recommended in the literature for each injection of bleomycin. [1] However, we believe that this dose can be still lower and the sclerosing effect of the solution is still effective. In our study, we have used a maximum dose of 0.8 units/kg and have achieved comparable results. The desired effect of the drug locally is dependent on the availability of the drug per unit surface area of the lesion; [6],[7] hence, the amount of drug given should depend on the size of the lesion and not only on the weight of the patient. Another factor that can influence the final dose of the solution is the ability to aspirate the lesion before injecting. Uniloculate lymphatic malformations that could be successfully aspirated completely showed excellent response even at a lower dose and volume of the solution. However, the exact factors influencing the local action of the solution will need further detailed studies.

 
Okada A, Kubota A, Fukuzawa M, Imura K, Kamata S. Injection of Bleomycin as a primary therapy of cystic lymphangiomas. J Pediatr Surg 1992;27:440-3.  
[PUBMED]  [FULLTEXT]  Tanigawa N, Shimomatsuya T, Takahashi K, Inomata Y, Tanaka K, Satomura K. Treatment of Cystic Hygroma and Lymphangioma using Bleomycin fat emulsion. Cancer 1987;60:741-9.  
Orford J, Barker A, Thonell S, King P, Murphy J. Bleomycin therapy for Cystic Hygroma. J Pediatr Surg 1995;30:1282-7.  
[PUBMED]  [FULLTEXT]  Yura J, Hashimoto T, Tsuruga N, Shibata K. Bleomycin treatment for cystic hygroma in children. Nippon Geka Hokan 1977;46:607-14.  
[PUBMED]    Tanaka K, Inomata Y, Utsunomiya H, Uemoto S,. Asonuma K, Katayama T. Sclerosing therapy with bleomycin emulsion for lymphangioma in children. Paediatric Surgery International 1990;5:270-3.  
Hardman JG, Limbird LE, Gilman AG. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 10th ed. New York: McGraw-Hill, 2001.  
Bracken RB, Johnson DE, Rodriquez L, Samuels ML, Ayala A. Treatment of multiple superficial tumors of bladder with intravesical bleomycin. Urology 1977;9:161-3.  
[PUBMED]    

[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]

[Table 1]

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Is Bleomycin a worthy alternative?

Is Bleomycin a worthy alternative?

Jyotsna Murthy
Department of Plastic Surgery, Sri Ramachandra Medical College and RI, Chennai, India

Correspondence Address:
Jyotsna Murthy
Department of Plastic Surgery, Sri Ramachandra Medical College and RI, Chennai
India

DOI: 10.4103/0970-0358.81442

How to cite this article:
Murthy J. Is Bleomycin a worthy alternative?. Indian J Plast Surg 2011;44:54

Bleomycin is an antibiotic discovered in 1966 and used as anti-cancer drug. It has also been used as sclerosant for lymphatic malformation with good results and minimum side effect. Like any sclerosant agent, bleomycin is popular for the treatment of lymphatic malformation with publication as recent as in January 2011. [1] Unlike surgery, sclerotherapy is better specially for avoiding injury to important nerves or structures in vicinity of lesions. [2] Acute pulmonary complication is a potential threat with bleomycin which need to be diagnosed early and treated. [4]

This study has shown the positive outcome, it does not scientifically draw conclusion for the following reasons.

In 1996, the International Society of the Study of Vascular Anomalies met in Rome issued guide for nomenclatures laying foundation for improve management. [5] Often it has been printed 'Wrong Diagnosis, Wrong Treatments'. The group has suggested two basic classifications of vascular anomalies: haemangiomas and vascular malformation. Lymphatic malformation belongs to vascular malformation and further classified as micro-cystic or macro-cystic. The lesions with more than 1 cm cavities are classified as macrocystic lesions. The diagnosis of lesions in this article is haemangiomas and lymphangiomas which are not comparable. Lymphatic malformations have not been sub-classified into micro/macro-cystic lesions because macro-cystic lesion will respond to sclerotherapy unlike micro-cystic one. The lack of clarity of diagnosis prevents any sound conclusion.

Bleomycin is an antibiotic with toxic cellular effect for which it has been used as an anti-cancer drug. It is also used for collapsing cavities specially following malignant effusion. Bleomycin has shown to be less effective than tetracyclin injections. [5] The tretracyclin injections are not easily available. However, its analogue doxycycline and monocyclin are available, and show similar results. Proper dose and concentration are paramount for the effectiveness of any drug. The concentration of bleomycin is 1 U=1 mg and concentration of 1 U/ml for injection is essential to get 60% of successful results. Authors' claim to have the same effect with lesser concentration without any scientific study is superfluous. Although injections of bleomycin are less painful compare to other sclerosant, it is a costly drug (approximate costs $350/15 units).

In view of the above lacunae in the study, it is not appropriate to draw any conclusion from this study but it only presents the anecdotal experience of author with bleomycin. A better diagnostic criteria and study design would have really been invaluable.

 
Yang Y, Sun M, Ma Q, Cheng X, Ao J, Tian L, et al. Bleomycin A5 sclerotherapy for cervicofacial lymphatic malformations. J Vasc Surg 2011;53:150-5.  
Karavelio?lu A, Temu?in CM, Tanyel FC, Ciftci AO, Senocak ME, Karnak I. Sclerotherapy with bleomycin does not adversely affect facial nerve function in children with cervicofacial cystic lymphatic malformation. J Pediatr Surg 2010;45:1627-32.  
Atwa K, Abuhasna S, Shihab Z, Hashaykeh N, Hasan R. Acute pulmonary toxicity following intralesional administration of bleomycin for a lymphovenous malformation. Pediatr Pulmonol 2010;45:192-6.  
Mulliken JB, Fischman SJ, Burrow PE. Vascular Anomalies. Curr Prob Surg 2000;37:517.  
Vargas FS, Wang NS, Lee HM, Gruer SE, Sassoon CS, Light RW. Effectiveness of bleomycin in comparison to tetracycline as pleural sclerosing agent in rabbits. Chest 1993;104:1582-4.  

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