Treatment of infantile subglottic hemangioma with electrocautery.

Laryngeal subglottic hemangioma is a rare but potentially life-threatening congenital lesion that can compromise that infant airway. A multitude of medical and surgical modalities have been used in the treatment of this lesion but no single approach has received universal acceptance. Three infants with subglottic hemangiomas were treated successfully with electrocautery; each was managed without tracheostomy. Bronchoscopic electrocautery appears to be a safe, effective, inexpensive way to manage infantile subglottic hemangioma.     

Surgical treatment of hemangioma on the dorsum of the penis

Therapies for hemangiomas of the penis include surgical excision, electrofulguration, cryotherapy, sclerotherapy, and neodymium:yttrium aluminum garnet laser treatment. Urologists often face difficulties in deciding whether to use surgery in penile hemangioma cases. In this study, we investigated the safety and feasibility of surgical treatment of hemangioma in the penis. The study included 6 patients, 19 to 42 years of age (median age 23 years), with hemangiomas on the dorsal aspect of the penis. All patients were treated with surgery. All operations were successful, and no complications were observed. Patients were followed up for 2 to 5 years (median 2.5 years) after discharge from the hospital. Five patients were assessed for sexual function. Lesions healed completely, and all patients were satisfied with the aesthetic results. All patients had returned to normal sexual activity within 3 months of the operation. Sexual function and sexual satisfaction were well maintained after the operation. A therapeutic reference standard for the treatment of penile hemangioma is still lacking because of the rarity of the disease. The results of our experience confirm that surgical treatment for penile hemangioma represents a safe radical curative procedure. Surgical treatment offers an alternative to the more conservative therapy previously advocated.     

Sclerotherapy of hemangioma of the glans penis

Penile hemangiomas are very rare, small lesions. Possible therapies include surgical excision, electrofulguration, cryotherapy, and sclerotherapy. We describe an extremely rare case of a large hemangioma of the glans that was treated by means of repeated injections of 2% polidocanol under local anesthesia (5% lidocaine-prilocaine cream). No complications were observed after the operation, and a satisfactory aesthetic result was obtained. No relapse was noted 18 months after the treatment. A therapeutic reference standard for the treatment of penile hemangiomas is still lacking because of the rarity of the disease. Sclerotherapy proved to be an effective, low-cost, and easy-to-perform procedure. Moreover, it is repeatable in case of failure.     

Metastatic neuroblastoma mimicking infantile hemangioma

Many lesions can masquerade as deep infantile hemangioma, the most common tumor of infancy. We describe an infant with infantile hemangioma and concomitant metastatic subcutaneous neuroblastoma mimicking deep hemangioma. The patient presented at 8 months of age with 3 superficial infantile hemangiomas as well as 3 subcutaneous masses. History, physical examination, and ultrasonography of the deep lesions were consistent with subcutaneous hemangioma. New masses appeared at 10 months of age that prompted biopsy; histopathology demonstrated metastatic neuroblastoma. Deviation from the predictable clinical features of a deep infantile hemangioma should prompt consideration for other causes of a subcutaneous mass in infancy, including metastatic neuroblastoma.     

CO2 laser excision of pediatric airway lesions

Treatment of life-threatening pediatric airway lesions has been greatly enhanced by development of the CO2 laser. Using this modality, endoscopic access and precise tissue destruction are possible with minimal local inflammation and subsequent edema of the narrow airway. From October 1986 through October 1988, 26 patients underwent 96 laser procedures for excision of airway lesions, in 23 patients via bronchoscopy and in three patients via microlaryngoscopy. Ages ranged from 1 day to 20 years, with most patients under 2 years of age. Diagnoses included: laryngeal cysts (1); cystic hygroma (3); tumor (neurofibroma, 1) subglottic hemangioma (1); excision of airway granulation tissue (8); and tracheal stenosis (13, including subglottic stenosis in 9). Therapy of the offending lesion required from one to eight laser procedures (mean, 2.8), excluding one patient with congenital long-segment tracheal stenosis who required 24 laser treatments for repeated excision of tracheal granulation tissue. Most lesions responded to only one or two laser treatments. No bleeding or perforation occurred secondary to laser use. Use of the laser was responsible for salvaging the airway or simplifying management of the airway in 21 of the 26 patients. In three patients with cystic hygroma affecting the laryngeal structures as well as soft tissues of the neck, laser excision was performed to maintain upper airway patency with a tracheostomy for airway control. Two patients with critical subglottic stenosis initially responded to laser excision, but moved away from the area and developed recurrence of their subglottic stenosis requiring tracheostomy, because further laser treatment was either unavailable or was deferred in their new locale.(ABSTRACT TRUNCATED AT 250 WORDS)     

Giant intracranial hemangioma in a neonate

In this report we detail the case of an infant presenting with a giant intracranial congenital hemangioma and describe the clinical features and surgical management. Congenital hemangiomas are benign vascular tumors that typically present as skin lesions in neonates and infants. On rare occasions they present as intracranial tumors. The possibility that these tumors may undergo spontaneous regression poses a treatment dilemma.     

Surgical treatment of nasal hemangiomas

The treatment of nasal hemangiomas continues to be controversial. The authors' experience with early surgical treatment of nasal hemangiomas is presented. This retrospective study includes 11 patients. Surgical intervention consisted of excision of the nasal hemangioma and reconstruction by local tissue transfer or rearrangement. Age at surgery ranged from 10 months to 6.5 years (mean age, 2.2 years). All patients have acceptable nasal contour and have demonstrated excellent nasal growth. The authors' experience demonstrates that early surgical intervention is an acceptable alternative for the management of nasal hemangiomas.     

Treatment of subglottic hemangiomas with propranolol: initial experience in 10 infants

Background: Subglottic hemangiomas (SGH) are a rare tumour, often associated with significant airway obstruction in infants. Current treatment options, while effective, often expose the infant to potential complications. Emerging evidence suggests a role for the beta blocker propranolol in the initial management of SGH. Methods: We report our experience with propranolol 2 mg/kg/day in 10 consecutive cases of SGH with significant airway obstruction (age range 2–4 months). Results: After a mean of 7.7 months of treatment, symptom resolution was observed in all cases and eight infants had regression and were stable. Two patients experienced regrowth after 9 months of therapy. To date, no infant has had a tracheostomy or surgical removal of the lesion. Conclusions: Early results with propranolol are promising; it is effective in controlling SGH, has a rapid onset of action, appears to obviate the need for tracheostomy and can allow tapering of the corticosteroid dose. Repeat laryngoscopy will be required to map the clinical course of these children and elucidate the long‐term benefits of propranolol.     

Slide thyrocricotracheoplasty for the treatment of high-grade subglottic stenosis in children

Background/Purpose

The aim of this study was to describe our early experiences with a novel surgical procedure, “slide thyrocricotracheoplasty,” for the treatment of high-grade subglottic stenosis in children.

Patients and Methods

A retrospective analysis was performed in 7 children who underwent slide thyrocricotracheoplasty for high-grade subglottic stenosis from 1996 to 2009.

Results

Three patients were male and four were female. The etiology of subglottic stenosis was congenital (n = 4) or acquired (n = 3). All patients had undergone a tracheostomy before slide thyrocricotracheoplasty. Median age at operation was 16 months (range, 1-25 months). The median follow-up period after definitive operation was 58 months (range, 13-156 months). There was one case requiring debridement and re-anastomosis of slide thyrocricotracheoplasty site because of anastomotic disruption caused by a methicillin-resistant Staphylococcus aureus infection of the cartilage and one case requiring a minor operation to remove granulation tissue. At final follow-up, all patients did not have any airway cannulation with satisfactory functional outcome in terms of breathing and swallowing. All except one were noted to have acceptable vocal function. The patient with unsatisfactory vocal function continued to receive voice rehabilitation treatment.

Conclusions

Slide thyrocricotracheoplasty offers an efficient surgical treatment option with minimal morbidity for high-grade subglottic stenosis in children.     

Argon laser treatment of an eyelid margin capillary hemangioma

When capillary hemangiomas do not resolve spontaneously, treatment may be indicated. Various forms of therapy have been employed. These include excisional surgery, cryotherapy, sclerosing solutions, embolization, external beam irradiation, steroids, and the argon laser. We report the use of a standard ophthalmic argon laser combined with curettage on a noninvoluting eyelid margin hemangioma found on a 29-year-old man. Details of the surgical technique are provided and postoperative results documented. We believe this to be the first case of a lid margin hemangioma successfully treated in this manner. The technique offers these advantages: (1) Selective absorption of the laser energy by the blood-filled tissue allows microablation of the lesion under ideal hemostatic conditions with minimal loss of normal lid tissue. (2) Oculoplastic lid repair is obviated since minimal normal tissue is removed. (3) The procedure can be performed under local anesthesia on an outpatient basis.     

Endobronchial cryotherapy in the treatment of tracheal strictures

Modern advances in ventilatory support systems have introduced a patient population requiring long term endotracheal intubation or tracheostomy. The formation of tracheal strictures in such patients remains a very significant clinical problem despite new modifications in endotracheal tube design and materials. Dissatisfied with standard modalities of treatment for these lesions, we have explored the usefulness of endobronchial cryotherapy for the treatment of such stricture. Cervical tracheal strictures were produced in 11 sheep. In six animals a prototype cryosurgical probe was passed through the bronchoscope and these lesions frozen to ?80°C. Respiratory epithelial regeneration was complete, but significant reduction in strictures was not noted. Utilizing the cryosurgical probe in conjunction with the endobronchial resection of tracheal strictures in three animals did, however, produce significant reduction in stricture size. Healing following cryonecrosis was associated with minimal fibrosis. Endobronchial cryotherapy is easily performed and has been well tolerated by these animals.     

Giant tumor of the right atrium in infancy

Cardiac hemangiomas can occur at any age, but they are extremely rare when they occur early after birth. We describe the case of a 5-month-old infant who had a giant right atrial capillary hemangioma associated with massive pericardial effusion. The tumor was incidentally diagnosed during routine clinical follow-up. The hemangioma was removed successfully under cardiopulmonary bypass, and the patient's postoperative course was uneventful. The occurrence of giant capillary hemangioma in infancy represents an unusual event in the relevant literature. Herein, we discuss the clinical features and surgical management of this rare primary tumor of infancy.     

Anterior cricoid split for subglottic stenosis

Subglottic stenosis is a common problem that often results from ventilatory support necessary in the premature infant. Previous methods of treatment include tracheostomy with dilatation of the stenosis, steroid injections, and procedures to stent the trachea. Results of these methods have been unsatisfactory because of the multiple procedures needed to obtain an adequate airway as well as the high mortality from long-term tracheostomy in infants. In the past 2 years, seven infants have undergone an anterior cricoid split for tight subglottic stenosis and airway obstruction. Of the seven patients, six were premature, five of whom required ventilatory support ranging from 4 to 30+ days. Each child presented in respiratory distress with symptoms present in five children from 1 to 11 months (mean 3.8) after birth. Bronchoscopy identified the site of obstruction in each case as subglottic, with a narrow lumen, usually less than 2.5 mm in diameter. Anterior cricoid split was performed at ages ranging from 2 to 11 months (mean 5.0). All children were extubated at 10 to 14 days and subsequently discharged home asymptomatic; none required postoperative tracheostomy. Complications developed in five children, including atelectasis, otitis media, phlebitis, and tracheocutaneous fistula in two, one of whom required operative closure. One child was rebronchoscoped at 3 weeks postoperatively for bronchospasm, which resolved on aminophylline. The subglottic trachea was normal. At follow-up ranging from 2 to 21 months (mean 8.3), no child has symptoms referrable to the subglottic region. In one patient, a brief period of respiratory distress recurred 3 months postoperatively due to tracheomalacia.(ABSTRACT TRUNCATED AT 250 WORDS)     

婴幼儿海绵状血管瘤的再分类及临床与实验室依据

目的 婴幼儿海绵状血管瘤的诊断存在性质上的混淆,故需对该组疾病进行合理的再分类。方法 通过对6个月龄以内进行正规激素治疗的16例婴幼儿海绵状血管瘤患者进行了为期逾8年的临床随访,分别检测细胞增殖标志物增殖细胞核抗原(proliferating cell riuclear antigen,PCNA)、血管形成标志物碱性成纤维细胞生长因子(basic fibroblastic growth factor,bFGF)、血管内皮细胞生长因子(vascular endothelial growth factor,VEGF)及组织学特征等。结果 可以根据最后是否消退分为两组,两组间无论在预后、上述标志物表达、体征、生长特征等方面都存在明显差异。结论 取消婴幼儿海绵状血管瘤这一诊断,重新划分为皮下毛细血管瘤与海绵状静脉畸形两类,将有利于正确的诊疗方案选择。     

椎体血管瘤诊治策略

目的探讨不同部位、不同类型椎体血管瘤的诊治策略。方法回顾性分析2000年1月至2011年6月收治的22例症状性椎体血管瘤病例,对不同部位、不同类型（依据MRI表现）的椎体血管瘤采取相应的治疗方法,观察患者治疗后症状缓解情况,同时记录并比较18例手术患者手术前后VAS评分。结果对4例颈椎症状性椎体血管瘤（病变椎体核磁信号为T1WI呈中高信号,T2WI呈高信号,属海绵状椎体血管瘤）行放射治疗;对18例颈椎以下症状性椎体血管瘤（病变椎体核磁信号为T1WI呈低信号,T2WI呈高信号,属毛细血管状椎体血管瘤）中的15例行经皮椎体成形术,3例行脊柱后路开放手术。随访4～60个月（平均26个月）,患者症状明显缓解,无手术相关并发症发生。手术病例VAS评分较术前有明显改善（P〈0.05）。结论 MRI影像学评估对椎体血管瘤的诊断和治疗具有指导意义。对不同部位及不同类型的椎体血管瘤选择个性化的治疗策略,效果良好。     

Vascular tumors of the breast. V. Nonparenchymal hemangiomas of mammary subcutaneous tissues

Nine patients with vascular lesions of the mammary subcutaneous tissue were studied. All were women who ranged in age from 20 to 76 years (average 53 years). The lesions were angiolipomas (three cases), cavernous hemangiomas (three cases), and one example each of juvenile hemangioma, venous hemangioma, and papillary endothelial hyperplasia. The average size of these tumors was 1.8 cm (range, 0.8-3.2 cm). Only one of the excisional biopsy specimens contained breast tissue, and in this case the hemangioma was also extra parenchymal. With follow-up available for seven patients ranging from 5 months to just over 5 years (average 29 months), there were no recurrences. Subcutaneous hemangiomas of the breast do not differ appreciably in their clinical or pathological features from comparable lesions at other anatomic sites. Although mammary subcutaneous hemangiomas are benign and are not prone to recurrence or progression to angiosarcoma, complete excision is recommended to exclude the possibility of an underlying angiosarcoma.     

Thyroid alar cartilage laryngotracheal reconstruction for severe pediatric subglottic stenosis

BACKGROUND/PURPOSE: Laryngotracheoplasty has become an accepted treatment alternative for subglottic stenosis. However, the best autogenous material for laryngotracheoplasty remains controversial. Autogenous superior thyroid alar cartilage (TAC) has been used successfully in single stage laryngotracheal reconstruction in children with subglottic stenosis. METHODS: This is a retrospective study of 6 children (mean age, 16.6 months) undergoing TAC graft laryngotracheoplasty between September 1995, and June 1999. Two children had immediate tracheal intubation for congenital subglottic stenosis. Four others had previous tracheostomy: 3 for severe postintubation subglottic stenosis and 1 for congenital subglottic stenosis. After an anterior cricoid split, a piece of TAC was sutured between the cut ends of the cricoid, with the graft perichondrium facing intraluminally. Endotracheal intubation was maintained postoperatively. RESULTS: Four children underwent successfully extubation 9 to 21 days (mean, 15.5 days) postoperatively. Two required tracheostomy, which was maintained because of severe laryngomalacia and laryngotracheobronchomalacia. One child was treated with CO2 laser because of symptomatic recurrence of the subglottic stenosis 3 weeks after the surgery; another required fundoplication for gastroesophageal reflux 12 months after laryngotracheoplasty. There were no donor site complications in any of the 6 cases. Repeat laryngoscopy and bronchoscopy showed a patent subglottic airway. All of them are without symptoms after a mean follow-up of 26 months. CONCLUSIONS: (1) This preliminary experience indicates that the TAC graft technique is a viable option for laryngotracheal reconstruction; (2) the TAC graft has significant advantages, including a single operative incision and absence of donor-site morbidity.     

Surgical removal of pontomesencephalic cavernous hemangiomas

Cavernous hemangiomas of the brain stem are usually discovered accidentally during evacuation of a hematoma, and successful surgical treatment of these lesions is seldom achieved. With the increasing use of magnetic resonance imaging, the presence of a cavernous hemangioma can be detected before surgery, allowing an elective surgical approach. We successfully removed pontomesencephalic cavernous hemangiomas from 2 patients and pontomedullary hemangiomas from 2 others. Elective surgery was performed with perioperative bimodal monitoring of somatosensory and auditory evoked potentials. Performing surgery soon after the hemorrhage minimizes the risk of additional postoperative neurological deficit, since surgical excision is facilitated when the hematoma is not completely organized. Pontine hemangiomas are approached via the 4th ventricle. Mesencephalic hemangiomas are removed by a midline supracerebellar approach when they are lateralized by using a subtemporal approach. The lesion can be removed through a small incision in the brain stem at the site of the lesion. The favorable results, which include marked improvement of preoperative neurological deficits and documentation of complete removal of the lesion by magnetic resonance imaging, support a more aggressive approach to the treatment of symptomatic cavernous hemangiomas of the brain stem. Further investigation of the natural history of these lesions is mandatory.     

皮肤血管瘤的发病机制及治疗的研究现状

皮肤血管瘤是婴幼儿时期最常见的血管性肿瘤,由于皮肤血管瘤的具体发病机制不清,临床表现不同,而且不同类型的皮肤血管瘤病理演变过程均有很大的不同,故给临床上的治疗带来了很大的困难,目前临床上皮肤血管瘤的治疗常根据不同年龄、类型、时期及面积大小来选择不同的治疗方法.     

聚焦超声治疗婴幼儿血管瘤的初步临床应用

目的探讨聚焦超声治疗婴幼儿血管瘤临床效果及适宜能量参数。方法 2009年1月-2010年9月,收治60例血管瘤患儿。男23例,女37例;年龄3～30个月,平均10个月。病变部位:头面部24例,躯干15例,四肢16例,臀部2例,会阴部1例,颈部、腹部及上肢多发2例。瘤体范围为0.8 cm×0.6 cm～6.0 cm×5.0 cm。根据应用的聚焦超声能量不同,随机分成A、B、C 3组(n=20)。采用超声治疗仪以3～5 mm/s速度连续辐照血管瘤表面,频率9 MHz,脉冲1 000,重叠10%,扫描5个来回,A、B、C组功率分别为3.5、4.0、4.5 W;治疗3次为1个疗程,每次治疗间隔1个月,观察治疗结束6个月后效果及辐照区皮肤破溃、瘢痕发生率。结果所有患儿均完成1个疗程治疗,治疗结束6个月按照血管瘤疗效判定标准评定,各组比较差异无统计学意义(P>0.05)。A组无皮肤破溃及瘢痕;B组4例(20%)辐照区皮肤出现不同程度破溃,经换药后遗留浅表瘢痕;C组7例(35%)辐照区皮肤出现溃烂,经换药后遗留较明显瘢痕。B、C组皮肤破溃及瘢痕发生率均明显高于A组(P<0.05)。结论聚焦超声辐照是治疗婴幼儿血管瘤有效方法...