聚桂醇局部注射治疗婴幼儿血管瘤疗效观察

目的:观察泡沫硬化剂聚桂醇治疗婴幼儿血管瘤的效果。方法:56例婴幼儿血管瘤,应用聚桂醇注射液0.4~4.0 mL向瘤体内局部多点均匀注射,每4周治疗1次,由家长和医师根据瘤体颜色、肿胀程度及生长情况共同评估治疗效果,疗效分为治愈、显效、有效和无效。同时记录并发症。结果:平均注射3.5次(1~5次),痊愈40例(71.4%),显效8例(14.3%),有效7例(12.5%),无效1例(1.8%),有效率85.7%,无明显不良反应。结论:聚桂醇局部注射治疗血管瘤是一种安全有效、简便易行的方法。     

Conventional ultrasonography and elastography for the diagnosis of congenital and infantile hemangiomas

Infantile and congenital hemangiomas are difficult to distinguish in infants. The aim of this study was to compare the conventional ultrasonographic (US) and elastographic features of infantile and congenital hemangiomas. The US findings in 118 patients with congenital hemangioma (58 non-involuting, 36 rapidly involuting, 24 partially involuting) and 111 with 120 infantile hemangioma were retrospectively evaluated. On US imaging, 31.7% of infantile hemangiomas were hyperechoic, 31.7% hypoechoic and 36.6% mixed-echoic with hyperechoic and hypoechoic areas; 57.6% of congenital hemangiomas were mixed-echoic with a hypoechoic area and many vessels visible, 39.0% hypoechoic and 3.4% were mixed-echoic with hyperechoic and hypoechoic area. Calcifications were present in 6.8% and visible vessels involving muscle in 24.6% of congenital hemangiomas. All infantile hemangiomas and 82.2% of congenital hemangiomas were well-defined. All congenital hemangiomas were subcutaneous whereas 17.5% of the infantile hemangiomas were superficial. The maximum diameter and vascular density were greater in congenital hemangiomas. Elastography demonstrated that the congenital hemangiomas were softer than the infantile hemangiomas. The maximum diameter (including of visible vessels), thickness, vascular density, venous blood flow velocity and elasticity scores were greater for rapidly and partially involuting congenital hemangiomas than for non-involuting ones. The density of visible vessels in congenital hemangiomas decreased in the order of non-involuting, partially involuting and rapidly involuting. In conclusion, congenital hemangiomas have distinctive US imaging characteristics, including a greater maximum diameter, vascular density, number of visible vessels, visible vessels involving muscle, calcifications and elasticity score.     

Potential complications of segmental hemangiomas of infancy

Although the majority of hemangiomas of infancy can be expected to follow a benign course, a significant subset may result in serious complications. Recently, hemangiomas of segmental morphology, or those which are large, plaque-like, and patterned in distribution, have been recognized as important markers for potential complications. PHACE syndrome represents the best known example of the variety of problems that can occur in this setting. The PHACE acronym, which stands for posterior fossa brain malformations, segmental cervicofacial hemangiomas, arterial anomalies, cardiac defects and coarctation of the aorta, and eye anomalies, is sometimes referred to as PHACE(S) when ventral developmental defects such as sternal clefting and supraumbilical raphe are present. This article reviews the specific manifestations of PHACE, reflects on pathogenesis, and discusses appropriate work-up and future directions for this complex and fascinating syndrome. We also discuss other complications associated with hemangiomas of segmental morphology, including ulceration, potential visceral involvement, and underlying anomalies related to the lumbosacral location.     

Unrelenting facial segmental hemangiomas: A case series of late growth and recurrent ulcerations

Late growth of infantile hemangiomas is an uncommon complication. We report three patients with segmental facial hemangiomas who experienced late growth and recurrent ulceration predominantly of the lower lip. These patients shared common clinical features including involvement of the S3 facial segment, oral and airway hemangiomas, and vascular anomalies associated with PHACE syndrome. This report highlights a clinical presentation at-risk for late growth and recurrent ulceration.     

Multiple pulmonary infantile hemangiomas responsive to oral propranolol

Intrathoracic infantile hemangiomas (IHs) are extremely rare. They may be located in the pericardium, trachea, bronchia, diaphragm, mediastinum, or the lungs and may be associated with cutaneous IHs. We present a newborn with multiple pulmonary IHs in the absence of skin lesions that showed a dramatic response to oral propranolol.     

婴幼儿血管瘤发病机制研究进展

婴幼儿血管瘤(infantile hemangioma, IH)是一种常见的血管异常性疾病,目前对于IH的发病机制,尤其是自行消退的机制尚不十分清楚。研究发现血管瘤的内皮细胞与胎盘来源的血管内皮祖细胞具有同源性,遗传易感性、一些血管生成调节因子、细胞因子、转录因子、信号通路及基因在IH的发病机制中发挥着重要作用。本文就IH发病机制研究进展进行综述,以期为IH的治疗提供新的思路。。     

A further experience of propranolol for severe infantile hemangiomas of the face: an observational study

Infantile hemangiomas (IHs) are the most common proliferating embrional tumors of infancy, which are constituted by endothelial cell hyperproliferation. The authors want to report their observations of further 14 patients suffering from complicated IHs involving the facial district who were treated with propranolol. 14 patients, with ages between 3 and 12 months, completed a cycle of treatment with propanolol. The observational study aimed at focusing IHs involving the facial district. The treatment with propranolol showed good to very good results in the major part of the treated young patients. The authors want to report their experience and add more data in the confirmation of the use of β‐blockers for IH (either in efficacy or in safety profile), focusing on the efficacy of propanolol when IHs involve the face.     

Successful treatment of oral itraconazole for infantile hemangiomas: A case series

Infantile hemangiomas can present a therapeutic challenge to clinicians, especially when associated with severe pain and feeding difficulties. The standard therapeutic management includes corticosteroids and propranolol. However, the clinical response is not always satisfactory. We present six cases of infantile hemangiomas successfully treated with oral itraconazole approximately 5 mg/kg per day. In the first month, the red color of the lesions became a little lighter and the growth of the lesions was controlled in all cases. An obvious clinical improvement was noted in all cases during the 3‐month period, with 80–100% improvement in each patient at the end of the treatment, which was judged by both their parents and the dermatologists. Compliance with treatment instructions of oral itraconazole in infants was judged to be very good. Side‐effects were mild and limited. Although itraconazole can inhibit angiogenesis and tumor growth in vitro and in vivo associated with some cancers, further research is required to understand the pathogenesis of infantile hemangiomas and the mechanism of itraconazole.     

胰岛素样生长因子-I受体在人皮肤血管瘤不同分期的表达

目的:探讨胰岛素样生长因子-I受体与血管瘤发生发展的关系。方法:采用免疫组化SP法和半定量RT-PCR检测不同分期血管瘤中IGF-IR的表达水平,并与血管畸形及正常皮肤进行比较。结果:SP法和半定量RT-PCR结果均显示增殖期血管瘤内皮细胞IGF-IR表达水平增高,与血管畸形及正常皮肤组织间差异显著;而消退期的IGF-IR表达水平降低与血管畸形及正常皮肤相比,差异无显著性。结论:IGF-IR与血管瘤的发生发展有密切关系,为寻找皮肤血管瘤的诊断与治疗的新靶点提供了新的思路。