口服普萘洛尔治疗婴儿血管瘤疗效观察

Objective The objective of this study is to evaluate the efficacy of propranolol in treatment of infantile hemangioma. Methods Oral propranolol was applied to 47 infants with heamngiomas in Fuzhou General Hospital of Nanjing Military Command,Department of General Surgery from January 2009 to Match 2010. The patients received medication at home and were revisited every 2 weeks. The changes of tumor size, texture,color and adverse effects were monitored and recorded at a regular interval. Results The results were evaluated using Achauer system; scale Ⅰ(poor) in 14 patient,scale Ⅱ(moderate) in 13 patients,scale Ⅲ(good) in 15 patients and scale Ⅳ(excellent) in 5 patients. The treatment response for strawberry hemangioma was significantly better than other hemangiomas (P＜0. 05) ,but no significant diffierence was found among different primary sites (P＞0. 05). Conclusions Oral propranolol treatment is an effective treatment for strawberry hemangiomas.     

经导管动脉栓塞治疗婴儿颌面部巨大血管瘤

Objective To evaluate the therapeutic effects and safety of transcatheter arterial em-bolization (TAE) in infantile huge hemangiomas. Methods From 2005 to 2007, 25 consecutive cases of huge hemangioma that aged 1- 9mon ( mean 3.7±1.34 mon) and weighed 4.3 to 8kg (mean 6.52 ±0.86 kg) were treated by TAE. The support artery of hemangioma was embolized by Bleomycin-lip-iodol emulsion (PLE) and Polyvinyl Alcohol (PVA) in succession. Results Twenty-five cases under-went 35 times of TAE (1-3 times per each case with a mean of 1.4 times). The average hospitalization was 3.2 days (range 2-5 d ). The effective rate was 100% (25/25). The average follow-up period was 10. 44 months (range 6-16 months) without relapse. No serious complications such as pulmonary em-bolism and cerebral embolism occurred. Conclusions The advantages of TAE in the treatment for huge hernangioma in infancy are safe , effective, less trauma, short hospitalization and good cosmetic out-come.     

经导管动脉栓塞治疗婴儿颌面部巨大血管瘤

Objective To evaluate the therapeutic effects and safety of transcatheter arterial em-bolization (TAE) in infantile huge hemangiomas. Methods From 2005 to 2007, 25 consecutive cases of huge hemangioma that aged 1- 9mon ( mean 3.7±1.34 mon) and weighed 4.3 to 8kg (mean 6.52 ±0.86 kg) were treated by TAE. The support artery of hemangioma was embolized by Bleomycin-lip-iodol emulsion (PLE) and Polyvinyl Alcohol (PVA) in succession. Results Twenty-five cases under-went 35 times of TAE (1-3 times per each case with a mean of 1.4 times). The average hospitalization was 3.2 days (range 2-5 d ). The effective rate was 100% (25/25). The average follow-up period was 10. 44 months (range 6-16 months) without relapse. No serious complications such as pulmonary em-bolism and cerebral embolism occurred. Conclusions The advantages of TAE in the treatment for huge hernangioma in infancy are safe , effective, less trauma, short hospitalization and good cosmetic out-come.     

经导管动脉栓塞治疗婴儿颌面部巨大血管瘤

Objective To evaluate the therapeutic effects and safety of transcatheter arterial em-bolization (TAE) in infantile huge hemangiomas. Methods From 2005 to 2007, 25 consecutive cases of huge hemangioma that aged 1- 9mon ( mean 3.7±1.34 mon) and weighed 4.3 to 8kg (mean 6.52 ±0.86 kg) were treated by TAE. The support artery of hemangioma was embolized by Bleomycin-lip-iodol emulsion (PLE) and Polyvinyl Alcohol (PVA) in succession. Results Twenty-five cases under-went 35 times of TAE (1-3 times per each case with a mean of 1.4 times). The average hospitalization was 3.2 days (range 2-5 d ). The effective rate was 100% (25/25). The average follow-up period was 10. 44 months (range 6-16 months) without relapse. No serious complications such as pulmonary em-bolism and cerebral embolism occurred. Conclusions The advantages of TAE in the treatment for huge hernangioma in infancy are safe , effective, less trauma, short hospitalization and good cosmetic out-come.     

经导管动脉栓塞治疗婴儿颌面部巨大血管瘤

Objective To evaluate the therapeutic effects and safety of transcatheter arterial em-bolization (TAE) in infantile huge hemangiomas. Methods From 2005 to 2007, 25 consecutive cases of huge hemangioma that aged 1- 9mon ( mean 3.7±1.34 mon) and weighed 4.3 to 8kg (mean 6.52 ±0.86 kg) were treated by TAE. The support artery of hemangioma was embolized by Bleomycin-lip-iodol emulsion (PLE) and Polyvinyl Alcohol (PVA) in succession. Results Twenty-five cases under-went 35 times of TAE (1-3 times per each case with a mean of 1.4 times). The average hospitalization was 3.2 days (range 2-5 d ). The effective rate was 100% (25/25). The average follow-up period was 10. 44 months (range 6-16 months) without relapse. No serious complications such as pulmonary em-bolism and cerebral embolism occurred. Conclusions The advantages of TAE in the treatment for huge hernangioma in infancy are safe , effective, less trauma, short hospitalization and good cosmetic out-come.     

经导管动脉栓塞治疗婴儿颌面部巨大血管瘤

Objective To evaluate the therapeutic effects and safety of transcatheter arterial em-bolization (TAE) in infantile huge hemangiomas. Methods From 2005 to 2007, 25 consecutive cases of huge hemangioma that aged 1- 9mon ( mean 3.7±1.34 mon) and weighed 4.3 to 8kg (mean 6.52 ±0.86 kg) were treated by TAE. The support artery of hemangioma was embolized by Bleomycin-lip-iodol emulsion (PLE) and Polyvinyl Alcohol (PVA) in succession. Results Twenty-five cases under-went 35 times of TAE (1-3 times per each case with a mean of 1.4 times). The average hospitalization was 3.2 days (range 2-5 d ). The effective rate was 100% (25/25). The average follow-up period was 10. 44 months (range 6-16 months) without relapse. No serious complications such as pulmonary em-bolism and cerebral embolism occurred. Conclusions The advantages of TAE in the treatment for huge hernangioma in infancy are safe , effective, less trauma, short hospitalization and good cosmetic out-come.     

经导管动脉栓塞治疗婴儿颌面部巨大血管瘤

Objective To evaluate the therapeutic effects and safety of transcatheter arterial em-bolization (TAE) in infantile huge hemangiomas. Methods From 2005 to 2007, 25 consecutive cases of huge hemangioma that aged 1- 9mon ( mean 3.7±1.34 mon) and weighed 4.3 to 8kg (mean 6.52 ±0.86 kg) were treated by TAE. The support artery of hemangioma was embolized by Bleomycin-lip-iodol emulsion (PLE) and Polyvinyl Alcohol (PVA) in succession. Results Twenty-five cases under-went 35 times of TAE (1-3 times per each case with a mean of 1.4 times). The average hospitalization was 3.2 days (range 2-5 d ). The effective rate was 100% (25/25). The average follow-up period was 10. 44 months (range 6-16 months) without relapse. No serious complications such as pulmonary em-bolism and cerebral embolism occurred. Conclusions The advantages of TAE in the treatment for huge hernangioma in infancy are safe , effective, less trauma, short hospitalization and good cosmetic out-come.     

经导管动脉栓塞治疗婴儿颌面部巨大血管瘤

Objective To evaluate the therapeutic effects and safety of transcatheter arterial em-bolization (TAE) in infantile huge hemangiomas. Methods From 2005 to 2007, 25 consecutive cases of huge hemangioma that aged 1- 9mon ( mean 3.7±1.34 mon) and weighed 4.3 to 8kg (mean 6.52 ±0.86 kg) were treated by TAE. The support artery of hemangioma was embolized by Bleomycin-lip-iodol emulsion (PLE) and Polyvinyl Alcohol (PVA) in succession. Results Twenty-five cases under-went 35 times of TAE (1-3 times per each case with a mean of 1.4 times). The average hospitalization was 3.2 days (range 2-5 d ). The effective rate was 100% (25/25). The average follow-up period was 10. 44 months (range 6-16 months) without relapse. No serious complications such as pulmonary em-bolism and cerebral embolism occurred. Conclusions The advantages of TAE in the treatment for huge hernangioma in infancy are safe , effective, less trauma, short hospitalization and good cosmetic out-come.     

经导管动脉栓塞治疗婴儿颌面部巨大血管瘤

Objective To evaluate the therapeutic effects and safety of transcatheter arterial em-bolization (TAE) in infantile huge hemangiomas. Methods From 2005 to 2007, 25 consecutive cases of huge hemangioma that aged 1- 9mon ( mean 3.7±1.34 mon) and weighed 4.3 to 8kg (mean 6.52 ±0.86 kg) were treated by TAE. The support artery of hemangioma was embolized by Bleomycin-lip-iodol emulsion (PLE) and Polyvinyl Alcohol (PVA) in succession. Results Twenty-five cases under-went 35 times of TAE (1-3 times per each case with a mean of 1.4 times). The average hospitalization was 3.2 days (range 2-5 d ). The effective rate was 100% (25/25). The average follow-up period was 10. 44 months (range 6-16 months) without relapse. No serious complications such as pulmonary em-bolism and cerebral embolism occurred. Conclusions The advantages of TAE in the treatment for huge hernangioma in infancy are safe , effective, less trauma, short hospitalization and good cosmetic out-come.     

普萘洛尔治疗婴儿型血管瘤溃疡

目的 总结普萘洛尔治疗婴儿型血管瘤溃疡的经验. 方法 2010年1月至2012年12月我们收治婴儿型血管瘤伴溃疡患儿40例,男21例,女19例.记录血管瘤溃疡的发病年龄、就诊年龄、血管瘤类型,部位,溃疡类型,普萘洛尔治疗后疗效及副作用. 结果 患儿平均就诊年龄（5.1±1.9）个月,溃疡发生平均年龄（4.3±2.1）个月.92.5％的患儿为草莓状血管瘤,溃疡好发于四肢和臀部,溃疡平均深度（2.8±1.3）mm.普萘洛尔治疗时间（3.1±0.4）周,短于治疗前溃疡平均持续时间（P=0.04）.仅1例于服药期间出现出血、低血糖,1例出现心率减慢,经纠治后好转.100％的家属认为普萘洛尔对加速溃疡愈合有效. 结论 普萘洛尔治疗婴儿型血管瘤伴溃疡安全有效,值得推广应用.     

Propranolol therapy of infantile hemangiomas: efficacy, adverse effects, and recurrence

Objective

To evaluate the efficacy, adverse effects, and recurrence of oral propranolol for treatment of infantile hemangioma.

Methods

Participants were treated with oral propranolol three times daily, with inpatient monitoring of adverse effects. The starting dosage was 2 mg/kg per day, which had been for the remaining duration of treatment. Therapy duration was planned for 4–6 months; if there was significant relapse, the period of treatment was extended. A photograph based severity scoring assessment was performed by three observers to evaluate efficacy by visual analog scale (VAS).

Results

Sixty-one infants [median age 3.3 (1.2–8.1) months] were included in the study. The median follow-up-time was 15 (6–20) months and 53 patients completed treatment at a median age of 10.3 (8.4–18.1) months, after a duration of 8.5 (4.5–14) months. In all patients, there was significant fading of color [with a VAS of ?9 (?6 to ?9) after 6 months] and significant decrease in size of the infantile hemangiomas [with a VAS of ?8 (?3 to ?10) after 6 months]. We did not observe any life-threatening adverse effects. The therapy was interrupted due to temporary aggravation of pre-existing bronchial asthma in one child. Four cases presented partial recurrences.

Conclusions

Oral propranolol 2 mg/kg per day was a well-tolerated and effective treatment, mild adverse effects, and low recurrence for infantile hemangiomas. Propranolol should now be used as a first-line treatment in hemangiomas when intervention is required. Also, prospective studies should be needed in determining the most effective treatment dosage, optimum treatment duration, and exact mechanism of action of propranolol in future.     

Effects of propranolol therapy in Moroccan children with infantile hemangioma

Infantile hemangiomas are the most common childhood vascular tumors. Propranolol is a β-adrenergic blocker that has proven effective in the treatment of this tumor. Numerous studies around the world have been published, describing satisfactory responses in pediatric populations with a higher cure rate and fewer adverse effects than when using corticosteroids. The aim of this study was to evaluate the efficacy and adverse effects of propranolol in Moroccan pediatric patients diagnosed with infantile hemangioma who were treated with oral propranolol. A prospective study was conducted from May 2009 to May 2017 in the department of dermatology of a hospital in Casablanca. All the patients who had infantile hemangioma were included. The study comprised 121 patients with infantile hemangioma: 90 girls and 31 boys. The mean age was 6 months. The majority of hemangiomas were mixed (63%) and located on the face and neck. The treatment was well tolerated by all the patients. The dosage of propranolol was gradually increased from 1 mg to 2 mg/kg/day. We noted a decrease in coloration after 48 hours. The healing period for ulcerated hemangiomas was 20 days. A decrease in size was noted after 1 month, while a decrease in palpebral obstruction occurred after 3 days. Treatment with propranolol in this group of Moroccan pediatric patients proved to be safe and effective at a dose of 2 mg/kg/day, reducing the size and coloration of the hemangioma. Treatment should be stopped at an appropriate time, which is determined primarily by the lesion regression rate after propranolol treatment.     

Propranolol treatment for severe infantile hemangiomas: a single-centre 3-year experience

Aim: To evaluate the effectiveness, safety and tolerability of propranolol as single‐agent treatment in patients with problematic, proliferative‐phase, infantile hemangiomas (IHs). Methods: Oral propranolol was administered at a dose of 2 mg/kg/day to 28 children. Cardiologic evaluation was performed before treatment initiation. Hemodynamic variables and blood glucose levels were monitored during the first 24 h of treatment, while the children were hospitalized. Clinical response and tolerance were assessed every month, along with photographic documentation. Macroscopic regression was considered the reduction >90% in the size of the IHs. Results: Effects on colour and growth were observed within the first month in all cases. Twenty‐four patients completed treatment after a mean duration of 7.56 months, and their hemangiomas were successfully regressed. Propranolol was administered again, with satisfactory results, in three patients (12.5%) because of hemangioma regrowth. Satisfactory response is noticeable in ongoing cases. Episodes of hypotension were noted in four patients. There were no treatment interruptions because of side effects. Conclusions: Propranolol, as first‐line treatment, yielded excellent results with very good clinical tolerance and also seems to be effective in relapses. The optimal duration of the treatment remains to be defined by long‐term observation.     

Efficacy and Safety of 2% Topical Propranolol Cream for the Treatment of Proliferating Infantile Strawberry Hemangiomas

Objective

To evaluate the efficacy and safety of 2% topical propranolol cream in the treatment of proliferating infantile strawberry hemangiomas.

Methods

A total of 40 infants were enrolled; 2% propranolol cream was applied three times daily. In the subsequent monthly visit, dynamic changes in tumor size, texture, and color were recorded. The adverse events (AEs) were observed. Treatment outcomes were scored on a four-point scale. All patients were followed up for 12 mo after treatment.

Results

The overall response was graded Scale 1 (poor response) in 2 patients, Scale 2 (moderate response) in 15 patients, Scale 3 (good response) in 17 patients, and Scale 4 (excellent response) in 6 patients. No significant differences were seen in treatment outcomes between female and male patients, among lesion locations/size, or in the age at the start of the treatment. No obvious AEs were reported.

Conclusions

2% topical propranolol cream is safe and effective for the treatment of proliferating infantile strawberry hemangiomas.

     

Propranolol Treatment of Complicated Hemangiomas

Objectives

To evaluate laboratory and radiological features of hemangiomas in childhood in addition to efficacy and safety of propranolol as a first-line treatment of complicated hemangiomas retrospectively.

Methods

The files of 60 patients who were diagnosed as capillary hemangioma were evaluated retrospectively. Fourteen children with complicated hemangiomas treated with propranolol were analysed, in terms of side effects, efficacy and duration of treatment.

Results

These fourteen patients (23 %) were treated with propranolol because of ulcerated, infected and/or deep seated localisations. The duration of treatment with propranolol were between 3 and 12 mo (median: 6 mo). Bronchospasm was observed in one patient during treatment. Except for two patients, all of them responded to propranolol treatment with limited side effects.

Conclusions

The present results support that propranolol is safe and effective treatment choice for complicated infantile hemangiomas, because of minimal side effects and encouraging response rates (80 %). In addition, the authors suggest that routine cranial radiological imagings might not be necessary for hemangiomas without any neurological symptoms.     

Propranolol for infantile hemangiomas: a preliminary report on efficacy and safety in very low birth weight infants

Despite the relatively recent introduction of propranolol in the treatment of infantile hemangiomas, there can be little doubt of its efficacy. With regard to safety issues, there are no prior data for very low weight infants. In this study, we used propranolol in preterm and very low weight infants. We used clinical criteria to assess the response to the therapy. We noted all side effects expected from beta-adrenergic blocking drugs, and followed the patients' weight gain during propranolol treatment. Objective, clinical evidence of hemangioma regression was seen after two months in all patients. None of the patients required treatment discontinuation due to adverse side effects. During the propranolol treatment, weight gain was normal in all patients. To the best of our knowledge, this is the first report on the use of propranolol in preterm and very low weight infants, and also the first report from Turkey on the use of propranolol in infantile hemangiomas.     

普萘洛尔治疗225例儿童血管瘤疗效及安全性初步分析

目的 通过对口服普萘洛尔治疗血管瘤的临床病例进行分析,评价其疗效与安全性.方法 2009年12月至2010年11月湖南省儿童医院皮肤科采用口服普萘洛尔治疗血管瘤患儿225例,其中男74例,女151例;年龄20 d至16岁,平均9.13个月;单发性血管瘤199例;多发性血管瘤18例（2～5个部位）,其中合并肝血管瘤1例;婴儿泛发性血管瘤6例,其中合并肝血管瘤3例;血管瘤-血小板减少综合征2例.以15例血管畸形为对照组,入院后完善心电图、腹腔B超、肿块彩超、心脏彩超,核磁共振、甲轴全套、血糖及肝肾功能后,予以普萘洛尔1.5～2 mg·kg-1·d-1,分2次口服,服药前3 d予心电监护,服药观察3～4 d后带药回家继续服药,并每1～2个月门诊复诊,按4级评分法评价疗效,均于2010年12月统一随访.结果 213例坚持口服普萘洛尔1个月以上患儿中,疗效Ⅰ级（差）19例,Ⅱ级（中）52例,Ⅲ级（好）60例,Ⅳ级（优）82例,有效率91.08%,17例完全痊愈.其疗效明显优于血管畸形组（P〈0.001）,且随着用药时间延长,疗效增加.不良反应少,发生率为2.08%,1例心率减慢,1例手足凉,2例出院后转氨酶升高.结论 普萘洛尔治疗儿童血管瘤疗效显著,无明显不良反应,可作为婴幼儿血管瘤的一线治疗药物.     

Preliminary results of propranolol treatment for patients with infantile hemangioma

Propranolol, a non-selective beta-blocker, has recently been introduced as a treatment for infantile hemangiomas. In this study, we evaluated the effect of propranolol in 12 infants with hemangioma. Twelve infants (9 girls) with a median age of 4.5 months were included in the study. All of the patients in the study group received short-term (1-9 weeks, median: 4 weeks) systemic corticosteroids as a first-line therapy. All patients received propranolol 2 mg/kg/day, divided into three doses. They were treated in an inpatient setting for the first 72 hours of the treatment. Vital signs, blood pressure and blood glucose were monitored. Propranolol treatment was given for 4-9 months (median: 5 months). In the study group, regression rate of the mean dimension of the lesion was 38% +/- 15 (range 15%-50, median 45%) at the 2nd month of therapy. Over 9 months, which was the maximum follow-up period, the regression rate of the mean dimension of the lesion was 55% +/- 31 (range 20%-80, median 50%). One patient had transient bradycardia, which improved spontaneously. No other side effect was observed in the study population. Propranolol appears to be an effective drug for infantile hemangiomas with good clinical tolerance. We suggest that propranolol is the preferable drug as the first-line therapy for infantile hemangiomas.     

Hepatic vascular tumors

The most common hepatic vascular tumor in the pediatric population is the infantile hepatic hemangioma. Although these lesions have a spectrum of presentations, there are three main subtypes that have been described—focal, multifocal, and diffuse. An algorithm on the workup, treatment, and follow-up of these lesions can be based on this categorization. Recent shifts in the management of hemangiomas with beta-blockers (propranolol) have also influenced the treatment of hepatic hemangiomas. This article reviews the current understanding of hepatic hemangiomas and protocols in the management of these patients.