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Wang Q, Wu YX, Zhang MX, Song DQ, Su BL, Li SM, Shan WY, Liu ZJ, Luo CF, Yu LJ. Efficacy of Bleomycin-Lauromacrogol Foam in Pediatric Macrocystic Lymphatic Malformations With and Without Intracapsular Hemorrhage. J Pediatr Surg 2024; 59:1128-1134. [PMID: 38368195 DOI: 10.1016/j.jpedsurg.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 01/14/2024] [Accepted: 01/26/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND Sclerotherapy is purportedly less effective in patients with hemorrhagic than with non-hemorrhagic lymphatic malformations (LMs). We aimed to compare the efficacy of bleomycin-lauromacrogol foam (BLF) sclerotherapy in the treatment of macrocystic LMs with and without intralesional hemorrhage. METHODS Fifty-five children with macrocystic LMs admitted to the Pediatric Surgery Department were retrospectively included. The patients were allocated into a hemorrhage group (23 cases) or a non-hemorrhage group (32 cases) based on the occurrence of an intracapsular hemorrhage. The diagnosis was confirmed by physical examination, color ultrasound, magnetic resonance imaging, and puncture findings. BLF was injected into the capsule after draining the cystic fluid under color ultrasound guidance. Patients whose lesions were unchanged or showed minor change after 1 month were treated again using the same method. Changes in lesion size and the number of treatments were recorded. Effectiveness was classified as excellent (volume reduction ≥90%), good (50%≤volume reduction<90%), or poor (volume reduction <50%). RESULTS In the hemorrhage group, 17, 6, and 0 patients' outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 100%. In the non-hemorrhage group, 23, 7, and 2 patients' outcomes were classified as excellent, good, and poor, respectively. The overall efficacy rate was 93.8%. There was no significant difference in efficacy rate between groups (P = 0.767). CONCLUSIONS BLF is an effective and safe treatment for macrocystic LMs with bleeding. The results were similar in patients with and without bleeding. LEVEL OF EVIDENCE Treatment, Level III.
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Affiliation(s)
- Qian Wang
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Yi-Xin Wu
- Department of Pediatrics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Mei-Xian Zhang
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Dai-Qiang Song
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Bao-Li Su
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Sheng-Miao Li
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Wang-Yong Shan
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Zheng-Ji Liu
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Aaffiliated to Wenzhou Medical University, Linhai, 317000, Zhejiang, China.
| | - Chun-Fen Luo
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, 317000, Zhejiang, China.
| | - Lin-Jun Yu
- Department of Pediatric Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai, 317000, Zhejiang, China.
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Heimlich FV, Arruda JAAD, Kato CDNADO, Silva LVDO, Souza LN, Ferreira MVL, Pinheiro JDJV, Silva TA, Abreu LG, Mesquita RA. Experience with 808-nm diode laser in the treatment of 47 cases of oral vascular anomalies. Braz Oral Res 2024; 38:e025. [PMID: 38597545 DOI: 10.1590/1807-3107bor-2024.vol38.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/20/2023] [Indexed: 04/11/2024] Open
Abstract
Treatment of oral vascular anomalies (OVA) has focused on minimally invasive techniques rather than radical surgery. We investigated the efficacy and safety of diode laser using the photocoagulation technique in the management of OVA. Forty-seven subjects with OVA were treated with forced dehydration with induced photocoagulation (FDIP) using diode laser (808 nm/4.5 W). This series consisted mostly of male (63.8%) and non-white (63.8%) patients with a mean age of 57.4 years. Varices (91.5%), venous malformations (6.4%), and hemangiomas (2.1%) with a mean size of 7.1 (±4.9) mm were the conditions treated. OVA presented as a nodular lesion (63.8%) involving mainly the lower lip (46.8%). Pulsed laser mode was used as standard and the number of applications varied from one to four sessions, with the majority requiring only one (83%) FDIP session. Kaplan-Meier analysis revealed that complete clinical healing can occur on the 15th day (n=9/29.5%), followed by the 20th (n=6/45.5%), and 30th (n=7/70.5%) days. Postoperative edema was observed in 31 (66%) patients, and recurrence of the lesion occurred in two (4.2%). Based on the data on complete clinical healing, minimal patient discomfort, and satisfactory esthetic results, we can confirm that FDIP by diode laser is a promising candidate for the safe and efficacious treatment of OVA.
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Affiliation(s)
- Fernanda Vieira Heimlich
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - José Alcides Almeida de Arruda
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Camila de Nazaré Alves de Oliveira Kato
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leni Verônica de Oliveira Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Leandro Napier Souza
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Marcus Vinicius Lucas Ferreira
- Department of Restorative Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Tarcília Aparecida Silva
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Lucas Guimarães Abreu
- Department of Child and Adolescent Oral Health, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ricardo Alves Mesquita
- Department of Oral Surgery, Pathology and Clinical Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Yan Z, Fan L, Xu D, Ma J, Hu Y, Li J, Liu Y. Knowledge, attitudes and practices regarding spinal vascular malformations among doctors in China: a cross-sectional study. BMJ Open 2024; 14:e077698. [PMID: 38387979 PMCID: PMC10882408 DOI: 10.1136/bmjopen-2023-077698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/28/2024] [Indexed: 02/24/2024] Open
Abstract
OBJECTIVE Knowledge, attitude and practice (KAP) models are essential tools for assessing healthcare professionals' understanding, beliefs and behaviours towards specific health issues. This study aimed to explore the KAP of Chinese doctors in diagnosing and treating spinal vascular malformations (SVM). DESIGN A web-based cross-sectional survey. SETTING This study was conducted between October and December 2022 through a self-administered questionnaire. PARTICIPANTS Participants include full-time doctors who voluntarily participate. Doctors in advanced training, regular training or internships were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES The KAP scores of Chinese doctors in diagnosing and treating SVM measured by the questionnaire. RESULTS A total of 517 doctors participated in the study, mostly in Shaanxi, China, working in SVM-relevant departments (n=396) or other departments (n=121). The doctors achieved an average knowledge score of 9.66±1.95 (range: 0-12), attitude score of 22.16±1.71 (range: 6-30) and practice scores of 46.13±5.35 for those in SVM-relevant departments (neurosurgery, orthopaedics and neurology) and 8.50±1.25 for those in other departments, respectively, revealing doctors have adequate knowledge, positive attitude and good practice, and those in SVM-relevant departments showing more adeptness compared with those in other departments. Moreover, multivariate logistic regression analysis showed that knowledge about SVM (OR=1.72, 95% CI 1.11 to 2.65, p=0.015), holding a master's degree (OR=1.85, 95% CI 1.14 to 3.00, p=0.013) and working in orthopaedics (OR=0.34, 95% CI 0.13 to 0.88, p=0.026) were independently associated with good attitude. CONCLUSION Chinese doctors showed adequate knowledge, moderate attitudes and good practice regarding SVM. A continuing education programme may improve clinical practitioners' ability to manage SVM.
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Affiliation(s)
- Zhongjun Yan
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
| | - Lingling Fan
- Department of Neurology, Xi'an First Hospital Affiliated to Xi'an Medical University, Xi'an, Shaanxi, China
| | - Dongwei Xu
- Department of Neurosurgery, 78th Group Army Hospital of Chinese PLA, Mudanjiang, Heilongjiang, China
| | - Jie Ma
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
| | - Yan Hu
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
| | - Jiang Li
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
| | - Yufeng Liu
- Department of Neurosurgery, Air Force Medical University Tangdu Hospital, Xi'an, Shaanxi, China
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Goldman A, Wollina U. Cavernous hemangioma of the lip: combined treatment with intralesional laser and surgery. Wien Med Wochenschr 2023:10.1007/s10354-023-01028-2. [PMID: 37975966 DOI: 10.1007/s10354-023-01028-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 10/30/2023] [Indexed: 11/19/2023]
Abstract
Infantile cavernous hemangioma is a benign vascular tumor in childhood. Cavernous hemangiomas have a tendency of slow enlargement with subsequent complications such as ulceration and bleeding. We report a case of a large cavernous hemangioma affecting the median upper lip in an 11-year-old girl. The lesion was growing and painful on pressure. The patient felt stigmatized. Treatment was wished for by patient and parents. After careful examination including Doppler ultrasound, we suggested a combined approach. In the first step the lesion was coagulated with an intralesional neodymium-YAG laser using a blunt tip. In the second step, immediately after the action of the laser, the lesion was removed completely by surgery. Defect closure was realized with bilateral tissue-expanding vermillion myocutaneous flaps. The patient was followed-up to 5 months. Disfigurement and functional impairment were eliminated. The result was satisfying for both patient and parents. Vascular lesions of the upper lip-particularly when close to Cupid's bow-can become disfiguring and cause functional impairment. We propose a combined approach with intralesional neodymium-YAG laser photocoagulation to avoid bleeding and to shrink the lesion before complete surgical removal. For defect closure, bilateral tissue-expanding vermillion myocutaneous flaps (Goldstein technique modified by Sawada) were used.
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Affiliation(s)
- Alberto Goldman
- Department of Plastic Surgery, Hospital São Lucas da PUCRS, 90610-001, Porto Alegre, Brazil
| | - Uwe Wollina
- Department of Dermatology and Allergology, Academic Teaching Hospital, Städtisches Klinikum Dresden, 01067, Dresden, Germany.
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5
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Shen Y, Su L, Wang D, Fan X. Overview of peripheral arteriovenous malformations: From diagnosis to treatment methods. J Interv Med 2023; 6:170-175. [PMID: 38312130 PMCID: PMC10831390 DOI: 10.1016/j.jimed.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/20/2023] [Accepted: 10/21/2023] [Indexed: 02/06/2024] Open
Abstract
Based on the latest classification by the International Society for the Study of Vascular Anomalies in 2018, vascular malformations (VMs) can be categorized into simple, combined VMs of major named vessels, and VMs associated with other anomalies. Simple VMs include lymphatic, venous, capillary, and arteriovenous malformations (AVMs). AVMs represent disorders of direct arteriovenous shunts caused by the absence of a capillary bed between the involved arteries and veins. This abnormal vascular communication causes arterial blood to accumulate in the venous vessels, thus resulting in venous hypertension and characteristic clinical manifestations, such as pulsation, tremors, and elevated temperature. AVMs can occur sporadically or as manifestations of syndromic lesions and are considered among the most complex and challenging VMs. The diagnosis and treatment of AVMs can vary depending on the lesion location and associated clinical symptoms, thus complicating their management. Herein, we discuss peripheral AVMs in terms of their clinical manifestations, imaging examinations, and staging systems to provide a comprehensive reference for the treatment, evaluation methods, and follow-up procedures for this vascular anomaly.
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Affiliation(s)
| | | | - Deming Wang
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, 200011, Shanghai, China
| | - Xindong Fan
- Vascular Anomaly Center, Department of Interventional Therapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, No. 639 Zhi Zao Ju Rd, 200011, Shanghai, China
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Zhang J, Croft J, Le A. Familial CCM Genes Might Not Be Main Drivers for Pathogenesis of Sporadic CCMs-Genetic Similarity between Cancers and Vascular Malformations. J Pers Med 2023; 13:jpm13040673. [PMID: 37109059 PMCID: PMC10143507 DOI: 10.3390/jpm13040673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/05/2023] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
Cerebral cavernous malformations (CCMs) are abnormally dilated intracranial capillaries that form cerebrovascular lesions with a high risk of hemorrhagic stroke. Recently, several somatic "activating" gain-of-function (GOF) point mutations in PIK3CA (phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit p110α) were discovered as a dominant mutation in the lesions of sporadic forms of cerebral cavernous malformation (sCCM), raising the possibility that CCMs, like other types of vascular malformations, fall in the PIK3CA-related overgrowth spectrum (PROS). However, this possibility has been challenged with different interpretations. In this review, we will continue our efforts to expound the phenomenon of the coexistence of gain-of-function (GOF) point mutations in the PIK3CA gene and loss-of-function (LOF) mutations in CCM genes in the CCM lesions of sCCM and try to delineate the relationship between mutagenic events with CCM lesions in a temporospatial manner. Since GOF PIK3CA point mutations have been well studied in reproductive cancers, especially breast cancer as a driver oncogene, we will perform a comparative meta-analysis for GOF PIK3CA point mutations in an attempt to demonstrate the genetic similarities shared by both cancers and vascular anomalies.
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Affiliation(s)
- Jun Zhang
- Departments of Molecular & Translational Medicine (MTM), Texas Tech University Health Science Center El Paso (TTUHSCEP), El Paso, TX 79905, USA
| | - Jacob Croft
- Departments of Molecular & Translational Medicine (MTM), Texas Tech University Health Science Center El Paso (TTUHSCEP), El Paso, TX 79905, USA
| | - Alexander Le
- Departments of Molecular & Translational Medicine (MTM), Texas Tech University Health Science Center El Paso (TTUHSCEP), El Paso, TX 79905, USA
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A Simple Surgical Solution for Functional Improvement of Deforming Vascular Malformations with Lip Involvement. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4816. [PMID: 36817280 PMCID: PMC9937089 DOI: 10.1097/gox.0000000000004816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/20/2022] [Indexed: 02/19/2023]
Abstract
The management of large, deforming facial arteriovenous malformations (AVMs) can be a daunting clinical challenge for patients and surgeons. Many patients delay treatment due to fear of surgical intervention and concern for unfavorable cosmetic outcomes. Delaying treatment can lead to soft-tissue hypertrophy. Occasionally, facial AVMs can also present with lip involvement, necessitating surgical intervention. A major potential issue regarding AVMs managed with surgical excision is excessive bleeding due to the enlarged dermal vascular plexus. Here, we present a simple surgical technique used to manage deforming AVMs involving the lips. A 32-year-old man with Sturge-Weber syndrome and a 72-year-old man with AVMs of the left face presented to clinic for management. The malformations involved the lips in both patients. Both patients had constant drooling and difficulty eating and talking, in addition to aesthetic concerns. They both underwent surgical excision of the redundant tissue with minimal undermining, advancement flaps, and layered closure. Minimal undermining allowed successful removal of the AVMs and redundant tissue without excessive blood loss and allowed healing without complications. Both patients had significant improvement in eating and talking without drooling. Aesthetically, satisfactory outcomes were maintained at 1-year follow-up appointments. Removal of AVMs while minimizing blood loss can be a challenging endeavor. Here, we have presented a successful, effective technique for restoring both form and function in patients with AVMs involving the lips, with good long-term results.
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8
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Passarello L, Lau C, McCahon E, Popat H. A neonatal case of central conducting lymphatic anomaly successfully treated with sirolimus. Pediatr Blood Cancer 2022; 69:e29752. [PMID: 35652569 DOI: 10.1002/pbc.29752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 11/07/2022]
Affiliation(s)
- Larissa Passarello
- The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Christine Lau
- Department of General Medicine, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,The Sydney Children's Hospitals Network, Sydney, Australia
| | - Emma McCahon
- Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
| | - Himanshu Popat
- Grace Centre for Newborn Intensive Care, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,The University of Sydney, Camperdown, Sydney, Australia
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9
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Zhang S, Xu Z, Zou C, Zhang G. Cardiac venous malformation concurrent with multiple hepatic venous malformations: A case report. Front Cardiovasc Med 2022; 9:1001996. [DOI: 10.3389/fcvm.2022.1001996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022] Open
Abstract
A 50-year-old woman who had previously undergone right radical mastectomy presented with chest tightness and shortness of breath after physical activities. A cardiac mass and multiple hepatic lesions were successively detected. We first performed hepatic puncture biopsy. Histopathologic examination confirmed that the multiple hepatic lesions were venous malformations. Based on the imaging findings and previous reports in the literature, we boldly speculated that the cardiac mass was also a venous malformation. The cardiac venous malformation was successfully resected, and the postoperative pathology confirmed our suspicion.
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10
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Wu Z, Zou Y, Fu R, Jin P, Yuan H. A nomogram for predicting sclerotherapy response for treatment of lymphatic malformations in children. Eur J Med Res 2022; 27:209. [PMID: 36271467 PMCID: PMC9585839 DOI: 10.1186/s40001-022-00844-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/06/2022] [Indexed: 11/10/2022] Open
Abstract
Purpose In this manuscript, we purposed to identify the prognostic factors for treatment of lymphatic malformations in children using polidocanol foam combined with pingyangmycin and to construct nomogram for predicting sclerotherapy response. Methods A retrospective analysis of 77 children having LMs who underwent sclerotherapy using polidocanol foam combined with pingyangmycin under ultrasound display from January 2017 to April 2020 was done. The clinical response was graded as excellent (≥ 90%), good (≥ 50%, < 90%), and poor (< 50%). More than 50% was considered as acceptable response. Prognostic factors were identified by Pearson’s Chi-square or Fisher’s exact test and multivariable logistic regression model was used to construct a nomogram to predict sclerotherapy response. The discrimination and calibration of nomogram were verified through the receiver operating characteristic cure and calibration plots. Results The mean number of treatment sessions was 3.1 (range, 1–6). Among 77 patients, 58 patients (75.3%) had excellent response to treatment (≥ 90%) and 68 patients (88.3%) had an acceptable response (≥ 50%, < 90%). Clinical disfigurement (P = 0.014), skin discoloration (P = 0.040), morphological subtype (P < 0.001) and extent of the lesion (P < 0.001) correlated with clinical response to sclerotherapy in LMs. Sclerotherapy response was predicted through nomogram constructed in this study, which shows good calibration and discrimination. Also, focal lesion and macrocystic or mixed morphological subtype lesion were seen more often in lower number of treatment sessions among the patients with excellent response. Conclusions An acceptable response to sclerotherapy using polidocanol foam combined with pingyangmycin was achieved in majority of LMs in children with extremely low complication rates. Nomogram based on the prognostic factors of sclerotherapy response for LMs in children was shown to possess an excellent performance to predict the probability of LMs sclerotherapy response.
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Affiliation(s)
- Zhiping Wu
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Yun Zou
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Ronghua Fu
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Pingliang Jin
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China
| | - Hua Yuan
- Department of Plastic Surgery, Jiangxi Provincial Children's Hospital, Nanchang, China.
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Vascular Abnormalities of the Parotid Region: An Uncommon Presentation of a Common Condition—A Case Series. Diagnostics (Basel) 2022; 12:diagnostics12092236. [PMID: 36140637 PMCID: PMC9497633 DOI: 10.3390/diagnostics12092236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/04/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
A variety of non-neoplastic diseases and benign and malignant lesions may involve parotid glands. In clinical practice, effective diagnosis is crucial to ensure proper treatment and achieve a good therapeutic effect. Unclear anamnesis and short medical history are factors that make diagnosis difficult, especially when cancer should be excluded. We present a case series of four patients who reported to the outpatient clinic with a unilateral nodule in the parotid region. The clinical presentation prevented an unequivocal diagnosis. The suspicion of a neoplastic disease resulted in profound diagnostics, including repeated cytology, ultrasound and magnetic resonance examination. Combining all the acquired information and follow-up, or a histopathologic examination, facilitated the final diagnosis. In all cases, thrombosis was diagnosed. We then analysed the diagnostic process and the associated difficulties. When thrombosis in vascular malformation occurs in the parotid region, it may have an unclear clinical and radiological presentation. Such an image can imitate both benign and malignant tumours. Ambiguous imaging in conjunction with blood cells in cytology should result in the inclusion of thrombosis in vascular malformations in the differential diagnosis.
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12
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Escobar K, Pandher K, Jahnke MN. Capillary Malformations. Dermatol Clin 2022; 40:425-433. [DOI: 10.1016/j.det.2022.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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13
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Pellacani A, Rozell-Shannon L, Negrello S, Di Bartolomeo M, Anesi A, Feminò R, Mariotti I, Chiarini L, Colletti G. The vanishing port-wine stain birthmark—consideration for a rare type of congenital vascular anomaly. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01948-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Yee A, Navuluri S, Sun R, Lindsey M, Gonzalez‐Krellwitz LA, Strub GM. Bronchogenic cyst of the posterior neck mimicking lymphatic malformation. Clin Case Rep 2022; 10:e05210. [PMID: 35280092 PMCID: PMC8898750 DOI: 10.1002/ccr3.5210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/09/2021] [Indexed: 11/26/2022] Open
Abstract
Bronchogenic cysts are embryologic malformations of the foregut and are rarely found head and neck region. Here we present a case of an upper scapular/lower posterior neck cystic mass which was initially suspicious for lymphatic malformation but confirmed by pathology to be an ectopic bronchogenic cyst.
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Affiliation(s)
- Addison Yee
- Department of Otolaryngology, Head and Neck Surgery University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Sriram Navuluri
- Department of Otolaryngology, Head and Neck Surgery University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Ravi Sun
- Department of Otolaryngology, Head and Neck Surgery University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | - Miki Lindsey
- Department of Pathology University of Arkansas for Medical Sciences Little Rock Arkansas USA
| | | | - Graham M Strub
- Department of Otolaryngology, Head and Neck Surgery University of Arkansas for Medical Sciences Little Rock Arkansas USA
- Division of Pediatric Otolaryngology Arkansas Children's Hospital Little Rock Arkansas USA
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15
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Systemic Therapy for Vascular Anomalies and the Emergence of Genotype-Guided Management. Dermatol Clin 2022; 40:127-136. [DOI: 10.1016/j.det.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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16
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Wang Q, Zhou Q, Zhao Z, Liu C, Zheng J. Successful Sclerotherapy for Cervicofacial Macrocystic Lymphatic Malformations Using Polidocanol and Pingyangmycin Combined Foam Sclerosants. Lymphat Res Biol 2022; 20:507-513. [PMID: 35041550 DOI: 10.1089/lrb.2021.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Sclerotherapy is the first-line therapeutic method for lymphatic malformations (LMs). This retrospective cohort study evaluated the effectiveness and safety of a novel combined foam sclerosant: polidocanol and pingyangmycin foam (PPF), for treating cervicofacial macrocystic LMs. Methods and Results: From July 2018 to October 2020, 51 patients with cervicofacial macrocystic LMs were enrolled in this study. All patients received intralesional 3% polidocanol or PPF injections. The outcome was evaluated regarding demographic and clinical characteristics, degree of treatment response, and post-treatment complications. Overall, 16 patients (31.4%) underwent PPF sclerotherapy. All these patients (100%) showed remarkable reduction in lesion size within three sessions. Excellent responses were shown in 88.5% of these patients within three sessions, which is higher than single polidocanol sclerotherapy (80%). The average sessions (duration) of PPF sclerotherapy were 2.5, which was significantly shorter than the single foam sclerotherapy (p < 0.05). Treatment duration was significantly associated with age, lesion location, lesion size, and number of cysts (p < 0.05). No severe complications were noted in this study. Local or systemic complications, such as swelling and mild fever occurred but subsided without any specific treatment. Conclusions: PPF is a safe, and effective combined foam sclerosant for the treatment of cervicofacial macrocystic LMs. This combined foam can improve treatment response and reduce treatment duration compared with a single sclerosant. It can be broadly used if further large-scale clinical trials verify its efficacy and safety.
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Affiliation(s)
- Qizhang Wang
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin Zhou
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zeliang Zhao
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Liu
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiawei Zheng
- Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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17
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Muse JC, Silveira LA, Liebelt B, Tranmer BI. Surgical removal of a compressive thoracic epidural vascular malformation in a patient with Klippel-Trénaunay syndrome: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21634. [PMID: 36131566 PMCID: PMC9379702 DOI: 10.3171/case21634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/17/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND Klippel-Trénaunay syndrome (KTS) is a combined capillary-lymphatic-venous malformation disorder traditionally associated with high surgical morbidity. Although rare, pathologic involvement of the spinal cord has been reported in the literature. However, the safety of surgical intervention remains unclear. We report a case of successful decompression of a thoracic epidural lesion in an individual with KTS who presented with spastic paraparesis. OBSERVATIONS The patient is a 38-year-old male, diagnosed with KTS as an infant, who presented with spastic paraparesis secondary to a thoracic epidural lesion. He underwent laminectomies and resection of the lesion with subsequent improvement of his symptoms and without significant postoperative morbidity. Histopathology confirmed the lesion to be a benign vascular malformation. LESSONS Currently, the literature regarding management of symptomatic vascular lesions in individuals with KTS supports nonoperative management, due to the increased risk of operative morbidity associated with this syndrome. This case presents evidence for safe and appropriate surgical management of a thoracic epidural vascular malformation in a patient with KTS in the setting of progressive neurological decline, establishing a role for neurosurgical intervention in this high-risk population when no conservative management portends further neurological deterioration.
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Affiliation(s)
- John C. Muse
- Department of Neurosurgery, University of Vermont, Burlington, Vermont
| | | | - Brandon Liebelt
- Department of Neurosurgery, University of Vermont, Burlington, Vermont
| | - Bruce Ian Tranmer
- Department of Neurosurgery, University of Vermont, Burlington, Vermont
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18
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Schmidt VF, Masthoff M, Czihal M, Cucuruz B, Häberle B, Brill R, Wohlgemuth WA, Wildgruber M. Imaging of peripheral vascular malformations - current concepts and future perspectives. Mol Cell Pediatr 2021; 8:19. [PMID: 34874510 PMCID: PMC8651875 DOI: 10.1186/s40348-021-00132-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 12/17/2022] Open
Abstract
Vascular Malformations belong to the spectrum of orphan diseases and can involve all segments of the vascular tree: arteries, capillaries, and veins, and similarly the lymphatic vasculature. The classification according to the International Society for the Study of Vascular Anomalies (ISSVA) is of major importance to guide proper treatment. Imaging plays a crucial role to classify vascular malformations according to their dominant vessel type, anatomical extension, and flow pattern. Several imaging concepts including color-coded Duplex ultrasound/contrast-enhanced ultrasound (CDUS/CEUS), 4D computed tomography angiography (CTA), magnetic resonance imaging (MRI) including dynamic contrast-enhanced MR-angiography (DCE-MRA), and conventional arterial and venous angiography are established in the current clinical routine. Besides the very heterogenous phenotypes of vascular malformations, molecular and genetic profiling has recently offered an advanced understanding of the pathogenesis and progression of these lesions. As distinct molecular subtypes may be suitable for targeted therapies, capturing certain patterns by means of molecular imaging could enhance non-invasive diagnostics of vascular malformations. This review provides an overview of subtype-specific imaging and established imaging modalities, as well as future perspectives of novel functional and molecular imaging approaches. We highlight recent pioneering imaging studies including thermography, positron emission tomography (PET), and multispectral optoacoustic tomography (MSOT), which have successfully targeted specific biomarkers of vascular malformations.
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Affiliation(s)
- Vanessa F Schmidt
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Max Masthoff
- Clinic for Radiology, University Hospital Muenster, Muenster, Germany
| | - Michael Czihal
- Angiology Division, Department for Medicine IV, University Hospital, LMU Munich, Munich, Germany
| | - Beatrix Cucuruz
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Beate Häberle
- Department for Pediatric Surgery, Dr. von Haunersches Kinderspital, University Hospital, LMU Munich, Munich, Germany
| | - Richard Brill
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A Wohlgemuth
- Clinic and Policlinic of Radiology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Moritz Wildgruber
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany. .,Clinic for Radiology, University Hospital Muenster, Muenster, Germany.
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19
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Reyes-Hadsall SC, Fayiga FF, Duarte AM. Verrucous venous malformation with thrombocytopenia in a neonate. Pediatr Dermatol 2021; 38:1553-1557. [PMID: 34749432 DOI: 10.1111/pde.14857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Verrucous venous malformations (VVM) are rare, congenital, slow-flow vascular anomalies that have been historically difficult to characterize due to clinical mimics and unclear histological evaluation. A life-threatening complication of VVMs is localized intravascular coagulation. Herein, we describe a male neonate who presented with a congenital VVM on the left lower extremity with associated severe thrombocytopenia. We discuss the multifaceted diagnostic approach used to identify this VVM, while highlighting the use of WT-1 as a negative predictive marker; we additionally outline novel treatment options and management beyond cutaneous involvement.
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Affiliation(s)
- Sophia C Reyes-Hadsall
- University of Miami Miller School of Medicine, Miami, FL, USA.,Children's Skin Center, Miami, FL, USA
| | - Folasade F Fayiga
- Children's Skin Center, Miami, FL, USA.,Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL, USA.,The Dr. Philip Frost Department of Dermatology and Cutaneous Surgery at The University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ana M Duarte
- Children's Skin Center, Miami, FL, USA.,Division of Dermatology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL, USA.,The Dr. Philip Frost Department of Dermatology and Cutaneous Surgery at The University of Miami Miller School of Medicine, Miami, FL, USA
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20
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Contrast-enhanced ultrasound in pediatric interventional radiology. Pediatr Radiol 2021; 51:2396-2407. [PMID: 33978796 DOI: 10.1007/s00247-020-04853-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/14/2020] [Accepted: 09/10/2020] [Indexed: 01/14/2023]
Abstract
There is growing interest in the use of contrast-enhanced ultrasound (CEUS) in diagnostic and interventional radiology. CEUS applications in interventional radiology are performed with intravascular or intracavitary administration of microbubble-based US contrast agents to allow for real-time evaluation of their distribution within the vascular bed or in body cavities, respectively, providing additional information beyond gray-scale US alone. The most common interventional-radiology-related CEUS applications in children have been extrapolated from those in adults, and they include the use of CEUS to guide lesion biopsy and to confirm drain placement in pleural effusions and intra-abdominal fluid collections. Other applications are emerging in interventional radiology for use in adults and children, including CEUS to optimize sclerotherapy of vascular malformations, to guide arthrography, and for lymphatic interventions. In this review article we present a wide range of interventional-radiology-related CEUS applications, emphasizing the current and potential uses in children. We highlight the technical parameters of the CEUS examination and discuss the main imaging findings.
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21
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Liu H, Li X, Zhang C, Fan C, Liu L, Wan J. Case Report: A Primary Right Ventricular Vascular Malformation Presenting as a Mass. Front Cardiovasc Med 2021; 8:736199. [PMID: 34660738 PMCID: PMC8517140 DOI: 10.3389/fcvm.2021.736199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 09/06/2021] [Indexed: 12/05/2022] Open
Abstract
Primary right ventricular vascular malformation is a rare primary benign anomaly in heart in nature. Due to the extremely low incidence and the progress on the classification of vascular malformation, a few cases were reported in the literatures. In the current case study, a 55-year-old women presented with a cardiac mass that was identified in right ventricle during a routine medical checkup. Magnetic resonance imaging demonstrated a well-circumscribed mass attached to the interventricular septum. Median sternotomy for the surgical resection of the mass and a cardiopulmonary bypass were performed. The intraoperative transesophageal echocardiogram showed that the mass had been successfully removed. The patient recovered well and was discharged from hospital 9 days after the surgery. The pathological diagnosis was primary cardiac arteriovenous malformation. No mass recurrence was shown by echocardiography during the 13 months' follow-up.
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Affiliation(s)
- Hongduan Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xin Li
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cuiwei Zhang
- Department of Pathology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chengming Fan
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Liming Liu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Juyi Wan
- Department of Cardiovascular Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, China
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22
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Arafa OM, Alzuhair AR, Alharbi SK, Alromaih NI. Surgical correction of foot equino-cavocarus deformity in Klippel-Trénaunay-Weber syndrome: a case report. J Surg Case Rep 2021; 2021:rjab434. [PMID: 34650788 PMCID: PMC8510640 DOI: 10.1093/jscr/rjab434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/06/2021] [Accepted: 09/12/2021] [Indexed: 01/19/2023] Open
Abstract
Klippel-Trénaunay-Weber syndrome (KTWS) is a rare condition characterized by a classic clinical triad. However, it can also have other features, such as cavocarus foot deformity, which is a rare presentation in a patient with KTWS. In this case report, we present our surgical technique of correcting such a complex deformity. Also, there are no other similar cases reported in the literature. An 18-year-old girl who is a known case of KTWS with a complaint of progressive unilateral left foot deformity. Her examination, revealed a rigid pes cavus with an equinus deformity in the left foot. Radiography of the left foot revealed marked cavus as well as hindfoot and forefoot varus. A successful surgical correction of the deformity was described in a stepwise fashion. The management of foot cavocarus deformity in KTWS patients is associated with high intra- and post-operative risk due to its complexity. Therefore, the management requires a multidisciplinary team approach.
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Affiliation(s)
- Orfan M Arafa
- Orthopaedic Surgery Consultant, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abduljabar R Alzuhair
- Assistant Consultant of Orthopaedic Surgery, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Sultan K Alharbi
- Orthopaedic Surgery Resident, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Norah I Alromaih
- Medical Intern, King Saud University Medical City, Riyadh, Saudi Arabia
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23
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From remodeling to quiescence: The transformation of the vascular network. Cells Dev 2021; 168:203735. [PMID: 34425253 DOI: 10.1016/j.cdev.2021.203735] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/14/2021] [Accepted: 08/16/2021] [Indexed: 12/15/2022]
Abstract
The vascular system is essential for embryogenesis, healing, and homeostasis. Dysfunction or deregulated blood vessel function contributes to multiple diseases, including diabetic retinopathy, cancer, hypertension, or vascular malformations. A balance between the formation of new blood vessels, vascular remodeling, and vessel quiescence is fundamental for tissue growth and function. Whilst the major mechanisms contributing to the formation of new blood vessels have been well explored in recent years, vascular remodeling and quiescence remain poorly understood. In this review, we highlight the cellular and molecular mechanisms responsible for vessel remodeling and quiescence during angiogenesis. We further underline how impaired remodeling and/or destabilization of vessel networks can contribute to vascular pathologies. Finally, we speculate how addressing the molecular mechanisms of vascular remodeling and stabilization could help to treat vascular-related disorders.
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24
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Abstract
Vascular and lymphatic malformations represent a challenge for clinicians. The identification of inherited and somatic mutations in important signaling pathways, including the PI3K (phosphoinositide 3-kinase)/AKT (protein kinase B)/mTOR (mammalian target of rapamycin), RAS (rat sarcoma)/RAF (rapidly accelerated fibrosarcoma)/MEK (mitogen-activated protein kinase kinase)/ERK (extracellular signal-regulated kinases), HGF (hepatocyte growth factor)/c-Met (hepatocyte growth factor receptor), and VEGF (vascular endothelial growth factor) A/VEGFR (vascular endothelial growth factor receptor) 2 cascades has led to the evaluation of tailored strategies with preexisting cancer drugs that interfere with these signaling pathways. The era of theranostics has started for the treatment of vascular anomalies. Registration: URL: https://www.clinicaltrialsregister.eu; Unique identifier: 2015-001703-32.
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Affiliation(s)
- Angela Queisser
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium (A.Q., L.M.B., M.V.), University of Louvain, Brussels, Belgium (M.V.)
| | - Emmanuel Seront
- Centre for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc Brussels, Belgium (E.S., L.M.B., M.V.).,Institut Roi Albert II, Department of Medical Oncology, Cliniques Universitaires Saint-Luc, Brussels, Belgium (E.S.).,VASCERN VASCA European Reference Centre Cliniques Universitaires Saint-Luc, Brussels, Belgium (E.S., L.M.B., M.V.)
| | - Laurence M Boon
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium (A.Q., L.M.B., M.V.), University of Louvain, Brussels, Belgium (M.V.).,Centre for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc Brussels, Belgium (E.S., L.M.B., M.V.).,VASCERN VASCA European Reference Centre Cliniques Universitaires Saint-Luc, Brussels, Belgium (E.S., L.M.B., M.V.)
| | - Miikka Vikkula
- Human Molecular Genetics, de Duve Institute, University of Louvain, Brussels, Belgium (A.Q., L.M.B., M.V.), University of Louvain, Brussels, Belgium (M.V.).,Centre for Vascular Anomalies, Division of Plastic Surgery, Cliniques Universitaires Saint-Luc Brussels, Belgium (E.S., L.M.B., M.V.).,University of Louvain, Brussels, Belgium (M.V.).,University of Louvain, Brussels, Belgium (M.V.).,Walloon Excellence in Life Sciences and Biotechnology (WELBIO), University of Louvain, Brussels, Belgium (M.V.).,VASCERN VASCA European Reference Centre Cliniques Universitaires Saint-Luc, Brussels, Belgium (E.S., L.M.B., M.V.)
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25
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Abstract
Lymphatic and mixed malformations are rare and variable in presentation. They arise due to errors in vascular and lymphatic formation during early embryonic development. This leads to persistent infiltration of lymph fluid into soft tissues and causes a locally invasive mass with pathologic sequelae. Departing from historically descriptive terminology, such as "cystic hygroma," lymphatic malformations are now categorized as macrocystic, microcystic, or mixed lesions, based on size. Advances in imaging modalities, such as ultrasonography and magnetic resonance imaging, have made accurate characterization of these lesions possible and ultimately allow for early diagnosis and implementation of appropriate treatment based on the morphology of the lymphatic malformation. Management of lymphatic malformations can be quite challenging, and a multidisciplinary approach is most effective for optimum aesthetic and functional outcomes. New discoveries in the molecular biology of lymphatic malformations have provided treatment targets and established a role for pharmacotherapy. Sclerotherapy, laser, and radiofrequency ablation have all proven to be effective as minimally invasive treatment options for lymphatic malformations. Surgical intervention has a role in the treatment of focal lesions recalcitrant to these less invasive techniques. Operative planning is dictated by clinical goals, size, anatomic location, characteristics, and extent of infiltration.
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Affiliation(s)
- Brynn A Hathaway
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Stephanie Radu
- Department of Undergraduate Medical Education, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Johanna Wilson
- Department of Undergraduate Medical Education, Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - Allison C Nauta
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon, USA
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26
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Daronch OT, Fachin C, D'Agnoluzzo Moreira B, Freitas RDS, Andrade MÂ, Becker KA, Tosi LF, Moraes IP, Rigolon LP. Complex giant arteriovenous and lymphatic malformation of the abdominal wall. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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27
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Anderson KR, Nguyen H, Schoch JJ, Lohse CM, Driscoll DJ, Tollefson MM. Skin-Related complications of Klippel-Trenaunay Syndrome: a retrospective review of 410 patients. J Eur Acad Dermatol Venereol 2020; 35:517-522. [PMID: 33070382 DOI: 10.1111/jdv.16999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 09/29/2020] [Indexed: 01/19/2023]
Abstract
BACKGROUND Little is known about skin-related complications in Klippel-Trenaunay syndrome (KTS), a complex vascular anomaly defined by capillary malformation (CM), venous malformation (VM) ± lymphatic malformation (LM) and limb overgrowth. Reported skin-related complications of KTS include ulceration, vascular ectasias (blebs), bleeding and infection. OBJECTIVE To determine the spectrum, prevalence and predictors of skin-related complications in KTS. METHODS A retrospective review of 410 patients fulfilling KTS criteria was performed to assess for the presence of skin-related complications. RESULTS Skin-related complications were present in 45% of patients. Most prevalent were CM-related complications including blebs, bleeding, thickening (25%), cellulitis (22%) and ulceration (21%). Features positively associated with skin-related complications were presence of LM (OR 17.17; P < 0.001), VM on the buttocks/perineum/genitalia (OR 1.92; P = 0.009), CM on the feet (OR 1.77; P = 0.039) and male sex (OR 1.63; P = 0.034). Features negatively associated with skin-related complications were CM on the trunk (OR 0.59; P = 0.029) and tissue hypertrophy of the hands (OR 0.27; P = 0.025). CONCLUSION Skin-related complications affect nearly half of patients with KTS. Those with lymphatic involvement or malformation presence in the undergarment area or feet are most at risk.
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Affiliation(s)
- K R Anderson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - H Nguyen
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA
| | - J J Schoch
- Department of Dermatology, University of Florida, Gainesville, FL, USA
| | - C M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - D J Driscoll
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - M M Tollefson
- Department of Dermatology, Mayo Clinic, Rochester, MN, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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28
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Berenguer B, Lorca-García C, San-Basilio M, Campos M, Lancharro A, Agra C. Successful treatment of giant lymphatic malformation with symptomatic cutaneous vesicles by surgical excision and coverage with Integra®. EUROPEAN JOURNAL OF PLASTIC SURGERY 2020. [DOI: 10.1007/s00238-020-01752-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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29
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McCormack L, Jones K, Huang JT. Micro- and Macrocystic Lymphatic Malformation. J Pediatr 2020; 219:275-276. [PMID: 31932019 DOI: 10.1016/j.jpeds.2019.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 11/29/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
Affiliation(s)
| | - Krystal Jones
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
| | - Jennifer T Huang
- Dermatology Program, Division of Immunology, Boston Children's Hospital, Boston, Massachusetts
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30
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Bostan E, Dogan S, Ates Ozdemir D, Elcin G. Coexistence of amelanotic melanoma and capillary malformation on the same sole: An unusual case with dermatoscopic findings. Int Wound J 2020; 17:1083-1085. [PMID: 32227568 DOI: 10.1111/iwj.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/20/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ecem Bostan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Sibel Dogan
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
| | - Deniz Ates Ozdemir
- Department of Pathology, School of Medicine, Hacettepe University, Ankara, Turkey
| | - Gonca Elcin
- Department of Dermatology and Venereology, Hacettepe University, School of Medicine, Ankara, Turkey
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31
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Li L, Yang B, Wei L, Zhang B, Han XF, Xu ZG, Ma L. Application of the adenosine triphosphate sensitivity assay in infantile vascular anomalies. BMC Pediatr 2020; 20:78. [PMID: 32075603 PMCID: PMC7029611 DOI: 10.1186/s12887-020-1974-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/11/2020] [Indexed: 12/29/2022] Open
Abstract
Background The term vascular anomalies include various vascular tumors and vascular malformations, among them infantile hemangiomas and capillary malformations are the most well-known associated diseases in early ages. Multiple drugs have been introduced for intervention, but susceptibility test in vitro were scarcely reported. Objective To evaluate the inhibition effect of different drugs by adenosine triphosphate sensitivity assay in vitro before the treatment of infantile hemangiomas and capillary malformations. Methods Specimens were selected from 5 cases of infantile hemangiomas and 11 cases of capillary malformations. Propranolol, rapamycin, sildenafil and itraconazole were tested for their growth inhibition effect by using the adenosine triphosphate sensitivity assay. Results Propranolol demonstrated inhibitory effects on infantile hemangiomas cells. Rapamycin and itraconazole both showed inhibitory effects on infantile hemangiomas cells and capillary malformations cells. Sildenafil has no growth inhibitory effect on infantile hemangiomas cells or capillary malformations cells. Conclusion Adenosine triphosphate sensitivity assay is a sensitive and useful testing method before the management of vascular anomalies, and individualized medication suggestions for the choice of therapeutic drugs were offered based on the testing result and together with a comprehensive evaluation of each infant.
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Affiliation(s)
- Li Li
- Department of Dermatology, Beijing Children' s Hospital, Capital Medical University, National Center for Children' s Health, Beijing, 100045, China
| | - Bin Yang
- Department of Dermatology, Beijing Children' s Hospital, Capital Medical University, National Center for Children' s Health, Beijing, 100045, China.,Department of Dermatovenereology, Maanshan people' s hospital, Maanshan, 243000, China
| | - Li Wei
- Department of Dermatology, Beijing Children' s Hospital, Capital Medical University, National Center for Children' s Health, Beijing, 100045, China
| | - Bin Zhang
- Department of Dermatology, Beijing Children' s Hospital, Capital Medical University, National Center for Children' s Health, Beijing, 100045, China
| | - Xiao-Feng Han
- Department of Dermatology, Beijing Children' s Hospital, Capital Medical University, National Center for Children' s Health, Beijing, 100045, China
| | - Zi-Gang Xu
- Department of Dermatology, Beijing Children' s Hospital, Capital Medical University, National Center for Children' s Health, Beijing, 100045, China
| | - Lin Ma
- Department of Dermatology, Beijing Children' s Hospital, Capital Medical University, National Center for Children' s Health, Beijing, 100045, China.
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Driessen F, Cushing T, Baines SJ. Retroperitoneal lymphatic malformation in a dog. Acta Vet Scand 2020; 62:8. [PMID: 32007092 PMCID: PMC6995647 DOI: 10.1186/s13028-020-0506-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 01/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background Lymphatic vascular malformations are rare findings in canine patients with six reports available in veterinary literature. Retroperitoneal cystic lymphatic malformations have not been described previously in canine patients and neither has the use of immunohistochemistry to determine their origin, i.e. vascular versus lymphatic. Case presentation An 8-year-old neutered female Cocker spaniel was referred for pollakiuria, dysuria and a painful abdomen. Computed tomography scanning of the abdomen showed a fluid filled structure adjacent to the urinary bladder. During surgical exploration, a thin walled cystic structure with sero-haemorrhagic fluid was found, extending from the retroperitoneal space into the abdomen. The mass was excised and submitted for histopathology, revealing a cystic mass lined by a fibrovascular capsule within the retroperitoneal/mesenteric adipose tissue. The inner surface of the cyst was lined by a single layer of bland, flattened spindle cells. Intramural blood vessels were well differentiated, with perivascular haemorrhage. On recurrence 11 months later, the mass was excised for the second time and a PleuralPort (Norfolk Animal products) was placed. Fifteen months after initial presentation, progression occurred with haemorrhagic fluid in the cystic space, pleural- and abdominal cavities and the owners opted for euthanasia. Histopathology and positive immunohistochemistry for lymphatic markers lymphatic vessel endothelial hyaluronic acid receptor-1 (LYVE-1) and prospero homeobox protein-1 (PROX-1) confirmed a lymphatic vascular origin of the cystic structure. Conclusions To our experience, a definitive diagnosis of retroperitoneal cystic malformation of lymphatic origin could be done only by combining the clinical presentation, advanced imaging, histopathology and LYVE-1 and PROX-1 immunohistochemistry. This is the first report of a vascular malformation in a dog where immunohistochemistry was used to make a final diagnosis. A lymphatic malformation, even if rare, should be added on the list of the differential diagnosis in a patient with a retroperitoneal cystic structure containing serohaemorrhagic fluid. Results of this case report can aid in diagnosis of future cases, however, further studies on therapy and management are needed to provide additional information about optimal treatment of these patients.
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Päts AB, Surov A, Roth C, Anders R, Gräfe D, Sorge I, Hirsch FW. [Differential diagnosis of cystic abdominal masses in children]. Radiologe 2019; 60:154-161. [PMID: 31828384 DOI: 10.1007/s00117-019-00627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cystic abdominal masses are a common main or incidental finding in daily radiological practice; however, differentiation is not always trivial. OBJECTIVES In children, cystic abdominal masses represent a special feature compared to adults, since the spectrum of congenital lesions must be taken into consideration. The article gives a structured overview of the most common entities. MATERIALS AND METHODS The standard methods in abdominal imaging in pediatric radiology are ultrasound and MRI. Based on a literature review, the most important differential diagnoses with their characteristics in ultrasound and MRI were compiled. RESULTS AND DISCUSSION With anatomical classification, presence or absence of solid components as well as the contrast agent behavior in the MRI, the cystic masses can be well differentiated and classified into three groups: congenital and acquired cysts as well as neoplasms.
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Affiliation(s)
- A B Päts
- Abteilung für pädiatrische Radiologie, Department für Bildgebung und Strahlenmedizin, Universitätsklinikum Leipzig, Liebigstraße 20a, 04103, Leipzig, Deutschland.
| | - A Surov
- Department für Bildgebung und Strahlenmedizin, Klinik für diagnostische und interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - C Roth
- Abteilung für pädiatrische Radiologie, Department für Bildgebung und Strahlenmedizin, Universitätsklinikum Leipzig, Liebigstraße 20a, 04103, Leipzig, Deutschland
| | - R Anders
- Abteilung für pädiatrische Radiologie, Department für Bildgebung und Strahlenmedizin, Universitätsklinikum Leipzig, Liebigstraße 20a, 04103, Leipzig, Deutschland
| | - D Gräfe
- Abteilung für pädiatrische Radiologie, Department für Bildgebung und Strahlenmedizin, Universitätsklinikum Leipzig, Liebigstraße 20a, 04103, Leipzig, Deutschland
| | - I Sorge
- Abteilung für pädiatrische Radiologie, Department für Bildgebung und Strahlenmedizin, Universitätsklinikum Leipzig, Liebigstraße 20a, 04103, Leipzig, Deutschland
| | - F W Hirsch
- Abteilung für pädiatrische Radiologie, Department für Bildgebung und Strahlenmedizin, Universitätsklinikum Leipzig, Liebigstraße 20a, 04103, Leipzig, Deutschland
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Abstract
PURPOSE OF REVIEW Sturge-Weber syndrome (SWS) is a rare, congenital disease which frequently involves the eye. It is important that ophthalmologists recognize this syndrome and are aware of its range of ocular manifestations. The aim of this article is to present our understanding of the pathogenesis and clinical manifestations of this syndrome and provide updated information on the treatment of SWS glaucoma and choroidal hemangioma. RECENT FINDINGS SWS glaucoma usually fails medical management. Surgical options include angle procedures, filtering procedures, device placement, and combination procedures. Combination procedures have become popular in this population due to the single procedure failure rate of angle surgery and the complications associated with device implantation. Choroidal hemangioma is best treated by photodynamic therapy. SUMMARY Lifelong monitoring for ocular complications related to SWS is essential. There is a need for consensus guidelines on care and surveillance of patients with SWS to provide the best care for these patients.
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Affiliation(s)
- Meerim Park
- Department of Pediatrics, Center for Pediatric Cancer, National Cancer Center, Goyang, Korea
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Bhatt NK, Kang LI, El-Mofty S, Nussenbaum B, Pipkorn P. Emergent parotidectomy after parotid lymphatic malformation hematoma. OTOLARYNGOLOGY CASE REPORTS 2018. [DOI: 10.1016/j.xocr.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Use of preputial skin as cutaneous graft in post excision of a verrucous hemangioma of the thumb. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.402591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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