1
|
Takeuchi N, Koshihara M, Motoyasu A, Tokumine J, Nakazawa H, Ozaki M, Yorozu T. General anesthesia for cesarean section in a pregnant woman with systemic vascular malformation: a case report. JA Clin Rep 2023; 9:88. [PMID: 38095776 PMCID: PMC10721568 DOI: 10.1186/s40981-023-00682-0] [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: 10/01/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Vascular malformations are composed of morphologically abnormal vascular tissue, and when located in the head and neck region, they can make it difficult to secure the airway during general anesthesia. CASE PRESENTATION A 28-year-old pregnant woman with vascular malformations in the pharynx was scheduled to undergo a cesarean section, for which spinal anesthesia was initially chosen. However, after magnetic resonance imaging results revealed the presence of multiple vascular malformations in the lumbar multifidus muscles, spinal anesthesia was considered to be of high risk. Thus, the patient was subjected to general anesthesia tracheal intubation under sedation, and the course of the surgery was without complications. CONCLUSIONS Because the pathophysiology and clinical sequelae of vascular malformations may be involved in complications, thorough presurgical evaluation of the patient's physical condition and careful anesthesia planning should be done.
Collapse
Affiliation(s)
- Noriko Takeuchi
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Misa Koshihara
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Akira Motoyasu
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Joho Tokumine
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Harumasa Nakazawa
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Mine Ozaki
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Tomoko Yorozu
- Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo, 181-8611, Japan
| |
Collapse
|
2
|
Haykal N, Daniels K, Konanur A, McCoy JL, Bykowski MR, Yilmaz S, Padia R. Impact of puberty on procedure frequency for treatment of simple head and neck lymphatic and venous malformations. Am J Otolaryngol 2023; 44:104005. [PMID: 37598616 DOI: 10.1016/j.amjoto.2023.104005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE Puberty has been shown to accelerate growth of vascular malformations, including lymphatic (LM) and venous malformations (VM). This study aims to compare the number of procedures performed before and after puberty in patients with LM and VM to assess whether the onset of puberty results in higher treatment frequency. METHODS A retrospective review of head and neck LM and VM patients who were evaluated between January 2009 and December 2019 was performed. Patient demographics, lesion characteristics, and procedural details were recorded. For the purposes of this study, 11 years or older in females and 12 years or older in males were the established cut-offs for the onset of puberty. RESULTS After initial screening of 357 patients, 83 patients were included in the study based on inclusion criteria. There were 34 patients with LM (41 %) and 49 with VM (59 %). The mean age at diagnosis was 6.1 ± 10.9 years (LM: 4.2 ± 7.0, VM: 7.4 ± 12.9, p = 0.489). 68 patients underwent treatments, which included sclerotherapy, surgical excision, and/or laser. For all patients, the average number of lifetime treatments when initiated before puberty was 3.78 ± 2.81 and when initiated after puberty was 2.17 ± 1.37 (p = 0.022). Patients diagnosed pre-puberty were more likely to undergo treatments vs. those diagnosed after puberty (OR 10.00, 95 % CI: 2.61-38.28, p < 0.001). CONCLUSION We found that the number of treatments was fewer in those who started treatment after puberty. This finding suggests that providers may elect to proceed with observation in asymptomatic patients, given that waiting until after the onset of puberty has not shown an increase in the procedural load on patients.
Collapse
Affiliation(s)
- Nadine Haykal
- UT Health San Antonio, Department of Otolaryngology-Head & Neck Surgery, Pediatric Otolaryngology, 7703 Floyd Curl Drive MC-7777, San Antonio, TX 78229-3900, United States of America
| | - Kelly Daniels
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, United States of America.
| | - Anisha Konanur
- University of Washington Department of Otolaryngology-Head and Neck Surgery, University of Washington Medical Center, 1959 NE Pacific Street, 3rd Floor, NE 300, Seattle, WA 98195, United States of America
| | - Jennifer L McCoy
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, United States of America
| | - Michael R Bykowski
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Plastic Surgery, Pittsburgh, PA, United States of America
| | - Sabri Yilmaz
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Department of Radiology, Pittsburgh, PA, United States of America
| | - Reema Padia
- University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, PA, United States of America
| |
Collapse
|
3
|
Utami AM, Halfwerk JBG, de Boer OJ, Mackaaij C, Pabittei DR, van der Horst CMAM, Meijer-Jorna LB, van der Wal AC. Relative expression of hormone receptors by endothelial and smooth muscle cells in proliferative and non-proliferative areas of congenital arteriovenous malformations. Eur J Med Res 2023; 28:449. [PMID: 37864259 PMCID: PMC10588228 DOI: 10.1186/s40001-023-01436-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 10/07/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Episodic growth due to microvascular proliferations (MVP) has been reported in congenital arteriovenous malformations (AVM), which are normally quiescent lesions composed of mature malformed vessels. Since AVM also may worsen under conditions of hormonal dysregulation, we hypothesized that hormonal influences may stimulate this process of vasoproliferative growth through potential interactions with hormone receptors (HR). METHODS 13 Cases of AVM tissue with histologically documented vasoproliferative growth were analyzed quantitatively for the presence and tissue localization of estrogen receptor (ER), progesterone receptor (PGR), growth hormone receptor (GHR) and follicle-stimulating hormone receptor (FSHR) in relation to resident cells of interest (endothelial cells (EC), smooth muscle cells (SMC) and mast cells (MC)) by applying multiplex immunohistochemistry (IHC) staining. Expression patterns in lesions with MVP and mature vessels were quantified and compared. Available fresh frozen tissues of 3 AVM samples were used to confirm the presence of HR using Reverse-Transcriptase quantitative Polymerase Chain Reaction (RT-qPCR). RESULTS All four HR studied were expressed in all cases within EC and SMC in areas of MVP and mature vessels, but not in normal skin tissue. ER, GHR, and FSHR showed more expression in EC of MVP and in SMC of mature vessels. RT-qPCR confirmed presence of all 4 HR in both areas. CONCLUSION Expression of ER, PGR, GHR, and FSHR in vasoproliferative areas of congenital AVM could explain onset of sudden symptomatic growth, as has observed in a subpopulation of patients. These findings may have implications for eventual anti-hormonal targeted therapy in the lesions involved.
Collapse
Affiliation(s)
- A M Utami
- Department of Pathology, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Anatomical Pathology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia.
| | - J B G Halfwerk
- Department of Pathology, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - O J de Boer
- Department of Pathology, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - C Mackaaij
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D R Pabittei
- Department of Physiology, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
| | - C M A M van der Horst
- Department of Plastic Surgery, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - L B Meijer-Jorna
- Symbiant Pathology Expert Center, NWZ- Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - A C van der Wal
- Department of Pathology, Amsterdam University Medical Center-Location AMC, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
4
|
Abstract
Differences exist between genders in intracerebral hemorrhage cause, epidemiology, and outcomes. These gender differences are in part attributable to physiologic differences; however, demographic, social/behavioral risk factors, along with health care system variation and potential family and/or clinician bias play a role as well. These factors vary from region to region and interact, making comprehensive and definitive conclusions regarding sex differences a challenging task. Differences between the genders in intracerebral hemorrhage epidemiology and extensive differences in underlying pathophysiology, intervention, risk factors, and outcome are all discussed.
Collapse
Affiliation(s)
- Nicholas Dykman Osteraas
- Department of Neurological Sciences, Division of Cerebrovascular Diseases, Rush University Medical Center, 1725 West Harrison Street Suite 118, Chicago, IL 60612, USA.
| |
Collapse
|
5
|
Utami AM, Horbach SE, Meijer-Jorna LB, Waas IS, de Boer OJ, van der Wal AC, van der Horst CM. Microvascular proliferation in arteriovenous malformation of the hand worsens during pregnancy: a case report. Ann Med Surg (Lond) 2023; 85:1262-1269. [PMID: 37113922 PMCID: PMC10129217 DOI: 10.1097/ms9.0000000000000507] [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: 02/09/2023] [Accepted: 03/18/2023] [Indexed: 04/29/2023] Open
Abstract
Arteriovenous malformations (AVMs) are rare congenital disorders characterized by episodes of disproportionate growth that can cause pain and severe bleeding, with microvascular proliferation (MVP) associated with these episodes. Hormonal influences can also worsen the symptoms in patients with AVM. Case presentation This case report presents a female patient with congenital vascular malformations of the left hand since birth, whose symptoms worsened during puberty and pregnancy, ultimately leading to amputation of the left hand due to unbearable pain and loss of function. Pathologic analysis revealed substantial MVP activity within the tissues of the AVM, with an expression of receptors for estrogen, growth hormone, and follicle-stimulating hormone in the vessels of the AVM, including MVP areas. Resected materials not related to pregnancy revealed chronic inflammation and fibrosis but hardly any MVP. Discussion and conclusion These findings suggest a role for MVP in the progressive growth of AVM during pregnancy, with a potential role for hormonal influences. The case highlights the relationship between AVM symptoms and size during pregnancy and the pathological findings of MVP areas within the AVM with hormone receptor expression on proliferating vessels in resected materials.
Collapse
Affiliation(s)
- Amalia M. Utami
- Department of Pathology
- Department of Pathology Anatomy, Faculty of Medicine, Hasanuddin University, Makassar, Indonesia
- Corresponding author. Address: Department of Pathology Anatomy, Faculty of Medicine, Hasanuddin University, Jln. Perintis Kemerdekaan Km.10, Makassar 90245, Indonesia. Tel./fax: +62411-586010. E-mail address: (A.M. Utami)
| | - Sophie E.R. Horbach
- Department of Plastic Surgery, Amsterdam University Medical Center, AMC, University of Amsterdam, Amsterdam
| | | | | | | | | | | |
Collapse
|
6
|
Portugal MFC, Tachibana A, Rocha MA, Naves ÉA, Amaral LTW, Camilo LP, Hallage B, Wolosker N, Teivelis MP. Radiological Profile of 18,430 Vascular Anomalies: Incidence and Demographic Distribution in an Adult Population. Ann Vasc Surg 2023:S0890-5096(23)00103-6. [PMID: 36805426 DOI: 10.1016/j.avsg.2023.01.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Most studies on focusing on the prevalence of vascular anomalies are either aimed to determine the individual occurrence of a specific type among known bearers of abnormalities or propose an estimation of prevalence for the general population by extrapolating from the paediatric population. In this scenario, we intended to assess the profile of vascular anomalies in a group of patients subjected to imaging studies, throughout a long period of time, to evaluate the frequency of abnormal findings in a consecutive, nonselected population. METHODS This is a retrospective review of 996,569 computed tomography and magnetic resonance studies between 2009 and 2019. Findings were grouped as vascular tumours (hemangiomas; vascular tumours), cavernomas, and vascular malformations. Positive findings were evaluated with regard to patients' demographic characteristics and anatomic distribution and the subset of vascular malformations was also evaluated with regard to size, classification in accordance to flow pattern, and Hamburg Classification. RESULTS Eighteen thousand four hundred thirty positive examinations were evaluated (mean age, 55.82 ± 15.43 years; 8,188 men). Vascular anomalies were present in 18.49 per 1,000 examinations (17.41 hemangiomas; 0.69 cavernomas and 0.39 vascular malformations per 1,000 examinations). Hemangiomas and cavernomas were homogeneous in anatomic location between sexes throughout the age groups. Complex malformations were heterogeneous in anatomic distribution between the sexes in each age group, with intracranial findings decreasing for female patients in older groups. CONCLUSIONS Vascular anomalies were found in 18.49 per 1,000 examinations. Hemangiomas and cavernomas were homogenously distributed, whereas complex malformations displayed a heterogeneous anatomic distribution pattern between sexes in each age group.
Collapse
Affiliation(s)
| | | | | | - Érica A Naves
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Luana Perrone Camilo
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil
| | - Bianca Hallage
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil
| | - Nelson Wolosker
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil; Faculdade de Medicina da Universidade de São Paulo - FMUSP, São Paulo, Brazil
| | - Marcelo Passos Teivelis
- Hospital Israelita Albert Einstein, São Paulo, Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Albert Eistein, São Paulo, Brazil
| |
Collapse
|
7
|
Arteriovenous Malformations. Dermatol Clin 2022; 40:445-448. [DOI: 10.1016/j.det.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
8
|
Rinaldi G, Creissen A, Mahon C, Syed SB. Triple pass laser therapy for recalcitrant facial port wine stains. Lasers Med Sci 2021; 37:1643-1650. [PMID: 34536181 DOI: 10.1007/s10103-021-03414-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/05/2021] [Indexed: 12/01/2022]
Abstract
Patients with recalcitrant facial port wine stains (rfPWS) can be challenging to manage, often leaving the clinician with difficult decisions for treatment options. 'Triple therapy' consists of using three different laser wavelengths at each treatment setting. The evidence on outcomes is limited as this treatment approach has not been previously reported to the best of our knowledge. Children who received triple therapy at least once for rfPWS, and for whom SIAscopy readings had been taken, were retrospectively identified. SIAscope readings were compared before the first triple therapy treatment and at final the most recent clinical follow-up. The clinical appearance was also assessed using a Visual Analogue Scale comparing clinical photographs taken before triple therapy to those taken at the most recent clinical follow-up. A total of 47 children were identified and included in our review. The SIAscope readings showed an overall significant (p < 0.001) lightening with 39 (83%) showing lightening and 8 (17%) patients showing a darkening. Scores using the VAS also showed improvement with 55% experiencing an improvement in their clinical appearance, 38% showing no visible change and 6% appearing to have worsened. Triple therapy can offer improvement of rfPWS which have failed to respond to single wavelength laser therapy. SIAscopy and VAS scores correlate well in assessing clinical response; however, the added clinical benefit of SIAscopy in vascular laser clinics remains uncertain.
Collapse
Affiliation(s)
- Giulia Rinaldi
- Department of Medicine, Guy's and St Thomas' Hospital NHS Trust, Westminster Bridge Road, London, SE1 7EH, UK.
| | | | - Caroline Mahon
- Christchurch Hospital, Christchurch, Canterbury, New Zealand
| | | |
Collapse
|
9
|
Li Y, Yang J, Huang Y, Ge S, Song X, Jia R, Wang Y. Cellular heterogeneity and immune microenvironment revealed by single-cell transcriptome in venous malformation and cavernous venous malformation. J Mol Cell Cardiol 2021; 162:130-143. [PMID: 34536440 DOI: 10.1016/j.yjmcc.2021.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/12/2021] [Accepted: 09/08/2021] [Indexed: 12/24/2022]
Abstract
Venous malformation (VM) and cavernous venous malformation (CVM) are two types of vascular malformations. Even if the two diseases are similar in appearance and imaging, the distinct cellular components and signaling pathways between them might help distinguish the two from a molecular perspective. Here, we performed single-cell profiling of 35,245 cells from two VM samples and three CVM samples, with a focus on endothelial cells (ECs), smooth muscle cells (SMCs) and immune microenvironment (IME). Clustering analysis based on differential gene expression unveiled 11 specific cell types, and determined CVM had more SMCs. Re-clustering of ECs and SMCs indicated CVM was dominated by arterial components, while VM is dominated by venous components. Gene set variation analysis suggested the activation of inflammation-related pathways in VM ECs, and upregulation of myogenesis pathway in CVM SMCs. In IME analysis, immune cells were identified to accounted for nearly 30% of the total cell number, including macrophages, monocytes, NK cells, T cells and B cells. Notably, more macrophages and monocytes were discovered in VM, indicating innate immune responses might be more closely related to VM pathogenesis. In addition, angiogenesis pathway was highlighted among the significant pathways of macrophages & monocytes between CVM and VM. In VM, VEGFA was highly expressed in macrophages & monocytes, while its receptors were all abundantly present in ECs. The close interaction of VEGFA on macrophages with its receptors on ECs was also predicted by CellPhoneDB analysis. Our results document cellular composition, significant pathways, and critical IME in CVM and VM development.
Collapse
Affiliation(s)
- Yongyun Li
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Jie Yang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yazhuo Huang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Shengfang Ge
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Xin Song
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Renbing Jia
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China
| | - Yefei Wang
- Department of Ophthalmology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Key Laboratory of Orbital Diseases and Ocular Oncology, Shanghai, China.
| |
Collapse
|
10
|
Strübing FF, Porubsky S, Bigdeli AK, Schmidt VJ, Krebs L, Kneser U, Sadick M. Interdisciplinary management of peripheral arteriovenous malformations: review of the literature and current proceedings. J Plast Surg Hand Surg 2021; 56:1-10. [PMID: 34292124 DOI: 10.1080/2000656x.2021.1913743] [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: 10/20/2022]
Abstract
Arteriovenous malformations (AVMs) are a rare congenital vascular disorder. They represent a fast-flow vascular malformation. Clinically, AVMs present a heterogenous expression and can affect every part of the body. Here, we will solely focus on extracranial AVMs. Generally, AVMs progress with the patient's age. Patients often suffer from pulsation, skin discoloration, pain, ulceration, bleeding, and disfigurement. Diagnostic tools include color-coded duplex sonography, MRI and CT imaging, as well as the clinical examination. 4D dynamic perfusion-computed tomography may help in the interventional planning. Digital subtraction angiography is required during interventional therapy. AVMs pose a great challenge to the treating physician. The therapy of this rare disease should be managed in an interdisciplinary center for vascular malformations. It consists of conservative measures, such as compression garments and pain medication, transcatheter or, more rarely, percutanous embolization, and surgical resection. In smaller, localized lesions, resection with primary wound closure may be feasible, whereas extensive AVMs regularly require the reconstruction of the resulting soft tissue defect and possibly affected functional structures by means of free tissue transfer. In the interdisciplinary setting required for an appropriate treatment of AVMs, extensive knowledge of the various therapies, including those from different specialties, is necessary. Therefore, this article aims to provide an overview over both the interventional and surgical therapeutic options.
Collapse
Affiliation(s)
- Felix F Strübing
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Stefan Porubsky
- Institute for Pathology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Volker J Schmidt
- Department of Plastic and Breast Surgery, Zealand University Hospital, Roskilde, Copenhagen University, Copenhagen, Denmark
| | - Lena Krebs
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| | - U Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Maliha Sadick
- Clinic for Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim - Heidelberg University, Mannheim, Germany
| |
Collapse
|
11
|
Markovic JN, Shortell CK. Venous malformations. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 62:456-466. [PMID: 34105926 DOI: 10.23736/s0021-9509.21.11911-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The often inexorable growth and expansion of congenital vascular malformations can result in substantial morbidity and, in some cases, premature death of these patients. Despite this, patients suffering from such lesions are often erroneously diagnosed and/or inadequately treated, due to a lack of expertise among primary care practitioners as well as specialists. Venous malformations are the most common type of congenital vascular malformations. Over the last two decades management of these lesions has significantly improved, predominantly due to the introduction and implementation of multidisciplinary team concept as well as improvement in diagnostic and treatment modalities. Relatively recently genetic studies are providing more insights into underlying pathophysiological mechanisms responsible for the development and progression of venous malformations and pharmacotherapy is becoming extensively evaluated for safety and efficacy in the treatment of these often challenging vascular lesions.
Collapse
Affiliation(s)
- Jovan N Markovic
- Department of Surgery, Division of Vascular Surgery, Duke University School of Medicine, Durham, NC, USA -
| | - Cynthia K Shortell
- Department of Surgery, Division of Vascular Surgery, Duke University School of Medicine, Durham, NC, USA
| |
Collapse
|
12
|
Hamamoto K, Futsuhara K, Chiba E, Matsuura K, Oishi M, Oyama-Manabe N. Spontaneous regression of a pulmonary arteriovenous malformation during endocrine therapy for breast cancer. Respir Med Case Rep 2020; 31:101311. [PMID: 33304810 PMCID: PMC7708854 DOI: 10.1016/j.rmcr.2020.101311] [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: 11/13/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 11/15/2022] Open
Abstract
A 52-year-old woman with right-sided breast cancer was diagnosed with a left pulmonary arteriovenous malformation (PAVM) by computed tomography (CT). Percutaneous embolization of the PAVM after treatment of the breast cancer was scheduled to prevent a paradoxical embolic event. She underwent lumpectomy, followed by systemic chemotherapy in combination with tangential field radiotherapy. Subsequently, she received endocrine therapy with tamoxifen, anastrozole, and exemestane, sequentially. There was no change in the PAVM on CT performed during the administration of anastrozole. Subsequently, CT performed five months after switching to exemestane showed obviously decreased size of the affected vessels, and the sac had almost disappeared. To the best of our knowledge, this is the first case report to describe the spontaneous regression of a PAVM during endocrine therapy for breast cancer.
Collapse
Affiliation(s)
- Kohei Hamamoto
- Department of Radiology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Kazushige Futsuhara
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Emiko Chiba
- Department of Radiology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Katsuhiko Matsuura
- Department of Radiology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Maya Oishi
- Department of Radiology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Noriko Oyama-Manabe
- Department of Radiology, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| |
Collapse
|
13
|
Treatment of Acquired Digital Arteriovenous Malformation with Progression during Pregnancy. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 7:e2535. [PMID: 32537293 PMCID: PMC7288866 DOI: 10.1097/gox.0000000000002535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/03/2019] [Indexed: 11/26/2022]
Abstract
Acquired digital arteriovenous malformation (AVM) is a relatively rare form of AVM that occurs in the fingers. Together with a review of the literature, we report a rare case of acquired digital AVM that enlarged after pregnancy. The patient was a 32-year-old woman with the chief complaint of digital swelling accompanied by a burning sensation. During her pregnancy, the swelling of the fingers recurred, with a symptom of throbbing sensation. After giving birth, the swelling reduced but did not completely disappear. At the first visit, we observed purple discoloration and swelling of the ulnar aspect of the proximal interphalangeal joints of the left hand. Contrast-enhanced computed tomography scanning via the digital arteries of the left hand revealed a lesion showing early venous return, leading to the diagnosis of AVM. Surgery was performed under general anesthesia. The digital artery supplying the lesion was identified and dissected under a surgical microscope. At 15 months after surgery, there was no recurrence, sensory dysfunction, or mobility impairment.
Collapse
|
14
|
Abstract
PURPOSE Despite many advances in the knowledge of vascular malformations, extracranial arteriovenous malformations (AVMs) remain an enigma and are usually misdiagnosed and mismanaged due to their associated rare morbidity. This study aimed to describe the clinical course and emphasize the progressive nature of AVMs through a retrospective study of 446 patients. METHODS Patients with cutaneous and soft-tissue AVMs presenting to our Vascular Anomalies Center between March 2011 and March 2017 were reviewed. Medical records were examined for disease course, age at first presentation at our institution, distributions and locations of lesions, clinical staging, progression, and previous treatments. Progression was defined as advancement to a higher Schobinger stage from a lower stage. RESULTS A total of 446 patients (mean age, 25.6 ± 14.0 years) were enrolled in this study, including 232 (52.0%) males (gender ratio, 1.08:1). Arteriovenous malformations lesions in 76.7% (342/446) of the patients were located in the head and neck. Children with Stage I AVMs had a 41.9% risk of progression before adolescence and an 80.0% risk of progression before adulthood. Nearly all patients (96.2%) showed progression in adulthood. Diffuse lesions were more likely to progress than localized lesions (P < 0.05) in childhood and adolescence. Lesions in the head and neck regions were less likely to progress than those in other regions in childhood (P = 0.005). A total of 216 (48.4%) patients had undergone previous treatments. Among these patients, bleomycin showed an unintentional positive effect in the treatment of AVMs. CONCLUSIONS Extracranial AVMs have a continuously progressive nature. A full understanding regarding the progressive course of AVMs can lead patients and physicians to attach importance to early diagnosis and management. Meanwhile exploring innovative treatments should be focused in the future to prevent potential destructive progression.
Collapse
|
15
|
Srivastava PK, Vyas N, Jones J, Wong TC, Holliman K, Small AJ, Rao RR, Dowling EP, Finn JP, Duckwiler GR, Reardon LC, Aboulhosn JA, Ascher SB, Hogeling M, Lluri G, Yang EH. High-Output Heart Failure From Growth of Vascular Malformations in Multiple Gestation Pregnancy. Circ Heart Fail 2019; 12:e006561. [PMID: 31658832 DOI: 10.1161/circheartfailure.119.006561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pratyaksh K Srivastava
- Division of Cardiology (P.K.S., A.J.S., L.C.R., J.A.A., E.H.Y.), University of California Los Angeles
| | - Nina Vyas
- Department of Obstetrics and Gynecology (N.V., T.C.W., K.H., R.R.R.), University of California Los Angeles
| | - Jesse Jones
- Division of Interventional Radiology (J.J., G.R.D.), University of California Los Angeles
| | - Thalia C Wong
- Department of Obstetrics and Gynecology (N.V., T.C.W., K.H., R.R.R.), University of California Los Angeles
| | - Kerry Holliman
- Department of Obstetrics and Gynecology (N.V., T.C.W., K.H., R.R.R.), University of California Los Angeles
| | - Adam J Small
- Division of Cardiology (P.K.S., A.J.S., L.C.R., J.A.A., E.H.Y.), University of California Los Angeles.,Ahmanson/University of California at Los Angeles Adult Congenital Heart Disease Center (A.J.S., L.C.R., J.A.A., G.L.), University of California Los Angeles
| | - Rashmi R Rao
- Department of Obstetrics and Gynecology (N.V., T.C.W., K.H., R.R.R.), University of California Los Angeles
| | - Erin P Dowling
- Department of Internal Medicine (E.P.D., S.B.A.), University of California Los Angeles
| | - J Paul Finn
- Division of Diagnostic Radiology (J.P.F.), University of California Los Angeles
| | - Gary R Duckwiler
- Division of Interventional Radiology (J.J., G.R.D.), University of California Los Angeles
| | - Leigh C Reardon
- Division of Cardiology (P.K.S., A.J.S., L.C.R., J.A.A., E.H.Y.), University of California Los Angeles.,Ahmanson/University of California at Los Angeles Adult Congenital Heart Disease Center (A.J.S., L.C.R., J.A.A., G.L.), University of California Los Angeles
| | - Jamil A Aboulhosn
- Division of Cardiology (P.K.S., A.J.S., L.C.R., J.A.A., E.H.Y.), University of California Los Angeles.,Ahmanson/University of California at Los Angeles Adult Congenital Heart Disease Center (A.J.S., L.C.R., J.A.A., G.L.), University of California Los Angeles
| | - Simon B Ascher
- Department of Internal Medicine (E.P.D., S.B.A.), University of California Los Angeles
| | - Marcia Hogeling
- Division of Dermatology (M.H.), University of California Los Angeles
| | - Gentian Lluri
- Ahmanson/University of California at Los Angeles Adult Congenital Heart Disease Center (A.J.S., L.C.R., J.A.A., G.L.), University of California Los Angeles
| | - Eric H Yang
- Division of Cardiology (P.K.S., A.J.S., L.C.R., J.A.A., E.H.Y.), University of California Los Angeles
| |
Collapse
|
16
|
Immunomodulation of carcinogens-induced steroids-dependent human diseases. Saudi J Biol Sci 2019; 26:244-251. [PMID: 31485161 PMCID: PMC6717089 DOI: 10.1016/j.sjbs.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/28/2017] [Accepted: 09/28/2017] [Indexed: 01/06/2023] Open
Abstract
The experimental and clinical data about antibodies against environmental chemical carcinogens and endogenous steroids are represented. The conception of immunomodulation of carcinogens- and steroids-dependent human diseases is proposed. It is postulated that antibodies to polycyclic aromatic hydrocarbons and heterocyclic amines in cooperation with antibodies to cholesterol, sex hormones, mineralo- and glucocorticoids stimulate or inhibit cancer, malformation, cardiovascular and autoimmune diseases depending on their personal combination. It is recommended to use immunoassay of these antibodies for the human diseases prediction. The alternative approaches for prevention using the probiotics transformed by anti-carcinogen antibodies are substantiated.
Collapse
Key Words
- Abs, antibodies
- Antibody formation
- BC, breast cancer
- BCP, breast cancer patients
- Benzo[a]pyrene
- Bp, benzo[a]pyrene
- CYP, cytochrome P-450
- Cg, chemical carcinogens
- Cholesterol
- ER+, estrogen receptors positive
- ER, estrogen receptors
- ER−, estrogen receptors negative
- Es, estradiol
- Estradiol
- HW, healthy women
- LC, lung cancer
- LCP, lung cancer patients
- MW, women with malformation
- PAH, polycyclic aromatic hydrocarbons
- PE, phytoestrogens
- PR+, progesterone receptors positive
- PR, progesterone receptors
- PR−, progesterone receptors negative
- Pg, progesterone
- Prediction
- Prevention
- Progesterone
- S, steroids
- cAhR, cytoplasmic
- mAhR, membrane aril hydrocarbon receptors
Collapse
|
17
|
Schattner A, Dubin I. Expansion of pulmonary arteriovenous malformations after grand mal seizures and other circumstances of PAVM growth. BMJ Case Rep 2019; 12:12/8/e229886. [PMID: 31401571 DOI: 10.1136/bcr-2019-229886] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A woman with asymptomatic pulmonary arteriovenous malformation (PAVM) discovered incidentally on admission developed recurrent generalised seizures. Immediately after, the PAVM demonstrated marked expansion, and was safely resected. Congenital PAVMs (associated with hereditary haemorrhagic telangiectasia or sporadic) are considered stable lesions that exhibit very slow growth if at all. A review of the literature reveals all circumstances of accelerated growth of PAVM (puberty, pregnancy, postpartum, pulmonary hypertension) and suggests a novel mechanism of seizure-associated expansion. This is important because the size and rapid growth of PAVMs correlate with the potential for rupture and other ominous complications such as right to left shunt and paradoxical emboli. The new seizures-PAVM progression association mandates recognition since the risk of seizures in patients with PAVM is substantial. Our observations strongly suggest the need to monitor PAVM in patients with or without haemorrhagic telangiectasis by repeated imaging after generalised seizures to evaluate potential expansion and risk.
Collapse
Affiliation(s)
- Ami Schattner
- Faculty of Medicine, Hebrew University Hadassah, Jerusalem, Israel.,Department of Medicine, Laniado Hospital, Sanz Medical Center, Netanya, Israel
| | - Ina Dubin
- Department of Medicine, Laniado Hospital, Sanz Medical Center, Netanya, Israel
| |
Collapse
|
18
|
Hormonal receptors in cutaneous vascular malformations: 51 cases. Virchows Arch 2019; 474:755-761. [PMID: 30810814 DOI: 10.1007/s00428-019-02546-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 01/29/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
Vascular malformations (VMs) are rare congenital anomalies that develop during embryogenesis in different types of vessels. Several triggering factors of cutaneous VMs include trauma, infections, or hormonal changes. We investigated the expression of hormonal receptors (androgen, estrogen, progesterone) in tissue samples of well-characterized VMs. A secondary objective was to identify self-reported triggering factors for these VMs, including hormonal changes, in the cohort of patients. We included patients with VM samples obtained in the tertiary center for vascular anomalies of the University Hospital Center of Tours, France, from January 1, 2007, to August 1, 2018. Immunohistochemistry was used to detect the expression of hormonal receptors (estrogen, progesterone, androgens). We obtained 51 samples from 51 patients: 13 cystic lymphatic malformations (CLMs), 16 venous malformations (VeMs), 11 arteriovenous malformations (AVMs), 4 combined VMs, 4 PIK3CA-related overgrowth spectrum, 1 Parkes-Weber syndrome, 1 Gorham syndrome, and 1 multiple lymphangioendotheliomatosis with thrombopenia. In total, 38 (74.5%) samples were positive for androgen receptor: 11 (84.6%) CLMs, 12 (75.0%) VeMs, 8 (72.2%) AVMs, and 7/11 (63.5%) other samples. All samples were negative for estrogen and progesterone receptors. Triggering factors were self-reported in 7 cases and were most frequently hormonal changes (n = 6, 18.2%). Hormonal triggers were frequent in AVMs (n = 4). Among patients with identified hormonal triggers, VM samples were positive for androgen receptor in 3 and negative in 3. Three-quarters of our VM samples expressed androgen receptor, and most CLM, VeM, and AVM samples were positive. Hormonal triggers were identified in 6/33 patients, mostly with AVMs.
Collapse
|
19
|
Maffei P, Dassie F, Wennberg A, Parolin M, Vettor R. The Endothelium in Acromegaly. Front Endocrinol (Lausanne) 2019; 10:437. [PMID: 31396153 PMCID: PMC6667653 DOI: 10.3389/fendo.2019.00437] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/18/2019] [Indexed: 12/12/2022] Open
Abstract
Growth hormone (GH) and insulin like growth factor-1 (IGF-1) excess induce well-known deleterious effects on the cardiovascular system, especially after long-term exposition. Acromegaly, a condition of chronic GH and IGF-1 hypersecretion, is frequently associated to cardiovascular complications, although recent studies have shown a reduction in the prevalence of these comorbidities in well-controlled patients and a mortality risk similar to normal aging population. Many factors could contribute to the increased cardiovascular risk of acromegaly patients. Among these factors, the endothelium plays a key role in the pathogenesis of atherosclerotic plaques and could be considered an early marker of atherosclerosis and cardiovascular dysfunction. In this review we examined the relationship between GH/IGF-1 excess and the endothelium, from basic studies to clinical evidence. Many studies involving various arterial districts (microvascular arteries of retina, kidney and brain, and major vessels as carotid and aorta) showed that GH/IGF-1 excess promotes endothelial dysfunction via several different mechanisms. Increased endothelial proliferation, dysfunction of endothelial progenitor cells, increased oxidative stress, and compromised oxidative defenses are the main factors that are associated with endothelial dysfunction. In the general population, these alterations are associated with the development of atherosclerosis with an increased incidence of coronary artery disease and cerebrovascular complications. However, in acromegaly this is still a debated issue, despite the presence of many pro-atherogenic factors and comorbidities, such as hypertension, diabetes, sleep apnoea, and metabolic syndrome. Preclinical markers of atherosclerosis as arterial intima media thickness, pulse wave velocity and flow mediated dilation seem to be impaired in acromegaly and partly mediated by the endothelium dysfunction. In conclusion, the pathophysiology of endothelial dysfunction in the condition of GH and IGF-1 excess remains a crucial area of investigation to fully dissect the association of acromegaly with cardiovascular disease complications.
Collapse
Affiliation(s)
- Pietro Maffei
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
- *Correspondence: Pietro Maffei
| | - Francesca Dassie
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Alexandra Wennberg
- Clinica Neurologica, Department of Neurosciences (DNS), Padua University Hospital, Padua, Italy
| | - Matteo Parolin
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| | - Roberto Vettor
- Clinica Medica 3, Department of Medicine (DIMED), Padua University Hospital, Padua, Italy
| |
Collapse
|
20
|
Tseng WK, Su IC, Chen MT, Lee JJ. Spontaneous Regression of Parapharyngeal Arteriovenous Malformation. Vasc Endovascular Surg 2018; 52:313-315. [PMID: 29495955 DOI: 10.1177/1538574418761982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arteriovenous malformations (AVMs) are fast-flow vascular malformations that mostly occur in the head and neck region. They are typically progressive and their spontaneous regression is almost never seen. We present a case with pulsatile tinnitus and a parapharyngeal AVM. It resolved completely after diagnostic catheter-based angiography alone.
Collapse
Affiliation(s)
- Wen-Kai Tseng
- 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - I-Chang Su
- 2 Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
| | - Ming-Ting Chen
- 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan.,3 Division of Plastic Surgery, Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Jian-Jr Lee
- 1 Division of Plastic and Reconstructive Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan.,4 Department of Anatomy and Cell Biology, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
21
|
A Research of Pyogenic Granuloma Genesis Factor With Immunohistochemical Analysis. J Craniofac Surg 2017; 28:2068-2072. [DOI: 10.1097/scs.0000000000004148] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
|
22
|
Li J, Qiao JB, Liu QY. Pingyangmycin Pretreatment Influences the Biological Behavior of Ocular Venous Malformation and Relates with Galectin-3 Expression. Chin Med J (Engl) 2017; 130:1804-1809. [PMID: 28748853 PMCID: PMC5547832 DOI: 10.4103/0366-6999.211537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Galectin-3 (Gal-3) plays a role in the mechanisms underlying ocular venous malformation. We conducted this study to investigate the effect of pingyangmycin pretreatment on the Gal-3 expressions and biological behavior of ocular venous malformation. METHODS Tissue samples were collected from 136 patients with ocular venous malformation. Patients were randomly divided into pingyangmycin (n = 69) and nonpingyangmycin group (n = 67). Patients in the pingyangmycin group received a local injection of 0.02% pingyangmycin once every 2 days for 2 weeks (7 doses) before removal surgery, whereas patients in the nonpingyangmycin group underwent removal surgery without local injection. The protein and messenger RNA (mRNA) expression of Gal-3 were detected by using immunohistochemistry and in situ hybridization. RESULTS Gal-3 protein was expressed in 35 (52%) of 67 samples in the nonpingyangmycin group and in 19 (28%) of 69 samples in the pingyangmycin group (P < 0.05). Gal-3 mRNA expression was detected in 39 (58%) of 67 samples in the nonpingyangmycin group and 22 (32%) of 69 samples in the pingyangmycin group (P < 0.05). The higher Gal-3 expressions were detected in samples with deeper invasiveness than those with superficial invasiveness before (χ2 = 12.720 and 13.369, respectively, both P < 0.05) and after pingyangmycin treatment (χ2 = 8.429 and 4.590, respectively, both P < 0.05). It was more frequently detected in mesh-like lesions with unclear boundary than round lesions with clear boundary before (χ2 = 30.291 and 41.466, respectively, both P < 0.05) and after pingyangmycin treatment (χ2 = 14.619 and 15.130, respectively, both P < 0.05). Pingyangmycin treatment led to a significant difference in Gal-3 expressions at both protein and mRNA levels (χ2 = 8.664 and 9.524, respectively, both P < 0.05). CONCLUSIONS Gal-3 expression may be involved in the development and invasiveness of ocular venous malformation, and pingyangmycin can inhibit Gal-3 expression, indicating a role of pingyangmycin treatment before the removal of ocular venous malformation.
Collapse
Affiliation(s)
- Jin Li
- Department of Ophthalmology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Henan Eye Institute and Henan Eye Hospital, Zhengzhou, Henan 450052, China
| | - Jun-Bo Qiao
- Department of Hemangioma Surgery, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan 450052, China
| | - Qiu-Yu Liu
- Department of Pathology, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan 450052, China
| |
Collapse
|
23
|
Siljee S, Keane E, Marsh R, Brasch HD, Tan ST, Itinteang T. Expression of the Components of the Renin-Angiotensin System in Venous Malformation. Front Surg 2016; 3:24. [PMID: 27200356 PMCID: PMC4853390 DOI: 10.3389/fsurg.2016.00024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/11/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Venous malformation (VM) is the most common form of vascular malformation, consisting of a network of thin-walled ectatic venous channels with deficient or absent media. This study investigated the expression of the components of the renin-angiotensin system (RAS), namely, (pro)renin receptor (PRR), angiotensin-converting enzyme (ACE), angiotensin II receptor 1 (ATIIR1), and angiotensin II receptor 2 (AIITR2) in subcutaneous (SC) and intramuscular (IM) VM. MATERIALS AND METHODS SC (n = 7) and IM (n = 7) VM were analyzed for the expression of PRR, ACE, ATIIR1, and ATIIR2 using 3,3-diaminobenzidine and immunofluorescent (IF) immunohistochemical (IHC) staining and NanoString gene expression analysis. RESULTS IHC staining showed expression of PRR, ACE, and ATIIR1, and faint expression of ATIIR2 in the endothelium of SC and IM VM. Furthermore, ATIIR2 was expressed by cells away from the endothelium in both SC and IM VM lesions examined. NanoString analysis demonstrated the presence of PRR, ACE, and ATIIR1 but not ATIIR2. CONCLUSION The presence of PRR, ACE, ATIIR1, and potentially ATIIR2, in both SC and IM VM, suggests a role for the RAS in the biology of VM. This novel finding may lead to a mechanism-based therapy for VM.
Collapse
Affiliation(s)
- Sam Siljee
- Gillies McIndoe Research Institute , Wellington , New Zealand
| | - Emily Keane
- Gillies McIndoe Research Institute , Wellington , New Zealand
| | - Reginald Marsh
- Gillies McIndoe Research Institute, Wellington, New Zealand; University of Auckland, Auckland, New Zealand
| | - Helen D Brasch
- Gillies McIndoe Research Institute, Wellington, New Zealand; Department of Pathology, Hutt Hospital, Wellington, New Zealand
| | - Swee T Tan
- Gillies McIndoe Research Institute, Wellington, New Zealand; Centre for the Study and Treatment of Vascular Birthmarks, Wellington Regional Plastic, Maxillofacial and Burns Unit, Hutt Hospital, Wellington, New Zealand
| | - Tinte Itinteang
- Gillies McIndoe Research Institute , Wellington , New Zealand
| |
Collapse
|
24
|
Abstract
A standardized classification system allows improvements in diagnostic accuracy. Multidisciplinary vascular anomaly centers combine medical, surgical, radiologic, and pathologic expertise. This collaborative approach tailors treatment and management of vascular anomalies for affected individuals.
Collapse
Affiliation(s)
- Lisa S Foley
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Ann M Kulungowski
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, USA.
| |
Collapse
|
25
|
Abstract
Arteriovenous malformations (AVMs) are fast-flow vascular malformations composed of a complex vessel network directly connecting feeding arteries to draining veins. The intervening normal capillary network is absent. Proper diagnosis and treatment of AVMs is challenging and in need of an interdisciplinary team of experienced physicians. Careful analysis of the clinical features and evaluation of therapeutic options represent the basis for successful management of AVMs. This article will focus on the clinical and radiological findings and in particular on interdisciplinary management strategies of AVMs including minimally invasive endovascular and surgical treatment.
Collapse
Affiliation(s)
- Wibke Uller
- Vascular Anomalies Center, Boston Children´s Hospital and Harvard Medical School, Boston, Massachusetts; Division of Vascular and Interventional Radiology, Boston Children´s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ahmad I Alomari
- Vascular Anomalies Center, Boston Children´s Hospital and Harvard Medical School, Boston, Massachusetts; Division of Vascular and Interventional Radiology, Boston Children´s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Gresham T Richter
- Vascular Anomalies Center of Excellence, Department of Otolaryngology-Head and Neck Surgery, Arkansas Children׳s Hospital, University of Arkansas for Medical Sciences, 4301 W Markham, Slot 546, Little Rock, Arkansas 72202.
| |
Collapse
|
26
|
Malformaciones arteriovenosas: un reto diagnóstico y terapéutico. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:347-58. [DOI: 10.1016/j.ad.2013.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Revised: 04/03/2013] [Accepted: 04/05/2013] [Indexed: 12/18/2022] Open
|
27
|
Uihlein LC, Garzon MC, Goodwin G, Liang MG. Growth hormone replacement in patients with PHACE association and hypopituitarism. Pediatr Dermatol 2014; 31:337-40. [PMID: 24602073 DOI: 10.1111/pde.12306] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Partially empty sella with growth hormone (GH) deficiency is rarely reported in association with PHACE (posterior fossa anomalies, cervicofacial infantile hemangiomas [IHs], arterial anomalies, cardiac defects, eye anomalies, and midline/ventral defects). Consequently, little is known about the effect of GH replacement on the proliferation and involution of IHs in children with PHACE. We describe two children with PHACE and partially empty sella, both of whom received GH replacement for treatment of hypopituitarism. In our first patient we observed erythema and prominence of the vasculature in the hemangioma shortly after initiation of therapy at age 20 months, although after 4 weeks of treatment the appearance of the hemangioma stabilized and little change was seen during eight additional years of therapy. In our second patient we noted enlargement of the hemangioma after starting low-dose GH at age 5 years, prompting discontinuation of GH replacement after 3 months of therapy. The hemangiomas continued to grow after discontinuation of GH treatment. GH administration in our patients was associated with erythema and prominence of IHs. Our findings suggest that GH replacement therapy may promote transient or more prolonged proliferation of IHs and should be administered with close clinical monitoring.
Collapse
Affiliation(s)
- Lily C Uihlein
- Dermatology Program, Boston Children's Hospital, Boston, Massachusetts
| | | | | | | |
Collapse
|
28
|
de Miguel R, López-Gutierrez J, Boixeda P. Arteriovenous Malformations: A Diagnostic and Therapeutic Challenge. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2013.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
29
|
|
30
|
A review of contemporary options for medical management of hemangiomas, other vascular tumors, and vascular malformations. Pharmacol Ther 2013; 139:327-33. [DOI: 10.1016/j.pharmthera.2013.05.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 04/26/2013] [Indexed: 01/06/2023]
|