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Düzenli Kar Y, Özdemir ZC, Acu B, Bör Ö. Infantile hemangioma: Efficacy of low-dose propranolol and of intralesional bleomycin injection for propranolol non-response. Pediatr Int 2019; 61:459-464. [PMID: 30861274 DOI: 10.1111/ped.13830] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/26/2019] [Accepted: 03/07/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infantile hemangioma (IH) is the most common form of benign childhood vascular tumor. Most resolve spontaneously, but treatment is recommended in patients who develop complication. Propranolol is recommended as the first-line therapy, while the treatment in the case of non-response to first-line therapy depends on the clinical experiences of each center. The aim of this study was to investigate the efficacy of low-dose propranolol in the treatment of IH, and the outcomes of percutaneous intralesional bleomycin injection (IBI) in patients unresponsive to propranolol. METHODS Medical records of 104 children diagnosed with IH between June 2014 and June 2017 were reviewed retrospectively. RESULTS Median patient age was 6 months (range, 3-12 months). Forty-five patients (43.3%) received therapy: 18 (40%) for cosmetic problems and 27 (60%) for lesion-related complications. The most common complications were hemorrhage (15.6%) and impairment in visual function (15.6%). All of the patients received propranolol 1 mg/kg/day as the first-line therapy. Response to treatment was excellent in 35 patients, good in four and poor in one, while five patients did not respond to therapy. The five unresponsive patients received percutaneous IBI at 0.3-0.5 mg/kg/dose as second-line therapy. The response to treatment was excellent in four patients, good in one. CONCLUSIONS The majority of IH resolved spontaneously. In the patients who required treatment, low-dose propranolol was successful in most, and IBI was effective and safe in the remaining five patients who did not respond to propranolol.
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Affiliation(s)
- Yeter Düzenli Kar
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Zeynep Canan Özdemir
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Berat Acu
- Division of Radiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Bör
- Division of Pediatric Hematology and Oncology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Eslahi A, Noorafshan A, Safarpour AR, Sepehrimanesh M, Ariafara A, Nadimi E. Stereological comparison of intraprostatic injection of alcohol and bleomycin with finasteride gavages in rats. Cent European J Urol 2017; 70:163-169. [PMID: 28721283 PMCID: PMC5510340 DOI: 10.5173/ceju.2017.1211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Revised: 04/03/2017] [Accepted: 04/10/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Resection of the prostate is one of the standard surgical treatments for symptomatic Benign Prostatic Hyperplasia (BPH). To evaluate minimally invasive treatments, intraprostatic injections of ethanol and bleomycin were compared with oral finasteride administration in rats with BPH. MATERIAL AND METHODS The rats were divided into six groups. The control rats received no BPH/no treatment. BPH was induced using injections of testosterone (2 mg/day/rat for 4 weeks) in groups II-VI. After 4 weeks, Group II received no treatment while Group III received oral finasteride (10 mg/kg/day). Moreover, Groups IV-VI received a single injection of ethanol (95%), bleomycin (5 mg/kg) and normal saline 25 mm3 in each ventral lobe of the prostate respectively. Two weeks after the injections, the ventral lobes underwent a quantitative stereological study. RESULTS The volume of the ventral lobes, glandular epithelium, fibromuscular tissue and microvessles increased by 1.7, 3.1, 2.4 and 1.6 times in BPH rats respectively (P <0.01). Alcohol or bleomycin injection in PBH rats induced drastic recession of the increased volume of the ventral lobe, glandular epithelium and fibromuscular tissue (P <0.01). Regarding the BPH+alcohol group, the glandular epithelium volume restored to the normal values of the control rats (P <0.01). BPH+finasteride also incited an atrophic change in the volume of the whole prostate and glandular epithelium, but not the fibromuscular tissue and microvessels (P <0.01). CONCLUSIONS Injection of alcohol and bleomycin (approximately 10% of the volume of ventral prostatic) as well as consuming finasteride can induce a reduction of 1/3, 1/4 and 1/5 in the hypertrophied gland respectively.
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Affiliation(s)
- Ali Eslahi
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Noorafshan
- Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali-Reza Safarpour
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Masood Sepehrimanesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Ariafara
- Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Elham Nadimi
- Gastrointestinal and Liver Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Tong S, Xu DP, Liu ZM, Du Y, Wang XK. Evaluation of the efficacy and safety of topical timolol maleate combined with oral propranolol treatment for parotid mixed infantile hemangiomas. Oncol Lett 2016; 12:1806-1810. [PMID: 27588127 PMCID: PMC4998099 DOI: 10.3892/ol.2016.4818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/08/2016] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to assess the efficacy and safety of topical timolol maleate combined with oral propranolol for parotid infantile hemangiomas. Between October 2012 and April 2014, propranolol was administered orally at a dose of 1.0-1.5 mg/kg/day to 22 infants with proliferating hemangiomas in the Department of Oral and Maxillofacial Surgery (Hospital of Stomatology, China Medical University, Shenyang, Liaoning, China). A small amount of 0.5% timolol maleate eye drop solution was topically applied with medical cotton swabs to the area of the lesion twice a day, every 12 h. The study group consisted of 9 males and 13 females, aged 2-9 months, with a median age of 4.7 months. The lesions were all located in the parotid region, and measured between 3.5×4×0.5 and 7×8×3 cm in volume. The planned duration of therapy was 6-8 months, or the two drugs were stopped when complete regression of the lesions was obtained. The therapeutic outcomes and safety were assessed by the change in the size and color of the tumor, and the presence of adverse effects throughout the course of treatment. The mean duration of therapy was 21.1 weeks and ranged from 3 to 8 months. Of the 22 patients, 16 demonstrated an excellent response, 6 showed a good response and 2 displayed a moderate response. No major collateral effects were observed. Overall, oral propranolol combined with topical timolol maleate may be used as the first-line therapeutic choice in the treatment of infantile parotid mixed hemangioma.
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Affiliation(s)
- Shuang Tong
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning 110002, P.R. China
| | - Da-Peng Xu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning 110002, P.R. China
| | - Zi-Mei Liu
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning 110002, P.R. China
| | - Yang Du
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning 110002, P.R. China
| | - Xu-Kai Wang
- Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning Institute of Dental Research, Shenyang, Liaoning 110002, P.R. China
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How to use bleomycin A5 for infantile maxillofacial haemangiomas: Clinical evaluation of 82 consecutive cases. J Craniomaxillofac Surg 2011; 39:482-6. [DOI: 10.1016/j.jcms.2010.06.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2007] [Revised: 05/12/2010] [Accepted: 06/09/2010] [Indexed: 11/30/2022] Open
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Surgical treatment of craniofacial haemangioma in children. ANNALS OF PEDIATRIC SURGERY 2011. [DOI: 10.1097/01.xps.0000405091.05305.65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
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Luo QF, Zhao FY. The effects of Bleomycin A5 on infantile maxillofacial haemangioma. Head Face Med 2011; 7:11. [PMID: 21736714 PMCID: PMC3148961 DOI: 10.1186/1746-160x-7-11] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 07/07/2011] [Indexed: 11/28/2022] Open
Abstract
Objective To examine the effects of bleomycin A5 on infantile maxillofacial haemangiomas. Methods Bleomycin A5 was given by multiple intralesinoal injections and the dosage was given according to the age of the patient and size of the lesion. Parts of patients were accompanied by prednisone treatment(2-5 mg/kg, po, QOD. Results All the haemangiomas involuted completely after treated with bloemycin A5 with better recovery of skin color and less scar forming in small haemangiomas. Conclusion Infantile haemangioma could be effectively treated with bleomycin A5 without serious side effects.
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Affiliation(s)
- Quan-feng Luo
- Peking University School and Hospital of Stomatology, Department of Oral and Maxillofacial Surgery, #22 Zhongguancun Nandajie, Haidian District, Beijing 100081, PR China.
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Intralesional bleomycin injection treatment for vascular birthmarks: a 5-year experience at a single United Kingdom unit. Plast Reconstr Surg 2011; 127:2031-2044. [PMID: 21532430 DOI: 10.1097/prs.0b013e31820e923c] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The authors present their experience using an established chemotherapeutic agent as a scarless treatment for vascular birthmarks. One hundred sixty-four of more than 600 patients seen in the authors' center received intralesional bleomycin injection over 5 years. METHODS Patient demographics, clinical response, treatment, and complication details were recorded prospectively. Respiratory surveillance was provided by adult and pediatric pulmonologists. Eighty-one venous malformations, 39 hemangiomas, 26 lymphatic malformations, 10 mixed malformations, two arteriovenous malformations, two cystic hygromas, two capillary malformations, and two angiokeratomas underwent intralesional bleomycin injection. RESULTS The authors observed that 45.7 percent of patients completed treatment in a mean of 3.8 sessions and mean duration of 107 days. Complete resolution occurred in 56.0 percent, with a 93.3 percent overall response rate, and 82.7 percent of lesions demonstrated complete response or significant improvement. Three patients developed transient skin hyperpigmentation. One patient each developed skin ulceration, blistering, infection, swelling, headache, bruising, and rash. One patient required intubation following treatment of a panfacial and thoracic lymphatic malformation. A full recovery ensued. No patients developed pulmonary fibrosis. One venous malformation recurred. CONCLUSIONS The authors' single-site multidisciplinary team has successfully treated complex and recurrent vascular anomalies with acceptable complication and recurrence profiles. These findings represent the authors' experience and provide a reference for the management of these challenging lesions.
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Zheng JW, Zhou Q, Yang XJ, Wang YA, Fan XD, Zhou GY, Zhang ZY, Suen JY. Treatment guideline for hemangiomas and vascular malformations of the head and neck. Head Neck 2010; 32:1088-98. [PMID: 19924783 DOI: 10.1002/hed.21274] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Vascular anomalies are among the most common congenital and neonatal dysmorphogenesis, which are separated into hemangiomas and vascular malformations. They can occur in various areas throughout the body, with 60% being located in the head and neck. The true mechanism of pathogenesis of vascular anomalies is still unclear. Various treatment methods have been reported, and there are still controversies over the selection of different treatment modalities. Based on the clinical and basic research and current literature, the Chinese Division of Oral and Maxillofacial Vascular Anomalies formulated a treatment guideline for hemangiomas and vascular malformations of the head and neck, which will be modified and updated periodically based on new medical evidence and research.
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Affiliation(s)
- Jia Wei Zheng
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Yang Y, Sun M, Cheng X, Hu X, Zhang P, Ma Q, Li J, Tian L, Lei D. Bleomycin A5 plus dexamethasone for control of growth in infantile parotid hemangiomas. ACTA ACUST UNITED AC 2009; 108:62-9. [DOI: 10.1016/j.tripleo.2009.02.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2008] [Revised: 02/07/2009] [Accepted: 02/09/2009] [Indexed: 11/29/2022]
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Zheng JW, Zhou Q, Yang XJ, He Y, Wang YA, Ye WM, Zhu HG, Zhang ZY. Intralesional injection of Pingyangmycin may be an effective treatment for epulis. Med Hypotheses 2009; 72:453-4. [DOI: 10.1016/j.mehy.2008.10.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2008] [Revised: 10/03/2008] [Accepted: 10/10/2008] [Indexed: 12/01/2022]
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Pandey A, Gangopadhyay AN, Gopal SC, Kumar V, Sharma SP, Gupta DK, Sinha CK. Twenty years' experience of steroids in infantile hemangioma--a developing country's perspective. J Pediatr Surg 2009; 44:688-94. [PMID: 19361627 DOI: 10.1016/j.jpedsurg.2008.10.038] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 10/05/2008] [Accepted: 10/06/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Hemangioma is a common vascular tumor. Though it involutes spontaneously, results are unpredictable. Steroid therapy is an effective mode of its regression. We present our experience of largest series and possible recommendations for treatment. MATERIALS AND METHODS A total of 2398 patients were treated during the study period of 20 years. They were given oral prednisolone, intralesional triamcinolone, or combination of both as per the protocol and followed for the response. Response to the treatment was graded as excellent, good, poor, or no response. RESULTS The male-to-female ratio was 1:2.3. In 81% of patients, hemangioma was noticed within first month of life. The commonest site of involvement was head and neck (57%). The commonest clinical presentation was discoloration and swelling. Mean age and size were 8.43 +/- 7.04 months and 23.64 +/- 20.13 cm(2). Response rate was highest for superficial type using any modality of treatment. Patients younger than 1 year showed better response (90.3%) in comparison with children older than 1 year (80.8%). The specific complications occurring were infections in 249 (12.4%), cushingoid facies and growth delay in 62 (3.1%), and hypertension in 51 (2.5%) patients. CONCLUSION Steroid therapy either oral or intralesional as per the requirement is an easy and safe modality. Results are good to satisfactory in most patients. The complications are minimal. If treatment is needed, it should be used as a first-line therapy, especially when cost is an important concern.
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Affiliation(s)
- Anand Pandey
- Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, UP, India
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Zhi K, Wen Y, Li L, Ren W. The role of intralesional Pingyangmycin in the treatment of venous malformation of facial and maxillary region. Int J Pediatr Otorhinolaryngol 2008; 72:593-7. [PMID: 18294701 DOI: 10.1016/j.ijporl.2008.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2007] [Revised: 12/23/2007] [Accepted: 01/05/2008] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the effect of intralesional Pingyangmycin injection in venous malformation of facial and maxillary region. MATERIALS AND METHODS From September 2001 to October 2004, 82 patients were referred with venous malformation for intralesional Pingyangmycin injection. RESULTS After a minimum follow-up of 2 years, 67 patients (81.7%) developed 76-100% regression in their lesions; 12 patients (14.6%) had 51-75% regression in their lesion; 3 patients underwent surgical excision for the residual swellings. No changes in renal function or cytopenias were encountered. No patients developed chest X-ray changes during the course of therapy. There were no mortalities. CONCLUSION Intralesional injection of Pingyangmycin is an effective, inexpensive, and safe method in venous malformation of facial and maxillary region. We now favor Pingyangmycin sclerotherapy before considering surgical excision in all cases of venous malformation in our hospital.
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Affiliation(s)
- Keqian Zhi
- Department of Oral and Maxillofacial Surgery, College of Stomatology, Xi'an Jiaotong University, Number 98, Xiwu Road, Xi'an 710004, ShaanXi, China.
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