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Sun CR, Liu MY, Ni QH, Cai F, Tang F, Yu ZY, Zhang JB, Zhang L, Zhang WW, Li CM. Clinical Guidelines on Compression Therapy in Venous Diseases. Ann Vasc Surg 2024:S0890-5096(24)00451-5. [PMID: 39032593 DOI: 10.1016/j.avsg.2024.07.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND In recent years, compression therapy has attracted gradually increasing clinical attention in lower extremity venous diseases. However, basic concepts and clear nomenclature, standard treatment methods, and consistent product standards for pressure equipment are lacking. Therefore, developing clinical guidelines for compression therapy is essential to improving the treatment of venous diseases. METHODS Our panel generated strong (grade I), moderate (grade IIa and IIb), and weak (grade III) recommendations based on high-quality (class A), moderate-quality (class B), and low-quality (class C) evidence, using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach and the European Society of Cardiology (ESC) grading system. RESULTS The panels made 30 recommendations from current evidence, focusing on 7 fields of lower extremity venous disease (venous thromboembolism, post-thrombotic syndrome (PTS), chronic venous insufficiency (CVI), varicose veins, hemangioma and vascular malformations, lymphedema, and venous ulcers) and 18 topics. CONCLUSIONS Of the 30 recommendations made across the 18 topics, 7 were strong (grade I) and 17 were based on high-quality (class A) evidence, highlighting the need for further research of the use of compression therapy.
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Affiliation(s)
- Cong-Rui Sun
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Ming-Yuan Liu
- Department of Vascular Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Qi-Hong Ni
- Department of Vascular Surgery, Renji Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Fei Cai
- Department of Vascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Tang
- Department of Vascular Surgery, The First Affiliated Hospital of Tsinghua University, Beijing, China
| | - Zi-You Yu
- The Department of Plastic and Reconstructive Surgery, The Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jian-Bin Zhang
- The Department of Cardiovascular Surgery, China-Friendship Hospital, Beijing, China
| | - Long Zhang
- Department of Vascular Surgery, Peking University Third Hospital, Beijing, China
| | | | - Chun-Min Li
- Department of Vascular Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China.
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Nakanishi Y, Kunihiro N, Umaba R, Matsusaka Y, Inoue T, Sakamoto H. Limited dorsal myeloschisis associated with intramedullary infantile hemangioma in the conus medullaris: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE22359. [PMID: 37096816 PMCID: PMC10550677 DOI: 10.3171/case22359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/28/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Limited dorsal myeloschisis (LDM) and intramedullary infantile hemangioma rarely coexist in the spinal cord. OBSERVATIONS The authors describe the case of a 3-month-old girl who, despite lacking neurological symptoms or signs, had a cigarette burn-like mark at the lumbosacral area and skin dimpling in the gluteal area. Magnetic resonance imaging showed a low-set conus due to a thickened filum and an abnormal subcutaneous stalk connected to the conus medullaris. In combination with the skin lesions, these findings strongly implied nonsaccular-type LDM. An intramedullary mass in the conus medullaris was also shown on magnetic resonance imaging and was homogenously enhanced with isointensity on T1- and T2-weighted images. We prophylactically untethered the spinal cord and partially removed the intramedullary mass, which had no clear borders, for a safe surgical dissection. Histologically, the intramedullary mass was an infantile hemangioma, and the subcutaneous stalk was a lesion associated with LDM. The patient remained neurologically intact after surgery, and then 2 years later, there was spontaneous regression of the residual tumor. LESSONS Although rare, nonsaccular type LDM may appear concurrently with intramedullary infantile hemangioma at the conus medullaris. The authors present a possible mechanism behind this concurrent presentation in the same area.
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Affiliation(s)
- Yoko Nakanishi
- Departments of Pediatric Neurosurgery, and
- Department of Neurological Surgery, Wakayama Medical University, Wakayama, Japan
| | | | | | | | - Takeshi Inoue
- Pathology, Osaka City General Hospital, Osaka, Japan; and
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An unusual cause of proteinuria: lessons for clinical nephrologists. J Nephrol 2022; 35:2403-2405. [PMID: 36151451 DOI: 10.1007/s40620-022-01457-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022]
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Morimoto A, Ozeki M, Sasaki S, Baba N, Kuwano Y, Kaneko T. Severe hypoglycemia in propranolol treatment for infantile hemangiomas. Pediatr Int 2022; 64:e15278. [PMID: 35972062 PMCID: PMC9541900 DOI: 10.1111/ped.15278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Infantile hemangioma (IH), formerly termed strawberry hemangioma, is a benign vascular tumor caused by capillary endothelial cell proliferation. The tumor regresses after 1 year of age, but sequelae occur in approximately half of the patients without systemic treatment. Propranolol (PPL) is currently the first-line therapeutic agent in Japan as well as in Western countries. It is not commonly known that PPL may induce severe hypoglycemia, in addition to cardiovascular and respiratory side effects. METHODS We retrospectively analyzed patients with severe PPL-induced hypoglycemia in the 3 years since the launch of Hemangiol®, a PPL preparation specific for IH, in Japan in 2016. RESULTS The incidence of severe hypoglycemia and of hypoglycemic convulsions following PPL treatment was estimated to be 0.54% and 0.35%, respectively. The incidence of hypoglycemic convulsions appeared to be higher in Japan than in Western countries. Severe hypoglycemia was common in infants aged >1 year, when PPL was used for ≥6 months. Severe hypoglycemia often develops from 05:00 a.m. to 09:00 a.m. and is frequently associated with prolonged periods of fasting, poor feeding, or poor physical conditions. CONCLUSION To avoid the risk of hypoglycemia, the treatment should be initiated by 6 months of age during the proliferative phase at the latest, and should not be extended indiscriminately beyond 1 year of age. Guardians should be advised not to administer PPL on an empty stomach, in the presence of poor feeding, or who are in poor physical condition, not to prolong fasting after PPL administration, and to monitor the child's condition immediately after he or she wakes up.
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Affiliation(s)
- Akira Morimoto
- Department of Pediatrics, Jichi Medical University School of Medicine, Shimotsuke, Japan.,Division of Pediatrics, Showa Inan General Hospital, Komagane, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Satoru Sasaki
- Center for Vascular Anomalies, KKR Sapporo Medical Center Tonan Hospital, Sapporo, Japan
| | - Naoko Baba
- Department of Dermatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yoshihiro Kuwano
- Department of Dermatology, Mizonokuchi Hospital, Teikyo University School of Medicine, Kawasaki, Japan
| | - Tsuyoshi Kaneko
- Department of Plastic and Reconstructive Surgery, National Center for Child Health and Development, Tokyo, Japan
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Li CX, Li H, Zhou YC, Gong ZC, Ling B. Application of topical betaxolol to cure superficial infantile hemangioma: A pilot study. Pediatr Int 2022; 64:e15384. [PMID: 36222187 DOI: 10.1111/ped.15384] [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] [Received: 09/22/2022] [Revised: 09/27/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Beta-blockers have gradually become an attractive option for the treatment of infantile hemangiomas. Topical application is preferred to oral administration because of their potential systemic adverse effects. The aim of this study is to investigate the effect of betaxolol in treating superficial infantile hemangioma. METHODS Seventy-four infants admitted to the First Affiliated Hospital of Xinjiang Medical University from 2018 to 2019 were observed and recorded. Variables such as color, size, tension, and thickness were recorded monthly and evaluated using visual analog scales. Multi-factor analysis of variance with repeated measurements and the non-parametric Kruskal-Wallis H test were used to compare clinical effectiveness across the different groups. RESULTS After 6 months of treatment, 33.78% (25/74) showed excellent results, 55.41% (41/74) had good responses, 8.11% (6/74) had moderate responses, and 2.70% (2/74) had poor responses. Local discomfort and systemic complications were not found. There was no significant difference in gender and location of occurrence among groups (p > 0.05), and the effect of topical application of betaxolol was optimum in the children aged 0-3 months (p = 0.002). None of three age groups had statistically significant difference in heart rate and blood pressure after accepting treatment (1 month, p = 0.618; 4 months, p = 0.138; 6 months, p = 0.757). CONCLUSIONS Our study showed that topical administration of betaxolol was effective and well tolerated for superficial infantile hemangiomas, particularly in the early proliferative stage. However, its safety and efficacy need further research.
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Affiliation(s)
- Chen-Xi Li
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China.,Laboratory for Tumor Genetics and Regenerative Medicine, Department of Oral and Maxillofacial Surgery, Department of Neurology, the Head and Neurocenter, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hong Li
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China
| | - Yu-Chuan Zhou
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China
| | - Zhong-Cheng Gong
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China
| | - Bin Ling
- Department of Oral and Maxillofacial Surgery & Oncology, The First Affiliated Hospital of Xinjiang Medical University, School/Hospital of Stomatology Xinjiang Medical University, Stomatological Research Institute of Xinjiang Autonomous Region, Urumqi, China
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Takahashi Y, Kinoshita Y, Kobayashi T, Arai Y, Ohyama T, Yokota N, Saito K, Sugai Y, Takano S. Management of refractory chylothorax in the neonatal intensive care unit: A 22-year experience. Pediatr Int 2022; 64:e15043. [PMID: 34706149 DOI: 10.1111/ped.15043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/01/2021] [Accepted: 10/25/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim was to assess the therapeutic strategy of patients with chylothorax in a neonatal intensive care unit. METHODS Twenty-eight infants with chylothorax were included in this study. Their clinical characteristics and outcomes were reviewed retrospectively. RESULTS The male-to-female ratio was 1:1. The mean gestational age and birthweight were 35.1 ± 3.5 weeks and 2,692 ± 791 g, respectively. Eighteen patients were diagnosed with congenital chylothorax; chylothorax occurred postoperatively in 10 patients. Chromosomal anomalies were diagnosed in 8 patients. Six patients received surgical therapy, such as pleurodesis, thoracic duct ligation, or lymphaticovenous anastomosis. Two patients required surgery due to resistance to pleurodesis. In surgically managed patients, the daily maximum amount of pleural effusion (mL)/bodyweight (kg) ratio was significantly larger than in non-surgically managed patients: 229.0 ± 180.5 versus 59.7 ± 49.2 mL/kg. In the receiver operating characteristic analysis of the daily maximum amount of pleural effusion/bodyweight ratio, the area under the curve was 0.889 when the cut-off value was 101 mL/kg, and the sensitivity was 0.8333 and the specificity was 0.8095 (P = 0.0059). CONCLUSIONS Pleurodesis using OK432 could become a surgical first-line therapy for chylothorax even for neonates. It was important to initiate pleurodesis for refractory chylothorax at an earlier stage. A daily chylous effusion/bodyweight ratio of >101 mL/kg was a good predictor and seemed to be a useful parameter for prompt surgical intervention.
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Affiliation(s)
- Yoshiaki Takahashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Yoshiaki Kinoshita
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Takashi Kobayashi
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Yuhki Arai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Toshiyuki Ohyama
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Naoki Yokota
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Koichi Saito
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Yu Sugai
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
| | - Shoichi Takano
- Department of Pediatric Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata City, Japan
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Nozaki T, Migita M, Niimi Y, Matsufuji H. PELVIS and CM-AVM syndromes: Vascular anomalies that require imaging studies. Pediatr Int 2021; 63:1546-1547. [PMID: 34894380 DOI: 10.1111/ped.14942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/09/2021] [Accepted: 07/27/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Taiki Nozaki
- Department of Radiology, St. Luke's International Hospital, Tokyo, Japan
| | - Misato Migita
- Department of Pediatric Surgery, St. Luke's International Hospital, Tokyo, Japan
| | - Yasunari Niimi
- Department of Neuroendovascular Therapy, St. Luke's International Hospital, Tokyo, Japan
| | - Hiroshi Matsufuji
- Department of Pediatric Surgery, St. Luke's International Hospital, Tokyo, Japan
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Abstract
The International Society for the Study of Vascular Anomalies classifies vascular anomalies into vascular tumors and vascular malformations. Vascular tumors are neoplasms of endothelial cells, among which infantile hemangiomas (IHs) are the most common, occurring in 5%-10% of infants. Glucose transporter-1 protein expression in IHs differs from that of other vascular tumors or vascular malformations. IHs are not present at birth but are usually diagnosed at 1 week to 1 month of age, rapidly proliferate between 1 and 3 months of age, mostly complete proliferation by 5 months of age, and then slowly involute to the adipose or fibrous tissue. Approximately 10% of IH cases require early treatment. The 2019 American Academy of Pediatrics clinical practice guideline for the management of IHs recommends that primary care clinicians frequently monitor infants with IHs, educate the parents about the clinical course, and refer infants with high-risk IH to IH specialists ideally at 1 month of age. High-risk IHs include those with life-threatening complications, functional impairment, ulceration, associated structural anomalies, or disfigurement. In Korea, IHs are usually treated by pediatric hematology-oncologists with the cooperation of pediatric cardiologists, radiologists, dermatologists, and plastic surgeons. Oral propranolol, a nonselective beta-adrenergic antagonist, is the first-line treatment for IHs at a dosage of 2-3 mg/kg/day divided into 2 daily doses maintained for at least 6 months and often continuing until 12 months of age. Topical timolol maleate solution, a topical nonselective beta-blocker, may be used for small superficial type IHs at a dosage of 1-2 drops of 0.5% gel-forming ophthalmic solution applied twice daily. Pulse-dye laser therapy or surgery is useful for the treatment of residual skin changes after IH involution.
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Affiliation(s)
- Hye Lim Jung
- Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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Akagi K, Matsutake T, Fukushima K, Mukae H, Kurohama H, Matsumoto H. A refractory pleural effusion caused by a pleural capillary hemangioma. Respir Med Case Rep 2021; 33:101384. [PMID: 33763325 PMCID: PMC7973380 DOI: 10.1016/j.rmcr.2021.101384] [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: 01/06/2021] [Revised: 02/14/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022] Open
Abstract
A 69-year-old man presented with a left pleural effusion. Even after repeated drainage, the pleural effusion had been increasing for more than two years. Thoracoscopy unexpectedly showed a pleural mass on the parietal pleura, and it was completely removed. The diagnosis was pleural capillary hemangioma, and the effusion has not recurred after the resection. Pleural hemangioma is one of the crucial differential diagnoses of refractory pleural effusion. Not a few cases are followed as non-specific pleuritis. Pleural hemangioma causes refractory but curable pleural effusion. If a pleural effusion remains over a year, thoracoscopy is recommended.
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Affiliation(s)
- Kazumasa Akagi
- Department of Respiratory Medicine, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Isahaya City, Nagasaki, 859-0497, Japan
| | - Toyoshi Matsutake
- Department of Respiratory Medicine, Kouseikai Hospital, Nagasaki City, Nagasaki, 852-8053, Japan
| | - Kiyoyasu Fukushima
- Department of Respiratory Medicine, Japanese Red Cross Nagasaki Genbaku Isahaya Hospital, Isahaya City, Nagasaki, 859-0497, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki City, Nagasaki, 852-8501, Japan
| | - Hirokazu Kurohama
- Department of Diagnostic Pathology, Isahaya General Hospital, Isahaya City, Nagasaki, 854-8501, Japan
| | - Hirofumi Matsumoto
- Department of Thoracic Surgery, Isahaya General Hospital, Isahaya City, Nagasaki, 854-8501, Japan
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