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This article mainly introduced the clinical features of a rare case of CLOVES syndrome of Interventional Therapy and Vascular Anomalies Department, Guangzhou Women and Children's Medical Center. This patient received sclerotherapy and laser treatment. The condition was well controlled and further observation was needed for the long-term prognosis.
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Objective To observe and evaluate the short-term therapeutic effect of intravitreal injection with topotecan for refractory vitreous seeding from retinoblastoma (RB).Methods Eleven patients (11 eyes) of RB with refractory vitreous seeding (received intravenous chemotherapy,intra-arterial chemotherapy,intravitreal melphalan,laser,cryotherapy and subsequently developed refractory viable vitreous seeds) were enrolled in this study.There were 6 males (6 eyes) and 5 females (5 eyes).The aged from 9 to 44 months,with the mean age of 26 months.According to International Intraocular Retinoblastoma Classification,11 eyes were initially classified as group E (3 eyes),D (6 eyes),B (1 eye) or A (1 eye).All patients were received intravitreal injection with topotecan.A total of 32 intravitreal topotecan injections were performed with a mean of 2.9 injections (median 3 injections;range 2-4 injections).The mean follow-up was 10 months.The safety and effectiveness of intravitreal injection with topotecan for refractory vitreous seeding from RB were observed.Results Complete regression of vitreous seeds was achieved in 11 of 11 eyes (100％),including complete disappearance in 9 eyes and fibrosis in 2 eyes.None of the patients needed enucleation and occured ocular or systemic complications in the follow-up period.Conclusion Intravitreal injection with topotecan for refractory vitreous seeds from RB is effective and safe.
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Objective To evaluate the safety and efficacy of percutaneous ethanol embolization (PEE) in treating arteriovenous malformation (AVM) of foot in children.Methods The clinical data of 11 sick children with arteriovenous malformation of foot,who were treated with PEE in authors' department during the period from January 2007 to January 2016,were retrospectively analyzed.The clinical symptoms,the type of tumor nidus,the therapeutic effect and the postoperative complications were analyzed.Results The 11 sick children included 6 boys and 5 girls,with a mean age of 9 years.Foot mass was seen in 8 children,pain in 8 children,claudication in 3 children and ischemic skin ulcer in one child.Cho Ⅲ b type was observed in 10 children and Cho Ⅱ type in one child;Yakes Ⅳ type was found in 10 children and Ⅱa type in one child.A total of 30 PEE procedures were performed,with an average of 2.7 times per case.The children were followed up for 6-48 months,with a mean of 24 months.Evaluation of curative effect showed that complete cure was achieved in 7 children and partial remission in 3 children,the effective rate was 90.9％.Treatment failure (showing no remission) was seen in one child,and no deterioration of disease was observed.Complications included transient blood oxygen decrease in operation (n=1),toe ischemia (n=1),postoperativeblister (n=1) and local skin ulcer (n=l),no severe complications were observed.Conclusion PEE is a safe and effective treatment for arteriovenous malformation of foot in children.
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Objective To investigate the efficacy and safety of transcather arterial embolization (TAE) plus sirolimus for the treatment of refractory Kasabach-Merritt syndrome (KMS) in infants. Methods Clinical data of twelve infants with refractory KMS treated between December 2015 and October 2016 in a single hospital were retrospectively analyzed. TAE were performed in all patients after failed traditional multiple therapies, followed by oral sirolimus administration. The dose of sirolimus was modulated according to the level of sirolimus, the count of platelet, the shrinkage of the lesion and the side effects, which were monitored regularly during the study. Results All 12 patients were treated with TAE plus sirolimus therapies successfully. The platelet count for all patients increased to≥100×109/L for the first time at (7±5) days. Stabilization of platelet level was obtained in (15±7) days averagely. Before the treatment, two infants had a normal fibrinogen level and the fibrinogen level in the other 10 infants was found to be increased to≥2.0 g/L at (9 ± 4)days for the first time and was then stabilized at levels>2.0 g/L at (19 ± 7)days after treatment. One patient showed skin fester (GradeⅡ), one patient had a fever with acute pulmonary infection (Grade Ⅲ) and both patients improved well after symptomatic treatment. There were no serious complications in the other ten patients. Conclusions TAE plus sirolimus can rapidly improve levels of platelets and fibrinogen, and it is a safe, useful and effective method for treatment of refractory KMS in infants.
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Objective To investigate the efficacy and safety of transcather arterial embolization (TAE) plus sirolimus for the treatment of refractory Kasabach-Merritt syndrome (KMS) in infants. Methods Clinical data of twelve infants with refractory KMS treated between December 2015 and October 2016 in a single hospital were retrospectively analyzed. TAE were performed in all patients after failed traditional multiple therapies, followed by oral sirolimus administration. The dose of sirolimus was modulated according to the level of sirolimus, the count of platelet, the shrinkage of the lesion and the side effects, which were monitored regularly during the study. Results All 12 patients were treated with TAE plus sirolimus therapies successfully. The platelet count for all patients increased to≥100×109/L for the first time at (7±5) days. Stabilization of platelet level was obtained in (15±7) days averagely. Before the treatment, two infants had a normal fibrinogen level and the fibrinogen level in the other 10 infants was found to be increased to≥2.0 g/L at (9 ± 4)days for the first time and was then stabilized at levels>2.0 g/L at (19 ± 7)days after treatment. One patient showed skin fester (GradeⅡ), one patient had a fever with acute pulmonary infection (Grade Ⅲ) and both patients improved well after symptomatic treatment. There were no serious complications in the other ten patients. Conclusions TAE plus sirolimus can rapidly improve levels of platelets and fibrinogen, and it is a safe, useful and effective method for treatment of refractory KMS in infants.
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Objective To analyze the angiographic characteristics of Kasabach-Merritt syndrome (KMS) and study the value of transcatheter arterial embolization (TAE) in KMS therapy. Methods The clinical data of 36 infants with KMS treated between June 2010 and June 2016 in our hospital were reviewed retrospectively. All infants performed angiography and TAE therapy. These angiographic characteristics were analyzed by comparing with infantile hemangioma(IH).The times of TAE and the level of platelet after TAE therapy were observed. Results The angiographic characteristics of KMS were as follows: The capillary blush of KMS were ill defined with no-uniform distribution. There were a lot of very fine feeding arteries. The diameter of feeding artery was disproportionate to the volume of tumor blush because the feeding arteries were too small or fine. Normal artery was usually embedded in tumor blush. However, the angiographic characteristics of IH were different as follows:the capillary blush of IH were well defined with uniform distribution.There were about 1-4 feeding arteries.The diameter of feeding artery was proportional to the volume of tumor blush. Normal artery was not embedded in tumor blush. Tumor blush was usually located beside the normal artery. In 36 patients, 107 embolization treatments were performed. The platelet declined for 11 times and increased for 96 times after TAE therapy. The platelet count for these 96 cases increased to ≥100×109/L at(7.1 ± 2.4)days following therapy. However, the platelet level fluctuated thereafter and the average relapse time was(45.9 ± 21.8)days. All cases were followed-up ranging from 6 months to 2 years and finally received other therapies.Eight cases were cured and the other 28 cases were improved. Conclusions The angiographic characteristics of KMS are different from common infantile hemangioma. It is difficult to embolize the feeding arteries of KMS because there are a lot of very fine feeding arteries.TAE may rapidly improve the level of platelets while the long term effect was poor.It might be better to combine TAE with other medical therapies to treat KMS.
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BACKGROUND:The type of simply youth compressibility fracture of thoracic and lumbar spine with posterior vertebral injury nailing reset scheme can effectively reset with mechanics from the rear, but due to bone characteristics of the youth, the rear force cannot effectively open anterior and middle columns. To improve the effect of rear reset during the operation becomes the focus of clinical attentionand difficult issues. OBJECTIVE:To retrospectively analyze reset reconstruction effects of posterior screw rod fixation for youth thoracolumbar simple flexion compression fracture. METHODS:Patients with youth thoracolumbar simple flexion compression fracture were treated with posterior screw rod fixation from June 2014 to June 2015. Perioperative indicators (operation time, blood loss, average length of stay and complication rate) were recorded. Patients were folowed up. Imaging indexes (anterior height of vertebral compression, Cobb angle of the injured vertebra) and subjective effect index (low back pain visual analog scale and the Oswestry Disability Index) were observed. RESULTS AND CONCLUSION:(1) Imaging index: Anterior height of vertebral compression and Cobb angle of the injured vertebra were significantly improved after treatment (P 0.05). (2) Subjective effect index: low back pain visual analog scaleand the Oswestry Disability Index were significantly improved after treatment (P 0.05). (3) No nerve injury complications appeared in al patients, without leakageof cerebrospinal fluid. (4) Results indicated that extended posterior screw rod fixation for youth thoracolumbar simple flexion compression fracture can obtain effective reduction due to special bone characteristics of the youth, improve reduction efficiency, do not increase patient’s trauma and the effects are affirmative.
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Objective To evaluate the efficacy and safety of interventional sclerotherapy for intraorbital venous malformation in children. Methods A retrospective analysis of 12 cases with intraorbital venous malformation from March 2007 to July 2013 in our department was made. Twelve lesions including 7 in left eyes and 5 in right eyes were evaluated. Three patients had surgical resection before interventional treatment. Sclerosing agent such as sclerosant foam or pingyangmycin was injected into the lesions guided by DSA. Interventional sclerotherapy was performed once every month until no blood return was observed. Then MRI was used to detect the lesions 1 month after operation. If there were residual lesions in MRI images, then repeat treatment was performed. Postoperative observation included patients' general situation and adverse reactions of eye after each treatment. Results Interventional sclerotherapy were performed to all patients for a total of 42 times (mean time 3.5 ± 1.0 per patient). After a follow?up of 24months, 7 cases were cured, 3 cases improved significantly and 2 cases with partial remission. Postoperative adverse reactions: transient exophthalmos in 39 case?times , peri?orbital and maxillofacial tissue swelling in 32 case?times. No severe complications were observed. Conclusion Interventional sclerotherapy is an easy, safe and effective method for treatment of intraorbital venous malformation.
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ObjectiveTo evaluate and compare the curative effect and the safety of sclerotherapy of venous malformation in children using absolute ethanol and pingyangmycin.MethodsEighty children with venous malformation were treated by sclerotherapy with absolute ethanol or pingyangmycin under general anesthesia during February of 2009 to May of 2011. Diagnostic criteria included the presence of a bluecolored lesion at birth,with gradual increase in its size associated with a positive postural test.MRI showed characteristic imaging features.Eighty patients were divided into two groups by randomization.Forty patients were treated with absolute ethanol,and the remaining 40 patients with pingyangmycin. The therapeutic effects and side effects were observed and recorded during a follow-up period of 6 to 24 months ( average 15 months).Treatment results weredividedinto four categories: cure, basiccure, effective, and ineffective,and the former three categories were considered effective in treatment.Chi-square test was used to compare the rate of effective treatment and rate of complications in these two groups.ResultsThe effective patients treated with absolute ethanol was 38 (95.0％,38/40),and the effective patients with pingyangmycin was 26(65.0％,26/40),x2 test ( x2 =11.25,P ＜ 0.01 ) difference was statistically significant.Eight patients developed skin necrosis; 4 patients serious local swelling,2 patients muscle fibrosis,1 patient cerebral embolism in the absolute alcohol group.Two patients developed postoperative fever and vomiting and 2 skin necrosis in the pingyangmycin group,the difference was statistically significant (x2 =12.29,P ＜0.01 ). ConclusionsSclerotherapyiseffectiveforthetreatmentofvenousmalformationsin children.Absolute ethanol is more effective,but associated with more complications,such as skin necrosis or as serious as cerebral embolism,than pingyangmycin.
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Objective To explore the effect and safty of interventional embolization of congenital arteriovenous fistula (CAVF) in the common femoral profounda artery in children.Methods Eight children (aged 6 to 14 years ;6 males and 2 females) with CAVF underwent interventional embolization From January 2006 and December 2010.Color Doppler sonography and DSA were performed on all patients.Arterial duplex imaging revealed the arteriovenous fistula in the common femoral profounda artery and DSA further confirmed the presence of an AVF over the common femoral profounda artery via the other vein.All children were treated with interventional embolization therapy by the injection ofcoils or ethanol through a microcather.It was necessary to performed repeated interventional embolization if the lesion was not obliterated in 4 weeks.All patients were followed-up from 6 months to 2 years and the clinical symptoms were observed.Results Arteriograpy can clearly demonstrate the femoral profounda artery and its branches as well as the fistula.Ten interventional embolization procedures were performed.Forty seven coils were deployedduring the procedure and seven ethanol embolization procedures were performed.Post-procedural angiography revealed complete occlusion in 8 patients.No major complications such as ectopic coil embolization,tissue necrosis,peripheral nerve palsy or cardio-pulmonary collapse were found.The abnormal AVFs were embolized completely in 7 cases after only one therapy and there was no recurrent disease in the 6 months to 2 years follow-up.Some tiny AVFs were still found in another case which underwent three additional treatments.However,the clinical symptoms were under control.Conclusion Interventional embolization is a safe and effective therapeutic method for CAVF of the common femoral profounda artery in children and it might become the primary treatment option.
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Objective To explore the clinical efficacy of interventional therapy for transplant renal artery stenosis (TRAS) after allograft renal transplantation.Methods Twenty-two patients with TRAS were treated with interventional therapy,including 10 patients (balloon group) underwent percutaneous transluminal angioplasty (PTA) and 12 patients (stent group) underwent stent implantation.The blood pressure,renal function and quality of life were recorded before and after interventional therapy within two years.Besides,two groups were compared with another group of 6 patients (medicine group) receiving medical treatment only.Results The technical success rate was 90.00% for PTA and 100%for stent implantation.The interventional treatment of TRAS with PTA or stent implantation was associated with significant improvement in blood pressure and renal function,while the conservatively medical treatment of TRAS was inefficient.There was no statistical difference in the short-term improvement of blood pressure or renal function between balloon group and stent group.Six to twenty-four-month follow-up indicated that there were 2 patients with restenosis (2/12,1 6.67%) in stent group.The total restenosis rate for PTA was 40.00%.Eleven patients in stent group achieved normal daily activities and works,except one was treated ineffectively with an uncertain cause.Conclusion Stent implantation for TRAS,especially for TRAS of type Ⅰ and Ⅱ,can be used as the primary therapy.