Hemangioma segmentario de la barba / Segmental Beard Hemangioma

Los hemangiomas infantiles son el resultado de la proliferación de células del endotelio vascular y representan los tumores benignos más frecuentes en la infancia, con una incidencia estimada del 4-10% en bebés caucásicos. Se clasifican según el número, la profundidad y la distribución. Dentro de esta última clasificación se encuentran aquellos denominados segmentarios, que se caracterizan por su distribución extensa en áreas de prolongaciones mesodérmicas embrionarias. Se comunica el caso de una paciente evaluada al mes y medio de vida, con un hemangioma extenso del área mandibular y cuello anterior (hemangioma segmentario de la barba). Se describe la importancia de los estudios complementarios para evaluar el compromiso de órganos subyacentes, para detectar síndromes asociados y definir el tratamiento sobre la base de estos resultados. (AU)

Infantile hemangiomas arise from the proliferation of vascular endothelial cells and represent the most common benign tumors in infancy, with an estimated incidence of 4-10% in Caucasian infants. They vary according to their number, depth, and distribution. Within the latter classification are the so-called segmental ones, which feature an extensive distribution in areas of embryonic mesodermal extensions. We report the case of a patient evaluated at one and a half months of life with an extensive hemangioma of the mandibular area and anterior neck (segmental hemangioma of the beard). We describe the importance of complementary studies for evaluating the involvement of underlying organs, detecting associated syndromes, and defining the treatment based on these findings. (AU)

A prospective randomized controlled study of different doses of oral propranolol in infantile hemangiomas / 中华整形外科杂志

Objective@#To study the efficacy of 1 mg·kg-1·d-1 and 2.0 mg·kg-1·d-1 of propranolol in the treatment of infantile hemangiomas, so as to provide an ideal dosage for clinical treatment.@*Methods@#From September 2015 to October 2016, there were 89 patients in accordance with the inclusion criteria of infantile hemangiomas. According to randomized and controlled principle, the patients were assigned to receive two propranolol regimens, Group A(n=45): propranolol at a dose of 1 mg·kg-1·d-1; Group B(n=44): propranolol at a dose of 2 mg·kg-1·d-1. 1 or 2 mg of propranolol base per kilogram per day, divided into two doses.The first dose was taken at 9, next at 15.The effective rate, cure rate and adverse effect rate were compared at the six months after treatment. The duration of the treatment was compared after 12 months′ treatment, and the recurrence rate was compared at the three months after being cured.The data were statistically processed with SPSS 22.0. The sample rate was compared with χ2 test, and the data were compared with t test. P<0.05 was statistically significant difference.@*Results@#Group A: Treatment for 6 months, 45 children were evaluated as follows: the effective rate was 91.1%(41/45), the cure rate was 60%(27/45). The incidence of adverse reactions was 13.3%(6/45). The cure rate of group A at 12 months was 86.7%(39/45). The duration of treatment was 7.6±2.7 months.The recurrence rate was 9.5%(4/42). Group B: Treatment for 6 months, 44 children were evaluated as follows: the effective rate was 90.9%(40/44), the cure rate was 72.7%(32/44). The incidence of adverse reactions was 15.9%(7/44). The cure rate of group B at 12 months was 88.6%(39/44). The duration of treatment was 6.2±1.9 months. The recurrence rate was 11.9%(5/42). The effective rate of the two groups at 6 months was not statistically significant(χ2=2.583, P=0.461). The cure rate of the two groups at 6 months was statistically significant(χ2=8.339, P=0.004). The incidence of adverse effects was not statistically significant(χ2=0.118, P=0.731). The cure rate of the two groups at 12 month was not statistically significant(χ2=0.080, P=0.778). The duration of treatment between the groups was statistically significant (t=0.290, P=0.009). The recurrence rate of the two groups after 3 months withdrawal was no statistical difference(χ2=0.124, P=0.724).@*Conclusions@#The propranolol doses at 1 mg·kg-1·d-1 and 2 mg·kg-1·d-1 in the treatment of infantile hemangiomas are safe and effective. The propranolol dose at 1 mg·kg-1·d-1 doesn′t decrease the effective and cure rate, not increase the recurrence rate in infantile hemangiomas. Low dose at 1 mg·kg-1·d-1 can be used as a common dose of propranolol in infantile hemangiomas.

Effect of topical propranolol gel on plasma renin, angiotensin II and vascular endothelial growth factor in superficial infantile hemangiomas / 华中科技大学学报（医学）（英德文版）

The effect of topical propranolol gel on the levels of plasma renin, angiotensin II (ATII) and vascular endothelial growth factor (VEGF) in superficial infantile hemangiomas (IHs) was investigated. Thirty-three consecutive children with superficial IHs were observed pre-treatment, 1 and 3 months after application of topical propranolol gel for the levels of plasma renin, ATII and VEGF in Department of General Surgery of Dongfang Hospital from February 2013 to February 2014. The plasma results of IHs were compared with those of 30 healthy infants of the same age from out-patient department. The clinical efficiency of topical propranolol gel at 1st, and 3rd month after application was 45%, and 82% respectively. The levels of plasma renin, ATII and VEGF in patients pre-treatment were higher than those in healthy infants (565.86 ± 49.66 vs. 18.19 ± 3.56, 3.20 ± 0.39 vs 0.30 ± 0.03, and 362.16 ± 27.29 vs. 85.63 ± 8.14, P < 0.05). The concentrations of VEGF and renin at 1st and 3rd month after treatment were decreased obviously as compared with those pre-treatment (271.51 ± 18.59 vs. 362.16 ± 27.29, and 405.18 ± 42.52 vs. 565.86 ± 49.66 P < 0.05; 240.80 ± 19.89 vs. 362.16 ± 27.29, and 325.90 ± 35.78 vs. 565.86 ± 49.66, P < 0.05, respectively), but the levels of plasma ATII declined slightly (2.96 ± 0.37 vs. 3.20 ± 0.39, and 2.47 ± 0.27 vs. 3.20 ± 0.39, P > 0.05). It was indicated that the increased renin, ATII and VEGF might play a role in the onset or development of IHs. Propranolol gel may suppress the proliferation of IHs by reducing VEGF.

Hemangiomas congénitos rápidamente involutivos: serie de 25 casos / Rapidly involuting congenital hemangiomas: twenty five case series

Los hemangiomas congénitos rápidamente involutivos son tumores vasculares muy poco frecuentes, que se caracterizan por estar completamente desarrollados al nacer (congénitos) y por tener una involución espontánea en un corto período (rápidamente involutivos). Describimos una serie de 25 casos de hemangiomas congénitos rápidamente involutivos, de los cuales 12 eran del sexo masculino y 13, femenino. Todos los pacientes eran nacidos a término, con peso adecuado para la edad gestacional. En 17, las lesiones fueron de pequeño tamaño y, en 8, de gran tamaño. Ningún paciente requirió tratamiento. En todos ellos, las lesiones mostraron una rápida involución inicial.

Rapidly involuting congenital hemangiomas are very rare vascular tumours, that are characterized for being completely developed at birth and for involuting in a short period of time after birth. We describe a case series of 25 patients with rapidly involuting congenital hemangiomas. Twelve patients were male and 13 female; they were all born at term. Lesions were small in 17 cases and big in 8. No patient needed active intervention and all lesions showed a rapid initial involution.

Puesta al día en hemangiomas de la infancia / Update in infantile haemangioma

Los hemangiomas de la infancia (HI) son los tumores de partes blandas más frecuentes de la infancia. Se presentan en un 5 por ciento- 10 por ciento de la población pediátrica. El comportamiento de estos tumores es especial, ya que, a diferencia de otras neoplasias benignas, los HI tienden a regresar e involucionar espontáneamente en un 90 por ciento. Algunos pacientes con HI pueden sufrir complicaciones tales como ulceración y hemorragia. Estas complicaciones han llevado a la búsqueda de alternativas terapéuticas, donde, por mucho tiempo fueron los esteroides la primera opción de tratamiento. Esto hasta el año 2008, cuando se descubre accidentalmente el propranolol administrado por vía oral, como alternativa terapéutica para los HI severos, convirtiéndose hasta el día de hoy, en el gold standard de tratamiento. Dado la diversidad en su presentación, y las diferentes alternativas de manejo existentes, es que esta revisión pretende abordar la patogenia, clínica y enfrentamiento de estos tumores de la infancia.

Hemangiomas of infancy (HI) are the most common soft tissue tumors of childhood. They occur in up to percent-10 percent of the pediatric population and they have a special behaviour because, unlike other benign neoplasms, HI tend to regress spontaneously in up to 90 percent of the cases. Complications such as ulceration and hemorrhage can occur. These complications have led to search for new therapeutic options. Steroids were the first choice of treatment for a long time, until 2008, when oral propranolol was accidentally discovered as a potential treatment for large HI4. Today, propranolol is the gold standard for treatment. Given their variable clinical presentation and different therapeutic options available nowadays, this paper to review the pathogenesis, clinical presentation and approach of these tumors of infancy.

Clinical research on the effects of propranolol on infantile hemangiomas / 重庆医学

Objective To study the efficacy and adverse reactions of the treatment on different types of infantile hemangiomas (IH) with different doses of propranolol .Methods One hundred and fifty cases of IH without contraindications were randomly treated with different doses of propranolol (low dose group:1 mg?kg -1 ?d-1 ;high dose group:2 mg?kg -1 ?d-1 ) under ECG monitoring inferior half an hour to breastfeeding taking ,and stay in hospital for observation for 6 to 24 hours after the treatment . The patients returned to the hospital for review every month(ECG and blood RT ;lung function in necessary) .Results The curative effect is better on strawberry IH than that on flat IH ,also better on deeply IH than that on superficial IH .The adverse reactions oc‐curred relatively slight in the low dose group and there was no significantly statistical differences on the treatment effects between the both groups(P>0 .05) .Conclusion It is safe and effective to treat IH with propranolol .

Research Progress in the Treatment of Infantile Hemangiomas by Propranolol / 中国药师

Objective:Infantile hemangiomas is the most common tumor in infants with congenital benign endothelial cell prolifera-tion. Propranolol is a non-selectiveβ-blocker commonly used in the treatment of arrhythmia, angina and hypertension, etc. Propranolol used in the treatment of hemangiomas was an accidental discovery, which creates a trend of research on the classic old drug at home and abroad. The efficacy of propranolol in the treatment of infantile hemangiomas has been affirmed in the clinical observation;howev-er, the safety and safe dosage need to be further evaluated by large sample control studies.

Effect of different concentrations of propranolol gel on infantile hemangiomas / 中华实用儿科临床杂志

Objective To evaluate the efficacy and safety of different concentrations of propranolol gel in treatment of infantile hemangiomas(IH).Methods Sixty-three consecutive infants with hemangiomas from Mar.2011to Sep.2012 in Department of General Surgery,Fuzhou General Hospital of Nanjing Military Command,were divided randomly into A,B,C groups and respectively treated with propranolol hydrochloride 1％ (20 g ∶ 200 mg,A group),2％ (20 g:400 mg,B group),3％ (20 g:600 mg,C group),evenly applied to the surface of the hemangiomas,3 times a day.Follow-up treatment was performed for 6 months.Details of adverse reactions,gender,age,tumor location,complications,and hemangioma size,texture,color and recurrence after stopping were recorded,and hospital review and efficacy evaluation were performed every month.Results After 6 months of treatment,A group had effective treatment in 11 patients(52.38％),ineffective treatment in 10 patients (47.62％),B group had effective treatment in 12 patients (57.14％),ineffective treatment in 9 patients (42.86％),and C group had effective treatment in 19 patients (90.48％),ineffective treatment in 2 patients(9.52％).After taking color Doppler ultrasound examination revealed IH thickness revealed significantly thinner.Conclusions External use of propranolol hydrochloride gel is an effective option for superficial hemangiomas,And 3％ concentration of propranolol gel is superior to the efficacy of the other 2 drugs.

The Efficacy and Adverse Effects of Propranolol in the Treatment of Infantile Hemangiomas / 대한피부과학회지

BACKGROUND: Recently, propranolol has been found to be an effective treatment agent for infantile hemangiomas. Several studies have documented the effectiveness of propranolol in involution of infantile hemangiomas. The known side effects of propranolol include bronchospasm, hypoglycemia, bradycardia, hypotension, hyperkalemia, cool extremities, sleep disturbance, etc. However, the exact prevalence of adverse effects of this drug in Korean infants is unclear. OBJECTIVE: The purpose of this study was to evaluate the efficacy and side effects of propranolol treatment in Korean patients with infantile hemangiomas. METHODS: A total of 29 patients diagnosed with infantile hemangioma were treated with propranolol ranging from 1.5 to 2.5 mg/kg/day given either 2 or 3 times per day. Echocardiography and vital signs, blood glucose levels, and serum electrolytes were checked before and after each additional increased dose thereafter, and also during or at the end of the treatment period. All patients with IH took photographs and their parents were asked questions regarding their side effects at intervals of two months. RESULTS: The mean age at treatment initiation was 3.9 months, and the average duration of treatment was 10.4 months. Most of the patients (82.98%) showed good response with a clearance of 75% or more. Three (10.34%) patients had sleep disturbance and one (3.45%) had hyperkalemia. No patient was reported to have severe side effects such as symptomatic hypoglycemia, bradycardia, and hypotension. CONCLUSION: Based on these results, propranolol therapy is a very safe and highly effective modality for the treatment of Korean infants with infantile hemangiomas.

Hemangiomas de la infancia, manejo actual / Hemangiomas of infancy, current management

Durante años se ha usado una nomenclatura imprecisa para designar a las “Anomalías Vasculares de la Infancia”. Esto ha contribuido a diagnósticos erróneos y como consecuencia, a tratamientos inadecuados. La clasificación actual las separa en dos grandes grupos: las malformaciones vasculares y un gran grupo de tumores vasculares, que incluyen principalmente a los clásicos hemangiomas de la infancia y a “nuevos tumores vasculares” que tienen una evolución distinta. Recientemente nuevos hallazgos asociados a las anomalías vasculares de la infancia ha obligado a establecer cambios en el diagnóstico y manejo de estas lesiones con un fuerte énfasis en el manejo multidisciplinario. En el presente artículo se analizan los hemangiomas de la infancia con sus características clínicas, asociaciones con otras patologías y evolución. Se plantean alternativas de estudio y tratamiento.

For years, a confusing nomenclature has been used in the classification of "Children's Vascular Anomalies." This has contributed to misdiagnosis and consequently inappropriate treatments. The current classification divides them in two groups: vascular malformations and a large group of vascular tumors, including mainly children's classic infantile hemangiomas and "new vascular tumors" that have a different behavior. In recent years new findings associated with vascular anomalies have led to changes in diagnosis and management, focusing in a personalized and multidisciplinary approach. This article discusses infantile hemangiomas in terms of their clinical picture, associated diseases and evolution. Study and treatment modalities are analyzed.

Propranolol en el tratamiento de los hemangiomas de la infancia / Propranolol in the treatment of infantile hemangioma

Infantile Hemangiomas (IH) are common vascular tumors in children. Only 10-15 percent) should be treated by any vital, functional or aesthetic complications. Oral corticosteroids are the treatment of choice. However, in the last two years an excellent response to treatment of hemangiomas with oral Propranolol has been reported. Objective: evaluate this new therapy in a limited number of chilean patients with IH with an indication of systemic treatment and present this experience. Patients and Methods: We present 30 cases of IH treated at our institution with oral Propranolol, using a dose of 2 mg/kg/day divided in 2 daily doses. Results: 11 percent of patients were female, 40 percent hemangiomas had segmental distribution, 90 percent were solitary, 61 percent were located in the head and neck and 23 percent were ulcerated. The treatment started at an average of 119 days of life and lasted for an average of 7 months. In all our patients the use of Propranolol accelerated the onset of involution of the hemangiomas and decreased color, brightness and growth too. 43 percent of the patients had irritability and sleep disorders. No significant adverse effects were reported in any of our patients. Conclusión: Propranolol treatment was highly effective and safe in our series of patients and we propose, taking into account published reports based on this data, it should become the treatment of choice for IH.

Los Hemangiomas de la Infancia (HI) son tumores vasculares frecuentes en la edad pediátrica. Sólo un 10-15 por cientoo debe ser tratado por eventuales consecuencias vitales, funcionales o estéticas. Los corticoides orales son el tratamiento de elección actual. Sin embargo, en los últimos 2 años se ha reportado la excelente respuesta de los hemangiomas al tratamiento con Propranolol oral. Objetivo: Evaluar esta nueva terapéutica en un número limitado de pacientes Chilenos con hemangiomas de la infancia con indicación de tratamiento sistémico y presentar esta experiencia. Pacientes y Método: Presentamos 30 casos de HI tratados en nuestra institución con Propranolol oral, usando una dosis de 2 mg/kg/día en 2 tomas diarias. Resultados: Un 77 por ciento de los pacientes eran de sexo femenino. El 40 por ciento de los hemangiomas eran segmentarios, 90 por ciento eran únicos, 67 por ciento estaban ubicados en cabeza y cuello y 23 por ciento estaban ulcerados. El tratamiento se inició en promedio a los 119 días de vida y duró en promedio 7 meses. En la totalidad de nuestros pacientes el uso de Propranolol aceleró el inicio de la involución del hemangioma y disminuyó el color, brillo y crecimiento. El 43 por ciento de los pacientes presentó irritabilidad y trastornos del sueño. No se presentaron efectos adversos importantes en ninguno de nuestros pacientes. Conclusión: El tratamiento con Propranolol fue altamente efectivo y seguro en nuestra serie de pacientes y proponemos, tomando en cuenta los reportes publicados al respecto, que debiera ser el tratamiento de elección para los hemangiomas de la infancia.

Eficacia y seguridad de la criocirugia en el tratamiento de hemangiomas infantiles de "alto riesgo" en lactantes menores tras sedación con hidrato de cloral 10% solución / Efficacy and security of cryosurgery in the treatment of "high risk" infantile hemangiomas after sedation with chloral hydrate 10% solution

Introducción: Los hemangiomas infantiles son las neoplasias benignas más frecuentes en la infancia. De 10% a 20% requieren tratamiento activo debido a interferencia funcional y/o desfiguración significativa. La criocirugía es hoy por hoy una excelente alternativa para los hemangiomas infantiles de "alto riesgo", y es considerada por muchos autores el tratamiento de elección. Afortunadamente, existen guías específicas para sedación pediátrica, que establecen estándares de sedación que hacen factible una intervención en lactantes menores. Objetivos: En este trabajo, se determinó la eficacia y la seguridad de la criocirugía en el tratamiento de hemangiomas infantiles de "alto riesgo" en lactantes menores tras sedación con hidrato de cloral. Material y Método: Este estudio, prospectivo y experimental incluyó a 3 pacientes de una población de 12; los cuales presentaron hemangioma infantil solitario de "alto riesgo" de localización facial. Se consideró eficaz la criocirugía cuando el hemangioma infantil disminuyó su tamaño (volumen) en más del 75% y la lesión residual no interfirió más con la función de la estructura vital próxima ni resultó desfigurante; se consideró seguro el procedimiento cuando sólo se presentaron eventos adversos leves, considerados así aquéllos que no comprometieron la vida del paciente ni demandaron atención por otra especialidad médica. Asimismo se midió la satisfacción de los padres con el resultado postcriocirugía, ésta se calificó como no satisfecho, poco satisfecho, medianamente satisfecho y muy satisfecho. Resultados: La edad promedio fue de 5 meses, el sexo predominante fue el femenino (67%). Los hemangiomas infantiles estuvieron presentes al nacimiento en 100% de casos; dos fueron de tipo mixto. Los lactantes mostraron una mejoría significativa post criocirugía en el tamaño de sus hemangiomas...

SUMMARY: Infantile hemangiomas are the most common benign tumors of infancy. Ten to 20% require active treatment due to functional interference and/or significant disfiguration. Nowadays, cryosurgery is an excellent alternative for "high risk" infantile hemangiomas, and it is considered by many authors the treatment of choice. Fortunately, there are specific guides for pediatric sedation which determine standards of sedation in infants. Objectives: To determine the efficacy and security of cryosurgery in the treatment of high risk infantile hemangiomas after sedation with chloral hydrate. Materials and Methods: This prospective and experimental study included 3 patients of a total population of 12, who presented a solitary facial high risk infantile hemangioma. The cryosurgery was considered effective when infantile hemangiomas decreased its size (volume) in more than 75% and the residual lesion didn't interfere with the function of vital structures nor resulted desfigurant; the procedure was secure when there were only mild adverse events that did not threat the life of infants nor needed medical attention by another medical department. Also, satisfaction of parents was evaluated as absent, little, moderate or big. Results: Medium age was 5 months old, the predominant sex was female (67%). Infantile hemangiomas were congenital in 100%; two were mixed (superficial and deep). The infants showed a significant improvement after cryosurgery, the reduction of size was more than 75% in all of them (between 87,5% - 100%). In all of them infantile hemangiomas wasn't anymore of "high risk", so efficacy was 100%. In none of 3 patients there were severe adverse events; they were mild in 100% of cases, showing security of cryosurgery after sedation.