Regression of a venous malformation during angiotensin-converting enzyme inhibitor treatment for hypertension.

Recent studies have reported that components of the renin-angiotensin system (RAS) are expressed in venous malformations by embryonic stem cell-like subpopulations. It has been hypothesized that these cells are sustained by the RAS and, therefore, could be a novel therapeutic target, using medications such as angiotensin-converting enzyme inhibitors. A young man with a symptomatic intramuscular venous malformation of the upper limb, and hypertension was treated with an angiotensin-converting enzyme inhibitor. After 8 months of treatment, we registered a considerable volume reduction of the venous malformation and a reduction in pain. Our observation warrants further research on the link between the RAS and venous malformations.

Facial paralysis reconstruction. / Rekonstruksjon ved facialisparese.

Facial paralysis can be a stigmatising condition, and in many cases it may affect the closing function of the eye, facial expression, the nasal airway passage, language and nutritional intake to varying degrees. For the majority of patients, treatment methods exist that may improve function and quality of life. This article aims to provide a review of relevant surgical reconstruction methods and treatment options for patients with facial paralysis.

[A six-year-old girl with dyspnea following tracheocutaneous repair]. / En seks år gammel jente med dyspné etter operasjon på halsen.

BACKGROUND: A few patients develop prominent scars combined with persistent fistula after the removal of a long-standing tracheostomy tube. The procedure needed to correct the condition is generally considered minor surgery, normally without any significant complications. We describe, however, a patient who developed a particularly complicated postoperative course. MATERIAL AND METHODS: The patient was a six-year-old girl who underwent surgery because of significant scar formation and a persistent small tracheocutaneous fistula eight months after removal of the tube. Postoperatively she had a cough attack and developed spontaneously subcutaneous emphysema, pneumomediastinum and bilateral pneumothorax. She required intensive care, thoracic drainage and antibiotic prophylaxis. Over the next days her situation improved and she was discharged on the sixth day. INTERPRETATION: Operative treatment of scarring after tracheostomy in which the surgeon also confronts a tracheocutaneous fistula or an opening into the tracheal lumen requires postoperative observation so that any severe complications can be managed.