Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies.

BACKGROUND: The aetiology and exact incidence of infantile haemangiomas (IHs) are unknown. Prior studies have noted immunohistochemical and biological characteristics shared by IHs and placental tissue. OBJECTIVES: We investigated the possible association between placental anomalies and the development of IHs, as well as the demographic characteristics and other risk factors for IHs. PATIENTS AND METHODS: Pregnant women (n = 578) were prospectively enrolled and their offspring followed for 9 months. Placental evaluations were performed and demographic data collected on all mother-infant pairs. RESULTS: We evaluated 594 infants: 34 haemangiomas [either IH or congenital (CH)] were identified in 29 infants, yielding an incidence of 4·5% for IH (27 infants) and 0·3% for CH (two infants). Placental anomalies were noted in almost 35% of haemangioma-related pregnancies, approximately twice the incidence noted in pregnancies with unaffected infants (P = 0·025). Other risk factors for IH included prematurity (P = 0·016) and low birth weight (P = 0·028). All IHs were present by 3 months of age, and cessation of growth had occurred in all by 9 months of age. Most occurred on the trunk. Of note, 20% of identified IHs were abortive or telangiectatic in nature, small focal lesions that did not proliferate beyond 3 months of age. Only one IH required intervention. CONCLUSIONS: This is the first prospective American study to document the incidence of IHs in infants followed from birth to early infancy. The association with placental anomalies was statistically significant. The overall incidence mirrors prior estimates, but the need for treatment was lower than previously reported.

[Magerl's subcapital osteotomy in the treatment of hallux valgus]. / Die subkapitale Osteotomie nach Magerl zur Behandlung des Hallux valgus.

The distal metatarsal osteotomy according to Magerl allows correction of a hallux valgus deformity by lateral and plantar displacement as well as by pronation and variasation. The length of the first metatarsal can be adjusted by the depth of the cut at the resection or by a slightly oblique osteotomy. If necessary, soft tissue release and/or a osteotomy of the first proximal phalanx can be done to relocate the sesamoids under the head of the first metatarsal. A review of 118 foot operations in 75 patients demonstrated a very good or good result in about 75%. Radiological examination showed sufficient lateralisation of the metatarsal head. Evaluating the length of the first metatarsal and the amount of variation, the results were less satisfying. The metatarsophalangeal angles could be corrected by 14 degrees and the intermetatarsal angles by 7 degrees on average. The sophisticated operative procedure limits the use of this technique as a standard procedure.

[Histologically controlled ultrasound findings in the transplanted kidney]. / Histologisch kontrollierte Ultraschallbefunde der Transplantatniere.

72 percutaneous diagnostic renal biopsies were performed on 53 recipients of renal allografts from cadavers with deterioration of the graft function. 40 patients received cyclosporine (CsA) and 13 Azathioprin with steroids (conventional immunosuppression). All biopsies were carried out under sonographic control. The echo patterns of the grafts were evaluated prior to the procedure. In 63 cases (87.5%) enough material could be obtained for histologic examination. The sonographic diagnoses were compared with histological results. In the sonographic detection of allograft rejection sensitivity was 80.85%, and specificity 56.25%. Grafts with symptoms of CsA-nephrotoxicity did not seem to produce a characteristic sonographic echo pattern. Macrohaematuria occurred after 9 biopsies (12.5%). A graft loss was not observed; in one case a temporary percutaneous nephrostomy had to be carried out. We conclude that sonography alone is not sufficient to diagnose parenchymatous changes in the graft. To obtain satisfactory long-term results biopsy is necessary. Under sonographic guidance the risk of percutaneous biopsy is minimal.