Clinical efficacy of propranolol in the treatment of hemangioma and changes in serum VEGF, bFGF and MMP-9.

The aim of this study was to observe the clinical efficacy and safety of propranolol in the treatment of hemangioma, and to reveal its possible mechanism. A total of 129 cases of proliferative hemangioma were divided into two groups: i) Treatment (n=97), in which the patients received oral propranolol therapy and ii) observation (n=32), in which the patients underwent clinical observation. The changes in the hemangiomas were noted and compared between the two groups. In addition, the heart rate, blood glucose levels, liver, kidney and thyroid function of the patients in the treatment group were monitored prior to and following treatment; the ELISA method was used for the measurement of the patients' serum concentrations of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and matrix metalloproteinase-9 (MMP-9) at the same time-points. A significant difference in curative effect was found between the treatment and observation group. The concentration of free thyroxine and sensitive thyroid-stimulating hormone and the heart rate of the treatment group exhibited significant changes prior to and following medication, but no statistical significance was found in the changes in blood glucose, liver and kidney function and free triiodothyronine concentration. Furthermore, the serum concentrations of VEGF, bFGF and MMP-9 in the treatment group 8 weeks after medication were decreased significantly compared with those before treatment. In conclusion, oral propranolol has a good curative effect in the treatment of proliferative hemangioma, with few side effects and a high level of safety. The mechanism underlying the effects of propranolol may be associated with the downregulation of VEGF, bFGF and MMP-9 expression.

[Clinical application of autologous buccal micro-mucosa graft in vaginal reconstruction].

UNLABELLED: OBJECTIVE To investigate the effect of vaginal reconstruction with autologous buccal micro-mucosa graft. METHODS: From March 2007 and April 2008, 10 patients with absence of vagina were treated, aged 18-31 years (mean 26 years). Nine of them were congenital absence of vagina, and the remaining one was vaginal stenosis after vaginal reconstruction. They all exhibited normal secondary sexual characteristics, normal hormonal levels and 46, XX karyotype. Their abdominal ultrasonography revealed the normal ovaries and tubes but absence of the uterus or small rudimentary horns. However the one with vaginal stenosis had normal uterus. The buccal mucosa graft was minced into 0.5 mm in size and was transplanted to the cavity which was dissected between the bladder and the rectum. RESULTS: The operation was performed successfully in all cases. The operative time was about 1-2 hours and operative blood loss was 80-100 mL. Postoperative complication occurred in only one case for vaginal bleeding. The patient recovered and the wound healed well after immediate management. The others healed primarily without any complications. All cases were followed up for 4-16 months. The depth of neovagina which was formed was 6-10 cm and the width was about two fingers. The lining was pink-colored and smooth, and was confirmed as nonkeratinizing squamous stratified mucosa by histopathological examination. The donor sites healed uneventfully with no change in mouth opening. The perineal area was not disturbed. Four patients were married and satisfied with their sexual life without pain and bleeding. CONCLUSION: Vaginal reconstruction with autologous buccal micro-mucosa graft is an easy, minimally invasive and useful method.

[Repair of hypospadias using scrotal septum vascular pedicle flap with two wing-like split-thickness skin graft].

OBJECTIVE: To investigate the effect of scrotal septum vascular pedicle flap with two wing-like split-thickness skin graft in reconstructing urethra in patients with hypospadias and in reducing the complications. METHODS: From January 2007 to March 2008, 30 cases of hypospadias were treated, with a median age of 10 years (2-20 years). There were 13 cases of proximal shaft type, 12 cases of penoscrotal type and 5 cases of scrotal type. There were 8 cases with operation history. The flap size ranged from 4.0 cm x 0.8 cm to 9.0 cm x 1.0 cm and 5 mm with two wing-like split-thickness skin graft. When the downward curvature corrected, length of the flap could be determined by the length of the urethra that needed to be reconstructed. RESULTS: All flaps survived. The incision healed by first intention in all patients except one whose incision healed after change dressing because of frequent erection. Incision at donor site healed well. Eighteen patients were followed up for 6-12 months, including 8 with second operation history. The reconstructed urethras were unobstructed and no urethrostenosis or urinary fistula happened. CONCLUSION: This is an improved technique of the scrotal septum flap in urethra reconstruction. It takes advantages of both flap and split-thickness skin graft in reconstructing urethra and avoids the disadvantages of a single tissue. It is a good choice for treating hypospadias whose urinary meatus locates neighborly to penoscrotal junctional zone.

[The reconstruction of funnel chest deformity with the reversed transplantation of sternum-costicartilage flap carried by the abdominal rectus pedicle].

OBJECTIVE: To investigate the reconstructive operative procedures of funnel chest with "sternum-costicartilage" flap carried by the abdominal rectus pedicle. METHODS: (1) In accordance with the lesioned area of funnel-like depressed deformity of anterior thoracic wall, a perpendicular median incision was designed and made; (2) The "sternum-costicartilage" flap carrying the abdominal rectus pedicle was used and reversed and transplanted to reconstruct severe funnel chest deformity. RESULTS: The procedure was used in 7 cases from 1999 to 2005. The results of surgery were satisfactory. There were no recurrence after operation. CONCLUSIONS: The procedure reported here is rather safe, solid and sound with good therapeutic results, and is of great value in clinical practice.