Experience of Two Different Techniques of Medial Epicanthoplasty with Four-Point Homologous Design: A Cohort Study.

BACKGROUND: Various methods have been introduced to eliminate the epicanthus; however, there are no clear guidelines to determine the optimal technique for epicanthus. We aimed to investigate the clinical effect of modified Z-plasty and modified Y-V flap on epicanthus and report our experience. METHODS: Medical records, including photographic information and scar score, of 81 eyes of 43 patients with congenital epicanthus were collected. All patients underwent epicanthus correction surgery by the modified Z-plasty or modified Y-V flap methods with a four-point design from January 2018 to December 2019 in Shanghai Ninth People's hospital and completed a follow-up of at least 6 months. The cosmetic outcome was evaluated in terms of by photographic evaluation and scar score, and the structural outcome was assessed by intercanthal distance (ICD) and palpebral fissure length, inner canthal angle, the canthal tilt angle. The results of two surgical techniques were compared and analyzed. RESULTS: The cosmetic outcome of both group is good in both groups. ICD is smaller and inner canthal angle is larger in modified Z-plasty group, compared to modified Y-V flap group, respectively (P < 0.05). Patients with severe epicanthus in the modified Z-plasty group showed greater improvement in structural outcomes than in the modified Y-V flap group (P < 0.05), while those with mild epicanthus in the modified Y-V flap group showed more improvement in ICD than those in the modified Z-plasty group (P < 0.05). By 6 months, scarring in the modified Z-plasty group was more hypertrophic and obvious compared to the modified Y-V flap group (P < 0.05). CONCLUSION: Modified Y-V flap technique caused less scarring. Conversely, the modified Z-plasty technique was more efficient in shortening the ICD and increasing inner canthal angle. While modified Z-plasty reconstruction is more suitable for patients with severe epicanthus, the modified Y-V flap is more suitable for patients with mild epicanthus. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

[Oral propranolol in the management of periorbital proliferating phase infantile hemangioma].

OBJECTIVE: To observe the efficacy and safety of oral propranolol in the treatment of periorbital proliferating phase infantile hemangioma. METHODS: A retrospective review of patient medical records was performed. 12 patients (9 female, 3 male; 1.5-8.5 months, average 3.3 months) with periorbital proliferating phase infantile hemangioma underwent oral propranolol therapy. The dosage was slowly increased to 2 mg/kg daily in divided doses for a mean duration of 16 weeks (range 4 weeks-41 weeks). Therapeutic outcomes and safety were established by evaluating colour, size of lesion, duration of treatment and side-effects of treatment before and after treatment. RESULTS: Of these, 9 had a signification reduction in colour and size of the lesions, 2 had no further growth. 1 is stopped therapy due to hypotension after drug administration. 11 other patients, although mild adverse effects were noted, no symptoms were severe enough to discontinue treatment. CONCLUSIONS: Propranolol appears to be a safe and effective treatment in the management of periorbital proliferating phase infantile hemangioma.

[The change of serum vascular endothelial growth factor and matrix metalloproteinases-9 in proliferative hemangioma treated with propranolol].

OBJECTIVE: To study the level of serum vascular endothelial growth factor, matrix metalloproteinases-9 in the proliferative hemangioma before and after propranolol treatment. METHODS: The serum VEGF, MMP-9 was detected with ELISA assay before treatment and after 4 weeks and 8 weeks of propranolol treatment. The relationship between the serum VEGF, MMP-9 and the prognosis was analyzed. RESULTS: The serum VEGF (295.4 +/- 158.1) pg/ml was high before treatment, then decreased after 4 weeks and 8 weeks of treatment (255.7 +/- 130.4) pg/ml, (224.2 +/- 120.6) pg/ml. The serum VEGF was significantly lower after 8 weeks of treatment (P < 0.05). The serum MMP-9 was also decreased after treatment, showing a positive relationship with VEGF. CONCLUSIONS: Propranolol can treat the proliferative hemangioma through decreasing the serum VEGF and MMP-9.

Effect of compound glycyrrhizin injection on liver function and cellular immunity of children with infectious mononucleosis complicated liver impairment.

OBJECTIVE: To investigate the effects of Compound Glycyrrhizin Injection (CGI) on liver function and cellular immunity of children with infectious mononucleosis complicated liver impairment (IM-LI) and to explore its clinical therapeutic effect. METHODS: Forty-two patients with IM-LI were randomly assigned, according to the randomizing number table, to two groups, 20 in the control group and 22 in the treated group. All the patients were treated with conventional treatment, but to those in the treated group, CGI was given additionally once a day, at the dosage of 10 ml for children aged below 2 years, 20 ml for 2-4 years old, 30 ml for 5-7 years old and 40 ml for 8- 12 years old, in 100-200 ml of 5% glucose solution by intravenous dripping. The treatment lasted for 2 weeks. T lymphocyte subsets and serum levels of alanine transaminase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) were detected before and after treatment. Besides, a normal control group consisting of 20 healthy children was also set up. RESULTS: Baseline of the percentage of CD3 + , CD8 + lymphocyte and serum levels of ALT, AST, TBiL in the children with IM-LI were markedly higher, while the percentage of CD4 + lymphocyte and the CD4 + /CD8 + ratio was markedly lower in IM-LI children as compared with the corresponding indices in the healthy children ( P<0.01). These indices were improved after treatment in both groups of patients, but the improvement in the treated group was better than that in the control group (P<0.01). CONCLUSION: Cellular immunity dysfunction often occurs in patients with IM-LI, and CGI treatment can not only obviously promote the recovery of liver function, but also regulate the immune function in organism.