Serum apelin as a potential biomarker for infantile hemangiomas.

BACKGROUND: Infantile hemangiomas (IHs) are common benign vascular tumors in infants. Apelin, an endogenous cytokine, is implicated in the angiogenesis of neoplastic diseases. We aimed to explore the association between apelin and IHs, providing a foundation for clinical applications. METHODS: We identified differential expression of apelin in proliferative IHs compared to healthy controls (HCs) through bioinformatics analysis of publicly available databases and verified by Immunofluorescence. Enzyme-linked immunosorbent assay was used to quantify the serum levels of apelin and vascular endothelial growth factor (VEGF) in a cohort of 116 cases of proliferative IHs, 65 cases of capillary malformations (CMs), and 70 HCs. RESULTS: Apelin and APJ (APLNR, apelin receptor) were identified as the significantly upregulated differentially expressed genes (DEGs) in proliferative IHs. Immunofluorescence staining indicated high expression of apelin in proliferative IHs, while minimal expression in non-IH lesions. Apelin in IHs was reduced following 6 months of propranolol treatment. Serum apelin levels were significantly higher in the IH group compared to both the CM and HC groups. Moreover, apelin exhibited excellent discriminatory ability in distinguishing IHs from HCs, with an area under the curve (AUC) exceeding 0.90. A positive correlation was observed between the levels of apelin and the size of superficial IHs. The expression profiles of VEGF and apelin in IHs were found to be consistent. CONCLUSIONS: Apelin shows promise as a potential biomarker for IHs. The association between apelin and IH size, as well as its responsiveness to propranolol treatment, indicates its possible utility as a valuable indicator for the therapeutic evaluation of IHs.

Evaluation of GLUT1, IGF-2, VEGF, FGF 1, and angiopoietin 2 in infantile hemangioma.

INTRODUCTION: Infantile hemangioma (IH) is a common vascular tumor in children. It is reported that IHs are associated with immunochemical markers such as vascular endothelial growth factor (VEGF)-A, glucose transporter isoform 1 (GLUT1), and insulin-like growth factor-2 (IGF-2). MATERIAL AND METHODS: This cross-sectional study focused on pediatric patients with IH. A total of 46 patients (mean age 14.2±21.9 months) with IH and 45 healthy controls (mean age 21.8±15.08 months) were enrolled. Demographic data, clinical findings, and laboratory parameters were recorded. Blood samples were collected. Serum GLUT1, IGF-2, VEGF-A, fibroblast growth factor 1 (FGF1), and angiopoietin 2 levels were assessed by enzyme-linked immunosorbent assay. RESULTS: Serum GLUT1, IGF-2, and VEGF-A levels were significantly higher in patients with IH than in healthy controls (8.80±4.07pg/mL vs. 5.66±4.34pg/mL, 281.10±84.12pg/mL vs. 234.19±75.38pg/mL, 1196.99±389.34pg/mL vs. 996.99±349.16pg/mL, respectively, p=0.026, p=0.030, and p=0.036). Serum GLUT1, IGF-2, and VEGF-A levels in patients with complicated hemangioma were significantly higher than in healthy controls (9.69±3.94pg/mL vs. 5.66±4.34pg/mL, 289.94±83.18pg/mL vs. 234.19±75.38pg/mL, 1276.22±388.24pg/mL vs. 996.99±349.16pg/mL, respectively, p=0.017, p=0.022, and p=0.011). Serum GLUT1, IGF-2, and VEGF-A levels in patients with hemangioma receiving propranolol treatment were significantly higher than in healthy controls. Serum FGF1 levels were higher in patients with IH, complicated hemangioma, and hemangioma receiving propranolol treatment than in healthy controls but the difference was not statistically significantly. CONCLUSION: Serum GLUT1, IGF-2, and VEGF-A levels were positively correlated with disease severity in patients with hemangioma, for example, in complicated hemangioma and hemangioma requiring propranolol treatment. However, further research on larger and different age subgroups is warranted to assess these markers.

Change of serum cytokine profiles by propranolol treatment in patients with infantile hemangioma.

Infantile hemangioma is a benign cutaneous tumor, which sometimes rapidly enlarges, causes cosmetic problem, destroys normal tissue, and possibly threatens life. Dye lasers, steroid administration, and watchful waiting had been the treatment options for infantile hemangioma, but in recent years propranolol therapy has become available. The mechanism underlying the action of propranolol, however, is still unknown. We hypothesized that cytokines whose expressions change before and during the treatment are responsible for the efficacy of the drug. This study aims to prove the hypothesis using patients' sera and membrane array. In this study, the serum cytokine concentrations of five patients with infantile hemangioma were measured using membrane array of 20 angiogenic cytokines. We compared them before and during propranolol treatment to identify the cytokines responsible for the effect of propranolol. Signals for angiogenin, epidermal growth factor (EGF), platelet-derived growth factor-BB (PDGF-BB), regulated on activation, normal T-cell expressed and secreted chemokine (RANTES), tissue inhibitor of metalloproteinases 1 (TIMP-1), and tissue inhibitor of metalloproteinases 2 (TIMP-2) were evident in all five cases before treatment. Furthermore, PDGF-BB was the only cytokine of which concentration was decreased during treatment with statistically significant difference. This report is a pilot study with a small number of samples, and further detailed research with increased number of samples is necessary. Nonetheless, our results suggest that PDGF-BB may be involved in the action of propranolol. In addition, its serum concentration can be utilized as a potential marker of the therapeutic effect.

Serum cytokine profiles in infants with infantile hemangiomas on oral propranolol treatment: VEGF and bFGF, potential biomarkers predicting clinical outcomes.

BACKGROUND: Oral propranolol has become first-line treatment for infantile hemangiomas (IHs). This study focused on identifying cytokines related to the biology of IH and early regression indicators of IH after propranolol treatment. METHODS: For inclusion, the patients had to be aged less than 1 year and have an IH with a largest diameter ≥2 cm. Patients were scheduled to receive 1 year of propranolol treatment. Serum cytokines involved in angiogenesis, vasculogenesis, and/or chronic inflammation were analyzed at 0, 1, and/or 12 months after treatment using Multiplex Luminex assays. RESULTS: Among the 49 evaluable patients, 33 completed the 1-year treatment: 16 showed excellent response and 12 had good response to propranolol. Significant decreases in serum MMP-2, bFGF, VEGF-α, and MCP-1 levels were observed after 1 year of treatment compared to pretreatment values. The maximal diameters of the lesions significantly correlated with pretreatment serum VEGF-α, bFGF, and MMP-9. Patients with higher bFGF and VEGF levels showed better response to propranolol at 1 year. CONCLUSION: MMP-2, VEGF-α, bFGF, and MCP-1 may involve in the biology of IH and their downregulation may be associated with involution processes of IH. Pretreatment bFGF and VEGF could be novel biomarkers for predicting response to propranolol. IMPACT: We found that decreases in the concentrations of MMP-2, bFGF, VEGF, and MCP-1 were associated with regression of the hemangioma, which indicates that one of the mechanisms of propranolol in the treatment of proliferative hemangiomas may involve downregulation of those cytokines. Patients with higher bFGF and VEGF levels showed better response to propranolol at 1 year. Importantly, serum bFGF higher than 37.07 pg/mL may predict an excellent response to propranolol. Therefore, along with the patient's age and the size and visual characteristics of the lesion, bFGF levels could help determine the viability of propranolol use in the treatment of IHs. Our study represented extensive serum profiling in IH, reporting the indicators and molecules clearly related to IH regression with propranolol treatment. The authors believe that monitoring serum cytokines, including MMP-2, bFGF, VEGF, and MCP-1, in IH patients could be important, in addition to clinical follow-up, for determining when to start and end propranolol treatment.

Therapeutic effect of high-frequency ultrasound-assisted dye laser on hemangioma and its influence on serum HIF-1α in patients.

BACKGROUND: To analyze the therapeutic effect of high-frequency ultrasound (HFU)-assisted dye laser on hemangioma patients and changes in serum hypoxia-inducible factor-1α (HIF-1α). METHODS: A total of 20 patients diagnosed with hemangioma in our hospital from January 2013 to March 2018 were selected, including 12 males and eight females. All patients were treated with HFU-assisted dye laser. The site and type of hemangioma and age distribution of patients were collected, and changes in data and area of hemangioma and serum HIF-1α before and after treatment were analyzed. RESULTS: The vascular condition of hemangioma in all patients was significantly improved at 7, 14, and 30 days after treatment. Gray-scale ultrasound displayed that the tumor area was reduced by more than 50%. After treatment, the serum HIF-1α level declined obviously after treatment compared with that before treatment, showing a statistically significant difference (P < 0.05). CONCLUSION: HFU-assisted dye laser can effectively reduce the tumor area, decrease the serum HIF-1α level, and improve the prognosis in the treatment of hemangioma.

Tumor-Associated Protein Profiles in Kaposi Sarcoma and Mimicking Vascular Tumors, and Their Pathological Implications.

We investigated protein profiles specific to vascular lesions mimicking Kaposi sarcoma (KS), based on stepwise morphogenesis progression of KS. We surveyed 26 tumor-associated proteins in 130 cases, comprising 39 benign vascular lesions (BG), 14 hemangioendotheliomas (HE), 37 KS, and 40 angiosarcomas (AS), by immunohistochemistry. The dominant proteins in KS were HHV8, lymphatic markers, Rb, phosphorylated Rb, VEGF, and galectin-3. Aberrant expression of p53, inactivation of cell cycle inhibitors, loss of beta-catenin, and increased VEGFR1 were more frequent in AS. HE had the lowest Ki-67 index, and the inactivation rates of cell cycle inhibitors in HE were between those of AS and BG/KS. Protein expression patterns in BG and KS were similar. Clustering analysis showed that the 130 cases were divided into three clusters: AS-rich, BG-rich, and KS-rich clusters. The AS-rich cluster was characterized by high caveolin-1 positivity, abnormal p53, high Ki-67 index, and inactivated p27. The KS-rich cluster shared the features of KS, and the BG-rich group had high positive expression rates of galectin-3 and low bcl2 expression. In conclusion, although the rate was different, AS and HE tended to have less cell cycle marker expression than KS, and features of BG and activated KS cell signaling were similar.

A study of serum vascular endothelial growth factor in infantile hemangiomas.

BACKGROUND: Though infantile hemangiomas are the most common benign tumor of infancy, their etiopathogenesis is not fully understood. Some studies report a diagnostic role for vascular endothelial growth factor (VEGF), but such studies are lacking from India. AIMS: To study the clinicoepidemiological profile of infantile hemangiomas, to estimate and compare the serum levels of VEGF in infantile hemangiomas and controls, and to determine correlations between serum levels of VEGF and growth characteristics of infantile hemangiomas. METHODS: A hospital-based, cross-sectional study was carried out on 30 clinically diagnosed cases of infantile hemangioma and 30 controls presenting with other disorders. VEGF levels were recorded for both cases and controls by the sandwich enzyme-linked immunosorbent assay (ELISA) technique. Results were analyzed using SPSS version 20.0, and their significance determined using appropriate tests. RESULTS: Mean serum VEGF level in the cases was 216.8 ± 49.2 pg/ml while in the control group it was 115.1 ± 43.1 pg/ml (P < 0.0001). There were no statistically significant correlations between serum VEGF levels and sex or size, phase of growth, morphological variants or ulceration of lesions. LIMITATIONS: Our sample was not large enough to draw clinically applicable conclusions. An adequate sample size could not be achieved because of low incidence of the disease, and resource and time constraints. CONCLUSIONS: The mean value of serum VEGF in the study group was significantly higher than that in the control group, suggesting that serum VEGF can serve as a diagnostic marker of infantile hemangiomas. Mean serum VEGF was higher in proliferative lesions than in involuting lesions, indicating that it may also be useful as a prognostic serological marker in cases of infantile hemangioma.

Glomeruloid haemangioma: a possible consequence of elevated VEGF in POEMS and Erdheim-Chester disease.

Glomeruloid haemangioma (GH) is considered a specific marker of POEMS syndrome, despite some published GH cases unrelated to POEMS syndrome. To present two cases with GH and atypical presentations of Erdheim-Chester disease (ECD) or POEMS syndrome, as well as a retrospective monocentric study of histologically-confirmed GH. Clinical, biological and histological data of the patients is presented. In addition to the two presented cases, 11 GH histologically-confirmed cases were retrospectively identified. Six patients were female (46.2%; 95 CI: 12-64.9) and median age was 54 years (31-85). For 11 patients (84.6%; 95 CI: 65-104.2), a diagnosis of POEMS syndrome was retained, one patient had autoimmune hepatitis, and another had ECD. GH was localised to the trunk in 10 cases (76.9%; 95 CI: 54-99) and the legs in the other three. The median number of haemangiomas in the cohort was three (SD: 3.08). Median level of VEGF was 1,490 (610-12,000) ng/mL. All immunohistochemical staining for human herpesvirus 8 (HHV-8) was negative. Of the 13 cases of GH, of which two were not clear-cut POEMS syndrome, we report the first case of GH associated with ECD. In this cohort, all patients had high serum levels of VEGF but no in situ HHV-8 latent infection. We hypothesise that GH might be linked to a high level of VEGF in these two rare diseases.

Serum cytokine profiles are altered in patients with progressive infantile hemangioma.

Infantile hemangioma sometimes grows rapidly to a significant size around the first 2 months of life, which can be problematic and even destroy normal tissue. However, it is very difficult to predict the tumor growth at the first visit and to decide necessity of treatment. Therefore the identification of the biomarkers that can indicate a tendency to grow is clinically very important. In the present study, we evaluated the possibility that serum cytokine levels are available as the marker of hemangioma growth. Progressive hemangioma was defined as a lesion showing increased tumor size and/or coloration two weeks before and after the serum sampling, and we used membrane array to compare the twenty cytokine profiles between the sera of 3 progressive hemangioma patients and sex-/age-matched non-progressive hemangioma patients. As a result, many of the 20 cytokines were detected in the patients' sera. When a 2-fold difference in the mean levels of each group was considered meaningful, 6 of the 20 cytokines (IGF-1, IL-6, IL-8, PIGF, RANTES, TGF-ß1) were down-regulated in the progressive hemangioma group compared to the non- progressive hemangioma group, and there were statistically significant difference (p < 0.05): especially, IGF-1, IL-6, IL-8, PIGF, and TGF-ß1 did not expressed in all 3 progressive hemangioma patients. Accordingly, complicated cytokine network by these multiple cytokines may control the pathogenesis, and these cytokine levels may become clinically useful tumor markers. Furthermore, immunotherapy against them will be novel therapeutic approach.

Safety and tolerance of propranolol in neonates with severe infantile hemangiomas: a prospective study.

Although the efficacy of propranolol for the treatment of infantile hemangiomas (IHs) has been well documented, there is a paucity of clinical data regarding the safety and tolerance of propranolol in neonates. A prospective study of 51 patients less than 30 days of age with severe IH was conducted. All patients were admitted to the hospital for monitoring during initial propranolol treatment at day 0 with dose adjustments at days 7 and 28. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), blood glucose (BG) levels and potential side effects were evaluated during treatment. There were significant decreases in mean heart rate and SBP after the initiation of propranolol therapy (P < 0.05). In contrast, no significant differences in mean DBP and BG levels were observed after each dose during hospitalization (P > 0.05). Bradycardia and hypotension were noted in at least 1 recorded instance in 11.8% and 5.9% of patients, respectively. These hemodynamic changes were not persistent and were asymptomatic. Two patients who had a history of neonatal pneumonia reported severe bronchial hyperreactivity during treatment. This study demonstrated that propranolol administered to properly selected young infants was safe and well tolerated. However, close monitoring should be considered in high-risk young patients.

[Perioperative management of patients on NOACs]. / Perioperatives Management von Patienten unter NOAK.

Regarding thromboembolic events, non-vitamin K antagonists, so-called new oral anticoagulative agents (NOACs), have widely enlarged prophylaxis and therapy. In contrast to vitamin K antagonists they can be administered in a definite dose and do not need any regular control of coagulation parameters. Thus being simple in handling, these drugs have become enormously attractive for both patient and physician.In spite of all their advantages NOACs have to be considered carefully. They have a significant disadvantage: the plasma concentration is not detectable by a simple blood test, nor is there any antidote available. As a consequence the bleeding risk remains unknown.In this review we focus on two different settings in routine surgical work: the preoperative management of patients undergoing elective surgery differs significantly from that needed in urgent surgery.

Tumores testiculares y paratesticulares en la edad pediátrica / Testicular and paratesticular tumors in children

OBJETIVOS: Los tumores testiculares (TT) y paratesticulares (TP) constituyen el 1-2% de los tumores sólidos infantiles. Estudios recientes recomiendan un manejo conservador, ante la mayor frecuencia de tumores benignos. Con estas premisas, revisamos nuestra experiencia, así como la actitud terapéutica adoptada. MÉTODOS: Todos los TT y TP tratados desde 1998 hasta 2016 se analizaron de manera retrospectiva. Entre los datos recogidos se encuentran la edad, clínica, lateralidad de la tumoración, pruebas de imagen, tratamiento realizado, tipo histológico y evolución. RESULTADOS: Se revisaron un total de 19 casos de TT y TP en 17 pacientes. El 79% de los casos debutaron como una masa escrotal asintomática con marcadores tumorales negativos. El estudio anatomopatológico demostró una proporción similar de TT estromales y de células germinales. En cuanto a los TP se evidenció una proporción similar entre los tumores de características benignas y malignas. Se practicó cirugía conservadora en el 58% de los TT y tumorectomía en el 57% de los TP. CONCLUSIONES: La alta incidencia de benignidad de los TT y TP en la infancia, sobre todo con marcadores tumorales normales, hace que deba considerarse la cirugía conservadora como primera opción terapéutica

OBJECTIVES: Testicular (TT) and paratesticular (PT) tumors account for 1-2% of all infant solid tumors. Due to the increased frequency of benign tumors, conservative management is recommended. Our experience and the therapeutic approach adopted considering testis-sparing surgery, was reviewed. METHODS: A retrospective observational study concerning testicular and paratesticular tumors in our hospital between 1998 and 2016, was performed. Age, side, symptoms, imaging, treatment methods, histological findings and evolution were reviewed. RESULTS: Nineteen cases of TT and PT were reviewed in 17 patients. A painless scrotal mass was found in most cases as the initial presentation (79%). Tumor markers were normal in all cases. Similar distribution between germ cell and stromal testicular tumors was found. Nevertheless, benign and malignant PT proportion was similar. Testis preserving surgery was performed in 58% of TT and in 57% of PT. CONCLUSIONS: Due to the high incidence of the benign histological findings, testicular sparing surgery should be considered as a first therapeutic option, especially in those cases with normal tumor markers

[Surgical treatment of liver haemangiomas in a third level hospital in south-east Mexico]. / Tratamiento quirúrgico de los hemangiomas hepáticos en una unidad médica de alta especialidad del sureste de México.

BACKGROUND: Liver haemangiomas are the most common benign tumours, commonly presented in women and considered giant when their diameter surpasses 4cm. They are mostly asymptomatic and incidental findings. They manifest with abdominal pain and mass effect. These tumours can be managed by observation, enucleation, resection, and embolisation. OBJECTIVE: To determine the experience in our unit as regards the treatment and post-surgical outcomes of patients with liver haemangiomas. MATERIALS AND METHODS: A retrospective study was performed on 14 patients with a histopathological diagnosis of liver haemangioma. An analysis was made using the sociodemographic, tumour-related and surgical related variables, as well as any complications. RESULTS: Of the 14 patients analyse, there were 7 males and 7 females, with a median age of 43.43±15.03 years, and a mean tumour size of 6.86±3.5cm. Eight (51.7%) of the tumours were located in the right lobe, 3 (21.4%) in the left lobe, and 3 (21.4%) in the caudate lobe. Resection was performed in 7 patients (50%), enucleation in 5 patients (35.7%), and biopsy in 2 patients (14.3). No relationship was found between sex, pathology, or tumour location. No morbidity or mortality was found. CONCLUSIONS: Liver haemangiomas in our unit have similar characteristics to those described in other studies. Surgical treatment in our hospital offers a positive outcome.

Diagnostic Evaluation of Des-Gamma-Carboxy Prothrombin versus α-Fetoprotein for Hepatitis B Virus-Related Hepatocellular Carcinoma in China: A Large-Scale, Multicentre Study.

An efficient serum marker for hepatocellular carcinoma (HCC) is currently lacking and requires intensive exploration. We aimed to evaluate the performance of des-gamma-carboxy prothrombin (DCP) for identifying hepatitis B virus-related HCC in a large, multicentre study in China. A total of 1034 subjects in three cohorts (A, B, and C) including HCC and various non-HCC controls were enrolled from 4 academic medical centers in China from January 2011 to February 2014. Blind parallel detections were conducted for DCP and AFP. The area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic efficacies. In cohort A, which comprised 521 subjects, including patients with HCC, liver metastasis, liver cirrhosis (LC), and liver hemangiomas as well as healthy controls (HCs), the accuracy of DCP for distinguishing HCC from various controls was 6.2-9.7% higher than that of AFP. In cohort B, which comprised 447 subjects, including patients with HCC, LC, and chronic hepatitis B as well as HC, the accuracy of DCP was further elevated (12.3-20.67% higher than that of AFP). The superiority of DCP to AFP was more profound in the surveillance of early HCC [AUC 0.837 (95% CI: 0.771-0.903) vs. 0.650 (0.555-0.745)] and AFP-negative HCC [AUC: 0.856 (0.798-0.914)] and in discriminating HCC from LC (accuracy: 92.9% vs.64.71%). Higher DCP levels were associated with worse clinical behaviors and shorter disease-free survival. DCP not only is complementary to AFP in identifying AFP-negative HCC and in excluding AFP-positive non-HCC (liver cirrhosis), but also demonstrates improved performance in HCC surveillance, early diagnosis, treatment response and recurrence monitoring in the HBV-related population.

Propranolol for infantile hemangioma: Effect on plasma vascular endothelial growth factor.

BACKGROUND: Propranolol has recently been shown to be highly effective for infantile hemangioma (IH), but the mechanism of action of propranolol and the usefulness of measurement of vascular endothelial growth factor (VEGF) remain poorly understood. The aim of this study was therefore to determine the efficacy of propranolol treatment and to evaluate changes in plasma VEGF in IH patients who underwent propranolol treatment. METHODS: The study group consisted of 35 children with IH. Oral propranolol was give at a dose of 2.0 mg/kg/day and was divided in three doses. Outcome was assessed using the visual analog scale (VAS) of size and color. Plasma VEGF concentration was analyzed on enzyme-linked immunoabsorbent assay, and compared between the groups. RESULTS: Improvement in VAS in patients who started propranolol before 6 months of age was superior to that in those who started propranolol after 6 months of age. VEGF concentration was significantly correlated with lesion size (P = 0.002), whereas no correlation was observed with age. VEGF concentration 4 weeks after treatment was significantly lower than that before treatment (P < 0.01). CONCLUSIONS: Measurement of VEGF may be a useful tool for predicting the course of IH and monitoring the effectiveness of treatment.

Hemangioma: descrição de um caso clínico e sua importância no diagnóstico diferencial / Hemangioma: description of a clinical case and the importance in the differential diagnosis

O hemangioma infantil é um tumor vascular benigno que ocorre devido a uma proliferação anormal dos vasos sanguíneos. O quadro clínico apresenta três fases bem definidas: proliferativa, involutiva e involuída. O diagnóstico é realizado basicamente por meio da anamnese e do exame físico, e quando necessário preconiza-se avaliação histopatológica. O presente trabalho, descreve um caso clínico de um hemangioma presente em um bebê de 3 meses de idade que foi, de principio, diagnosticado como mucocele ou fibroma. A cirurgia excisional foi realizada eo material encaminhado para análise histopatológica, confirmando o diagnóstico de hemangioma. Nessas situações, vale ressaltar a importância do diagnostico diferencial, manobra cirúrgica adequada e a avaliação das características clínicas da lesão para evitar possíveis complicações cirurgicas.

The infantile hemangioma is a benign vascular tumor which occurs due to an abnormal proliferation of blood vessels. The clinical features three well-defined phases: proliferative, involution,and involuted. The diagnosis is made primarily by clinical history and physical examination, but when necessary, help to close the histopathological diagnosis. This paper describes a clinical case of a gift hemangioma in a baby three months old who was, in principle, diagnosed as mucocele or fibroma. The excisional surgery was performed and material sent for histopathological confirmation hemangioma. It is worth emphasizing the importance of differential diagnosis, appropriate surgical maneuver, assessment of clinical characteristics of the lesion to prevent potential surgical complications possible.

[Effect of propranolol gel on plasma VEGF, bFGF and MMP-9 in proliferating infantile hemangiomas of superficial type].

OBJECTIVE: To investigate the effect of topical propranolol gel on the levels of plasma vascular endothelial growth factor (VEGF), basic fibroblastic growth factor (bFGF) and matrix metalloproteinases-9 (MMP-9) in proliferating infantile hemangiomas (IHs) of superficial type. METHODS: 33 consecutive children with superficial IHs were observed pre-treatment, 1 and 3 months after application of topical propranolol gel for the levels of plasma VEGF, MMP-9 and bFGF by enzyme-linked immunosorbent assay (ELISA) 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. The clinical efficacy in IHs was evaluated by Achauer system. Differences of plasma results between the healthy group and the IHs group pre-treatment were analyzed using Mann-Whitney U-test. Paired sample comparisons of any two time points of pre-treatment, 1 month and 3 months after treatment in IHs were evaluated by Wilcoxon signed-rank test. RESULTS: The clinical efficiency of topical propranolol gel at 1, 3 months after application were 45.45%, 81.82% respectively. The levels of plasma VEGF and MMP-9 in patients pre- treatment were higher than those in healthy infants [(362.16 ± 27.29) pg/ml vs (85.63 ± 8.14) pg/ml, (1376.41 ± 42.15) pg/ml vs (687.27 ± 44.1) pg/ml, P < 0.05], but the level of bFGF did not show significant difference [(176.03 ± 13.60 ) pg/ml vs (235.94 ± 35.43 ) pg/ml, P > 0. 05 ]. The concentrations of VEGF and bFGF at 1, 3 months after treatment decreased obviously [(271.51 ± 18.59) pg/ml vs (362.16 ± 27.29 ) pg/ml, (135.85 ± 12.66) pg/ml vs (176.03 ± 13.60) pg/ml], 1 month after treatment vs pre-treatment, P < 0.05; (240.80 ± 19.89) pg/ml vs (362.16 ± 27.29) pg/ml, (107.31 ± 5.82) pg/ml vs (176.03 ± 13.60) pg/ml, 3 month after treatment vs pre-treatment, P < 0.05, whereas the levels of plasma MMP-9 declined slightly [(1321.18 ± 48.74) pg/ml vs (1376.41 ± 42.15 ) pg/ml, (1468.68 ± 32.78) pg/ml vs (1376.41 ± 42 2.15 ) pg/ml, P > 0.05 ]. CONCLUSIONS: Propranolol gel may suppress the proliferation of superficial infantile bemangiomas by reducing VEGF and bFGF.

Hematuria macroscópica gestacional: a propósito de un caso tratado con RIRS / Gestational gross hematuria: report of a case treated with RIRS

La hematuria, durante la gestación, es debida a causas urológicas comunes como la litiasis y la infección de orina, los tumores del riñón y la vejiga, y las malformaciones vasculares renales. Anomalías de la implantación de la placenta y complicaciones obstétricas pueden ocasionar sangrado en orina. Entre las causas nefrológicas figura el síndrome hemolítico urémico. Alteraciones hematológicas asociadas a la gestación como la plaquetopenia favorecen la hematuria, en especial si existe una patología urológica subyacente. Se presenta un caso clínico de hematuria recidivante en una gestante que requirió estudio con RM y URS, resuelto después del parto con cirugía endoscópica intrarrenal (RIRS) (AU)

Hematuria during pregnancy is due to common urological causes such as stones and urinary tract infection, kidney and bladder tumors, and renal vascular malformations. Abnormalities of placenta implantation and obstetric complications are the cause of bleeding in urine. Among nephrological causes is the hemolitic-uremic syndrome. Hematologic abnormalities as a thrombocytopenia favor gestational hematuria, especially if there is an underlying urologic pathology. A case report of recurrent hematuria in a pregnant is presented. MRI and URS was required to study it. The case was resolved after birth with intrarenal endoscopic surgery (RIRS) (AU)

Hemangioma papilar como causa de macrohematuria. Presentación de un caso y revisión de la literatura / Papillary hemangioma as a cause of macrohematuria. A case report and review of the literature

La hematuria recidivante unilateral supone un reto diagnóstico y terapéutico para el urólogo. El hemangioma renal (HR) figura entre las posibles causas. La localización en la papila renal es típica. Se presenta un caso de hematuria secundaria a HR que fue diagnosticado en primera instancia como síndrome del cascanueces. Tras una revaloración se realizó ureterorrenoscopia que demostró un hemangioma papilar sangrante. La lesión fue tratada con fotovaporización láser con buen resultado. Se revisa la etiopatogenia, diagnóstico y las opciones terapéuticas frente al HR sangrante (AU)

Unilateral recurrent hematuria is a diagnostic and therapeutic challenge for the urologist. The renal hemangioma (RH) is a possible cause. The location is typically the renal papilla. A case of hematuria secondary to RH who was diagnosed at first instance and nutcracker syndrome is presented. After a diagnostic reassessment ureterorenoscopy was performed which showed a bleeding papillary hemangioma. The lesion was treated with laser PVP with good results. The pathogenesis, diagnosis and therapeutic options against the bloody RH is reviewed (AU)