Infantile Hemangioma with Minimal or Arrested Growth: Further Observations on Clinical and Histopathologic Findings of this Unique but Underrecognized Entity.

BACKGROUND: Infantile hemangioma (IH) with minimal or arrested growth (IH-MAG) is becoming increasingly recognized in the literature. It is important to be aware of their existence, because the correct diagnosis is essential for prognostication and treatment and, in the case of facial segmental lesions, the direction of further investigations if PHACE (posterior fossa abnormalities and other structural brain abnormalities; hemangioma(s) of the cervical facial region; arterial cerebrovascular anomalies; cardiac defects, aortic coarctation, and other aortic abnormalities; eye anomalies) syndrome or Sturge-Weber syndrome is suspected. Although the clinical and histologic characteristics of IH-MAG resemble capillary malformations, positive GLUT-1 status is a delineating feature. METHODS: We reviewed nine cases of infants who presented after 2000 with birthmarks showing unique clinical features suggestive of a special variant of IHs. All patients had serial photographs taken demonstrating resolution of the birthmark over time. Five of these cases had skin biopsy performed, all of which confirmed GLUT-1 positivity. RESULTS: This photographic series of IH-MAG demonstrates their unique clinical, histologic, and immunochemistry features. They were nearly fully formed at birth, and their common clinical features included telangiectasia, venules, and matte erythema with light and dark areas. Spontaneous resolution over time without cosmetic disfigurement was the observed natural history in the majority of cases. CONCLUSION: IH-MAG is a unique clinical subset of hemangioma for which close observation is the preferred treatment. When in doubt, a biopsy for histology and GLUT-1 status may be needed to confirm the diagnosis before embarking on unnecessary laser treatment or medical interventions.

Emerging epidemic in Australia: abdominal stab wounds. Twenty-four months at a major trauma centre.

BACKGROUND: The incidence of abdominal stab wounds treated at the Royal Melbourne Hospital, Parkville, Vic., Australia has noticeably increased over the 12 month period to March 2006, mirroring an increase in penetrating abdominal trauma throughout many Australian trauma centres. Management protocols for abdominal stab wounds are still contentious. The current study quantifies the increase in stab wounds at the Royal Melbourne Hospital over a 24 month period and analyses the management modalities used. METHODS: A review of the Trauma Unit of the Royal Melbourne Hospital was performed for the period of 20 March 2004 until 20 March 2006. All anterior abdominal stab wounds were collated for the site of injury, investigations performed on admission, results of investigations, operations performed and findings at operation. RESULTS: There were 4244 emergency trauma presentations over the 24 month period between 20 March 2004 and 20 March 2006. The second 12 month period showed a 21.5% increase in overall trauma admissions and a 91.3% increase in anterior abdominal stabbings. The percentage of stab wounds treated conservatively fell by 21.8%, with the percentage of laparotomies increasing by 14.2%. Almost 30% of all patients undergoing surgery had no visceral injury at operation. Twenty CT scans were performed preoperatively, with a sensitivity of 79% and specificity of 100%. CONCLUSION: Abdominal stab wounds treated at Royal Melbourne Hospital have substantially increased over the past 12 months. Although management is still contentious, a management protocol for anterior abdominal stab wounds is proposed, outlining the role of CT scanning, conservative management, laparoscopy and laparotomy.