This meta-analysis was to evaluate the efficacy of current treatment modalities for kaposiform hemangioendothelioma and tufted angioma. A systematic review was performed using PubMed (Medline), Web of Science and Embase for clinical studies. The outcome was measured by pooled response rate with 95% confidence intervals (CIs), together with heterogeneity, subgroup analysis, sensitivity analysis and publication bias. Fifteen studies with 244 participants were included in this analysis. Vincristine therapy exhibited a relatively higher response rate (0.72; 95%CI, 0.64-0.79) compared with other therapies including systemic corticosteroid (0.27; 95%CI, 0.17-0.36), interferon (0.36; 95%CI, 0.24-0.48), radiotherapy (0.49; 95%CI, 0.26-0.73), embolization (0.66; 95%CI, 0.48-0.83), aspirin/ticlopidine (0.42; 95%CI, 0.06-0.78) and sirolimus (0.57; 95%CI, 0.00-0.10), in treating KHE/TA. Subgroup analysis indicated that the efficacy of systemic corticosteroids therapy was age-related. The pooled response rate was 0.15 (95%CI, 0.08-0.23) for participants 3.5 months of age and older compared with 0.35 (95% CI, 0.26-0.44) for participants less than 3.5 months. Regarding side effects, systemic corticosteroids treatment was 0.32 (95%CI, 0.15-0.50), vincristine modality was 0.16 (95%CI, 0.08-0.24) and interferon therapy was 0.28 (95%CI, 0.13-0.43). In conclusion, as one of the first reviews evaluating the effect of common therapies in the treatment of KHE/TA, our meta-analysis displayed that vincristine was more effective. Thus, vincristine was the most effective, providing evidence supporting the use of vincristine as a first-line therapy for KHE/TA.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.30216

Treatment of kaposiform hemangioendothelioma and tufted angioma

A 2-month-old female patient presented an extensive bilateral parotid hemangioma (PH) focally ulcerated. Additionally, hepatic ultrasonography revealed a hemangioendothelioma located at right lobe. She was treated with oral prednisolone (3 mg/kg/day) during 10 months with clinical improvement of PH, despite failure to thrive and arterial hypertension. However, regrowth of the lesion occurred after discontinuation of oral steroid. Propranolol hydrochloride (2 mg/kg/day divided into two doses) was then started and maintained for 16 months, with marked involution of the hemangioma and with no systemic side effects during treatment course. Curiously, also the liver hemangioendothelioma completely resolved after starting propranolol.PH is a threatening cervicofacial segmental hemangioma that frequently proliferates after the year of age and needs long-term treatment. On the other hand, hepatic hemangioendotheliomas may be associated with cutaneous hemangiomas in some patients and their natural history is simil...

Efficacy and safety of propranolol in the treatment of parotid hemangioma.

Infantile hemangioma (IH) is a type of benign tumor that develops during infancy and spontaneously involutes after 1 year of age. Before the introduction of propranolol in 2008, some patients with IH were instructed to wait for the involution without treatment. This long-term follow-up study was conducted to assess the prognosis of East-Asian children with untreated deep or mixed facial IH. Skin sequelae were assessed by comparing images obtained during the patients' first and last visits in our clinic. Possible factors were assessed for their association with IH prognosis. The mean follow-up time was 7.4 years. Among the 48 patients with deep or mixed facial IH, 26 (54%) achieved complete involution without sequelae and 22 encountered various sequelae, including telangiectasia (36.3%), fibrofatty residue (68.2%), and scars (4%). The complete regression rate of deep or mixed IH occurring in the central facial region was significantly lower than for those in the perifacial region (33.3% vs 66.7%, respectively, χ2 , P = 0.025). Further, the most common sequelae in this area are fibrofatty residue.

A 7-year follow-up study on untreated deep or mixed facial infantile hemangioma in East-Asian patients: When propranolol was not yet an option.

Outpatient Treatment of Infantile Hemangiomas With Propranolol: A Prospective Study

Resumen Objetivo Valorar la efectividad y seguridad del propranolol oral (PO) para tratar hemangiomas infantiles (HI). Material y metodos Estudio prospectivo de los HI tratados con PO entre octubre de 2008 y marzo de 2011. Fueron candidatos a tratamiento los HI en fase proliferativa con rapido crecimiento, compromiso de alguna estructura vital o ulceracion y para evitar problemas funcionales o esteticos tras la fase proliferativa. Los pacientes se trataron con 2 mg/kg/dia de PO, y fueron controlados ambulatoriamente. Se valoro la respuesta terapeutica mediante una escala en la que se considero la reduccion del volumen, aclaramiento del color y mejoria de los sintomas del HI, ademas del grado de satisfaccion paterna. Se registro el momento de respuesta inicial y maxima, efectos secundarios y secuelas. Resultados Se trataron 20 casos de HI (17 ninas y 3 ninos). Las localizaciones predominantes fueron: periorbitaria (20%), nariz (15%), cuello/nuca (15%) y tronco (15%). La mayoria HI fueron focales y en fase proliferativa (90%). El tratamiento se inicio entre 2 y 19 meses, siendo el principal motivo para empezarlo el rapido crecimiento (50%). El inicio de respuesta se observo en el 70% de los casos a los 5 dias y en solo 2 tardiamente (mas de un mes). El pico maximo de respuesta se obtuvo a los 3 meses. En el 55% de casos la respuesta fue excelente, buena en el 35%, minima en el 10% y en ninguno nula. Fueron factores predictores de respuesta el HI focal, la fase proliferativa, la localizacion periorbitaria y la ulceracion. No hemos constatado efectos adversos importantes. Conclusion Hemos comprobado la efectividad clinica del PO en la reduccion de los HI, pero no su completa desaparicion al concluir el tratamiento, persistiendo parte de su volumen, color, telangiectasias o cicatrices. El PO ha resultado seguro bajo control ambulatorio.

Tratamiento de hemangiomas infantiles con propranolol en régimen de control ambulatorio. Estudio prospectivo

Objective
To explore the indications of hemangiomas of different types by observing the clinical efficacy of oral propranolol.


Methods
For this retrospective study from October 2009 to June 2013, a total of 1 080 cases were classified into 5 types according to their clinical characteristics. There were 338 males and 742 females. Their types were telangiectasis (n=58), papular (n=424), plump (n=106), deep (n=176) and mixed (n=306). Propranolol was orally administered at a dose of 1.0 or 1.5 mg/kg daily (1.0 mg/kg for infants aged 2.5 months or under; 1.5 mg/kg for those aged 2.5 months or above). Dynamic observations of hemangioma size, texture or color change and adverse events during treatment were performed. Drug withdrawal was usually made after dosing for 1 year or under when there was a total regression of hemandiomas. The efficacy was evaluated on a 4-level scale.


Results
Rank test results showed no significant differences between 5 types during the changes of lesions (χ2=1.738, P>0.05). Changing of lesions occurred 8.0 (3.7, 16.2) hours after dosing in telangiectasis type, whereas 6.5 (4.1, 14.3) hours in papular type, 7.0 (5.5, 12.7) hours in plump type, 7.5 (3.8, 11.3) hours in deep type and 6.5 (4.2, 13.4) hours in mixed type. After a follow-up of 6 months to 2.5 years, there were 378 grade Ⅳ case (35.00%), 574 grade Ⅲ case (53.15%), 120 grade Ⅱcases (11.11%) and 8 gradeⅠcases (0.74%). And there were significant differences between patients of different types (P<0.05). Patients of deep type had the best grade Ⅳ curative effect rate of 59.09% (104/176), then papular type of 51.25% (162/316) and telangiectasis type of 26.41% (112/424).


Conclusion
As a first-line treatment for hemangioma, propranolol shows excellent efficacies for patients of deep, mixed, plaque and papular types.


Key words: 
Hemangioma; Infant; Propranolol; Treatment outcome; Adverse effects

Clinical analysis for treatment of 1 080 cases of infantile hemangiomas with oral propranolol

Objective To evaluate the short-term results and safety of propranolol for the treatment of infantile parotid hemangiomaMethods Oral propranolol was administered to 17 infants with parotid heamngiom at a dose of 10-15 mg per kilogram of body weight per dayThe patients were revisited once a weekThe changes of the tumor size, texture and colour were monitored and recorded at a regular intervalThe adverse effects after medication were observed and managed accordinglyThe short-term results were evaluated using a 4 scales systemResults Among the 17 patients treated, the follow-up time was 5 to 10 monthsThe overall response was scale I in 0 patient, scale Ⅱ in 0 patients, scale Ⅲ in 5 patients, and scale Ⅳ in 12 patientsNo serious adverse effects were encounteredConclusions Oral propranolol at a lower dose is a safe and effective method for the treatment of infantile parotid heamngiomaThe short-term results were excellent and the side effects minimal

Key words: 
Hemangioma; Parotid gland; Propranolol

Treatment of infantile parotid hemangioma with propranolol

Aim

This study aims to evaluate the efficacy and adverse effects of the mesh suture treatment for infants of Kasabach–Merritt phenomenon and to report our treatment experience.



Methods

Of the three patients, two of the cases occurred in the scalp and one occurred in the back of the chest, with platelet counts < 40 × 109/L before the treatment, reduced fibrinogen levels and increased D-dimer levels. All the three patients underwent the mesh suture treatment of the tumour area. Post-treatment observations were made regarding the surface colour and texture of the tumours, periodic routine blood examination results, fibrinogen and D-dimer levels.



Results

After treatment, the degree of swelling on the tumour surface was reduced, surface tension was decreased, the tumour colour turned pale red from dark red and the skin gradually returned to normal. Two days after treatment, the platelet counts increased to 70 × 109/L or higher; the platelet count reached a normal level after 1 week in two cases. The fibrinogen level increased in varying degrees after treatment, whereas the D-dimer level was reduced. One case showed a small amount of exudate at the suture area, 1 month after the treatment; improvements were observed 3 days after changing the local dressing. All the patients were followed up for 6 months to 1 year, during which the patients showed complete regression of the lesion and relapse, normal platelet counts and normal fibrinogen and D-dimer levels.



Conclusions

We recommend the mesh suture treatment as the first treatment of choice for paediatric Kasabach–Merritt phenomenon.

Clinical observations in mesh suture treatment for infants of Kasabach-Merritt phenomenon.

ObjectivesTo evaluate the safety and feasibility of microwave ablation for treating venous malformations (VMs) with severe localized intravascular coagulopathy (LIC).Patients and methodsData for pa...

Venous malformations with severe localized intravascular coagulopathy treated with microwave ablation.

BACKGROUND The aim of the present study is to evaluate the short-term efficacy and feasibility of radiofrequency ablation in the treatment of complex diffuse arteriovenous (AV) malformations. METHODS The data of 18 patients (8 male and 10 female) with complex AV malformations treated between December 2014 and June 2019 were analyzed retrospectively. The lesion area was 10 × 7 cm ~ 28 × 30 cm. Under duplex ultrasound guidance, the site with the most abundant blood flow signals in the lesion was percutaneously punctured with the radiofrequency ablation needle (electrode). The impedance automatic adjustment mode was adopted, and ablation was monitored usingduplex ultrasoundduring the entire process. RESULTS Of the included patients, 1 had a high fever after two rounds of treatment, 2 had transient hemoglobinuria, and 1 had tissue necrosis in the original ruptured tumor area as well as a penetrating defect in the cheek, which was repaired with a pedicled trapezius myocutaneous flap. In 9 patients who experienced bleeding, the bleeding stopped after one round of treatment. During the follow-up period of 1-5 years, there were 0 grade I (poor) cases, 0 grade II (medium) cases, 7 grade III (good) cases, and 11 grade IV (excellent) cases. CONCLUSION The "high power and continuous" radiofrequency ablation technique conducted under real-time duplex ultrasoundmonitoring can completely destroy the deep core lesions of AV malformations and effectively control life-threatening massive hemorrhage; it is an effective alternative treatment method for complex diffuse AV malformations in which interventional embolization, sclerotherapy, and surgery are ineffective.

/pdf/analysis-of-18-complex-diffuse-arteriovenous-malformation-54e0h3tshl.pdf

Chunxiao Ge

Papers

Clinical analysis for treatment of 1 080 cases of infantile hemangiomas with oral propranolol

Treatment of infantile parotid hemangioma with propranolol

Clinical observations in mesh suture treatment for infants of Kasabach-Merritt phenomenon.

Venous malformations with severe localized intravascular coagulopathy treated with microwave ablation.

Analysis of 18 complex diffuse arteriovenous malformation cases treated with percutaneous radiofrequency ablation.