Objective: The aim of this study was to describe a novel anesthesia, intralesional lidocaine anesthesia (ILA), for ethanol sclerotherapy of venous malformation and evaluate the efficacy and safety. Methods: A prospective study of 100 patients with venous malformations undergoing 100 sclerotherapy procedures with intralesional lidocaine anesthesia (ILA) was conducted. Pain was evaluated by numeric rating scale (NRS) immediately following the procedure. The grade of pain was classified by the NRS as no pain (0), mild (1–3), moderate (4–6), and severe (7–10). Local and systemic complications caused by lidocaine were recorded. Results: The median injected volume of absolute ethanol and 0.25% lidocaine was 5.9 mL and 17.0 mL, respectively. In ILA group, 13 patients had no pain during the procedure, 42 patients had mild pain, 38 patients had moderate pain, and 7 patients had severe pain. The mean NRS scores of the whole ILA group were 3.2 (0–8). No local or systemic complications attributed to lidocaine were reported. Conclusion: In a limited series, intralesional lidocaine anethesia seems to be efficient and safe for use in pain management for ethanol sclerotherapy of venous malformation. This anesthesia technique may be a promising first approach for the ethanol sclerotherapy of venous malformations, as it is easy to handle and has minimal sequelae.
Uterine myoma, the most common form of uterine tumor, occurs in approximately 25% of reproductive-aged women. Parasitic myoma, which outgrows its uterine blood supply and obtains a secondary blood supply from another organ such as the omentum, is rare. It is extremely rare if it is on the peritoneum of the right pelvic wall. Only a few cases have been found in this location so far. Here, the authors report an interesting case of parasitic myoma on the peritoneum of the right pelvic wall. They conclude with seven key points, which should be paid more attention to avoid iatrogenic parasitic myoma.
Propranolol has been the first-line treatment for problematic infantile hemangioma (IH) since 2008. The recurrence of IHs after stopping treatment with propranolol was reported in several studies. Mechanisms underlying this phenomenon have not been elucidated so far. Our study is the first to show the general pathology of recurrence of IH after stopping treatment with propranolol. It can provide help for the clinical treatment of IHs.
Background: Compared with singletons, a twin pregnancy is associated with a larger thyroid hormone demand and an increased stimulation of gestational thyroid function due to higher concentrations of human chorionic gonadotropin. However, such effects have been sparsely quantified. The aim of this study was to evaluate thyroid function and thyroid function test abnormalities in twin pregnancies during early and late pregnancy compared with singletons. Methods: We included 1208 twin pregnancies and 46,834 singleton pregnancies with thyroid function tests available. Thyroid function test abnormalities were defined using population-based reference ranges. The analyses were adjusted for potential confounders including maternal age and body mass index. Results: Compared with singletons, a twin pregnancy was associated with a lower thyrotropin (TSH) (β = -0.46 [95% confidence interval, CI -0.49 to -0.44], p < 0.001) and a higher free thyroxine (fT4) (β = 0.91 [CI 0.69-1.16], p < 0.001) during early pregnancy. During late pregnancy, a twin pregnancy was associated with a higher TSH (β = 0.35 [CI 0.29-0.42], p < 0.001) while fT4 did not differ (β = -0.11 [CI -0.22 to 0.01], p = 0.065). During early pregnancy, a twin pregnancy was associated with a higher risk of overt hyperthyroidism (odds ratio, OR = 7.49 [CI 6.02-9.33], p < 0.001), subclinical hyperthyroidism (OR = 5.26 [CI 4.17-6.64], p < 0.001), and isolated hypothyroxinemia (OR = 1.89 [CI 1.43-2.49], p < 0.001), but with a lower risk of subclinical hypothyroidism (OR = 0.27 [CI 0.13-0.54], p < 0.001). In late pregnancy, a twin pregnancy was associated with a higher risk of subclinical hypothyroidism (OR = 4.05 [CI 3.21-5.11], p < 0.001), isolated hypothyroxinemia (OR = 1.48 [CI 1.04-2.10], p = 0.028), and subclinical hyperthyroidism (OR = 1.76 [CI 1.27-2.43], p < 0.001). Conclusions: During early pregnancy, a twin pregnancy was associated with a higher thyroid function and a higher risk of (subclinical) hyperthyroidism, as well as a higher risk of isolated hypothyroxinemia. During late pregnancy, a twin pregnancy was associated with a higher TSH concentration and a higher risk of subclinical hypothyroidism, as well as a persistently higher risk of isolated hypothyroxinemia and subclinical hyperthyroidism. The study was approved by Chinese Clinical Trial Registry (registration no. ChiCTR1800014394).
Purpose: Despite many advances in the knowledge of vascular malformations, extracranial arteriovenous malformations (AVMs) remain an enigma and are usually misdiagnosed and mismanaged due to their associated rare morbidity. This study aimed to describe the clinical course and emphasize the progressive nature of AVMs through a retrospective study of 446 patients. Methods: Patients with cutaneous and soft-tissue AVMs presenting to our Vascular Anomalies Center between March 2011 and March 2017 were reviewed. Medical records were examined for disease course, age at first presentation at our institution, distributions and locations of lesions, clinical staging, progression, and previous treatments. Progression was defined as advancement to a higher Schobinger stage from a lower stage. Results: A total of 446 patients (mean age, 25.6 ± 14.0 years) were enrolled in this study, including 232 (52.0%) males (gender ratio, 1.08:1). Arteriovenous malformations lesions in 76.7% (342/446) of the patients were located in the head and neck. Children with Stage I AVMs had a 41.9% risk of progression before adolescence and an 80.0% risk of progression before adulthood. Nearly all patients (96.2%) showed progression in adulthood. Diffuse lesions were more likely to progress than localized lesions ( P < 0.05) in childhood and adolescence. Lesions in the head and neck regions were less likely to progress than those in other regions in childhood ( P = 0.005). A total of 216 (48.4%) patients had undergone previous treatments. Among these patients, bleomycin showed an unintentional positive effect in the treatment of AVMs. Conclusions: Extracranial AVMs have a continuously progressive nature. A full understanding regarding the progressive course of AVMs can lead patients and physicians to attach importance to early diagnosis and management. Meanwhile exploring innovative treatments should be focused in the future to prevent potential destructive progression.
To the Editor: Arteriovenous malformation (AVM), a vascular hamartomatous malformation, is rarely found on biopsy of hypertrophic and nodular port-wine stains (PWS).1Sanchez-Carpintero I. Mihm M.C. Mizeracki A. Waner M. North P.E. Epithelial and mesenchymal hamartomatous changes in a mature port-wine stain: morphologic evidence for a multiple germ layer field defect.J Am Acad Dermatol. 2004; 50: 608-612Abstract Full Text Full Text PDF PubMed Scopus (47) Google Scholar, 2Chen D. Hu X.J. Lin X.X. Ma G. Jin Y.B. Chen H. et al.Nodules arising within port-wine stains: a clinicopathologic study of 31 cases.Am J Dermatopathol. 2011; 33: 144-151Crossref PubMed Scopus (26) Google Scholar Digital subtraction angiography (DSA) is the gold standard method for diagnosis of AVM.3Liu A.S. Mulliken J.B. Zurakowski D. Fishman S.J. Greene A.K. Extracranial arteriovenous malformations: natural progression and recurrence after treatment.Plast Reconstr Surg. 2010; 125: 1185-1194Crossref PubMed Scopus (236) Google Scholar Lesions that show an early visualized draining vein during DSA is one of the main characteristics. We herein provide DSA evidence of limited AVM in mature PWS. A 22-year-old man visited our plastic and reconstructive surgery unit for treatment of his PWS birthmark (Fig 1). A PWS hyperplasia nodule in his temporal region had enlarged over the past 5 years. He had received no other treatment, except cryotherapy in his cervical region at age 1, and he had no previous trauma to the lesion or family history of vascular malformations. Magnetic resonance imaging and enhanced computed tomography showed abundant blood flow supplying the lesion and a well-defined soft tissue mass in the temporal region. DSA showed a tortuous feeding artery and an early visualized draining vein in arterial phase (Fig 2), suggesting the existence of AVM in the mass. A mass biopsy specimen was composed of large numbers of capillaries, and possible arterioles or postcapillary venules. Another patient, a 34-year-old man with a PWS birthmark on his left mid-facial region, was examined on our unit. A PWS hyperplasia nodule on his upper eyelid had enlarged slowly over the past 10 years. He had no previous treatment. His case history and the manifestation profile of his PWS lesion were similar to that of the previous patient. DSA showed that the feeding artery of the hyperplasia lesion was the ophthalmic artery, and the draining vein was visualized early, in 1.9 seconds. Draining veins of normal organs are usually seen about 3 seconds after the arterial phase. AVM is a progressive vascular malformation, and the expansion of an AVM lesion progresses inevitably according to its natural course. DSA in these 2 cases proved the existence of limited abnormal arteriovenous communications. Micro-AVM may be the cause of the enlargement in these two hypertrophic PWS nodules. Moreover, we suspect the existence of unknown micro-AVM or AVM in some cases of hypertrophic and nodular PWS. The diagnoses in these two cases are not analogous to “capillary malformation−arteriovenous malformation” (CM-AVM). Differentiating characteristics of CM-AVM include4Eerola I. Boon L. Mulliken J. Burrows P. Dompmartin A. Watanabe S. et al.Capillary malformation-arteriovenous malformation, a new clinical and genetic disorder caused by RASA1 mutations.Am J Hum Genet. 2003; 73: 1240-1249Abstract Full Text Full Text PDF PubMed Scopus (550) Google Scholar: (1) Autosomal dominance (RASA1 mutation); (2) manifestation as Sturge-Weber syndrome, Klippel-Trenaunay syndrome, or Parkes Weber syndrome; (3) pale pink CM lesions accompanied by high skin temperature; (4) diffuse AVM lesions under CM lesions.
Functional impairment is a common complaint in patients with venous malformations. Equinus can occur when the venous malformation involves the lower limb, a challenging condition with only a few studies to guide treatment choices. This study was aimed to investigate the operative management of equinus associated with lower limb venous malformations.Between August 2015 and September 2017, a total of 12 patients presented with equinus associated with lower limb venous malformations and underwent surgical correction. Preoperative and postoperative clinical symptoms, physical examination and orthopaedic evaluation were retrospectively reviewed. 8 patients who experienced pain underwent percutaneous sclerotherapy prior to the operation. Surgical management included gastrocnemius intramuscular aponeurotic recession, Z-lengthening of the Achilles tendon, Hoke technique and Taylor Spatial Frame external fixation.There were eight female and four male patients with a mean age of 14.3 ± 5.9 years. The mean follow-up period was 34.8 ± 9 months. The range of motion of ankle dorsiflexion (with knee extended) improved for each patient (mean, 25.4 degrees; standard deviation, 8.5 degrees). No neurovascular complications were observed.Operative correction of equinus associated with lower limb venous malformations is safe and effective. Selective preoperative sclerotherapy is necessary for optimal outcomes.
Head and neck arteriovenous malformations (AVMs) involving branches of the facial nerve often cause tremendous cosmetic, functional, and psychological problems that are challenging to treat. We proposed an algorithm to obtain the optimal treatment and esthetic outcome.Medical records of 24 patients were reviewed between 2002 and 2015. The lesions were classified into 4 types: type 1, involving no more than 2 facial nerve branches, with a maximal diameter of lesion of 5 cm or less (n = 7); type 2, involving no less than 2 facial nerve branches, with a maximal diameter of lesion of greater than 5 cm (type 2a, facial nerve preservation, n = 8; type 2b, facial reanimation, n = 5); and type 3, involving the mastoid segments or the trunk of the facial nerve (n = 4). Treatment efficacy was assessed and facial function was evaluated using the regional House-Brackmann Facial Nerve Grading System.Cure was achieved in 11 (45.8%) patients, and improvement was achieved in 12 (50.0%) patients, with a follow-up of 36.3 ± 32.9 months (range, 12-144 months). There was no significant difference of the regional House-Brackmann Facial Nerve Grading System score before and after treatment (type 1, unchanged; type 2a, P = 0.356; type 2b, P = 0.423; type 3, unchanged). Treatment outcomes were not significantly related to the type of nerve involvement (P = 1.000) and the facial reanimation procedure (P = 1.000).Surgical excision or ethanol embolization alone is efficient for type 1 AVMs. The optimal approach for type 2a AVMs was surgery, followed by well-vascularized tissue transfer. In type 2b AVMs, the satisfied treatment results are achieved by lesion excision and immediate facial reanimation. A 2-stage strategy may result in contented treatment outcome in type 3 AVMs.
'/%3e%3cuse xlink:href='%23a' transform='rotate(23.036 .093 25.536)'/%3e%3cuse xlink:href='%23a' transform='rotate(45.87 1.273 16.18)'/%3e%3cuse xlink:href='%23a' transform='rotate(69.945 .996 12.078)'/%3e%3cuse xlink:href='%23a' transform='rotate(20.66 -19.689 31.932)'/%3e%3c/svg%3e)