Fetal neck giant hemangioma associated with postnatal arising Kasabach-Merritt syndrome.

We report a prenatal ultrasound dia-gnosis of giant neck hemangioma at 30+1 weeks in a fetus resulting in the postnatal development of Kasabach-Merritt syndrome. Ultrasound scan revealed a large isoechoic mass occupying the whole neck, infiltrating the nasopharyngeal cavity, tongue, lower lip and mandible. Complex sonographic visualization with 2D and 4D was helpful in the process of parental counseling.

Polidocanol injection therapy for small-bowel hemangioma by using double-balloon endoscopy.

BACKGROUND AND AIMS: Small-bowel hemangioma is a rare disease that often causes active bleeding. The standard therapeutic method for small-bowel hemangioma is surgical resection. The aim of this study was to evaluate the usefulness of polidocanol injection (PDI) for small-bowel hemangiomas. METHODS: This study included 12 patients with obscure GI bleeding (6 male; mean age 62 years) with 39 small-bowel hemangiomas; patients were treated with PDI by using double-balloon endoscopy (DBE). EUS with DBE was performed before PDI. The lesions were divided into 2 groups according to tumor size: Group A (size <10 mm; 20 lesions) and group B (size ≥10 mm; 19 lesions). The outcomes of PDI treatment for small-bowel hemangioma were evaluated between the 2 groups. Additionally, in order to standardize the amount of PDI injected, the total amount of polidocanol according to lesion size was calculated. RESULTS: There was no difference in the location of lesions and treatment times between the 2 groups. Group B had a significantly higher injection time per lesion (P < .05) and amount of polidocanol per lesion than group A (P < .01). Rebleeding occurred in only 1 case (8%). There were no adverse events related to PDI. The contribution ratio between the lesion size and amount of polidocanol showed a correlation (r = 0.77). The optimal amount of polidocanol for small-bowel hemangioma was determined to be 0.2 mL/mm. CONCLUSIONS: PDI is an easy, safe, and effective method to treat small-bowel hemangiomas.

Gulossectomy and Skeletal Anchorage as Aajuncts to Orthodontic Correction of a Severe Open Bite Case.

Etiology of open bite malocclusion is multifactorial; therefore, elimination of the main etiologic factor is the key for successful treatment. Tongue size and posture can cause open bite; thus, glossectomy is one of the treatment choices in severe cases. A 19 year old girl with a chief complaint of extra-large tongue and anterior open bite due to hemangioma was referred to us. Hemangioma removal and partial glossectomy were performed. With no other intervention, the anterior open bite decreased 10 millimeters within 3 years. Since the patient refused orthognathic surgery, the remaining malocclusion was resolved by orthodontic treatment using skeletal anchorage.

[Excision of a superior vena cava aneurysm with venous malformations in the face, neck and mouth].

Aneurysm of the superior vena cava is a very rare disease, and there have been few reports of such cases. We report a case of superior vena cava aneurysm excision with venous malformations in the face, neck and mouth. The aneurysm was excised after performing sclerosing therapy for multiple hemangiomas over a period of about one year.

[Anesthetic management of a patient with Sturge-Weber syndrome associated with a giant facial hemangioma].

A 32-year old man with Sturge-Weber syndrome, a rare congenital disease of multiple angiomatous lesions including cervical cortex, face, oral soft tissues, larynx and trachea, underwent the excision of a back lipoma. His hemangioma which extended into the region of the right ophthalmic nerve and superior maxillary nerve is extremely large. He also had mental retardation and epilepsy. No apparent hemangioma was found in his oral cavity, pharynxes, larynx and trachea by preoperative exam. His hemangioma made it difficult to cover his mouth and nose by usual face mask. Though we first considered awake intubation, he was difficult to obey our command. So we searched for the face mask covering his nose and mouth without pressing his facial angioma. Finally, we discovered the full-face mask for NIPPV. After induction with propofol, we confirmed the perfect mask fit, and ventilation by two-person method was effective. Then we administered rocuronium and fentanyl, and intubated without difficulty. The patient was maintained by sevoflurane. He was hemodynamically stable. He was extubated without bleeding and respiratory problems. We experienced general anesthesia of a patient with Sturge-Weber syndrome who had a giant facial hemangioma. With full-face NIPPV mask we safely induced general anesthesia.

Forty-five-months follow-up of a minimally invasive, interdisciplinary treated hemangioma of the mandible with a high risk of severe bleeding - a case report.

BACKGROUND: Hemangiomas are benign tumours, mostly seen in the soft tissues. The intraosseous appearance is rare, in particular in the jaws they represent a very seldom malformation. AIM: To present a combined endodontic and surgical management report of a clinical case with a rare intraosseous hemangioma diagnosis in the mandible. CASE PRESENTATION: This well-documented case report describes the interdisciplinary treatment approach of an intraosseous hemangioma in the left mandible of a 70-year-old male patient. This incidental finding was detected through a routine dental examination. The panoramic radiograph revealed an asymptomatic, apical translucency approximately 15 mm diameter with contact to the mesial root of the tooth 36. The clinical examinations showed no abnormalities. The multifaceted specialized treatments started with the endodontic treatment of the tooth prior to the surgical removal of the lesion and were followed by the histological assessment. As derived from the histologically verified diagnosis, this rare case included the risk of severe bleeding complications during therapy.

Percutaneous vertebral augmentation: the status of vertebroplasty and current controversies.

Vertebroplasty is a cost-effective procedure for the relief of pain and suffering in the appropriate patient when done by a skilled practitioner under good image guidance. No study has ever shown any cost benefit of any balloon-based osteoporotic spine intervention over simple vertebroplasty. No study has ever shown any benefit of any intravertebral implant over vertebroplasty for osteoporotic compression fracture. Recent controversy has highlighted weaknesses in our practice of technology evaluation, and we need to address these issues across the board in the future more scientifically then we have done in the past.

Vertebral augmentation: 7 years experience.

Percutaneous vertebroplasty and kyphoplasty are procedures used to treat pain associated with vertebral compression fractures. Controversies are still open regarding indications, efficacy and safety of the procedures, and regarding the potential benefits, advantages and shortcomings of PV versus KP.Aim of this article is to report 7 years' experience in vertebral augmentation of the E.VE.RES.T. (European VErtebroplasty RESearch Team) group. The main topics are the treatments of hemangioma and malignant lesions, technically challenging cases such as vertebra plana, multifragmented fractures, multilevel treatments, refracture of augmented vertebra, and treatment of cervical junction and sacrum.

Infantile haemangiomas: Identifying high-risk lesions in primary care.

BACKGROUND: Infantile haemangiomas (IHs) are benign vascular tumours that affect up to 10% of infants and arise in the first few weeks-to-months of life. Some are associated with an increased risk of complications and poor cosmetic outcomes. General practitioners (GPs) are ideally placed to identify high-risk IHs and coordinate their management. OBJECTIVE: The aim of this article is to outline strategies to identify high-risk IHs and when to involve a multidisciplinary team. DISCUSSION: IHs that involve the lower face or neck can be associated with airway obstruction. Having five or more IHs is associated with hepatic haemangiomas, high-output cardiac failure and hypothyroidism. IHs that involve the eyes or mouth can cause functional impairments such as amblyopia and feeding difficulties, respectively. Large segmental IHs maybe associated with syndromic presentations including PHACE syndrome when on the lower face, PELVIS syndrome when on the perineum and LUMBAR syndrome when on the lower back.

[Annular elastolytic giant cell granuloma]. / Granulome élastolytique annulaire à cellules géantes.

BACKGROUND: Annular elastolytic giant cell granuloma (AEGCG) is a rare form of granulomatous dermatosis. It is characterised histologically by phagocytosis of elastic fibres by multinucleated cells. We report a favourable outcome in a case of AEGCG following PUVA therapy and treatment with synthetic antimalarials. PATIENTS AND METHODS: A 67-year-old retired wine grower presented with highly pruritic annular lesions with raised borders on the shoulders and trunk that had been present for several months. Histological examination of a biopsy sample from the erythematous border was characteristic of AEGCG. Various topical treatments proved ineffective and systemic corticosteroids attenuated the patient's pruritus but had no effect on the skin lesions. PUVA therapy resulted in regression of lesions on the trunk, but the rash spread to the patient's arms and was covered with epidermal microcysts. PUVA therapy was discontinued and treatment with a synthetic antimalarial (hydroxychloroquine 400mg/d) was initiated, resulting in complete regression of the lesions. DISCUSSION: AEGC was isolated in 1979 by Hanke et al. on the basis of five cases seen in females. This is a rare form of dermatosis with some 30 cases being reported in the English literature. The clinical aspect is fairly evocative, with erythematous papular lesions, either alone or in groups, with a raised border and a lighter centre tending towards atrophy. In most cases, the lesions are found predominantly in areas exposed to sunlight. The histological appearance is characteristic, with an image of giant cell elastophagic granuloma from which the name of the disease is taken. This appearance allows the disease to be differentiated from a number of other granulomatous diseases. The aetiology is unknown and treatment is empirical. Spontaneous cure can occur and consistent results have not been obtained with any treatments. In our case, PUVA was partly successful, and the synthetic antimalarials resulted in complete regression of residual lesions.

Periodontal management of gingival enlargement associated with Sturge-Weber syndrome.

BACKGROUND: Sturge-Weber syndrome (encephalotrigeminal angiomatosis) is a rather uncommon congenital condition that is characterized by a combination of venous angioma of leptomeninges over the cerebral cortex and ipsilateral angiomatous lesions of the face and sometimes of the skull, jaws, and oral soft tissues. It is commonly referred to as Sturge-Weber syndrome after Sturge and Weber who first described this affliction in 1879. This article presents a case of Sturge-Weber syndrome associated with severe gingival enlargement, its management, and follow-up results. METHODS: A 15-year-old male patient was referred to the Department of Periodontics, Government Dental College and Hospital, for severe gingival enlargement. A detailed dental and medical history, clinical examination, and investigations confirmed the diagnosis of Sturge-Weber syndrome. This report reveals a classic presentation of the syndrome with emphasis on its oral manifestations. Periodontal management included thorough scaling and root planing followed by periodontal flap surgery to treat the gingival enlargement. Histopathologic examination of the excisional biopsy specimen revealed features suggestive of fibrous gingival enlargement. RESULTS: Reevaluation of the patient after 2 years showed remarkable (90%) reduction of the gingival enlargement in the maxillary arch and complete diminution (100%) in the mandibular arch. However, a slight recurrence was noted in the maxillary right quadrant. CONCLUSIONS: Sturge-Weber syndrome is clinically important to the periodontist because of its associated gingival vascular features and their complicating manifestations. Periodic systemic and oral examinations are recommended to identify and prevent any complications from the cranial and oral lesions.

[Percutaneous vertebroplasty for vertebral fractures caused by multiple myeloma, an aggressive vertebral haemangioma and in a traumatic burst fracture]. / Percutane vertebroplastiek bij wervelfracturen door de ziekte van kahler, agressief vertebraal hemangioom en bij een traumatische burstfractuur.

Percutaneous vertebroplasty (PVP) using polymethylmethacrylate bone cement is frequently used in the treatment of painful osteoporotic vertebral compression fractures in the Netherlands. In three patients there was another indication. A 44-year-old woman suffering from vertebral pain due to an osteolytic lesion caused by multiple myeloma was treated with vertebroplasty of 4 vertebral levels. A 60-year-old woman with progressive complaints of back pain due to an aggressive vertebral haemangioma was treated with vertebroplasty after embolisation had only been partially successful. Lastly, a 50-year-old non-osteoporotic man with back pain persisting for six weeks due to a stable traumatic burst fracture of TIX could not be treated with standard care, i.e. corset and analgesics, because of obesity. He was treated with PVP after a cavity had been created in the vertebral corpus. Vertebroplasty is a minimal invasive procedure resulting in most patients in rapid diminishment of the pain caused by pathological vertebral fractures, which may be present for a longer period and may have different causes. The indication triad for vertebroplasty consists of localised back pain, pain when pressure is applied to the processus spinosus of the fractured level and MRI bone oedema, findings suggestive of microfractures in a pathologically changed vertebral body. The procedure is also suitable in patients with extensive comorbidity or a short life expectancy.

Skin integrity and silicone: Appeel 'no-sting' medical adhesive remover.

This article offers an overview of skin and the importance of maintaining intact skin in relation to wound and stoma care. Various patients and their conditions are considered in relation to their potential for skin damage with the removal of adhesive products, including paediatrics, those with epidermolysis bullosa, haemangioma, fragile skin, elderly skin and ostomates. The importance of protecting fragile skin and protecting the peri-wound and peri-stoma area is discussed and the impact of such damage on quality of life is considered. The evidence relating to the impact that silicone-based adhesive removers can have is reviewed with a conclusion that an evidence-based approach can significantly affect patient outcomes.

Gingival hemangioma with port wine nevi of the face. A case report.

Hemangioma is a proliferating mass of blood vessels. Its occurrence in gingiva is rare. The diagnosis and treatment of hemangioma is complex, and any attempt to carry out biopsy/surgical excision may lead to fatal consequences due to severe hemorrhage. A rare case of gingival hemangioma with port wine nevi of face is reported. The case is of periodontal interest because the lesion occurred on the gingiva, a reliable diagnostic approach (Ultrasound Spectra Doppler Flow) was used and a conservative treatment using a sclerosing agent was employed.

Asociación de hemangioma en zona cérvico facial y hemangioma subglótico en un neonato / Association of cervical-facial and subglottic hemangioma in neonates / Associação de hemangioma cervicofacial e subglótico em neonatos

Se presenta un neonato con hemangioma cérvico facial y posterior diagnóstico de hemangioma subglótico. Los hemangiomas en el período neonatal y los primeros meses de vida requieren una atención cuidadosa. Debido a su patrón de crecimiento y la futura aparición de nuevas lesiones, son considerados imprevisibles en esta etapa. Se encontró una fuerte asociación entre los hemangiomas difusos de localización cérvico facial y los hemangiomas sintomáticos de la vía aérea alta. El riesgo está relacionado con el grado de extensión de la afectación cutánea en un área que incluye la piel de la región mandibular, el mentón, el labio inferior y la parte anterior del cuello. Los hemangiomas infantiles requieren tratamiento cuando presentan riesgo vital y alteraciones funcionales, como compromiso de la vía aérea.

This is the case of a newborn with cervical hemangioma and a subsequent diagnosis of subglottic hemangioma. Hemangiomas in neonates and infants require careful attention. Due to their growth pattern and the potential appearance of new lesions, they are considered unpredictable at this stage. A strong link was found between diffuse cervical-facial and symptomatic upper airway hemangiomas. The risk is related to the extent of skin involvement in a given area, which might include the jaw, chin, lower lip, and front of the neck skin. Infant hemangiomas require treatment when they present life-threatening and functional alterations, such as airway compromise.

Relatamos o caso de um recém-nascido com hemangioma cervical com diagnóstico posterior de hemangioma subglótico. Hemangiomas em recém-nascidos e lactentes requerem atenção cuidadosa. Devido ao seu padrão de crescimento e ao potencial aparecimento de novas lesões, são considerados imprevisíveis nessa fase. Uma forte associação foi encontrada entre hemangiomas cervicofaciais difusos e hemangiomas sintomáticos das vias aéreas superiores. O risco está relacionado à extensão do envolvimento da pele da mandíbula, o queixo, o lábio inferior e a pele da frente do pescoço. Os hemangiomas infantis necessitam de tratamento quando apresentam alterações funcionais ou risco de vida, como comprometimento das vias aéreas.

Interventional Treatment for Giant Hepatic Hemangioma Accompanied by Arterio-portal Shunt with Ascites.

A 73-year-old woman with massive ascites associated with a giant hepatic mass accompanied by arterio-portal (AP) shunt was admitted to our hospital. Based on contrast-enhanced computed tomography (CT) and angiography findings, hepatic hemangioma with AP shunt and ascites due to portal hypertension was diagnosed. Transcatheter arterial embolization (TAE) by N-butyl-2-cyanoacrylate (NBCA) was performed without complications. The patient's ascites disappeared, and her liver function test results improved after the treatment. The patient has maintained a steady state for two years. This case indicates that TAE with NBCA is a safe and effective treatment for hepatic hemangioma accompanied by AP shunt.

Multiple Enlarged Aneurysms in Primary Racemose Hemangioma of the Bronchial Artery: Successful Prophylactic Transcatheter Arterial Embolization Using N-butyl-2-cyanoacrylate and Coils.

An asymptomatic 48-year-old man presented with multiple aneurysms in a primary racemose hemangioma of the right bronchial artery. Bronchial arteriography revealed a tortuous artery with four fusiform aneurysms of varying sizes and aneurysmal dilatation with marked thrombus formation in the long segment of the distal portion. Because the tip of catheter could not pass beyond the aneurysmal dilatation, we performed balloon-occluded embolization using a mixture of N-butyl-2-cyanoacrylate (NBCA) and iodized oil. For four other aneurysms, we performed embolization using a coil alone or with NBCA. After 6 months, right bronchial arteriography revealed no enhancement of the aneurysms. Despite the rarity of this procedure, embolization with NBCA is a good option for bronchial artery aneurysm embolization.

[Vertebroplasty: state of the art]. / Vertébroplastie: état de l'art.

Over the last 10 years, there has been much development in the management of metastatic and osteoporotic vertebral compression fractures using vertebroplasty. This percutaneous image-guided interventional radiology procedure allows stabilization of a vertebral body by injection of an acrylic cement and frequently results in significant symptomatic relief. During cement polymerisation, an exothermic reaction may destroy adjacent tumor cells. Advances have been made to reduce complications from extravasation of cement in veins or surrounding soft tissues. Safety relates to experience but also to technical parameters: optimal cement radio-density, adequate digital fluoroscopy unit (single or bi-plane digital angiography unit), development of cements other than PMMA to avoid the risk of adjacent vertebral compression fractures. The rate of symptomatic relief from vertebroplasty performed for its principal indications (vertebral hemangioma, metastases, osteoporotic fractures) reaches 90-95%. The rate of complications is about 2% for metastases and less than 0.5% for osteoporotic fractures. Vertebroplasty plays a major role in the management of specific bone weakening vertebral lesions causing, obviating the need for kyphoplasty.