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Arminda A. Intense Pulsed Light (IPL) for the treatment of vascular and pigmented lesions. J Cosmet Dermatol 2024; 23 Suppl 1:1-6. [PMID: 38587306 DOI: 10.1111/jocd.16281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND IPL devices emit a wide range of wavelengths that can be absorbed by different chromophores in the skin. Selective destruction of a specific chromophore with minimal side effects is controlled by wavelength, pulse duration, and fluence. AIM This study aims to evaluate the treatment of vascular and pigmented lesions using narrow-band Intense Pulsed Light (IPL) with Advanced Fluorescence Technology (AFT), which offers more efficient energy usage per pulse to increase safety, and improve clinical outcomes. METHODS A retrospective analysis of data from 100 patients treated with narrow-band IPL for vascular and pigmented lesions. Efficacy was measured by the Global Aesthetic Improvement Scale (GAIS) and Patient Satisfaction Scale (0-10). Safety was assessed by evaluating pain levels and adverse events. RESULTS Mean GAIS scores were 8.02 ± 0.84 for vascular and 8.14 ± 0.9 for pigmented lesions with no significant difference between groups (p=0.49, α=0.05). Patient satisfaction correlated with GAIS scores (correlation coefficient 0.8). No pain was reported and two patients experienced temporary and transient side effects. CONCLUSION Overall, the advanced IPL treatments provided favorable outcomes for vascular and pigmented lesions.
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Calik J, Zawada T, Bove T, Dzięgiel P, Pogorzelska-Antkowiak A, Mackiewicz J, Woźniak B, Sauer N. Healing Process after High-Intensity Focused Ultrasound Treatment of Benign Skin Lesions: Dermoscopic Analysis and Treatment Guidelines. J Clin Med 2024; 13:931. [PMID: 38398246 PMCID: PMC10888560 DOI: 10.3390/jcm13040931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/27/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Background: High-Intensity Focused Ultrasound (HIFU) has emerged as a precise and non-invasive modality for tissue ablation and healing. This study presents a detailed dermoscopic analysis of skin healing post-High-Intensity Focused Ultrasound (HIFU) treatment, focusing on common benign skin lesions, such as seborrheic keratosis, sebaceous hyperplasia, vascular lesions, and sebaceous nevi. Methods: Prior to HIFU treatment, a comprehensive assessment was conducted, integrating ultrasound scanning and clinical evaluations. The TOOsonix System ONE-M was employed for HIFU treatments, with parameters tailored to each lesion type. Results: A common pattern observed across all lesions includes initial whitening post treatment, followed by scab formation and the development of a pink area with reparative vessels. This study, however, highlights distinct differences in fibrosis patterns and healing timelines across different lesion types. Each lesion type exhibited unique fibrosis patterns post treatment. Flatter variants of seborrheic keratosis healed within a month, displaying hypopigmentation and reparative vessels, alongside a distinct lattice fibrosis pattern in more verrucous forms, which took about two months to heal. Sebaceous hyperplasia, characterized by rapid healing within three weeks, demonstrated fibrosis with pink areas and perpendicular white lines, concluding with a slight depression. Vascular lesions varied in healing time based on depth, with superficial ones showing whitening and crust formation, while deeper lesions had vessel occlusion and size reduction accompanied by concentric fibrotic bands. Sebaceous nevi presented the longest healing duration of three months, characterized by amorphous white-gray structures, scab formation, and the emergence of pink areas with branching vessels, leading to clear skin with reduced white lines. Conclusions: in conclusion, this meticulous clinical evaluation highlights the unique healing characteristics and timelines for each skin lesion type treated with HIFU. These insights are invaluable for optimizing follow-up assessments, identifying potential complications, and refining treatment protocols. By providing detailed insights into the healing timelines and patterns for different types of lesions, patients can be better informed about their post-treatment journey.
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Affiliation(s)
- Jacek Calik
- Department of Clinical Oncology, Wroclaw Medical University, 50-556 Wrocław, Poland
- Old Town Clinic, 50-136 Wroclaw, Poland;
| | - Tomasz Zawada
- TOOsonix A/S, 2970 Hoersholm, Denmark; (T.Z.); (T.B.)
| | - Torsten Bove
- TOOsonix A/S, 2970 Hoersholm, Denmark; (T.Z.); (T.B.)
| | - Piotr Dzięgiel
- Division of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, T. Chalubinskiego 6a, 50-368 Wroclaw, Poland;
- Department of Human Biology, Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
| | | | - Jacek Mackiewicz
- Department of Medical and Experimental Oncology, Institute of Oncology, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | | | - Natalia Sauer
- Old Town Clinic, 50-136 Wroclaw, Poland;
- Faculty of Pharmacy, Wroclaw Medical University, 50-556 Wroclaw, Poland
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Farahani M, Hashemi SA, Goodarzi S, Hajikarimloo B, Pour-Ghazi F, Noori S, Alijani S, Khavandegar A. A rare case report of cervical hemangioma and a comprehensive literature review of 137 cases of cervical and uterine hemangiomas. Int J Gynaecol Obstet 2024; 164:421-435. [PMID: 37382400 DOI: 10.1002/ijgo.14961] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/01/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
The cervix of the uterus is a rare site for cavernous hemangiomas. Cervical hemangiomas are slow-growing tumors with characteristic histological findings, including dilated vessels with increased endothelial cells. Although their pathophysiology remains unclear, hormones are believed to play an important role in the development of these vascular tumors. They may be asymptomatic due to their small size, but they can cause gynecological and obstetrical complications, including abnormal uterine bleeding and impaired fertility. Due to their small size, conservative treatment is the first line of management. Hysterectomy is considered for refractory cases or for patients who are not of childbearing age. In this study, firstly, we presented a case of a 60-year-old postmenopausal female without any gynecological-related signs or symptoms with a polypoid nodule hanging over the anterior cervical wall through its stalk. The surgical biopsy revealed no signs of neoplastic changes, with the only notable finding being a benign vascular lesion representing a cavernous hemangiomatous cervical polyp. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy and she is currently healthy without any further abnormal findings. Additionally, we provided a comprehensive review of 137 cases in the literature since 1883, detailing their characteristics, signs and symptoms, and pathology.
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Affiliation(s)
- Maasomeh Farahani
- Department of Gynecology and Obstetrics Medicine, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Seyyed-Ali Hashemi
- Department of Pathology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Sogand Goodarzi
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Bardia Hajikarimloo
- Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzad Pour-Ghazi
- Center for Orthopedic Trans-Disciplinary Applied Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Noori
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Saba Alijani
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Armin Khavandegar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Emami A, Bahadoran E, SamieeRad F. Cavernous hemangioma of corpus imitating endometrial polyp in a young non-pregnant woman: A case report study. Clin Case Rep 2024; 12:e8413. [PMID: 38188844 PMCID: PMC10766558 DOI: 10.1002/ccr3.8413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/21/2023] [Accepted: 12/24/2023] [Indexed: 01/09/2024] Open
Abstract
Key Clinical Message Cavernous hemangiomas are rare and have various non-specific clinical presentations, such as menorrhagia. It can mimic different diseases such as endometrial polyps. Pathologists and gynecologists should be aware of performing histopathological examinations of this neoplasm for accurate diagnosis and to avoid unwarranted therapeutic interventions. Abstract Internal genital tract hemangiomas are rare and can be divided into capillary and cavernous. We present a rare case of cavernous hemangioma (CH) of the corpus in a young, non-pregnant woman. The patient was a 28-year-old woman who had complained of menorrhagia for 2.5 years. Sonography showed a hypoechoic intramural area measuring 35 × 23 mm. Histomorphology revealed neoplastic proliferation of dilated thin-walled arteries of various sizes within the myometrium. Due to the variable clinical presentations of CH, histopathological examination should be performed for an accurate diagnosis. It is a rare entity and we recommend training pathologists and gynecologists on this neoplasm for accurate diagnosis and to avoid unwarranted therapeutic interventions.
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Affiliation(s)
- Ali Emami
- School of MedicineQazvin University of Medical SciencesQazvinIran
| | | | - Fatemeh SamieeRad
- Department of Pathobiology, Faculty of Medical SchoolQazvin University of Medical SciencesQazvinIran
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Almatrudi M, Alnowaishiri K, Babiker S, Alsufyani D, Abdelaziz A. Surgical Intervention in Pediatric Orbital Hemangioma: A Case Report. Cureus 2023; 15:e50156. [PMID: 38186409 PMCID: PMC10771630 DOI: 10.7759/cureus.50156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 01/09/2024] Open
Abstract
Infantile hemangiomas are common vascular tumors in infancy, typically affecting the skin. However, intraconal orbital hemangiomas are rare and present diagnostic challenges due to their impact on critical structures within the orbit. We present the case of a 1-year-old male with progressive orbital swelling and proptosis. Initial conservative management with propranolol was attempted, but due to the lack of response, surgical resection of the intraconal hemangioma was performed. Pediatric orbital hemangiomas, particularly intraconal variants, pose distinctive diagnostic challenges. While conservative approaches, such as propranolol, align with evolving strategies for infantile hemangiomas, surgical intervention may be necessary in cases with an inadequate response. This case underscores the importance of recognizing the need for timely surgical intervention in pediatric orbital hemangiomas, even after initial conservative measures. Successful surgical outcomes contribute to understanding pediatric orbital pathology and emphasize the ongoing evolution of management strategies in this challenging clinical scenario.
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Affiliation(s)
| | | | - Sabrin Babiker
- General Practice, National Ribat University, Khartoum, SDN
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Koueik J, Larson S, Ahmed A, Hanna AS. Large vertebral artery pseudoaneurysm masquerading as a schwannoma: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23168. [PMID: 37392763 PMCID: PMC10555631 DOI: 10.3171/case23168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/30/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Extracranial vertebral aneurysms or pseudoaneurysms are rare and result primarily from trauma. Large pseudoaneurysms can masquerade as mass lesions, making it challenging to identify the correct diagnosis. OBSERVATIONS This is a case report in which a large vertebral pseudoaneurysm posed as a schwannoma and biopsy was attempted. It was later identified as a vascular lesion and treated appropriately with no complications. LESSONS Vascular etiologies should always be included in the differential diagnosis of spine and nerve pathologies especially lesions that are in the vicinity of major vascular channels such as the transverse foramina of the cervical spine.
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Affiliation(s)
| | - Sarah Larson
- Department of Neurologic Surgery, University of Wisconsin, Madison, Wisconsin
| | - Azam Ahmed
- Department of Neurologic Surgery, University of Wisconsin, Madison, Wisconsin
| | - Amgad S. Hanna
- Department of Neurologic Surgery, University of Wisconsin, Madison, Wisconsin
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7
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Hasan S, Khan A, Banerjee A, Ramalingam K. Infantile Hemangioma of the Upper Lip: Report of a Rare Case With a Brief Review of Literature. Cureus 2023; 15:e42556. [PMID: 37637601 PMCID: PMC10460138 DOI: 10.7759/cureus.42556] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Hamartomas are tumor-like abnormalities typified by the presence of cellular proliferation indigenous to the native site. However, hamartomas maintain growth cessation without the potential for further growth or malignant transformation. Hamartomas are commonly seen in the lungs, kidney, liver, and spleen and rarely occur in the orofacial region. Various hamartomatous oral lesions include hemangiomas, lymphangiomas, tori, exostosis, dens invaginatus, dens evaginatus, odontomas, nevi, and cherubism. Infantile hemangiomas are benign vascular tumors that emerge soon after birth and experience rapid growth within the first year. Oral hemangiomas affect up to 6.4% of infants and are more common on the ventral surface of the tongue, as opposed to oral vascular malformations, which are more prevalent on the lips. It also has a 3:1 female-to-male predominance. Afterward, their growth usually stabilizes and enters a prolonged, incomplete involution phase. Uncomplicated hemangiomas generally exhibit spontaneous resolution, whereas few can leave behind scars and telangiectasias on the external surface of the skin on which it occurs. Thus, lesions located in anatomically sensitive regions necessitate vigilant surveillance and treatment. This paper deals with an asymptomatic swelling of the upper lip in a four-year-old female child but with problems in aesthetics, speech, and feeding. A thorough history, clinical examination, positive diascopy, ultrasonography, and histopathology confirmed the diagnosis of infantile hemangioma.
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Affiliation(s)
- Shamimul Hasan
- Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
| | - Ateeba Khan
- Oral Medicine and Radiology, Faculty of Dentistry, Jamia Millia Islamia, New Delhi, IND
| | - Abhishek Banerjee
- Oral and Maxillofacial Pathology, Awadh Dental College and Hospital, Jamshedpur, IND
| | - Karthikeyan Ramalingam
- Oral Pathology and Microbiology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Urdiales-Gálvez F, Castellano-Miralla A. Effectiveness and safety of a narrow band spectrum intense pulsed-light dye with long pulse Nd:YAG laser for treating facial vascular lesions. J Cosmet Dermatol 2023; 22 Suppl 2:8-15. [PMID: 37318787 DOI: 10.1111/jocd.15772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Different devices are currently used for treating facial vascular lesions (FVL). This paper presents the aesthetic outcomes using different light-based and laser devices, including narrow band spectrum intense pulsed-light dye (NB-Dye-VL), Pulsed dye laser (PDL)-neodymium-doped yttrium-aluminum-garnet (Nd:YAG) dual-therapy, and either PDL or LP Nd:YAG for treating FVL in a clinical setting. METHODS A retrospective and single-center study conducted on subjects ≥18 years with FVL. Patients underwent treatment with either PDL + LP Nd:YAG dual-therapy, NB-Dye-VL, PDL, or LP Nd:YAG, according to the patient and lesion characteristics. The primary outcome was the weighted degree of satisfaction. RESULTS The cohort consisted of fourteen patients, nine women (64.3%) and five men (35.7%). The most prevalent FVL types treated were rosacea (28.6%; 4/14) and spider hemangioma (21.4%; 3/14). Seven patients underwent PDL + Nd:YAG (50.0%), three were treated with NB-Dye-VL (21.4%), and PDL or LP Nd:YAG was performed in two patients each (14.3%). Eleven patients rated their treatment outcome as excellent (78.6%), and three as very good (21.4%). Practitioners 1 and 2 classified treatment results as excellent in eight cases (57.1%) each. No serious or permanent adverse events were reported. Two (14.3%) patients, one treated with PDL and the other with PDL + LP Nd:YAG dual-therapy, had post-treatment purpura, which was successfully resolved with topical treatment after 5 and 7 days, respectively. CONCLUSIONS NB-Dye-VL and the PDL + LP Nd:YAG dual-therapy devices achieve excellent aesthetic outcomes for treating a wide range of FVL.
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Marlow C, Cuoco JA, Ravina K, Sloboda CA, Entwistle JJ. Endovascular treatment of a ruptured pure arterial malformation and associated dysplastic middle cerebral artery dissecting aneurysm: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE23150. [PMID: 37218731 PMCID: PMC10550645 DOI: 10.3171/case23150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/24/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND Pure arterial malformations are characterized as unique cerebrovascular lesions with a dilated, coil-like appearance and tortuous arteries without early venous drainage. Historically, these lesions have been described as incidental findings with a benign natural history. However, pure arterial malformations can rarely demonstrate radiographic progression and develop associated focal aneurysms with an unclear risk of rupture. Whether radiographic progression of these lesions or the presence of an associated aneurysm warrants treatment remains controversial. OBSERVATIONS A 58-year-old male presented with sudden-onset left hemiparesis. Computed tomography revealed a large, acute, right frontotemporoparietal intraparenchymal hemorrhage with underlying irregular curvilinear calcifications. Diagnostic cerebral angiography revealed a dysplastic right middle cerebral artery dissecting aneurysm along the M2 segment associated with a pure arterial malformation, which was treated with endovascular flow diversion in a delayed fashion. LESSONS Pure arterial malformations with associated focal aneurysms may not exhibit a benign natural history as once thought. Intervention should be considered for ruptured pure arterial malformations to mitigate the risk of rerupture. Asymptomatic patients with a pure arterial malformation with an associated aneurysm should at least be followed closely with interval radiographic imaging to evaluate for malformation progression or changes in aneurysmal morphology.
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Affiliation(s)
| | - Joshua A. Cuoco
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia; and
- Virginia Tech School of Neuroscience, Blacksburg, Virginia
| | - Kristine Ravina
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia; and
- Virginia Tech School of Neuroscience, Blacksburg, Virginia
| | - Cole A. Sloboda
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia; and
- Virginia Tech School of Neuroscience, Blacksburg, Virginia
| | - John J. Entwistle
- Virginia Tech Carilion School of Medicine, Roanoke, Virginia
- Department of Neurosurgery, Carilion Clinic, Roanoke, Virginia; and
- Virginia Tech School of Neuroscience, Blacksburg, Virginia
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Bhesania N, Patil DT, McCleary B, Selvakumar PKC, Radhakrishnan K. Segmental Arterial Mediolysis Presenting as a Pancreatic Mass in a Pediatric Patient: A Case Report. JPGN Rep 2023; 4:e298. [PMID: 37200713 PMCID: PMC10187858 DOI: 10.1097/pg9.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/14/2023] [Indexed: 05/20/2023]
Abstract
We describe a case of segmental arterial mediolysis (SAM) in a 2-year-old male who presented with symptoms of acute pancreatitis. SAM is a vascular entity of unknown etiology that involves medium-sized arteries in which the integrity of the vessel wall is compromised, resulting in increased susceptibility to ischemia, hemorrhage, and dissection. The clinical presentation is variable and can range from abdominal pain to more ominous findings of abdominal hemorrhage or organ infarction. This entity should be considered in the correct clinical setting and after other vasculopathies have been excluded. We aim to bring awareness to pediatric providers given this is a rare entity with variable presentation, which could be potentially life threatening.
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Affiliation(s)
- Natalie Bhesania
- From the Division of Pediatric Gastroenterology, UMMC, Jackson, MS
| | - Deepa T. Patil
- Department of Pathology, Brigham and Women’s Hospital, Boston, MA
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El-Abtah ME, Kashkoush A, Achey R, Patterson T, Moore NZ, Bain MD. Diagnostic yield of cerebral angiography for intracranial hemorrhage in young patients: A single-center retrospective analysis. Interv Neuroradiol 2023:15910199231152505. [PMID: 36691317 DOI: 10.1177/15910199231152505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Intracranial hemorrhage (ICH) secondary to hypertension (HTN) classically occurs in the basal ganglia, cerebellum, or pons. Vascular lesions such as aneurysms or arteriovenous malformations (AVMs) are more common in younger patients. We investigated the utility of diagnostic subtraction angiography (DSA) in young hypertensive patients with non-lobar ICH. METHODS A retrospective review (2013-2022) identified young (18-60 years) patients who underwent DSA for ICH. HTN history, ICH location, presence/absence of subarachnoid hemorrhage (SAH), and computed tomography angiography (CTA) findings were collected. The main outcome was DSA-positivity, defined as presence of an AVM, aneurysm, Moyamoya disease, reversible cerebral vasoconstriction syndrome, or dural arteriovenous fistula on DSA. RESULTS Two hundred sixty patients were included, and the DSA-positivity rate was 19%.DSA-positivity was lower in hypertensive patients with ICHs in the cerebellum, pons, or basal ganglia compared to the rest of the patient sample (9% vs 26%, p = 0.0002, Fisher's exact test). We developed the ICH-Angio score (0-5 points) based on CTA findings, ICH location, HTN history, and presence of SAH to predict risk of underlying vascular lesions. DSA-positivity was lower in those with a score of 0 (0/62; 0%) compared to a score of 1 (5/52; 10%), 2 (17/48; 35%), 3 (10/20; 50%), 4 (5/6; 83%), or 5 (3/3; 100%). CONCLUSION The ICH-Angio score was able to non-invasively rule out an underlying vascular etiology for ICH in up to one-third of patients. HTN, ICH location, CTA findings, and associated SAH can identify patients at low risk for harboring underlying vascular lesions.
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Affiliation(s)
- Mohamed E El-Abtah
- 12304Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ahmed Kashkoush
- Department of Neurological Surgery, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Rebecca Achey
- Department of Neurological Surgery, 2569Cleveland Clinic, Cleveland, OH, USA
| | - Thomas Patterson
- Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nina Z Moore
- Department of Neurological Surgery, 2569Cleveland Clinic, Cleveland, OH, USA
- Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Mark D Bain
- Department of Neurological Surgery, 2569Cleveland Clinic, Cleveland, OH, USA
- Cerebrovascular Center, Cleveland Clinic Foundation, Cleveland, OH, USA
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Mazzotti A, Zielli SO, Artioli E, Facchini G, Miceli M, Faldini C. Iatrogenic Lesion of the Lateral Plantar Artery following Plantar Fasciotomy for Cavus Foot Correction - A Case Report. J Orthop Case Rep 2022; 12:10-13. [PMID: 36874890 PMCID: PMC9983385 DOI: 10.13107/jocr.2022.v12.i10.3344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/23/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction The aim of this study was to report a patient with a iatrogenic lesion of the lateral plantar artery following plantar fasciotomy (PF) for cavus foot correction, an extremely rare complication. Case Report A 13-year-old male patient with bilateral cavus foot was surgically treated at the right foot. At 36 days follow-up, after plaster cast removal, a massive soft plantar bulge was located on the medial aspect of the foot. Once suture stiches removal was performed, a huge blood collection was evacuated, and active bleeding observed. Contrast-enhanced angio-CT revealed a lesion of the lateral plantar artery. A vascular suture was performed. At 5 months follow-up, the patient was pain-free in his foot. Conclusion Despite a iatrogenic lesion of the plantar vascular structures following PF is extremely rare, it is a potential complication to consider. Meticulous attention to surgical technique and careful inspection of the foot the day after surgery, before patient discharge, are recommended.
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Affiliation(s)
- Antonio Mazzotti
- Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simone Ottavio Zielli
- Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elena Artioli
- Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Miceli
- Diagnostic and Interventional Radiology Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Cesare Faldini
- Orthopaedics and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania, United States
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Abstract
The kidney biopsy is an essential tool for diagnosis of many kidney diseases. Obtaining an adequate biopsy sample with appropriate allocation for various studies is essential. Nephrologists should understand key lesions and their interpretation because these are essential elements underlying optimal approaches for interventions. This installment in the AJKD Core Curriculum in Nephrology will review these topics. We will first briefly discuss considerations for allocation and processing of kidney biopsies. We will then present in outline form the differential diagnoses of a spectrum of patterns of injury and consideration for interpretation of specific lesions. Lesions are presented according to anatomic site as glomerular, vascular, or tubulointerstitial. Native and transplant kidney biopsy lesions are included. These lesions and differential diagnoses and specific diseases are then linked to detailed clinicopathologic discussion of specific diseases presented in the AJKD Atlas of Kidney Pathology II. Correlation with immunofluorescence, electron microscopy, and clinical findings are emphasized to reach a differential diagnosis and the final diagnosis.
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Affiliation(s)
- Behzad Najafian
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Mark A Lusco
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Charles E Alpers
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle, Washington
| | - Agnes B Fogo
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Colafati GS, Piccirilli E, Marrazzo A, Carboni A, Diociaiuti A, El Hachem M, Esposito F, Zama M, Rollo M, Gandolfo C, Tomà P. Vascular lesions of the pediatric orbit: A radiological walkthrough. Front Pediatr 2022; 10:734286. [PMID: 36533238 PMCID: PMC9748295 DOI: 10.3389/fped.2022.734286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 11/03/2022] [Indexed: 12/05/2022] Open
Abstract
Vascular anomalies of the pediatric orbit represent a heterogeneous group that include both vascular tumors and vascular malformations. The disorder may initially be silent and then associated with symptoms and/or function damage, depending on the type of vascular anomaly and its extension. Vascular tumors include benign, locally aggressive (or borderline) and malignant forms while vascular malformations are divided into "simple", "combined" and syndromic, or "low flow" or "high flow". Both entities can arise in isolation or as part of syndromes. In this review, we describe the imaging findings of the vascular lesions of the orbit in the pediatric population, which are key to obtain a correct diagnosis and to guide the appropriate treatment in the light of the new genetic and molecular discoveries, and the role of the radiologist in their multidisciplinary management. We will also touch upon the main syndromes associated with orbital vascular abnormalities.
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Affiliation(s)
| | - Eleonora Piccirilli
- Department of Neuroscience, Imaging and Clinical Science, University "G. d'Annunzio" of Chieti, Chieti, Italy
| | - Antonio Marrazzo
- Neuroradiology Unit, Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Alessia Carboni
- Neuroradiology Unit, Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Diociaiuti
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - May El Hachem
- Dermatology Unit and Genodermatosis Unit, Genetics and Rare Diseases Research Division, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Francesco Esposito
- Department of Radiology, Santobono-Pausilipon Children Hospital, Naples, Italy
| | - Mario Zama
- Craniofacial Centre-Plastic and Maxillofacial Surgery Unit, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Massimo Rollo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Carlo Gandolfo
- Neuroradiology Unit, Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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15
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Hara M, Kusaba T, Ono K, Masuzawa N, Nakamura I, Urata N, Shiraishi H, Hara S, Konishi E, Matoba S, Shiotsu Y, Tamagaki K. Extraglomerular Vascular Involvement of Glomerulopathy with Fibronectin Deposits. Intern Med 2021; 60:2103-2107. [PMID: 33551409 PMCID: PMC8313931 DOI: 10.2169/internalmedicine.6558-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Glomerulopathy with fibronectin deposits (GFND) is a rare hereditary kidney disease with autosomal dominant inheritance. A 21-year-old woman who had been diagnosed with GFND 10 years ago was admitted for investigation of a rapid decline in her renal function, hemolytic anemia, and cardiac dysfunction. A renal biopsy showed GFND accompanied by extraglomerular vascular lesions. Comprehensive treatments against hypertension and anemia improved the renal function. Although there have been few reports of vascular lesions in GFND, we suspect that endothelial hyperpermeability resulting from hypertension caused the fibronectin deposition and narrowing of the extraglomerular vascular lumens, thereby accelerating hypertension and inducing hemolytic anemia.
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Affiliation(s)
- Masayuki Hara
- Department of Nephrology, Kyoto Prefectural University of Medicine, Japan
- Department of Nephrology, Omihachiman Community Medical Center, Japan
| | - Tetsuro Kusaba
- Department of Nephrology, Kyoto Prefectural University of Medicine, Japan
| | - Kenshi Ono
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Naoko Masuzawa
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Japan
- Department of Diagnostic Pathology, Otsu City Hospital, Japan
| | - Itaru Nakamura
- Department of Nephrology, Kyoto Prefectural University of Medicine, Japan
| | - Noriko Urata
- Department of Nephrology, Kyoto Prefectural University of Medicine, Japan
| | - Hirokazu Shiraishi
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Shigeo Hara
- Department of Diagnostic Pathology, Kobe City Medical Center, General Hospital, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Kyoto Prefectural University of Medicine, Japan
| | - Yayoi Shiotsu
- Department of Nephrology, Kyoto Prefectural University of Medicine, Japan
| | - Keiichi Tamagaki
- Department of Nephrology, Kyoto Prefectural University of Medicine, Japan
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Filaj V, Jorgaqi E, Byzhyti M. Our experience in the treatment of hemangioma with intense pulsed light laser: A 10 year study in Albania. Dermatol Ther 2021; 34:e14880. [PMID: 33583146 DOI: 10.1111/dth.14880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
Laser treatment brought an innovation in the treatment of hemangiomas and vascular anomalies. The range of superficial vascular lesions that can be treated with laser continues to expand. In our country laser device date relatively late, since then these technologies have facilitated the treatment of many skin condition. The goal of laser therapy is to maximize vascular destruction while minimizing injury to surrounding healthy epidermis and dermal tissues. We present our experience with IPL as a first line therapy in the treatment of superficial hemangiomas. After institutional review, board approval we analyzed the medical records of 202 patients diagnosed with hemangioma and treated with the IPL laser during January 2009 to January 2019. The performed procedure consists of using impulses of light with wave length that varies from 590 to 595 nm, duration 1.5 ms, and fluency by 11 to 12 J/cm2 . For each patient, four PDL sessions have been performed. We aim to evidence the efficacy and the good safety profile of (IPL) laser but with small adverse events that this treatment represent. The importance of proper patient selection, use of appropriate equipment settings, skin cooling mechanisms, and other safety measures minimize the occurrence of adverse events due to IPL treatment.
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Affiliation(s)
- Vladimir Filaj
- Service of Burns and Plastic Surgery, University Hospital Center "Mother Theresa", Tirana, Albania
| | - Etleva Jorgaqi
- Dermatology Clinic, University Hospital Center "Mother Theressa", Tirana, Albania
| | - Mirela Byzhyti
- Service of Pediatric Oncohematology, University Hospital Center "Mother Theressa", Tirana, Albania
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Arora N, Rambhatla S, Vittal R. Orbital spindle cell haemangioma: An uncommon entity! INDIAN J PATHOL MICR 2021; 64:545-547. [PMID: 34341269 DOI: 10.4103/ijpm.ijpm_1031_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Spindle Cell Haemangioma (SCH) is a benign vascular lesion, which commonly affects the dermis and subcutaneous tissue of distal extremities. The occurrence of SCH in the head and neck region and more so in the orbit is very few and rare. SCH should be considered as one of the differential diagnosis in vascular tumors of the orbit. We are reporting a case of solitary SCH in the orbit which was mimicking orbital cavernous venous malformation (orbital venous haemangioma).
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Affiliation(s)
- Neha Arora
- Sankara Eye Hospital, Bengaluru, Karnataka, India
| | | | - Rakshith Vittal
- Neuberg Anand Reference Laboratory, Bengaluru, Karnataka, India
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18
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Zerbinati N, Protasoni M, D'Este E, Mocchi R, Coricciati L, Rauso R, Sbano P, Greco M, Rodighiero E, Satolli F. Skin vascular lesions: A new therapeutic option with sequential laser-assisted technique. Dermatol Ther 2020; 34:e14573. [PMID: 33222349 DOI: 10.1111/dth.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022]
Abstract
Treatment of skin unaesthetic vascular lesions is still suboptimal. In this article, we present a multicenter study evaluating the efficacy and safety of the sequential 755 nm Alexandrite and 1064 nm ND:YAG lasers for the treatment of acquired and congenital vascular lesions of the skin. A total of 171 patients were included in the study (141 female and 30 male), median age 38, skin type from I to IV. Numbers of patients categorized for treated disease: 22 spider angiomas, 67 facial telangiectasia/spider veins, 58 leg telangiectasia/reticular leg veins, 24 port wine stains (PWS). Of those lesions 30.7% was on legs, 63.7% on face (6.7% on forehead, 10.1% on temples, 21.7% on cheeks, 25.2% on nose, 1.7% on chin) and 5.6% on chest. Spider angiomas required from 1 to 3 treatments. Facial telangiectasias had been treated from 1 to 4 times. Leg telangiectasias needed from 2 to 6 treatment sessions. Regarding PWS, it takes from 6 to 9 laser treatment to reach the clearance of the lesion. All the vascular disorders treated showed marked improvement while side effects were limited to low pain sensation and transitory fenomena. This sequential treatment is an effective, safe, and new approach for unaesthetic skin vascular lesions.
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Affiliation(s)
- Nicola Zerbinati
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Marina Protasoni
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Edoardo D'Este
- Department of Dermatology, Centro Medico Polispecialistico, Pavia, Italy
| | - Roberto Mocchi
- UB - CARE S.r.l. - Spin-off, University of Pavia, Pavia, Italy
| | | | - Raffaele Rauso
- Maxillofacial Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Paolo Sbano
- Department of Dermatology, University of Siena, Siena, Italy
| | - Maurizio Greco
- Department of Dermatology, Centro Medico Polispecialistico, Pavia, Italy
| | - Eleonora Rodighiero
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesca Satolli
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy.,Dermatologic Unit, University Hospital of Parma, Parma, Italy
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19
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Xue YZ, Li ZJ, Liu WT, Shan JJ, Wang L, Su Q. Down-regulation of lncRNA MALAT1 alleviates vascular lesion and vascular remodeling of rats with hypertension. Aging (Albany NY) 2019; 11:5192-205. [PMID: 31343412 DOI: 10.18632/aging.102113] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/16/2019] [Indexed: 12/28/2022]
Abstract
Objective: Recently, the effect of long non-coding RNAs (lncRNAs) in hypertension (HTN) has been identified. This study aims to explore the expression of lncRNA metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) in HTN and its role in vascular lesion and remodeling of HTN rats. Results: LncRNA MALAT1 expression was up-regulated in HTN patients, and lncRNA MALAT1 could be an effective index of HTN diagnosis. Down-regulated MALAT1 and inhibited Notch-1 could reduce relative factor expression, including inflammation-related factors, endothelial function-related factors and oxidative stress-related factors, and inhibit apoptosis of aortic endothelial cells of HTN rats. Methods: LncRNA MALAT1 expression in HTN patients and healthy controls was detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR). Angiotensin II (Ang II)-induced HTN rat models were injected with MALAT1-siRNA, empty lentivirus vector, Notch pathway inhibitor (DAPT) and dimethyl sulphoxide (DMSO) via caudal vein. After three-week treatment, changes of blood pressure, inflammatory factor levels, endothelial function-related factors, oxidative stress indices and apoptosis of vascular endothelial cells were determined by a series of assays. Conclusion: This study revealed that down-regulated lncRNA MALAT1 could alleviate the vascular lesion and remodeling of HTN rats, the mechanism may be related to the inhibited activation of Notch signaling pathway.
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20
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Faria B, Canão P, Cai Q, Henriques C, Matos AC, Poppelaars F, Gaya da Costa M, Daha MR, Silva R, Pestana M, Seelen MA. Arteriolar C4d in IgA Nephropathy: A Cohort Study. Am J Kidney Dis 2020; 76:669-678. [PMID: 32439421 DOI: 10.1053/j.ajkd.2020.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 03/10/2020] [Indexed: 12/20/2022]
Abstract
RATIONALE & OBJECTIVE Glomerular C4d (C4dG) as an indicator of the lectin pathway of complement activation in immunoglobulin A nephropathy (IgAN) has been associated with more severe kidney damage. Recent studies have suggested that vascular lesions in IgAN biopsy specimens with complement deposition are also associated with disease progression. We aimed to study the clinical significance of arteriolar C4d (C4dA) in IgAN kidney biopsy tissue. STUDY DESIGN Retrospective cohort study. SETTING & PARTICIPANTS Kidney biopsy specimens from 126 adults with IgAN diagnosed by Oxford classification criteria were stained using immunohistochemistry and classified according to C4dG and C4dA deposition. Additionally, vascular lesions including acute and chronic microangiopathy, arteriolar hyalinosis, and arterial intima fibrosis were characterized. PREDICTOR C4dA. OUTCOME Progressive kidney disease, defined as a decline in estimated glomerular filtration rate by≥50% or occurrence of kidney failure. ANALYTICAL APPROACH The association of C4dA and C4dG with baseline clinical and histologic characteristics, as well as progressive kidney disease, were assessed with survival analysis using multivariable Cox regression analysis. RESULTS C4dA was identified in 21 (17%) patients and was associated with mean arterial pressure, arterial intima fibrosis, and chronic microangiopathy. C4dA was also significantly associated with C4dG and both were associated with progressive kidney disease. In regression analysis, C4dA remained significantly associated with progressive kidney disease after adjusting for other significant predictors, including baseline estimated glomerular filtration rate, mean arterial pressure, and the presence of crescents. LIMITATIONS Findings based on the retrospective evaluation of a single center's experience, limited number of events, a small number of patients with a broad range of kidney disease stages, and use of immunohistochemistry rather than immunofluorescence to detect C4d. CONCLUSIONS C4dA is a potential biomarker for disease progression in IgAN. It should be further investigated in larger cohorts to determine the value of C4dA in improving prediction of IgAN disease progression.
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Affiliation(s)
- Bernardo Faria
- Nephrology and Infectious Disease R&D Group, INEB, Institute of Investigation and Innovation in Health (i3S), University of Porto, Porto, Portugal; Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Pedro Canão
- Department of Anatomic Pathology, Centro Hospitalar Universitário São João, Porto
| | - Qingqing Cai
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Carla Henriques
- School of Technology and Management, Polytechnic Institute of Viseu, Viseu; Centre for Mathematics, University of Coimbra (CMUC), Coimbra
| | - Ana Cristina Matos
- School of Technology and Management, Polytechnic Institute of Viseu, Viseu; Centre for Research in Digital Services and CISeD, Viseu, Portugal
| | - Felix Poppelaars
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mariana Gaya da Costa
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Mohamed R Daha
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands; Department of Nephrology, University of Leiden, Leiden University Medical Center, Leiden, the Netherlands
| | - Roberto Silva
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Manuel Pestana
- Nephrology and Infectious Disease R&D Group, INEB, Institute of Investigation and Innovation in Health (i3S), University of Porto, Porto, Portugal; Division of Nephrology, Centro Hospitalar Universitário São João and Department of Medicine, Faculty of Medicine of Porto University, Porto, Portugal
| | - Marc A Seelen
- Division of Nephrology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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21
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Abstract
The bacterial pathogen Shigella flexneri causes more than 250 million cases of bacillary dysentery (blood in stool) every year across the world. This human-specific disease is characterized by profuse bloody diarrhea, dramatic ulceration of the colonic epithelium and immune cell infiltration of the colonic tissue. A major challenge in understanding the mechanisms supporting bacillary dysentery is the reliance on animal models that do not fully recapitulate the symptoms observed in humans, including bloody diarrhea. Here we outline advances provided by a recently developed infant rabbit model of bacillary dysentery. The infant rabbit model defines bacillary dysentery as a critical combination of massive vascular lesions and dramatic epithelial fenestration due to intracellular infection and cell-to-cell spread, respectively. The infant rabbit model provides an unprecedented framework for understanding how the cell biology of Shigella flexneri infection relates to pathogenesis.
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Affiliation(s)
- Lauren K. Yum
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Hervé Agaisse
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, VA, USA,CONTACT Hervé Agaisse Department of Microbiology, Immunology, and Cancer Biology, University of Virginia School of Medicine, Charlottesville, Virginia22908, USA
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22
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Abstract
The occipital artery (OA) is a critical artery in vascular lesions. However, a comprehensive review of the importance of the OA is currently lacking. In this study, we used the PubMed database to perform a review of the literature on the OA to increase our understanding of its role in vascular lesions. We also provided our typical cases to illustrate the importance of the OA. The OA has several variations. For example, it may arise from the internal carotid artery or anastomose with the vertebral artery. Therefore, the OA may provide a crucial collateral vascular supply source and should be preserved in these cases. The OA is a good donor artery. Consequently, it is used in extra- to intracranial bypasses for moyamoya disease (MMD) or aneurysms. The OA can be involved in dural arteriovenous fistula (DAVF) and is a feasible artery for the embolisation of DAVF. True aneurysms and pseudoaneurysms can occur in the OA; surgical resection and embolisation are the effective treatment approaches. Direct high-flow AVF can occur in the OA; embolisation treatment is a good option in such cases. The OA can also be involved in MMD and brain arteriovenous malformation (AVM) by forming transdural collaterals. For a patient in the prone position, if occipital and suboccipital craniotomies are performed, the OA can also be used for intraoperative angiography. In brief, the OA is a very important artery in vascular lesions.
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Affiliation(s)
- Yunbao Guo
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
| | - Hao Chen
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
| | - Xuan Chen
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
| | - Jinlu Yu
- Department of Neurosurgery, The First Hospital of Jilin University, PR China
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23
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Thanthoni M, Rajeev P, Sathasivasubramanian S. Caliber-Persistent Labial Artery: A Report of a Rarely Recognized Lip Swelling. J Clin Imaging Sci 2018; 8:41. [PMID: 30283723 PMCID: PMC6157096 DOI: 10.4103/jcis.jcis_43_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 08/17/2018] [Indexed: 12/02/2022] Open
Abstract
Calibre-persistent labial artery (CPLA) is a commonly underdiagnosed vascular lesion of the lip. CPLA is an arterial branch that penetrates the submucosal tissue without loss of calibre. Clinical diagnosis is significant as misdiagnosis can lead to profuse haemorrhage following an excisional biopsy or surgical excision. Colour Doppler ultrasonography is a safe and non-invasive diagnostic tool to confirm the diagnosis. Here, we report a case of a 24-year-old man who complained of an asymptomatic pulsating non-progressive nodule on the left side of upper lip initially diagnosed as peripheral angiomatous lesion. Diagnosis was confirmed by high-resolution Colour Doppler Ultrasonography. The purpose of this case report is to highlight the clinical importance and diagnosis of a rarely reported soft tissue swelling of the lip to the attention of clinicians.
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Affiliation(s)
- Malarkodi Thanthoni
- Department of Oral Medicine and Radiology, Faculty of Dental Sciences, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - P Rajeev
- Department of Radiology and Imaging Sciences, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
| | - S Sathasivasubramanian
- Department of Oral Medicine and Radiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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24
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Affiliation(s)
- Dena Elkeeb
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
| | | | - Scott R Florell
- Department of Dermatology, University of Utah School of Medicine, Salt Lake City, Utah
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25
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Miyazaki H, Ohshiro T, Romeo U, Noguchi T, Maruoka Y, Gaimari G, Tomov G, Wada Y, Tanaka K, Ohshiro T, Asamura S. Retrospective Study on Laser Treatment of Oral Vascular Lesions Using the "Leopard Technique": The Multiple Spot Irradiation Technique with a Single-Pulsed Wave. Photomed Laser Surg 2018; 36:320-325. [PMID: 29717920 DOI: 10.1089/pho.2017.4410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aimed to retrospectively evaluate the efficacy and safety of laser treatment of oral vascular lesions using the multiple spot irradiation technique with a single-pulsed wave. BACKGROUND DATA In laser therapy for vascular lesions, heat accumulation induced by excessive irradiation can cause adverse events postoperatively, including ulcer formation, resultant scarring, and severe pain. To prevent heat accumulation and side effects, we have applied a multiple pulsed spot irradiation technique, the so-called "leopard technique" (LT) to oral vascular lesions. This approach was originally proposed for laser treatment of nevi. It can avoid thermal concentration at the same spot and spare the epithelium, which promotes smooth healing. The goal of the study was to evaluate this procedure and treatment outcomes. PATIENTS AND METHODS The subjects were 46 patients with 47 oral vascular lesions treated with the LT using a Nd:YAG laser (1064 nm), including 24 thick lesions treated using a combination of the LT and intralesional photocoagulation. RESULTS All treatment outcomes were satisfactory without serious complications such as deep ulcer formation, scarring, bleeding, or severe swelling. CONCLUSIONS Laser therapy with the LT is a promising less-invasive treatment for oral vascular lesions.
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Affiliation(s)
- Hidetaka Miyazaki
- 1 Department of Plastic and Reconstructive Surgery, Wakayama Medical University , Wakayama, Japan
| | - Takafumi Ohshiro
- 2 Plastic and Reconstructive Surgery, Ohshiro Clinic , Tokyo, Japan
| | - Umberto Romeo
- 3 Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome , Rome, Italy
| | - Tadahide Noguchi
- 4 Department of Dentistry, Oral and Maxillofacial Surgery, Jichi Medical University , Tochigi, Japan
| | - Yutaka Maruoka
- 5 Division of Dentistry/Oral and Maxillofacial Surgery, National Center for Global Health and Medicine , Tokyo, Japan
| | - Gianfranco Gaimari
- 3 Department of Oral Sciences and Maxillofacial Surgery, Sapienza University of Rome , Rome, Italy
| | - Georgi Tomov
- 6 Department of Oral Pathology, Faculty of Dental Medicine, Medical University of Plovdiv , Plovdiv, Bulgaria
| | - Yoshitaka Wada
- 1 Department of Plastic and Reconstructive Surgery, Wakayama Medical University , Wakayama, Japan
| | - Kae Tanaka
- 7 Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo, Japan
| | - Toshio Ohshiro
- 2 Plastic and Reconstructive Surgery, Ohshiro Clinic , Tokyo, Japan
| | - Shinichi Asamura
- 1 Department of Plastic and Reconstructive Surgery, Wakayama Medical University , Wakayama, Japan
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26
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Komatani H, Okamoto Y, Aoki T, Noguchi K, Morioka M. Long-term Prognosis after Extracranial-intracranial Bypass Surgery for Symptomatic Cerebrovascular Occlusive Disease. Kurume Med J 2018; 64:1-4. [PMID: 28603158 DOI: 10.2739/kurumemedj.ms6400016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prognosis after extracranial-intracranial (EC-IC) bypass surgery has only been studied for a few years and the benefits of this procedure are still controversial. In this single-center retrospective study, we examined the long-term prognosis of patients who underwent EC-IC bypass surgery. Subjects were patients with symptomatic internal carotid artery or intracranial lesion occlusive disease who underwent EC-IC bypass surgery between 1991 and 2003. Of these, long-term prognosis was examined in 57 patients (39 male, 18 female; mean age, 61.8 years) who showed good surgical outcomes 30 days after bypass surgery, measured as a 0-2 on the modified Rankin Scale (mRS). They were divided into 2 groups (survivors and non-survivors) and were analyzed to identify factors effecting long-term survival after bypass surgery. Sixteen patients (28%), whose mean follow-up period (survival time) was 8.3±3.8 years, died after the bypass surgery. The average follow-up period for the survivors was 12.0±1.1 years, which was significantly longer than that for the non-survivors (P<0.0001). At surgery, the non-survivors (mean age 71.5 years) were significantly older than the survivors (P=0.0012). Pneumonia and other respiratory diseases were a frequent cause of death (31.2%), but death by cerebrovascular disease also occurred (12.5%). The rate of recurrent ischemic stroke was 28%, with no significant difference between groups (survivors vs. non-survivors: 31.2% vs. 26.1%, P= 0.82). In the absence of perioperative complications, the long-term prognosis of patients who underwent EC-IC bypass surgery was very good.
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Affiliation(s)
- Hideki Komatani
- Department of Neurosurgery, Saiseikai Yahata General Hospital
| | - Yuji Okamoto
- Department of Neurosurgery, Saiseikai Yahata General Hospital
| | - Takachika Aoki
- Department of Neurosurgery, Kurume University School of Medicine
| | - Kei Noguchi
- Department of Neurosurgery, Kurume University School of Medicine
| | - Motohiro Morioka
- Department of Neurosurgery, Kurume University School of Medicine
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27
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Abstract
Different mechanisms explain thermoregulatory dysfunction following ischemic stroke, hemorrhagic stroke, and traumatic brain injury. Temperature instability following brain injury likely involves hypothalamic injury, pathologic changes in cerebral blood flow, metabolic derangement, and a neurogenic inflammatory response. Although targeted temperature management (TTM) exerts pleiotropic effects, the heterogeneity of brain injury has hindered identification of patient subsets most likely to benefit from TTM. Early optimism about TTM's role in brain injury has been tempered by the failure of successive clinical trials to show improved patient outcomes. However, given the deleterious effects of fever, aggressive fever management is still warranted in the critically ill neurologic patient.
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Affiliation(s)
- Ram Gowda
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Matthew Jaffa
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Neeraj Badjatia
- Program in Trauma, Department of Neurology, University of Maryland School of Medicine, Baltimore, MD, United States.
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28
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Ghanem AA, el Hadidi YN. Management of a Life Threatening Bleeding Following Extraction of Deciduous Second Molar Related to a Capillary Haemangioma. Craniomaxillofac Trauma Reconstr 2017; 10:166-170. [PMID: 28523092 PMCID: PMC5435487 DOI: 10.1055/s-0037-1598102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/27/2016] [Indexed: 01/01/2023] Open
Abstract
Various forms of vascular lesion affect the head and neck region. The head and neck vascular lesions are classified into neoplasms and malformations. Neoplasm presents either as hemangioma or lymphangioma; neoplasm usually presents in young age compared with vascular malformation. A 9-year-old female patient presented to the outpatient clinic referred from the department of pedodontics after extraction of a right mandibular second deciduous molar. Extraction was done by dental GP in outpatient clinic. Massive bleeding followed the extraction. Bleeding was controlled by electrocoagulation of bleeding site and systemic and local application of antifibrinolytic agent. An intravenous line was placed to provide fluid replacement. Injection of intravenous cyklokapron was given to stabilize the blood clot. Selective embolization was performed 24 hours prior to surgical resection of lesion and the lesion was removed under general anesthesia followed by peripheral ostectomy of bone to remove any feeders. Different protocols are used to control life-threatening bleeding. Primary local measures such as Gelfoam packing, Tranexamic or Aminocaproic topical application, Surgicel application, Electrocautery, Bone wax, Ligation of External Carotid or Common Carotid Artery, or Selective Embolization of feeder vessel may be used to control the bleeding. Interventional radiographic blockage of feeder vessel currently shows high success rate in the management of life-threatening bleeding compared with previous techniques.
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Affiliation(s)
- Amr Amin Ghanem
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Yasser Nabil el Hadidi
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
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29
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Sawani A, Huber K, Zibadi S, Payne WG. Diagnosis of Arteriovenous Malformation in the Finger. Eplasty 2017; 17:ic10. [PMID: 28507659 PMCID: PMC5408223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Ali Sawani
- aC.W. Bill Young Bay Pines VA Medical Center, Bay Pines, Fla,Correspondence:
| | - Katherine Huber
- bDivision of Plastic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa
| | - Sherma Zibadi
- aC.W. Bill Young Bay Pines VA Medical Center, Bay Pines, Fla
| | - Wyatt G. Payne
- aC.W. Bill Young Bay Pines VA Medical Center, Bay Pines, Fla,bDivision of Plastic Surgery, Department of Surgery, University of South Florida Morsani College of Medicine, Tampa
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30
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Lohia S, Momin S, Richardson MS, Neskey D. Intravascular Papillary Endothelial Hyperplasia of the Neck: A Case Report. OTO Open 2017; 1:2473974X17699795. [PMID: 30480181 PMCID: PMC6239024 DOI: 10.1177/2473974x17699795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 02/17/2017] [Accepted: 02/24/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shivangi Lohia
- Department of Otolaryngology–Head and
Neck Surgery, Medical University of South Carolina, Charleston, South Carolina,
USA
| | - Suhael Momin
- Department of Otolaryngology–Head and
Neck Surgery, Medical University of South Carolina, Charleston, South Carolina,
USA
| | - Mary S. Richardson
- Department of Pathology and Laboratory
Medicine, Medical University of South Carolina, Charleston, South Carolina,
USA
| | - David Neskey
- Department of Otolaryngology–Head and
Neck Surgery, Medical University of South Carolina, Charleston, South Carolina,
USA
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31
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Affiliation(s)
- Matthew G Crowson
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Calhoun D Cunningham
- 1 Division of Head and Neck Surgery & Communication Sciences, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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32
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Ghali MGZ, Srinivasan VM, Mohan AC, Jones JY, Kan PT, Lam S. Pediatric cerebral cavernous malformations: Genetics, pathogenesis, and management. Surg Neurol Int 2016; 7:S1127-S1134. [PMID: 28194299 PMCID: PMC5299150 DOI: 10.4103/2152-7806.196921] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 06/14/2016] [Indexed: 12/15/2022] Open
Affiliation(s)
- Michael G Z Ghali
- Department of Neurobiology, Drexel University College of Medicine, Philadelphia, USA
| | - Visish M Srinivasan
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Arvind C Mohan
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jeremy Y Jones
- Department of Radiology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Peter T Kan
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Sandi Lam
- Department of Neurosurgery, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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Affiliation(s)
- Elorch Hamza
- Université Mohammed V Souissi, Service d'Ophtalmologie B, Hôpital des Spécialités CHU, Rabat, Maroc
| | - Alami Fadoua
- Université Mohammed V Souissi, Service d'Ophtalmologie B, Hôpital des Spécialités CHU, Rabat, Maroc
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34
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Cortese A, Pantaleo G, D'Alessio G, Garzi A, Amato M. Hemangiomas of the maxillofacial area: Case Report, Classification and Treatment Planning. Open Med (Wars) 2015; 10:529-534. [PMID: 28352749 PMCID: PMC5368859 DOI: 10.1515/med-2015-0066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 11/04/2015] [Indexed: 12/20/2022] Open
Abstract
Vascular lesions of the maxillofacial area are even more challenging than in other different body district, because of the high aesthetic and functional relevance of this area for the sense organs presence like eye, brain, tongue, ear and nose. For these reasons, we propose an accurate classification based on hemodynamic and histologic aspects usefulthat is for diagnostic and therapeutic planning. A female, 60 years old patient came to our observation showing a vascular lesion of the lower left lip, and complaining for aesthetical and functional impairment. To confirm the diagnosis of vascular malformation and to detect lesion flow rate or other possible localization, a Tc red blood cell scintigraphy was carried out. Result was a venous low flow lesion; hence, sclerotherapy by a 3% Polidocanol solution (Atossisclerol) followed by surgery was planned. The aim of this work was to propose a diagnostic and therapeutic scheme with an integration of ISSVA and a flow rate classifications for a three-step planning based on 1) the biological findings in an early age at the lesion discover with a pharmacological treatment; 2) Hemodynamic study of the lesions at growing age followed by sclerotherapy or embolization; 3) Imaging study of these lesions for patients candidate to surgery when after step 1 and step 2 diagnostic and therapeutic planning results were incompletely successful.
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Affiliation(s)
- Antonio Cortese
- Department of Medicine and Surgery, Unit of Maxillofacial Surgery, University of Salerno, Salerno, Italy
| | - Giuseppe Pantaleo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Corso Umberto I, 40, 80138 Napoli, Italy
| | - Giuseppe D'Alessio
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Alfredo Garzi
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | - Massimo Amato
- Department of Medicine and Surgery, University of Salerno, Salerno, Italy
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35
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Panta P. A purple swelling on the tongue. Pan Afr Med J 2015; 21:234. [PMID: 26523176 PMCID: PMC4607988 DOI: 10.11604/pamj.2015.21.234.7497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 07/20/2015] [Indexed: 12/03/2022] Open
Affiliation(s)
- Prashanth Panta
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Sangareddy, Andhra Pradesh, India
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36
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Abstract
Chorangiomas of the placenta are often discovered incidentally and, although they are not common (1 in 9000 to 1 in 50 000 placentas), these tumors may be found in 0.5% to 1% of carefully examined placentas. The vast majority are of no clinical importance and complications are seen only in association with tumors measuring more than 4 cm in diameter. In contrast, hemangioendotheliomas are vascular tumors with varying grades of malignant potential and hardly ever involve the placenta. Here we describe a large placental chorangioma causing fetal hydrops and demonstrating distinctive intravascular luminal endothelial proliferation and tufting. To the best of our knowledge, this is probably only the second case of a placental hemangioendothelioma reported in the literature.
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Affiliation(s)
- Sunil Jaiman
- 1 Department of Anatomic and Perinatal Pathology and Cytology, Fernandez Hospital Unit 3, Plot 769, Road No. 44, Jubilee Hills, Hyderabad - 500033, India
| | - Evita Fernandez
- 2 Department of Obstetrics, Fernandez Hospital Unit 3, Plot 769, Road No. 44, Jubilee Hills, Hyderabad - 500033, India
| | - Sirisha Rao Gundabattula
- 3 Department of Gynaecology, Fernandez Hospital Unit 3, Plot 769, Road No. 44, Jubilee Hills, Hyderabad - 500033, India
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37
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Dziegielewski PT, Durmus K, Ozer E. Transoral robotic surgery for the excision of base of tongue vascular lesions. Head Neck 2015; 37:1211-2. [PMID: 25752267 DOI: 10.1002/hed.24029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Peter T Dziegielewski
- Department of Otolaryngology-Head and Neck Surgery, Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Department of Otolaryngology, University of Florida, Gainesville, Florida
| | - Kasim Durmus
- Department of Otolaryngology-Head and Neck Surgery, Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Enver Ozer
- Department of Otolaryngology-Head and Neck Surgery, Comprehensive Cancer Center-Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
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38
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Tosun A, Kurtgoz S, Dursun S, Bozkurt G. A case of Ehlers-Danlos syndrome type VIA with a novel PLOD1 gene mutation. Pediatr Neurol 2014; 51:566-9. [PMID: 25266621 DOI: 10.1016/j.pediatrneurol.2014.06.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 06/27/2014] [Accepted: 06/28/2014] [Indexed: 01/18/2023]
Abstract
BACKGROUND The kyphoscoliotic type of the Ehlers-Danlos syndrome is an autosomal recessive connective tissue disorder characterized by soft extensible skin, laxity of joints, severe muscle hypotonia at birth, and kyphoscoliosis. PATIENT We describe a 3-year-old girl with the kyphoscoliotic type of the Ehlers-Danlos syndrome whose parents were cousins. She was born with breech presentation by vaginal delivery at term after a normal pregnancy. At birth she manifested hypotonia and congenital kyphosis. On the second postnatal day, subdural and intraparenchymal hemorrhages were detected by magnetic resonance imaging. During follow-up at 18 months of age, strabismus, umbilical hernia, kyphoscoliosis, joint laxity, bilateral hip dislocation, muscular hypotonia, and motor developmental delay. RESULTS The cranial magnetic resonance imaging revealed periventricular leukomalacia and abnormal signal related to previous hemorrhage. Metabolic investigations and neuromuscular evaluation were normal, excluding other possible explanations of hypotonia. An analysis of urinary cross-links demonstrated an increase in the lysyl-pyridinoline to hydroxylysyl-pyridinoline ratio, suggesting the diagnosis of kyphoscoliotic type of the Ehlers-Danlos syndrome. Molecular analysis of the PLOD1 gene revealed that she had a novel homozygous p.Pro622Argfs*3 (c. 1863_1864dupCG) mutation in exon 17 that is expected to cause complete loss of the enzyme lysyl hydroxylase 1 and to cause kyphoscoliotic type of the Ehlers-Danlos syndrome. CONCLUSIONS We describe a child with the kyphoscoliotic type of the Ehlers-Danlos syndrome with a novel mutation of the PLOD1 gene. Our observations suggest that vascular lesions in the neonatal period may be a rare additional clinical feature of kyphoscoliotic type of the Ehlers-Danlos syndrome.
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39
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Alshahrani ST, Al Shamsi HN, Kahtani ES, Ghazi NG. Spectral-domain optical coherence tomography findings in polypoidal choroidal vasculopathy suggest a type 1 neovascular growth pattern. Clin Ophthalmol 2014; 8:1689-95. [PMID: 25214762 PMCID: PMC4159396 DOI: 10.2147/opth.s68471] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To report spectral-domain optical coherence tomography (SD-OCT) findings in polypoidal choroidal vasculopathy (PCV). PATIENTS AND METHODS Seventeen eyes of 15 consecutive patients diagnosed with PCV based on typical clinical and angiographic findings were imaged with macular SD-OCT including line scans passing through the polyps. RESULTS SD-OCT findings included typical and atypical retinal pigment epithelial (RPE) detachments and subretinal and intraretinal fluid in all eyes. In the areas corresponding to the polypoidal lesions, well-delineated round-oval, sub-RPE cavities were present and were adherent to the posterior surface of the detached RPE above Bruch membrane. No retinal or choroidal connections to the cavities were noted. CONCLUSION These SD-OCT findings document that the vascular lesions in PCV are not located in the inner choroid, but in the sub-RPE space, suggesting that PCV is a variant of type 1 choroidal neovascularization rather than a distinct clinical entity as initially thought.
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Affiliation(s)
- Saeed T Alshahrani
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | | | - Eman S Kahtani
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Nicola G Ghazi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- University of Virginia, Department of Ophthalmology, Charlottesville, VA, USA
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