Background: /Objective: We aimed to evaluate whether additional intralesional bleomycin injections benefit children with proliferative infantile hemangiomas (IHs). Methods: In this retrospective case -control study, we examined the medical records of 216 infants who were followed up for proliferative IH. Patients in group 1 were treated with propranolol orally at 2 mg/ kg/day. Group 2 was treated with oral propranolol combined with intralesional bleomycin injections. Results: We retrospectively reviewed 95 and 121 patients in groups 1 and 2, respectively. No significant differences were observed between both groups regarding visiting age, sex, lesion thickness, or risk site. The overall cure rates in groups 1 and 2 were 77.89% (74/95) and 84.30% (102/121), respectively. The overall distribution of the length of cure significantly differed between both groups (P = 0.035). From the survival analysis (P = 0.026), the median survival time was 198 days (95% confidence interval (CI) 174.46 -221.54) for group 1 and 139 days (95% CI 114.58-163.42) for group 2. The effect of treatment modality (hazard ratio (HR) = 1.41, P = 0.031) and risk site on survival time (HR = .54, P < 0.001) was significant. Conclusion: No significant differences were observed in the resolution of proliferative IH; however, intralesional bleomycin injection with systemic propranolol for proliferative IH treatment may provide a more rapid resolution. (c) 2023 Asian Surgical Association and Taiwan Robotic Surgery Association. Publishing services by Elsevier B.V. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

Purpose To assess the effectiveness and safety of transcatheter arterial sclerosing embolization (TASE) for the treatment of subglottic hemangiomas that did not respond appreciably to propranolol. Materials and Methods This study was a retrospective analysis. Of the 101 patients with subglottic hemangiomas admitted to our center, 10 (4 male and 6 female) patients were included in this study. All these patients underwent arterial embolization using Pingyangmycin and polyvinyl alcohol particles (300–500 μm). All patients were examined 1 month after the last treatment and monthly thereafter. Results TASE treatment was technically successful in all patients. Ten lesions were located in the subglottic region. The blood supply included the superior thyroid artery, brachiocephalic trunk, facial artery, and ascending pharyngeal arteries. The median maximal diameter of the hemangiomas significantly decreased from 8.5 mm before treatment to 2 mm after TASE (P <.05). The degree of laryngeal obstruction improved in all patients. No serious complications were noted. One patient developed fever postoperatively, and three patients had a mild cough. Conclusions For even subglottic hemangiomas with suboptimal efficacy of propranolol, TASE significantly reduced the size of hemangiomas with minimal adverse effects. It had a positive effect on the improvement of airway stenosis caused by subglottic hemangioma with poor effect of oral propranolol.

To assess the efficacy of transcatheter arterial embolization (TAE) plus propranolol treatment for infantile hepatic hemangioma (IHH). A retrospective study of symptomatic IHH and hemodynamic changes in IHH was conducted between 2016 and 2019. There were five boys and seven girls with diffuse lesions (n = 7) and multifocal lesions (n = 5). Hepatomegaly and abdominal distension (n = 6) were the predominant clinical presentations. Seven patients (58.3%) had multiple cutaneous hemangiomas. Pulmonary arterial hypertension, heart failure (n = 4), and hypothyroidism (n = 4) were observed. A total of 17 TAE procedures were performed in 12 IHH cases, with a technical success rate of 100%. All patients received standard propranolol orally, and one patient was orally administered metacortandracin. Two patients died of heart failure and multiple organ dysfunction caused by an enlarged liver. In addition, one patient was not reexamined after discharge. Of the remaining nine children, the average follow-up time was 10.78 months (range 2–28 months), and they all responded well to TAE combined with oral propranolol. TAE combined with propranolol is safe and effective for the treatment of IHH, demonstrating low complication rates.

Kaposiform hemangioendothelioma (KHE) is a rare vascular neoplasm associated with the Kasabach–Merritt phenomenon (KMP), which is a consumptive coagulopathy with associated potentially life-threatening thrombocytopenia. There are no standardized treatment protocols for the management of KHE with KMP. Moreover, there are limited reports regarding the treatment of cases of rebound. Herein, we describe a rare case of rebound of KHE/KMP, during systemic sirolimus treatment, successfully treated with embolization and vincristine infusion combined with microwave ablation.

Successive current trials using immune response checkpoint blockade, the systemic therapy for progressive hepatocellular carcinoma (HCC) has shifted dramatically towards targeting the tumor microenvironment (TME). Locoregional therapies (LRTs) like radiofrequency ablation (RFA)/rhizotomy, trans-arterial chemoembolization (TACE) and surgical resection in the initial stages are critical. LRTs perform the crucial task of modulating the immune system surrounding the tumor, which is of great importance in the prevailing era of developing immuno-oncology treatments and their direct effect on tumor cells. Significant efforts are needed in exploring the mechanisms of latest combinational approach to boost clinical advantage with tolerable side effects. The present review highlights the tumor microenvironment of HCC followed by current immunotherapeutic approaches for HCC. Next, we discussed the concealed mechanisms of LRTs given in combination with immunotherapy and their utilization in clinical practice.

目的 观察眼动脉灌注化学治疗(IAC)儿童视网膜母细胞瘤(RB)的效果及安全性.方法 回顾性分析接受IAC的238例RB患儿,记录其一般资料,观察IAC不良反应及其预后.结果 238例RB患儿共接受692次IAC,其中68 次(68/692,9.83％)出现骨髓抑制,包括轻、中度 48 次(48/692,6.94％)和重度 20 次(20/692,2.89％);80 次(80/692,11.56％)出现消化道反应.238例中,IAC后86例出现眼睑水肿、58例玻璃体积血、42例眼球内陷、30例额部红斑、视网膜脱离及上睑下垂各4例.术后随访2～43个月,期间36例接受眼球摘除术、202例保留患眼,保眼率84.87％;所有患儿均未见明确新发转移.结论 眼动脉IAC治疗儿童RB安全有效,保眼率较高且不良反应较少.

Abstract Background: Venous malformations (VMs) are the most common vascular malformations. VMs can be classified as focal, multifocal, or diffuse types. Focal venous malformations with muscle involvement is not well defined.Objective: The aim of our study was to characterize characteristics of focal VMs and classify them based on position that are associated with invasion of muscle.Methods: This is a single-center, retrospective review of patients treated for focal VMs between February 2021 and February 2022.Results: We assessed 26 patients focal VMs with 47 lesions; 18 (69%) were unifocal, 3 (12%) were dual-focal and 5（19%）were multifocal type VMs, and 29（62%) were intramuscular VMs. Of all focal VMs, 32 (68%) lesions arose in the extremities, 10 (21%) in the head and neck region and 5 (11%) in the torso. The three groups were no statistical difference for the intramuscular VMs, 19 (68%) arose in extremities, 6 (21%) in the head and neck region and 3 (11%) in the torso. But the lower limbs intramuscular VMs had a signifificantly elevated risk of focal VMs(relative risk [RR],1.7; 95% confidence interval [CI], 1.148-2.394). Limitations: Retrospective, single-institution study.Conclusion: Intramuscular involvement of the body should be considered in focal VMs. The lower limbs intramuscular VMs had a signifificantly elevated risk of focal VMs.

BackgroundIntralesional injection of lauromacrogol has proven to be an efficient treatment method for infantile hemangioma. This study aims to explore a novel injection therapy and evaluate its efficacy and complications.MethodsThe medical records of 368 children with infantile hemangioma who received a lauromacrogol injection from January 2021 to April 2022 were retrospectively analyzed. All patients were reviewed every 4 weeks, and their condition was assessed according to symptoms and medical records. The patient’s age, lesion type, location, size and thickness, lesion photographs, ultrasound, and complications were recorded.ResultsAmong the 368 infants who accept sclerotherapy with lauromacrogol, 226(61.4%)achieved excellent regression. In total, 108(29.4%)cases achieved good regression. 24(6.5%)achieved complete moderate regression. 10(2.7%)achieved poor regression. The reported incidence of adverse events was 4.9% and severe complications were not observed. Before and after three courses of treatment, the median vascular endothelial growth factor levels were 104.12 pg/ml and 28.982 pg/ml. There was a significant difference between the two groups (P=0.0043).ConclusionsThe results showed that this novel injection therapy a safe and effective treatment method. The therapy accelerated the regression of infantile hemangiomas without serious complications.

BACKGROUND Pyogenic granuloma (PG) is a benign vascular lesion that is commonly observed in the skin and mucosa. Sclerotherapy is the first-line conservative treatment option for PG. OBJECTIVE This retrospective study aimed to evaluate the efficacy of sclerotherapy with 1.0% polidocanol for the treatment of PG. MATERIALS AND METHODS All patients who were clinically diagnosed with PG consecutively at the Pediatric Outpatient Service of Qilu Children's Hospital of Shandong University from March 2018 to October 2019 received sclerotherapy with 1.0% polidocanol. RESULT The procedure resulted in the complete excision of PG, with inconspicuous scars. The procedure was well-tolerated, and recurrence was not observed. Allergic reactions, cutaneous necrosis, and pigmentary changes were not observed. CONCLUSION Sclerotherapy with 1.0% polidocanol is considered an effective treatment for PGs in children. Early treatment was associated with a more favorable outcome.

目的 探讨DSA导引下经皮硬化治疗儿童阴茎区静脉畸形的效果和安全性.方法 回顾性分析2016年1月至2017年6月山东大学齐鲁儿童医院采用经皮穿刺硬化治疗的11例阴茎区静脉畸形患儿临床资料.DSA透视下行局部静脉造影,判断瘤巢形态、范围和引流静脉回流情况.根据造影流速情况选择硬化剂(平阳霉素或聚多卡醇),DSA监视下经皮注射治疗.术后1个月复查MRI,显示仍有残留病灶予重复治疗.每次治疗后记录不良反应,随访评价疗效.结果 11例患儿14处病灶共接受32次硬化治疗,平均(2.5±1.0)次/例.随访24个月,6例治愈,3例症状明显缓解,2例部分缓解,均无复发或进展.所有患儿均未出现溃破、出血、感染及功能障碍等严重并发症.结论 DSA引导经皮硬化治疗儿童阴茎区静脉畸形安全有效,不影响阴茎外观和功能,值得临床推广.

目的 分析婴幼儿口服不同剂量普萘洛尔治疗血管瘤短期内对心率的影响.方法 对于2019年在山东大学齐鲁儿童医院住院的口服普萘洛尔治疗的153例血管瘤婴幼儿进行服药前后心率统计.结果 服用普萘洛尔0.5mg/kg/d(p>0.05)心率与服药前心率无统计学差异,1.0mg/kg/d、1.5mg/kg/d和2.0mg/kg/d(p<0.05)心率与服药前心率有统计学差异.结论 婴幼儿口服低剂量普萘洛尔对心率有影响.口服普萘洛尔治疗血管瘤的最低有效剂量仍需进一步大数据研究,减慢心率是否会影响患儿后期长远生长仍需长期随访.

Background Extensive and complex head and neck lymphatic malformations (LMs) are challenging to manage through traditional therapy. The purpose of this retrospective study was to assess the efficacy and safety of sirolimus in infants with refractory head and neck LMs. Methods Sirolimus was administered orally on a continuous dosing schedule. Patients were seen every month for the first three months and then subsequently every three months. The primary endpoints were safety and efficacy based on clinical and radiological evaluations. Results Eight patients, refractory to standard care, were enrolled and received sirolimus continuously. After 12 months of follow-up, the response and safety to medication was evaluated: all patients experienced reductions in LMs bulk, ranging from modest to significant. Some minor adverse effects were reported: mouth sores, eczema, gastrointestinal reaction, dyslipidemia, and neutropenia. Conclusion Sirolimus was efficient in children with refractory head and neck LMs and was well tolerated.

Purpose: To report effectiveness and safety of transcatheter arterial sclerosing embolization (TASE) for the treatment of parotid infantile hemangiomas that did not respond appreciably to propranolol. Materials and Methods: A total of 21 infants (12 male and 9 female) with large propranolol-resistant infantile hemangiomas in the parotid region were enrolled in this study. During TASE, the feeding arteries of the lesions were embolized using pingyangmycin-lipiodol emulsion and polyvinyl alcohol particles (300-500 mu m) to reduce the blood flow rate. All children were followed up as outpatients at 2 weeks and monthly thereafter. The curative effect was evaluated at the 1- and 3-month follow-up visits. Results: Nine lesions were located on the right side of the parotid gland, whereas 12 were located on the left side. The feeding arteries in all patients originated from branches of the external carotid artery. TASE was technically successful in all patients. The mean (+/- SD) maximal diameter of the hemangiomas significantly decreased from 6.50 cm +/- 2.28 before treatment to 3.56 cm +/- 1.84 at 1 month after TASE (P <. 05). Three months after TASE, the mean maximal diameter further significantly decreased to 1.94 cm +/- 1.58 (P < 05). During the follow-up period, 16 cases were rated as excellent and 5 as good; no recurrence or serious complications were noted. Minor side effects, such as slight pain, mild fever, and tissue swelling, were observed. Conclusions: TASE significantly decreased the size of the parotid hemangiomas with minor side effects during a short follow-up period.

Background:Transcatheter arterial embolization (TAE) is regarded as an effective treatment for patients with symptomatic hepatic hemangioma. However, few studies have evaluated the efficacy of TAE alone for treating hepatic hemangioma. The aim of this study was to identify the factors that influence the response to TAE and formulate a quantitative nomogram to optimize the individualized management of hepatic hemangioma.Methods:We retrospectively studied 276 patients treated with TAE for hepatic hemangioma at our center from January 2011 to December 2019. The full cohort was randomly divided into training and validation cohorts. After assessing the potential predictive factors for the efficacy of TAE in the training cohort, a nomogram model was established and evaluated by discrimination and calibration.Results:During follow-up, the symptom relief rate was 100%. The tumor blood supply (p< 0.001), tumor number (p= 0.004), and tumor size (p= 0.006) were identified as significant predictors of the failure of tumor shrinkage in response to TAE. The nomogram model showed favorable discrimination and calibration, with a C-index of 0.775 (95% CI, 0.705–0.845) in the training cohort, which was further confirmed in the validation cohort (C-index 0.768; 95% CI, 0.680–0.856). The side effects of TAE were relatively minor and included mainly abdominal pain, nausea, vomiting, fever, and the presence of elevated hepatic transaminases.Conclusion:TAE is a safe and effective treatment for symptomatic hepatic hemangioma. The established nomogram performed well for the estimation of the effect of TAE in patients with hepatic hemangioma and can facilitate the selection of patients who would benefit most from the treatment.

BACKGROUND:Laparoscopic anatomic liver resection of segment 7 (S7) is technically challenging because of the posterosuperior location and the lack of clear anatomical landmarks [1-4]. Here, we introduce a caudo-dorsal approach, which may offer a benefit for the difficult procedure. METHODS:The patient was a 53-year-old man with hepatocellular carcinoma located in S7 of the liver. After the transection of caudate process, the Glissonean pedicle of S7 (G7) extending from the right posterior Glissonean pedicle was identified on the liver dorsal side. The demarcation line was noted by isolating and clamping G7. The intraoperative ultrasound was then used to assess the extent of the tumor. The right hepatic vein was approached from the dorsal side and continuously exposed in a caudal-cranial direction along the anterior surface of inferior vena cava after isolating and cutting the venous branches draining S7. Following the dissection of G7, the liver parenchymal transection was proceeded along the ischemic line between segment 6 and 7 with the ventral cutting plane extended to join the dorsal one. The liver parenchyma of the ventral side of the exposed right hepatic vein (RHV) was further transected from the dorsal side toward the root side of RHV. The resection of S7 was completed with perihepatic ligaments dissection. RESULTS:The intermittent Pringle maneuver (15 min occlusion and 5 min reperfusion) was applied when necessary with a total time of 45 min. The operation time was 200 min, the estimated blood loss was 300 ml, and no transfusion was required. Pathology confirmed moderately differentiated HCC with negative surgical margin. The patient was discharged on postoperative day 8 with no complications and has been followed up for 8 months without recurrence. CONCLUSION:This caudo-dorsal approach for laparoscopic anatomical S7 segmentectomy is easy and feasible when performed by experienced surgeons at experienced centers in well-selected patients.

INTRODUCTION:Infantile hepatic hemangioendothelioma is a type of benign hepatic tumor that occurs in infancy. Many hepatic tumors are diagnosed when screening is done for multiple cutaneous hemangiomas. Hepatic tumors are small multifocal lesions and are mostly asymptomatic. There have been many case reports of asymptomatic infantile hepatic hemangioendothelioma, but few of these have pointed out that hepatic hemangiomas can sometimes be life-threatening due to fatal hepatomegaly complications such as pulmonary artery hypertension or even congestive heart failure. At present, there are no standard protocols for treating infantile hepatic hemangioendothelioma, though most clinicians agree that treatment is unnecessary for multiple small hepatic hemangiomas in asymptomatic patients. Little is known about treatment for cases with life-threatening complications induced by infantile hepatic hemangioendothelioma as there are so few reported cases. Here, we report a special case with hepatomegaly, pulmonary artery hypertension, and cardiac insufficiency induced by infantile hepatic hemangioendothelioma.PATIENT CONCERNS:We present a case with hepatomegaly, pulmonary artery hypertension, and cardiac insufficiency caused by infantile hepatic hemangioendothelioma.DIAGNOSIS:Infantile hepatic hemangioendothelioma was diagnosed.INTERVENTIONS:The patient underwent transcatheter arterial embolization and was given propranolol.OUTCOMES:The patient responded well to treatment with transcatheter arterial embolization and propranolol. The patient gained weight steadily, liver volume, and mass size have decreased considerably, echocardiography showed normal pulmonary artery pressure and ejection fraction, and we discovered no serious complications after 1 year of follow-up.CONCLUSION:Transcatheter arterial embolization combined with propranolol is an effective treatment for life-threatening infantile hepatic hemangioendothelioma.

Background Laparoscopic major liver resection, such as laparoscopic left hemihepatectomy (LLH), is still perceived as a complicated procedure due to technical difficulties and slow learning curve. The study introduced an optimized procedure using the liver parenchyma transection-first approach and investigated its advantages on surgical outcomes by comparison with the conventional hilar dissection approach for LLH. Methods Between January 2015 and May 2019, 96 patients who underwent laparoscopic left hemihepatectomy for hepatocellular carcinoma (HCC) were enrolled in the study. Among these, 41 patients underwent the liver parenchyma transection-first approach (LP-first group) and the other 55 underwent the conventional hilar dissection approach (conventional group). A 1:1 propensity score matching (PSM) was performed to compare the perioperative and long-term oncological outcomes of the two groups. Results After 1:1 PSM, 37 patients in each group were selected for further analysis. The LP-first group was associated with shorter median operative time (210 vs 235 min, P = 0.035) and less blood loss (200 vs 300 mL, P = 0.410). In addition, no statistical differences were found in overall complications between the two groups (8.1% vs 24.3%, P = 0.058). There were no significant differences between the two groups in terms of 1-year and 3-year disease-free survival (DFS, P = 0.608) and overall survival (OS, P = 0.414). Conclusion The prior liver parenchyma approach for LLH is safe and reproducible in selected patients, which showed improved perioperative outcomes and comparable long-term oncological outcomes compared with the conventional approach.