| Background:Venous malformations (VMs) are the most common low-flow vascular anomalies encountered clinically, and the occurrence in head and neck accounts for 40%. Sclerotherapy is the first choice and major treatment recommended for VMs. In recent years, sclerosing foam produced by mixing liquid sclerosant with air in a ratio of 1:4 according to Tessari’s method, has been widely used in treating head and neck venous malformations, and performed a better potency than liquid sclerotherapy. Polidocanol (POL) and sodium tetradecyl sulphate (STS), are two most common agents in producing sclerosing foams worldwide, and 1% polidocanol (Lauromacrogol) is widely used in China. Radiologic guidance with ultrasound and digital subtraction angiography (DSA) is extremely essential for complex head and neck VMs treatment. The ultrasonography is limited to detecting the venous outflow and extravasation of sclerosing agents and requires specially trained operators. However, sole lesion and venous drainage can be displayed for the technique of digital subtraction under DSA, and foam flows can be traced with a "filling defects" technique:injecting contrast agents first into the lesion to display the malformed lesions and then injecting the sclerosing foam to displace the contrast agent. But this two-step technique is complicated and time-consuming, and maybe not suitable for complex head and neck VMs. Therefore, it is of urgent necessities to establish a new method of treating complex venous malformations in head and neck region conveniently, quickly and precisely.Purpose1. To establish a new method of producing the radiopaque sclerosing foam under DSA by mixing liquid sclerosant with contrast agent in a certain proportion.2. To treat patients of complex head and neck VMs with the new radiopaque sclerosing foam to simplify the traditional DSA guiding technique.Methods:1. Sclerosant (polidocanol) and contrast agent (iopromide) were mixed to prepare a new sclerosing foam according to Tessari’s method, and different ratios of the two materials were used to study the stability (half-life) of the produced foams. Three groups named A (pure polidocanol), B (iopromide/polidocanol=1:1) and C (iopromide/polidocanol=1:2) were divided. The foam stability was evaluated by the foam half-life, which defined as the time when half-volume liquid separated out from original liquid sclerosant. The liquid/air ratio was 1:4 according to Tessari’s method. SPSS 18.0 software package was used for statistical analysis, and Kruskal-Wallis Test was applied to estimate the homogeneity of variance of the half-lives among Groups A, B and C.P< 0.05 was considered significant.2. The X-ray absorption under DSA of 1:2 (iopromide/polidocanol) was compared to the iopromide group, and was evaluated as the degree of darkness on the display.Results1. In general, all three group foams were stable. The median half-lives of the foams (groups A, B and C) were 111.5 s (95 s-124 s),111 s (103 s-140 s) and 141 s(127 s-158 s), respectively. The Kruskal-Wallis Test (Chi-square= 10.093, df= 2,P= 0.006< 0.01) indicated significant differences among the three groups. Among the three groups, there were significant differences between A and C(P= 0.002< 0.01), B and C (P= 0.028< 0.05) but not between A and B (P= 0.461> 0.05).2. Both iopromide and the mixed foams indicated the structure of the lesions completely. The initial infused iopromide displayed as nearly dark images, and lighter images were achieved after injecting the mixed foams.Conclusions:1. A new method of mixing contrast agent with sclerosant to prepare radiopaque foams is established, and a ratio of 1:2 is recommend for iopromide and polidocanol.2. The new radiopaque sclerosing foam supplies a new choice for complex head and neck VMs treatment under the guidance with DSA.Background:Infantile hemangioma (IH) is the most common benign tumor occurred during infancy. Female children are more susceptible than male to IH, and about 60 percent of IH occurred in head and neck. Despite of spontaneous regression, ulceration, bleeding and infection are very common in rapidly proliferating phrase, and even asphyxia and visual disturbance. Thus, early interference during IH is of great necessities. In 2008, Leaute-Labreze reported two cases with combined inherited heart disease and severe IH. After oral propranolol, the tumor reduced sharply as well as achieved fine improvement of heart disease. Therefore, propranolol widened its application in IH area and gradually became the first line drug for IH treatment. Propranolol was assimilated into blood after oral taken, and accumulated in heart, brain, lung and kidney etc. Considering of mere seven years application, rare reports were concerned about the effects on growth and development of children after long-term and low-dose oral propranolol.Purpose:1. Retrospective analysis of efficacy and side effects after oral propranolol treatment in our department.2. To study effects on growth and development of children after long-term and low-dose oral propranolol.Methods:1. One hundred sixty-four (164) cases of IH during Jan 2010 and Aug 2014 with propranolol treatment in Oral & Maxcillofacial Surgery Department of Qilu Hospital were analyzed. Patients were visited to evaluate the efficacy and side effects referring to Achauer Classification, and the influencing factors were analyzed.2. Five hundred seventy-seven (577) cases of IH during Jan 2010 and Aug 2014 with surgery (212 cases) and propranolol (365 cases) treatment in Qilu Hospital were achieved. Ten indicators containing weight, height (length), sitting height, head circumstance, chest circumstance, upper limber circumstance, body weight index (BMI), weight/height(length), chest/height and sitting height/height were selected to evaluate their growth and development levels. Obtained data were analyzed referring to Chinese Growth Reference Standards under 7 and WHO(Child Growth Standards, and tested by covariance analysis.Results1. Seventy-one (71) cases containing 88 lesions were visited, and an average of 9.9 months and median of 10 months were taken for drugs. According to Achauer Classification, lesions achieved level I to IV degrees respectively are 3 cases (2.9%),5 cases (5.7%),11 cases (12.9%) and 69 cases (78.6%). The longer drug used, the better of efficacy. Efficacy of deep cases was superior to superficial lesions. After a successive of oral propranolol in ward of 71 cases, their heart rates decreased significantly, while somnolence occurs in 1 case and diarrhea in 7 cases. None other complications were detected.2. One hundred eighteen (118) cases (92 for propranolol and 26 for surgery) were visited. Low-weight occurred in none groups and low-weight occurred in propranolol group with 4.3%and 2.2% cases, according to Chinese Growth Reference Standards under 7 and WHO Child Growth Standards. Covariance analysis indicated statistical differences of height and chest circumstance among ten indicators between surgery and propranolol groups (P= 0.038< 0.05, P= 0.041 < 0.05), and the average differences are 11.11 cm and 3.25 cm.Conclusions:1. Propranolol is effective and safe for IH.2. Hypoevolutism of height and chest circumference may be expectant complications after long-term and low-dose oral propranolol. |
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