Publications by authors named "Zhong-Ping Qin"

23 Publications

  • Page 1 of 1

Standards of care for Kasabach-Merritt phenomenon in China.

World J Pediatr 2021 Apr 26;17(2):123-130. Epub 2020 Aug 26.

Department of Pediatric Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China.

Kasabach-Merritt phenomenon (KMP) is a rare disease that is characterized by severe thrombocytopenia and consumptive coagulation dysfunction caused by kaposiform hemangioendothelioma or tufted hemangioma. This condition primarily occurs in infants and young children, usually with acute onset and rapid progression. This review article introduced standardized recommendations for the pathogenesis, clinical manifestation, diagnostic methods and treatment process of KMP in China, which can be used as a reference for clinical practice.
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http://dx.doi.org/10.1007/s12519-020-00379-9DOI Listing
April 2021

[Chinese expert consensus on the use of topical timolol maleate treatment of infantile hemangiomas].

Shanghai Kou Qiang Yi Xue 2016 Dec;25(6):744-747

Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China.

Non-selective β-blocker propranolol has been proved by FDA as the first-line agent for infantile hemangioma (IH) with dramatic response. To reduce the side effects caused by systemic administration of propranolol, timolol maleate treatment has been increasingly used as an alternative to systemic β-blockers and watchful waiting for many IH patients in recent years. However, the appropriate indications, drug dosage, dosing regimen, time for initiation, optimal duration, monitoring for side effects still remains controversial. To standardize the use of topical timolol in treating IH, avoid overtreatment or under-treatment, as well as minimize complications, a Chinese expert consensus on the use of topical timolol treatment of IH has been approved and written by a multidisciplinary experts group based on an up-to-date literature review and repeated discussion, which can be used to reduce inappropriate variations in clinical practice and to promote the delivery of high quality, evidence-based health care for IH patients.
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December 2016

[Chinese experts consensus on the use of oral propranolol for treatment of infantile hemangiomas].

Shanghai Kou Qiang Yi Xue 2016 Jun;25(3):257-60

Department of Oral and Maxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China.

Infantile hemangioma (IH) is one of the most common benign vascular tumors in children. A variety of treatment methods have been documented for the management of IH over the past years, including pharmacotherapy via oral administration or injection of corticosteroids, vincristine, alpha interferon and bleomycin; laser therapy, radionuclide therapy, cryotherapy and excisional surgery. The therapeutic efficacy of each treatment modality is variable, while adverse effects or complications are common and sometimes serious. Since the serendipitous discovery of propranolol, a nonselective beta-adrenergic receptor blocker, being very efficacious in treating IH in 2008, oral propranolol has earned a role as a first-line medical therapy for complicated IH. However, the appropriate drug dosage, dosing regimen, time for initiation, optimal duration, monitoring for side effects remains controversial. To standardize the use of propranolol in treating IH, avoid overtreatment or under-treatment, as well as minimize complications, a Chinese experts consensus on the use of oral propranolol for treatment of IH has been approved and written by a multidisciplinary experts group based on an up-to-date literature review and repeated discussion.
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June 2016

[Subsequent therapy for infantile hemangiomas after discontinuation of oral propranolol].

Shanghai Kou Qiang Yi Xue 2015 Dec;24(6):716-20

Department of Hemangiomas, Linyi Tumor Hospital. Linyi 276001,China.

Purpose: To summarize the subsequent therapy experiences for infantile hemangiomas after discontinuation of oral propranolol treatment, and explore the relationships between clinical interventions and types of infantile hemangioma.

Methods: In this retrospective study from January 2010 to May 2014, a total of 137 infants with hemangiomas undergoing sequential therapy after oral propranolol treatment. There were 41 males and 96 females. The median age was 16 months, ranging from 14 to 25 months. After oral propranolol treatment, the outcomes were evaluated to be grade III in 74 cases, grade IIin 62 cases and grade Ⅰ in 1 case. The types were papula (n=31), telangiectasis (n=11), plump (n=74), deep (n=12) and compound (n=9). The primary sites were 3 cases in scalp, forty-nine in face, thirty-three in trunk, thirty-eight in extremities. Cutis laxa presented in 45 cases, and parenchyma hypertrophy presented in 80 cases. Sequential therapy were performed including laser therapy for 38 cases, intralesional Pingyangmycin injection for 63 cases, and plastic surgery for 16 cases. The efficacy was re-evaluated on a 4-level scale, combined with evaluations of scar, cutis laxa or pigment alteration. SPSS18.0 software package was used for statistical analysis.

Results: Chi-square test showed significant differences between 5 types in occurrence of cutis laxa and parenchyma hypertrophy (x(2)=28.458,68.276, P<0.01). After a follow-up of 6 months to 4 years, the outcomes were evaluated to be grade IV in 122 cases, grade III in 15 cases, without grade IIor gradeⅠ case. There were significant differences in 5 types of infantile hemangiomas before and after sequential therapy( H=53.445, 9.941, 120.324, 17.000, 18.899, P<0.01). Postoperative scar was presented in 2 cases around to joints, and mild pigment alteration was noticed in 2 cases after intralesional Pingyangmycin injection.

Conclusions: Cutis laxa and parenchyma hypertrophy may be more likely present in infantile hemangiomas after oral propranolol treatment. Laser therapy is recommended for patients with papula or telangiectasis, when necessary, intralesional Pingyangmycin injection should be combined. Intralesional Pingyangmycin injection should be the first choice for plump or compound type,whereas surgery should be executed in patients with deep type or other plump type complicated by severe hyperplasia, after which combined intralesional Pingyangmycin injection may be required for postoperative superficial residues.
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December 2015

A practical guide for diagnosis and treatment of arteriovenous malformations in the oral and maxillofacial region.

Chin J Dent Res 2014 ;17(2):85-9

Arteriovenous malformations (AVMs) are congenital vascular malformations (CVMs) resulting from birth defects of the vasculature. It is rarely seen, only accounting for 1.5% of all vascular anomalies, and 50% of the lesions are located in the oral and maxillofacial region. Regardless of the type, AVMs may ultimately lead to significant anatomical, pathophysiological and hemodynamic consequences. Therefore, despite their relative rarity, AVMs still remain the most challenging and/or life-threatening form of vascular anomalies. Transarterial coil embolisation or ligation of feeding arteries are incorrect approaches and may result in progress of the lesion. Furthermore, such procedures would prevent future endovascular access to the lesions via the arterial route, and should be abandoned. Interventional embolisation using various sclerosants is currently the mainstay of treatment for AVMs, and elimination of the nidus (if present) is the key to success. Among various embolosclerotherapy agents, ethanol sclerotherapy produces the best long-term outcomes, with minimal complications. For more complex cases, multidisciplinary approaches and interventions may provide an excellent potential for a curative result. Based on the published literature and clinical experiences, a practical treatment guideline was established in order to provide a criterion for the management of oral and maxillofacial AVMs. This protocol will be renewed and updated to reflect cutting edge knowledge, and provide the newest treatment modalities for oral and maxillofacial AVMs.
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March 2015

Propranolol inhibits angiogenesis via down-regulating the expression of vascular endothelial growth factor in hemangioma derived stem cell.

Int J Clin Exp Pathol 2014 15;7(1):48-55. Epub 2013 Dec 15.

Special Department of Vascular Anomalies, Linyi Tumor Hospital Linyi 276000, Shandong Province, China.

Background: Oral propranolol (PRN) has recently been shown to be highly effective for infantile hemangiomas (IHs), and is currently recommended as the first-line treatment of complicated IHs. However, the therapeutic mechanism(s) still remain unclear.

Methods: In this study, we tested hemangioma-derived stem cells for expression of vascular endothelial growth factor (VEGF) in vitro and studied the inhibition of VEGF expression. We used PCR, Elisa, Western blotting and immunohistochemistry in vivo and in vitro trial.

Results: The study demonstrated that application of PRN at a "normal" concentration equivalent to plasma concentration did not inhibit proliferation or promote apoptosis of hemangioma derived stem cells (HemSCs) isolated from IH patients. PRN suppressed expression of vascular endothelial growth factor (VEGF) and basic Fibroblast Growth Factor (bFGF) in HemSCs in vitro. Morphological, histological and immunohistological improvement were observed in vivo using murine IH model in which HemSCs pre-treated with PRN were implanted into BALB/c-nu mice. In the pre-treated HemSC grafts, mean micro-vessel density (MVD) significantly decreased and protein levels of VEGF markedly decreased, while bFGF was still detectable.

Conclusions: The results suggested PRN inhibited angiogenesis via down-regulating the expression of vascular endothelial growth factor in hemangioma derived stem cell. These findings provide critical insight into the potential mechanisms of PRN action on IH.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3885459PMC
September 2014

A practical guide to treatment of infantile hemangiomas of the head and neck.

Int J Clin Exp Med 2013 25;6(10):851-60. Epub 2013 Oct 25.

Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine No. 639, Zhi Zao Ju Road, Shanghai 200011, China.

Infantile hemangiomas are the most common benign vascular tumors in infancy and childhood. As hemangioma could regress spontaneously, it generally does not require treatment unless proliferation interferes with normal function or gives rise to risk of serious disfigurement and complications unlikely to resolve without treatment. Various methods for treating infant hemangiomas have been documented, including wait and see policy, laser therapy, drug therapy, sclerotherapy, radiotherapy, surgery and so on, but none of these therapies can be used for all hemangiomas. To obtain the best treatment outcomes, the treatment protocol should be individualized and comprehensive as well as sequential. Based on published literature and clinical experiences, we established a treatment guideline in order to provide criteria for the management of head and neck hemangiomas. This protocol will be renewed and updated to include and reflect any cutting-edge medical knowledge, and provide the newest treatment modalities which will benefit our patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3832322PMC
November 2013

Guidelines for the treatment of head and neck venous malformations.

Int J Clin Exp Med 2013 22;6(5):377-89. Epub 2013 May 22.

Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University Shanghai 200011, China.

Venous malformation is one of the most common benign vascular lesions, with approximately 40% of cases appearing in the head and neck. They can affect a patient's appearance and functionality and even cause life-threatening bleeding or respiratory tract obstruction. The current methods of treatment include surgery, laser therapy, sclerotherapy, or a combined. The treatment of small and superficial venous malformations is relatively simple and effective; however, the treatment of deep and extensive lesions involving multiple anatomical sites remains a challenge for the physicians. For complex cases, the outcomes achieved with one single treatment approach are poor; therefore, individualized treatment modalities must be formulated based on the patient's condition and the techniques available. Comprehensive multidisciplinary treatments have been adapted to achieve the most effective results. In this paper, based on the national and international literature, we formulated the treatment guidelines for head and neck venous malformations to standardize clinical practice. The guideline will be renewed and updated in a timely manner to reflect cutting-edge knowledge and to provide the best treatment modalities for patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664006PMC
June 2013

Preliminary study on plasma RPN concentration of patients with infantile hemangioma treated with propranolol.

Int J Clin Exp Med 2013 22;6(5):342-5. Epub 2013 May 22.

Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology Shanghai 200011, PR China.

Propranolol (PRN) has recently been recommended as the first-line medicine for complicated infantile hemangiomas (IHs), because of the significant effect. However, no pharmacokinetic parameters have ever been reported for infants who receive PRN treatment for IH. In this study, we show that plasma PRN concentration is affected by the frequency of administration of PRN. A single daily administration of PRN (1 mg/kg/d) resulted in an early elevation of plasma PRN compared to a twice a day administration of the same dose. In contrast, the twice a day application resulted in a more prolonged expression at a later time-point. Our findings provide pharmacokinetic parameters of PRN action in IH for clinic.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664000PMC
June 2013

CD133 selected stem cells from proliferating infantile hemangioma and establishment of an in vivo mice model of hemangioma.

Chin Med J (Engl) 2013 Jan;126(1):88-94

Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.

Background: Infantile hemangioma (IH) is the most common benign tumor in children with prevalence in the face and neck. Various treatment options including oral propranolol have been described for IH, but the mechanism of drugs remains enigmatic. The aim of this study was to investigate the pathogenesis and establish a reliable in vivo model of IH which can provide platform for drug exploration.

Methods: Stem cells from the proliferating hemangiomas (HemSCs) were isolated by CD133-tagged immunomagnetic beads. Their phenotype and angiogenic property were investigated by flow cytometry, culturing on Matrigel, real-time polymerase chain reaction (PCR), immunofluorescent staining and injection into BALB/c-nu mice.

Results: HemSCs had robust ability of proliferating and cloning. The time of cells doubling in proliferative phase was 16 hours. Flow cytometry showed that HemSCs expressed mesenchymal markers CD29, CD44, but not endothelial/hematopoietic marker of CD34 and hematopoietic marker CD45. The expression of CD105 was much lower than that of the reported hemangioma derived or normal mesenchymal stem cell (MSC). Real-time PCR showed that the mRNA levels of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and matrix metalloproteinase-1 (MMP-1) of HemSCs were higher than that of neonatal human dermal fibroblasts (NHDFs) and human umbilical vein endothelial cells (HUVECs). After HemSCs were cultured on Matrigel in vitro, they formed tube-like structure in a short time (16 hours) and differentiated into endothelial cells in 7 days. After 1 - 2 weeks of implantation into immunodeficient mice, HemSCs generated glucose transporter 1 positive blood vessels. When co-injected with HUVECs, the vascularization of HemSCs was greatly enhanced. However, the single implantation of HUVECs hardly formed blood vessels in BALB/c-nu mice (P < 0.05).

Conclusions: HemSCs may be some kinds of primitive mesoderm derived stem cells with powerful angiogenic ability, which can recapitulate human hemangioma by co-injecting into immunodeficient mice with HUVECs.
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January 2013

New treatment strategy for granulomatous epulis: intralesional injection of propranolol.

Med Hypotheses 2012 Feb 30;78(2):327-9. Epub 2011 Nov 30.

Department of Oral and Maxillofacial Surgery and Institute of Dental Medicine, Qilu Hospital of Shandong University, PR China.

Epulis is a relapsable lesion in gingiva without specific treatment for its unexplained pathogenesis. Nowadays, surgical excision is the most popular method of treatment. To prevent recurrence, it is necessary to resect diseased tissues thoroughly, and even to remove the involved teeth. However, this may cause functional and cosmetic deformities. Therefore, it is urgent to find a new therapy without severe side effects. Infantile hemangioma is a common benign pediatric tumor which shares many features with epulis, such as rich vascularity, high incidence of female patients, high hormone level and similar treatments. A recent study showed that propranolol, a beta adrenergic receptor (β-AR) antagonist, was effective as treatment for infantile hemangioma. Our preliminary work showed that mRNA and protein levels of β2-AR were higher in epulis than in adjacent tissue. Therefore, we hypothesize that intralesional injection of propranolol may be useful as epulis treatment. Further work need to be done to confirm the safety and therapeutic effect of the treatment. After that, this specific β2-AR antagonist may be the first choice for epulis treatment.
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http://dx.doi.org/10.1016/j.mehy.2011.11.013DOI Listing
February 2012

Treatment guidelines of lymphatic malformations of the head and neck.

Oral Oncol 2011 Dec 8;47(12):1105-9. Epub 2011 Sep 8.

Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Key Lab of Stomatology, Shanghai Jiao Tong University School of Medicine, No. 639, Zhi Zao Ju Road, Shanghai 200011, China.

Lymphatic malformations, traditionally called lymphangiomas, are diseases caused by development errors of the lymphatic system. About 90% of the cases occur within 2years of age, except a few cases which occur in adulthood, and approximately 75% of the lesions are located in the head and neck region. The lesions can grow rapidly with infection, trauma or bleeding, resulting in disfigurement as well as severe impairment of respiration, swallow and speech. Although lymphatic malformations are benign lesions, they rarely resolve spontaneously, their infiltrating nature coupled with the difficulty in distinguishing involved vital structures of head and neck from adjacent normal tissues makes complete surgical resection even more difficult. The likelihood of postsurgical recurrence and complications is thus higher than other vascular lesions. Surgical resection, sclerotherapy and laser therapy are currently the main treatment modes of lymphatic malformations. Various treatment options have their advantages and disadvantages, the selection of treatment modalities should depend on the patient's individual status and available technology and expertise. The treatment protocol should be individualized, comprehensive as well as sequential in order to obtain the best treatment outcome. Based on published literatures and clinical experiences, we devised the treatment guideline for management of head and neck lymphatic malformations. This protocol will be reviewed and updated periodically to include cutting edge knowledge to provide the best treatment options to benefit our patients.
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http://dx.doi.org/10.1016/j.oraloncology.2011.08.001DOI Listing
December 2011

Detection of RASA1 mutations in patients with sporadic Sturge-Weber syndrome.

Childs Nerv Syst 2011 Apr 7;27(4):603-7. Epub 2010 Sep 7.

Department of Oral and Maxillofacial Surgery, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Stomatology, Shanghai, 200011, China.

Objective: The aim of this study was to identify RASA1 mutation in Chinese population with sporadic Sturge-Weber syndrome (SWS).

Methods: Genomic DNA was obtained from peripheral blood of nine patients with sporadic SWS. The 25 exons, promoter regions (-1,000 bp) as well as intron-exon boundaries of RASA1 were amplified by polymerase chain reaction, and products were sequenced directly.

Results: A novel synonymous mutation (c.1229 G > A [p.K420K]) of RASA1 was identified in the present series.

Conclusion: It implied that RASA1 may be not a virulence gene, but further study is needed to know RASA1 gene mutation in SWS patients.
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http://dx.doi.org/10.1007/s00381-010-1258-zDOI Listing
April 2011

[Treatment of infantile parotid hemangioma with propranolol].

Zhonghua Kou Qiang Yi Xue Za Zhi 2010 May;45(5):292-4

Department of Hemangioma, Tumor Hospital of Linyi City, Linyi Shandong 276000, China.

Objective: To evaluate the short-term results and safety of propranolol for the treatment of infantile parotid hemangioma.

Methods: Oral propranolol was administered to 17 infants with parotid hemangioma at a dose of 1.0-1.5 mg per kilogram of body weight per day. The patients were revisited once a week. The changes of the tumor size, texture and colour were monitored and recorded at a regular interval. The adverse effects after medication were observed and managed accordingly. The short-term results were evaluated using a 4 scales system.

Results: Among the 17 patients treated, the follow-up time was 5 to 10 months. The overall response was scale I in 0 patient, scale II in 0 patients, scale III in 5 patients, and scale IV in 12 patients. No serious adverse effects were encountered.

Conclusions: Oral propranolol at a lower dose is a safe and effective method for the treatment of infantile parotid hemangioma. The short-term results were excellent and the side effects minimal.
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May 2010

[Treatment of infantile vascular malformations associated with airway obstruction].

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2010 Jan;45(1):32-7

Special Department of Hemangioma, Tumor Hospital of Linyi City. Linyi 276000, China.

Objective: To summarize the clinical features of vascular malformations complicated with airway obstruction and to evaluate the therapeutic methods of these disease.

Methods: Forty-seven children with airway obstruction and dyspnea (25 males, 22 females) were treated from Jun 1985 to Dec 2007, and their clinical data were retrospectively analyzed. Among 47 patients, there were 27 cases of venous malformations, 17 cases of macrocystic lymphatic malformations, and 3 cases of microcystic lymphatic malformations. Injection with absolute alcohol were performed in 20 patients with venous malformations, whereas both surgery and injection were performed in 7 patients with extensive or multiple lesions. Seventeen patients with macrocystic lymphatic malformations were treated with pingyangmycin injection. While surgery combined with pingyangmycin injection were used in other 3 patients with microcystic lymphatic malformations. According to the degree of airway obstruction and therapeutic conditions, tracheal intubation was performed in 27 patients, urgent preoperative tracheotomy was performed in 3 patients, prophylactic tracheotomy was performed in 2 patients, and postoperative tracheotomy was performed in 1 patient.

Results: Tracheal intubation was remained for 24 to 48 hours in 30 patients, whose intubation was removed successfully in 29 patients except 1 patient who occurred dyspnea after removal of tracheal intubation resulting in tracheotomy. Tracheal cannula was successfully removed in all 6 patients 3 weeks to 4 months after the tracheotomy. There were 9 patients treated once, whereas injections were repeated 2 to 5 times in 38 patients. Necrosis of mucosa occurred in 2 cases after the injection with absolute alcohol, while temporary hemoglobinuria one occurred in 1. There were 5 cases of light or mediate fever after the pingyangmycin injection who recovered well after the symptomatic treatment. Follow-up lasted 1 to 23 years, 38 patients cured, 9 patients valid, and no patient invalid.

Conclusions: It is suggested that sclerotherapy should be the first choice in the treatment of vascular malformations complicated with airway obstruction, in which absolute alcohol should be used in venous malformations compared to pingyangmycin in lymphatic malformations. Combined therapy should be carried out in patients with extensive lesions in order to shorten the course of treatment and to get good therapeutic result.
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January 2010

[Treatment of infantile hemangiomas with low-dose propranolol: evaluation of short-term efficacy and safety].

Zhonghua Yi Xue Za Zhi 2009 Dec;89(44):3130-4

Specialty Department of Hemangioma and Lymphangioma, Tumor Hospital of Linyi, Shandong Province, Linyi 276001, China.

Objective: To evaluate the short-term efficacy and safety of propranolol in the treatment of infantile hemangiomas.

Methods: Between October 2008 and May 2009, oral propranolol was applied to 58 infants with hemangiomas at a dose of 1.0 - 1.5 mg per kilogram of body weight per day in Linyi, Shandong and Shanghai. There were 19 males and 39 females 1 to 12 months old with a mean age of 4 months. The primary tumor size was 1.5 cm x 1.0 cm to 18.0 cm x 5.0 cm. Twenty-seven were superficial, nine deep-seated and 22 mixed. The tumors were located in head and neck (n = 41), trunk and extremities (n = 12), labium vulvae (n = 2), perianal region (n = 1), perineum (n = 1) and scrotum (n = 1). The patients were hospitalized for 7 to 10 days, continued medication at home and revisited every 2 weeks. The changes of tumor size, texture and color were monitored and recorded at a regular interval. The adverse effects after medication were observed and managed accordingly. The short-term results were evaluated using a 4-point scale system.

Results: At 24 hours post-medication, all the tumors decreased in density, color and size. The changes became conspicuous within 5 to 7 days. Seven patients had medication for 2 months, 22 for 3 months, 21 for 4 months and 8 for 5 months. The follow-up period was 5 to 9 months. The overall response was scale I (poor) in 1 patient (1.7%), scale II (moderate) in 12 patients (20.7%), scale III (good) in 35 patients (60.4%) and scale IV (excellent) in 10 patients (17.2%). Statistical analysis showed that the treatment response for deep-seated hemangiomas was significantly better than that for superficial hemangiomas (P < 0.05), but no significant difference was found among different primary sites (P > 0.05). The main adverse effects were bradycardia (100%), diarrhea (63.8%) and sleep change (30.2%), which resolved after expectant treatment without any significant sequel. No serious adverse effect was observed.

Conclusions: Oral propranolol treatment at a low dose is a safe and effective regimen for infantile proliferating hemangiomas. And it can be used as the first-line therapeutic modality. The short-term efficacy is excellent while the side effects are minimal.
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December 2009

[Clinical analysis of 17 cases of pneumatic compression therapy in infants with Kasabach-Merritt phenomenon].

Zhonghua Yi Xue Za Zhi 2009 Jul;89(26):1830-3

Specialty Department of Hemangioma and Lymphangioma, Tumor Hospital of Linyi, Shandong Province 276001, China.

Objective: To summarize the efficacy and safety of employing pneumatic compression therapy in infants with Kasabach-Merritt phenomenon (KMP).

Methods: Seventeen patients with KMP (11 males, 6 females) were treated with pneumatic compression therapy from October 1997 to May 2008. And their clinical characteristics, course of treatment and clinical and laboratory data were retrospectively analyzed. Among 17 patients, 8 cases were located in trunk, 5 in lower extremities and 4 in upper extremities. The diameters of lesions exceeded 8 cm in all patients. The platelet count was all < 100 x 10(9)/L while hemoglobin < 110 g/L and fibrinogen < 2.0 g/L. The self-designed device for pneumatic compression hemangioma therapy was employed (Patent No: ZL97232266. 3). Biopsy and exairesis were performed from the local lesions with KMP in order to determine the pathological features.

Results: Two patients were cured after pneumatic compression therapy for 4 and 6 months respectively, and their lesions disappeared, blood parameters became normal and remained relapse-free after a 5/11-year follow-up. Eleven patients were effective after pneumatic compression therapy for 4 - 6 months, and improvement was demonstrated after 6 - 24 months follow-up without any treatment. Two patients showed improvement after pneumatic compression therapy for 6 months after a follow-up for 5 months or 2 years without progression. After a 6-month pneumatic compression therapy, 2 ineffective patients underwent surgical resection. There were 14 cases of kaposiform hemangioendothelioma (KHE) and 3 cases of tufted hemangioma (TA).

Conclusion: Pneumatic compression therapy has definite curative effects for KMP lesions in extremities and trunk and its side effects are fewer.
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July 2009

Photodynamic therapy of port wine stains-a report of 238 cases.

Photodiagnosis Photodyn Ther 2007 Mar 12;4(1):53-9. Epub 2007 Feb 12.

Special Clinic for Hemangioma, Cancer Hospital of Linyi City, Shandong 276001, PR China.

Objective: Retrospective analysis of clinical effects of vascular acting photodynamic therapy (PDT) for the treatment of port wine stains (PWS).

Methods: Between September 1997 and June 2003, a total of 238 PWS cases (2-56 years old) were treated with Photocarcinorin-mediated PDT using a copper vapour laser. Among them, 20 cases were pink lesions (Type I), 44 cases red lesions (Type II), 99 cases dark red lesions (Type III), 51 cases purple lesions (Type IV), and 24 cases nodular or thickened lesions (Type V), respectively. Patient received a slow intravenous injection of Photocarcinorin (4-5mg/kg b.w.) and light was delivered during the drug injection at dose levels of 160-260J/cm(2) at fluence rates of 70-100mW/cm(2). The same procedure was repeated 2-4 times for some patients. All patients were followed up for 6 months to 4 years.

Results: Sixty-eight cases (28.6%) showed excellent response, 76 cases (31.9%) good response, 87 cases (36.6%) fair response and 7 cases (2.9%) poor or no response. Secondary scar formation was reported in three cases. Highest good to excellent response rates were seen in patients of 5-20 years old. PDT-induced transitional hyperpigmentation was reported in some patients but disappeared without the need of treatment within 3-6 months.

Conclusion: Copper vapour laser PDT can selectively destroy PWS vessels without damage to the normal skin. If the technique is applied properly, it can cure superficial lesions and greatly improve thick lesions.
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http://dx.doi.org/10.1016/j.pdpdt.2007.01.001DOI Listing
March 2007

[Management of lymphatic malformations in oral and maxillofacial regions: the rationale according to the new classification].

Shanghai Kou Qiang Yi Xue 2005 Dec;14(6):553-6

According to the classification of ISSVA, Waner and Suen, the traditionally called lymphangiomas are now referred to as lymphatic malformations, including both macrocystic and microcystic lesions. They are commonly seen vascular anomalies, and most frequently diagnosed at birth and most often occur in the head and neck area. The etiology of lymphatic malformations is still unknown, resulting in a variety of treatment modalities. This paper reviewed the recent literatures with respect to the indications, contraindications, advantages and disadvantages of surgical excision, sclerotherapy and laser ablation of lymphatic malformations of the head and neck, with detailed discussion of the advances in molecular biology and clinical treatment prospects. It is concluded that although lymphatic malformations are benign lesions, they seldom involute spontaneously. Of all vascular malformations, lymphatic malformations are the most difficult to be eradicated. Their infiltrating nature coupled with the difficulty in distinguishing involved important structures of the head and neck from adjacent normal tissues makes complete surgical extirpation even more difficult. The likelihood of postsurgical recurrence and complications is thus higher than other vascular lesions. Although many treatment protocols are available in clinic, indications, contraindications, advantages and disadvantages exist in each modality. The selection of treatment modalities should depend on the patients' status and techniques available. The treatment protocol should be individualized and comprehensive as well as sequential, in order to obtain the best treatment outcomes. In general, treatment will vary according to the depth and the extent of the lesions. Superficial mucosal microcystic lesions and cervicofacial macrocystic lesions are amenable to ablation with sclerotherapy using Bleomycin and OK-432 with the advantages of the absence of a surgical scar. The sclerosing agent OK-432 is effective for macrocystic lymphatic malformations but showed less promise for microcystic lesions, mixed lesions, and lesions outside the head and neck region. In addition, superficial mucosal microcystic lesions are also amenable to CO2 laser therapy. Deeper microcystic lesions are still challenging head and neck surgeons, which are usually extensive and sometimes need to be resected in stages, and even may be impossible to be completely removed. Somnoplasty shows promise for reduction of tongue lymphatic malformations. Surgical excision, staged when necessary, continues to be integral to management in many cases, but should not be overused without consideration of the histologic types and extent. Localized mucosal microcystic lesions and major cervicofacial macrocystic lesions are amenable to primary excision. Care should be exercised in identifying and preserving important cervical and facial structures because anatomical planes are often distorted. Combined sequential approach is recommended for mixed lesions as well as extensive lesions involving both the mucosa and soft tissues.
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December 2005

[A study on clinical differential diagnosis between hemangioma and vascular malformation in infant].

Zhonghua Kou Qiang Yi Xue Za Zhi 2005 Jul;40(4):280-3

Special Department of Hemangioma, Tumor Hospital of Linyi, Linyi Shandong 276001, China.

Objective: To explore the main points of clinical differentiation between hemangioma and vascular malformation in infant.

Methods: Based on Mulliken and Waner's classification, from March, 1997 to February, 1999, 81 baby patients with hemangioma were included in this study. Thirty-eight cases, 43 cases received medical treatment of steroids.

Results: All the patients were followed up from 5 to 7 years. Thirty-eight cases of red strawberry-like lesions limited in the skin began to involute within two years old. Of the 30 patients with strawberry-like lesions and subcutaneous mass, 20 cases involuted in varying degree; 10 cases' subcutaneous mass grew gradually and didn't involute, in 4 cases biopsy was performed, 3 cases were confirmed as hemangioma accompanied with venous malformation by pathology, 1 case was hemangioma accompanied with arteriovenous malformation. Of 13 cases with light blue or normal skin and subcutaneous mass, 7 cases involuted in varying degree; 6 cases grow gradually and didn't disappear, 2 cases were confirmed as venous malformation by biopsy.

Conclusions: Hemangioma in infant begins to involute within two years old. Vascular malformation or hemangioma with deep vascular malformation grows persistently and does not disappear. Skin temperature of lesion surface and dilative veins on the skin artery pulsation, are indexes compressibility, for differentiation between hemangioma and vascular malformation in clinical diagnosis.
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July 2005

[Clinical analysis of 13 cases of hemangioma and vascular malformation associated with thrombopenia].

Shanghai Kou Qiang Yi Xue 2005 Apr;14(2):108-12

Special Department of Hemangioma, Tumor Hospital of Linyi, Linyi 276001, Shandong Province, China.

Purpose: To explore the diagnosis and treatment of hemangioma and vascular malformation associated with thrombopenia (Kasabach-Merritt syndrome, KMS).

Methods: From October 1997 to December 2003, 13 cases of KMS were treated in our hospital. Among the 13 patients, 4 were located in the maxillofacial region, 3 were located in the trunk, 6 were located in the lower limb. The size of the lesion of all patients exceeded 8 cm; 10 were hemangioma, 1 was arteriovenous malformation (AVM), 1 was venous malformation (VM), 1 was Klippel-Trenaunay Syndrome (KTS). The platelet count was all lower than 70 x 10(9)/L, the lowest was 10 x 10(9)/L, the average was 41 x 10(9)/L. The clinical characteristics and course of treatment were analyzed.

Results: 9 patients were cured, 1 improved, 1 had no response, and 2 died. The treatment of choice for KMS was steroids, but the response rate was not high (23.08% in this series). If patients had no response to steroids, they also had no response to interferon.

Conclusions: If a proper treatment was taken in early stage, most patients could get a good result, but for patients with an extensive vascular malformation that can't be removed, the prognosis was poor. For lesions in the limbs and trunk, pneumatic compression therapy has certain curative effect, fewer side effects, therefore worthy of popularization.
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April 2005

[The clinical classification and treatment of arteriovenous malformations of maxilloface].

Zhonghua Wai Ke Za Zhi 2004 Sep;42(18):1128-31

Special Department of Hemangioma, Cancer Hospital of Shandong Linyi, Linyi 276001, China.

Objective: To explore the clinical classification and ideal therapy for maxillofacial AVMs.

Methods: According to the clinical characteristics, 106 patients with maxillofacial AVMs were divided into the 4 types Of them, 38 cases were cystic dilatation lesions, 22 cases were limited thicken lesions, 42 case were diffuse thicken lesions, 4 cases were central maxillary hemangioma. 106 patients with maxillofacial AVMs were treated in our hospital, of them, 8 cases received operation (group 1); 23 cases received embolization of supplying artery alone (group 2); 37 cases received embolization of supplying artery plus hardener intra-tumorous injection (group 3); 38 cases received embolization of supplying artery plus tumor resection (group 4).

Results: Of all the patients were followed up 1 - 11 years, In group 1, 2, 3, and 4, the cure rates is 62.50%, 17.39%, 89.19%, and 97.37% respectively. one patient died of embolization of abnormal communication branches between external carotid and intra-cranical arteries.

Conclusions: (1) This new clinical classification is beneficial for selecting method of treatment. (2) It is necessary that a good digital subtraction angiography for maxillofacial AVMs. (3) The embolization of tumor supplying artery alone could cure the small AVM with single branch terminal blood supply. (4) The embolization of supplying artery plus hardener intratumorous injection or the embolization of supplying artery plus tumor resection is an effective method for maxillofacial AVMs.
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September 2004

[Interventions for nasal hemangiomas in children].

Shanghai Kou Qiang Yi Xue 2002 Sep;11(3):210-2

Special Department for Hemangiomas of Shandong Province, Tumor Hospital of Linyi City, Shandong Linyi, China.

Objective: To explore an ideal therapy for nasal hemangiomas in children.

Methods: From June 1998 to April 2001, 110 patients with nasal hemangiomas in children were treated. Of them, 76 cases received Pingyangmycin intralesional injection (group I); 11 cases received steroids injection (group II); 7 cases received intralesional injection of absolute ethanol (group III); 6 cases received cryotherapy (group IV) and 10 cases with tumor resection (group V).

Results: In group I, II, III, IV and V, the cure rates were 88.16%, 27.27%, 100%, 50% and 80%, respectively. The satisfactory rates of the nasal contour after treatment were 86.84%, 18.18%, 0,0% and 10.00%, respectively.

Conclusion: The nose is a special portion of the body with fine configuration. Once destroyed, it is difficult to restore. Therefore, it is necessary to adopt an effective therapy in the earlier stage. It is not advocated to wait for spontaneous involution. Intralesional injection of Pingyangmycin is an effective method in the treatment of nasal hemangiomas in children; Its result is exact, without significant side effects. The nasal appearance remains good after treatment.
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September 2002