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      Surgical management of vascular anomalies in children at a tertiary care hospital in a resource-limited setting: a Tanzanian experience with 134 patients

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          Abstract

          Background

          Vascular anomalies pose major diagnostic and therapeutic challenges among pediatricians and pediatric surgeons practicing in resource limited countries. There is paucity of published data regarding this subject in Tanzania and Bugando Medical Centre in particular. This study describes our experiences on the challenges and outcome of surgical management of childhood vascular anomalies in our environment.

          Methods

          Between January 2009 and December 2013, a prospective study on the surgical management of vascular anomalies was undertaken at Bugando Medical Centre.

          Results

          A total of 134 patients (M; F = 1:2.5) were studied. The median age at presentation was 6 years. Of the 134 patients, 101 (75.4 %) were diagnosed as having vascular tumors and 33 (24.6 %) had vascular malformations. The head and the neck were the most frequent anatomical site recorded as having a tumor (56.7 % of patients). Out of 134 patients, 129 (96.3 %) underwent surgical treatment. Failure to respond to non-operative treatment (86.8 %), huge disfiguring/obstructing mass (4.7 %), infection (3.1 %), ulceration (3.1 %) and hemorrhage (2.3 %) were indications for surgical intervention. Tumor excision and primary wound closure was the most common type of surgical procedure performed in 80.6 % of patients. Surgical site infection was the most frequent complications accounting for 33.8 % of cases. Mortality rate was 1.5 %. Tumor excision and primary wound closure gave better outcome compared with other surgical options (p < 0.001). Outcome of injection sclerotherapy in 3 (3.7 %) children, serial ligation of feeder vessels employed in 2 (1.6 %), and conservative treatment in 5 (3.7 %), were poor and required conversion to surgical excision. Despite low mortality rate recorded in this study, but ugly scar, 14 (20.6 %) and limb deformity, 6 (8.8 %) were problems. The overall result of surgical treatment at the end of follow up period was excellent in 108 (87.1 %) patients.

          Conclusion

          Surgical excision and primary wound closure gave good outcome which could be employed in complicated and vascular anomalies which failed to respond to other treatment in regions with limited resources.

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          Most cited references 36

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          Hemangiomas and vascular malformations in infants and children: a classification based on endothelial characteristics.

          Forty-nine specimens from a variety of vascular lesions were analyzed for cellular characteristics. Two major categories of lesions emerged from this investigation: hemangiomas and vascular malformations. This classification and its implications are justified by several considerations. Hemangiomas in the proliferating phase (n = 14) were distinguished by (1) endothelial hyperplasia with incorporation of [3H]thymidine, (2) multilaminated basement membrane formation beneath the endothelium, and (3) clinical history of rapid growth during early infancy. Hemangiomas in the involuting phase (n = 12) exhibited (1) histologic fibrosis and fat deposition, (2) low to absent [3H]thymidine labeling of endothelial cells, and (3) rapid growth and subsequent regression. The endothelium in hemangiomas had many characteristics of differentiation: Weibel-Palade bodies, alkaline phosphatase, and factor VIII production. Vascular malformations (n = 23) demonstrated no tritiated thymidine incorporation and normal ultrastructural characteristics. These lesions were usually noted at birth, grew proportionately with the child, and consisted of abnormal, often combined, capillary, arterial, venous, and lymphatic vascular elements. This cell-oriented analysis provides a simple yet comprehensive classification of vascular lesions of infancy and childhood and serves as a guide for diagnosis, management, and further research.
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            Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment.

            Infantile hemangiomas are the most common tumor of infancy. Risk factors for complications and need for treatment have not been studied previously in a large prospective study. This study aims to identify clinical characteristics associated with complications and the need for therapeutic intervention. We conducted a prospective cohort study at 7 US pediatric dermatology clinics with a consecutive sample of 1058 children, aged < or = 12 years, with infantile hemangiomas enrolled between September 2002 and October 2003. A standardized questionnaire was used to collect data on each patient and each hemangioma, including clinical characteristics, complications, and treatment. Twenty-four percent of patients experienced complications related to their hemangioma(s), and 38% of our patients received some form of treatment during the study period. Hemangiomas that had complications and required treatment were larger and more likely to be located on the face. Segmental hemangiomas were 11 times more likely to experience complications and 8 times more likely to receive treatment than localized hemangiomas, even when controlled for size. Large size, facial location, and/or segmental morphology are the most important predictors of poor short-term outcomes as measured by complication and treatment rates.
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              Vascular tumors and vascular malformations (new issues).

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                Author and article information

                Contributors
                drphillipoleo@yahoo.com
                n_eema@yahoo.com
                prambau@bugando.ac.tz
                mmajfe@hotmail.com
                drgilyoma2@yahoo.com
                Journal
                BMC Res Notes
                BMC Res Notes
                BMC Research Notes
                BioMed Central (London )
                1756-0500
                30 November 2015
                30 November 2015
                2015
                : 8
                Affiliations
                [ ]Department of Surgery, Bugando Medical Centre, Mwanza, Tanzania
                [ ]Department of Paediatrics, Bugando Medical Centre, Mwanza, Tanzania
                [ ]Department of Pathology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
                [ ]Department of Anatomy, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
                [ ]Department of Otorhinolaryngology, Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
                Article
                1718
                10.1186/s13104-015-1718-3
                4666117
                26621505
                © Chalya et al. 2015

                This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Categories
                Research Article
                Custom metadata
                © The Author(s) 2015

                Medicine

                vascular anomalies, children, surgical management, challenges, outcome, tanzania

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