Penile vascular anomalies:A retrospective single center study and cumulative analysis of studies from China

Objective Penile vascular anomalies(PVAs)or hemangioma can arouse patient concern about aesthetics and cause symptoms like bleeding and sexual dysfunction.However,its low incidence and the deficiency of large-volume studies hinder urologists from making informed decisions.This study aimed to investigate the clinical features and treatment experience of PVAs at the Seventh Medical Center of PLA General Hospital,Beijing,China.Furthermore,by systematically analysis of studies on PVAs in Chinese people,we aimed to provide novel insights on the management of this condition.Methods We retrospectively investigated clinical features and pathology of surgery-treated PVAs at our center.Moreover,by systemically reviewing the literature from PubMed and the three largest medical databases(China National Knowledge Infrastructure,Wan Fang,and Chinese Medical Journal Database)in China,we analyzed the clinical features and various therapies of PVAs in Chinese people.Results Between March 1,2018 and March 1,2023,a total of 356 cases with vascular anomalies were treated with surgery at out center.Only seven(2.0%)cases had lesions involving the perineum and external genitalia.All the seven cases were pathologically benign and demonstrated no recurrence over a follow-up period of 1-52 months(median 14 months).A total of 410 cases from 44 studies were selected in the cumulative analysis.Most patients(92.4%)diagnosed with PVAs were asymptomatic,and 68.8%of the patients were treated with sclerotherapy.As to the pathology,57.1%were venous malformation.Conclusion The most common PVA is venous malformation and the majority of patients are asymptomatic.Sclerotherapy and laser have emerged as viable options for treating small lesions.Surgery still has its role in treating large lesions and obtaining pathology.Although PVAs often relapse or demand multiple treatments,the prognosis is favorable.

Optimal timing for plastic surgical procedures for common congenital anomalies:A review

Apart from listening to the cry of a healthy newborn,it is the declaration by the attending paediatrician in the labour room that the child is normal which brings utmost joy to parents.The global incidence of children born with congenital anomalies has been reported to be 3%-6%with more than 90%of these occurring in low-and middle-income group countries.The exact percentages/total numbers of children requiring surgical treatment cannot be estimated for several reasons.These children are operated under several surgical disciplines,viz,paediatric-,plastic reconstructive,neuro-,cardiothoracic-,orthopaedic surgery etc.These conditions may be life-threatening,e.g.,trachea-oesophageal fistula,critical pulmonary stenosis,etc.and require immediate surgical intervention.Some,e.g.,hydrocephalus,may need intervention as soon as the patient is fit for surgery.Some,e.g.,patent ductus arteriosus need‘wait and watch’policy up to a certain age in the hope of spontaneous recovery.Another extremely important category is that of patients where the operative intervention is done based on their age.Almost all the congenital anomalies coming under care of a plastic surgeon are operated as elective surgery(many as multiple stages of correction)at appropriate ages.There are advantages and disadvantages of intervention at different ages.In this article,we present a review of optimal timings,along with reasoning,for surgery of many of the common congenital anomalies which are treated by plastic surgeons.Obstetricians,paediatricians and general practitioners/family physicians,who most often are the first ones to come across such children,must know to guide the parents appropriately and convincingly impress upon the them as to why their child should not be operated immediately and also the consequences of too soon or too late.

Clinical analysis of vascular anomalies： a hospital-based retrospective study of 592 patients in southeast China

Background Vascular anomalies are common and multidisciplinary involved diseases. The greatest impediment to their treatment in the past was their confusing terminology and clinical heterogeneities. This hospital-based retrospective study assessed some clinical characteristics, diagnosis, therapies and outcomes of patients with vascular anomalies in southeast China.Methods A total of 592 vascular anomalies patients （patients with intracranial tissues or viscera involved were excluded）, admitted to the First Affiliated Hospital of Sun Yat-sen University from January 2006 to September 2009, were enrolled in the study. Data for clinical characteristics, diagnosis, therapies and outcomes were collected and analyzed.Results Of the 592 patients, the male：female ratios in the vascular tumor group （n=187） and the vascular malformation group （n=405） were 1∶1.49 and 1∶1.06 respectively, with no significant difference between them. The mean onset age of the vascular tumor group was significantly younger than that of the vascular malformation group （P 〈0.001）. The head and neck were the most commonly （31.4%） involved areas in vascular anomalies. A total of 23.8% of the patients with vascular anomalies had definite symptoms caused by the vascular lesions. In the vascular tumor group, 94.1% of them were infantile hemangiomas. Venous malformation was the most common （41.0%） subtype of vascular malformations.Surgical therapy was undertaken in 94.2% of the patients with vascular anomalies. Of the 519 patients available for the 16-58 month follow-up, 322 patients （62.0%） were cured, 108 patients （20.8%） were markedly improved, 57 patients （11.0%） were partially improved, and 32 patients （6.2%） were uncured.Conclusions Vascular anomalies are clinically heterogeneous. While the outcome is generally favorable, further effort should be made to determine the appropriate terminology and management.

Vascular injury during laparoscopic cholecystectomy:An oftenoverlooked complication

Laparoscopic cholecystectomy is one of the most frequently performed procedures in gastrointestinal surgery worldwide.Bleeding complications due to vascular injuries represent an important cause of morbidity and mortality,especially when facing major bleeding during laparoscopy,where bleeding control can be technically challenging in inexperienced hands.Interestingly,the reported incidence rate of conversion to open surgery due to vascular lesions is approximately 0%-1.9%,with a mortality rate of approximately 0.02%.The primary aim of this article was to perform an up-to-date overview regarding the incidence and surgical management of vascular injuries during laparoscopic cholecystectomy according to the available scientific evidence.

Vascular anomaly in the levator aponeurosis of neurofibromatosis type 1

Dear Editor,I am Satoru Kase,from the Department of Ophthalmology,Faculty of Medicine and Graduate School of Medicine,Hokkaido University,Sapporo City,Japan.I write to present a case of neurofibromatosis type 1（NF1）showing massive hemorrhage during involutional blepharoptosis surgery.

Overview of peripheral arteriovenous malformations:From diagnosis to treatment methods

Based on the latest classification by the International Society for the Study of Vascular Anomalies in 2018,vascular malformations(VMs)can be categorized into simple,combined,VMs of major named vessels,and VMs associated with other anomalies.Simple VMs include lymphatic,venous,capillary,and arteriovenous malformations(AVMs).AVMs represent disorders of direct arteriovenous shunts caused by the absence of a capillary bed between the involved arteries and veins.This abnormal vascular communication causes arterial blood to accumulate in the venous vessels,thus resulting in venous hypertension and characteristic clinical manifestations,such as pulsation,tremors,and elevated temperature.AVMs can occur sporadically or as manifestations of syndromic lesions and are considered among the most complex and challenging VMs.The diagnosis and treatment of AVMs can vary depending on the lesion location and associated clinical symptoms,thus complicating their management.Herein,we discuss peripheral AVMs in terms of their clinical manifestations,imaging examinations,and staging systems to provide a comprehensive reference for the treatment,evaluation methods,and follow-up procedures for this vascular anomaly.

第16届国际脉管性疾病学术研讨会述评

第16届国际脉管性疾病学术研讨会(16th International Workshop on Vascular Anomalies)于2006年6月14～17日在意大利米兰市Palazzo Mezzanotte举行。会议共收到论文200余篇,来自世界各地(以欧美为主)的300多名代表参加了会议。国际著名脉管性疾病专家Mulliken教授(美国)、Waner教授(美国)、Yakes教授(美国)、Enjolras教授(法同)、Boon教授(比利时)、Vikkula教授(比利时)、Mattassi教授(意大利)。

Preservation of aberrant right hepatic arteries does not affect safety and oncological radicality of pancreaticoduodenectomy-own results and a systematic review of the literature

Background:Aberrant right hepatic arteries(aRHA)are frequently encountered during pancreaticoduodenectomy(PD).Their effects on surgical morbidity and resection margin are still debated.This study aimed to compare the short term and long term outcomes in patients with and without aRHA.Methods:A single-center retrospective analysis of 353 consecutive PD during a 5-year period was done.The type of arterial supply was determined preoperatively by CT and confirmed at surgery.Hiatt types III-VI included some type of aRHA and comprised the study group.Hiatt types I and II were considered irrelevant for PD and used as controls.Primary endpoints were the rates of major postoperative complications and the rate of R0-resection in cases of malignant disease.Secondary endpoints included duration of surgery,postoperative stay,number of harvested lymph nodes and survival in patients with pancreatic cancer.Own results were compared to existent data using a systematic review of the literature.Results:No aRHA had to be sacrificed or reconstructed.Surgical morbidity and specific complications such as post-pancreatectomy hemorrhage(PPH),pancreatic fistula and bile leak were the same in patients with and without aRHA.There was no significant difference in operative time,blood loss,length of ICU-and hospital stay.Patients with malignancy had similar high rates of R0-resection and identical number of harvested lymph nodes.Survival of patients with pancreatic cancer was not affected by aRHA.Conclusions:aRHA may be preserved in virtually all cases of PD for resectable pancreatic head lesions without increasing surgical morbidity and without compromising oncological radicality in patients with cancer,provided the variant anatomy is being recognised on preoperative CT and a meticulous surgical technique is used.