Abstract
Background: The current survey aimed to describe the clinical features of critical infantile hepatic hemangioma (IHH) and the implications of recent treatments. Materials and Methods: A nationwide survey of critical IHH patients treated between 2005 and 2010 was performed in all 117 registered pediatric surgical hospitals in Japan. As a result, 19 patients were identified and reviewed using a statistical analysis. Results: Abdominal distention (47.4%), high-output cardiac failure (47.4%), coagulopathy (42.1%), and respiratory distress (31.6%) were the major symptoms. Three patients died (1 of coagulopathy, 1 of cardiac failure, and 1 of both). An accompanying portovenous shunt was also highlighted. Infantile hepatic hemangioma was totally insensitive to steroid treatment in 3 (23.1%) of the 13 patients, and 9 (47.4%) of the 19 patients required other treatments. Surgical resection and β-blocker improved the hematologic data, whereas hepatic arterial ligation and embolization seemed to produce a limited effect. Among the dead patients, several hematologic parameters were significantly worse: the thrombocyte count (pretherapeutic: 73 000 vs 300 000/mm 3, dead vs survivor, respectively [P <.03]; posttherapeutic: 66 000 vs 388 700/mm 3 [P <.003]) and the prothrombin time (posttherapeutic, 35.0 vs 12.1 seconds [P <.0001], dead vs survivor, respectively). Conclusion: For critical IHH cases with steroid-insensitive hematologic disorders, alternative treatments including β-blocker therapy, surgery, and liver transplantation should be considered.
| Original language | English |
|---|---|
| Pages (from-to) | 2239-2243 |
| Number of pages | 5 |
| Journal | Journal of Pediatric Surgery |
| Volume | 46 |
| Issue number | 12 |
| DOIs | |
| Publication status | Published - 2011 Dec |
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Keywords
- β-blocker
- Hemangioendothelioma
- Infantile hepatic hemangioma
- Liver transplantation
ASJC Scopus subject areas
- Surgery
- Pediatrics, Perinatology, and Child Health
Cite this
Critical infantile hepatic hemangioma : Results of a nationwide survey by the Japanese Infantile Hepatic Hemangioma Study Group. / Kuroda, Tatsuo; Kumagai, Masaaki; Nosaka, Shunsuke; Nakazawa, Atsuko; Takimoto, Tetsuya; Hoshino, Ken.
In: Journal of Pediatric Surgery, Vol. 46, No. 12, 12.2011, p. 2239-2243.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Critical infantile hepatic hemangioma
T2 - Results of a nationwide survey by the Japanese Infantile Hepatic Hemangioma Study Group
AU - Kuroda, Tatsuo
AU - Kumagai, Masaaki
AU - Nosaka, Shunsuke
AU - Nakazawa, Atsuko
AU - Takimoto, Tetsuya
AU - Hoshino, Ken
PY - 2011/12
Y1 - 2011/12
N2 - Background: The current survey aimed to describe the clinical features of critical infantile hepatic hemangioma (IHH) and the implications of recent treatments. Materials and Methods: A nationwide survey of critical IHH patients treated between 2005 and 2010 was performed in all 117 registered pediatric surgical hospitals in Japan. As a result, 19 patients were identified and reviewed using a statistical analysis. Results: Abdominal distention (47.4%), high-output cardiac failure (47.4%), coagulopathy (42.1%), and respiratory distress (31.6%) were the major symptoms. Three patients died (1 of coagulopathy, 1 of cardiac failure, and 1 of both). An accompanying portovenous shunt was also highlighted. Infantile hepatic hemangioma was totally insensitive to steroid treatment in 3 (23.1%) of the 13 patients, and 9 (47.4%) of the 19 patients required other treatments. Surgical resection and β-blocker improved the hematologic data, whereas hepatic arterial ligation and embolization seemed to produce a limited effect. Among the dead patients, several hematologic parameters were significantly worse: the thrombocyte count (pretherapeutic: 73 000 vs 300 000/mm 3, dead vs survivor, respectively [P <.03]; posttherapeutic: 66 000 vs 388 700/mm 3 [P <.003]) and the prothrombin time (posttherapeutic, 35.0 vs 12.1 seconds [P <.0001], dead vs survivor, respectively). Conclusion: For critical IHH cases with steroid-insensitive hematologic disorders, alternative treatments including β-blocker therapy, surgery, and liver transplantation should be considered.
AB - Background: The current survey aimed to describe the clinical features of critical infantile hepatic hemangioma (IHH) and the implications of recent treatments. Materials and Methods: A nationwide survey of critical IHH patients treated between 2005 and 2010 was performed in all 117 registered pediatric surgical hospitals in Japan. As a result, 19 patients were identified and reviewed using a statistical analysis. Results: Abdominal distention (47.4%), high-output cardiac failure (47.4%), coagulopathy (42.1%), and respiratory distress (31.6%) were the major symptoms. Three patients died (1 of coagulopathy, 1 of cardiac failure, and 1 of both). An accompanying portovenous shunt was also highlighted. Infantile hepatic hemangioma was totally insensitive to steroid treatment in 3 (23.1%) of the 13 patients, and 9 (47.4%) of the 19 patients required other treatments. Surgical resection and β-blocker improved the hematologic data, whereas hepatic arterial ligation and embolization seemed to produce a limited effect. Among the dead patients, several hematologic parameters were significantly worse: the thrombocyte count (pretherapeutic: 73 000 vs 300 000/mm 3, dead vs survivor, respectively [P <.03]; posttherapeutic: 66 000 vs 388 700/mm 3 [P <.003]) and the prothrombin time (posttherapeutic, 35.0 vs 12.1 seconds [P <.0001], dead vs survivor, respectively). Conclusion: For critical IHH cases with steroid-insensitive hematologic disorders, alternative treatments including β-blocker therapy, surgery, and liver transplantation should be considered.
KW - β-blocker
KW - Hemangioendothelioma
KW - Infantile hepatic hemangioma
KW - Liver transplantation
UR - http://www.scopus.com/inward/record.url?scp=83455187951&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=83455187951&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2011.09.007
DO - 10.1016/j.jpedsurg.2011.09.007
M3 - Article
C2 - 22152857
AN - SCOPUS:83455187951
VL - 46
SP - 2239
EP - 2243
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 12
ER -