L.M. MIROLYUBOV^1,2, I.N. NURMEEV^1,2, L.F. RASHITOV^2,3, D.V. OSIPOV¹, A.Yu. OSIPOV^1,2, A.R. NURMEEVA²

¹Children’s Republican Clinical Hospital of the MH of RT, 140 Orenburgskiy Trakt, Kazan, Russian Federation, 420138

²Kazan State Medical University, 49 Butlerov Str., Kazan, Russian Federation, 420012

³Kazan (Volga region) Federal University, 18 Kremlevskaya Str., Kazan, Russian Federation, 420008

Mirolyubov L.M. — D. Med. Sc., Professor, Head of the Department of Pediatric Surgery, tel. (843) 267-89-69, e-mail: [email protected]

Nurmeev I.N. — D. Med. Sc., associate professor of the Department of Pediatric Surgery, tel. (843) 267-89-69, e-mail: [email protected]

Rashitov L.F. — Cand. Med. Sc., associate professor of the Department of emergency medical service and simulation medicine, tel. (843) 236-68-02, e-mail: [email protected]

Osipov D.V. — Cand. Med. Sc., vascular surgeon, tel. (843) 267-89-69, e-mail: [email protected]

Osipov A.Yu. — assistant of the Department of Pediatric Surgery, tel. (843) 267-89-69, e-mail: [email protected]

Nurmeeva A.R. — dermatologist, assistant of the Department of Dermatology, tel. (843) 267-89-69, e-mail: [email protected]

Experience of nonsurgical (conservative) treatment of complicated hemangiomas in 3104 children is presented in this article. In 133 (4,28%) of them the disease had a complicated character. The following methods were used: laser and surgical removal, Propranolol therapy with in-patient and out-patient phases. There was traced a significant elimination of bleeding and ulceration, as well as the symptoms associated with the pressure of hemangioma on the surrounding tissues. It is testified that the purification (epithelialization) of ulcers occurs significantly faster when giving medical treatment with Propranolol. The tactics of medical management of patients with hemangiomas proved to be effective and safe; medical treatment is preferred for the group of children with complicated hemangiomas.

Key words: children, hemangioma, hemorrhage, ulcer, treatment.

REFERENCES

1. Gutkin D.V., Lagunova Z.V., Pancheshnikova E.S., Potekaev N.N., Tkachenko S.B. Hemangiomas: etiology and pathogenesis. Eksperimental’naya i klinicheskaya dermatokosmetologiya, 2004, no. 2, pp. 20-23 (in Russ.).
2. Isakov Yu.F. Khirurgicheskie bolezni detskogo vozrasta: ucheb. v 2 t. [Surgical diseases of childhood: studies. 2 vols]. Moscow: GEOTAR-MED, 2004.
3. Chiller K.G., Passaro D., Frieden I.J. Hemangiomas of infancy: clinical characteristics, morphologic subtypes, and their relationship to race, ethnicity, and sex. Arch Dermatol, 2002, vol. 138, pp. 1567-1576.
4. Janmohamed S.R., Madern G.C., de Laat P.S., Oranje A.P. Haemangioma of infancy: two case reports with an overdose of propranolol. Case Rep Dermatol, 2011, vol. 3(1), pp. 18-21.
5. Abshilava D.I., Kolygin B.A., Gasanov D.G. Vrachebnaya taktika pri gemangiomakh u detey [Medical Management of hemangiomas in children]. Leningrad, 1984. 24 p.
6. Boye E., Paranya G., Mulliken J.B., Olsen B.R., Bischoff J. Clonality and altered behavior of endothelial cells from hemangiomas. Clin. Invest, 2001, vol. 107(6), pp. 745-752.
7. Bruckner A.L., Frieden I.J. Hemangiomas of infancy. J. Am. Acad. Dermatol, 2003, vol. 48(4), pp. 477-493.
8. Puttgen K.B., Summerer B., Schneider J., Cohen B.A., Boss E.F.,  Bauman N.M. Cardiovascular and blood glucose parameters in infants during propranolol initiation for treatment of symptomatic infantile hemangiomas . Ann Otol Rhinol Laryngol, 2013, vol. 122(9), pp. 550-554.
9. Lèautè-Labréze C., Dumas de la Roque E., Hubiche T., Boralevi F., Thambo J.B., Tapeb A. Propranolol for severe hemangiomas of infancy. N. Engl. J. Med, 2008, vol. 358, pp. 2649-2651.
10. Tan C.E., Itinteang T., Leadbitter P., Marsh R.,  Tan  S.T.  Low-dose propranolol regimen for infantile haemangioma. J Paediatr Child Health, 2014, vol. 3. doi: 10.1111.
11. Fette A. Propranolol in use for treatment of complex infant hemangiomas: literature review regarding current guidelines for preassessment and standards of care before initiation of therapy. Scientific World Journal, 2013, vol. 20, pp. 850193.
12. Marchuk D.A. Pathogenesis of hemangioma. Clin. Invest, 2001, vol. 107(6), pp. 665-666.
13. Farhangi V., Sansone R.A.  QTc prolongation due to propranolol overdose. Int J Psychiatry Med, 2003, vol. 33(2), pp. 201-202.
14. Jacobs A.H. Strawberry hemangiomas; the natural history of the untreated lesion . Cal Medicine, 1957, vol. 86(1), pp. 8-10.
15. Reith D.M., Dawson A.H., Epid D., Whyte I.M., Buckley N.A., Sayer G.P. Relative toxicity of beta blockers in overdose. J ToxicolClinToxicol, 1996, vol. 34(3), pp. 273-278.
16. Hong E., Fischer G. Propranolol for recalcitrant ulcerated hemangioma of infancy. Ped Dermatol, 2012, vol. 29, pp. 64-67.