Resumen El sangrado del intestino delgado es una causa poco frecuente de sangrado en el tracto gastrointestinal. La mayoría de casos son secundarios a angiodisplasias; sin embargo, rara vez se asocia a hemangiomas del intestino delgado, los cuales son una neoplasia vascular benigna que se diagnostica principalmente con cápsula endoscópica y enteroscopia asistida por balón en pacientes estables de forma preoperatoria. Hasta la fecha solo se había publicado un caso con inestabilidad hemodinámica al momento del diagnóstico. Se reporta el caso de una mujer de 21 años que debuta con sangrado agudo y choque hemorrágico secundario a hemangioma capilar del yeyuno, el cual fue diagnosticado mediante una enteroscopia intraoperatoria y manejado con resección quirúrgica de forma exitosa.

Abstract Bleeding from the small intestine is an uncommon cause of gastrointestinal tract bleeding. Most cases are secondary to angiodysplasias; however, they are rarely associated with hemangiomas of the small intestine, which are benign vascular neoplasms primarily diagnosed using capsule endoscopy and balloon-assisted enteroscopy in stable patients preoperatively. To date, only one case has been published with hemodynamic instability at the time of diagnosis. This report presents the case of a 21-year-old woman who presented with acute bleeding and hemorrhagic shock secondary to capillary hemangioma of the jejunum, which was diagnosed via intraoperative enteroscopy and successfully managed with surgical resection.

ABSTRACT Purpose: To assess the anterior and posterior segments of full-term neonates over a 1.5-year period. Methods: The findings of full-term neonates who underwent ophthalmological examinations between June 2019 and December 2020 were analyzed, and the results were retrospectively recorded. Results: The study comprised 2972 neonates with a mean birth week of 38.7 ± 1.2 weeks and a mean birth weight of 3235 ± 464 g. The neonates were examined on an average of 49.3 ± 18.9 postnatal days. Of the examined neonates, 185 (6.2%) showed abnormal ophthalmological findings, the most prevalent of which were retinal hemorrhage in 2.3% (n=68) and white changes in the peripheral retina in 1.9% (n=55) of the neonates. Cases of optic disc pathologies (n=20), choroidal nevus (n=10), iris-choroidal coloboma (n=5), subconjunctival hemorrhage (n=6), non-specific retinal pigmentary change (n=4), congenital cataract (n=3), posterior synechia (n=3), iris nevus (n=3), corneal opacity (n=1), choroidal coloboma (n=1), iris coloboma (n=1), buphthalmos (n=1), anophthalmos (n=1), microphthalmia (n=1), lid hemangioma (n=1), and vitreous hemorrhage (n=1) collectively accounted for approximately 2% of all neonates. Pathologies that could potentially impair vision, which were detected by ophthalmological examination, accounted for 1.2% of all neonates (n=37). Conclusion: The most prevalent finding of the ophthalmological examinations of neonates in the present study was retinal hemorrhage. Ophthalmological examinations of neonates can help in identifying diseases that may affect their vision and are curable or may lead to amblyopia in the long term. Purpose fullterm full term 1.5year 15year year 1.5 1 5 period Methods 201 202 analyzed recorded Results 297 387 38 7 38. 12 2 1. 323 46 g 493 49 3 49. 189 18 9 18. days 6.2% 62 6 (6.2% 23 2.3 n=68 n68 n 68 (n=68 19 1.9 n=55 n55 55 (n=55 n=20, n20 n=20 , 20 (n=20) n=10, n10 n=10 10 (n=10) irischoroidal n=5, n5 n=5 (n=5) n=6, n6 n=6 (n=6) nonspecific non specific n=4, n4 n=4 4 (n=4) n=3, n3 n=3 (n=3) n=1, n1 n=1 (n=1 examination n=37. n37 n=37 . 37 (n=37) Conclusion 5year 15 29 32 6.2 (6.2 2. (n=6 (n=5 n2 n=2 (n=20 (n=10 n= (n=4 (n=3 (n= (n=37 6. (6. (n=2 (n (6 (

RESUMO Objetivo: Avaliar os segmentos anterior e posterior em recém-nascidos a termo durante um período de 1,5 anos. Métodos: Foram analisados recém-nascidos a termo que tiveram os olhos examinados entre junho de 2019 e dezembro de 2020, e os resultados foram registrados retrospectivamente. Resultados: O estudo foi composto por 2.972 recém-nascidos com média de uma semana de nascimento de 38,7 ± 1,2 semanas e um peso médio ao nascer de 3235 ± 464 g. Os recém-nascidos foram examinados em média pós-natal de 49,3 ± 18,9 dias. Dos recém-nascidos, 185 (6,2%) apresentaram resultados oculares anormais. Os achados oculares anormais mais prevalentes foram hemorragia da retina em 2,3% (n=68) e alterações brancas na retina periférica em 1,9% (n=55) dos recém-nascidos. Casos de patologias de disco óptico (n=20), nevo de coroide (n=10), coloboma iris-coroide (n=5), hemorragia subconjuntival (n=6), alteração pigmentar da retina não específica (n=4), catarata congênita (n=3), Sinequia posterior (n=3), nevo da íris (n=3), opacidade da córnea (n=1), coloboma de coroide (n=1), coloboma de íris (n=1), buftalmos (n=1), anoftalmia (n=1), microftalmia (n=1), hemangioma de pálpebra (n=1) e hemorragia vítrea (n=1) contabilizaram coletivamente cerca de 2% dos recém-nascidos. As patologias que potencialmente prejudicam a visão, detectadas por exame ocular, representaram 1,2% dos recém-nascidos (n=37). Conclusão: O achado mais prevalente de exames oculares de recém-nascidos neste estudo foi hemorragia da retina. Exames oftalmológicos em recém-nascidos podem ser úteis na identificação de doenças que podem impactar a visão deles, podendo ser curáveis ou levar à ambliopia no longo prazo. Objetivo recémnascidos recém nascidos 15 1 5 1, anos Métodos 201 2020 retrospectivamente Resultados 2972 2 972 2.97 387 38 7 38, 12 323 46 g pósnatal pós natal 493 49 3 49, 189 18 9 18, dias recémnascidos, nascidos, 6,2% 62 6 (6,2% 23 2,3 n=68 n68 n 68 (n=68 19 1,9 n=55 n55 55 (n=55 recémnascidos. nascidos. n=20, n20 n=20 , 20 (n=20) n=10, n10 n=10 10 (n=10) iriscoroide iris n=5, n5 n=5 (n=5) n=6, n6 n=6 (n=6) n=4, n4 n=4 4 (n=4) n=3, n3 n=3 (n=3) n=1, n1 n=1 (n=1 ocular n=37. n37 n=37 . 37 (n=37) Conclusão deles prazo 202 297 97 2.9 32 6,2 (6,2 2, (n=6 (n=5 n2 n=2 (n=20 (n=10 n= (n=4 (n=3 (n= (n=37 29 2. 6, (6, (n=2 (n (6 (

Abstract Pulmonary veno-occlusive disease (PVOD) and pulmonary capillary hemangiomatosis are rare types of histopathological substrates within the spectrum of pulmonary arterial hypertension (PAH) with a very poor prognosis. They are characterized by a widespread fibroproliferative process of the small caliber veins and/or capillaries with sparing of the larger veins, resulting in a pre-capillary pulmonary hypertension phenotype. Clinical presentation is unspecific and similar to other PAH etiologies. Definitive diagnosis is obtained through histological analysis, although lung biopsy is not advised due to a higher risk of complications. However, some additional findings may allow a presumptive clinical diagnosis of PVOD, particularly a history of smoking, chemotherapy drug use, exposure to organic solvents (particularly trichloroethylene), low diffusing capacity for carbon monoxide (DLCO), exercise induced desaturation, and evidence of venous congestion without left heart disease on imaging, manifested by a classical triad of ground glass opacities, septal lines, and lymphadenopathies. Lung transplant is the only effective treatment, and patients should be referred at the time of diagnosis due to the rapid progression of the disease and associated poor prognosis. We present a case of a 58-year-old man with PAH with features of venous/capillary involvement in which clinical suspicion, prompt diagnosis, and early referral for lung transplantation were determinant factors for the successful outcome. venoocclusive veno occlusive PVOD (PVOD (PAH prognosis andor or precapillary pre phenotype etiologies analysis complications However smoking use trichloroethylene, trichloroethylene , trichloroethylene) DLCO, DLCO (DLCO) desaturation imaging opacities lines lymphadenopathies treatment 58yearold yearold 58 year old venouscapillary suspicion outcome (DLCO 5

Resumo A doença veno-oclusiva pulmonar (DVOP) e a hemangiomatose capilar pulmonar são tipos raros de substratos histopatológicos dentro do espectro da hipertensão arterial pulmonar (HAP) com prognóstico muito ruim. Caracterizam-se por um processo fibroproliferativo generalizado das veias e/ou capilares de pequeno calibre com preservação das veias maiores, resultando em um fenótipo de hipertensão pulmonar pré-capilar. A apresentação clínica é inespecífica e semelhante a outras etiologias de HAP. O diagnóstico definitivo é obtido por meio de análise histológica, embora a biópsia pulmonar não seja aconselhada devido ao maior risco de complicações. No entanto, alguns achados adicionais podem permitir um diagnóstico clínico presuntivo de DVOP, especialmente história de tabagismo, uso de drogas quimioterápicas, exposição a solventes orgânicos (particularmente tricloroetileno), baixa capacidade de difusão do monóxido de carbono (DLCO), dessaturação ao esforço e evidências de doença venosa sem doença cardíaca esquerda no exame de imagem, manifestada por uma tríade clássica de opacidades em vidro fosco, linhas septais, e linfadenopatias. O transplante pulmonar é o único tratamento eficaz e os pacientes devem ser encaminhados no momento do diagnóstico, devido à rápida progressão da doença e ao prognóstico ruim. Apresentamos o caso de um homem de 58 anos com HAP com características de envolvimento venoso/capilar em que a suspeita clínica, o pronto diagnóstico e o encaminhamento precoce para transplante pulmonar foram determinantes para um bom desfecho. venooclusiva veno oclusiva DVOP (DVOP (HAP ruim Caracterizamse Caracterizam se eou ou maiores précapilar. précapilar pré capilar. pré-capilar histológica complicações entanto tabagismo quimioterápicas particularmente tricloroetileno, tricloroetileno , tricloroetileno) DLCO, DLCO (DLCO) imagem fosco septais linfadenopatias 5 venosocapilar venoso desfecho (DLCO

ABSTRACT Littoral cell angioma is an extremely rare splenic vascular tumor originating from the cells lining the splenic red pulp sinuses. Approximately 150 cases of littoral cell angioma have been reported since 1991. Its clinical manifestation is usually asymptomatic and is mostly diagnosed as an incidental finding through abdominal imaging. Herein, we present a case of littoral cell angioma in a 41-year-old woman with no previous comorbidities, which initially presented as a nonspecific splenic lesion diagnosed on imaging in the emergency room. The patient was treated through laparoscopic intervention. sinuses 15 1991 Herein 41yearold yearold 41 year old comorbidities room intervention 1 199 4 19

ABSTRACT Giant hepatic hemangiomas are occasional in patients with cirrhosis. It remains a challenge to decide on the need for treatment and choose the most appropriate intervention. A 62-year-old woman was recently diagnosed with cirrhosis and complained of upper abdominal fullness, reduction in oral food intake, and weight loss of 6 kg over the last three years. Upper digestive endoscopy evidenced thin-caliber esophageal varices and significant extrinsic compression of the lesser gastric curvature. Abdominal computed tomography revealed an exophytic tumor in the left hepatic lobe, measuring 11.5 cm, which had progressive centripetal contrast enhancement from the arterial phase, compatible with hepatic hemangioma. Serum tumor markers were negative, and her liver function was unimpaired. The patient underwent surgical resection (non-anatomical hepatectomy of segments II and III) which had no immediate complications, and the histopathological evaluation confirmed cavernous hepatic hemangioma. Two weeks later, she was admitted to the emergency room with jaundice, signs of hepatic encephalopathy, and moderate ascites, and was further diagnosed with secondary bacterial peritonitis. As no perforations, abscesses, or fistulas were observed on subsequent imaging tests, clinical management was successfully carried out. This case highlights that giant hepatic hemangiomas may be symptomatic and warrant treatment. In the setting of cirrhosis and portal hypertension, physicians should be aware of the risk of hepatic decompensation following surgical resection, even in patients with Child-Pugh class A. intervention 62yearold yearold 62 year old fullness intake years thincaliber thin caliber curvature lobe 115 11 5 11. cm phase hemangioma negative unimpaired nonanatomical non anatomical III complications later jaundice encephalopathy ascites peritonitis perforations abscesses tests out hypertension ChildPugh Child Pugh 1

ABSTRACT Vascular anomalies comprise a wide spectrum of clinical manifestations related to disturbances in the blood or lymph vessels. They correspond to mainly tumors (especially hemangiomas), characterized by high mitotic activity and proliferation of the vascular endothelium, and malformations, endowed with normal mitotic activity and no hypercellularity or changes in the rate of cell turnover. However, the classifications of these lesions go beyond this dichotomy and consist various systems adapted for and by different clinical subgroups. Thus, the classifications have not reached a consensus and have historically caused confusion regarding the nomenclatures and definitions. Cavernous venous malformations of the orbit, previously called cavernous hemangiomas, are the most common benign vascular orbital lesions in adults. Herein, we have compiled and discussed the various evidences, including clinical, radiological, morphological, and molecular evidence that indicate the non-neoplastic nature of these lesions. vessels especially hemangiomas , hemangiomas) endothelium turnover However subgroups Thus definitions orbit adults Herein evidences radiological morphological nonneoplastic non neoplastic

RESUMEN Las enfermedades que afectan el tejido sinovial de la rodilla son diversas desde los puntos de vista clínico, imagenológico e histológico. Entre estas entidades se encuentran la sinovitis vellonodular pigmentada, el hemangioma sinovial y la condromatosis sinovial. El objetivo de la investigación es actualizar y brindar información sobre la condromatosis sinovial. En la búsqueda y análisis de la información, que se realizó del 1 de diciembre de 2023 al 31 de enero de 2024, se emplearon las siguientes palabras: synovial condromatosis; knee synovial condromatosis; joint tumors; synovial tumors. A partir de la información obtenida, se realizó una revisión bibliográfica de 121 artículos publicados en las bases de datos PubMed, Hinari, SciELO y Medline mediante el gestor de búsqueda y administrador de referencias EndNote; de ellos, se utilizaron 34 citas seleccionadas para realizar la revisión, 30 de los últimos cinco años. En el estudio se mencionan las características fisiopatológicas de la condromatosis sinovial, así como las principales diferencias entre la primaria y la secundaria. Se hace referencia a la clasificación y los aspectos imagenológicos e histológicos. Se exponen el diagnóstico diferencial, las principales modalidades de tratamiento y complicaciones. Se concluye que la condromatosis sinovial es una entidad de origen sinovial de tipo primaria o secundaria con características específicas en cada tipo. El diagnóstico se basa en elementos clínicos, imagenológicos, artroscópicos e histológicos. La extracción de cuerpos libres y la sinovectomía por la vía artroscópica constituyen el procedimiento de elección en estos enfermos.

ABSTRACT The diseases that affect the synovial tissue of the knee are diverse from the clinical, imaging and histological points of view. Among these entities are pigmented villonodular synovitis, synovial hemangioma and synovial chondromatosis. The objective of the research is to update and provide information on synovial chondromatosis. In the search and analysis of the information, that was carried out from December 1st 2023 to January 31st, 2024, the following words were used: synovial chondromatosis; knee synovial chondromatosis; joint tumors; synovial tumors. From the information obtained, a bibliographic review of a total of 121 articles published in the PubMed, Hinari, SciELO and Medline databases was carried out using the search manager and reference manager EndNote; of these, 34 selected citations were used to carry out the review, 30 of the last five years. The pathophysiological characteristics of synovial chondromatosis are mentioned in the study, as well as the main differences between primary and secondary chondromatosis. Reference is made to the classification and the imaging and histological aspects. The differential diagnosis, the main treatment modalities and complications are presented. It is concluded that synovial chondromatosis is an entity of synovial origin of primary or secondary type with specific characteristics in each type. The diagnosis is based on clinical, imaging, arthroscopic and histological elements. Removal of loose bodies and arthroscopic synovectomy are the procedure of choice in these patients.

RESUMO Diversas patologias conduzem frequentemente a divergências quanto à sua identificação na prática clínica, nomeadamente no contexto das patologias orais. Os dados obtidos durante a anamnese e o exame físico frequentemente necessitam de revisão para o diagnóstico. Objetivo: O presente estudo teve como objetivo avaliar a concordância entre os diagnósticos clínicos e histopatológicos e relatar a frequência de preenchimento de formulários de espécimes submetidos ao exame histopatológico, examinados retrospectivamente. Métodos: Dados de 93.950 espécimes submetidos para exame histopatológico foram obtidos de prontuários médicos. Resultados: Foram incluídos 5.052 laudos de pacientes de 0 a 14 anos. A concordância foi definida a partir da categorização da natureza da lesão de acordo com sua categoria diagnóstica. A maior taxa de concordância foi observada para mucocele e papiloma (86%), seguido por granuloma piogênico (60%). Baixas taxas de confirmação histopatológica de impressões clínicas foram observadas para hemangioma (17,5%) e lesão periférica de células gigantes (35%). Entre as lesões relacionadas aos tecidos dentários, o odontoma apresentou maior concordância (84%), seguido pelo ceratocisto (74%), enquanto o cisto radicular apresentou maior discordância (21%). Conclusão: Este estudo encontrou nível de concordância aceitável para as lesões mais frequentes. No entanto, compreender as características das lesões orais em crianças e suas correlações clinicopatológicas é crucial para proporcionar o tratamento ideal em cada caso. clínica diagnóstico Objetivo retrospectivamente Métodos 93950 93 950 93.95 médicos Resultados 5052 5 052 5.05 1 anos diagnóstica 86%, 86 86% , (86%) 60%. 60 60% . (60%) 17,5% 175 17 (17,5% 35%. 35 35% (35%) dentários 84%, 84 84% (84%) 74%, 74 74% (74%) 21%. 21 21% (21%) Conclusão frequentes entanto caso 9395 9 95 93.9 505 05 5.0 8 (86% 6 (60% 17,5 (17,5 3 (35% (84% 7 (74% 2 (21% 939 93. 50 5. (86 (60 17, (17, (35 (84 (74 (21 (8 (6 (17 (3 (7 (2 ( (1

ABSTRACT Several pathologies often lead to disagreements regarding their identification in clinical practice, particularly in the context of oral pathologies. The data obtained during anamnesis and physical examination frequently require revision to reach a diagnosis. Objective: The present study aimed to evaluate the agreement between clinical and histopathological diagnoses and report the frequency of completing forms for specimens submitted to histopathological examination, examined retrospectively. Methods: Data on 93,950 specimens submitted for histopathological examination were retrieved from medical records. Results: A total of 5,052 reports from patients aged 0 to 14 years were included. Agreement was defined based on categorizing the nature of the injury according to its diagnostic category. The highest agreement rate was observed for mucocele and papilloma (86%), followed by pyogenic granuloma (60%). Low rates of histopathological confirmation of clinical impressions were observed for hemangioma (17.5%) and peripheral giant cell lesion (35%). Among lesions related to dental tissues, odontoma showed the highest agreement (84%), followed by keratocyst (74%), while radicular cyst showed the most discordance (21%). Conclusion: This study found an acceptable level of agreement for the most frequent injuries. However, understanding the characteristics of oral lesions in children and their clinicopathological correlations is crucial for providing optimal treatment in each case. practice diagnosis Objective retrospectively Methods 93950 93 950 93,95 records Results 5052 5 052 5,05 1 included category 86%, 86 86% , (86%) 60%. 60 60% . (60%) 17.5% 175 17 (17.5% 35%. 35 35% (35%) tissues 84%, 84 84% (84%) 74%, 74 74% (74%) 21%. 21 21% (21%) Conclusion injuries However case 9395 9 95 93,9 505 05 5,0 8 (86% 6 (60% 17.5 (17.5 3 (35% (84% 7 (74% 2 (21% 939 93, 50 5, (86 (60 17. (17. (35 (84 (74 (21 (8 (6 (17 (3 (7 (2 ( (1

Resumo Introdução: As lesões vasculares iatrogénicas são uma causa importante de morbilidade e mortalidade após intervenções cirúrgicas ortopédicas ou neurocirúrgicas. Neste artigo, os autores apresentam dois casos clinicos de quasi-iatrogenia vascular. Casos clínicos: Dois casos, um procedimento ortopédico e um procedimento neurocirúrgico, são apresentados. O primeiro caso refere-se a uma mulher de 80 anos com migração do componente acetabular de uma prótese da anca, associado a trombose da veia ilíaca externa. O segundo caso reporta um homem de 27 anos com compressão medular ao nível de D6 por motivo de um hemangioma ósseo. Após a operação, verificou-se a presença de material de fixação (parafuso) fazendo protusão para o lúmen da aorta torácica. Este foi removido num segundo momento. Ambas as operações decorreram sem complicações. Conclusão: Os autores consideram que uma abordagem multidisciplinar contribuiu significativamente para o sucesso dos casos apresentados.

RESUMEN Reportamos el caso clínico de un lactante menor con una presentación anular de hemangioma, que nos plantea dudas en su clasificación. Se precisan los diagnósticos diferenciales y la necesidad de la determinación del marcador GLUT 1 en hospitales públicos.

ABSTRACT We report the clinical case of a young infant with an annular presentation of hemangioma, which raises doubts regarding its classification. Differential diagnoses and the need to determine the GLUT 1 marker in public hospitals are specified.

Abstract Intramuscular hemangiomas (IHs) are benign soft-tissue tumors that represent less than 1% of all hemangiomas. This clinical entity is rarely considered as a differential diagnosis in cases of musculoskeletal pain. A healthy 38-year-old woman presented to our office with complaint of left omalgia, with 8 months of evolution, limiting her daily activities. She reported the appearance of tumefaction in the previous 4 months. She was medicated with analgesic and antiinflammatory drugs with no clinical improvement. The objective examination showed limitation of left shoulder abduction (0–90°). The patient underwent a magnetic resonance imaging (MRI), in which a well-circumscribed nodular formation was detected in the deltoid muscle. Then, she underwent a biopsy, which confirmed the diagnosis of hemangioma. The patient was referred for sclerotherapy. Intramuscular hemangiomas are usually observed in young patients. The gold-standard examination for diagnosis is MRI, which often forestalls the need for a biopsy. In many cases, IHs are asymptomatic and tend to involute over time. Despite the low frequency of this clinical entity, it is important to place it as a diagnostic hypothesis in cases of chronic pain of the limbs in young patients with poor therapeutic response to antiinflammatory drugs and analgesia. (IHs softtissue soft tissue 1 38yearold yearold 38 year old omalgia evolution activities improvement 0–90°. 090 0–90° . 0 90 (0–90°) MRI , (MRI) wellcircumscribed well circumscribed muscle Then biopsy hemangioma sclerotherapy goldstandard gold standard time analgesia 3 09 0–90 9 (0–90° (MRI 0–9 (0–90 0– (0–9 (0– (0 (

Resumo Os hemangiomas intramusculares (HIs) são tumores benignos de tecidos moles que representam menos de 1% de todos os hemangiomas. Esta entidade clínica raramente é considerada como diagnóstico diferencial nos casos de dor musculoesquelética. Uma paciente do sexo feminino, de 38 anos de idade, saudável, se apresentou ao nosso consultório com queixa de omalgia esquerda, com 8 meses de evolução, que limitava suas atividades diárias. Ela relatou o aparecimento de tumefação 4 meses antes da consulta. A paciente estava medicada com analgésico e antiinflamatório sem melhoria clínica. Ao exame objetivo, ela apresentava limitação da abdução do ombro esquerdo (0–90°). A paciente foi submetida a uma ressonância nuclear magnética (RNM) na qual foi detectada uma formação nodular bem circunscrita no músculo deltoide,. Em seguida, foi realizada uma biópsia que confirmou o diagnóstico de hemangioma. A paciente foi então encaminhada para a realização de escleroterapia. Os HIs normalmente são observados em pacientes jovens. O exame padrão-ouro para o diagnóstico é a RNM, que muitas vezes torna a realização de biópsia desnecessária. Em muitos casos, os HIs são assintomáticos e tendem a involuir com o tempo. Apesar da baixa frequência desta entidade clínica, é importante colocá-la como hipótese de diagnóstico em casos de dor crônica dos membros em pacientes jovens com má resposta terapêutica a antiinflamatórios e analgesia. (HIs 1 musculoesquelética feminino 3 idade saudável esquerda evolução diárias consulta objetivo 0–90°. 090 0–90° . 0 90 (0–90°) RNM (RNM deltoide deltoide, seguida hemangioma escleroterapia padrãoouro padrão ouro desnecessária tempo colocála colocá la analgesia 09 0–90 9 (0–90° 0–9 (0–90 0– (0–9 (0– (0 (

Abstract Background Infantile hemangiomas (IH) are the most common soft tissue tumors of childhood. Although most of these tumors are not worrisome, some IH may be life or function-threatening, can lead to permanent disfigurement, or have associated structural congenital anomalies, requiring early recognition and referral to specialists for treatment consideration. Since 2008, oral propranolol has been widely considered to be the first-line treatment for IH. Objectives To evaluate aesthetic and functional outcome in propranolol-treated infantile hemangiomas according to the age of treatment onset. Methods Retrospective, observational study of infantile hemangioma patients under 4 years of age at the time of diagnosis, treated with oral propranolol. Evaluated parameters included: pre and post-treatment morphologic/aesthetic aspects of the hemangioma, total resolution rate, degree of functional compromise of affected areas and its evolution. Two independent pediatric dermatologists evaluated all cases reviewing clinical data from medical records and comparing clinical photographs taken at initiation and at the end of treatment of each patient. Data were analyzed with STATA 13.0 program. Results The cohort included 138 patients, with a female predominance. The median age at therapy onset was 3 months. The morphological/aesthetic improvement rate was 99% (95% CI 96‒99), the total resolution rate was 48% (95% CI 44‒60) and the functional improvement rate reached 100%. When comparing total resolution outcome versus age when treatment started, the improvement was larger in younger patients (3.5 vs. 4.9 months, p = 0.01). When comparing the total resolution rate in those younger or older than 3 months at treatment initiation, the percentage of total resolution in the younger group was 57% vs. 40% in the older one (p = 0.05). Study limitations Retrospective design; patients photographs were the sole indicators used to measure regression rates. Visual assessment is subjective. Conclusion The present results strongly suggest that early (before 3 months of age) initiation of treatment of infantile hemangiomas with propranolol results in significantly higher aesthetic and functional improvement rates and a higher percentage of total resolution. (IH childhood worrisome functionthreatening, functionthreatening function threatening, threatening function-threatening disfigurement anomalies consideration 2008 firstline first line propranololtreated diagnosis posttreatment post morphologicaesthetic morphologic evolution patient 130 13 0 13. program predominance morphologicalaesthetic morphological 99 95% 95 (95 96‒99, 9699 96‒99 , 96 96‒99) 48 44‒60 4460 44 60 100 100% started 3.5 35 5 (3. vs 49 9 4. 0.01. 001 0.01 . 01 0.01) 57 40 0.05. 005 0.05 05 0.05) design subjective before 200 1 (9 969 96‒9 44‒6 446 6 10 3. (3 00 0.0 20 ( 96‒ 44‒ 0. 2

RESUMEN Las anomalías vasculares de la órbita (AVO) son un grupo heterogéneo de patologías que pueden presentarse con frecuencia en el cono orbitario, la región periorbitaria o dentro de la órbita misma. Las AVO se dividen en tumores y malformaciones. Su presentación clínica más frecuente es el exoftalmos, asociado o no a alteración del eje visual. Además, pueden presentar complicaciones agudas, como hemorragia intralesional o celulitis entre las más frecuentes, y complicaciones crónicas, como ambliopía y afectación de la agudeza visual a largo plazo. La evolución de las técnicas de imágenes, el uso de nuevos fármacos y la utilización de innovadores procedimientos en radiología intervencionista han posibilitado obtener una mejora significativa en los procesos diagnósticos y terapéuticos de estos pacientes, permitiendo un diagnóstico y tratamiento preciso.