Congenital cystic lymphangiomas (CCL) or lymphatic malformations (LMs) are benign malformations due to a developmental disorder of lymphatic vessels. Besides surgical excision, sclerosant therapy of ...these lesions by intracavitary injection of OK-432 (Picibanil®), a lyophilized mixture of group A Streptococcus pyogenes, is a common therapeutical option.
In a single center retrospective study we analyzed 37 consecutive patients (30 children, 3 adolescents and 4 adults) who were diagnosed with lymphangioma and subsequently treated with OK-432 (Picibanil®) in a general hospital between October 2000 and November 2021.
The median follow-up period was 2.5 months (range 0.7–56.7 months). The lymphangiomas were localized in the head and neck region (n = 25), the thorax/abdomen (n = 6) and extremities (n = 6). The majority of patients had 1 injection with OK-432 (n = 28), five patients had 2 injections, three patients had 3 injections and one patient had more than 3 injections. The most common complications were swelling (89%), fever (81%), redness at the injection site (81%) and pain (73%). The response to therapy was excellent or good in 32 patients (86.4%), 2 patients had a medium response and 3 patients did not show any response. The clinical reaction after the instillation of OK-432 is not predictive for the quality of outcome.
The application of Picibanil is safe and without serious side effects. Parents and patients prefer local sclerotherapy versus surgery as it has less complications. We therefore suggest that Picibanil sclerotherapy should be the first-line treatment for macrocystic and mixed type lymphangiomas.
•Lymphatic malformations tend to augment in size and may cause life-threatening complications.•Complete surgical excision of lymphatic malformations often is not possible.•The treatment of lymphatic malformations with OK-432 has a high rate of excellent/good response.•Clinical symptoms following the injection of OK-432 are not predictive for the outcome.•Sclerotherapy has less complications than surgery.
Congenital cystic lymphangiomas or lymphatic malformations are benign malformations due to a developmental disorder of lymphatic vessels. The most frequent localization of lymphangiomas is the neck ...and head region. The fact that the lesions usually have no spontaneous regression, tend to augment in size and may cause life-threatening complications such as occlusion or infiltration of neighbouring organs and structures, underlines the need of an early adequate therapy. Surgical excision used to be the first-line treatment of lymphangiomas. However, complete excision often is not possible. Besides surgical excision, sclerosant therapy of these lesions by intracavitary injection of OK-432 (Picibanil®), a lyophilized mixture of group A Streptococcus pyogenes, is a common therapeutical option.
We present two cases of lymphangioma which were challenging to manage, yet the results were good in one case and excellent in the other case (according to the Acevedo classification).
Sclerotherapy with Ok-432 is recommended primary for macrocystic lymphangiomas. The application is safe and without serious side effects. It can be used alone or in combination with other treatment modalities.
Abstract Introduction Primary omental infarction (POI) has a low incidence worldwide, with most cases occurring in adults. This condition is rarely considered in the differential diagnosis of acute ...abdominal pain in childhood. Material and methods We present 2 cases of omental infarction in an obese 8-year-old boy and a 5-year-old boy who presented with acute abdominal pain in the right abdomen. Both patients were initially treated with intravenous fluids and analgesics with no improvement. Abdominal ultrasound of the first patient showed free intraperitoneal fluid, meteorism and distended bowel loops. The appendix was not visualized. With a presumptive clinical diagnosis of appendicitis the child underwent laparotomy. On entering the peritoneal cavity an omental infarction was seen and a portion of the omentum was resected. Appendectomy was performed. The second patient presented with acute abdominal pain in the right upper quadrant, which started 2 days before. There was a history of possible abdominal trauma about 3 weeks earlier. The patient had repeated ultrasound examinations and a CT scan of the abdomen which showed a omental infarction. He underwent laparoscopy and resection of the omental infarction, as well as incidental appendectomy. Results The postoperative period was uneventful. The first patient was discharged on day 3, the second patient on day 4 after surgery. Histology showed a normal vermiform appendix and an omental infarction in both cases. Conclusion and discussion Since the omental infarction as etiology of acute abdominal pain is uncommon in children, we emphasize the importance of accurate diagnosis and appropriate treatment of omental infarction.
Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is the most common congenital anomaly of the esophagus.
There is little consensus on the definition of long gap esophageal ...atresia (LGEA). However, the term is used to describe cases in which a primary anastomosis of the proximal and distal ends of the esophagus cannot easily be performed under acceptable tension by the operating surgeon. LGEA remains a technically challenging subset of EA cases.
We present a case of long gap esophageal atresia type IIIA (Vogt classification)/Type B (Gross classification) which had a successful final outcome after multiple procedures which allowed the maintenance of the original esophagus, thus not needing esophageal replacement.
The patient is now 6 years old, is thriving well and does not have any complaints.
We present the design and the realization of active photonic crystal (PhC) semiconductor lasers. The PhC consists of semiconductor nanostructure pillars which provide gain at a quantized transition ...energy. The vertical layer sequence is that of a terahertz quantum cascade laser. Thereby, the artificial crystal itself provides the optical gain and the lateral confinement. The cavities do not rely on a central defect, the lasing is observed in flat-band regions at high symmetry points. The experimental results are in excellent agreement with the finite-difference time-domain simulations. For the vertical confinement a double-metal waveguide is used. The lasers are showing a stable single-mode emission under all driving conditions. Varying the period of the PhC allows to tune the frequency by 400 GHz.
•Testicular hemangioma is exceedingly rare and typically occurs in patients younger than 20 years.•Hemangiomas of the testis have a similar sonographic and magnetic resonance imaging appearance to ...that of malignant tumors of the testis, especially seminoma.•Clinicians and pathologists must be aware of the rare entity of testicular hemangiomas, as clinical examination and imaging studies do not often suffice to arrive at a correct diagnosis.•The association of testicular torsion with testicular hemangioma is a rarity in children.
Testicular neoplasms that are derived from connective tissue, blood vessels and musculature are uncommon and intra-testicular tumors of vascular origin are extremely rare; both are benign in nature. Testicular hemangioma is exceedingly rare and typically occurs in patients younger than 20 years, the age in which a primary germ cell tumor of the testis may present, necessitating a radical approach to management with orchidectomy, although potential conservative focal partial surgical excision is desirable. Hemangiomas of the testis have a similar sonographic and magnetic resonance imaging appearance to that of malignant tumors of the testis, especially seminoma.
The work has been reported in line with the SCARE criteria.
We present a case of testicular torsion in a 15-year-old male patient who had a painful left testis for 6 days, no vomiting, no fever or dysuria.
With clinical suspicion of an old testicular torsion the patient was examined by ultrasound which confirmed the clinical diagnosis.
The patient underwent emergency surgical exploration. The left testis was found to be necrotic after a 360° testicular torsion and an orchiectomy was performed.
The postoperative course was uneventful. The patient was discharged on day 4 after surgery. Histology showed a complete ischemic infarction of the testicular parenchyma as part of a ruptured intratesticular cavernous hemangioma.
Cavernous hemangioma is a rare tumor of the testicle in either childhood or adult period. The particularity of the presented case is the possible association of a cavernous intratesticular hemangioma with the torsion of the testis in a teenager. Clinicians and pathologists must be aware of the rare entity of testicular hemangiomas, as clinical examination and imaging studies do not often suffice to arrive at a correct diagnosis.
Purpose
To follow up on child protection children after their discharge from hospital in order to assess efficiency of our child protection team (CPT) and collaboration of family and of Youth Welfare ...Agencies (YWA) with the clinical CPT.
Methods
Collaboration of the family considering treatment and controls was documented. Questionnaires were sent to the involved social worker and collaboration with the YWA was analyzed.
Results
From 2004 to 2008 57 children entered our child protection program. Clinical cooperation of the families and outcome was good overall. In 56 cases, an official information was sent to the YWA. In ten cases, the injuries were reported to the police which led to convictions in four cases. YWA installed further supervision and support in 53 patients. Cooperation of the families with the social workers was good in 50% of cases, ambivalent in 15% and not existent in 8%. Cooperation with the YWA was wearing.
Conclusion
Measurements initiated to protect children were efficient in 98%. While cooperation with the families and the social workers was good, cooperation with the institution of the YWA was wearing caused by discrepancies in understanding data protection acts and act of information. Here clarification is required to improve and simplify collaboration between all involved groups.
We report on the emission characteristics of microcavity quantum-cascade lasers emitting in the terahertz frequency range based on circular-shaped microresonators. Strong mode confinement in the ...growth and in-plane directions are provided by a double-plasmon waveguide and due to the strong impedance mismatch between the gain material and air. This allows laser emission from devices with overall dimensions much smaller than the free-air emission wavelength (lambda > 100 mu m). Hence, for the smallest microdisks we achieved a threshold current as low as 13.5 mA (350 A/cm 2 ) in pulsed-mode operation at 5 K and stable single-mode emission up to 95 K in continuous-wave mode operation. We have observed dynamical frequency pulling of the resonator mode on the gigahertz scale, as a consequence of the gain shift due to the quantum-confined Stark effect. Thus, we were able to estimate the peak gain of the material to 27 cm -1 . The smallest microcavities exhibited a strong dependence on the exact placement of the bond wire which resulted in single- as well as double-mode emission. Finite-difference time-domain simulations were performed in order to identify the modes of the recorded spectra. They confirm that most of the observed spectral features can be attributed to the lasing emission of whispering-gallery modes.
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