Rus Articles Journal

Cryogenic treatment of benign vascular tumors (gemangiy) at children of

Morphology gemangiy

Sometimes on skin of the child can see any specks. What they are? What with them to do?

the small pigmentary dark stains in popular speech called by birthmarks Most often meet. If they do not show tendency to growth and “behave quietly“, without disturbing the child, them both in the people, and in medicine it is not accepted to touch.

with

the Special attention of parents is drawn by bright red spots, often speakers over a skin surface. These are gemangioma. If you found such education on the child`s skin, it should be shown to the children`s surgeon. Why? Because it is the vascular tumor demanding supervision and, with tendency to growth - removals. So serious relation to it is connected with its ability to widespread growth. In such cases serious cosmetic defect and volume of surgical intervention can be created will be significantly wider.

the Same can tell

about any other educations on skin. If they are located in the “inconvenient“ place (a groin, genitals, eyelids, near clothes folds) - it is better to address the surgeon. The doctor will decide what education and that with it should be done - to leave alone is, to observe, or, perhaps, to remove in the cryosurgical way.

Kriokhirurgicheski`s

- means by means of low temperature. Usually it is for this purpose used special devices with liquid nitrogen. Procedure is painless, and only after a while after its termination perhaps easy morbidity and puffiness of skin. But under supervision of the surgeon these phenomena quickly pass, and on skin usually does not remain rough, as after usual operation, hems.

of Gemangioma (HECTARE) - good-quality vascular educations.

Distribution of HECTARE. occurs from - for formations of new vascular courses in fabrics and the strengthened blood-groove on them.

of HECTARE develop due to proliferation vascular an endoteliya that is confirmed by existence mitotic of the sharing tumor cells.

at

At premature children of HECTARE 2 - 3 times quicker, than at full-term grow, especially it concerns to extensive HECTARES of difficult anatomic (critical) localization.

of Feature gemangiy:

Congenital character of a disease - at 93% of sick HECTARES are observed by
  1. at the child`s birth.
  2. the Tumoral nature of a disease - high mitotic activity in cells of a vascular tumor.
  3. High quality of pathological process.
  4. Clinically malignant current of HECTARE - possibility of considerable functional and cosmetic violations with an intensive growth of a vascular tumor.

Prevalence

are Made by 50% among other tumors of soft fabrics at children. Among diseases of children`s age make from 3% to 8% of all newborns.

occur At girls of a gemangioma by 2 - 3 times more often than at boys.

the Clinic and diagnostics gemangiy

In 90% of supervision of HECTARE are found at the child`s birth, and also in the first days and months of life.

grow at

At premature children of a gemangioma 2 - 3 times quicker therefore treatment is shown them more earlier.

Favourite localization of HECTARE - area of the head and neck.

Despite the high quality, HECTARES possess rapid growth. Expanding, they destroy surrounding fabrics that results in major cosmetic defects. The greatest activity of growth tumors at children of the first half of the year of life with primary localization in the head and a neck possess.

Growth and a further current gemangiy, is unpredictable today.

Calculation on spontaneous regression more often is insolvent, and loss of time affects obviously not in favor of the patient.

Despite a possibility of self-healing and a stop of growth of HECTARE with the subsequent involution (at full-term, mainly on the closed parts of the body), its further current nevertheless remains unpredictable.

Appearance, color and a consistence is defined by the fabrics which are a part of a vascular tumor.

of the Problem of treatment

  1. growth Termination gemangiy (prevents further destruction by a vascular tumor of surrounding fabrics).
  2. Elimination of tumoral process - positive oncological result (fabrics of a tumor disappear completely, turning into cicatricial fabric).
  3. Achievement of the best functional and cosmetic favorable result.

of the Possibility of a cryogenic method of treatment

  1. of Warty growths
    • Simple warts - the dense painless hilly semi-spherical small knots towering over skin serovato - white color. Their surface is rough, granular, sometimes with sosochkovy growths. The sizes vary from 0,2 to 0,7 cm, at merge big conglomerates can be formed.
    • Flat warts - has a smooth surface, indistinctly polygonal or roundish outlines, sharp borders, up to 0,3 cm in size. On color do not differ from normal skin, sometimes I have zheltovatoserovaty coloring. Flat warts are localized on the back of brushes, forearms, a neck and a face.
    • Plantar warts.
    • Warty giperkeratoz brushes and feet;
  2. the Pigmentary nevus - to treatment subjects to
  3. of Teleangiektaziya a nevus the sizes no more than 5 - 7 cm?. Before cryoapplication hair over education cut off.
  4. Hypertrophic and keloidny hems
  5. of Kandiloma

of the Explanation to some nosological forms

  1. of Capillary a dysplasia - malformations of peripheral krovennostny vessels. Distinctive feature - lack of proliferation of capillary structures, infiltration of surrounding fabrics and the synchronous growth corresponding to growth of a body of the child.

    1. of Congenital teleangiektaziya of skin. Meet often - from 5%do 40% of cases of HECTARE. Can be a star-shaped form, in the form of round plaques darkly - red color or it is bright - the red centers on face skin, necks, a trunk and extremities. Usually appear since the birth, independently do not disappear. Terms, without proliferation an endoteliya and adventitsialny cages are histologically characterized by the same ektaziya of capillaries within epidermis also. Their characteristic is the accompanying malformations of appendages of skin like Pringl`s adenoma or an allotopia of unripe hair follicles, and also hyper plastic transformations of epidermis.
    2. Lateral or lateral vascular nevus. Represent widespread defeat of capillaries of skin with characteristic localization: occupy a half of the face, lateral surfaces of a neck, trunk and leg on one party. An extensive lateral nevus or Unn`s nevus are always observed since the birth and do not change throughout all life. Intensity of coloring changes when pressing and from change of temperature.
    3. Osler`s Illness - Randyu - multiple hereditarily the caused teleangiektaziya with gemorragiya are characterized by existence of “papules“ of Osler on mucous membranes of a nose, a mouth, a pharynx, a gastrointestinal tract and mainly on integuments. The main clinical feature - constant gemorragiya that Osler`s illness - Randyu pulls together with Kazabakh`s syndrome - Merritt to a certain extent.
    4. Louis`s Syndrome - Bar (a teleangiektaziya + an ataxy) diagnose a characteristic combination of the progressing cerebellar ataxy to star-shaped symmetric teleangiektaziya on skin and conjunctivas of eyes For patients.
    5. Syndrome of Gorkhem (gemangiomatozny osteoliz).
  2. Piogenny granulomas (botriomiksoma) - spherical or fungoid educations on a leg, with a smooth or hilly surface, it is dark - red color, the sizes from 2 mm to 1,5 cm. Are characterized by developing of spontaneous bleedings then their surface becomes covered by a bloody crust. Bek, 1966., Luger, Horn, consider 1977 as the reason of their developing of a microtrauma of an integument with the subsequent introduction of the gnoyerodny microbes causing a peculiar productive form of an inflammation. Histologically against a set of again formed capillaries polimorfnozernisty leukocytes decide on proliferation an endoteliya and mukoidny hypostasis of fabrics that indirectly indicates inflammatory character of a disease.
  3. of Gemangiokeratoma. Has an appearance of a dense plaque it is yellow - pink color, inclined to inflammatory changes, sometimes moderately painful. The amount of education fluctuates from 4 to 8 mm in the diameter.
  4. Shturge`s Syndrome - Weber - a combination of superficially located HECTARE to kavernozny HECTARE of bones of a skull and a brain. It is clinically shown by existence of HECTARE of a mucous membrane of the sky, gums, skin of the corresponding half of the face, frequent spasms, increase in the top jaw, lag in intellectual and physical development. At children of advanced age bleeding at a teething which are pathologically mobile is noted, deep into gums palpatorno plunge. The forecast adverse of - for opportunities of profuzny bleedings or development of the epileptic status.
  5. Glomus - Barret`s gemangioma - Masson - a hillock Xing - black or it is dark - red color, the sizes 1 - 3 mm, acting over an education surface. Into structure Glomus - gemangioma together with vessels (like arteriovenozny soustiya terms) are included sensitive nervous fibers, than and sharp morbidity of these educations speaks.

treatment Methods

Krioterapiya`s

the action Mechanism

the Basis of death of fabric - water crystallization process, and also dehydration of cages, increase of concentration of electrolytes and metabolites to toxic level.“ Critical temperature“ death of cages - - 10? With - - 20? With, at the same time there is a blocking of small and average arterial and venous vessels while the trombirovaniye of large vessels at the same time does not come.

an Important role in development of a cryonecrosis of fabric is played by the speed of process of freezing and thawing, frequency rate of cryoinfluence.

according to authors (Sitkovsky N. B., Geraskin V. V., the Saffron V. V., Novak M. M of 1986) distinguish 2 ways of impact of low temperature on fabrics: primary - direct damage and secondary - development of an aseptic inflammation. The theoretical prerequisite of primary damage of fabric is out of - and intracellular crystallization of water under the influence of low temperature. Water binding by ice crystals in extracellular liquid leads to increase of concentration of all electrolytes that is followed by destruction of cellular membranes. Then as a result of more high pressure of vapors of the overcooled water in cages it comes out in extracellular space. At the same time in a cage concentration of electrolytes sharply increases that can lead of cages to death. The “wrinkling“ of a cage which is caused dehydration promotes violation of spatial ratios of molecules that can also cause death of a cage.

value and speed of freezing Has

. The condition of overcooling thermodynamic is unstable and has 2 outcomes: dehydration and intracellular freezing. Slow cooling causes dehydration and extracellular formation of ice. Fast cooling causes inside - and extracellular freezing. A certain value for death of a cage has warming speed. At slow warming small intracellular crystals of ice slopes to raise and damage a cage by means of the processes called by recrystallization or growth of grains. At superfast warming crystals of intracellular ice thaw before manage to grow considerably, and cages remain intact.

the Morphological changes developing as a result of cryoinfluence have the following dynamics. The full necrosis of the frozen fabric develops in an interval from 4 to 24 h after cryoinfluence. With 2 - x days the granulyatsionny fabric consisting of mesenchymal cages begins to be formed. There are capillaries and fibroblasta replacing nekrotizirovanny fabric. To 7 - mu to day granulyatsionny fabric completely carries out a zone of the died fabric, and in 14 - 16 days the created gentle hem is defined.