Kliničke značajke i modaliteti suvremenog liječenja hemangioma u djece

master's thesis

• Title (english): Clinical features and current treatment modalities of infantile hemangiomas
• Author: Lidija Barčot
• Mentor: Božidar Župančić (mentor)
• Committee member: Zrinka Bukvić Mokos (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Božidar Župančić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2016-06-27, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics

Abstract

Krvožilne anomalije podijeljene su u dvije glavne skupine: vaskularne malformacije i vaskularne tumore. Važan početni aspekt pravilne diferencijacije i dijagnostike različitih pojavnih oblika je korištenje ispravne terminologije. Infantilni hemangiom je najčešći tumor u djetinjstvu. Benigan je zbog svog tipičnog tijeka. U većini slučajeva razvija se ubrzo nakon rođenja, slijedi proliferacijska faza eksponencijalnog rasta, a nakon 9 do 12 mjeseci počinje involucijska faza koja može trajati i do 7-10 godina. Epidemiološka zapažanja govore da su češći u ženskom spolu, pokazuju veću sklonost za svijetlije tipove kože te su veće incidencije u nedonoščadi, osobito one koja ima manje od 1500 grama porođajne težine. Unatoč svim istraživačkim naporima u ovoj oblasti, patogeneza još uvijek nije u potpunosti razumljiva. Predložene su tri su glavne hipoteze: teorija hipoksije tkiva, teorije embolizacije endotelnih stanica posteljice te teorija povećane angiogeneze i vaskulogene aktivnosti. Dokazano je da su mezenhimalne stanice izolirane iz proliferirajućih hemangioma sposobne za diferencijaciju u endotelne, perivaskularne i adipocitne stanice. Premda su hemangiomi djetinjstva dobroćudni i ograničeni tumori, ozbiljne komplikacije mogu nastati zbog njihove lokalizacije i brzog proliferativnog rasta. Hemangiomi djetinjstva često ne trebaju nikakav tretman, međutim princip „gledati i čekati" u današnje vrijeme postaje sve rjeđi, osobito nakon otkrića da β-blokatori primjenjeni sistemski, a kod površinskih vrsta i lokalno također mogu igrati važnu ulogu u njihovu liječenju. S druge strane, hemangiomi povezani s komplikacijama, ulceracijama i krvarenjima ili oni bez komplikacija, ali s velikim rizikom od njihovog razvoja s posljedicama ozbiljne funkcionalne ili estetske ugroženosti zahtijevaju hitnu sistemsku terapiju. U tim slučajevima potrebno je započeti liječenje. Broj studija koje uspoređuju različite vrste terapije u stalnom je porastu. U posljednjem desetljeću terapija se značajno promijenila i unaprijedila. Sistemsku primjenu kortikosteroida s relativno niskim postotkom uspješnosti, ali ponekad ozbiljnih komplikacija gotovo u potpunosti je zamijenila terapija propranololom. Pulsed dye laser se najčešće primjenjuje kao dio multimodalnog liječenja kod zaostalih lezija nakon involucije te površnih i ulceriranih hemangioma.

Abstract (english)

Vascular anomalies are subdivided into two main groups: vascular malformations and vascular tumours. The important initial aspect to consider is the use of correct terminology for proper differentiation and diagnosis of vascular lesions. Infantile haemangioma is the most frequent childhood tumour benign due to its typical course: development shortly after birth in most cases than proliferative exponential growth followed by involuting stage starting after 9 to 12 months and which can last for up to 7–10 years. Epidemiological observations suggest that infantile hemangiomas are more common in females, with a greater preference for lighter skin types and have higher incidence in premature infants, especially those with less than 1500 grams of the birth weight. Despite all research efforts in this field, the pathogenesis is still not fully understood. Three main hypotheses have been proposed: the theory of tissue hypoxia, the theory of embolization of placental endothelial cells and the theory of increased angiogenic and vasculogenic activity. Evidence was found that mesenchymal cells, isolated from proliferative infantile hemangiomas are capable of differentiating into endothelial perivascular and adipogenic cells. Although infantile hemangiomas are benign and self-limiting, severe complications can arise due to localization and fast tumour growth. IH often needs no treatment but the „watch and wait“ principle is followed less often nowadays, especially after the discovery that β-blockers both orally and topically in superficial types can also play an important role in their treatment. On the other hand, infantile hemangiomas associated with complications or those without complications but with great risk of developing complications obviously require immediate systemic treatment as well as ulcerated or hemangiomas giving serious cosmetic and functional impairment. In these cases therapy is necessary. The number of studies comparing different therapies is increasing. For many years systemic options used to be corticosteroids, with low success rates and sometimes important complications. Therapy has changed considerably over the last ten years. Currently propranolol has a main role in systemic treatment due to its safety et efficacy. Pulsed dye laser is the most commonly applied modality as a part of multimodal therapy for residual lesions, superficial and ulcerated infantile hemangiomas.

• Keywords: infantilni hemangiom; laser; propranolol; steroidi; timolol
• Keywords (english): infantile hemangioma; laser; propranolol; steroids; timolol
• Language: croatian
• URN:NBN: urn:nbn:hr:105:157091
• Study programme: Title: Studies in Nursing; Study programme type: university; Study level: graduate; Academic / professional title: magistar/magistra sestrinstva (magistar/magistra sestrinstva)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-03-17 10:56:29