Faculty Bibliography

Hemangioma is the most common soft-tissue tumor of infancy. Despite the frequency of these vascular tumors, the origin of hemangioma-endothelial cells is unknown. Circulating endothelial progenitor cells (EPCs) have recently been identified as vascular stem cells with the capacity to contribute to postnatal vascular development. We have attempted to determine whether circulating EPCs are increased in hemangioma patients and thereby provide insight into the role of EPCs in hemangioma growth. METHODS AND RESULTS: Peripheral blood mononuclear cells (PBMCs) were isolated from hemangioma patients undergoing surgical resection (N = 5) and from age-matched controls (N = 5) undergoing strabismus correction surgery. PBMCs were stained with fluorescent-labeled antibodies for AC133, CD34, and VEGFR2/KDR. Fluorescent-labeled isotype antibodies served as negative controls. Histologic sections of surgical specimens were stained with the specific hemangioma markers Glut1, CD32, and merosin, to confirm the diagnosis of common hemangioma of infancy. EPCs harvested from healthy adult volunteers were stained with Glut1, CD32, and merosin, to assess whether cultured EPCs express known hemangioma markers. Hemangioma patients had a 15-fold increase in the number of circulating CD34 AC133 dual-staining cells relative to controls (0.78+/-0.14% vs.0.052+/-0.017%, respectively). Similarly, the number of PBMCs that stained positively for both CD34 and KDR was also increased in hemangioma patients (0.49+/-0.074% vs. 0.19+/-0.041% in controls). Cultured EPCs stained positively for the known hemangioma markers Glut1, CD32, merosin. CONCLUSIONS: This is the first study to suggest a role for EPCs in the pathogenesis of hemangioma. Our results imply that increased levels of circulating EPCs may contribute to the formation of this vascular tumor

Placement of endosseous implants and inferior alveolar nerve transposition is a treatment option for patients with an edentulous posterior mandible with inadequate bone height superior to the inferior alveolar canal. Complications associated with these procedures include infection, prolonged neurosensory disturbances, and/or pathologic fracture. This report presents the surgical management of a patient with a mandible fracture after inferior alveolar nerve transposition with concurrent placement of two endosseous implants.

Objective: Based on a few reports that describe obstructive sleep apnea (OSA) patients as having an increased risk of acute upper airway obstruction (UAO) after pharmacological sedation, this population is less likely to receive sedation prior to surgery. Our objective was to evaluate pediatric patients with sleep-disordered breathing who received preoperative sedation to determine if there was an increase in preoperative airway obstruction. Design: Retrospective chart review from 1995 to 2000. Setting: Two tertiary care academic medical centers. Patients: Sixty-five children (mean age= 4.7 +/- 2.3 years; 49 boys, 16 girls) diagnosed with sleep-disordered breathing by sleep study or clinical evaluation that received preoperative midazolam hydrochloride. Outcome measure: The occurrence of preoperative adverse events defined as UAO, hypoventilation, desaturation, bradycardia, or sustained lethargy that required active intervention after the administration of midazolam hydrochloride within 24 It of surgery. Results: None of the 65 children evaluated in this study experienced respiratory compromise requiring intervention after the administration of preoperative sedation. Potential risk factors such as patients' age, sex, weight, comorbidities, midazolam hydrochloride dose, and severity of sleep apnea did, not appear to affect outcome. Conclusion: The preliminary data suggested that preoperative sedation might be safely administered to children with mild or moderate sleep-disordered breathing, and possibly to children with severe OSA, if children are closely observed prior to surgery. Further prospective studies are needed to confirm these results. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved