No abstract

The natural history and appropriate treatment of giant liver haemangioma remain poorly defined. The diagnostic strategy and the results of a longitudinal study of 78 such lesions are described. Sixteen resected patients and 62 with asymptomatic giant haemangiomas were entered into a follow-up programme consisting of clinical assessment and abdominal ultrasonography every 6 months. Resection was considered only for symptomatic patients (14 cases) and rapidly growing lesions (two cases). The mean follow-up was 36 months for the resected patients and 55 months for the observed group. Surgery permanently relieved symptoms. No recurrence of haemangioma was observed. Some 32 of 36 unresected lesions followed up remained stable in size. Minor changes were observed in four of 36. None ruptured or became symptomatic. It is concluded that asymptomatic large haemangiomas can be managed safely by observation. However, the occasional occurrence of rapid growth might represent a further indication for resection and justifies strict imaging follow-up. The pattern of growth, rather than absolute size, of a lesion is suggested for selection of asymptomatic patients who might benefit from preventive surgical excision. When feasible, the authors prefer enucleation to remove giant haemangiomas.

T he endothelium plays a crucial role in acute regulation of vascular tone and in long-term vascular remodeling. In healthy conditions, nitric oxide (NO) is the most important endothelium-derived vasodilator molecule able to inhibit the major key mechanisms promoting the development of atherosclerosis, thus, promoting vascular health.1 NO breakdown by reactive oxygen species (ROS) is the main cause of reduced NO availability and endothelial dysfunction, both in physiological aging and in many pathological conditions, including arterial hypertension.1,2 Hypertension is supposed to induce early vascular aging in different arterial districts. However, vascular features of physiological aging and hypertension are not necessarily similar. With respect to endothelial function, essential hypertensive patients (HT) show a reduced response to acetylcholine (Ach) as compared with normotensive individuals (NT) in each age range. However, with increasing age, vascular response to Ach is similarly reduced among HT and NT. 3,4 Vascular structure changes in the microcirculation represent another hallmark of essential hypertension. 5,6 Increased media to lumen ratio (M/L), which characterizes vascular remodeling, can result from a reduced outer diameter that narrows the lumen without net growth (eutrophic remodeling) or from a thicker media encroaching on the lumen (hypertrophic remodeling). Eutrophic remodeling is most often found in essential hypertension. 7-9 M/L is considered the most reproducible index of small resistance artery structure, 10,11 with a relevant prognostic value, being associated with increased prevalence of cardiovascular events in a high-risk population. 12 Vascular fibrosis is critically important in determining vascular remodeling in hypertension, and it involves, among others, changes in collagen deposition. 13,14 The impact of physiological aging on microvascular structure and the role of vascular fibrosis are still unknown. Therefore, in the present study, we evaluated whether vascular remodeling is physiologically present with advancing age at the level of peripheral small resistance arteries. We also assessed whether the hypertensive disease causes an acceleration of the aging process for vascular function and structure. Collagen deposition as a Abstract-We evaluated whether vascular remodeling is present in physiological aging and whether hypertension accelerates the aging process for vascular function and structure. Small arteries from 42 essential hypertensive patients (HT) and 41 normotensive individuals (NT) were dissected after subcutaneous biopsy. Endothelium-dependent vasodilation (pressurized myograph) was assessed by acetylcholine, repeated under the nitric oxide synthase inhibitor N-nitro-larginine methylester or the antioxidant tempol. Structure was evaluated by media-lumen ratio (M/L). Intravascular oxidative generation and collagen deposition were assessed. Inhibition by N-nitro-l-arginine methylester on ACh was inversely related to age in both groups (P<0.0001) and blunted in HT vers...