Beta-blockers for the treatment of problematic hemangiomas

OBJECTIVE:

To examine treatment indications, efficacy and side effects of oral beta-blockers for the treatment of problematic hemangiomas.

METHODS:

A retrospective review of patients with hemangiomas presenting to the Alberta Children’s Hospital Vascular Birthmark Clinic (Calgary, Alberta) between 2009 and 2011 was conducted. The subset of patients treated with oral beta-blockers was further characterized, investigating indication for treatment, response to treatment, time to resolution of indication, duration of treatment, occurrence of rebound growth and side effects of therapy.

RESULTS:

Between 2009 and 2011, 311 new patients with hemangiomas were seen, of whom 105 were treated with oral beta-blockers. Forty-five patients completed beta-blocker treatment while the remainder continue to receive therapy. Indications for treatment were either functional concerns (68.6%) or disfigurement (31.4%). Functional concerns included ulceration (29.5%), periocular location with potential for visual interference (28.6%), airway interference (4.8%), PHACES syndrome (3.8%), auditory interference (0.95%) and visceral location with congestive heart failure (0.95%). The median age at beta-blocker initiation was 3.3 months; median duration of therapy was 10.6 months; and median maximal treatment dose was 1.5 mg/kg/day for propranolol and 1.6 mg/kg/day for atenolol. Ninety-nine patients (94.3%) responded to therapy with size reduction, colour changes, softened texture and/or healing of ulceration. Rebound growth requiring an additional course of therapy was observed in 23 patients. Side effects from beta-blockers included cool extremities (26.7%), irritability (17.1%), lower gastrointestinal upset (14.3%), emesis (11.4%), hypotension (10.5%), poor feeding (7.6%), lethargy (4.8%), bronchospasm (0.95%) and rash (0.95%). Side effects did not result in complete discontinuation of beta-blocker treatment in any case; however, they prompted a switch to a different beta-blocker preparation in some cases. Resolution of the primary indication, requiring a median time of three months, occurred in 87 individuals (82.9%).

CONCLUSIONS:

Treatment of infantile hemangiomas with oral beta-blocker therapy is highly effective and well tolerated, with more than 94% of patients demonstrating a response to treatment and 90% showing resolution of the primary functional indication for treatment.     

Studies of the role of the central nucleus of the amygdala in controlling cardiovascular functions

Studies on cats anesthetized with a mixture of chloralose and Nembutal addressed the effects of high-frequency stimulation (100 impulses/sec) of the central nucleus of the amygdala on bioelectrical activity in two postganglionic sympathetic nerves—the inferior cardiac nerve and the vertebral branch of the stellate ganglion, which innervate the coronary vessels and the vessels of the anterior thorax respectively. The central nucleus of the amygdala was found to have differential, selective effects, in most experiments producing increases in the amplitude of integrated activity in the inferior cardiac nerve and decreases in the amplitude of biopotentials in the vertebral nerve. In a few experiments, a second type of modulation of the activities of these two postganglionic nerves was seen, with selective inhibition of activity in the inferior cardiac nerve and an accompanying increase in activity in the vertebral nerve. Stimulation of the central nucleus of the amygdala induced significant increases in systemic arterial blood pressure. The role of the central nucleus of the amygdala in the development of experimental neurogenic hypertension was studied in a series of chronic experiments on rats; these established that rats subjected to bilateral electrolytic lesioning of the central nucleus of the amygdala prevented the development of neurogenic hypertension induced by daily imposition of stress for four weeks for induction of operant aversive conditioned reflexes, which was not the case in control rats. The role of the central nucleus of the amygdala in the regulation of vascular tone is discussed. Translated from Rossiiskii Fiziologischeskii Zhurnal imeni I. M. Sechenova, Vol 84, No. 12, pp. 1370–1376, December, 1998.     

Activity of neurons in limbic cortex during stimulation of somatosensory zones

The effect of high-frequency and burst stimulation of the first and second somatosensory zones on the activity of identical neurons in the anterior limbic cortex was studied comparatively in acute experiments with cats. A histogramic analysis of neuronal responses in the limbic cortex showed that most background-active cells responded to stimulation of both the first and the second somatosensory zones. Both zones variously adjusted the activity of neurons in the limbic cortex. It was found that the responses in the limbic cortex with the maximum density of the potentionals of long-latent reactions are recorded during stimulation of the first somatosensory zone. It was established that the first and second somatosensory zones exert a preferentially activating influence on neurons in the anterior limbic cortex (51.5 and 66.6%, respectively), inhibitory responses comprised 33.3 and 20.0%, while mixed responses were recorded in 15.5 and 13.3% of the neurons, respectively. It was shown that the somatosensory zones exert a modulating influence on the activity of neurons, thus participating in the regulation and processing of information entering the limbic cortex.Translated from Fiziologicheskii Zhurnal SSSR imeni I. M. Sechenova, Vol. 69, No. 9, pp. 1137–1142, September, 1983.     

Characteristics of a donor population in western Venezuela

To determine the characteristics of blood donors in western Venezuela, we collected data from 1983 to 1985 on 31,320 volunteer donors at the Blood Bank of the State of Zulia in Maracaibo. Fifty-nine percent of the donors were blood group O, 30 percent were group A, 9 percent were group B, and 2 percent were group AB. Most of the donors (93%) were Rh positive. One percent of donors had positive reactions to hepatitis B surface antigen, 3.15 percent for syphilis, 1.43 percent for antibodies to Trypanosoma cruzi, and 0.32 percent to human immunodeficiency virus antibodies. About one-half of the donors were between 18 and 30 years old, and only 10 percent were women. To determine if iron deficiency anemia was a cause for the small size of the female donor pool, we measured serum ferritin in 50 first-time female donors. Ten of these (20%) had serum ferritin values below normal, and the distribution of serum ferritin levels of all 50 was very similar to that reported for frequent donors in Europe and the United States, with a clustering of ferritin values between 10 and 70 ng per ml. The data indicate that blood donors in western Venezuela are markedly different from those in the United States and that iron supplementation may be indicated for female Venezuelan donors.     

Effects of acute hypoxia on the EEG and impulse activity of the neurons of various brain structures in rats

The EEG and impulse activity of the neurons of the cerebral cortex and other structures of the brain were studied in the dynamics of hypoxic influence. In the initial phase of hypoxia (2000–6000 m), activation of the EEG and impulse discharge of neurons set in; in this case EEG activation arose earlier and was more pronounced, In the second phase of hypoxia (7500–10,000 m), the EEG changed in the direction of a reorganization of the frequency spectrum from one rhythm to another — from fast to slow activity of the type of waves. At this time the impulse activity was gradually suppressed, and the cortical neurons exhibited higher sensitivity to hypoxia and were inhibited earlier than the cells of the hypothalamus and medulla oblongata.Translated from Fiziologicheskii Zhurnal SSSR imeni I. M. Sechenova, Vol. 68, No. 5, pp. 576–582, May, 1982.