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.     

Modern concept on the role of phagocytes in the pathogenesis of complications during pregnancy

Here we review modern concept of the role of phagocytes, the key cell component of natural immunity, in the course of pregnancy and in the pathogenesis of its complications. Phagocytes contribute to the development, maintenance, and favorable outcome of pregnancy. These cells play a role in the pathogenesis of various pregnancy complications, including fetal growth retardation, late gestosis, and intrauterine infections. The understanding of the pathophysiological mechanisms that occur in the mother-placenta-fetus system would allow us to improve diagnostic procedures, perform pathogenetically substantiated therapy, and decrease the incidence of obstetrical complications.     

Fluorescent antibodies to creatine kinase for detecting the enzyme in tissue culture

Different methods for the preparation of antibodies to rabbit FITC-labeled MM creatine kinase are compared. Highly specific fluorescent antibodies have been employed to detect MM creatine kinase in isolated cells and in tissue culture. Prospects for research and clinical diagnostic application of the direct method for the detection of creatine kinase in biological samples are discussed.     

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.     

Review of historical monitoring data on Techa River contamination.

The Mayak Production Association was the first Russian site for the production and separation of plutonium. The extensive increase in plutonium production during 1948-1955, as well as the absence of reliable waste-management technology, resulted in significant releases of liquid radioactive effluent into the rather small Techa River. This resulted in chronic external and internal exposure of about 30,000 residents of riverside communities; these residents form the cohort of an epidemiologic investigation. Analysis of the available historical monitoring data indicates that the following reliable data sets can be used for reconstruction of doses received during the early periods of operation of the Mayak Production Association: Temporal pattern of specific beta activity of river water for several sites in the upper Techa region since July 1951; average annual values of specific beta activity of river water and bottom sediments as a function of downstream distance for the whole river since 1951; external gamma-exposure rates near the shoreline as a function of downstream distance for the whole Techa River since 1952; and external gamma-exposure rate as a function of distance from the shoreline for several sites in the upper and middle Techa since 1951.     

Prophylaxis of psychosomatic disorders in sailors]

Subject of the analysis was incidence of incipient and clinical forms of psychosomatic pathologies (PSP) in the military personnel of a remote garrison on the Kola Peninsula including contractors on active (AS) and written off (WS) nuclear submarines, and in coastguard unit (CU). Incipient PSP was found in 15.61 % of the military. The PCP percentage rose to 13.44, 14.18 and 20.15 in the crews of active and written battleships, and the coastguard unit, respectively. Dynamics of the PCP incidence was age-dependent. Within the PCP structure cardiovascular diseases averaged 11.3 % (AS - 7.69 %, WS - 7.09 % and CU - 20.16 %) and gastro-intestinal disturbances averaged 67.63 % (AS - 6.11 %, WS - 5.91 % and CU - 8.12 %). The analysis produced an ample proof of the necessity to give psychotherapeutic consultation to somatic patients and laid a ground for a concept of treatment of these patients.