Safe and Effective Treatment of Intracranial Infantile Hemangiomas with Beta-Blockers

Infantile hemangiomas are common benign vascular tumors but are rarely found in an intracranial location. Our literature review identified 41 reported cases. There is no general consensus on management of these rare lesions and until recently, treatment was limited to surgery or pharmacological management with steroids or interferon. Although beta-blockers have been widely prescribed in the treatment of cutaneous infantile hemangiomas since 2008, their use in the treatment of intracranial infantile hemangiomas has been minimal. We present a case of infantile hemangioma affecting the right orbit, associated with intracranial extension, causing intermittent right facial nerve palsy. The patient achieved an excellent outcome following combined treatment with oral propranolol and topical timolol maleate 0.5%, with complete regression of the lesion by 4 months. We conclude that beta-blockers are a safe and effective treatment of intracranial infantile hemangiomas and can be employed as first-line management of these lesions.

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TREATMENT OF INFANTILE FACE HEMANGIOMAS WITH PROPRANOLOL

Российский стоматологический журнал ◽

10.18821/1728-2802-2019-23-5-212-216 ◽

2019 ◽

Vol 23 (5) ◽

pp. 212-216

Author(s):

Ilya Vyacheslavovich Stepanov ◽

D. Yu Haritonov ◽

I. V Korytina ◽

M. A Agapova ◽

A. V Podoprigora

Keyword(s):

Drug Therapy ◽

Tumor Volume ◽

Beta Blockers ◽

Combined Treatment ◽

Vascular Tumors ◽

Active Therapy ◽

Direct Indication ◽

To Receive ◽

Therapy Treatment ◽

Area And Volume

The aim of the study was to increase the effectiveness of treatment of facial hemangiomas in children because of the usage of non-selective beta-blocker - propranolol in complex treatment. Materials and methods of research. 18 children under the age of 1 year with maxillofacial hemangiomas were observed. Localized hemangioma was observed in 38.8% (n=7). In 44.4% (n=8) hemangiomas occupied 2-3 adjacent anatomical areas. In 16.8% (n=3) hemangioma occupied more than 3 anatomical areas. For drug therapy of facial hemangiomas in children, non-selective beta - blockers - «Propranolol»were used. Results. The minimum course of treatment was 6 months, the average - 9 months, the maximum - 13. Treatment was completed in 11 (61.1%) children, 4 of them (22.2%) had involution of education. 2 (11.1%) were operated after a course of therapy of betablockers. 5 (27.8%), after 12 months of photothermolysis. Another 5 (27.8%) continue to receive drug therapy with non-selective beta-blockers to date. there is a positive dynamics, consisting in persistent degradation of tumor volume. All children had a significan t decrease in the area and volume of hemangioma. Summary. Localization of vascular tumors in the maxillofacial region, rapid growth, leading to irreversible functional and aestheti c disorders - is a direct indication for active therapy. Treatment of facial hemangiomas in children with non-selective beta-blockers as an independent method refers to the method of choice, in case of impossibility or high risk of surgical treatment, or is part of the combined treatment.

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Role of topical beta blockers in regression of infantile capillary hemangioma

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.7.4317 ◽

2021 ◽

Vol 37 (7) ◽

Author(s):

Murtaza Sameen Junejo ◽

Rebecca . ◽

Maria Nazish Memon ◽

Sajida Parveen Shaikh

Keyword(s):

Beta Blockers ◽

Case Series ◽

Infantile Hemangioma ◽

Capillary Hemangioma ◽

Complete Regression ◽

Timolol Maleate ◽

Creative Commons ◽

Cardio Vascular Disease ◽

Cardio Vascular

Objective: To observe efficacy of Timolol maleate 0.5% by topical and surface application in infantile superficial capillary hemangioma of eyelid. Methods: This multi-centered clinical case series was carried out at Ophthalmology Department of Bilawal Medical College and Institute of Ophthalmology, LUMHS, Jamshoro from November 2019 to May 2020. We included 14 subjects. All the patients were subjected to detailed clinical examination. Before starting the topical beta blockers, the enrolled subjects had obtained the expert opinion by pediatrician to rule out any preexisting developmental cardio vascular disease. Topical beta blockers 0.5% drops were thus started with, against the ongoing finding of superficial capillary hemangioma of eyelid. Results: There was significant regression in size of infantile hemangioma after treating with topical timolol maleate 0.5%. We included 14 subjects in this study. Mean±SD age of patients was 4.94. Complete regression was seen in 08 subjects at the end of 12 weeks (64%) while 03 were completely cured at 08 weeks (21%) and 01 patient lost follow up with us. No significant ocular and systemic side effects were noted. Conclusion: Topical timolol maleate 0.5% can be the first-line treatment modality for superficial capillary hemangiomas due to its better safety and efficacy. doi: https://doi.org/10.12669/pjms.37.7.4317 How to cite this:Junejo MS, Rebecca, Memon MN, Shaikh SP. Role of topical beta blockers in regression of infantile capillary hemangioma. Pak J Med Sci. 2021;37(7):---------. doi: https://doi.org/10.12669/pjms.37.7.4317 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Five years’ experience of combined intralesional therapy in infantile hemangioma

Annals of Pediatric Surgery ◽

10.1186/s43159-019-0008-6 ◽

2019 ◽

Vol 15 (1) ◽

Author(s):

Ahmed Abdelghaffar Helal ◽

Mohammad Alsayed Daboos

Keyword(s):

Head And Neck ◽

Effective Treatment ◽

Treatment Modality ◽

Clinical Presentation ◽

Infantile Hemangioma ◽

Vascular Tumors ◽

University Hospitals ◽

Good Efficacy ◽

Intralesional Therapy ◽

Effective Treatment Modality

Abstract Background Infantile hemangiomas (IHs) are common vascular tumors. Although it involutes spontaneously, outcomes are unpredictable. Intralesional therapy is one of its treatment modality. We present our experience with combined intralesional therapy for IHs over a 5-year duration. A total of 427 patients were treated and followed at Al-Azhar University Hospitals during the study period of 5 years. All patients were treated by intralesional therapy in the form of combined injection of triamcinolone and bleomycin. All patients were followed for the response. Response to the treatment was graded as marked, partial, and poor improvement. Results IHs were noticed within the first month of life in 90.2% of patients. The commonest site of involvement was head and neck in 90% of patients. The commonest clinical presentation was swelling with discoloration. Mean age was 7.43 ± 6.04 months and mean IHs size was 15.54 ± 11.13 cm2. The response to the treatment was highest for patients below 1 year of age. The reported complications were ulceration, scarring, and subcutaneous atrophy in some cases. Conclusion Combined intralesional therapy in IHs showed good efficacy in most patients. It is a reliable and safe treatment modality with clear curative effects and minimal complications. If IHs treatment is indicated, combined intralesional therapy should be considered as an alternative effective treatment modality.

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The right to effective treatment for people with developmental disabilities and severe problem behaviors.

Behavior Analysis Research and Practice ◽

10.1037/bar0000133 ◽

2018 ◽

Vol 18 (4) ◽

pp. 436-447 ◽

Cited By ~ 1

Author(s):

Gabrielle T. Lee ◽

Don E. Williams ◽

Jason Simmons ◽

Kate Johnson-Patagoc

Keyword(s):

Developmental Disabilities ◽

Effective Treatment ◽

Problem Behaviors ◽

Severe Problem ◽

The Right

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Supraventricular tachycardias in the first year of life: what is the best pharmacological treatment? 24 years of experience in a single centre

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01843-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Guglielmo Capponi ◽

Gilda Belli ◽

Mattia Giovannini ◽

Giulia Remaschi ◽

Alice Brambilla ◽

...

Keyword(s):

Sinus Rhythm ◽

Beta Blocker ◽

Pharmacological Treatment ◽

Beta Blockers ◽

Combined Treatment ◽

First Year ◽

Single Centre ◽

International Consensus ◽

First Year Of Life ◽

Supraventricular Tachycardias

Abstract Background Supraventricular tachycardias (SVTs) are common in the first year of life and may be life-threatening. Acute cardioversion is usually effective, with both pharmacological and non-pharmacological procedures. However, as yet no international consensus exists concerning the best drug required for a stable conversion to sinus rhythm (maintenance treatment). Our study intends to describe the experience of a single centre with maintenance drug treatment of both re-entry and automatic SVTs in the first year of life. Methods From March 1995 to April 2019, 55 patients under one year of age with SVT were observed in our Centre. The SVTs were divided into two groups: 45 re-entry and 10 automatic tachycardias. As regards maintenance therapy, in re-entry tachycardias, we chose to start with oral flecainide and in case of relapses switched to combined treatment with beta-blockers or digoxin. In automatic tachycardias we first administered a beta-blocker, later combined with flecainide or amiodarone when ineffective. Results The patients’ median follow-up time was 35 months. In re-entry tachycardias, flecainide was effective as monotherapy in 23/45 patients (51.1%) and in 20/45 patients (44.4%) in combination with nadolol, sotalol or digoxin (overall 95.5%). In automatic tachycardias, a beta-blocker alone was effective in 3/10 patients (30.0%), however, the best results were obtained when combined with flecainide: overall 9/10 (90%). Conclusions In this retrospective study on pharmacological treatment of SVTs under 1 year of age the combination of flecainide and beta-blockers was highly effective in long-term maintenance of sinus rhythm in both re-entry and automatic tachycardias.

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US-guided percutaneous microwave ablation (MWA) of submandibular gland: A new minimal invasive and effective treatment for refractory sialorrhea and treatment response evaluation with contrast-enhanced imaging techniques

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-211115 ◽

2021 ◽

pp. 1-12

Author(s):

Hui-Li Zhang ◽

Jing-E Zhu ◽

Jia-Xin Li ◽

Xiao-Long Li ◽

Li-Ping Sun ◽

...

Keyword(s):

Effective Treatment ◽

Submandibular Gland ◽

Microwave Ablation ◽

Imaging Techniques ◽

Symptom Relief ◽

Minimal Invasive ◽

Whole Saliva ◽

Patient Reported ◽

The Right ◽

Percutaneous Microwave Ablation

A 33 years’ old male complained of excessive salivation with frequent swallowing and spitting, which resulted in communication disturbance, reduced quality of life, and social embarrassment for 19 years. He had been diagnosed as sialorrhea and submandibular gland hyperfunction by stomatologist, then had unilateral submandibular gland resection 13 years ago, but the symptom relief was not satisfactory. After that, he had been treated with glycopyrrolate for less than a year, which was withdrawn because of the short duration of symptomatic control after each tablet take-in and intolerable side effects. With the wish to receive a new treatment with long term effectiveness, low re-operation risk and normal preserved saliva secretion function, the patient was subject to MWA for the right submandibular gland. After systematic clinical evaluation, US-guided percutaneous MWA was successfully performed with an uneventful post-operative course. The volume of the right submandibular gland and ablated area were measured precisely by an ablation planning software system with automatic volume measurement function based on three-dimensional reconstruction of the pre-operative and post-operative enhanced magnetic resonance imaging (MRI) raw data. Finally, the ablated volume was calculated as 62.2% of the whole right submandibular gland. The patient was discharged 1 day after the operation, with symptoms relieved significantly, the mean value of whole saliva flow rate (SFR) decreased from 11 ml to 7.5 ml per 15 minutes. During the follow up by phone three months after operation, the patient reported that the treatment effect was satisfactory, whereas the SFR value became stable as 7 ml per 15 minutes, drooling frequency and drooling severity (DFDS) score decreased from 6 to 5, drooling impact scale (DIS) score decreased from 43 to 26. US-guided percutaneous MWA of submandibular gland seems to be an alternative, minimal invasive, and effective treatment for refractory sialorrhea. We described a patient with refractory sialorrhea treated successfully with ultrasound (US) guided percutaneous microwave ablation (MWA).

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Combined surgical treatment of arteriovenous malformation of the lower jaw

Endovascular Neuroradiology ◽

10.26683/2304-9359-2020-4(34)-95-104 ◽

2020 ◽

Vol 34 (4) ◽

pp. 95-104

Author(s):

D.V. Shchehlov ◽

V.M. Zahorodnii ◽

I.V. Altman ◽

N.V. Kiselyova ◽

I.I. Kashkish

Keyword(s):

Arteriovenous Malformation ◽

Cerebral Angiography ◽

Combined Treatment ◽

The Body ◽

Facial Artery ◽

External Carotid ◽

Maxillary Artery ◽

Terminal Branch ◽

Lower Jaw ◽

The Right

The objective – to presents the observation of combined treatment of a patient with arteriovenous malformation of the lower jaw.A man, 21 years old, was hospitalized in the Scientific-Practical Center of Endovascular Neuroradiology NAMS of Ukraine with complaints of bleeding from a tooth socket after an attempt to remove the 6th tooth (first painter) of the lower jaw on the left. According to the performed survey radiography of the lower jaw, an aneurysmal bone cyst was revealed in the body of the lower jaw on the left, corresponding to the localization of bleeding. According to cerebral angiography, an arteriovenous malformation of the lower jaw was revealed on the left, the afferent arteries of which were: the right facial artery (a branch of the right external carotid artery (ECA)), the left facial artery (a branch of the left ECA), the lower alveolar artery, the superior-posterior alveolar artery (branches of the maxillary artery ‒ the terminal branch of the left ECA) with drainage into a vein, which was located in the body of the lower jaw. In order to exclude the malformation from the bloodstream and prevent bleeding, a controlled embolization of the malformation was performed using non-spherical emboli – polyvinyl alcohol (PVA) particles from Cook, USA. Using a transfemoral approach, a guide catheter was inserted into the orifice of the ECA, then a Headway 27 microcatheter (Microvention, USA) was passed through it along a Traxes 14 guide wire (Microvention, USA), the afferent arteries of the malformation were selectively cathete-rized in turn, and embolization was performed after superselective angiography. The patient was discharged in a satisfactory condition. Two weeks after the operation, the bleeding resumed. The performed control cerebral angiography revealed a relapse of the malformation with a change in its angioarchitectonics ‒ the filling of the malformation in the late arterial and venous phases of cerebral blood flow was noted. Re-embolization was performed using PVA emboli (Cook), which was supplemented by transcutaneous puncture of the drainage vein in the mandible and its embolization with histoacryl (B. Braun, Germany) and lipiodol (Guerbet, France) in a 1 : 1 ratio. Results. As a result of using this technique, it was possible to turn off the malformation completely. For 6 months from the moment of surgery, no bleeding was noted, and subsequently the patient had a tooth removed without complications.Conclusions. The proposed method for treating arteriovenous malformation of the lower jaw, proposed in this case, showed the effectiveness of a combination of endovascular embolization in combination with transcutaneous embolization of the draining vein and can be successfully used to treat this pathology.

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IDIOPATHIC SCOLIOSIS. /LECTURE, PART I. «PARADOXES»/

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors1161-65 ◽

2013 ◽

Vol 1 (1) ◽

pp. 61-65

Author(s):

Michael G. Dudin ◽

Dmitry Yu. Pinchuk

Keyword(s):

Idiopathic Scoliosis ◽

Children And Adolescents ◽

Effective Treatment ◽

Vertebral Column ◽

Plane Deformation ◽

Homo Erectus ◽

Point Of View ◽

History Of ◽

The Right ◽

Statistical Indicators

In the paper we discussed and analyzed the issues that confront practicing orthopedists with the most mysterious and at the same time the most studied vertebral column lesion in children and adolescents - idiopathic scoliosis. Nowadays a great amount of information on its various aspects has been already accumulated, but a practical output in the form of a system of effective treatment has not been yet found and (we can’t even speak about) there is no speech at all about the prevention (prophylactic) of the disease (scoliosis). On the basis of the own many year’s experience with this category of patients and the results of a comprehensive multi-faceted survey, the authors acquired the right to form their own point of view on the etiology and pathogenesis of the three-plane deformation in orthograde human (homo erectus). In this paper, the authors present their reflections on the history of the study of scoliosis, the terminology, statistical indicators and the existing views on its origins. Concerning argumentation on the own findings (conclusions) and views on the disease the authors plan to tell in the following sections.

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SUN-932 Successful Response of Temozolomide (TMZ) in two Patients with Metastatic Pheochromocytoma/Paragangliomas (PPGLs)

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.1949 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Tobias Skrebsky de Almeida ◽

Roberta P Borges ◽

Janeczko Laís ◽

Giovana Caroline Marx Becker ◽

Ticiana Costa Rodrigues ◽

...

Keyword(s):

Lung Metastases ◽

Left Lung ◽

Vena Cava ◽

Lung Lesion ◽

Chest Ct ◽

Complete Regression ◽

Lung Lesions ◽

The Right ◽

Urinary Metanephrines

Abstract Introduction: PPGLs are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla or their neural crest progenitors, being able to secrete catecholamines. Its treatment is primarily surgical; however, for metastatic/inoperable tumors, effective treatments are lacking. The use of TMZ, an oral alkylating agent, has been scarcely reported with variable response rates. We report 2 patients with reasonable clinical, biochemical and structural responses. Case Reports: Case 1) A 14-year old girl presented with neck pain, sweating, hypertension and tachycardia. Urinary hormonal profile revealed metanephrines 80 (up to 320 ug/24h) and normetanephrines 2983 (up to 390 ug/24h). Abdominal MRI showed a 10x6x5 cm retroperitoneal lesion in close contact with celiac trunk, superior mesenteric artery, renal arteries, aorta, left renal vein and vertebral bodies of T10, T11 and T12. A chest CT revealed multiple lung metastases. After 11 months, both the primary abdominal lesion and lung metastases increased in size.. Due to disease severity, after excluding surgical possibilities and confirming diagnosis by lesion biopsy, rescue treatment with TMZ was started for 5 days on a 28-day cycle. After 11 cycles, lung and abdominal lesions decreased more than 30% in size, and urinary metanephrines decreased 53.4%. After 21 cycles, there is no evidence of disease progression. Case 2) A 44-year old female was first diagnosed at the age of 31 with a right adrenal mass invading the kidney and the inferior vena cava associated with hypertension, sweating, headaches and palpitations. She underwent right adrenalectomy and nephrectomy. Immunohistochemistry confirmed the diagnosis of pheochromocytoma. Seven years later, follow-up CT`s showed a 3 x 2 cm liver metastasis, which was resected, and two lung lesions, one located at the right inferior lobe (1.6 cm) and the other at the left superior lobe (0.9 cm), which initially were just followed-up. At this time, a 7-month sorafenib trial was performed but the drug was stopped due to intolerable side effects. After 3 years of follow-up, the lung lesions increased in size and the right lesion was resected, but the patient refused surgery for the remainder left lung lesion. After 1 year, left lung lesion increased to 2.4 cm and mediastinal and paratracheal lymphadenomegaly developed. TMZ in the same aforementioned schedule was prescribed and after 7 cycles a new chest CT revealed complete regression of the lung and lymph node metastases.. Urinary metanephrines were 2.1 times the upper limit of normal before TMZ and decreased to normal range. Conclusion: These cases highlight the promising role of a well-tolerated single drug chemotherapy regimen in severe cases of metastatic and inoperable PPGLs. TMZ could be considered an alternative strategy for the treatment of these cases and, if possible, should be tested in adequate clinical trials.

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