scholarly journals Propranolol treatment for infantile hemangioma: a case series of sixty-two patients

2016 ◽  
Vol 38 (2) ◽  
Author(s):  
Giovanna Stringari ◽  
Giulia Barbato ◽  
Matteo Zanzucchi ◽  
Maddalena Marchesi ◽  
Giuseppe Cerasoli ◽  
...  
Keyword(s):  
Case Series ◽  
Severe Hypoglycemia ◽  
Infantile Hemangioma ◽  
Treatment Length ◽  
Endoscopic Findings ◽  
Life Threatening ◽  
Propranolol Treatment ◽  
The Mean ◽  
The Impact ◽  
Oral Propranolol

Infantile hemangiomas (IH) complicated by ulceration, disfigurement, functional impairment or life-threatening conditions need early, safe and effective treatment. This study explores the impact of propranolol on complicated IH. We report our experience of 62 patients treated with oral propranolol for complicated IH. The effect of propranolol was assessed using a score on a visual analogue scale integrated with echo, magnetic resonance or endoscopic findings. The average age at the beginning of the treatment was seven months [standard deviation (SD)±8.9], with a median of four months (range 1-53 months). The average age at the end of the treatment was 15 months (SD±8.4), with a median of 13 months (range 7-59 months). The mean treatment length was eight months (SD±3.2). Oral propranolol was successful in 95.2% of the patients in reducing the volume, the intensity of color and the elevation of IH. Statistically significant improvement of IH volume was observed in the first two months of therapy (P≤0.001), and between the second month and the end of the treatment (P<0.05). No significant bradycardia or hypotension occurred. Severe hypoglycemia occurred in one patient. Mild adverse effects were observed in seven patients. Our study demonstrates that propranolol administered orally at 2 to 3 mg/kg/day has a rapid therapeutic effect leading to remarkable shortening of the natural course of IH and it is safe in the majority of patients.

scholarly journals The effectiveness of oral propranolol for infantile hemangioma on the head and neck region: A case series

2021 ◽  
pp. 106120
Author(s):  
Prasetyanugraheni Kreshanti ◽  
Nandya Titania Putri ◽  
Valencia Jane Martin ◽  
Chaula Luthfia Sukasah
Keyword(s):  
Head And Neck ◽  
Case Series ◽  
Neck Region ◽  
Infantile Hemangioma ◽  
Head And Neck Region ◽  
Oral Propranolol

scholarly journals Propranolol treatment of infantile subglottic hemangioma: a report of two cases and a literature review

Folia Medica ◽  
2021 ◽  
Vol 63 (4) ◽  
pp. 601-607
Author(s):  
Kalina Ganeva ◽  
Petar Shivachev ◽  
Nikolay Sapundzhiev ◽  
Lora Nikiforova
Keyword(s):  
Literature Review ◽  
Inhaled Corticosteroids ◽  
Previous Treatment ◽  
Infantile Hemangioma ◽  
Benign Tumors ◽  
Close Monitoring ◽  
Upper Respiratory Tract ◽  
Life Threatening ◽  
Propranolol Treatment ◽  
The Subject

Infantile hemangioma is one of the most common benign tumors of infancy. The natural evolution includes rapid growth followed by gradual involution. Airway hemangiomas are not that common, but they can lead to dyspnoea, as well as to life-threatening complications. Two children aged 3 months were admitted to the Pediatric Department with difficulties in breathing and with biphasic stridor. They had previously been hospitalized because of the same symptoms and misdiagnosed as having an upper respiratory tract infection. The previous treatment included intravenous or inhaled corticosteroids, without any significant improvement. Laryngoscopy was performed for both of the children. There was a mass in the subglottic area with the appearance of a hemangioma causing significant airway stenosis. We started treatment with propranolol at a dose of 1 mg/kg/day twice daily. The dose was gradually increased up to 3 mg/kg/day, under close monitoring. In the first 7 to 10 days after initiation of treatment, we observed a significant improvement of the respiratory distress. The second laryngoscopy showed an almost complete involution of the mass in the subglottis.  The focus of this article will be primarily on the clinical presentation and the therapeutic response of subglottic hemangioma, along with a literature review on the subject.

Aeromedical Decision Making for Military Aircrew with Graves’ Disease

2021 ◽  
Vol 92 (12) ◽  
pp. 980-986
Author(s):  
Edwin Hong-Teck Loh ◽  
Feng Wei Soh ◽  
Brian See ◽  
Benjamin Boon Chuan Tan
Keyword(s):  
Decision Making ◽  
Air Force ◽  
Case Series ◽  
Definitive Treatment ◽  
Antithyroid Drugs ◽  
Graves Disease ◽  
First Line Therapy ◽  
The Mean ◽  
Stable Maintenance ◽  
The Impact

BACKGROUND: Graves’ Disease (GD) is a common cause of hyperthyroidism. Although definitive treatment with radioactive iodine (RAI) is preferred for military aircrew, there are cultural and individual differences in receptivity toward RAI, and clinical guidelines that recommend antithyroid drugs (ATD) as the first line therapy. We examined a case series of Republic of Singapore Air Force (RSAF) aviators with GD treated with ATD and the impact of their condition on aeromedical disposition.CASE SERIES: All RSAF aircrew diagnosed with GD and treated with ATD over a 15-yr period were retrospectively identified and analyzed to determine the impact on their fitness for flying duties. The mean age of the 13 aircrew was 33 ± 7.1 yr (range, 25–47 yr), with 11 (84.6%) being males. There were 10 (76.9%) who had ATD as the only treatment while 3 (23.1%) were initially treated with ATD but subsequently underwent RAI or surgery. Of the 10 treated with only ATD, 3 (30.0%) were returned to restricted flying, 6 (60.0%) were returned to unrestricted flying, and 1 (10.0%) is still undergoing ATD titration. There were 10 (76.9%) aircrew who were returned to some form of flying duties while on low doses of ATD.DISCUSSION: This case series suggests that ATD is a viable treatment modality in the aeromedical management of military aviators with GD and it is possible to return military aircrew on a stable maintenance dose of ATD to flying duties. A framework is proposed to support the aeromedical decision-making process for military aircrew in the treatment of GD.Loh EH-T, Soh FW, See B, Tan BBC. Aeromedical decision making for military aircrew with Graves’ disease. Aerosp Med Hum Perform. 2021; 92(12):980–986.

scholarly journals COVID-19 in HIV: a Review of Published Case Reports

2020 ◽  
Vol 2 (12) ◽  
pp. 2647-2657
Author(s):  
Zoya Morani ◽  
Saumil Patel ◽  
Sudeshna Ghosh ◽  
Falah Abu Hassan ◽  
Shriya Doreswamy ◽  
...  
Keyword(s):  
Morbid Obesity ◽  
Web Of Science ◽  
Case Reports ◽  
Case Series ◽  
Hiv Patients ◽  
High Burden ◽  
Cardiovascular Comorbidities ◽  
Life Threatening ◽  
The Mean ◽  
Immunocompromised State

AbstractPatients with COVID-19 present with a myriad of comorbidities. An immunocompromised state like HIV in patients with COVID-19 can be life-threatening. We searched PubMed/Medline, Scopus, and Web of Science for case reports and case series about COVID-19 in HIV patients. We finally reviewed 20 case reports including cases of 43 patients with HIV and COVID-19. The mean age of 43 adult patients was 51.56 ± 27.56 years (range 24–76 years). Of these, 30 were male (69.77%), 11 were female (25.58%), and 2 were transgender (4.65%). A total of 25 patients (58.14%) were above 50 years of age. The most common cardiovascular comorbidities were hypertension and hyperlipidemia (48.8%), diabetes (20.93%), and morbid obesity (11.63%). Out of 43 HIV patients with COVID-19, 6 resulted in death (13.95%). All the patients who died were elderly above 50 years and required mechanical ventilation. HIV patients infected with COVID-19 had a high mortality rate. A high burden of pre-existing comorbidities and an advanced age in these patients make them prone to disease progression and worse outcomes.

scholarly journals Risks associated with oral deferiprone in the treatment of infratentorial superficial siderosis

2019 ◽  
Vol 267 (1) ◽  
pp. 239-243 ◽  
Author(s):  
Y. Sammaraiee ◽  
G. Banerjee ◽  
S. Farmer ◽  
B. Hylton ◽  
P. Cowley ◽  
...  
Keyword(s):  
Side Effects ◽  
Case Series ◽  
Iron Chelator ◽  
Superficial Siderosis ◽  
Neutropenic Sepsis ◽  
Favourable Safety ◽  
Favourable Safety Profile ◽  
Life Threatening ◽  
The Mean ◽  
Mean Time

Abstract Objective Deferiprone is an iron chelator that has recently been used to treat patients with infratentorial superficial siderosis (iSS). It is considered to have a generally favourable safety profile but concerns have been raised due to the risk of agranulocytosis. We aimed to evaluate the safety and tolerability of oral deferiprone as a treatment for patients with iSS. Methods We present a case series of 10 consecutive patients presenting with classical iSS treated with deferiprone. Results Ten patients were followed up for a mean period of 2.3 years (range 0.5–5.5 years). Four patients (40%) were withdrawn from treatment because of treatment-related side effects. The reasons for treatment discontinuation were neutropenic sepsis (n = 3) and fatigue (n = 1). In 2 out of the 3 cases of neutropenic sepsis, patients initially developed neutropenia without sepsis. The mean time to neutropenic sepsis following deferiprone was 1.2 years (range 0.3–2.5) with mean neutrophil count of 0.4 (range 0.3–0.5). Six patients (60%) reported no change in neurological function while on treatment, and four patients (40%) reported that their condition deteriorated. Conclusions Deferiprone was poorly tolerated, with 40% of patients withdrawing from treatment, most commonly due to neutropenic sepsis, after an average of 2 years on treatment. This study increases the number of reported cases of agranulocytosis in patients with iSS treated with deferiprone. Clinicians treating iSS patients with deferiprone should be aware that this drug has a potentially life-threatening side effect of neutropenic sepsis, and should ensure that appropriate haematological monitoring is in place.

Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure

2020 ◽  
pp. 107110072097266
Author(s):  
Joseph T. O’Neil ◽  
Otho R. Plummer ◽  
Steven M. Raikin
Keyword(s):  
Computerized Adaptive Testing ◽  
Case Series ◽  
Adaptive Testing ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean ◽  
Ability Measure ◽  
The Impact

Background: Patient-reported outcome measures are an increasingly important tool for assessing the impact of treatments orthopedic surgeons render. Despite their importance, they can present a burden. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure (FAAM), a validated anatomy-specific outcome measure. Methods: A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment over a 3-year period (2017-2019). A total of 15 902 responses for the Activities of Daily Living (ADL) subscale and a total of 14 344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed. Results: The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (range, 11-12). The number of questions answered on the Sports subscale was 6 (range, 5-6) in 66.4% of cases. The mean difference between the full FAAM ADL subscale and CAT was 0.63 of a point. The mean difference between the FAAM Sports subscale and CAT was 0.65 of a point. Conclusion: The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do. Level of Evidence: Level IV, case series.

scholarly journals Coronavirus disease 2019 and stroke in Iran: a case series and effects on stroke admissions

2020 ◽  
pp. 174749302093739 ◽  
Author(s):  
M Mehrpour ◽  
A Shuaib ◽  
M Farahani ◽  
HR Hatamabadi ◽  
Z Fatehi ◽  
...  
Keyword(s):  
Case Series ◽  
Absolute Number ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Pathological Characteristics ◽  
Significant Difference ◽  
Duration Of Hospitalization ◽  
Life Threatening ◽  
Treatment Plans ◽  
The Impact

Objective The coronavirus disease 2019 pandemic has affected healthcare systems around the globe and massively impacted patients with various non-infectious, life-threatening conditions. Stroke is a major neurological disease contributing to death and disability worldwide, and is still an ongoing issue during the pandemic. Here we investigate the impact of the coronavirus disease 2019 outbreak on stroke manifestations, treatment courses, the outcome of stroke patients, and the hospitalization rate in a referral center for stroke management in Tehran, Iran. Methods We extracted data regarding 31 stroke patients (10 patients with laboratory-confirmed coronavirus disease 2019) and compared the demographic and pathological characteristics of the patients with or without coronavirus disease 2019 infection. The association of demographic/pathological characteristics of stroke patients during the coronavirus disease 2019 pandemic and a corresponding period during the previous year (49 patients) and an earlier period during the same year as the pandemic (50 patients) was also evaluated. Results The absolute number of admissions decreased about 40% during the coronavirus disease 2019 pandemic. Except for the stroke severity (P = 0.002), there were no significant changes in the demographic and pathological characteristics of the stroke patients during the three studied periods. A significantly higher mean of age (75.60 ± 9.54 versus 60.86 ± 18.45; P = 0.007), a significant difference in the type of stroke (P = 0.046), and significantly higher stroke severity (P = 0.024) were observed in stroke patients with coronavirus disease 2019 compared with those of stroke patients without coronavirus disease 2019. Treatment approaches, duration of hospitalization, and mortality rates did not differ significantly. Conclusions This report shows that the pandemic caused the number of acute stroke admissions to plummet compared to other periods. Although the pandemic did not affect the treatment plans and care of the patients, stroke cases with coronavirus disease 2019 had higher age, more large vessel ischemic stroke, and more severe stroke. Further studies are urgently needed to realize the probable interaction of the coronavirus disease 2019 pandemic and the neurologic disease.

Polysomnography Outcomes after Supraglottoplasty in Children with Obstructive Sleep Apnea

2019 ◽  
Vol 161 (4) ◽  
pp. 694-698 ◽  
Author(s):  
Bharat Bhushan ◽  
James W. Schroeder ◽  
Kathleen R. Billings ◽  
Nicholas Giancola ◽  
Dana M. Thompson
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Tertiary Care ◽  
Case Series ◽  
Apnea Hypopnea Index ◽  
Historical Cohort ◽  
Tertiary Care Medical Center ◽  
Obstructive Sleep ◽  
The Mean ◽  
The Impact

ObjectiveLaryngomalacia has been reported to contribute to the severity of obstructive sleep apnea (OSA) in children. It is unclear if surgical treatment of laryngomalacia improves polysomnography (PSG) outcomes in these patients. The objective of this study is to report the impact of supraglottoplasty on PSG parameters in children with laryngomalacia-related OSA.Study DesignRetrospective case series.SettingTertiary care medical center.Subjects and MethodsHistorical cohort study of consecutive children with laryngomalacia who underwent supraglottoplasty and who had undergone overnight PSG before and after surgery.ResultsForty-one patients were included in the final analysis: 22 (53.6%) were male, and 19 (46.3%) were female. The mean ± SEM age of patients at preoperative PSG was 1.3 ± 0.89 years (range, 0.003-2.9). In entire cohort, the mean obstructive apnea-hypopnea index score was reduced from 26.6 events/h before supraglottoplasty to 7.3 events/h after surgery ( P = .003). Respiratory disturbance index was reduced from 27.3 events/h before supraglottoplasty to 7.8 events/h after surgery ( P = .003). The percentage of REM sleep decreased from 30.1% ± 2.4 to 24.8% ± 1.3 ( P = .04). Sleep efficiency was improved ( P = .05).ConclusionOverall, supraglottoplasty significantly improved several PSG outcomes in children with laryngomalacia. However, mild to moderate OSA was still present postoperatively in most children. This suggested a multifactorial cause for OSA in this population.

scholarly journals Impact of Age, Sex and Route of Administration on Adverse Events after Opioid Treatment in the Emergency Department: A Retrospective Study

2015 ◽  
Vol 20 (1) ◽  
pp. 23-28 ◽  
Author(s):  
Raoul Daoust ◽  
Jean Paquet ◽  
Gilles Lavigne ◽  
Éric Piette ◽  
Jean-Marc Chauny
Keyword(s):  
Emergency Department ◽  
Adverse Events ◽  
Respiration Rate ◽  
Tertiary Care ◽  
Route Of Administration ◽  
Urban Hospital ◽  
Opioid Administration ◽  
Life Threatening ◽  
The Mean ◽  
The Impact

BACKGROUND: The efficacy of opioids for acute pain relief in the emergency department (ED) is well recognized, but treatment with opioids is associated with adverse events ranging from minor discomforts to life-threatening events.OBJECTIVE: To assess the impact of age, sex and route of administration on the incidence of adverse events due to opioid administration in the ED.METHODS: Real-time archived data were analyzed retrospectively in a tertiary care urban hospital. All consecutive patients (≥16 years of age) who were assigned to an ED bed and received an opioid between March 2008 and December 2012 were included. Adverse events were defined as: nausea/vomiting (minor); systolic blood pressure (SBP) < 90 mmHg, oxygen saturation (Sat) < 92% and respiration rate < 10 breaths/min (major) within 2 h of the first opioid doses.RESULTS: In the study period, 31,742 patients were treated with opioids. The mean (± SD) age was 55.8± 20.5 years, and 53% were female. The overall incidence of adverse events was 12.0% (95% CI 11.6% to 12.4%): 5.9% (95% CI 5.6% to 6.2%) experienced nausea/vomiting, 2.4% (95% CI 2.2% to 2.6%) SBP < 90 mmHg, 4.7% (95% CI 4.5% to 4.9%) Sat that dropped to < 92% and 0.09% respiration rate < 10 breaths/min. After controlling for confounding factors, these adverse events were associated with: female sex (more nausea/vomiting, more SBP < 90 mmHg, less Sat < 92%); age ≥65 years (less nausea/vomiting, more SBP < 90 mmHg, more Sat < 92%); and route of administration (intravenous > subcutaneous > oral).CONCLUSIONS: The incidence of adverse events associated with opioid administration in the ED is generally low and is associated with age, sex and route of administration.

scholarly journals Management of Upper Airway Infantile Hemangiomas: Experience of One Italian Multidisciplinary Center

2021 ◽  
Vol 9 ◽  
Author(s):  
Marialuisa Corbeddu ◽  
Duino Meucci ◽  
Andrea Diociaiuti ◽  
Simona Giancristoforo ◽  
Roberta Rotunno ◽  
...  
Keyword(s):  
Case Series ◽  
Upper Airway ◽  
Duration Of Treatment ◽  
Cutaneous Lesions ◽  
Phaces Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Line Of Therapy ◽  
Oral Propranolol

Airway infantile hemangiomas (IHs) can represent a life-threatening condition since the first months of life. They may be isolated or associated to cutaneous IHs, and/or part of PHACES syndrome. Diagnosis, staging, and indication to treatment are not standardized yet despite the presence in the literature of previous case series and reviews. The diagnosis might be misleading, especially in the absence of cutaneous lesions. Airway endoscopy is the gold standard both for diagnosis and follow-up since it allows evaluation of precise localization and entity of obstruction and/or stricture. Proliferation of IH in the infant airways manifests frequently with stridor and treatment is required as soon as possible to prevent further complications. The first line of therapy is oral propranolol, but duration of treatment is not yet well-defined. All considered, we report the experience of our multidisciplinary center from 2009 to date, on 36 patients affected by airway IHs, and successfully treated with oral propranolol. Thus, the authors propose their experience for the management of airway IHs, specifically early diagnosis, when to perform endoscopy, how to interpret its findings, and when to stop the treatment.

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