Bleomycin for orbital and peri-orbital veno-lymphatic malformations – A systematic review

Background Orbital and peri-orbital venolymphatic malformations (VLM) are low flow vascular malformations. Intralesional bleomycin is now commonly being used to treat such malformations. Objective The purpose of this systematic review is to synthesize evidence on the safety and efficacy of bleomycin/pingyangmycin sclerotherapy for the treatment of orbital and peri-orbital VLM. Methods We searched Medline, Embase, Scopus and Cochrane database for studies reporting outcomes of bleomycin/pingyangmycin sclerotherapy for orbital and peri-orbital VLM between 1974 to April 5th, 2019. Nine retrospective cohort studies enrolling 132 patients were included. Two reviewers independently screened and extracted data and assessed the risk of bias. Predefined outcome measures were subjective and objective reduction of the lesion and associated complications. Results Subjective reduction of the lesions was seen in 96.2% of the studies. Objective reduction of the lesion and symptomatic improvement were reported in 91.6 and 95% of the studies respectively. Non responders were 9.0%. Minor adverse events were reported in 18.1% of the studies. Major complications like pulmonary toxicity or pulmonary fibrosis was not encountered in any of the included studies. Quality of evidence was generally low. Conclusion Bleomycin/pingyangmycin sclerotherapy is very effective and relatively safe for the treatment of orbital and periorbital VLM and is not associated with any major side effects including pulmonary fibrosis. Limitations: The systematic review is limited mainly due to low quality of the included studies with retrospective design.

Correction of symptoms of impaired urination in men with the drug Diunorm®.

Introduction. Lower urinary tract symptoms are a socially significant problem on a global scale. Material and methods. The clinical study included 57 men with complaints of LUTS. Patients were randomized to receive LUTS medication. The main observation group consisted of 42 primary patients aged 41 to 67 years. For therapy in whom the drug Diunorm® was used at a dose of 400 mg once a day. The control group included 15 patients aged 50 to 64 years. As an initial therapy, Tamsulosin 0.4 mg was prescribed once a day. The observation period last 90 days in both groups. The effectiveness of therapy was assessed on the basis of questionnaire scales, ultrasound and uroflowmetry. Results and discussion. Conservative therapy of LUTS in both groups was accompanied by a subjective reduction in symptoms according to the total score on the IPSS scale (p <0.0001). A similar dynamics in the study groups took place in relation to a decrease in the frequency of nocturia (p <0.01). Analysis of the IIEF-5 questionnaire and ultrasound did not reveal any changes in the observation groups for 3 months (p> 0.05). A significant increase in the maximum urination rate was recorded in patients taking Diunorm®. The growth rate was on average 29.3 ± 21.0% (p <0.001). Conclusion. The drug Diunorm® reliably and comparable to tamsulosin reduces the severity of LUTS and the frequency of nocturia in primary relatively young patients, without causing ejaculatory disorders.

Physical and neurodevelopmental outcomes in children with single-ventricle circulation

ObjectiveTo investigate longer-term physical and neurodevelopmental outcomes of patients with hypoplastic left heart syndrome (HLHS) compared with other patients with functionally single-ventricle circulation surviving beyond the age of 10 years.DesignA retrospective, observational study from a UK tertiary centre for paediatric cardiology.Results58 patients with HLHS and 44 non-HLHS patients with single-ventricle physiology were included. Subjective reduction in exercise tolerance was reported in 72% (95% CI 61% to 84%) of patients with HLHS and 45% (31% to 60%) non-HLHS patients. Compared with non-HLHS patients, educational concerns were reported more frequently in patients with HLHS, 41% (29% to 54%) vs 23% (10% to 35%), as was a diagnosis of a behaviour disorder (autism or attention deficit hyperactivity disorder) 12% (4% to 21%) vs 0%, and referral to other specialist services 67% (55% to 79%) vs 48% (33% to 63%).ConclusionsWithin a group of young people with complex congenital heart disease, those with HLHS are likely to have worse physical, psychological and educational outcomes.

Effects of Palliative Radiation Therapy on Nonsplenic Hemangiosarcoma in Dogs

Medical records for 20 dogs with histologically confirmed nonsplenic hemangiosarcomas treated with palliative radiation therapy were reviewed to evaluate factors influencing tumor response and survival time. The Kaplan-Meier median survival time of dogs that received palliative radiation therapy was 95 days (range 6 to 500 days). Subjective reduction in tumor size was seen in 14 dogs, with four complete responses. Tumor location was a significant univariate prognostic factor for survival, and dogs with retroperitoneal masses had longer survival times.

Obstructive sleep apnea treatment with dental appliance

The case of a 40-year-old male patient with obstructive sleep apnea syndrome (OSAS) is reported, with emphasis on treatment with a dental appliance. This therapeutic approach, which has been focused on recent research, has as its objective, the posturing of the mandibule and, consequently, the tongue more anteriorly, thus in turn leading to an increase in the posterior oropharyngeal airway space (PAS). Cephalometry contributed determining in this case whereby enlargement limits were observed in the PAS with mandibular displacement. Clinical and polysomnographic controls showed subjective reduction of the excessive daytime sleepiness and objective decrease in apneas intensity to normal limits. Eight months follow-up evidenced the steady improvement.