51
|
|
52
|
Successful treatment of visceral infantile hemangioma of the omentum and mesentery with propranolol. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2014.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
53
|
Kuroda T, Hoshino K, Nosaka S, Shiota Y, Nakazawa A, Takimoto T. Critical hepatic hemangioma in infants: recent nationwide survey in Japan. Pediatr Int 2014; 56:304-8. [PMID: 24689756 DOI: 10.1111/ped.12347] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Revised: 03/04/2014] [Accepted: 03/24/2014] [Indexed: 12/16/2022]
Abstract
The International Society for the Study of Vascular Anomalies (ISSVA) classification divides vascular lesions into two major entities: neoplasms originating from the vascular endothelium and vascular malformations. Although this concept has been widely accepted, little has been established regarding vascular lesions in deep organs, such as infantile hepatic hemangioma (IHH). The current nationwide survey identified 19 critical infantile hemangiomas during the most recent 5 years. On histopathology all the lesions examined were neoplastic, but portovenos shunt was found histologically or clinically in some cases. High-output cardiac failure, consumption coagulopathy, and respiratory distress were the major symptoms, and treatment-resistant coagulopathy seemed to be the most reliable predictor of fatal outcome. Although steroid has been the gold standard treatment for these lesions, 25% of the patients were totally insensitive to steroids, whereas propranolol had a prompt effect in one case. For critical IHH with steroid-insensitive thrombocytopenia and prothrombin time prolongation, novel therapeutic options including beta-blocker therapy, surgery, and liver transplantation should be urgently considered as alterative treatment. The present review summarizes the results of the survey.
Collapse
Affiliation(s)
- Tatsuo Kuroda
- Infantile Hepatic Hemangioma Study Group, Department of Pediatric Surgery, Keio University, School of Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
54
|
Abstract
Infantile hemangiomas (IH) are common benign vascular tumors seen in children. Although the majority will improve spontaneously without treatment, a small subset will require therapy due to a variety of complications. Less than a decade ago, propranolol replaced corticosteroids as first-line treatment for most IH and it has proven to be a relatively safe, effective therapy. After initiation of propranolol, most hemangiomas show evidence of significant improvement relatively rapidly, often within days. Although propranolol is generally felt to have a more limited side-effect profile than systemic corticosteroids, its use has been infrequently associated with adverse events, including sleep disturbances, acrocyanosis, hypotension, bradycardia, respiratory events, and hypoglycemia. Rarely, hypoglycemic seizures have been reported, usually occurring in the setting of prolonged fasting.
Collapse
Affiliation(s)
| | | | - Teresa S. Wright
- Department of Dermatology, Texas Children's Hospital, Houston, Texas
| |
Collapse
|
55
|
Abstract
Propranolol has replaced corticosteroids as preferred first-line therapy for the management of infantile hemangiomas (IH). The topical β-blocker timolol is now an alternative to oral propranolol and watchful waiting for smaller IH. Research in the last decade has provided evidence-based data about natural history, epidemiology, and syndromes associated with IH. The most pressing issue for the clinician treating children with IH is to understand current data to develop an individualized risk stratification for each patient and determine the likelihood of complications and need for treatment. This article emphasizes the nuances of complicated clinical presentations and current treatment recommendations.
Collapse
Affiliation(s)
- Katherine B Püttgen
- Division of Pediatric Dermatology, Department of Dermatology, Johns Hopkins University School of Medicine, 200 North Wolfe Street, Unit 2107, Baltimore, MD 21287, USA.
| |
Collapse
|
56
|
Luu M, Frieden IJ. Haemangioma: clinical course, complications and management. Br J Dermatol 2014; 169:20-30. [PMID: 23701395 DOI: 10.1111/bjd.12436] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2013] [Indexed: 11/30/2022]
Abstract
Despite their high incidence, most infantile haemangiomas (IH) do not require treatment as they regress spontaneously and most do not leave significant sequelae. For the subset of haemangiomas that require treatment, indications for intervention can be divided into three main categories: ulceration, disfigurement and impairment of function or vital structures. In addition, certain IH have a risk of associated structural anomalies. Given the wide heterogeneity of haemangiomas, deciding which haemangiomas need intervention and when to intervene requires a detailed knowledge of natural history and clinical indicators of increased risk.
Collapse
Affiliation(s)
- M Luu
- Department of Dermatology, University of California San Francisco, 3rd floor, 1701 Divisidero Street, San Francisco, CA 94115, USA
| | | |
Collapse
|
57
|
Gunturi N, Ramgopal S, Balagopal S, Scott JX. Propranolol therapy for infantile hemangioma. Indian Pediatr 2013; 50:307-13. [PMID: 23680605 DOI: 10.1007/s13312-013-0098-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
CONTEXT There has been widespread interest surrounding the use of beta-blockers (i.e. propranolol, timolol, nadolol, acebutolol) in the treatment of infantile hemangiomas (IH). OBJECTIVE To review literature evaluating treatment of IH with propranolol. EVIDENCE ACQUISITION We conducted a literature search on PubMed and investigated for case reports, case series, and controlled trials by using search terms including hemangioma and propranolol. RESULTS Data suggest that beta-blockers are efficacious in cutaneous, orbital, subglottic, and hepatic hemangiomas and assist in the resolution of ulcerated hemangiomas. Improvement has also been documented in children with PHACE syndrome. Propranolol produces favorable results in children who do not respond to steroids and with no long-term adverse effects. Propranolol should be administered with caution due to rare but serious side effects including hypoglycemia, wheezing, hypotension, and bradycardia. Additionally, recurrence of lesions following the cessation of treatment has been documented. CONCLUSIONS Although large-scale randomized controlled trials must be conducted in order to further evaluate the safety and the possible role of propranolol in the treatment of IH, the reviewed literature suggests that propranolol carries promise as a potential replacement for corticosteroids as first-line therapy or as a part of a multimodal approach.
Collapse
Affiliation(s)
- Nivedita Gunturi
- Department of Pediatrics, Sri Ramachandra University, Chennai, India
| | | | | | | |
Collapse
|
58
|
Ferrandiz L, Toledo-Pastrana T, Moreno-Ramirez D, Bardallo-Cruzado L, Perez-Bertolez S, Luna-Lagares S, Rios-Martin JJ. Diffuse neonatal hemangiomatosis with partial response to propranolol. Int J Dermatol 2013; 53:e247-50. [PMID: 23834677 DOI: 10.1111/ijd.12155] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Lara Ferrandiz
- Dermatology Unit, Hospital Universitario Virgen Macarena, Seville, Spain
| | | | | | | | | | | | | |
Collapse
|
59
|
Vercellino N, Romanini MV, Pelegrini M, Rimini A, Occella C, Dalmonte P. The use of propranolol for complicated infantile hemangiomas. Int J Dermatol 2013; 52:1140-6. [PMID: 23829783 DOI: 10.1111/j.1365-4632.2012.05795.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess propranolol efficacy and safety in complicated infantile hemangiomas in two different age groups. PATIENTS AND METHODS We report on 68 infants with infantile hemangiomas treated with oral propranolol at the lowest effective dose at different ages for a period of six months. Inclusion criteria were life-threatening hemangiomas, function-threatening hemangiomas, facial hemangiomas with risk for disfigurement, and extensive and ulcerated hemangiomas. A previously designed safety protocol was applied to all patients. The evolution of all hemangiomas since baseline (pre-therapy) until the end of follow-up was assessed on the basis of clinical features (color, palpable softening, size, and volume) and taken at follow-up visits. RESULTS Our results showed that propranolol was effective in arresting the proliferative phase and in accelerating the involution of infantile hemangiomas in 92.6% of cases. Propranolol efficacy was clear even when it was started after 12 months of life at low dose; after discontinuation of therapy there was a moderate-to-severe regrowth in 9.3% of cases and a mild regrowth in 22.5%. No adverse events were observed. CONCLUSIONS Propranolol should be used as first-line medical treatment in all cases of complicated infantile hemangiomas.
Collapse
Affiliation(s)
- Nadia Vercellino
- Department of Cardiovascular, IRCCS Giannina Gaslini Children's Hospital, Genoa, Italy
| | | | | | | | | | | |
Collapse
|
60
|
Dreyfus I, Maza A, Mazereeuw-Hautier J. Quoi de neuf dans les hémangiomes infantiles ? Arch Pediatr 2013; 20:809-16. [DOI: 10.1016/j.arcped.2013.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 12/21/2022]
|
61
|
Pride HB, Tollefson M, Silverman R. What's new in pediatric dermatology? J Am Acad Dermatol 2013; 68:899.e1-11; quiz 910-2. [DOI: 10.1016/j.jaad.2013.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 03/20/2013] [Indexed: 12/27/2022]
|
62
|
Uzunaslan D, Saygin C, Gungor S, Hasiloglu Z, Ozdemir N, Celkan T. Novel use of propranolol for management of pain in children with vertebral hemangioma: report of two cases. Childs Nerv Syst 2013; 29:855-60. [PMID: 23306960 DOI: 10.1007/s00381-012-2012-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/19/2012] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Vertebral hemangioma (VH) is an exceedingly rare neoplasm in pediatric population with less than 10 cases reported in the literature. It is usually asymptomatic in adults and diagnosed incidentally at radiographic investigations of other medical conditions. In this report, we describe two children who presented to our institution with severe back pain and were diagnosed with VH. CASE REPORTS Case 1 was an 8-year-old male with a pain score of 10 out of 10 at presentation. Clinical investigations eliminated the possibility of a neoplasm or infectious process and MRI findings were highly suggestive of an aggressive vertebral hemangioma. Case 2 was a 17-year-old female who presented with back pain radiating to shoulders. Her pain score was 4 out of 10 and she was diagnosed with vertebral hemangioma due to the specific findings on MRI studies. DISCUSSION Both patients received propranolol with a dose of 20 and 40 mg per day, respectively. They were free of pain at 2 months follow-up. There are different invasive treatment modalities for the management of VH, including vertebroplasty, kyphoplasty, radiotherapy, alcohol injection, embolization, and surgery. These methods have been used in adult patients for several years, but each of them has potential risks which make these options unsuitable for children. CONCLUSION Propranolol is a beta blocker which is safely used in the management of infantile hemangiomas. This is the first report demonstrating its efficacy in symptomatic treatment of childhood VH. The lesions did not show any regression, but the pain relief obtained was very significant under propranolol therapy.
Collapse
Affiliation(s)
- Didem Uzunaslan
- Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
| | | | | | | | | | | |
Collapse
|
63
|
Craiglow BG, Antaya RJ. Management of infantile hemangiomas : current and potential pharmacotherapeutic approaches. Paediatr Drugs 2013; 15:133-8. [PMID: 23456550 DOI: 10.1007/s40272-013-0008-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infantile hemangiomas (IH), benign vascular neoplasms, are the most common tumors of infancy and childhood. Most IH are medically insignificant; however, a proportion will require treatment because of interference with vital structures, threat of significant disfigurement, ulceration, or bleeding. This article reviews current and potential pharmacotherapeutic approaches to the treatment of IH. While corticosteroids have long been considered the mainstay of medical therapy for IH, several new treatments have recently emerged, the most promising of which is oral propranolol. Topical timolol and imiquimod are additional new therapies that may also prove to be effective, particularly for the treatment of superficial IH.
Collapse
Affiliation(s)
- Brittany G Craiglow
- Department of Dermatology, Yale University School of Medicine, P.O. Box 208059, New Haven, CT 06520, USA.
| | | |
Collapse
|
64
|
Abstract
Infantile hemangioma (IH) is a common vascular tumor of infancy. Although benign, infants with IH can experience complications including ulceration, visual and airway impairment, and residual scarring and disfigurement. It is often challenging for clinicians to predict which tumors are in need of systemic treatment. However, data from various demographic and other studies have revealed further insights into this tumor. This article reviews the identification, evaluation, and management of high-risk IHs, including the indications for treatment and the use of systemic treatments such as corticosteroids, β-blockers, and vincristine.
Collapse
|
65
|
Greenberger S, Bischoff J. Infantile hemangioma-mechanism(s) of drug action on a vascular tumor. Cold Spring Harb Perspect Med 2013; 1:a006460. [PMID: 22229118 DOI: 10.1101/cshperspect.a006460] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Infantile hemangioma (IH), a benign vascular tumor, is the most common tumor of infancy, with an incidence of 5%-10% at the end of the first year. The tumor displays a distinctive life cycle consisting of a proliferating phase, occurring in the first months of life, followed by an involuting phase. Thus, IH represents a unique model of postnatal vasculogenesis, angiogenesis, and vessel regression. Traditionally, corticosteroids were the drug of choice when treatment of IH was indicated. In recent years, beta-blockers, most specifically propranolol, have serendipitously been shown to be an effective pharmacological treatment. This article will focus on the mechanism of action of these two drugs, the old and the new treatments, in slowing the growth and accelerating involution of IH.
Collapse
Affiliation(s)
- Shoshana Greenberger
- Department of Dermatology and Sheba Cancer Research Center, Sheba Medical Center, Ramat-Gan 52621, Israel
| | | |
Collapse
|
66
|
Propranolol as a first-line treatment for diffuse infantile hepatic hemangioendothelioma. J Pediatr Gastroenterol Nutr 2013; 56:e17-20. [PMID: 22331019 DOI: 10.1097/mpg.0b013e31824e50b7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
67
|
Abstract
Infantile hemangiomas are the most common tumors of infancy. The serendipitous discovery of the therapeutic efficacy of propranolol in the management of infantile hemangiomas has revolutionized the care and understanding of these lesions, and greatly improved the prognosis for a good cosmetic outcome. In addition, there has been an expansion of indications for treatment of hemangiomas, taking into account not only those hemangiomas that can cause airway compromise, amblyopia, and cardiac overload, but also those lesions that can lead to unsatisfactory cosmetic outcome or deformity after involution. Current concepts of pathogenesis of infantile hemangiomas, of segmental hemangiomas with systemic associations, of hepatic hemangiomas, and of the use of systemic and topical beta-blockers for the management of IH are all reviewed.
Collapse
Affiliation(s)
- Kachiu C Lee
- Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI 02903, USA
| | | |
Collapse
|
68
|
Filippi L, Cavallaro G, Fiorini P, Malvagia S, Della Bona M, Giocaliere E, Bagnoli P, Dal Monte M, Mosca F, Donzelli G, la Marca G. Propranolol concentrations after oral administration in term and preterm neonates. J Matern Fetal Neonatal Med 2013. [DOI: 10.3109/14767058.2012.755169] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
69
|
Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE, Chun RH, Garzon MC, Holland KE, Liberman L, MacLellan-Tobert S, Mancini AJ, Metry D, Puttgen KB, Seefeldt M, Sidbury R, Ward KM, Blei F, Baselga E, Cassidy L, Darrow DH, Joachim S, Kwon EKM, Martin K, Perkins J, Siegel DH, Boucek RJ, Frieden IJ. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics 2013; 131:128-40. [PMID: 23266923 PMCID: PMC3529954 DOI: 10.1542/peds.2012-1691] [Citation(s) in RCA: 325] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Infantile hemangiomas (IHs) are common neoplasms composed of proliferating endothelial-like cells. Despite the relative frequency of IH and the potential severity of complications, there are currently no uniform guidelines for treatment. Although propranolol has rapidly been adopted, there is significant uncertainty and divergence of opinion regarding safety monitoring, dose escalation, and its use in PHACE syndrome (PHACE = posterior fossa, hemangioma, arterial lesions, cardiac abnormalities, eye abnormalities; a cutaneous neurovascular syndrome characterized by large, segmental hemangiomas of the head and neck along with congenital anomalies of the brain, heart, eyes and/or chest wall). A consensus conference was held on December 9, 2011. The multidisciplinary team reviewed existing data on the pharmacologic properties of propranolol and all published reports pertaining to the use of propranolol in pediatric patients. Workgroups were assigned specific topics to propose protocols on the following subjects: contraindications, special populations, pretreatment evaluation, dose escalation, and monitoring. Consensus protocols were recorded during the meeting and refined after the meeting. When appropriate, protocol clarifications and revision were made and agreed upon by the group via teleconference. Because of the absence of high-quality clinical research data, evidence-based recommendations are not possible at present. However, the team agreed on a number of recommendations that arose from a review of existing evidence, including when to treat complicated IH; contraindications and pretreatment evaluation protocols; propranolol use in PHACE syndrome; formulation, target dose, and frequency of propranolol; initiation of propranolol in infants; cardiovascular monitoring; ongoing monitoring; and prevention of hypoglycemia. Where there was considerable controversy, the more conservative approach was selected. We acknowledge that the recommendations are conservative in nature and anticipate that they will be revised as more data are made available.
Collapse
Affiliation(s)
| | | | - Sarah L. Chamlin
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Anita Haggstrom
- Departments of Dermatology and Pediatrics, Indiana University, Indianapolis, Indiana
| | - Nancy M. Bauman
- Department of Otolaryngology, Children’s National Medical Center, Washington, District of Columbia
| | | | | | | | | | | | | | - Anthony J. Mancini
- Departments of Pediatrics and Dermatology, Northwestern University, Chicago, Illinois
| | - Denise Metry
- Department of Dermatology, Baylor College of Medicine, Houston, Texas
| | | | - Marcia Seefeldt
- Department of Dermatology, Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Robert Sidbury
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Kendra M. Ward
- Department of Pediatrics, Northwestern University, Chicago, Illinois
| | - Francine Blei
- Departments of Hematology & Oncology, Vascular Birthmark Institute of New York, New York, New York
| | - Eulalia Baselga
- Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Laura Cassidy
- Biostatistics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - David H. Darrow
- Departments of Otolaryngology and Pediatrics, Eastern Virginia Medical School, Norfolk, Virginia; and
| | | | | | | | | | | | - Robert J. Boucek
- Departments of Pediatrics, and Cardiology, Seattle Children’s Hospital, Seattle, Washington
| | - Ilona J. Frieden
- Departments of Dermatology & Pediatrics, University of California San Francisco, San Francisco, California
| |
Collapse
|
70
|
Georgountzou A, Karavitakis E, Klimentopoulou A, Xaidara A, Kakourou T. Propranolol treatment for severe infantile hemangiomas: a single-centre 3-year experience. Acta Paediatr 2012; 101:e469-74. [PMID: 22804809 DOI: 10.1111/j.1651-2227.2012.02783.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM To evaluate the effectiveness, safety and tolerability of propranolol as single-agent treatment in patients with problematic, proliferative-phase, infantile hemangiomas (IHs). METHODS Oral propranolol was administered at a dose of 2 mg/kg/day to 28 children. Cardiologic evaluation was performed before treatment initiation. Hemodynamic variables and blood glucose levels were monitored during the first 24 h of treatment, while the children were hospitalized. Clinical response and tolerance were assessed every month, along with photographic documentation. Macroscopic regression was considered the reduction >90% in the size of the IHs. RESULTS Effects on colour and growth were observed within the first month in all cases. Twenty-four patients completed treatment after a mean duration of 7.56 months, and their hemangiomas were successfully regressed. Propranolol was administered again, with satisfactory results, in three patients (12.5%) because of hemangioma regrowth. Satisfactory response is noticeable in ongoing cases. Episodes of hypotension were noted in four patients. There were no treatment interruptions because of side effects. CONCLUSIONS Propranolol, as first-line treatment, yielded excellent results with very good clinical tolerance and also seems to be effective in relapses. The optimal duration of the treatment remains to be defined by long-term observation.
Collapse
Affiliation(s)
- Anastasia Georgountzou
- First Department of Paediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece.
| | | | | | | | | |
Collapse
|
71
|
|
72
|
Propranolol induces regression of hemangioma cells through HIF-1α-mediated inhibition of VEGF-A. Ann Surg 2012; 256:146-56. [PMID: 22580939 DOI: 10.1097/sla.0b013e318254ce7a] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the mechanism of propranolol on regression of infantile hemangiomas. BACKGROUND Propranolol has been found to be effective in treatment of severe hemangiomas of infancy. However, its mechanism of action is as yet unknown. METHODS Cultured proliferating and involuting hemangioma endothelial cells were treated with varying concentrations of propranolol for up to 4 days. Analysis was performed using cell viability, migration, and tubulogenesis assays, as well as quantitative RT-PCR and flow cytometry. Western blots and ELISA assays were used to assess protein expression. RESULTS Treatment with propranolol led to a dose dependent cytotoxic effect in hemangioma endothelial cells with decreased cell viability, migration, and tubulogenesis. This cytotoxic effect was VEGF (vascular endothelial growth factor) dependent, as demonstrated by decreased VEGF, VEGF-R1, and VEGF-R2 production. Decreased signaling through the VEGF pathway resulted in downregulation of PI3/Akt and p38/MAPK activity. Decreased VEGF activity was mediated through the hypoxia inducible factor (HIF)-1α pathway but not through NF-κβ signaling. CONCLUSIONS Collectively, these data suggest that propranolol exerts its suppressive effects on hemangiomas through the HIF-1α-VEGF-A angiogenesis axis, with effects mediated through the PI3/Akt and p38/MAPK pathways. These findings provide a plausible mechanism of action of propranolol on regression of infantile hemangiomas.
Collapse
|
73
|
Thompson PA, Chintagumpala M. Renal and hepatic tumors in the neonatal period. Semin Fetal Neonatal Med 2012; 17:216-221. [PMID: 22595862 DOI: 10.1016/j.siny.2012.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Renal and hepatic tumors in neonates are extremely rare. Nevertheless it is important for clinicians to be familiar with them. Both renal and hepatic neonatal tumors are heterogeneous collections of several tumor types. Some renal and hepatic tumors are benign and may require no interventions whereas others can be associated with significant morbidity and even mortality and may require multimodality treatment. Early diagnosis and initiation of the proper treatment plan is crucial for achieving the best outcomes for these rare tumors in this vulnerable population.
Collapse
Affiliation(s)
- Patrick A Thompson
- Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St. 1410.00, Houston, TX 77030, USA.
| | - Murali Chintagumpala
- Texas Children's Cancer Center, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St. 1410.00, Houston, TX 77030, USA
| |
Collapse
|
74
|
Multifocal infantile hepatic hemangiomas--imaging strategy and response to treatment after propranolol and steroids including review of the literature. Eur J Pediatr 2012; 171:1023-8. [PMID: 22234480 DOI: 10.1007/s00431-011-1671-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 12/24/2011] [Indexed: 02/07/2023]
Abstract
Infantile hepatic hemangioma is the most common benign liver tumor during infancy. Prompt diagnosis and timely institution of therapy are of utmost importance. Magnetic resonance imaging (MRI) plays a key role in the correct diagnosis and monitoring of treatment. We report on a 15-week-old girl with multifocal infantile hemangiomas of the liver and high output congestive heart failure. Diagnosis was confirmed by MRI. Subsequent treatment with propranolol and steroids showed dramatic regression of the lesions within 24 weeks. We present the characteristic MRI findings and discuss treatment options together with a comprehensive review of the relevant literature. Conclusion Propranolol appears highly efficacious in the management of infantile hepatic hemangioma; dedicated MRI is essential in confirming the diagnosis and monitoring of treatment.
Collapse
|
75
|
Madan N, Arnon R, Arnon R. Evaluation of cardiac manifestations in pediatric liver transplant candidates. Pediatr Transplant 2012; 16:318-28. [PMID: 22420530 DOI: 10.1111/j.1399-3046.2012.01667.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Knowledge concerning the involvement of the cardiovascular system in children awaiting liver transplant is limited. Therefore, no guidelines have been established on evaluating this group of patients for cardiac disease. This review examines the diverse cardiovascular manifestations of liver disease in children. We also discuss the available testing and its applicability in screening for cardiac disease in this vulnerable population.
Collapse
Affiliation(s)
- Nitin Madan
- Division of Pediatric Cardiology, Department of Pediatrics, Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
| | | | | |
Collapse
|
76
|
|
77
|
Balma-Mena A, Chakkittakandiyil A, Weinstein M, Lansang P, Ho N, Cammisuli S, Pope E. Propranolol in the Management of Infantile Hemangiomas: Clinical Response and Predictors. J Cutan Med Surg 2012; 16:169-73. [DOI: 10.1177/120347541201600306] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: Recent data suggest that propranolol is an effective treatment for infantile hemangiomas (IHs). Data on the optimal dose, duration of therapy, and predictors of response are currently lacking. Objective: To assess the clinical response to and predictors of propranolol use in the treatment of IH. Methods: Retrospective cohort study of 44 patients. Two independent assessors evaluated improvement by comparing serial digital photographs using a 100 mm visual analogue scale (VAS), where 5 mm change represented 10% change in the size or appearance of the IH. Results: Propranolol was started at a mean age of 7.8 (SD 8.21) months and was used for 7.3 (SD 4.8) months before weaning. The mean percent improvement compared to baseline (as measured by the VAS) was 78% (SD 23%). Minor adverse events were noted in 32% of patients. The most significant predictor of regrowth after weaning was a IH > 5 cm in size ( p = .017). Conclusions: Propranolol is effective in IH, but the side effects and the possibility of regrowth should be considered.
Collapse
Affiliation(s)
| | | | - Miriam Weinstein
- Pediatric Dermatology, The Hospital for Sick Children, Toronto, ON
| | - Perla Lansang
- Pediatric Dermatology, The Hospital for Sick Children, Toronto, ON
| | - Nhung Ho
- Pediatric Dermatology, The Hospital for Sick Children, Toronto, ON
| | | | - Elena Pope
- Department of Dermatology, Sunnybrook Hospital, Toronto, ON
| |
Collapse
|
78
|
Hsu TC, Wang JD, Chen CH, Chang TK, Wang TM, Chou CM, Lin HK. Treatment with propranolol for infantile hemangioma in 13 Taiwanese newborns and young infants. Pediatr Neonatol 2012; 53:125-32. [PMID: 22503260 DOI: 10.1016/j.pedneo.2012.01.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/22/2011] [Accepted: 08/19/2011] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Hemangioma in infants has a benign self-limited course, but the 10% of cases with complications need further treatment. Successful treatment with propranolol in western countries has been reported over the past few years. We evaluated the efficacy of propranolol for treating infantile hemangioma in Taiwanese newborns and young infants. METHODS Patients below 1 year of age treated with propanolol between November 2009 and March 2011 were enrolled. Demographic data, clinical features, imaging findings, treatment regimens of propranolol, and outcome were investigated. RESULTS Thirteen patients were treated with propranolol at a dose of 2-3 mg/kg/day. Seven (53.8%) patients had solitary hemangioma and six had multiple ones. The indications for treatment were risk of local event in nine patients, functional risk in four, local complication in one, and life-threatening complication in one. The median age for starting propranolol was 4 months (range: 1-11 months). Responses to propranolol, such as decolorization, regression in tumor size, or improvement of hemangioma-associated complications were observed in all patients within 1-2 weeks after treatment. Propranolol-associated adverse effects occurred in two patients. One infant had occasional tachypnea, and the other had occasional pale-looking appearance. The symptoms resolved after dosage tapering. CONCLUSION Propranolol may be a promising therapeutic modality for infantile hemangioma. Therapeutic strategies are needed to evaluate the optimal treatment protocol and long-term adverse effects.
Collapse
Affiliation(s)
- Teng-Chin Hsu
- Department of Pediatrics, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | | | | | | | | | | | | |
Collapse
|
79
|
Abstract
PURPOSE OF REVIEW To review and evaluate the medical literature on new treatments for periocular infantile (capillary) hemangioma. Recent studies have shown a promising new therapy for infantile hemangioma using nonselective β-blockers, including oral propranolol and topical timolol. RECENT FINDINGS Conventional treatments for infantile hemangioma include the use of corticosteroids, laser, surgery, and immunomodulator therapy. Recently, systemic and topical β-blockers have been used to successfully treat infantile hemangioma. The drugs' mechanism of action remains uncertain, but plausible theories include vasoconstriction, modulation of pro-survival signal transduction pathways, and endothelial cell apoptosis. Whereas no life-threatening adverse events from β-blocker treatment have been described, there have been reports of bradycardia, hypotension, bronchospasm, hypoglycemia, and electrolyte disturbances resulting from systemic use of propranolol to treat infantile hemangioma. Sleep and gastrointestinal disturbances have also been frequently reported. Topical timolol application for localized, superficial tumors may confer similar efficacy as oral propranolol while reducing systemic effects. SUMMARY Despite the recent explosion of interest surrounding this novel treatment, current treatment and protocol-monitoring recommendations are based largely on the experience of individual centers. Several randomized controlled studies are currently underway, the results of which will guide future standard-of-care treatment for infantile hemangioma.
Collapse
|
80
|
Menezes MD, McCarter R, Greene EA, Bauman NM. Status of propranolol for treatment of infantile hemangioma and description of a randomized clinical trial. Ann Otol Rhinol Laryngol 2011; 120:686-95. [PMID: 22097156 DOI: 10.1177/000348941112001010] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Our primary objective was to review the current use of propranolol for treatment of infantile hemangioma (IH), specifically regarding 1) the age at initiation of therapy, 2) the method of initiation, 3) the use of other adjuvant therapy, 4) the duration of therapy and relapse rate, 5) the adverse events, and 6) the outcome. Our secondary objective was to describe a randomized, controlled, single-blinded trial comparing propranolol to prednisolone for treatment of IH. METHODS Ovid Medline and PubMed searches were completed for the MeSH keywords "propranolol" and "hemangioma." Forty-nine English-language articles were published between June 2008 and September 2010, and 28 of these reported data from a total of 213 patients. Only 6 studies treated more than 10 patients, and these were selected for review in detail (154 patients). RESULTS The treatment was initiated during infancy in 92.9% of patients (mean, 4.5 months). Sixty-five percent of patients were treated with 2 mg/kg per day, and 25.3% with 3 mg/kg per day. Patients were monitored overnight at initiation of treatment in 3 series (59 patients), for 4 to 6 hours as outpatients in 2 series (62 patients), and initially as inpatients but later as outpatients in 1 series (32 patients). Propranolol was used as sole therapy in about two thirds of patients (103 patients). Treatment was ongoing in 46% of patients at the time of publication. The average treatment duration in the remaining patients was 5.1 months. Rebound growth occurred in 21% of patients after a mean of 4.3 months of therapy. Adverse events occurred in 18.1% of patients and included hypotension in 6, somnolence in 6, wheezing in 4, insomnia, agitation, and/or nightmares in 6, cool hands or night sweats in 2, gastroesophageal reflux in 3, and psoriasis-like rash in 1. All authors reported a favorable outcome with propranolol, but the definition of efficacy was not standardized. CONCLUSIONS Propranolol is an attractive alternative to other treatments for IH. Despite apparent widespread use of this medication, the data are limited, and prospective studies are lacking for this indication. The relatively high rate of adverse effects supports the need for careful monitoring of patients on this therapy. Fastidious reporting of adverse events and objective evaluation of early and late outcomes are necessary to improve our understanding of the use of propranolol for this indication.
Collapse
|
81
|
Critical infantile hepatic hemangioma: results of a nationwide survey by the Japanese Infantile Hepatic Hemangioma Study Group. J Pediatr Surg 2011; 46:2239-43. [PMID: 22152857 DOI: 10.1016/j.jpedsurg.2011.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 09/03/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The current survey aimed to describe the clinical features of critical infantile hepatic hemangioma (IHH) and the implications of recent treatments. MATERIALS AND METHODS A nationwide survey of critical IHH patients treated between 2005 and 2010 was performed in all 117 registered pediatric surgical hospitals in Japan. As a result, 19 patients were identified and reviewed using a statistical analysis. RESULTS Abdominal distention (47.4%), high-output cardiac failure (47.4%), coagulopathy (42.1%), and respiratory distress (31.6%) were the major symptoms. Three patients died (1 of coagulopathy, 1 of cardiac failure, and 1 of both). An accompanying portovenous shunt was also highlighted. Infantile hepatic hemangioma was totally insensitive to steroid treatment in 3 (23.1%) of the 13 patients, and 9 (47.4%) of the 19 patients required other treatments. Surgical resection and β-blocker improved the hematologic data, whereas hepatic arterial ligation and embolization seemed to produce a limited effect. Among the dead patients, several hematologic parameters were significantly worse: the thrombocyte count (pretherapeutic: 73,000 vs 300,000/mm(3), dead vs survivor, respectively [P < .03]; posttherapeutic: 66,000 vs 388,700/mm(3) [P < .003]) and the prothrombin time (posttherapeutic, 35.0 vs 12.1 seconds [P < .0001], dead vs survivor, respectively). CONCLUSION For critical IHH cases with steroid-insensitive hematologic disorders, alternative treatments including β-blocker therapy, surgery, and liver transplantation should be considered.
Collapse
|
82
|
Successful first-line treatment with propranolol of multifocal infantile hepatic hemangioma with high-flow cardiac overload. J Pediatr Gastroenterol Nutr 2011; 53:693-5. [PMID: 21519284 DOI: 10.1097/mpg.0b013e3182201a4e] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
|
83
|
Sánchez-Carpintero I, Ruiz-Rodriguez R, López-Gutiérrez J. Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2012.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
84
|
Sánchez-Carpintero I, Ruiz-Rodriguez R, López-Gutiérrez J. Propranolol en hemangiomas infantiles: eficacia clínica, riesgos y recomendaciones. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:766-79. [DOI: 10.1016/j.ad.2011.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 04/10/2011] [Accepted: 05/11/2011] [Indexed: 12/16/2022] Open
|
85
|
Maruani A, Piram M, Sirinelli D, Herbreteau D, Saliba E, Machet MC, Lorette G. Visceral and mucosal involvement in neonatal haemangiomatosis. J Eur Acad Dermatol Venereol 2011; 26:1285-90. [PMID: 22044599 DOI: 10.1111/j.1468-3083.2011.04285.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Two types of neonatal haemangiomatosis (NH) are distinguished: diffuse which is associated with a high rate of mortality linked to mucosal/visceral involvement, and benign. OBJECTIVES First, this study aimed to examine the frequency of mucosal and visceral (especially hepatic) involvement in NH, according to skin extension, and second, it aimed to examine clinical, pathological (with glucose transporter 1 (GLUT-1) immunostaining), and imaging features of NH, including follow-up data. METHODS This was a descriptive retrospective study carried out in the University Hospital Center of Tours, France. RESULTS The study included 19 patients with cutaneous NH (number of skin haemangiomas ranging from 5 to >100). Mucosal involvement was observed in 32% of all cases (100% and 19% in diffuse and other cutaneous cases respectively) and hepatic involvement in 42% (67% and 38% respectively). The number of hepatic haemangiomas ranged from 1 to >10. Half of the hepatic haemangiomas cases exhibited increased hepatic arterial blood flow. CONCLUSIONS Mucosal and hepatic involvement was frequent in cases with a high number of cutaneous haemangiomas (>100), but only frequency of mucosal involvement was statistically significant (P = 0.021).
Collapse
Affiliation(s)
- A Maruani
- University Francois Rabelais, Tours, France.
| | | | | | | | | | | | | |
Collapse
|
86
|
Rössler J, Schill T, Bähr A, Truckenmüller W, Noellke P, Niemeyer CM. Propranolol for proliferating infantile haemangioma is superior to corticosteroid therapy--a retrospective, single centre study. J Eur Acad Dermatol Venereol 2011; 26:1173-5. [PMID: 22035186 DOI: 10.1111/j.1468-3083.2011.04314.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
87
|
Hämangiome. Monatsschr Kinderheilkd 2011. [DOI: 10.1007/s00112-011-2428-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
|
88
|
Hogeling M, Adams S, Wargon O. A randomized controlled trial of propranolol for infantile hemangiomas. Pediatrics 2011; 128:e259-66. [PMID: 21788220 DOI: 10.1542/peds.2010-0029] [Citation(s) in RCA: 212] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE Propranolol hydrochloride is a safe and effective medication for treating infantile hemangiomas (IHs), with decreases in IH volume, color, and elevation. METHODS Forty children between the ages of 9 weeks and 5 years with facial IHs or IHs in sites with the potential for disfigurement were randomly assigned to receive propranolol or placebo oral solution 2 mg/kg per day divided 3 times daily for 6 months. Baseline electrocardiogram, echocardiogram, and laboratory evaluations were performed. Monitoring of heart rate, blood pressure, and blood glucose was performed at each visit. Children younger than 6 months were admitted to the hospital for monitoring after their first dose at weeks 1 and 2. Efficacy was assessed by performing blinded volume measurements at weeks 0, 4, 8, 12, 16, 20, and 24 and blinded investigator scoring of photographs at weeks 0, 12, and 24. RESULTS IH growth stopped by week 4 in the propranolol group. Significant differences in the percent change in volume were seen between groups, with the largest difference at week 12. Significant decrease in IH redness and elevation occurred in the propranolol group at weeks 12 and 24 (P = .01 and .001, respectively). No significant hypoglycemia, hypotension, or bradycardia occurred. One child discontinued the study because of an upper respiratory tract infection. Other adverse events included bronchiolitis, gastroenteritis, streptococcal infection, cool extremities, dental caries, and sleep disturbance. CONCLUSION Propranolol hydrochloride administered orally at 2 mg/kg per day reduced the volume, color, and elevation of focal and segmental IH in infants younger than 6 months and children up to 5 years of age.
Collapse
Affiliation(s)
- Marcia Hogeling
- Department Pediatric Dermatology, Sydney Children's Hospital, Randwick, New South Wales 2031, Australia.
| | | | | |
Collapse
|
89
|
Blatt J, Morrell DS, Buck S, Zdanski C, Gold S, Stavas J, Powell C, Burkhart CN. β-blockers for infantile hemangiomas: a single-institution experience. Clin Pediatr (Phila) 2011; 50:757-63. [PMID: 21525081 DOI: 10.1177/0009922811405517] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Propranolol has become first-line therapy for the treatment of infantile hemangiomas in many centers. Of 302 children with hemangiomas seen at the University of North Carolina from 2008 through 2010, 15.6% were treated with oral propranolol alone, 5.6% with topical timolol (a propranolol derivative) alone, and 2.3% with both. The use of these agents increased over time from 7% of patients seen in 2008 to 54% of patients first seen in 2010. Starting doses of propranolol ranged from 0.25 to 1 mg/kg/d, with target doses of 1 to 4 mg/kg/d. Serious side effects, noted in 6/54 (10.9%) patients, included somnolence, bradycardia, hypotension, hypoglycemia, and mottling of extremities.The authors confirm the variation in use of propranolol for vascular lesions and extend experience with timolol. They suggest daily home monitoring of patients for the first 2 weeks of initiating or increasing doses. Frequent feeding of infants and young children on this drug is recommended.
Collapse
Affiliation(s)
- Julie Blatt
- University of North Carolina School of Medicine and the University of North Carolina School of Medicine Vascular Anomalies Clinic, Chapel Hill, NC, USA.
| | | | | | | | | | | | | | | |
Collapse
|
90
|
Subtotal splenic embolization is a safe and effective treatment for isolated splenic vascular tumors associated with consumptive coagulopathy. J Pediatr Hematol Oncol 2011; 33:383-6. [PMID: 21606851 PMCID: PMC3120923 DOI: 10.1097/mph.0b013e3182172515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Consumptive coagulopathy is a known complication of large vascular tumors. We describe 2 episodes of consumptive coagulopathy in young children, which were secondary to isolated splenic vascular tumors. One child was successfully treated by subtotal embolization of the spleen, whereas the second child required splenectomy after an initial embolization improved--but did not fully control--his consumptive coagulopathy.
Collapse
|
91
|
Léauté-Labrèze C, Prey S, Ezzedine K. Infantile haemangioma: part II. Risks, complications and treatment. J Eur Acad Dermatol Venereol 2011; 25:1254-60. [PMID: 21569113 DOI: 10.1111/j.1468-3083.2011.04105.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Because of their spontaneous involution, most infantile haemangiomas (IH) do not require therapeutic intervention. However, in 10 to 15% of cases such as segmental and multifocal IH, locations in the periocular, airway and perineal areas, or complications of ulceration, treatment is necessary. Moreover, the risk of permanent scarring and disfigurement associated with IH, even if involution is complete, has been increasingly recognized as a rationale for treatment. Treatments for IH currently include topical, intralesional, systemic therapies, laser and surgical modalities depending on the clinical scenario. However, clinicians must carefully weigh the risks and benefits for each treatment. Recently, the efficacy of propranolol, a non-cardioselective beta-blocker, was reported and has been revolutionary in the management of IH.
Collapse
Affiliation(s)
- C Léauté-Labrèze
- Unité de Dermatologie Pédiatrique et Centre de Référence des Maladies Rares de la Peau, CHU de Bordeaux, Hôpital Pellegrin-Enfants, and Université de Bordeaux, Biothérapies des Maladies Génétiques et Cancers, Bordeaux, France.
| | | | | |
Collapse
|
92
|
Abstract
Management of pediatric liver tumors has significantly improved over the last 2 decades. The management options for hepatocelluar carcinoma (HCC) are not well defined. In the pediatric context, the main clinical aims are to reduce chemotherapy toxicity (predominantly ototoxicity and nephrotoxicity) in children treated for hepatoblastoma and to investigate additional modes of treatment for HCC. An increasing number of children develop HCC in the background of chronic liver disease, and screening methods need to be better observed.
Collapse
Affiliation(s)
- Nedim Hadzic
- King's College Hospital Denmark Hill, London SE5 9RS, UK.
| | | |
Collapse
|
93
|
Horii KA, Drolet BA, Frieden IJ, Baselga E, Chamlin SL, Haggstrom AN, Holland KE, Mancini AJ, McCuaig CC, Metry DW, Morel KD, Newell BD, Nopper AJ, Powell J, Garzon MC. Prospective study of the frequency of hepatic hemangiomas in infants with multiple cutaneous infantile hemangiomas. Pediatr Dermatol 2011; 28:245-53. [PMID: 21517952 DOI: 10.1111/j.1525-1470.2011.01420.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Multiple cutaneous infantile hemangiomas have been associated with hepatic hemangiomas. Screening of infants with five or more cutaneous infantile hemangiomas with abdominal ultrasound is often recommended. The aim of this study was to determine the frequency with which hepatic hemangiomas occur in infants with five or more cutaneous infantile hemangiomas compared to those with one to four cutaneous infantile hemangiomas and to characterize the clinical features of these hepatic hemangiomas. A multicenter prospective study of children with cutaneous infantile hemangiomas was conducted at pediatric dermatology clinics at Hemangioma Investigator Groups sites in the United States, Canada, and Spain between October 2005 and December 2008. Data were collected, and abdominal ultrasonography was performed on infants younger than 6 months old with five or more cutaneous infantile hemangiomas and those with one to four cutaneous infantile hemangiomas. Twenty-four (16%) of the 151 infants with five or more cutaneous infantile hemangiomas had hepatic hemangiomas identified on abdominal ultrasound, versus none of the infants with fewer than five (p = 0.003). Two of the 24 infants with hepatic hemangiomas received treatment specifically for their hepatic hemangiomas. Infants with five or more cutaneous infantile hemangiomas have a statistically significantly greater frequency of hepatic hemangiomas than those with fewer than 5. These findings support the recommendation of five or more cutaneous infantile hemangiomas as a threshold for screening infants younger than 6 months old for hepatic hemangiomas but also demonstrate that the large majority of these infants with hepatic hemangiomas do not require treatment.
Collapse
Affiliation(s)
- Kimberly A Horii
- Section of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
94
|
Yeh I, Bruckner AL, Sanchez R, Jeng MR, Newell BD, Frieden IJ. Diffuse infantile hepatic hemangiomas: a report of four cases successfully managed with medical therapy. Pediatr Dermatol 2011; 28:267-75. [PMID: 21517953 DOI: 10.1111/j.1525-1470.2011.01421.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
We report four cases of diffuse infantile hepatic hemangioma, a rare but potentially life-threatening subset of hepatic hemangiomas. All patients demonstrated distinctive dome-shaped red-purple cutaneous hemangiomas. Two patients responded to steroids and propranolol (one in combination with vincristine), and two responded to steroids and vincristine. After a systematic literature review, we identified 26 previously reported cases of diffuse infantile hepatic hemangioma. Diffuse infantile hepatic hemangioma had a mortality rate of 17% and a >70% incidence of hypothyroidism, often severe (n = 30). More than one-third of patients developed heart failure (high output in half the cases). Based on our experience, early aggressive medical management, as well as thyroid replacement when indicated, should be initiated early in the course of diffuse infantile hepatic hemangioma pending evaluation for liver transplant.
Collapse
Affiliation(s)
- Iwei Yeh
- Department of Pathology, University of California San Francisco, San Francisco, California, USA.
| | | | | | | | | | | |
Collapse
|
95
|
Boralevi F. [What's new in paediatric dermatology?]. Ann Dermatol Venereol 2011; 137 Suppl 4:S145-57. [PMID: 21193118 DOI: 10.1016/s0151-9638(10)70041-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This paper summarizes a review of the medical literature focused on the field of pediatric dermatology from December 2009 to November 2010. Our objective was to select the papers published in the main journals of dermatology, internal medicine, pediatrics, infectious diseases and allergy that bring new information and significant advances concerning skin diseases in children. Recent advances in the field of infantile hemangiomas and atopic dermatitis are particularly detailed. This review also covers the main the following topics: psoriasis, Kawasaki disease, head lice and warts management, lichen, rare diseases such as epidermolyses bullosae.
Collapse
Affiliation(s)
- F Boralevi
- Unité de dermatologie pédiatrique, Hôpital Pellegrin-enfant, Place Amélie Raba-Léon, 33076 Bordeaux cedex, France.
| |
Collapse
|
96
|
Mhanna A, Franklin WH, Mancini AJ. Hepatic infantile hemangiomas treated with oral propranolol--a case series. Pediatr Dermatol 2011; 28:39-45. [PMID: 21261702 DOI: 10.1111/j.1525-1470.2010.01355.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hepatic infantile hemangiomas may be associated with morbidity and mortality, and traditional therapies may be associated with significant side effects. Since propranolol has been recently used successfully to treat cutaneous infantile hemangiomas, we decided to use it in three patients who presented with hepatic and skin hemangiomatosis. Three patients with skin and hepatic infantile hemangiomas, two of whom had evidence of cardiovascular compromise and one of whom had extensive liver involvement and hypothyroidism, were treated with oral propranolol. Regression of both skin and hepatic hemangiomas was noted in all patients, as was resolution of the cardiac symptoms and decreased thyroid requirement in two patients each. Propranolol was well tolerated without any adverse effects. Propranolol should be considered as a potential first-line therapy in patients with symptomatic hepatic hemangiomatosis.
Collapse
Affiliation(s)
- Amal Mhanna
- Department of Pediatrics, Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | |
Collapse
|
97
|
Blei F. Literature Watch. Lymphat Res Biol 2010. [DOI: 10.1089/lrb.2010.8402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
98
|
Fay A, Nguyen J, Waner M. Conceptual approach to the management of infantile hemangiomas. J Pediatr 2010; 157:881-8.e1-5. [PMID: 20884010 DOI: 10.1016/j.jpeds.2010.08.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Revised: 06/30/2010] [Accepted: 08/12/2010] [Indexed: 11/29/2022]
Affiliation(s)
- Aaron Fay
- Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.
| | | | | |
Collapse
|