Propranolol and infantile hemangiomas: Outcome from a tricentric study.

INTRODUCTION: The introduction of propranolol as systemic therapy for infantile hemangiomas (IH) has changed the natural history of these tumors. Cases presenting with ulceration, functional limitation, and visceral or life-threatening localization are excellent indications to medical therapy. The aim was to report the medium term follow-up after the introduction of propranolol in 3 referral centers with particular attention to outcome and surgical treatments. MATERIALS AND METHODS: In the period 2011-2018 348 patients underwent systemic therapy with propanolol at a mean age of 3.5 months (range 1-10). The indications to begin the treatment were: visceral localization (10,6%), ulceration (20%), risk of severe esthetic impairment (27%), and peri­orifices localization (42.4%). RESULTS: The minimum follow-up was 1 year. Propranolol was administered for a mean of 11 months (range: 6-19) and in 22 cases it was resumed for extra 4.5 months due to rebound. Overall, 97.4% responded to therapy without severe side effects. Seven patients underwent surgery and 9 laser therapy . Twenty-four cases are scheduled for surgery for evident inesthetisms and 4 will undergo laser therapy to complete the treatment. CONCLUSIONS: The use of propranolol has considerably decreased the surgical indications for IH, improved the esthetic and functional outcome, and simplified the definitive surgical treatment. The response rate to therapy is very high and in case of failure both laser and surgery are still very effective. The correct diagnosis, early starting, and adequate duration of therapy are key factors for the success of treatment.

[Acute abdomen in children: a continuous challenge. Two cases report: Meckel's diverticulum with small bowel volvolus and internal herniation related to epiploic appendagitis mimicking acute appendicitis]. / Addome acuto in età pediatrica: una sfida continua. Due casi clinici: volvolo intestinale su residue del dotto onfalo mesenterico e strangolamento ileale su appendice epiploica cecale.

Acute abdomen is a continuous clinical challenge in pediatric age. The aim of our study is to describe two pediatric rare cases: the first case is a small bowel volvolus related to Meckel's diverticulum confused with an intestinal intussusception; the second an internal herniation related to epiploic appendagitis with intestinal obstruction mimic acute appendicitis in two years old children. We review the current literature.

Iatrogenic traumas by nasogastric tube in very premature infants: our cases and literature review.

OBJECTIVE: The nasogastric tube is the chosen nutritional technique in premature infants. However, it is not without complications. The aim of this study is to compare our experience in iatrogenic complications caused by nasogastric tube (especially in very low birth weight infants) to a review of the most recent literature. METHODS: From january to december of 2008, in the Department of Neonatal Pathology at the Hospital of Treviso, 118 premature patients were treated. 110 of them had a body weight less than 1,500gr: serious complications caused by nasogastric tube occurred in two of these very low birth weight infants. The first case relates an injury of the esophagus, while the second case is about a perforation of the posterior wall of the stomach, left lobe of the liver and the spleen hilus. RESULTS: The surgical treatment was limited to the second case ending in splenectomy and repair of the posterior gastric wall and liver lobe. DISCUSSION AND CONCLUSIONS: Among all the iatrogenic injuries described in the literature, this last case is the most serious. It is important to verify always the position of the gastric tube and to doubt for a dislocation in any case of deviation of the tube from the normal course. In those cases in which a patient suddenly goes from a full well-being to a critical state without a precise contingent cause it is imperative to check the nasogastric tube place. In addition those cases have guided us to change our habits for managing these critical patients: we are then oriented toward the usage of silastic gastric probes, which are softer, less dangerous for ulcer damages, and long term replaceable, thus reducing the possibility of a iatrogenic injury.

[Foreign body ingestion: a common problem in paediatric age]. / L'ingestione di corpi estranei in età pediatrica: una costante realtà.

Foreign body (F.B.) ingestion occurs very frequently in paediatric age. The kind of ingested foreign bodies depends on the patient's age. Children between 1 and 3 years of age mostly swallow coins, toy parts, stones and small batteries; instead, older children typically ingest boluses of meat. The aim of this study is to review our case histories according to the latest literature, focusing on some events that needed a therapeutic emergency treatment.