Infantile Sacral Region Hemangioma and Combination Treatment with Propranolol and Topical Timolol: Case Review and Reference Review.

BACKGROUND: Infantile hemangiomas (IH) are the most common vascular, benign tumors of childhood with a prevalence of 4-5%. Due to intense vasculogenesis, they proliferate during infancy, then involute at an unpredictable rate, extent of involution, and quality of residual tissue. Depending on the location, they may be associated with anomalies of other organ systems (PHACE, PELVIS syndroms). In recent decades, knowledge about hemangiomas has improved, and therefore therapeutic possibilities have improved. Today, the non-selective beta blocker-propranolol is considered the drug of first choice in the treatment of infantile hemangiomas. It is desirable to start treatment in the proliferative phase of hemangioma growth for the best possible effect. The dynamics of drug administration, time interval of dose increase and monitoring of patients during treatment vary from one Institution to another and are still the subject of discussion. OBJECTIVE: We presented the case of a child with infantile hemangioma of the lumbo-sacral region, treated with combination therapy with systemic propranolol and topical timolol, with satisfactory effect in the end. CONCLUSION: Propranolol is considered a drug with well-studied side effects and a safety profile. During 6 months of treatment, it leads to complete or almost complete withdrawal of the hemangioma. Treatment should be started in the hemangioma proliferation phase for the best possible therapeutic effect.

Therapeutic Modalities in the Treatment of Persistent Ductus Arteriosus in Premature Babies: Report of Two Cases.

BACKGROUND: Persistent Ductus Arteriosus (PDA) is a vascular structure that connects the pulmonary artery and the descending aorta. It plays an important role in the fetal blood flow pattern. OBJECTIVE: The aim of this paper is to present two cases from Neonatology of Cantonal hospital in Bihac, with hemodynamically significant ductus, different "timing" of treatment and different therapeutic options. RESULTS AND DISCUSSION: The ductus closes functionally within the first 72 to 96 hours after the birth. Its anatomical closure follows in the next 14 days. If it remains open after the third month of life, it is treated as a congenital heart anomaly with a left-right shunt. Approximately 10% of all congenital heart defects are PDA with an incidence of 2-4 per 1000 live births. It has been clinically proven that PDA is present in 45% of premature babies with a birth weight of less than 1750 g and in about 80% of premature babies with a birth weight below 1200 g. As criteria for the application of drug therapy (in this case we use Paracetamol) for ductal closure, we took into account clinical parameters and echo parameters that indicated that it was a hemodynamically significant ductal shunt. Prerequisites for treatment were normal liver function confirmed by laboratory tests, normal platelet count, no intracranial hemorrhage, normal gastrointestinal function, normal coagulation parameters, normal renal function, calm parameters of inflammation. CONCLUSION: The diagnosis of PDA in the early, asymptomatic phase, in premature babies, is made by early echocardiographic examination. The decision on treatment should be based on clinical and echocardiographic criteria. Paracetamol is an alternative in the treatment of this cardiac problem of premature infants and could be more effective if used in early, presymptomatic phase.

Implementation of Congenital Heart Diseases Screening at the Bihac Cantonal Hospital.

INTRODUCTION: Congenital heart defects (CHD) were the most common birth defects, and the most common cause of death in infants with congenital anomalies in developed countries. Early detection of these anomalies would greatly enhance the effect of therapeutic procedures and the final outcome. Lately, pulse oximetry (PO) is used for the purpose of screening the cyanotic congenital heart defects. PO in combination with the clinical examination has greater diagnostic sensitivity in detection of CHD. OBJECTIVE: Application of PO screening in combination with a novel clinical examination methodology of cardiovascular system in neonate towards earlier detection of CHD. PATIENTS AND METHODS: Study included newborn children in Bihac Cantonal Hospital in the year 2012. The sample included 1,865 children. A total of 29 children with congenital heart disease was diagnosed during the neonatal period. CONCLUSION: Modern algorithm for early detection can significantly improve the diagnosis of congenital heart anomalies. Early detection allows optimal care for these children. This concept is simple, inexpensive and reproducible in most maternity wards.

Modern Strategy for Identification of Congenital Heart Defects in the Neonatal Period.

INTRODUCTION: Congenital heart defects are the most common congenital anomalies and occur with an incidence from 0.8 to 1% per 1000 live births. In recent years, the pulse oximetry has become a strong candidate for detecting cyanogen congenital heart defects and in combination with routine clinical exam can improve diagnostic of congenital heart diseases. OBJECTIVE: To apply the modern algorithm for early detection of congenital heart defects in order to improve the diagnosis in the neonatal period. PATIENTS AND METHODS: This was a prospective study that included children born in Bihac Cantonal Hospital during 2012. The diagnostic algorithm included a clinical examination of the newborn, measuring of transcutaneous oxygen saturation with the pulse oximeter between 24 and 48 hours of life, and, in some cases, additional tests (cardiac ultrasound). RESULTS: A total of 1,865 children were examined. The application of diagnostic protocol identified the existence of congenital heart defects in 29 children. In re-evaluating the auscultator and ultrasound findings, we identified congenital heart defects in 19 children. CONCLUSION: The application of the modern algorithm for early detection of congenital heart diseases in the neonatal period can significantly improve the making of diagnosis of these anomalies. The concept is simple, inexpensive and applicable in most maternity wards.

Leopard syndrome: a report of five cases from one family in two generations.

UNLABELLED: This is the first reported family with Leopard syndrome (LS) from Bosnia and Herzegovina. We report five cases of LS from two generations of the same family. In the present series of patients from one family, all patients carry the same recurrent mutation Y279C in the PTPN11 gene, exhibiting different phenotypes and a variable expression of multiple lentigines. The diagnosis may be on clinical basis as the diagnostic clues of LS are: multiple lentigines and cafè-au-lait-spots, short stature, distinctive face, congenital heart disease, conduction abnormalities, abnormal genitalia, and sensorineural deafness. CONCLUSION: the clinical diagnosis of LS should be molecularly confirmed in the patient.

The importance of heart murmur in the neonatal period and justification of echocardiographic review.

INTRODUCTION: Heart murmurs can be functional (innocent) and pathological (organic). Although it is not considered a major sign of heart disease, it may be a sign of a serious heart defect. In most cases the noise is initiation for cardiac treatment. Is it possible to differentiate on the basis of auscultation innocent from pathological heart murmur? In this article we present the results of ultrasonography of newborns with positive auscultation finding of the heart in the neonatal and early infancy period. GOAL: To determine the role of murmurs in the heart detected by routine clinical examination in the neonatal period and early infancy, and to establish the legitimacy of cardiology consultation and ultrasound of the heart. METHODS: A retrospective review of medical records in the period from January 1 to December 31, 2011 at the Maternity ward of Cantonal Hospital in Bihac 1899 children was born. In 32 neonates was registered a heart murmur, in the period from birth up to 6 weeks of life. All children with positive auscultation finding of the heart were examined echocardiography by ultrasound ALOCA 2000, multifrequency probe from 3.5 to 5 MHz, and used M-mode, 2-D, continuous, pulsed and color Doppler. RESULTS: Of the 32 examined children regular echocardiographic findings had two children (6.25%), aberrant bunch of left ventricle 11 (34.37%), patent foramen ovale 5 (15.62%), atrial septal defect 3 children (9.37%), ventricular septal defect 8 children (25%), cyanogen anomaly 2 children (6.25%), stenosis of the pulmonary artery 1 child (3.12%). We see that 14 children (43.75%) had a structural abnormality of the heart that requires further treatment and monitoring. CONCLUSION: Echocardiography is necessary to set up or refute the diagnosis of structural heart defect in children with positive auscultation finding in the neonatal period.

Penile duplication in newborn with multiple anomalies.

We present a case of male, premature born child with multiple anomalies. The physical status was dominated by penile duplication, with additional, abortion scrotum in the median line, without palpable content and omphalocele with semi septum of the anus. By ultrasound examination of internal organs, we found a complex congenital heart anomaly, multiple anomalies in abdomen and micro calcifications in the central nervous system. General condition of the child required a prolonged mechanical ventilation and intensive care, so with clinical picture of liver failure at the age of 45 days occurred fetal outcome.