Oral Atenolol versus Propranolol in the Treatment of Infantile Hemangioma: A Systematic Review and Meta-Analysis.

Background: Infantile hemangioma (IH) is the most common benign vascular tumor of infancy. Propranolol is considered first-line therapy for IH. However, it is associated with side effects. Therefore, there was a need for alternative therapy. Atenolol, a selective b1-blocker may be free from such side effects. Hence, the present study aims to develop a more accurate estimate of the safety and efficacy of atenolol compared to propranolol in the treatment of IH. Methodology: A search of various literature databases (PubMed, Embase, Ovid, Scopus, Cochrane Central, CINAHL, Web of Science, and Google Scholar) was done to identify studies which compared propranolol versus atenolol in the treatment of IH. The combined odds ratio along with corresponding 95% confidence intervals (CIs) were evaluated using a fixed-effects model. Results: A total of 300 articles were screened of which five studies including 116 patients in atenolol arm and 138 patients in the propranolol arm were analyzed. Atenolol was comparable to propranolol in terms of efficacy as no significant difference was seen between both the treatment arms in terms of hemangioma activity score (mean difference 0.25 [95% CI;‒0.21, 0.71]) and complete response (odds ratio [OR] =0.43; 95% CI; 0.17, 1.11; P = 0.08,). Atenolol therapy was better than propranolol in terms of safety, i.e., serious/potentially serious side effect, (OR = 0.11; 95% CI; 0.02, 0.51; P = 0.005) and wheezing/bronchial hyperreactivity (OR = 0.11; 95% CI; 0.02, 0.51; P = 0.005). Conclusion: The present meta-analysis provides evidence that atenolol has got a comparable efficacy and better safety profile with propranolol.

A Fix for a Scalp Varix! A Rare Case of Cirsoid Aneurysm in a Child.

Cirsoid aneurysm (CA) is a rare arteriovenous fistula of the scalp. There exists scant literature on the incidence and approach to CA in children. We describe a case of CA in a 7-year-old boy which was diagnosed by angiography and managed with angiographic embolization followed by surgical excision.

Extrapulmonary Pleuropulmonary Blastoma in a 3-Year-Old Child: A Case Report and Review of Literature.

Pleuropulmonary blastomas (PPBs) are very rare, highly aggressive, dysembryonic neoplasms of thoracopulmonary mesenchyme. These have been reported in the pediatric population and account for only 0.5%-1% of all primary malignant lung cancers. They normally arise from lung tissue, however rarely the parietal pleura may be the tissue of origin (extra pulmonary PPB) which are extremely rare. Common age of presentation is three to 4 years. The prognosis is poor with distant metastasis to central nervous system and bone with survival rate of approximately 42.9% at 5 years. They are managed by aggressive multimodal therapies including surgery and chemotherapy. We report a case of a 3-year-old male child with Type 2 PPB of the left hemithorax, managed by surgical excision of the mass and adjuvant chemotherapy.

Evaluation of various anthropometric airway parameters as predictors of difficult airway in neonates: A prospective observational study.

OBJECTIVE: To determine the relationship between various anthropometric parameters (age, weight, neck circumference, head circumference, thyromental distance, sternomental distance, frontal plane to chin distance, and frontal plane to chin distance by weight ratio) in neonates with difficult laryngoscopy and difficult intubation. DESIGN: A Prospective, double-blind, observational study. SETTING: Conducted in a Tertiary care Hospital in India. The study was conducted over a period of one year. PATIENTS: Participants included 100 neonates undergoing either elective or emergency non-cardiac surgery under general anesthesia. INTERVENTIONS: The various anthropometric parameters were correlated with Difficult laryngoscopy (Cormack Lehane grading III, IV) and Difficult intubation (Intubation Difficulty score>5). MEASUREMENTS: Difficult laryngoscopy (Cormack lehane grade III, IV) and Difficult intubation (Intubation Difficulty score >5). MAIN RESULTS: We found a statistically significant difference between weight (2.5 (2.2-2.8) kg vs 1.9 (1.55-2.35) kg), (p = 0.006), TMD (3.03 (2.74-3.46) cm vs 2.70 (2.45-3.13) cm), (p = 0.029), SMD (5.18 (5.06-5.76) cm vs 5.02 (4.84-5.29) cm), (p = 0.020) and FPCD/Wt ratio (0.31 (0.27-0.36) vs 0.44 (0.37-0.44)) with p = 0.001 in neonates with Easy and Difficult laryngoscopy. Using ROC curve analysis we calculated AUC, optimal cut off value, sensitivity, specificity, PPV and NPV for weight, TMD, SMD and FPCD/Wt ratio and found FPCD/Wt ratio to be best predictor for difficult laryngoscopy with highest AUC (0.844), high sensitivity (77.78%) and NPV (97.44%). CONCLUSIONS: No single parameter can provide a high index of sensitivity and specificity to predict difficult airway in neonates. Therefore, a combination of tests, including Weight, TMD, SMD, and FPCD/Wt ratio, should be used. To the best of our knowledge, this is the first prospective study to assess predictors to the difficult airway in neonates.

Intraoperative Dilemmas in Polyorchidism: To Pex or not to Pex!!

Supernumerary testis or polyorchidism is a rare congenital anomaly. It is often associated with processus vaginalis anomalies and with increased risk of malignancy and infertility. The approach to management has changed over time, with improvements in imaging techniques allowing surveillance to replace surgical excision or exploration and biopsy. In this study, two patients were managed with orchidopexy and have had a close follow-up of 2 years.

Ventilation Failure due to Endotracheal Tube Migration Into a Tracheal Pouch in a Toddler With a Repaired Tracheoesophageal Fistula: A Case Report.

A tracheal pouch is a rare complication of successful repair of a congenital tracheoesophageal fistula (TEF). An 18-month-old child with a repaired congenital TEF was scheduled for esophageal dilation to treat his esophageal stricture. Migration of the distal end of the endotracheal tube into a previously undetected tracheal pouch caused an abrupt failure to ventilate at the end of surgery. Given our experience, we recommend to screen the trachea of every patient with corrected TEF for a tracheal pouch when they are scheduled for another procedure requiring general anesthesia.

Effect of propranolol vs prednisolone vs propranolol with prednisolone in the management of infantile hemangioma: a randomized controlled study.

AIMS AND OBJECTIVES: The purpose of this study was to compare the efficacy of orally administered propranolol versus prednisolone versus both in the treatment of potentially disfiguring or functionally threatening infantile hemangiomas. MATERIAL AND METHODS: A prospective study of 30 patients aged 1 week-8 months was randomized into three equal groups. These were as follows: A, propranolol (2-3 mg/kg/d); B, prednisolone (1-4 mg/kg/d); and C, receiving both for a minimum duration of 3 months. Dimensions, color, consistency, ultrasonography, photographic documentation based on Visual Analogue Scale (VAS) were recorded before and periodically after starting treatment. A minimum 75% improvement was considered as success with no regrowth up to 1 month of stopping treatment. RESULTS: Mean initial response time (days) in A (4.1±3.3 SD) and C (4.7±3.4SD) was significantly lower than B (9.78±7.8SD) (p<0.047). Significant change in consistency was noted very early in A (24 hours) compared to B and C (8 days). VAS results are as follows: (a) color fading--significant reduction in A within 48 hours compared to B and C (p=0.025), (b) flattening--more significant and earlier in A and C than B (p<0.05), and (c) mean reduction in size: significant in A and C at 3 months (p=0.005, p=0.005), 6 months (p=0.005, p=0.008), 12 months (p=0.005, p=0.008), and 18 months (p=0.02, p=0.04), whereas in B, it was seen only at 6 months (p=0.008). CONCLUSIONS: Propranolol had a consistent, rapid therapeutic effect compared to prednisolone. A combination of the two had a comparable but not higher efficacy than propranolol alone. Prednisolone was associated with a higher number of complications, thereby decreasing patient compliance.