Treatment of infantile haemangiomas with atenolol: comparison with a historical propranolol group.

Propranolol, a lipophilic non-selective beta-blocker, has proven to be effective in the treatment of infantile haemangioma (IH). However, several side effects have been reported. Atenolol, a hydrophilic selective beta-1 blocker, could be an alternative and associated with fewer side effects. Thirty consecutive patients with IH were treated with atenolol between June 2010 and May 2011. The therapeutic effect was judged by clinical assessment and quantified by using a visual analogue scale (VAS) and the Haemangioma Activity Score (HAS). Side effects were also evaluated. The atenolol cohort was compared with a previously described cohort of 28 patients treated with propranolol between July 2008 and December 2009. Clinical involution was present in 90% (27/30) of the IH patients treated with atenolol. Mild side effects occurred in 40% (12/30) of these patients and severe side effects occurred in 3% (1/30). Compared with the previously described cohort treated with propranolol, mild side effects occurred in 50% (14/28) and severe side effects in 25% (7/28) of the patients (p=0.04). Quantitative improvement of the IH in the atenolol group (n=27) showed no significant difference in either the VAS score or the HAS compared to the propranolol group (n=24). This study indicates that atenolol is effective in the treatment of IH. Compared with a historical control group treated with propranolol, the effects of atenolol seem to be similar and less frequently associated with severe side effects. Randomised clinical trials are necessary to evaluate the efficacy and safety of atenolol treatment in IH.

Gastric adenocarcinoma in a 13-year-old boy: a diagnosis not often seen in this age group.

Gastric adenocarcinoma is not uncommon in the adult population, but in the pediatric population it is an extremely rare entity. A 13-year-old boy was referred to a pediatric oncology unit for evaluation of a tumor in the upper abdomen. Further investigation revealed an advanced stage gastric carcinoma with metastases suggestive for a hereditary cause. Awareness for uncommon diagnoses is a key issue in regard of accurate treatment and overall prognosis.

Assessment of flexural strength of two self-curing acrylic resins containing pigment

Aim: To assess the flexural strength of orthodontic acrylic resins from two different manufacturers (VIPI, OrtoCril versus Clássico, OrtoClas) by comparing pigmented resins to colorless ones. Methods: Resins of blue, yellow and green colors were studied. A total of 120 specimens were made and then divided into groups of 15 elements each, all having the same dimensions. Next, they were kept in aqueous medium until being subjected to mechanical testing. The flexural strength was tested in a universal test machine (EMIC DL 10000) in which the specimens were subjected to a gradual load until fracture occurred. Results: Pigmented resins had flexural strength values compatible with clinical use, being similar to those from colorless ones, except for OrtoClas green-colored and yellow-colored resins, which showed greater flexural strength. The OrtoClas green-colored resin was the most resistant to fracture (482.2 N), whereas the OrtoCril colorless resin was the least resistant (368.4 N). All OrtoClas resins showed higher strength values compared to OrtoCril resins of same color, except for the OrtoCril’s blue-colored resin, which presented higher flexural strength than that of the other trademark. Conclusions: The use of pigments seems to have no effect on decreasing the flexural strength of self-curing acrylic resins. Therefore, pigmented resins are compatible with clinical use.

[Sweets from the pharmaceutical industry reason to suspect intoxication with quetiapine]. / Snoepgoed van de farmaceutische industrie aanleiding voor een vermoeden van intoxicatie met quetiapine.

A 13-year-old boy was presented to the emergency department with a presumed intoxication with quetiapine, an antipsychotic. The tablets turned out to be peppermints, used as advertisement gift from the pharmaceutical industry. This misunderstanding could have led to unnecessary treatment and observation of the patient in hospital, for a moderately serious intoxication.

[Nephrotic syndrome as a paraneoplastic symptom of Hodgkin's disease in two children]. / Nefrotisch syndroom als paraneoplastisch verschijnsel van de ziekte van Hodgkin bij twee kinderen.

A 13-year-old girl and a 3-year-old boy presented with the clinical symptoms of nephrotic syndrome. Both patients developed a nodular mass in the cervical region, which appeared to be due to Hodgkin's disease. The renal disease was a paraneoplastic phenomenon of Hodgkin's disease. Chemotherapy given for Hodgkin's disease also cured the nephrotic syndrome. A few years later one of the patients experienced a recurrent episode of nephrotic syndrome in conjunction with a recurrence of Hodgkin's disease but this was once again treated successfully. Nephrotic syndrome is a known but rare paraneoplastic syndrome accompanying Hodgkin's disease. It is thought that T cell dysfunction leads to a secretion of cytokines which alters the permeability of the glomerular basement membrane. This dysfunction is not only apparent during the period of active disease and this could clarify why paraneoplastic syndrome can exist or recur outside the period in which the malignancy is overt. The clear recognition of a paraneoplastic syndrome is important, as it is often only necessary to treat the malignancy.