Propranolol for hemangiomas.

OBJECTIVE: Hemangiomas are the most common benign soft tissue tumors occurring in 5-10 % of children at around the age of 1 year and of them 10 % are associated with significant morbidity and entail medical attention. In this study, efficacy and adverse effects of the drug propranolol were observed on hemangiomas. METHODS: Oral propranolol was given to 36 children at a dose of 3 mg/kg/day in three divided doses. Blood pressure and heart rate were recorded during the first 3 h of treatment. Treatment was continued at home and the children were re-evaluated at monthly interval. Photographs were taken in pre- and post-treatment phages and changes of hemangiomas were measured with visual analog scale. RESULTS: Immediate effects on color and growth were noted in all cases that were especially dramatic in cases of extensive lesions. Clinical evidence of regression was seen within 30 days in all cases and completely regressed within 7 months. Mean duration of treatment was 4.1 months. CONCLUSION: Propranolol had a rapid stabilizing effect leading to early regression of hemangiomas when administered orally at a dose of 3 mg/kg/day with good quality safety profile.

Treatment of venous malformations with ethanolamine oleate: a descriptive study of 83 cases.

PURPOSE: To evaluate the outcome and complications of sclerotherapy with injection ethanolamine oleate for the treatment of venous malformations (VMs). METHODS: Eighty-three patients' (39 males and 44 females) age ranging from 3 months to 21 years with 85 lesions were followed clinically for about 1 year following treatment with injection of ethanolamine oleate. The cases were enrolled between January 2006 and December 2009. The amount of ethanolamine oleate per treatment session ranged from 0.50 to 10 ml, and maximum dose was 0.40 ml per kg body weight. All patients were evaluated after 8 weeks of last injection session. All of the treatment sessions were performed on a day-case basis. RESULTS: Eighty-five lesions have under gone 201 sclerotherapy sessions with 39 requiring one, 27 requiring two and 19 lesions requiring more than two sessions. Sclerotherapy with ethanolamine oleate provided complete resolution of symptoms in 79 lesions and significant improvement of 6 lesions. There is no recurrence of studied patients. All patients experienced pain and swelling to a variable degree for short duration. Skin sloughed out in four patients which were healed spontaneously. No other complications were observed in our study. CONCLUSION: The treatment of VMs with injection ethanolamine oleate is safe and effective.

Treatment of venous malformations with ethanolamine oleate.

OBJECTIVE: To describe the outcome and complications following ethanolamine oleate treatment of venous malformations. METHODS: Seventy-two patients (27 male, 45 female; age range, 3 months to 16 years) with 76 lesions were treated with ethanolamine oleate at 0.50-16 mL per session, with a maximum dose of 0.40 mL/kg. All patients were evaluated 8 weeks after the final injection and were followed-up for about 1 year. All the patients were treated on a day-case basis except for one who required general anaesthesia. RESULTS: Seventy-six lesions underwent 149 sclerotherapy sessions, with 41 requiring one session, 21 requiring two and 14 requiring more than two. Ethanolamine oleate significantly improved five lesions and completely resolved symptoms in 71. All patients experienced pain and swelling to a variable degree for a short time. Skin sloughing took place in three patients. No other complications were observed. CONCLUSION: Treatment of venous malformations with ethanolamine oleate is safe and effective.

Insulin-like growth factor-I as a follicular growth promoter during early pregnancy in thoroughbred mares.

To elucidate the physiological role of insulin-like growth factor-I (IGF-I) during early pregnancy in mares, number of ovarian follicles was monitored ultrasonically during different stages of the first trimester of pregnancy in 36 thoroughbred mares. From 9 of 36 mares, blood samples were collected weekly from the mating day till the end of the first trimester of pregnancy and plasma IGF-I profiles were examined with other hormones, like follicle stimulating hormone (FSH), luteinizing hormone (LH), ir-inhibin, progesterone and estradiol-17beta. Plasma IGF-I level fluctuated throughout the studied period with four peaks on the 7th, 28th, 49th and 84th days of pregnancy. Plasma IGF-I showed a positive correlation with plasma FSH (P<0.05), whereas no correlation was found with other hormones during the studied period. Plasma IGF-I had no correlation with the foetal size, but positive correlation with the number of large (> 30 mm) and medium (10-30 mm) follicles. These results suggested that IGF-I might produce from the medium and large follicles during early pregnancy and promote to develop their growth via pituitary FSH mediated effects in the mares.

Effect of active immunization of pony mares against recombinant porcine inhibin alpha subunit on ovarian follicular development and plasma steroids and gonadotropins.

Two pony mares were immunized against recombinant porcine inhibin alpha subunit three times with 39 day intervals. Clinical findings and endocrinological changes before immunization were taken as the control. The first significant rise in the anti-inhibin titre (P<0.05) in the circulation was found 27 days after the first injection. Maximum binding activity was reached by the 12th day after the second booster dose. The number of small, medium and large sized follicles had increased significantly compared to before immunization (11.75 +/- 4.30, 2.75 +/- 0.69 and 2.51 +/- 0.63 vs 6.50 +/- 1.43, 1.83 +/- 0.44 and 1.33 +/- 0.38, respectively), but the ovulation rate remained unchanged after immunization. The average plasma concentration of FSH and estradiol-17beta during the estrous cycle increased significantly (P<0.05) after immunization. These results suggest that immunization against inhibin is a useful tool to increase the number of ovarian follicles during the estrous cycle of pony mares. Moreover, the present study supported the concept that inhibin plays a major role in the control of follicular growth through its inhibitory effect on FSH secretion synergistically with steroid hormones.

Endocrinological changes before and after removal of the granulosa theca cell tumor (GTCT) affected ovary in 6 mares.

To clarify the endocrinological characteristics of the mares with granulosa theca cell tumor (GTCT), peripheral plasma samples from the 6 mares affected with GTCT were collected before and after the surgical removal of the affected ovary. Concentrations of testosterone (T), follicle stimulating hormone (FSH), luteinizing hormone (LH), immunoreactive-inhibin (ir-INH), progesterone (P) and estradiol-17beta (E(2)) in the plasma samples were measured by radioimmunoassay. Before removal of GTCT in all cases, the concentrations of T were significantly higher than those of normal mares at the breeding and non-breeding seasons, whereas plasma concentrations of FSH, LH, ir-INH, P and E(2) were lower. After surgical removal of the affected ovary, the circulatory concentrations of T was declined, but the concentrations of other hormones were constantly low as compared with those of normal mares. The present study suggests that 1) the source of higher T may be due to the abnormal follicles in ovary of GTCT, 2) in the case of GTCT the elevated level of T is observed due to the lack of aromatase, and 3) the high level of T is a typical characteristics for GTCT in mares. It is also suggested 4) due to the elevated levels of T the concentrations of gonadotropins may be suppressed.

Localization of inhibin alpha-, betaA- and betaB-subunits and aromatase in ovarian follicles with granulosa theca cell tumor (GTCT) in 6 mares.

To clarify the morphological and immunohistochemical characteristics in mares with granulosa theca cell tumor (GTCT), the localization of inhibin subunits (alpha, betaA, betaB) and aromatase in the granulosa cell layers and theca layers in the ovarian follicles were determined by immunohistochemical staining. The follicles were obtained from the ovaries of 6 mares with GTCT and 4 normal mares as controls. Immunohistochemically, inhibin alpha-subunit was localized in the granulosa cells of all follicles showing different sizes in all GTCT cases and betaA- subunit was localized in two GTCT cases in all sized follicles. But inhibin betaB- subunit and aromatase were not localized in GTCT cases. On the other hand, inhibin alpha-, betaA-, and betaB-subunits and aromatase were localized in the large and medium sized follicles, but inhibin betaA- and betaB-subunits and aromatase were not stained in the small sized follicles in normal cases. These findings suggest that some mares with GTCT can secrete dimeric inhibin (inhibin A), but all GTCT cases cannot secrete inhibin B. By the results of aromatase staining it is clear that testosterone is not converted into estradiol due to the lack of aromatase in the GTCT follicles.

Spontaneous repair of the atrophic contralateral ovary without ovariectomy in the case of a granulosa theca cell tumor (GTCT) affected mare.

A 21 year old thoroughbred mare with granulosa theca cell tumor (GTCT) in the right side and atrophic contralateral ovary was investigated in this study. After arrival at our laboratory on 10th December 1999, the clinical diagnosis of GTCT was examined by rectal palpation and ultrasonographic image of ovaries. Plasma from peripheral blood was collected in the breeding and non-breeding seasons for hormonal analysis. The results showed that the contralateral ovary regained normal activity without any treatment of the GTCT affected ovary and contained follicles showing different sizes 19 months later. However, the affected right ovary, which became smaller after 4 months, was totally inactive without any follicle. The observations clearly demonstrate that without any treatment of the GTCT affected ovary, a mare can return to her normal estrous cycle within a certain period in some GTCT cases.

Síndrome del niño maltratado: espectro de un problema / The battered child syndrome: spectrum of a problem

El espectro del síndrome del niño maltratado es muy amplio. Panorámicamente hablando, pude ser dividido en abuso físico y mental, de donde se desprenden el abuso emocional, sexual y corporal siendo éste último el que más a fondo se conoce en virtud de que es el que cobra un sin número de víctimas cada año. El espectro de la enfermedad incluy mordizcos, moretones, quemaduras, fracturas, restricción voluntaria y tendendiosa de agua, alimento, medicamentos, intoxicación por drogas, envenenamiento por barbitúricos, hidrato de cloral, impedimento de transfusiones por creencias religiosas, administración parenteral de hidratos de carbono, inserción subcutánea de agujas, anudamiento prepucial, etc. Las lesiones enecefálicas y abdominales son usualmente complicaciones que frecuentemente requieren la participación de un equipo quirúrgico. Presentamos cuatro casos ilustrativos del síndrome del niño maltratado: ruptura duodenal, ruptura yeyunal, laceraciones múltiples del colon y hematoma subdural bilateral. Dos de los niños fallecieron como consecuencia de las heridas recibidas. Adicionalmente efectuamos una revisión acerca del estado actual que guarda este especial problema social