Tratamiento de hemangiomas infantiles con propranolol en régimen de control ambulatorio. Estudio prospectivo / Outpatient Treatment of Infantile Hemangiomas With Propranolol: A Prospective Study

Objetivo: Valorar la efectividad y seguridad del propranolol oral (PO) para tratar hemangiomas infantiles (HI). Material y métodos: Estudio prospectivo de los HI tratados con PO entre octubre de 2008 y marzo de 2011. Fueron candidatos a tratamiento los HI en fase proliferativa con rápido crecimiento, compromiso de alguna estructura vital o ulceración y para evitar problemas funcionales o estéticos tras la fase proliferativa. Los pacientes se trataron con 2mg/kg/día de PO, y fueron controlados ambulatoriamente. Se valoró la respuesta terapéutica mediante una escala en la que se consideró la reducción del volumen, aclaramiento del color y mejoría de los síntomas del HI, además del grado de satisfacción paterna. Se registró el momento de respuesta inicial y máxima, efectos secundarios y secuelas. Resultados: Se trataron 20 casos de HI (17 niñas y 3 niños). Las localizaciones predominantes fueron: periorbitaria (20%), nariz (15%), cuello/nuca (15%) y tronco (15%). La mayoría HI fueron focales y en fase proliferativa (90%). El tratamiento se inició entre 2 y 19 meses, siendo el principal motivo para empezarlo el rápido crecimiento (50%). El inicio de respuesta se observó en el 70% de los casos a los 5 días y en solo 2 tardíamente (más de un mes). El pico máximo de respuesta se obtuvo a los 3 meses. En el 55% de casos la respuesta fue excelente, buena en el 35%, mínima en el 10% y en ninguno nula. Fueron factores predictores de respuesta el HI focal, la fase proliferativa, la localización periorbitaria y la ulceración. No hemos constatado efectos adversos importantes. Conclusión: Hemos comprobado la efectividad clínica del PO en la reducción de los HI, pero no su completa desaparición al concluir el tratamiento, persistiendo parte de su volumen, color, telangiectasias o cicatrices. El PO ha resultado seguro bajo control ambulatorio (AU)

Objective: To assess the safety and effectiveness of oral propranolol (OP) in the treatment of infantile hemangiomas. Material and method: We conducted a prospective study of infantile hemangiomas (IHs) treated with oral propranolol between October 2008 and March 2011. We included fast-growing IHs in the proliferative phase, IHs affecting vital structures, ulcerated IHs, and IHs that could cause functional or aesthetic problems after the proliferative phase. The patients received oral propranolol 2 mg/kg/d and were monitored on an outpatient basis. Response to treatment was assessed by volume reduction, lightening of color, improvement of symptoms, and parent satisfaction. Time of initial and peak response, as well as side effects and sequelae, were recorded. Results: We analyzed 20 IHs, corresponding to 17 girls and 3 boys. The main sites of involvement were around the eyes (20%), the nose (15%), the neck (15%), and the trunk (15%). Ninety percent of the hemangiomas were focal and in the proliferative phase. Treatment was started between the ages of 2 and 19 months and the main reason for starting treatment was rapid growth (50%of cases). Initial response was observed in 70% of cases and only in 2 of them it took over a month. Peak response occurred at 3 months. All the IHs responded to treatment; response was excellent in 55% of cases, good in 35%, and minimal in 10%. The following factors were predictive of response: focal IH, proliferative phase, periorbital location, and ulceration. No serious side effects were observed. Conclusion: Oral propranolol was clinically effective in reducing the volume and color of infantile hemangiomas, although the reduction was not complete and telangiectasia and scarring persisted after treatment. Oral propranolol also proved to be safe for use in outpatients (AU)

Outpatient treatment of infantile hemangiomas with propranolol: a prospective study.

OBJECTIVE: To assess the safety and effectiveness of oral propranolol (OP) in the treatment of infantile hemangiomas. MATERIAL AND METHOD: We conducted a prospective study of infantile hemangiomas (IHs) treated with oral propranolol between October 2008 and March 2011. We included fast-growing IHs in the proliferative phase, IHs affecting vital structures, ulcerated IHs, and IHs that could cause functional or aesthetic problems after the proliferative phase. The patients received oral propranolol 2mg/kg/d and were monitored on an outpatient basis. Response to treatment was assessed by volume reduction, lightening of color, improvement of symptoms, and parent satisfaction. Time of initial and peak response, as well as side effects and sequelae, were recorded. RESULTS: We analyzed 20 IHs, corresponding to 17 girls and 3 boys. The main sites of involvement were around the eyes (20%), the nose (15%), the neck (15%), and the trunk (15%). Ninety percent of the hemangiomas were focal and in the proliferative phase. Treatment was started between the ages of 2 and 19 months and the main reason for starting treatment was rapid growth (50% of cases). Initial response was observed in 70% of cases and only in 2 of them it took over a month. Peak response occurred at 3 months. All the IHs responded to treatment; response was excellent in 55% of cases, good in 35%, and minimal in 10%. The following factors were predictive of response: focal IH, proliferative phase, periorbital location, and ulceration. No serious side effects were observed. CONCLUSION: Oral propranolol was clinically effective in reducing the volume and color of infantile hemangiomas, although the reduction was not complete and telangiectasia and scarring persisted after treatment. Oral propranolol also proved to be safe for use in outpatients.

Prevalence of Wernicke-Korsakoff syndrome in Australia: has thiamine fortification made a difference?

OBJECTIVE: To determine the prevalence of the Wernicke-Korsakoff syndrome (WKS) in Australia and compare this with previous studies. DESIGN AND SETTING: Prospective autopsy study at the New South Wales Institute of Forensic Medicine, 1996-1997. METHODS: Brains of deceased people (aged over 15 years) derived from 2212 sequential autopsies performed between 1 January 1996 and 31 December 1997 were studied macroscopically and microscopically to identify cases of WKS. MAIN OUTCOME MEASURES: Standard histological criteria for WKS and any available clinical data. RESULTS: Twenty-five cases of WKS were identified (prevalence, 1.1%), mostly among the 5.9% of the 2212 people who had a history suggestive of alcohol abuse. Only four cases (16%) had been diagnosed during life. CONCLUSIONS: There has been a significant reduction in the prevalence of WKS in Australia since the introduction of thiamine enrichment of bread flour. While the prevalence is still higher than in most other Western countries, further research is needed before adding thiamine to alcoholic beverages can be recommended.