Surgical and Laser Treatment of Hemangiomas of the Lips.

INTRODUCTION: Single or multiple cavernous hemangiomas involving the lips can be disfiguring and are subject to traumatic hemorrhage and ulceration. Furthermore, the cavernous hemangiomas may increase in size over time. The lip is a unique body tissue because of the vermilion color. Thus, surgical removal of lesions involving the vermilion borders present esthetic concerns. CASE PRESENTATION: A 51-year-old male presented with a chief complaint of a "red-blue puffy" and protruding lower lip of several years duration. Clinical examination revealed four raised soft tissue lesions ranging from 0.4 to 1 cm in diameter. Similar lesions were noted on the dorsal tongue surface. All lesions blanched on palpation but were not pulsatile. The preliminary diagnosis was cavernous hemangioma. Given the range in size, distribution, and esthetic concerns, the two largest lip lesions were surgically excised and the smallest was ablated by carbon dioxide laser irradiation. A small lesion involving both lips at the commissure was not treated because of lack of esthetic and functional concerns. CONCLUSIONS: Treatment was successful in that no complications were incurred and the esthetic result was pleasing to the patient. This case demonstrates that laser ablation of a cavernous hemangioma with good hemostasis is possible and should be considered a viable treatment option.

AMPA and GABA(A/B) receptor subunit expression in the cortex of adult squirrel monkeys during peripheral nerve regeneration.

The primate somatosensory neuroaxis provides a highly translational model system with which to investigate adult neural plasticity. Here, we report immunohistochemical staining data for AMPA and GABAA/B receptor subunits in the area 3b cortex of adult squirrel monkeys one and five months after median nerve compression. This method of nerve injury was selected because it allows unique insight into how receptor expression changes during the regeneration of the peripheral nerve. One month after nerve compression, the pattern of subunit staining provides evidence that the cortex enters a state of reorganization. GABA α1 receptor subunits are significantly down-regulated in layer IV, V, and VI. Glur2/3 AMPA receptor subunits and postsynaptic GABABR1b receptor subunits are up and down regulated respectively across all layers of cortex. After five months of recovery from nerve compression, the pattern of AMPA and GABAA/B receptor subunits remain significantly altered in a layer specific manner. In layer II/III, GluR1, GluR2/3, and GABA α1 subunit expression is significantly up-regulated while post synaptic GABABR1b receptor subunits are significantly down regulated. In layer VI, V, and VI the GluR2/3 and presynaptic GABABR1a receptor subunits are significantly up-regulated, while the postsynaptic GABABR1b receptor subunits remain significantly down-regulated. Taken together, these results suggest that following nerve injury the cortex enters a state of reorganization that has persistent effects on cortical plasticity even after partial or total reinnervation of the peripheral nerve.

A prospective open-label trial of quetiapine monotherapy in preschool and school age children with bipolar spectrum disorder.

BACKGROUND: Although bipolar disorder frequently onsets in the preschool years, treatment studies to guide management of these highly dysfunctional children are limited. This study evaluates the response to quetiapine monotherapy in preschool and school age children with bipolar spectrum disorder (BSD). METHOD: Two eight-week, prospective, open-label trials utilizing identical methodology to assess the effectiveness and tolerability of quetiapine monotherapy in the treatment of BSD in preschool (age 4-6 years) and school age children (age 6-15 years). RESULTS: Forty-nine children (30 preschool and 19 school age) with BSD (Young Mania Rating Scale [YMRS] at entry: 34.5±5.5 and 30±6.5 respectively) were enrolled and 34 (20 preschool and 14 school age) completed the trial. Quetiapine was titrated to a mean endpoint dose of 175.8±63.8 mg/day in preschool and 248.7±153.1 mg/day in school age children. At endpoint, treatment with quetiapine was associated with similar and statistically significant improvement in mean YMRS scores in preschool (-14.5±11.5, p<0.001) and school age (-13±9.8, p<0.001) children. Quetiapine was generally well tolerated with treatment limiting adverse-events observed in 3/30 preschool and 1/19 school age children. Quetiapine monotherapy in preschool and school age children was associated with significant weight gain (+3.1±1.8 and +7.4±7.7 lb respectively, p<0.001) and with clinically insignificant changes in vital signs. LIMITATIONS: As an uncontrolled study, the assessments were not blind to treatment and the effects of treatment cannot be separated from time. CONCLUSIONS: Open-label quetiapine treatment was beneficial for the treatment of BSD in preschool and school age children. Further controlled trials are warranted.

The heavy burden of psychiatric comorbidity in youth with autism spectrum disorders: a large comparative study of a psychiatrically referred population.

The objective of the study was to systematically examine patterns of psychiatric comorbidity in referred youth with autism spectrum disorders (ASD) including autistic disorder and pervasive developmental disorder not otherwise specified. Consecutively referred children and adolescents to a pediatric psychopharmacology program were assessed with structured diagnostic interview and measures of psychosocial functioning. Comparisons were made between those youth satisfying diagnostic criteria for ASD and age and sex matched youth without ASD referred to the same clinical program. 9.3% (217/2323) of the referred youth (age range: 3-17 years) met DSM-III-R criteria for ASD. ASD youth suffered from significantly higher number of comorbid disorders than comparisons (6.4 ± 2.7 vs. 5.2 ± 2.9; p < 0.001). Ninety-five percent of the youth with ASD had three or more comorbid psychiatric disorders and 74% had five or more comorbid disorders. ASD youth were also more functionally impaired and required extra-assistance in school and therapeutic interventions at higher rates than age and sex matched non-ASD referred youth. Youth with ASD have high levels of psychiatric comorbidity and dysfunction comparable to the referred population of youth without ASD. These findings emphasize the heavy burden of psychiatric comorbidity afflicting youth with ASD and may be important targets for intervention.

A prospective open-label trial of extended-release carbamazepine monotherapy in children with bipolar disorder.

OBJECTIVE: The aim of this study was to evaluate the safety and efficacy of extended release carbamazepine (CBZ-ER) monotherapy in the treatment of pediatric bipolar disorder (BD). METHOD: This was an 8-week, open-label, prospective trial of CBZ-ER monotherapy (788 +/- 252 mg/day) to assess the effectiveness and tolerability of this compound in treating pediatric bipolar spectrum disorders. Assessments included the Young Mania Rating Scale (YMRS), Clinical Global Impressions-Improvement scale, Children's Depression Rating Scale, and Brief Psychiatric Rating Scale. Adverse events were assessed through spontaneous self-reports, vital signs weight monitoring, and laboratory analysis. RESULTS: Of the 27 participating children with BD, 16 (59.%) completed the study. CBZ-ER treatment was associated with statistically significant, but modest, levels of improvement in mean YMRS scores (-10.1 +/- 10.2, p < 0.001) with end-point mean YMRS score (21.8 +/- 12.2) suggesting a lack of complete resolution of mania. CBZ-ER treatment also resulted in significant improvement in the severity of depressive, attention-deficit/hyperactivity disorder, and psychotic symptoms. With the exception of 2 participants who discontinued due to skin rash, CBZ-ER was well tolerated with marginal increase in body weight (0.8 +/- 2.5 kg, p = 0.04) and was not associated with any abnormal changes in laboratory parameters. CONCLUSIONS: Open-label CBZ-ER treatment was beneficial for the treatment of BD in children. Future controlled trials are warranted.