PAS 661 Pediatrics EBM Assignment Elizabeth Arnold 6/29/15 Clinical Question: Does topical timolol have the same efficacy in treatment of superficial infantile hemangiomas compared to oral propranolol? Introduction: Infantile hemangioma (IH), a benign vascular tumor, is the most common tumor of infancy, with an incidence of 5%–10% at the end of the first year (1). Most lesions are not visible at birth but appear in the first four to six weeks of life. Hemangiomas are characterized by a growth phase which continues for the first year followed by a involution phase lasting from one to nine years (1). Risk factors for development of hemangiomas are being female, Caucasian, low birth weight, and those of multiple gestations (1). The cause …show more content…
Although there are no FDA-approved treatments for IH, corticosteroids have been the first-line agents for systemic treatment for many years. Oral propranolol, a nonselective beta-blocker, has emerged as an alternative to corticosteroids for treatment of high-risk hemangiomas(2), although both of these treatments may have significant systemic effects(3). Topical timolol malate gel has also shown efficacy and tolerability showing gradual improvement with longer treatment in patients with superficial IH …show more content…
One of them being that it was a randomized controlled trial which increases its internal and external validity. One of the main limitations of the study was the heterogeneous patient population and small numbers. The dramatic response of IH’s to propranolol is encouraging and suggests early treatment could result in decreased scarring and disfigurement. Propranolol hydrochloride administered orally reduced the volume, color, and elevation of focal and segmental IH in infants younger than 6 months up to 5 years of age. LOE II: Evidence obtained from at least one well-designed Randomized Controlled Trial (4). The main strength in the study completed by Chakkittakandiyil et al. was that it demonstrated further clinical evidence of the safety and efficacy of topical timolol maleate. The study had several limitations. The procedures for digital photography were not uniformly standardized and the investigators were not blinded to duration of treatment. Topical timolol was shown to be an effective treatment for superficial IH with decreased risk of adverse events compared to oral beta-blockers. LOE IV: Evidence from well-designed case-control and cohort studies
Evaluating the eight papers for quality evidence was critical when selecting the two papers to utilise. The evidence hierarchy was considered, aiming to use the highest evidence possible, such as systematic reviews and meta-analyses; and randomized, controlled, double-blind studies, to ensure the most accurate evidence informed the clinical decision for the patient (Bloom, Olinzock, Radjenoic & Trice, 2013). When sorting the results, other various factors were also taken into consideration; credibility, reputability, reasonability and support. With these factors taken into account, the two papers selected are highly esteemed in regards to evidence, and are most relevant to the patient (Stichler, 2010).
Hemangeol (propranolol oral liquid 4.28 milligrams) is given to infants who are at least 5 weeks old to treat a genetic condition called infantile hemangiomas. Hemangiomas are caused by blood vessels grouping together in an abnormal way. These blood vessels form benign (non-cancerous) growths that can develop into ulcers or red marks on the skin. Hemangiomas
The study was a double blind, placebo-controlled study performed between October 2002 and November 2003. The study was conducted in 53 centers throughout the United States, Mexico, South America, Europe, Asia, Australia, South Africa, and Israel. There were a total of 360 patients initially screened, however only 278 patients were included in the randomization process. The reaming 82 patients
Finally, one article was found by conducting a search of the identified article’s reference section. This article was searched by title on the Cochrane database and was found useful to the clinical
The advances offer supplementary data, when subjects with hemineglect need to be assessed, and this data is progress in hemineglect. According to Bensalah, et al, (2003) study, group one includes accurate portrayals, and nearly half were made by standard individuals; furthermore, patients with spinal cord or right or left hemisphere injuries are capable of producing ordinary self-portrayals (Bensalah, et al, 2003). This proposes that figure illustration does not replicate the observable modifications or errors of the figure (Bensalah, et al, 2003). In the Bensalah, et al, (2003) experiment, group two contains ordinary subjects with spinal cord, limbs, or brain anatomy, in quantities which do not fluctuate from those witnessed in the complete
Hemangioma is the most common non-cystic benign hepatic lesion. Depending on imaging findings, hepatic hemangiomas can be categorized as typical and atypical. Typical hemangiomas comprised of three distinct histological subtypes, including (i) the cavernous hemangioma, (ii) the capillary hemangioma and (iii) the sclerosed hemangioma (1). The atypical group includes various categories such as giant and heterogeneous large hemangiomas (2, 3).
Rosacea affects millions of women and men and can interfere with day-to-day life. It is embarrassing at best and may cause anxiety or psychological problems at worst. Rosacea is a chronic disease that may respond to oral and topical antibiotics, but some patients continue to have symptoms of persistent flushing even after taking antibiotics. Intense pulsed light (IPL) is another treatment for rosacea that has been shown through clinical research to be effective in reducing redness, flushing and acneiform breakouts for up to 77.8 percent of participants. It also improved skin texture for 75 percent of participants. Not only did IPL reduce the symptoms, the effects were long lasting. In another study at the University of Utah, IPL therapy resulted
Severity of PG lesions determines treatment options. Treatment of milder cases involves intralesional/topical corticosteroids, with most efficacy observed with the use of superpotent class I agents. Topical agents can also include: nitrogen mustard, sodium cromoglycalate, 5-amino-salicyclic acid, tacrolimus ointment, and hyaluronic acid. Hyaluronic acid stimulates angiogenesis, through activation of endothelial cells, and epithelialization. Wound healing can be augmented with lyophilized type I bovine collagen or beclaplermin (platelet derived growth factor). Systemic therapy can be utilized for more severe cases, with newer agents demonstrating efficacy including: infliximab, mycophenolate mofetil, and oral tacrolimus. Other systemic agents that can be used are azathioprine, cyclosporine, sulfasalazine, minocycline, dapsone, cyclophosphamide, chlorambucil, thalidomide, clofazamine, and corticosteroids (oral or pulse intravenous therapy) (Hata 2006). 10
Patients also start to develop small red spots, or telangiectasia’s on the face, mouth, fingers, and in the gastrointestinal tract. A high number of HHT patients will also have or develop artery malformations (AVM’s) in one or ore body organs, where capillaries between arteries and veins are missing. Other common symptoms of HHT include: shortness of breath, exercise tolerance, fatigue, migraine headaches, seizures, abdominal pain, leg swelling, intestinal bleeding, anemia. Also very small proportion of patients have multiple benign polyps in the large intestine, which may bleed or transform into colorectal cancer. A similarly small proportion experiences pulmonary
Von Hippel Lindau (VHL) disease has characteristic tumors that result from germ mutations in the VHL tumor suppressor gene on chromosome 3p25.13 One of these tumors is the hemangioblastoma. These tumors consistently occur in “the retina, cerebellum, brainstem and dorsal spinal cord.”13 Hemangioblastomas are benign neoplasms with no potential to metastasize. They are space occupying lesions that can cause neurological deficit and can have a high mortality rate due to tonsillar herniation, compression of the brainstem, and hydrocephalus if left untreated. Hemangioblastomas may have a syrinx or pseudocyst evident with magnetic resonance imaging (MRI). Also on MRI, they can have the typical appearance of a “densely contrast-enhancing solid mass with smooth margins.”13 Central nervous
A comprehensive search was used to locate the studies meeting the selected criteria: (a) the studies involved children using CIs (b) the studies involved children ages 2 to 16 years old, (c) the studies used children with
Recently physicians at Lucile Packard Children’s Hospital at Stanford found a potential treatment to Lymphangiomas. Lymphangiomas is the overgrowth of the lymph channels, which can cause airway constriction, and other aspects to the heart and lung function. The lymphatic systems function is to filter out pathogens in the blood. Vessels of the lymphatics are a one-way system allowing fluids to come in but not to flow out. The issue lies in when these lymph vessels swell or begin to back up. In the case of lymphangiomas, these channels swell and get abnormally large. At Stanford, a common drug used for erectile dysfunction called sildenafil has been found to treat symptoms of lymphangiomas. The topic that is now up for debate is that if the use of sildenafil or commonly known Viagra should be used as a treatment for lymphangiomas in children and infants.
Nodular hidradenomas are usually seen in third to fifth decade of life and are twice more common in females2. Clinically the tumour usually presents as an asymptomatic, solitary, 0.5 to 6 cm sized, skin coloured intra-dermal nodule, slightly elevated above the surrounding skin 3,4. Occasionally brown, blue or red discoloration and surface erosions or ulceration may be observed. It is a slow growing tumour and rapid growth may represent trauma, haemorrhage or a malignant change.
New Jersey is home to many rocks and minerals. That is because of the state’s location when the North American Continental Plate was Separated from the African plate a long time ago, during Pangea. When the continents broke apart, volcanic rifts rose, pouring new rocks and minerals over New Jersey. One of the minerals found here is Hemimorphite. It can be found in many places in New Jersey, including Sterling Hill, Sterling Mine, and other places in Sussex County.
Among the conditions those mimic CHH are fibrous dysplasia, dyschondroplasia, congenital lymphedema, arterio-venous aneurysms, hemangioma, Klippel-Trenaunay syndrome, Von Recklighausen’s neurofibromatosis, malignant conditions such as osteosarcoma and chondrosarcoma. They normally exhibit sufficient clinical differences with CHH and should be distinguished on the basis of specific radiographic, clinical and laboratory findings. [8] Treatment procedures are usually planned when the physiological growth ceases and when cosmetic considerations are involved. An extensive search of the literature revealed no evidence of malignant transformation. The remodelling procedures may involve orthognathic surgeries, soft tissue debulking, cosmetic reconstruction like face lift and orthodontic therapy.