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Infantile hemangioma (IH) is a common condition in children. It may lead to cosmetic disfigurement, functional impairment, and various complications. There are various treatment options available for this condition. This article aims to discuss the various therapeutic options available for the treatment of IH. We searched PubMed, Google Scholar, and Embase (from December 2013 to December 2023) for human studies/case reports/case series assessing the management of IH. We reviewed 198 papers including different therapeutic regimens. β-blockers other than propranolol, such as nadolol, timolol, atenolol, acebutolol, and captopril, have shown comparable results to propranolol. Pulsed dye laser (PDL) and neodymium-doped yttrium aluminum garnet laser have shown promising results. Other therapies observed were sclerotherapy, cryotherapy, and surgical resection. A conventional combination of β-blockers with a laser might be the first-line treatment to arrest the growth of IH. PDL has shown promising results.

Aim: To present the rare localization of haemangioma in a premature child and to point out the importance of early treatment to prevent possible complications. Case report: A female prematurely born child was referred for a consultative examination by an ophthalmologist due to oedema of the upper eyelid of the left eye and bulbous protrusion lasting three weeks. Physical examination revealed mild axial, painless left bulbar proptosis, palpebral oedema and slower pupillary response. Native and postcontrast MR and UTZ B scan of the bulbus and retroorbital space were performed. MR showed protrusion of the left bulb caused by haemangioma along the lateral contour and the orbital roof, which impregnates the surrounding muscles and with localized signs of intraconal spread in the area of the posterior part of the orbit. Expansion was also observed through the upper orbital fissure to the level of the cavernous sinus region. Propranolol therapy was started. After three months after the start of therapy, UTZ and MRI showed a complete retreat of tumour formation. Conclusion: Because of their localization, retrobulbar haemangiomas can cause numerous serious complications, which, in order to prevent them, require early diagnosis and the start of treatment. Due to the limited therapeutic options, the drug of first choice is oral propranolol. [ABSTRACT FROM AUTHOR]

Infantile hemangioma (IH) is a common condition in children. It may lead to cosmetic disfigurement, functional impairment, and various complications. There are various treatment options available for this condition. This article aims to discuss the various therapeutic options available for the treatment of IH. We searched PubMed, Google Scholar, and Embase (from December 2013 to December 2023) for human studies/case reports/case series assessing the management of IH. We reviewed 198 papers including different therapeutic regimens. β-blockers other than propranolol, such as nadolol, timolol, atenolol, acebutolol, and captopril, have shown comparable results to propranolol. Pulsed dye laser (PDL) and neodymium-doped yttrium aluminum garnet laser have shown promising results. Other therapies observed were sclerotherapy, cryotherapy, and surgical resection. A conventional combination of β-blockers with a laser might be the first-line treatment to arrest the growth of IH. PDL has shown promising results. [ABSTRACT FROM AUTHOR]

Cavernous sinus haemangiomas are neoplastic lesions notoriously difficult to diagnose and excise. We present a case of a lesion that was clinically, biochemically, and radiologically consistent to a giant pituitary macroadenoma and discuss the unexpected near intra-operative exsanguination which enabled a pathognomonic diagnosis of a much rarer lesion to be made. This highlights the sinister nature of such a lesion, and its potential impact on patient care if partially excised, and that despite our advances in neurosurgical diagnostics the unexpected is to be expected. [ABSTRACT FROM AUTHOR]

Hemangioma of the nasal tip is commonly described as “Cyrano nose” and his treatment is extremely difficult because of its location and possible severe aesthetic complications like definitive nasal deformation. We describe a patient who presented at two months of age with a “Cyrano nose” associated with multiple hepatic and cutaneous hemangiomas, which completely resolved after therapy with propranolol. Treatment was well tolerated and aesthetic result was excellent.

Objective: Severe burn injuries are associated with a rapid escalating hypermetabolic state and catabolism of muscle mass. To ameliorate this process a standardized approach using pharmacological and interventions was implemented within a single burns center. Whilst individual components of this standardized package are well documented in the literature, their collective or bundled effect has not as yet been assessed. The aim of this study was to evaluate the efficacy of this standardized bundle of metabolic modulators and assess the safety of including the anabolic steroid oxandrolone within it.Methods: This retrospective observational study constituted all patients in whom the metabolic bundle including oxandrolone therapy was applied. The other elements of the metabolic bundle consisted of early surgical burn excision within seven days to completion, early active mobilization, increased ambient room temperature, expediated carbohydrate and protein rich enteral feeding with glutamine and trace element supplements (such as copper and zinc). Finally, administration of propranolol as a non-selective beta-blocker. Data collection was through review of the patient data management system focusing on the outcome criteria and hepatic blood values.Results: The study looked at fifty consecutive patients meeting the inclusion criteria. Median patient age and burned total body surface area (TBSA) were 62 years [51.75; 73] and 33.75% [24.75; 51] respectively with an abbreviated burn severity index (ABSI) of 10 [9; 10.25]. Definitive surgical burn wound excision was completed in 44 patients [88%] within 7 days. 39 patients (78%) received propranolol over a therapeutic period of 29 days [19; 44]. Glutamine was supplemented in 45 patients (90%), while zinc and copper were applied to 42 (84%) and 31 (62%) respectively. Significant low zinc values were noted at therapeutic onset (6.5 mmol/l [4.7; 7.9]) requiring sustained substitution over 37.5 days [22; 46.75]).In respect of the inclusion criteria, all patients received oxandrolone at 20 mg/day [20; 20]. This was commenced on day 6.5 [4; 14] post burn injury and continued over 26 days [19; 31]. Despite a transitory elevation of hepatic enzyme values (ALT, GGT), these were only clinically relevant (>10 µmol/l*S) in 2.4% and 4.6% of all measurements respectively. None were sufficiently of concern to merit cessation of treatment.Conclusion: The application of a standardised bundle of metabolic treatment options of severe burns injured patients is reliable, repeatable and safe. Potential concerns of oxandrolone treatment regarding hepatic compromise remain unfounded.

Highlights: • The biochemical marker of inflammation and suggests a potential mechanism through which propranolol affects hypermetabolism in burn patients. • The administration of propranolol giving effectivity of hypermetabolism which is characterized by decreasing in CRP levels. Abstract: Introduction: The incidence of burns in Indonesia progressively increases with the increase in its population and industries. From January to September 2000, 158 patients were treated in the burn unit of Dr. Soetomo General Academic Hospital with a mortality rate reaching 5.8%. Burns have a direct effect in causing both local and systemic changes in the body, not occurring in other injuries. In severe burns, a hypermetabolic state can occur, which increases cardiac workload and causes muscle atrophy and other morbidities. The purpose of this study is to examine the effect of propranolol on the hypermetabolic state in severely burned patients by measuring various clinical & laboratory parameters. Methods: This is an experimental study using pre and post test control group design with the objective of assessing the treatment outcome with oral propranolol given in 15 consecutive days for burn patients involving 25%- 60% TBSA. Measurements were taken three times, on day 0.7 and 14. Discussion: Obtained 16 samples divided into 2 groups. In the treatment group, there was a significant decrease in CRP levels on days 0.7 and 14 (p

Os hemangiomas infantis (HI) são os tumores vasculares benignos da infância mais frequentes, com uma incidência aproximada de 4-5%, sendo mais prevalentes no sexo feminino, recém-nascidos prematuros ou de baixo peso e gravidezes gemelares. A maioria apresenta-se como lesões pequenas e inócuas que, pela sua natureza autolimitada, para além de observação periódica, não necessita de tratamento activo. No entanto, cerca de 10-15% dos HI, seja devido ao seu tamanho ou à sua localização (por exemplo HI perioculares, subglóticos, periorais, perineais...) podem trazer consequências funcionais e estéticas importantes, pelo que necessitam de tratamento activo. Estes casos carecem de observação célere pela Dermatologia e uma intervenção precoce, para que não se perca a janela de oportunidade de início de tratamento e, assim, tentar minimizar efeitos adversos a curto e longo prazo, melhorando os cuidados a estas crianças e reduzindo a morbilidade. Desde 2008, após Léauté-Labrèze ter descoberto acidentalmente a boa resposta do HI ao propranolol, que o paradigma do tratamento dos HI se alterou, passando este a ser recomendado como escolha de primeira linha em 2014. O propranolol oral é um fármaco muito eficaz, com taxas de resposta até 98%, com um perfil de segurança superior aos fármacos tradicionalmente usados no tratamento dos HI (corticoesteróides sistémicos, vincristina, interferão). Deve ser iniciado, idealmente, entre as 5 semanas e os 5 meses de vida (reiterando a importância da referenciação precoce dos HI complicados), na dose de 1 mg/kg/dia, devendo ser aumentado até à dose máxima de 3 mg/kg/dia (dose bidiária), por um período de 6 meses. É um fármaco relativamente bem tolerado, sendo raros e rapidamente reversíveis com a suspensão da terapêutica os efeitos adversos graves (hipoglicémia, bradicardia, broncospasmo). O tempo de duração do tratamento e o modo de suspensão (imediata vs desmame) não são consensuais, havendo casos em que há necessidade de prolongar o tempo da sua administração além dos 6 meses, preconizada na maioria dos casos. Estes pontos devem ainda ser definidos de forma clara para ajudar os clínicos na abordagem dos HI complicados. A utilização do propranolol oral veio revolucionar, sem dúvida, o tratamento dos HI. Lesões complexas, com sequelas funcionais e estéticas potencialmente graves, são tratadas de forma rápida, cómoda, segura e em ambulatório, diminuindo de maneira notável e impressionante a morbilidade associada a estes tumores vasculares. Resta, no entanto, saber se os novos betabloqueantes em estudo, mais selectivos, podem manter ou mesmo ultrapassar a eficácia do propranolol e reduzir os efeitos adversos conhecidos. Este número da Revista da SPDVinclui dois estudos de revisão (1,2) muito clarificadores sobre o estado da arte actual no tratamento dos HI, bem como das eventuais novas terapêuticas que poderão surgir nos próximos anos e, assim, nos auxiliar na abordagem desta entidade tão frequente na Dermatologia Pediátrica.

Autobiographical memory is fundamental to the process of self-construction. Therefore, the possibility of modifying autobiographical memories, in particular with memory-modulation and memory-erasing, is a very important topic both from the theoretical and from the practical point of view. The aim of this paper is to illustrate the state of the art of some of the most promising areas of memory-modulation and memory-erasing, considering how they can affect the self and the overall balance of the “self and autobiographical memory” system. Indeed, different conceptualizations of the self and of personal identity in relation to autobiographical memory are what makes memory-modulation and memory-erasing more or less desirable. Because of the current limitations (both practical and ethical) to interventions on memory, I can only sketch some hypotheses. However, it can be argued that the choice to mitigate painful memories (or edit memories for other reasons) is somehow problematic, from an ethical point of view, according to some of the theories of the self and personal identity in relation to autobiographical memory, in particular for the so-called narrative theories of personal identity, chosen here as the main case of study. Other conceptualizations of the “self and autobiographical memory” system, namely the constructivist theories, do not have this sort of critical concerns. However, many theories rely on normative (and not empirical) conceptions of the self: for them, the actions aimed at mitigating or removing specific (negative) memories can be seen either as an improvement or as a depletion or impairment of the self.

Introduction: Infantile hemangiomas are frequent benign tumors in childhood. In newborns its incidence is estimated at 1-3%, reaching 10% in children under one year. Case report: Female patient, who from the birth she had a single raised, protruding lesion, with sharp edges, bright red, on the left ear. This lesion became more evident at three months of age, with a faster growth rate compared to the patient's growth, covering the entire ear; on multiple occasions she presented ulcerations and bleeding. She was admitted to the emergency department with hypovolemic shock data; and she was treated with crystalloids, transfusion of erythrocyte concentrate, and treatment with propanolol was started. She underwent surgery at the age of two years 10 months without complications. Discussion: Hemangioma cases, such as this patients require multidisciplinary treatment approach, given the size, site location and high risk of sequelae. [ABSTRACT FROM AUTHOR]

Autobiographical memory is fundamental to the process of self-construction. Therefore, the possibility of modifying autobiographical memories, in particular with memory-modulation and memory-erasing, is a very important topic both from the theoretical and from the practical point of view. The aim of this paper is to illustrate the state of the art of some of the most promising areas of memory-modulation and memory-erasing, considering how they can affect the self and the overall balance of the "self and autobiographical memory" system. Indeed, different conceptualizations of the self and of personal identity in relation to autobiographical memory are what makes memory-modulation and memory-erasing more or less desirable. Because of the current limitations (both practical and ethical) to interventions on memory, I can only sketch some hypotheses. However, it can be argued that the choice to mitigate painful memories (or edit memories for other reasons) is somehow problematic, from an ethical point of view, according to some of the theories of the self and personal identity in relation to autobiographical memory, in particular for the so-called narrative theories of personal identity, chosen here as the main case of study. Other conceptualizations of the "self and autobiographical memory" system, namely the constructivist theories, do not have this sort of critical concerns. However, many theories rely on normative (and not empirical) conceptions of the self: for them, the actions aimed at mitigating or removing specific (negative) memories can be seen either as an improvement or as a depletion or impairment of the self. [ABSTRACT FROM AUTHOR]

A neonate presented to our clinic for evaluation of unusual congenital cleft lip. The clinical follow-up showed at first an ulceration of the lesion and then a stable result after propanolol systemic therapy. After 18 months of clinical follow-up, surgical treatment was performed, which consisted of double unilimb Z-plasty according to Mulliken's microform cleft lip repair. Knowing the existence of these strange vascular anomalies of the lip will allow us to improve the differential diagnosis and treatment plan. [ABSTRACT FROM AUTHOR]

Thyroidectomy is the most common endocrine surgical procedure being carried out throughout the world. Besides, many patients who have deranged thyroid physiology, namely hyperthyroidism and hypothyroidism, have to undergo various elective and emergency surgical procedures at some stage of their life. The attending anesthesiologist has to face numerous daunting tasks while administering anesthesia to such patients. The challenging scenarios can be encountered at any stage, be it preoperative, intra-op or postoperative period. Preoperatively, deranged thyroid physiology warrants optimal preparation, while anticipated difficult airway due to enlarged thyroid gland further adds to the anesthetic challenges. Cardiac complications are equally challenging as also the presence of various co-morbidities which make the task of anesthesiologist extremely difficult. Thyroid storm can occur during intra-op and post-op period in inadequately prepared surgical patients. Postoperatively, numerous complications can develop that include hemorrhage, laryngeal edema, nerve palsies, tracheomalacia, hypocalcemic tetany, pneumothorax, etc., The present review aims at an in-depth analysis of potential risk factors and challenges during administration of anesthesia and possible complications in patients with thyroid disease.

Hemangiomas are the most frequent vascular tumors observed in early childhood. The presentation is unique, with an initial phase of proliferation, followed by a phase of slow, spontaneous regression after the age of 1 year.1,2 Most hemangiomas are uncomplicated and do not require intervention. However, therapy may be needed if the hemangioma is located at certain body sites, such as the face, or if it results in a functional handicap, such as limitation of eye opening. In addition, ulcerated, rapidly growing hemangiomas may require treatment.3

Introduction: Several therapeutic approaches have been developed to treat choroidal hemangioma. However, all these therapies are associated with a potential risk of damaging the overlying retina. Case Report: We report a case of circumscribed choroidal hemangioma (CCH) in a 59-year-old man refractory to laser treatment. Visual acuity was 20/200 and a serous macular detachment was present. The CCH was treated with oral propanolol, whereupon visual acuity improved to 20/20 and the macular detachment resolved without systemic or local adverse effects. Discussion: Propanolol is a β-blocker commonly used in cardiology that may induce endothelium vasoconstriction and inhibit endothelial proliferation. It has been shown to be effective in infantile facial hemangiomas, and proved safe and effective for the CCH in our patient. Further studies are needed to confirm our observation.

Se efectuó un estudio descriptivo y transversal de todos pacientes que consumían propanolol, independientemente de la edad, sexo, raza e indicación, a fin de evaluar la calidad de la prescripción de este medicamento por los facultativos (endocrinólogo, neurólogo y cardiólogo) responsables en el área de salud "Dr. Carlos Juan Finlay" de Santiago de Cuba. Los especialistas de medicina general integral tuvieron los peores resultados en cuanto a prescripción inadecuada durante el proceso, a diferencia de lo realizado por profesionales de las ramas de neurología y medicina interna. La evaluación de los resultados de la satisfacción de los proveedores de salud fue inadecuada y de los usuarios, adecuada.A descriptive and cross sectional study of all patients that were prescribed propanolol, independently of the age, sex, race and indication was carried out, in order to evaluate the quality of the prescription for this medication by doctors (endocrinologist, neurologist and cardiologist) who worked in "Dr. Carlos Juan Finlay" health area from Santiago de Cuba. The specialists in Comprehensive General Medicine had the worst results regarding inappropriate prescription during the process, contrary to what professionals from the neurology and internal medicine specialities do. The evaluation of the satisfaction results for the health providers was inappropriate and that of the users was appropriate.

The Brazilian Society of Cardiology (SBC) proposes that hypertensive subjects who use beta-blockers and practice physical exercises must have their training heart rate (HR) corrected due to the negative chronotropic effect of this drug. Nevertheless, if the physical activity is performed outside of plasmatic half-life, correction may not be necessary. This study investigated the exercise chronotropic response both inside and outside the beta-blocker plasmatic half-life. Nine subjects in use of atenolol or propranolol, and six controls, carried out three walking sessions in three days according to different schedules: EX2 (two hours after drug administration, at the plasmatic peak); EX11 (eleven hours after drug administration, at the end of plasmatic half-life); and EX23 (twenty-three hours after drug administration, outside the plasmatic half-life. The walking sessions were performed on an ergometric treadmill and HR was monitored by a heart rate monitor. During the exercises, mean HRs were 97.2, 108.4 and 109 for EX2, EX11 and EX23, respectively, with the value for EX2 statistically lower than the others (p0.05). The study concludes that the attenuation of the positive chronotropic response which occurs during exercise in subjects using beta-blockers, is less evident when the exercise is performed outside the plasmatic half-life of the drug.A Sociedade Brasileira de Cardiologia (SBC) propõe que os hipertensos que utilizam beta-bloqueadores e praticam exercícios físicos devem ter sua frequência cardíaca de treinamento (HR) corrigida devido ao efeito cronotrópico negativo desse fármaco. Contudo, se a atividade física é realizada fora da meia-vida plasmática do fármaco, a correção pode não ser necessária. Este estudo investigou a resposta cronotrópica ao exercício dentro e fora da meia-vida plasmática do beta-bloqueador. Nove indivíduos que usavam atenolol ou propranolol e seis controles, efetuaram três sessões de caminhada em três dias, de acordo com diferentes esquemas: EX2 (duas horas após a administração do fármaco, no pico plasmático); EX11 (11 horas após a administração do fármaco, no fim da meia-vida plasmática) e EX23 (23 horas após a administração do fármaco, fora da meia-vida plasmática). As caminhadas foram realizadas em esteira ergométrica e a HR foi monitorada por monitor de freqüência cardíaca. Durante os exercícios, as HR médias foram de 97,2, 108,4 e 109, para EX2, EX11 e EX23, respectivamente, com valor de EX2 estatisticamente mais baixo do que os outros (p0,05). O estudo conclui que a atenuação da resposta cronotrópica positiva, que ocorre durante o exercício em indivíduos que utilizam beta-bloqueadores, é menos evidente quando o exercício é realizado fora da meia-vida plasmática do fármaco.

Las taquiarritmias son las alteraciones del ritmo cardiaco más comunes en el feto que pueden generar complicaciones fatales. En general, se recomienda tratamiento cuando son persistentes. Los medicamentos más usados para el tratamiento de esta arritmia en los fetos son digoxina, flecainida, sotalol y amiodarona. Si bien son efectivos, su aplicación en los fetos se fundamenta en las características mecánicas y no electrofisiológicas, con riesgo de generar arritmias fatales o de más difícil control. El fenómeno pro-arritmogénico y los efectos secundarios, comprometen también a las gestantes. La hipotensión y arritmias como el flutter auricular, exigen una vigilancia comprometida. Es importante considerar un medicamento más seguro que pueda ser útil en las formas más simples y comunes de taquiarritmias del feto. Objetivo: mostrar, por medio de un caso clínico y mediante la revisión de artículos relevantes, que el propanolol puede estar dentro del grupo de los medicamentos para el tratamiento de la taquicardia supraventricular del feto. Para el tratamiento de esta patología se han impuesto una serie de alternativas, con resultados adecuados; sin embargo, son exigentes en su conocimiento y control, y definitivamente no están exentas de riesgos. El objetivo es mostrar que el propanolol es aún una alternativa para casos específicos de taquiarritmias del feto, ya sea como aplicación aislada o en combinación con otros fármacos.Tachyarrhythmias are common alterations of cardiac rhythm in the fetus that may generate fatal complications. In general, when they are persistent, treatment is advised. The more used drugs for the treatment of this arrhythmia in fetuses are digoxin, flecainide, sotalol and amiodarone. Even though they are effective, its use in fetuses is based on mechanical and not in electrophysiological characteristics, with the risk of generating fatal arrhythmias or some of more difficult control. The pro-arrhythmogenic phenomenon and the secondary effects involve also the pregnant women. Hypotension and arrhythmias such as auricular flutter demand a compromised vigilance. It is important to consider a safer drug that may be useful in the simpler and more common forms of fetal tachyarrhythmias. Objetivo: to show by means of a clinical case and by revision of relevant articles, that propanolol can be part of the group of drugs for the treatment of fetal supraventricular tachycardia. A series of alternatives have been imposed with adequate results; nevertheless, these are exigent in its knowledge and control and definitely not exempt of risks. Our objective is to show that propanolol is still an alternative for specific cases of tachyarrhythmias in fetuses, isolated or combined with other drugs.

Harlequin syndrome (HS) is a rare entity derived from the dysfunction of the sympathetic nervous system. It is characterised by unilateral facial flushing and sweating induced by exercise, heat and emotion. Most cases are primary with an unknown pathogenic mechanism. In these cases, the prognosis is favourable. Medical or surgical treatments are not usually required for idiopathic HS. However, symptomatic treatment may be indicated when symptoms affect the quality of life of patients. We present the case of a patient with idiopathic HS successfully treated with oxybutynin and propranolol. In this patient, a marked improvement in both hyperhidrosis and facial erythema was noted with this combined therapy. We consider it of interest to highlight the response of our patient to the treatment employed, which may be advantageous in future cases of this rare disorder. [ABSTRACT FROM AUTHOR]

BACKGROUND: Propanolol prescription for the treatment of several solid tumours has been increased lately trying to block VEGF. Respiratory papillomatosis have β adrenergic receptors 1 and 2 that respond theorically to propanolol generating vasoconstriction and decreasing long lasting tumour NO2 levels, extending surgical time results. OBJECTIVE: To assess the efficacy of propanolol as adjuvant treatment of respiratory papillomatosis. MATERIAL AND METHOD: A prospective study was done including six patients in the control protocol. All patients were part of the cidofovir protocol at Pediatric Hospital of Chihuahua State, Mexico, with a follow-up of nine months to three years; all patients started treatment with propanolol after the last direct laryngoscopy and administration of cidofovir at dose of 7.5 g total in the injection. All patients had a biopsy of the lesion that confirmed the diagnosis of respiratory papillomatosis and a typification study of the virus by polymerase chain reaction. RESULTS: Five patients continued the treatment established in the protocol, and one male patient abandoned it due to hypotension and moderate bradichardia during exercise. Two of six patients required a new laryngoscopy and intralesional cidofovir. None patient has had any adverse drug reaction during protocol. CONCLUSIONS: Propanolol is a useful drug as adjuvant treatment of respiratory papillomatosis, is cheap and has little systemic effects. [ABSTRACT FROM AUTHOR]

Objectives With the emergence of propranolol as the primary treatment for hemangiomas the indications for surgical intervention have been greatly reduced. There remains a role for surgical management in those patients who fail medical therapy, particularly for hemangiomas involving the airway. Detailed is our experience with subglottic hemangiomas, including three patients who failed propranolol treatment and were successfully treated with surgical excision and single stage laryngotracheoplasty (LTP) with thyroid ala graft. Methods Retrospective case series (level of evidence: 4). Results Six patients were treated with propranolol for subglottic hemangiomas over a 6 year period (2008–2014). Three patients responded to propranolol therapy and required no adjunctive surgical procedures. Three patients failed propranolol treatment, and required open resection of their subglottic hemangiomas and thyroid ala graft placement. Indications for resection were complete lack of response to propranolol in one patient, and initial response to propranolol with subsequent regrowth in the other two patients. All three patients were treated with submucosal extirpation of their hemangioma and single stage LTP; hemangioma was confirmed in all cases by positive GLUT-1 staining. All three surgical patients were successfully extubated post-operatively and none had hemangioma regrowth. Conclusions Fifty percent of patients in our series did not have long-term response to propranolol for subglottic hemangioma, highlighting the importance of close follow-up. When identified early, subglottic hemangiomas refractory to propranolol treatment can be successfully addressed with single stage LTP and tracheotomy can be avoided. [ABSTRACT FROM AUTHOR]

Infantile hemangiomas ( IHs) are the most common proliferating embrional tumors of infancy, which are constituted by endothelial cell hyperproliferation. The authors want to report their observations of further 14 patients suffering from complicated IHs involving the facial district who were treated with propranolol. 14 patients, with ages between 3 and 12 months, completed a cycle of treatment with propanolol. The observational study aimed at focusing IHs involving the facial district. The treatment with propranolol showed good to very good results in the major part of the treated young patients. The authors want to report their experience and add more data in the confirmation of the use of β-blockers for IH (either in efficacy or in safety profile), focusing on the efficacy of propanolol when IHs involve the face. [ABSTRACT FROM AUTHOR]

Highlights: [•] The overall quality of research addressing this use of beta blockers is poor. [•] Research suggests that a symptom based approach is used by clinicians in prescribing of beta blockers. [•] There is some evidence for positive outcomes for a range of problem behaviours. [•] Beta blockers appear to be well tolerated in the populations studied. [Copyright &y& Elsevier]

ABSTRACT The presence of pharmaceuticals and personal-care products (PPCPs) in aquatic environments is of concern. Although measured concentrations of individual substances are low, little consideration has been given to the likely chronic nature of the exposures or to the potential for mixture effects. The purpose of the present study was to use the RTG-2 rainbow trout cell line to analyse sub-lethal and cytotoxic effects of PPCPs present in a wastewater-treatment-plant (WWTP) effluents and their mixtures. Interactions with cytochrome P450 1A enzyme, oxidative stress, cellular senescence and cell viability were assessed using 7-ethoxyresorufin-o-deethylase (EROD), reactive oxygen species (ROS), ß-galactosidase (ß-gal) and neutral red (NR) uptake assays, respectively. Not all of the compounds that were tested exhibited significant effects. The lowest-observed-effect concentrations and half maximal effective concentrations (EC50) were within the range 0.15 to 784.47 µg l-1. Clear dose-response curves were found for cells exposed to different mixtures of PPCPs. The lowest-observed-effect concentrations and concentrations causing EC50 were within the range 0.05 to 54.61 µg l-1. Four out the seven tested mixtures induced EROD activity. ROS production was detected in two mixtures. The ß-gal inhibition response was observed in six out the seven tested mixtures and occurred at a higher concentration than was observed for EROD induction activity or ROS generation. The present study clearly shows that the stress response through which cells mount a homeostatic response to toxicants can be potentially used for an initial, rapid and cost-effective assessment of the complex mixtures of PPCP that present in WWTP effluents are difficult and expensive to analyse chemically. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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Thyroidectomy is the most common endocrine surgical procedure being carried out throughout the world. Besides, many patients who have deranged thyroid physiology, namely hyperthyroidism and hypothyroidism, have to undergo various elective and emergency surgical procedures at some stage of their life. The attending anesthesiologist has to face numerous daunting tasks while administering anesthesia to such patients. The challenging scenarios can be encountered at any stage, be it preoperative, intra-op or postoperative period. Preoperatively, deranged thyroid physiology warrants optimal preparation, while anticipated difficult airway due to enlarged thyroid gland further adds to the anesthetic challenges. Cardiac complications are equally challenging as also the presence of various co-morbidities which make the task of anesthesiologist extremely difficult. Thyroid storm can occur during intra-op and post-op period in inadequately prepared surgical patients. Postoperatively, numerous complications can develop that include hemorrhage, laryngeal edema, nerve palsies, tracheomalacia, hypocalcemic tetany, pneumothorax, etc., The present review aims at an in-depth analysis of potential risk factors and challenges during administration of anesthesia and possible complications in patients with thyroid disease. [ABSTRACT FROM AUTHOR]

Background and Purpose: Infantile hemangiomas (IH) often pose a significant risk to visual development. The lesions interfere with visual development by causing deprivation, astigmatism, or strabismus. Propranolol has been suggested as the new standard of care for treatment of IH. Alternative treatments such as intralesional steroids or surgery may need to be considered as equal or better treatments in some cases. The purpose of this study was to evaluate the potential risks and benefits of the various modalities for periocular IH. Method: Aliterature search was conducted for IH and propranolol, steroids, and surgery. The pertinent published literature on surgical resection of IH were reviewed and summarized. A retrospective analysis was also performed of the Vanderbilt Children's Hospital (VCH) surgical case series of twelve children who underwent surgical resection of a sight threatening IH. Results: Seven articles reported twenty or more patients treated with propranolol for IH. Many of these patients only had a partial response to propranolol in spite of months of treatment. In addition to the impact on IH, propranolol has been demonstrated to block neural pathways critical for learning and memory. Twelve children underwent surgical resection of a visual threatening IH at VCH. Two of these children had failed treatment with oral propranolol. The average time of surgery was 80 minutes. All twelve children had immediate resolution of the visual compromise. Conclusion: Early surgical intervention can successfully and quickly result in excellent visual and anatomic outcomes. Propranolol may have unrecognized neurocognitive impact and should be reserved for those lesions unamenable to surgical or local steroid injection. [ABSTRACT FROM AUTHOR]

Introduction: Paroxysmal sympathetic hyperactivity occurs in association with several conditions that affect central nervous system. The main clinical manifestations are self-limited episodes of hypertension, tachycardia, tachypnea, hyperhidrosis, alterations in level of consciousness, excessive salivation, hypertonia with extensor posture, fever and pupillary dilation. Recognition is often delayed, which increases the morbidity and mortality. Case report: We report two pediatrics cases that developed sympathetic storm, one of them after a severe cranial trauma and the second case associated to hydrocephalus and hypoxic encephalopathy. Discussion: The pathophysiology remains unclear. Limited knowledge exist about the cerebral area involved or the specific biochemical abnormalities responsible for the syndrome. Some of the proposed mechanisms include heightened activity of the sympathoexcitatory centers in diencephalon or brainstem, with alterations in neurotransmitters. The pharmacological management with first-line drugs like morphine sulfate and beta-blockers are considered the most effective although the level of evidence is low as it is based on some small case reports. In our cases we use baclofen and propranolol with good control of the disorder. Conclusions: Early identification of paroxysmal sympathetic hyperactivity on high-risk patients is important to minimize unnecessary diagnostic testing and therapeutic interventions, as well as to promote timely and appropriate treatment and minimize secondary morbidity. [ABSTRACT FROM AUTHOR]

Landiolol is an ultra-short-acting β 1 -adrenergic receptor-blocking agent that is used with perioperative patients who are at risk of cardiac events. The drug is hydrolyzed very rapidly by pseudocholinesterase in the blood. Using physostigmine (final concentration: 10−4 mol/L) as a cholinesterase inhibitor, we developed a simple and rapid quantification method for landiolol using high-performance liquid chromatography. Chromatographic separations were achieved on a C18 column with 20 mM KH2PO4/acetonitrile (70/30, v/v). Propranolol was used as an internal standard. The peaks were detected using a fluorescence detector (excitation 220 nm and emission 310 nm). The retention times of landiolol and propranolol were 5.6 min and 6.7 min, respectively. The lower limit of quantification was estimated as being 0.1 µg/mL. The precision of the inter- and intra-assay varied between 1.8% and 12.6%, and the accuracy varied between −8.1% and 7.7%. This method was useful for the determination of landiolol in human plasma after intravenous administration. [ABSTRACT FROM AUTHOR]

The effect of Adenanthera pavonina (AP) seed extract on the blood pressure of normotensive rats was evaluated. Twelve adult male Wistar rats divided into 3 groups of 4 animals each were used and were treated orally with normal saline (control group), propanolol (positive control, and was given at 1mg/kg) and 200mg/kg of AP seed extract over a 4- week period. Condon manometer was used to measure the mean arterial blood pressure. The mean arterial blood pressure of the normal saline treated animal was 60mmHg, those of propanolol treated animals was 23mmHg while the 200mg/kg extract treated group was 30mmHg. Phytochemical screening showed that the extract contained cardiac glycosides, tannins, saponins, alkaloids and flavonoids. Cyanogenetic glycosides and anthraquinones were absent. The sodium level for the 200mg/kg group was significantly lower than that of control group. The total bilirubin, total protein and the globulin fraction were significantly higher in the extract treated groups compared to the control group. Histopathological examination showed that the extract did not cause any significant lesion changes in the liver, kidney and even the testes. The study showed that Adenanthera pavonina seed extract have the potential to cause a blood pressure lowering effect. The serum biochemistry changes may suggest that the extract has a tonic effect on the kidneys and the liver and these organs play central role in drug metabolism. Absence of significant lesion in the kidney, liver and testes may indicate that the plant is safe for medicinal use. [ABSTRACT FROM AUTHOR]

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Abstract: The propensity to self-administer cocaine may be a function of both its positively reinforcing and aversive effects, with the latter acting as a limiting factor on overall drug taking. However, relative to what is known about the physiological underpinnings of cocaine''s positively reinforcing effects, little is known about its aversive effects. There is some evidence that cocaine''s aversive effects, as indexed in the conditioned taste aversion (CTA) preparation, are catecholaminergically mediated, i.e., through cocaine''s actions on the dopaminergic and noradrenergic neurotransmitter systems. Although limited evidence suggests a role for dopamine, there has yet to be a direct assessment of noradrenergic involvement. To better characterize a role for this system, cocaine-induced CTAs (10, 18 and 32 mg/kg) were conducted under conditions of antagonism at the norepinephrine α1 and β receptors using prazosin (0.3 mg/kg; Experiment 2) and propranolol (10 mg/kg; Experiment 3), respectively, at doses that were determined to be non-aversive (Experiment 1). In each case of noradrenergic antagonism, CTAs with cocaine were not attenuated, suggesting that this drug''s conditioned aversive effects are mediated by non-noradrenergic NT activity. Furthermore, prazosin and propranolol administration appeared to facilitate the conditioned aversive effects of cocaine. The implications of these findings in regards to other neurochemical processes are discussed. [Copyright &y& Elsevier]

Abstract: Predicted environmental concentrations for five commonly used pharmaceuticals were calculated using data from the UK Department of Health according to risk assessment guidelines proposed by the European Agency for the Evaluation of Medicinal Products. Surface waters from the South–East of England were analysed and results were compared with predicted concentrations and findings from other studies from the UK and Europe. It was found that the efficacy of these predictions varied and was hampered by a shortage of data for many of the drugs. Ibuprofen, paracetamol and salbutamol were detected and quantified in all locations sampled. Ibuprofen was consistently found at the highest concentrations (up to 3μgl−1). Levels up and downstream of two wastewater treatment works were compared in order to investigate the link between sewage discharge and environmental concentrations of pharmaceuticals. Results from one site demonstrated a considerable increase in concentrations of ibuprofen, salbutamol and paracetamol downstream from the treatment works; however, no link was established for a second works. [Copyright &y& Elsevier]

Summary: Patients with tachyarrythmias as a result of thyroid storm have been typically treated with beta-blockers to decrease the heart rate and alleviate beta-receptor mediated symptoms such as anxiety and tremulousness. We report an unusual case of a previously well young man presenting to the emergency department with atrial flutter and who was clinically hyperthyroid. The patient was treated with propanolol to control his heart rate but suffered cardiovascular collapse. Although the patient was successfully resuscitated, he required inotropic support and intra-aortic balloon pump. The use of propanolol should be carefully considered in patients with thyrotoxic cardiomyopathy especially in those with heart failure because of the risk of exacerbation. [Copyright &y& Elsevier]

Abstract: A simple, rapid and sensitive procedure using solid phase extraction and capillary zone electrophoresis for the determination of propranolol (a beta-blocker) and one of its metabolites, N-desisopropylpropranolol, has been developed and validated. The optimum separation of both analytes was obtained in a 37cm×75μm fused silica capillary using 20mmol/L phosphate buffer (pH 2.2) as electrolyte, at 25kV and 30°C, and hydrodynamic injection for 5s. Prior to the electrophoretic separation, the samples were cleaned up and concentrated using a C18 cartridge and then, eluted with methanol, allowing a concentration factor of 30. Good results were obtained in terms of precision, accuracy and linearity. The limits of detection were 28 and 30μg/L for N-desisopropylpropranolol and propranolol, respectively. Additionally, a robustness test of the method was carried out using the Plackett–Burman fractional factorial model with a matrix of 15 experiments. The presented method has been applied to the determination of both compounds in human urine. [Copyright &y& Elsevier]

The effect of an artificial conductivity step on the migration time for rac-propranolol was investigated with the purpose to give a strict physical background to the intensively studied migration time and integration variations in voltage stabilized capillary electrophoresis. The experiments verified a theoretical derivation of migration time disturbances caused by the sometimes unavoidable conductivity variations in the system. The verified equation describing migration time variations was used for simulations of a number of relevant cases, such as variation in injected sample conductivity, post-injection diffusional broadening of the sample zone, and the physical effect of a selector zone in the partial filling mode. A similar theoretical and experimental treatment of the integration errors caused by non-uniform velocity was also included with special reference to enantiomer separation in the partial filling mode. The same experiments were also used to show that the standard migration time related method for integration correction fails if the velocity of a component is not constant throughout the experiment, such as the situation when a selector is employed in partial-filling mode. [Copyright &y& Elsevier]

Presents an index of terms used in the December 2002 issue of 'Ailment Pharmacology Therapeutics.' Alpha-antagonist; Adenosine triphosphate; Ampicillin; Amoxicillin; Antibiotic prophylaxis; Anticonvulsants; Antidepressants; Bisacodyl; Cyclo-oxygenase; Cytosolic hepatic function; Colonic motility; Complementary therapy.

It is well established that after acclimatization at high altitude, many sympathetic pathways are hyperactive yet heart rate (HR) remains unchanged. In this study, we attempted to determine if this unchanged heart rate is due to compensatory mechanisms such as changes in parasympathetic activity or levels of receptors for autonomic neurotransmitters. We also examined the role played by hypoxia in these autonomic adaptations to high altitude. Three experiments were carried out on five healthy lowlanders both at sea level (SL) and after 2 weeks of acclimatization at 3800 m (Post-Ac) with: (a) placebo (control); (b) acute β-adrenergic receptor blockade by propranolol (PRO), or (c) acute parasympathetic receptor blockade by glycopyrrolate (GLY). Compared with SL control values, post-Ac venous norepinephrine (NE) and dopamine increased by 96% (p<0.001) and 55% (p<0.05), but epinephrine and HR did not change. PRO resulted in a smaller decrease in HR (bpm) Post-Ac than at SL (15±6 vs. 21±6, p<0.05), while GLY caused a greater increase in HR Post-Ac than at SL (59±8 vs. 45±6, p<0.05). Breathing oxygen at SL concentration while at altitude did not decrease NE, or alter the effect of PRO on HR, but reduced the chronotropic effect of GLY by 14% (p<0.05). These results suggest that after acclimatization to altitude, increased parasympathetic neurotransmitter release and decreased β-adenoreceptor activity account for the unchanged HR despite enhanced sympathetic activity. Acute oxygen replacement rapidly counteracted the parasympathetic, but not sympathetic hyperactivity that occurs at high altitude. [Copyright &y& Elsevier]

The influence exerted by stimulation of the anterior hypothalamus (zone of cholinergic vasodilatation) on the performance of triceps surae during tetanic contraction has been investigated. Hypothalamic stimulation, if combined with indirect muscle stimulation, improves muscle performance, i.e. slows down the rate of decrease of contraction. The effect is abolished by atropine (0.5 mg/kg) and insensitive to propanolol (0.1 mg/kg). The cholinergic influence is only effective if hypothalamic stimulation coincides with the beginning of motor nerve stimulation. In some of our experiments stimulation of the same central structures elicited another influence on muscle performance, associated with the release of adrenaline into the blood. In this case, contrary to the cholinergic influence, the force of contraction increases only when hypothalamic stimulation does not start earlier than 100 s after the initiation of contraction (phase of slow decline of tension). The effect is insensitive to atropine (0.1 mg/kg) and abolished by propanolol (0.1 mg/kg). [ABSTRACT FROM AUTHOR]

Sixty healthy male volunteers were randomly assigned to one of six treatment groups on a doubleblind basis: Tests were carried out before treatment, 2 h after the first dose, after seven doses, and after 21 doses. Subjects performance on the Stroop Colour-Word Test was assessed in terms of (a) word reading speed and (b) an 'interference' score based on the difference between the incongruous colour word and colour card reading speed. No evidence was found of central effects of the beta-blockers, but personality x drug interactions were found, particularly in the reserpine group. [ABSTRACT FROM AUTHOR]