Infantile Hemangiomas: Pathogenesis and Review of Propranolol Use.

BACKGROUND: Infantile hemangiomas are complex benign vascular tumors that present after birth. Hemangioma lesions have a predictable course of growth, but little is understood about the mechanism behind their development. Infantile hemangiomas are considered proliferative lesions of the endothelial cells. PURPOSE: To effectively manage infants with infantile hemangiomas, a clear understanding of the pathogenic pathways is important and can assist the healthcare provider with effective treatment. This understanding will facilitate a relationship of support with the families of affected infants. METHODS/SEARCH STRATEGIES: EBSCO host and Ovid database search for key words of infantile hemangiomas, propranolol, vascular lesion, and proliferative lesion was utilized. Articles on pathophysiology along with recent research studies were include in the search. FINDINGS/RESULTS: The use of propranolol is a recent development in the treatment of infantile hemangiomas, which has shown a high rate of response in decreasing the size and reducing the potential for life-long complications. Different studies have shown the same success rate with the use of propranolol but with different variables. IMPLICATIONS FOR PRACTICE: As a healthcare team member, better identification and customized care of these patients can reduce the rare but devastating complications of infantile hemangiomas. IMPLICATIONS FOR RESEARCH: Future research can help identify the most effective dose and course of propranolol administration.

[An experience nursing an ambulatory pediatric surgery patient and his mother: the practice of caring].

A seven-year old child was scheduled for excision of hemangioma under local anesthesia. Utilizing the concept of caring, we provided pre- and intra-operative support to both the patient and his mother. Before the operation, we effectively established the self-confidence of the patient by providing sufficient disease-related information and encouragement in a child-oriented approach, in order to enable the patient to overcome fear and pain. This caring approach proved effective during the operation since the patient was fully aware of each surgical step and the levels of pain to be experienced. The mother was also involved throughout the process. She was therefore not only emotionally pacified, but also actively involved in the psychosocial support process. Traditionally, almost all surgical procedures in pediatric patients have been performed under general anesthesia. This report indicates that under appropriate care some of the less invasive surgical procedures in school-age children can be carried out under local anesthesia to avoid the risks involved in general anesthesia.

Vascular birthmarks: a care study of an infant with haemangioma.

This care study describes the application of an evidence-based approach to the care of an infant with a sacral haemangioma. It explores four key aspects of management: specific therapeutic modalities; local wound management; pain management; and management of infection. Clinical governance and evidence-based practice are now important elements of care delivery in the NHS (Department of Health (DoH), 1997). Current evidence relating to haemangiomas and wound management is critically appraised and applied to an individual patient within the primary care setting. The appropriateness of theories and models of nursing are considered in relation to holistic assessment. Recent evidence regarding the management of pain at dressing change (Moffatt et al, 2002) and its relevance to haemangiomas are highlighted. Reflective practice is an integral part of experiential learning and the development of practical knowledge (Ghaye, 2000). Reflective practice and critical analysis have facilitated the provision of high-quality care and allowed a deeper and clearer understanding of both practice and theory, and their relationship within clinical practice. It is concluded that reflective practice aids the delivery of high-quality care at a personal, professional and practice development level.

Flying home.

In the rapidly progressing field of critical care, the diverse delivery of such care seems to be reaching new "heights." In particular, aeromedical transport of critically ill patients involves detailed preparation for the worst possibilities but with expectations for the best outcomes. The following case is presented as testimony to the challenges of critical care transport.

Flashlamp-pumped pulsed dye laser treatment of vascular birthmarks.

Before the availability of the flashlamp-pumped pulsed dye laser (FPDL), patients with vascular birthmarks were treated with lasers that had a significant risk of scarring. For more than a decade, such patients have had the choice of being treated with the FPDL, which is safe, effective, and has a low risk of scarring; however, not all vascular birthmarks are amenable to treatment with the FPDL. The laser surgeon must understand the classification and natural history of the various vascular birthmarks to select the most appropriate therapy for a given patient. This article reviews FPDL treatment of port wine stains and hemangiomas, as well as the nursing care required for the laser procedure.