Decreased body-fat accumulation and increased vasorelaxation to glyceryl trinitrate in middle-aged male rats following six-weeks consumption of coconut milk protein

Abstract We investigated whether coconut milk protein (CMP) contributes to the beneficial effects of coconut milk consumption on cardiovascular health markers previously found in middle-aged rats. CMP was isolated and precipitated from dried fresh coconut milk, then gavaged (1 g/kg) to middle-aged male rats for six weeks; control rats received distilled water. Compared to controls, CMP caused decreased body fat and lipid accumulation in liver cells and the platelet count. CMP did not affect basal blood pressure or heart rate in anesthetized rats. Vascular responsiveness to phenylephrine, DL-propargylglycine (PAG), acetylcholine or sodium nitroprusside was unaffected, but vasorelaxation to glyceryl trinitrate (GTN) increased. Effects of ODQ on vasorelaxation to GTN were similar in both groups. Expression of blood vessel eNOS, CSE and sGC was normal. The cyclic guanosine monophosphate (cGMP) level of CMP-treated rats was normal but addition of GTN increased cGMP and NO concentration more in CMP-treated rats than in controls, an effect unaltered by addition of diadzin. Taken together, CMP appears partially responsible for the improvement in cardiovascular health markers caused by coconut milk in middle-aged male rats

Sclerotherapy of benign oral vascular lesions with non-diluted ethanolamine oleate / Escleroterapia de lesiones vasculares orales benignas con oleato de etanolamina no diluido

Benign oral vascular lesions are anomalies characterized by the blood vessels proliferation or malformation and the treatment with the sclerosing agent ethanolamine oleate acts irrigating the vessel producing a sterile inflammatory response. The objective of this study was to report and discuss the results from treatment of benign oral vascular lesions with non-diluted ethanolamine oleate through the analysis of clinical records. The sample was composed by the selection of twenty-six patients (12 male and 14 female), with oral vascular malformations. All lesions were treated with intralesional injections of undiluted ethanolamine oleate. These patients attended in Oral Medicine outpatient clinic of the Federal University of Paraná between the years of 2011 to 2015. The average age was 60.65 years, with a higher prevalence for women. The majority of the individuals had one lesion and its location was mostly in the lower lip. The main complaint was about a physical discomfort. The lesions had the average size of 6.52 mm and received a median number of 2.32 applications. Only one patient reported feeling pain in the postoperative week. In most cases the resolution of the lesion was considered partial. Follow-up was obtained up to one month after the end of treatment. The sclerotherapy with undiluted ethanolamine oleate shows acceptable results in the treatment of small benign oral vascular lesions with a few minor side effects.

Las lesiones vasculares orales benignas son anomalías caracterizadas por la proliferación o malformación de los vasos sanguíneos y el tratamiento con el agente esclerosante etanolamina oleato actúa irrigando el vaso produciendo una respuesta inflamatoria estéril. El objetivo de este estudio fue informar y discutir los resultados del tratamiento de lesiones vasculares orales benignas con oleato de etanolamina no diluido a través del análisis de historias clínicas. La muestra estuvo compuesta por la selección de veintiséis pacientes (12 hombres y 14 mujeres), con malformaciones vasculares orales. Todas las lesiones fueron tratadas con inyecciones intralesionales de oleato de etanolamina sin diluir. Estos pacientes acudieron a la clínica ambulatoria de Medicina Oral de la Universidad Federal de Paraná entre los años 2011 a 2015. La edad promedio fue de 60,65 años, con una mayor prevalencia para las mujeres. La mayoría de los individuos tenían una lesión y su ubicación era principalmente en el labio inferior. La queja principal era sobre una molestia física. Las lesiones tenían un tamaño promedio de 6,52 mm y recibieron una mediana de 2,32 aplicaciones. Solo un paciente informó haber sentido dolor en la semana postoperatoria. En la mayoría de los casos, la resolución de la lesión se consideró parcial. El seguimiento se obtuvo hasta un mes después del final del tratamiento. La escleroterapia con oleato de etanolamina sin diluir muestra resultados aceptables en el tratamiento de pequeñas lesiones vasculares orales benignas con algunos efectos secundarios menores.

Síndrome PAGOD y anomalías vasculares: ¿es un defecto de la angiogénesis embrionaria? Un nuevo caso y revisión / PAGOD syndrome and vascular anomalies: is a defect embryonic angiogenesis? A case report and review

El Síndrome PAGOD es un acrónimo de hipoplasia de pulmón y arterias pulmonares, agonadismo, onfalocele / defecto diafragmático y dextrocardia. Se describe una serie de 21 pacientes, en la cual, 90,5 % presentó un cariotipo 46,XY y solo dos casos 46,XX; el 66,6 % exhibió un fenotipo femenino y 28,6 % genitales ambiguos. La ocurrencia de dos paciente 46,XX excluye al cromosoma Y como portador del defecto genético y plantea la posibilidad de una herencia recesiva ligada al cromosoma X, sin descartar que los casos observados en hermanos puedan deberse a mutaciones en otros genes como STRA6, VEGFA, VEGFB, VEGFC, transcritos de empalmes alternativos de VEGFA, HIF1, HIF2, entre otros. Las malformaciones congénitas observadas en los pacientes fueron: genitales y gónadas 85,7 %, diafragma y pared 66,6 %, cardíaco 80,9 %, pulmonar 71,4 %, vascular 80,9 % y abdomen 42,8 %. La revisión de los pacientes ha demostrado un alto grado de variabilidad en la expresividad de malformaciones de órganos, aparatos o sistemas. Las malformaciones vasculares representan un componente importante y característico del síndrome PAGOD y cuya base morfogenética del síndrome pueda deberse a un defecto de la angiogénesis embrionaria temprana con repercusión en la organogénesis de aparatos y sistemas. Dentro de los genes relacionados con el remodelamiento vascular durante la embriogénesis, regeneración tisular y carcinogénesis está el Factor de Crecimiento del Endotelio Vascular D (VEGFD), localizado en Xp22.31, con expresión en pulmón, corazón, intestino delgado, pulmón fetal, útero, mamas, tejido neural y neuroblastoma, el cual representa un fuerte candidato para su análisis molecular como una de las posibles causa del síndrome.

PAGOD Syndrome is an acronym for lung and pulmonary arteries hypoplasia, agonadism, omphalocele / diaphragmatic defect and dextrocardia. A series of 21 patients is described, where 90.5% had a 46,XY karyotype and only two cases 46,XX; 66.6% exhibited a female phenotype and 28.6% ambiguous genitalia. The occurrence of two patients 46,XX excludes the Y chromosome as a carrier of the genetic defect and raises the possibility of a recessive X-linked inheritance, without ruling out that the observed cases in siblings may be due to mutations in other genes as Stra6, VEGFA, VEGFB, VEGFC, and alternative splicing of transcripts VEGFA, HIF1, HIF2, among others. Congenital malformations were observed in patients’ genitals and gonads 85.7%, 66.6% in diaphragm and abdominal wall , heart 80.9%, 71.4% lungs, blood vessels 80.9% and 42.8% in abdomen. The review of patients has demonstrated a high degree of variability in the expression of malformations of organs and organ systems. Vascular malformations represent an important and characteristic component of PAGOD syndrome and whose base morphogenetic syndrome may be due to a defect in early embryonic angiogenesis with impact on organogenesis and system development. Among genes related to vascular remodeling during embryogenesis, tissue regeneration and carcinogenesis, the Endothelial Growth Factor D Vascular (VEGFD), located in the Xp22.31 region, with expression in lung, heart, small intestine, uterus, breast, neuroblastoma and neural tissue, represents a strong candidate for molecular analysis as a cause of the syndrome.

Vasculitis leucocitoclástica / Leukocytoclastic Vasculitis

Introducción: la vasculitis leucocitoclástica constituye un proceso clínico patológico caracterizado por inflamación y necrosis de los vasos sanguíneos. Objetivo: describir las características clínicas de la vasculitis leucocitoclástica y el tratamiento utilizado. Resultados: se indicaron estudios de laboratorios: eritrosedimentación, células LE I, II y III, factor reumatoide, exudado faríngeo, U.S.A y biopsia de piel; arrojando este último vasculitis leucocitoclástica. Conclusiones: la vasculitis leucocitoclástica se conoce con el nombre de venulitis cutánea necrotizante y ocurre en asociación a enfermedades crónicas, puede ser precipitada por infecciones o drogas y desarrollarse por causa desconocida. Los fármacos y agentes terapéuticos que se describen son: penicilina, sulfonamida, tiamina, hidantoina, alopurinol, hidralazina propiltiuracilo y después de la estreptoquinaza recombinante, anticuerpos monoclonales y radioterapia(AU)

Introduction: Leukocytoclastic vasculitis is a clinicopathologic process characterized by inflammation and necrosis of blood vessels. Objective: Describe the clinical features of leukocytoclastic vasculitis and the treatment used. Results: Laboratory studies were initiated: ESR, LE cellsI, II and III, rheumatoid factor, throat swab, and skin biopsy; the latter showed leukocyte clastic vasculitis. Conclusions: leukocytoclastic vasculitis is known also as cutaneous necrotizing venulitis and it occurs in association with chronic diseases. Infections or drugs can precipitated it andit can be developed by unknown causes.The drugs and therapeutic agents described are penicillin, sulfonamide, thiamine, hydantoin, allopurinol, propylthiouracil and hydralazine after recombinantestreptoquinaza, monoclonal antibodies and radiotherapy(AU)

Importance of GLUT1 in differential diagnosis of vascular anomalies / Importância da GLUT1 no diagnóstico diferencial das anomalias vasculares

Vascular anomalies (VAs) include a group of distinct lesions, such as vascular system congenital malformations, as well as benign and malignant vascular tumors. These lesions may present similar clinical and histopathological features, leading to mistaken diagnoses and incorrect treatment choices. It is important that professionals responsible for monitoring the development of VAs conduct precise investigations and use the appropriate terminology. The human glucose transporter protein isoform 1 (GLUT1) has been proposed as a tool to aid in differential diagnosis between different VAs, given that it is a sensitive and specific marker for identification of infantile hemangiomas (HIs) in any organ. This article presents a review of the literature on this protein as an effective tool for identification and possible differential diagnosis between several VAs.

As anomalias vasculares (AVs) incluem um grupo de lesões distintas, como as más formações congênitas e os tumores vasculares benignos ou malignos. Estas lesões podem apresentar características clínicas e histopatológicas semelhantes, ocasionando equívocos diagnósticos e terapêuticos. Uma investigação precisa e o uso de terminologia adequada são fundamentais para as decisões do profissional responsável pelo acompanhamento da evolução de uma AV. A isoforma 1 da proteína humana transportadora de glicose (GLUT1) tem sido proposta como uma ferramenta auxiliar para o estabelecimento de diagnóstico diferencial entre AVs, uma vez que representa um marcador sensível e específico para a identificação de hemangiomas da infância de qualquer órgão. Este estudo objetiva fazer uma revisão da literatura acerca desta proteína como ferramenta eficaz na identificação e no possível diagnóstico diferencial entre as diversas AVs.

Embolización transcatéter con dispositivo, una promisoria opción en el tratamiento del secuestro pulmonar: casos clínicos / Transcatheter embolization device as a promising option in the treatment of pulmonary sequestration: case reports

Introducción: El secuestro pulmonar (SP) ha sido tratado por muchos años con cirugía convencional efectuando remoción del tejido pulmonar ectópico y ligadura de los vasos sanguíneos aberrantes que nacen desde la aorta. Existe evidencia establecida, especialmente en literatura de habla inglesa que apoya el uso de la embolización arterial transcatéter mediante dispositivo para ocluir el vaso anómalo, como una opción de tratamiento seguro y definitivo para el SP intralobar. Objetivo: Mostrar nuestra experiencia pionera de la técnica de tratamiento del SP por medio de embolización transcatéter. Caso clínico: Presentamos los casos clínicos de dos adolescentes, de 13 y 14 años y de un recién nacido de 26 días de vida, portadores de SP intralobar, cuyos diagnósticos se realizaron a través de Tomografía Axial Computarizada (TAC) con contraste, tratados mediante embolización arterial transcatéter, con buen resultado y sin complicaciones en el seguimiento precoz y tardío. Conclusión: Con este tratamiento se logra en los pacientes afectados de SP resultados definitivos, menos invasivos y sin complicaciones al seguimento.

Introduction: Pulmonary sequestration (PS) has been treated for many years with conventional surgical removal of the ectopic lung tissue and ligation of aberrant vessels that arise from the aorta. There is evidence, especially in English-language literature that supports the use of transcatheter arterial embolization through a device for occlusion of the anomalous vessel, as a safe option and definitive treatment for intralobar PS. Objective: To show our experience pioneering the technique of PS treatment through transcatheter embolization. Case report: The case reports of two teenagers aged 13 and 14 and a 26-day-old newborn that developed intralobar PS are described. The diagnosis was made through computerized axial tomography (CT scan) and successfully and without complication, during early and long term follow-up, treated by arterial embolization transcatheter. Conclusion: The use of transcatheter arterial embolization is a less invasive and definitive treatment for patients with PS.

Anillos vasculares como diagnóstico diferencial del asma / Vascular rings in differential diagnosis of asthma

Aortic arch abnormalities and vascular rings are a rare cause of compression of trachea and esophagus causing respiratory and digestive symptoms in adults. We report a 64 years old woman with exercise induced asthma not resolving with adequate treatment. Flow/volume loop shape suggested an intrathoracic major airway obstruction. Chest X ray showed a right sided aortic notch and CT scan revealed a vascular ring composed by a right aortic arch with aberrant left subclavian artery and Kommerell's diverticulum compressing trachea and esophagus. Bronchoscopy confirmed posterior wall compression of trachea exacerbated by tachycardia as a cause of symptoms. We think that is important to consider vascular rings as a differential diagnostic entity in difficult to treat asthma.

Las anomalías del arco aórtico y sus ramas son infrecuentes. La presencia de un anillo vascular determina la aparición de sintomatología relacionada con compresión traqueal o esofágica. El diagnóstico en la edad adulta es extremadamente inusual. Se presenta el caso de una mujer de 64 años con diagnóstico de Asma inducida por ejercicio, refractaria a tratamiento, la cual presentó disnea sibilante en relación al ejercicio, que no cedió con tratamiento bien llevado. La curva flujo-volumen sugirió obstrucción variable de la vía aérea central intratorácica, la radiografía de tórax mostró botón aórtico situado a derecha, la tomografía computada del tórax demostró un anillo vascular formado por un arco aórtico derecho, con la arteria subclavia izquierda aberrante, divertículo de Kommerell comprimiendo el esófago y con la aorta descendente que en su trayecto comprime la pared posterior de la tráquea, lo que es corroborado por videobroncoscopía, describiéndose compresión pulsátil, que se exacerbaba con la taquicardia. Se concluye que la paciente tiene un anillo vascular causante de los síntomas descritos y nos orienta a establecer que en el esquema de estudio de pacientes con asma atípica o de difícil manejo, es necesario incluir las malformaciones del arco aórtico en el diagnóstico diferencial, realizando al menos radiografía de tórax y revisando atentamente la gráfica de la curva flujo-volumen.

AKAP12 regulates vascular integrity in zebrafish

The integrity of blood vessels controls vascular permeability and extravasation of blood cells, across the endothelium. Thus, the impairment of endothelial integrity leads to hemorrhage, edema, and inflammatory infiltration. However, the molecular mechanism underlying vascular integrity has not been fully understood. Here, we demonstrate an essential role for A-kinase anchoring protein 12 (AKAP12) in the maintenance of endothelial integrity during vascular development. Zebrafish embryos depleted of akap12 (akap12 morphants) exhibited severe hemorrhages. In vivo time-lapse analyses suggested that disorganized interendothelial cell-cell adhesions in akap12 morphants might be the cause of hemorrhage. To clarify the molecular mechanism by which the cell-cell adhesions are impaired, we examined the cell-cell adhesion molecules and their regulators using cultured endothelial cells. The expression of PAK2, an actin cytoskeletal regulator, and AF6, a connector of intercellular adhesion molecules and actin cytoskeleton, was reduced in AKAP12-depleted cells. Depletion of either PAK2 or AF6 phenocopied AKAP12-depleted cells, suggesting the reduction of PAK2 and AF6 results in the loosening of intercellular junctions. Consistent with this, overexpression of PAK2 and AF6 rescued the abnormal hemorrhage in akap12 morphants. We conclude that AKAP12 is essential for integrity of endothelium by maintaining the expression of PAK2 and AF6 during vascular development.

Proteus syndrome: a case report

Proteus Syndrome is an extremely rare, sporadic and progressive disorder. We describe a four-month-old male baby with central nervous system manifestations in this article. A four-month-old boy was admitted into our hospital with three tonic- clonic generalized seizure attacks which started from the day before admission. Each seizure attack lasted less than 10 minutes and the baby was well between attacks. No fever was detected. On physical examination, abnormal facial features, macrocrania, a wide nasal bridge, overgrowth of the right lower limb, macrodactyly in the third left toe, epidermal nevus on the left side of the abdomen and skin vascular abnormalities were detected. His developmental status was normal. Brain Magnetic Resonance Imaging [MRI] revealed left sided hemihypertrophy, ventricle enlargement and macrocrania on the same side

Sinus pericranii: an uncommon tortuous vascular anomaly with traumatic origin

Sinus pericranii is an unusual venous anomaly characterized by communication of pericranial varicosities with an underlying dural sinus. The varicosities are intimately associated with the periostium, are distensible, and vary in size with changes in intracranial pressure. Symptoms are infrequent but include headache, vertigo, feelings of fullness, local pain, or dermatological lesion. It presents at the paediatric age group more than other age groups and it affects males more than females. Although its aetiology has not been settled yet, however, computerized tomography scan discloses those of traumatic nature. Although, in many instances, it raises a cosmetic concern to the patient and parents, the condition is not without possible "significant' complications, e.g., haemorrhage, infection, dermatological, and air embolism during operative intervention. We describe the clinical features, imaging and operative findings of a case of Sinus pericranii presented to our department, the reason for the surgical treatment of which was the cosmetic concern of the patient's parents

Lesión de dieulafoy en colon: una causa inusual de hemorragia gastrointestinal en el paciente pediátrico / Colonic dieulafuy lesion: an unusual cause of gastrointestinal hemorrhage in children

La lesión de Dieulafoy es una causa importante pero infrecuente de hemorragia gastrointestinal. Se ha descrito a nivel gástrico y menos frecuente en duodeno, yeyuno y colon. Macroscópicamente es una malformación arterial, con tortuosidad y elongación del vaso, que aparece como un pequeño defecto de la mucosa e histológicamente son vasos largos que envuelven la submucosa y están por debajo de la mucosa. Tiene una incidencia del 0,3-1,5 por ciento como causa de sangrado gastrointestinal masivo. Pre-escolar masculino de cuatro años de edad quien ingresa por cuerpo extraño en vías aéreas (grano de maíz). Al estar hospitalizado presenta melenas con anemia e inestabilidad hemodinámica. Rectosigmoidoscopia con evidencia de sangrado descendente. Gammagrafía reporta zona de hipercaptación en ángulo esplénico de colon. En pabellón se realiza colonoscopia trans-operatoria, evidenciándose efusión sanguínea con puntillado hemorrágico en ángulo esplénico, por lo que se procede a realizar colectomía y anastomosis. Anatomía patológica reporta proliferación de vasos de mediano calibre en la submucosa, rodeados por estrona fibroso con infiltrado linfohistocitario, vasos congestivos en la serosa. Se plantea Lesión de Dieulafoy. Esta entidad clínica es infrecuente, el diagnóstico es difícil de realizar, cuando la ubicación es inusual. La gammagrafía es útil para el diagnóstico. Si el sangramiento digestivo compromete la vida del paciente el tratamiento definitivo es quirúrgico.

The Dieulafoy´s lesion is an infrequent but important cause of gastrointestinal haemorrhage. These lesions have been described at the gastric level and less frequently in the duodenum, jejune and colon. Macroscopically it is an arterial malformation, with tortuosity and elongation of the vessels that appear like a small defect in the mucosa and by histology as long vessels that surround the sub mucosa below the mucosa. It has an incidence of 0,3-1,5% as cause of massive gastrointestinal bleeding. 4 years old male that presents with a foreign body (corn seed) in the airway that required bronchoscophy. During admission presents frequent melena with anemia and hemodynamic instability. Rectosigmoidoscopy showed lower gastrointestinal bleeding without abnormal findings. Gammagram reported hypercaptant zone at the splenic angle of the colon. During surgery, trans-operating colonoscopy demonstrated hemorrhagic punctiform lesions with blood effusion at the splenic angle of the colon, and a segment of the colon was resected. Histopathology reported congestive blood vessels with proliferation of medium-caliber vessels, surrounded by fibrous stroma with linfohistiocitic infiltrate in the serosa, confirming the diagnose of Dieulafoy´s lesion. This is an infrequent cause of gastrointestinal bleeding that is difficult to diagnose when it presents in an inusual location. Gammagram is helpful for the diagnosis. If the gastrointestinal bleeding compromises the life of the patient, definite treatment should be surgical.

Evaluation of pediatric patients with vascular malformations managed with endovascular and radiosurgical techniques using a modified Rankin Disability Scale

BACKGROUND: Pre- and postoperative evaluation of the pediatric patient with a cerebrovascular malformation can be cumbersome. This may be due to several factors, including age and ability to verbalize. Functional evaluation scales have been devised, yet application to a retrospective study, where information can be limited, may not be possible. Simpler scales, serving the purpose of functional description and categorization would be beneficial in these cases. METHODS: Between December 1997 and December 2003, 24 patients between the ages of 4 months to 17 years old underwent endovascular treatment for cerebrovascular lesions at our institution. The majority of the arteriovenous malformation cases underwent further radiosurgical treatment. Mean follow-up period from the time of the last endovascular or radiosurgical intervention was 22 months. A pediatric modification of the Rankin Disability Scale was used for evaluation of pre-procedural and post-procedural functional status. RESULTS: Combined embolization/radiosurgical approach had 4% mortality and 4% morbidity rates. This combined technique achieved a 46% cure in a variety of pediatric vascular anomalies. Overall improvement in disability using the pediatric modification of the Rankin Scale was noted for all of the cases, and a tendency for improvement was noted in the arteriovenous malformation subgroup though not statistically significant, p = 0.0547. CONCLUSIONS: These results indicate that a pediatric modification of the Rankin Disability Scale can be used for functional evaluation in this population. Although other functional evaluation scales are available and validated, using a Rankin Disability Scale modification is straightforward, and it can provide functional categorization in retrospective studies.

Manifestaciones cutáneas de las enfermedades gastrointestinales: segunda parte / Cutaneous manifestations of gastrointestinal diseases: second part

En la segunda parte de este artículo de revisión de las manifestaciones cutáneas de las enfermedades gastrointestinales, se discutirán algunas de las genodermatosis con potencial maligno, que presentan manifestaciones digestivas y dermatológicas y los síndromes asociados a hemorragia gastrointestinal.

Potential Role of Homer-2a on Cutaneous Vascular Anomaly

Homer protein was identified based on its rapid induction in rat hippocampal granule cell neurons following excitatory synaptic activity. Although the presence of the Homer gene in the peripheral tissues has been observed in previous reports, the physiological function of the Homer protein in these tissues has not been noted. In this experiment, a Homer-2a cDNA fragment was successfully amplified by RTPCR in the involuting phase of human hemangioma but not in the human vascular malformation and normal vessel. After isolation of full Homer cDNA in a mouse liver cDNA library, E1-deleted recombinant adenovirus expressing the Homer protein (Adv.CMV.mHomer-2a) was constructed to determine its physiological function in peripheral tissues. Adv.CMV.mHomer2a, but not Adv.CMV.LacZ (recombinant adenovirus expressing beta-galactosidase), strongly inhibited the growth rate of HUVECs (human umbilical vein endothelial cells) probably via inducing apoptosis determined by acridine orange/ethidium bromide (AO/EB) staining methods. This study suggests that the Homer gene is present in human specimens in the involuting phase of hemangioma, and it might be involved in the growth control.

Colaterales aortopulmonares toracoabdominales y ductus arterioso permeable: hallazgos de US Doppler y embolización / Aortopulmonary thoraco abdominal vascular anomalies and persistent ductus arteriosus: US Doppler and embolization

Se presenta el caso de un caso en un recién nacido (RN) con ductus arterioso permeable asociado a colaterales arteriales pulmonares toracoabdominales detectadas con ecografía Doppler Color y tratado con embolización. Un RN prematuro que desarrolló a los 37 días de vida insuficiencia cardíaca severa y persiste con la sintomatología luego de la ligadura quirúrgica del Ductus. Fue estudiado con ecografía Doppler Color abdominal y tratado con embolización mediante coils. Se detectó inicialmente con US Doppler Color una arteria colateral infradiagfragmática. Por cateterismo, se observaron dos vasos anómalos que nacían de la Aorta cerca del origen de la arteria subclavia y un tercero que nace cerca del tronco celíaco. El retorno venoso pulmonar era normal y fue posible la embolización con coils con oclusión total de las colaterales. Los síntomas mejoraron dramáticamente luego del procedimiento. Este caso ilustra que los pacientes con insuficiencia cardíaca de etiología no clara deben ser estudiados con ecografía Doppler Color. El tratamiento de elección de arterias colaterales sistémicas anómalas es la embolización con coils, evitando cirugías

Hemangiomatosis neonatal difusa / Neonatal disseminated hemangiomatosis

Introducción. La hemangiomatosis neonatal difusa (HND) es un síndrome raro que consiste en la aparición de múltiples hemangiomas cutáneos pequeños y sobreelevados, los cuales pueden estar asociados a hemangiomas en el hígado, pulmones, tracto gastrointestinal, laringe y sistema nervioso central entre otros. Estos hemangiomas pueden estar presentes al momento del nacimiento y con el transcurso del tiempo pueden desarrollarse nuevos hemangiomas. De existir hemorragias importantes, estos niños pueden fallecer; sin embargo, se han reportado casos de involución espontánea. Actualmente no se cuenta con ningún método que permita predecir la evolución final de estos niños, pero con el advenimiento de esteroides e interferón su pronóstico se ha favorecido.Caso clínico. Se reporta el caso de una recién nacida quien presentó hemangiomas cutáneos múltiples al nacimiento corroborado mediante biopsia. Se investigaron asociaciones y se detectó un hemangioma hepático mediante ultrasonografía Doppler, tomografía axial computada y arteriografía. Recibió tratamiento con hidroclorotiazida e interferón, y evolucionó satisfactoriamente. Conclusión. El diagnóstico y tratamiento oportuno tanto de la HND como de las asociaciones viscerales que comprometen la vida, favorecen su evolución y pronóstico. Hemangiomatosis neonatal difusa; esteroides; interferón.