Propranolol therapy in 55 infants with infantile hemangioma: dosage, duration, adverse effects, and outcome.

Propranolol has recently been reported to be a highly effective treatment for infantile hemangioma (IH) and is emerging as a first-line therapy. This study reports the observations after completed propranolol therapy in 55 patients. Propranolol was administered in a dosage of 2 mg/kg per day with initial monitoring of vital signs. Therapy duration was planned for 4 to 6 months; if there was significant relapse, the period of treatment was extended. The mean age of 55 patients at the beginning of the treatment was 6 months (52.7% <4 mos, 30.9% 4-9 mos, 16.3% >9 mos). Thirteen patients (21.7%) showed a reaction possibly due to the medication, but we did not observe any life-threatening adverse effects. The therapy was interrupted due to temporary aggravation of preexisting bronchial asthma in one child. The initially administered dosage was adjusted to the increase of weight in 21 patients (38.2%), but most did not require a dosage adjustment despite somatic growth. Mean duration of treatment was 6 months; younger patients needed longer treatment periods. Response to treatment was favorable; eight (14.5%) showed total regression and 46 (83.4%) partial regression, and one (1.8%) had no response. Propranolol is an efficacious therapy for severe IH. Risks and complications appear moderate. If indicated, therapy should be initiated early to minimize the extent of residual changes. Young patients show quick and extended benefit. Prospective controlled trails are necessary to observe the effects on a long-term basis.

Pain and anxiety during interventional radiologic procedures: effect of patients' state anxiety at baseline and modulation by nonpharmacologic analgesia adjuncts.

PURPOSE: To assess how patients' underlying anxiety affects their experience of distress, use of resources, and responsiveness toward nonpharmacologic analgesia adjunct therapies during invasive procedures. MATERIALS AND METHODS: Two hundred thirty-six patients undergoing vascular and renal interventions, who had been randomized to receive during standard care treatment, structured empathic attention, or self-hypnotic relaxation, were divided into two groups: those with low state anxiety scores on the State-Trait Anxiety Inventory (STAI, scores < 43; n = 116) and those with high state anxiety scores (> or = 43; n = 120). All had access to patient-controlled analgesia with fentanyl and midazolam. Every 15 minutes during the procedure, patients rated their anxiety and pain on a scale of 0-10 (0, no pain/anxiety at all; 10, worst possible pain/anxiety). Effects were assessed by analysis of variance and repeated-measures analysis. RESULTS: Patients with high state anxiety levels required significantly greater procedure time and medication. Empathic attention as well as hypnosis treatment reduced procedure time and medication use for all patients. These nonpharmacologic analgesia adjunct treatments also provided significantly better pain control than standard care for patients with low anxiety levels. Anxiety decreased over the time of the procedure; patients with high state anxiety levels experienced the most significant decreases in anxiety with nonpharmacologic adjuncts whereas patients with low state anxiety levels coped relatively well under all conditions. CONCLUSION: Patients' state anxiety level is a predictor of trends in procedural pain and anxiety, need for medication, and procedure duration. Low and high state anxiety groups profit from the use of nonpharmacologic analgesia adjuncts but those with high state anxiety levels have the most to gain.

Lutein, zeaxanthin, macular pigment, and visual function in adult cystic fibrosis patients.

BACKGROUND: Pancreatic insufficiency in cystic fibrosis (CF), even with replacement pancreatic enzyme therapy, is often associated with decreased carotenoid absorption. Because the macular pigment of the retina is largely derived from 2 carotenoids, lutein and zeaxanthin, the decreased serum concentrations seen in CF may have consequences for ocular and retinal health OBJECTIVES: Our aims were to determine plasma carotenoid concentrations, determine absorption and distribution of macular pigment, and assess retinal health and visual function in CF patients. DESIGN: In 10 adult CF patients (ages 21-47 y) and 10 age- and sex-matched healthy control subjects, we measured macular pigment density in vivo, measured serum lutein and zeaxanthin concentrations, and comprehensively assessed visual performance (including contrast sensitivity, color discrimination, and retinal function) under conditions of daylight illumination. RESULTS: Serum lutein and zeaxanthin were significantly reduced (P < 0.005) in CF patients ( +/- SD: 87 +/- 36.1 and 27 +/- 15.8 nmol/L, respectively) compared with control subjects (190 +/- 72.1 and 75 +/- 23.6 nmol/L, respectively). Although macular pigment optical density was significantly lower (P < 0.0001) in the CF group (0.24 +/- 0.11) than in the control group (0.53 +/- 0.12), no significant differences in visual function were observed. CONCLUSIONS: Adults with CF have dramatically low serum and macular concentrations of carotenoids (lutein and zeaxanthin), but their ocular status and visual function are surprisingly good. The clinical implications of low plasma concentrations of carotenoids in CF are yet to be clarified.