Subclinical Ultrasound Characteristics of Infantile Hemangiomas That May Potentially Affect Involution.

OBJECTIVES: Infantile hemangiomas (IHs) are the most common benign tumors in children. Color Doppler ultrasound is a noninvasive imaging modality that can show subclinical anatomic parameters in a wide range of dermatologic conditions. The purpose of this study was to describe the ultrasound characteristics of IHs and look for subclinical features with the potential to influence the involution and therapeutic response. METHODS: A review of the ultrasound database of children with clinical and ultrasound IH diagnoses was conducted. The clinically reported duration and the ultrasound assessment of the proliferative phase were compared. Descriptive and statistical analyses of qualitative and quantitative parameters of the series were performed. Significance was set at P < .05. RESULTS: A total of 204 IHs were included. Twenty percent had arteriovenous shunts; 15% had afferent branches from main regional arteries; and almost 30% showed involvement of deep structures. Sixty-one percent of IHs were in the head and neck. Deep hemangiomas showed significantly thicker lesional vessels. A prolonged proliferative stage was significantly associated with a higher presence of arteriovenous shunts and a higher peak systolic velocity of the arterial vessels (≥15 cm/s) within the lesions. CONCLUSIONS: Color Doppler ultrasound can support the detection of subclinical anatomic features that may potentially influence the involution and response to treatment of IHs. Some of these characteristics may serve as potential markers to predict and manage IHs in prolonged proliferative stages.

Siringocistoadenoma papilífero y carcinoma basocelular en nevo sebáceo: reporte de caso / Papilliferous sarcomatocystoma and basal cell carcinoma in nevus sebaceous: case report

El nevo sebáceo o nevo de Jadassohn es un hamartoma cutáneo congénito poco frecuente formado por múltiples estructuras cutáneas. Presenta potencial de transformación a una variedad de neoplasias epidérmicas benignas y malignas, que suelen presentarse de manera individual. Si bien esta descrito en la literatura, es inusual el desarrollo de más de una neoplasia sobre un nevo sebáceo. En esta publicación se presenta el caso de un hombre de 62 años con una lesión de 3 años de evolución, cuyo estudio histopatológico demostró la presencia de un carcinoma basocelular y un siringocistoadenoma papilífero sobre un nevo sebáceo de Jadassohn.

Nevus sebaceous of Jadassohn is an infrequent cutaneous congenital hamartoma, formed by multiple cutaneous structures. It possesses a transformation potential to benign and malignant epidermic neoplasms, that usually present individually. Even though a few cases have been published, the coexistence of two or more tumors is rare. We hereby present the case of a 62 years old male, with a nevus sebaceous of Jadassohn history, that after excisional biopsy showed the presence of a basal cell carcinoma associated to a syringocystoadenoma papilliferum.

[Laugier-Hunziker syndrome in a patient with Sjögren’s syndrome: Report of one case]. / Posible asociación autoinmune entre síndrome de Laugier-Hunziker y síndrome de Sjögren: reporte de un caso y revisión de la literatura.

Laugier-Hunziker syndrome is a rare benign idiopathic condition characterized by acquired macular pigmentation of lips and buccal mucosa, often accompanied with melanonychia. The main concern with this condition is to rule out other differential diagnosis with systemic repercussions and similar hyperpigmentation patterns, such as Peutz-Jeghers syndrome, adrenal insufficiency and melanoma. We report a 58-year-old female with a 20-year history of Sjögren’s syndrome, presenting with melanonychia and hyperpigmentation in the buccal mucosa. She had no relevant medication history and is a non-smoker. The patient denied any other symptoms. The histopathology confirmed the diagnosis of Laugier-Hunziker syndrome.

Posible asociación autoinmune entre síndrome de Laugier-Hunziker y síndrome de Sjögren: reporte de un caso y revisión de la literatura / Laugier-Hunziker syndrome in a patient with Sjögren’s syndrome: report of one case

Laugier-Hunziker syndrome is a rare benign idiopathic condition characterized by acquired macular pigmentation of lips and buccal mucosa, often accompanied with melanonychia. The main concern with this condition is to rule out other differential diagnosis with systemic repercussions and similar hyperpigmentation patterns, such as Peutz-Jeghers syndrome, adrenal insufficiency and melanoma. We report a 58-year-old female with a 20-year history of Sjögren’s syndrome, presenting with melanonychia and hyperpigmentation in the buccal mucosa. She had no relevant medication history and is a non-smoker. The patient denied any other symptoms. The histopathology confirmed the diagnosis of Laugier-Hunziker syndrome.

Existen límites en la decisión de los padres sobre el tratamiento de sus hijos / Are there limits on parental decision- making over children's treatment

In medical practice, there are situations where medical opinion differs from the patient's perception of their own benefit. This situation becomes more complex when the parents of a minor child are who deny their children life- saving treatment. It is necessary to determine how far professionals will fight over the management of a child's care if parents refuse treatment. To help in the development of criteria, three recently publicized cases are reviewed, including an analysis of the possible limits of parents to decide the treatment of their children. It is concluded that while it is vital to understand and respect the parents' beliefs, the fundamental duty is to the patient and their right to live. Therefore, it is justified to access the Courts when persuasion fails.

En la práctica de la medicina nos encontramos ocasionalmente con situaciones en las que la opinión médica discrepa con la del paciente acerca de su mayor beneficio. Esta situación se torna aún más compleja cuando son los padres del paciente menor de edad quienes se niegan a que sus hijos reciban un tratamiento que le puede salvar la vida. Se hace necesario precisar hasta dónde luchar por la salud de un niño si sus padres rechazan los tratamientos. Con el propósito de contribuir a establecer criterios en este tema, se presentan tres casos públicos recientes y se analizan los posibles límites de la autoridad de los padres para decidir los tratamientos de sus hijos. Se concluye que es de vital importancia comprender y respetar las creencias de los padres del menor, pero que en último término nuestro compromiso fundamental es con el paciente y su derecho a la vida, razón por la cual se justifica, ante el fracaso de la persuasión, recurrir a los tribunales como última instancia.