TY  - BOOK
AU  - Ayman Ismail Mahmoud Ismail,
AU  - Sahar Shaker Sheta
AU  - Walaa Mohamed Elnaggar
AU  - Kareem Bakr El essawy
TI  - Comparative study of clinical effectiveness and safety of oral versus intralesional -blockers in treatment of infantile cutaneous hemangiomas
U1  - 618.92 
PY  - 2024///
KW  - Pediatrics
KW  - qrmak
KW  - Hemangioma
KW  - Oral beta blocker
KW  -  Intralesional beta blocker
N1  - Thesis (Ph.D)-Cairo University, 2024; Bibliography: pages 78-118; Issues also as CD
N2  - Infantile hemangiomas (IHs) are the most common benign tumors of infancy affecting 1% to 2.6% of newborns and up to 10% of children in the age of one year. Different modalities have been reported for the treatment of IHs, including surgery and pharmacotherapy. Oral propranolol has become the treatment of choice of large and complicated IHs. However, as expected with oral administration, systemic adverse effects may not be completely avoided. Use of alternative intralesional administration of propranolol could result in a better drug safety profile, higher localized drug concentration within the lesion, and less systemic risk for the recipients.
Aim of the work:
The aim of this study was to compare between oral Versus Intralesional propranolol in treatment of Infantile Hemangiomas regarding clinical efficacy and side effects.
Methodology:
Patients were divided into 2 groups: group A included 20 children received an oral propranolol hydrochloride starting at a dose of 1 mg/kg per day, then increased to 2 mg/kg per day gradually in 2 weeks, divided into two doses for 3 months. Group B that included 20 children, who were subjected to intralesional propranolol injection (1 mg/mL), the volume of the injected drug depended on the size of the lesion (0.2 mL injected per cm of lesion diameter), with a maximum volume of 1 mL for a lesion of 5 cm diameter under complete aseptic condition in the operating theater.
Results:
Group A, (received oral propranolol)a total number of 20 patients were included, 6 patients (30%) were males and 14 patients (70%) were females. The mean age of this group is 12.35±10.09 months with a range of 4-48 months. While in Group B (received intra-lesional propranolol), a total number of 20 patients were included, there were 5 patients (25%) were males and 15 patients (75%) were females. The mean age of this group is 15.45±13.75 months with a range of 4-72 months. In which, there is no significant difference between the two groups regarding sex and age, with P value >0.05 NS.
In the present study, in group A, the commonest sites were hemangiomas of upper lip (15%), behind the left ear (15%) and left upper eye lid (15%). While in group B, the commonest sites were hemangiomas of left upper eye lid (40%) followed right upper eye lid (15%). In which we found there was insignificant difference between both studied groups with p-value (>0.05 NS).
In the present study, in the Oral Group, the size of hemangioma ―cm‖ was compared initially and ―after 1m, 2months and 3months‖; from the start of oral propranolol which was initially 3.66±2.89 compared to ―2.78±2.00,
2.16±2.05 and 1.56±1.26‖ respectively. There was statistically significant reduction in the size of hemangioma in follow up visits compared to initial presentation with p-value <0.05.
In this study we found that in Group B, the size of hemangioma ―cm‖ was compared initially and ―after 1m, 2 months and 3months‖; from the time of injection which was initially 2.99±2.73 compared to ―1.91±1.76,
1.69±1.33 and 1.32±1.18‖ respectively. There was statistically significant reduction in the size of hemangioma in follow up visits compared to initial with p-value <0.05.
In this study, we found that the two groups were comparable regarding the size of hemangioma ―cm‖ after 3 months was 1.56±1.26 in group A compared to 1.32±1.18 in group B. There is no statistically significant difference with (p-value 0.538 insignificant).
In this study we showed that, in the oral group, one patient (5%) had bradycardia and one patient (5%) had diarrhea. While in the injection group, 20 patients (100%) had local edema and one patient (5%) had local infection. In which, there was insignificant difference between both studied groups as regards adverse effect; الأورام الدموية عند الأطفال هي الأورام الحميدة الأكثر شيوعًا في مرحلة الطفولة، حيث تصيب من 1% إلى 2.6% من الأطفال حديثي الولادة وحتى 10% من الأطفال في عمر سنة واحدة. وقد تم الإبلاغ عن طرق مختلفة لعلاج الأورام الدموية عند الأطفال، بما في ذلك الجراحة والعلاج الدوائي. أصبح البروبرانولول عن طريق الفم هو العلاج المفضل للأورام الدموية عند الأطفال الكبيرة والمعقدة. ومع ذلك، وكما هو متوقع مع الإعطاء عن طريق الفم، قد لا يتم تجنب الآثار الجانبية الجهازية تمامًا. قد يؤدي استخدام الإعطاء البديل داخل الآفة للبروبرانولول إلى تحسين ملف سلامة الدواء، وتركيز الدواء الموضعي الأعلى داخل الآفة، وتقليل المخاطر الجهازية للمتلقين.
هدف العمل:
كان الهدف من هذه الدراسة هو المقارنة بين البروبرانولول عن طريق الفم مقابل الإعطاء داخل الآفة في علاج الأورام الدموية عند الأطفال فيما يتعلق بالفعالية السريرية والآثار الجانبية.
المنهجية:
تم تقسيم المرضى إلى مجموعتين: المجموعة (أ) التي ضمت 20 طفلاً تلقوا هيدروكلوريد بروبرانولول عن طريق الفم بجرعة تبدأ بجرعة 1 مجم/كجم يوميًا، ثم تزداد إلى 2 مجم/كجم يوميًا تدريجيًا في غضون أسبوعين، مقسمة إلى جرعتين لمدة 3 أشهر. المجموعة (ب) التي ضمت 20 طفلاً، خضعوا لحقن بروبرانولول داخل الآفة (1 مجم/مل)، وكان حجم الدواء المحقون يعتمد على حجم الآفة (0.2 مل محقون لكل سم من قطر الآفة)، مع حد أقصى للحجم 1 مل لآفة قطرها 5 سم في ظل ظروف معقمة تمامًا في غرفة العمليات
ER  -