We found there to be a limited evidence base for the treatment of infantile haemangiomas: a large number of interventions and outcomes have not been assessed in RCTs.Our key results indicate that in the management of IH in children, oral propranolol and topical timolol maleate are more beneficial than placebo in terms of clearance or other measures of resolution, or both, without an increase in harms. We found no evidence of a difference between oral propranolol and topical timolol maleate with regard to reducing haemangioma size, but we are uncertain if there is a difference in safety. Oral propranolol is currently the standard treatment for this condition, and our review has not found evidence to challenge this. However, these results are based on moderate- to very low-quality evidence.The included studies were limited by small sample sizes and risk of bias in some domains. Future trials should blind personnel and participants; describe trials thoroughly in publications; and recruit a sufficient number of children to deduce meaningful results. Future trials should assess patient-reported outcomes, as well as objective outcomes of benefit, and should report adverse events comprehensively. Propranolol and timolol maleate require further assessment in RCTs of all types of IH, including those considered problematic, as do other lesser-used interventions and new interventions. All treatments should be compared against propranolol and timolol maleate, as beta blockers are approved as standard care.
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LF. Sarcoidosis y carcinoma fibrolamelar del hígado. AnMed Interna (Madrid) 2007; 24: 431-434. RESUMENSe presenta el caso de una paciente de 20 años de edad con el diagnóstico de sarcoidosis asociada a carcinoma hepático fibrolamelar. Se exponen algunos aspectos clínicos de estas dos enfermedades, así como la conducta diagnóstica y terapéutica seguida. Se resaltan las opiniones de diferentes investigadores sobre la posible relación de la sarcoidosis con las enfermedades neoplásicas, las cuales hasta el momento actual son contradictorias. Se concluye que esta asociación es supremamente rara y debe tenerse en cuenta en el estudio de pacientes jóvenes con sintomatología compatible. INTRODUCCIÓNLa sarcoidosis es una enfermedad de etiología desconocida que se caracteriza por la acumulación en los tejidos afectos de linfocitos CD4+ y monocitos, así como la presencia de granulomas no caseificantes que conducen a la alteración de la arquitectura tisular normal (1). Aunque suele existir anergia cutánea y disminución de los procesos de inmunidad celular en sangre, en los lugares afectados la sarcoidosis se caracteriza por un aumento de la actividad inmunitaria en la que intervienen los linfocitos T colaboradores (TH1) (1). El HLA-DRB1 se señala como un factor de riesgo para esta enfermedad (2).Esta entidad puede afectar cualquier parte del organismo, siendo más frecuente en el pulmón, ganglios, piel, ojos, así como en el hígado y en el bazo. Se ha señalado la asociación de sarcoidosis con enfermedades inmunes (3), neoplasias (4) e infecciones (5).El hepatocarcinoma fibrolamelar (HF) fue primeramente reportado por Edmonson en 1956, es un tipo especial de hepatocarcinoma, dado que la mayoría de los casos ocurren en ausencia de cirrosis del hígado y pueden ser resecables (6); este tumor es muy raro, y lo es más aún en América Latina, donde sólo se han reportado hasta el 2002, 12 casos (7), y en la literatura revisada a nivel mundial, entre 1980 y 1999 se habían informado solamente 165 casos (7).El objetivo de este trabajo es la presentación de una paciente con sarcoidosis asociada a un HF, asociación que no hemos encontrado reportada en la literatura médica después de un profundo rastreo bibliográfico, y que además constituye el primer caso expuesto en nuestro pais. CASO APORTADOPaciente femenina, negra, de 20 años de edad, estudiante, soltera, sin hábitos tóxicos, ni antecedentes patológicos familiares de interés, refiere que desde los 12 años sufría de bronquitis recurrentes, por lo que fue asistida desde la niñez en consulta de alergología, recibiendo tratamiento con antihistamínicos, esteroides inhalados, y vacunas
Summary Infantile haemangiomas are a type of birthmark. They are soft, raised swellings on the skin, often with a bright‐red surface caused by a non‐cancerous overgrowth of blood vessels in the skin. The majority of these lesions are uncomplicated and will shrink on their own by age seven; however, some require treatment if they occur in high‐risk areas or cause psychological distress. This article summarises the major findings of a Cochrane Review, which aimed to assess the benefits and harms of treatments for haemangiomas of the skin in infants and children, collecting evidence up to February 2017. The review included 28 studies (1728 children), which assessed lasers, beta‐blockers, steroids and radiation therapy, among other treatments. When compared with placebo treatment, propranolol taken by mouth at a dose of 3 mg/kg/day is probably more beneficial in terms of complete or almost‐complete clearance of swelling and reduction in volume of the haemangioma (moderate‐quality evidence). In addition, timolol maleate 0.5%‐gel applied topically (to the skin) twice daily may reduce redness when assessed against placebo (low‐quality evidence). Short‐ or long‐term serious cardiovascular events were not reported in either group. Likewise, there was no evidence of a difference between propranolol taken by mouth (via a tablet once per day, at a 1.0 mg/kg/dose) and topical timolol maleate (0.5% eye drops applied twice daily) in terms of their effect on reducing haemangioma size by 50% or more (low‐quality evidence). Oral propranolol is currently the standard treatment for this condition, and we did not find evidence to contest this treatment in terms of efficacy and safety. High‐quality future research should assess the effects of propranolol and timolol maleate, as well as other alternative medications, on outcomes that are important to patients, including adverse‐related events (unwanted side effects), parents’/children's opinions of improvement, and cosmetic appearance.
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