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  1. Home
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  3. Diffuse and benign Hemangiomatosis

Diffuse and benign Hemangiomatosis

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Finding out that your child has a hemangioma can be upsetting. If your child’s hemangioma does need treatment, you’re in the right place. Here at Sakra, we have expert teams of surgical specialties who are specialists in the field of vascular anomalies. The team’s approach ensures that your child’s treatment plan is carefully developed and coordinated with the expertise of our specialists in vascular anomalies.

As with other conditions, bleeding and ulceration are the complications of hemangioma. The doctors at Sakra, help you to determine if your child’s hemangioma may be likely to have a complication based on the location, size and speed of the growth. Our surgeons emphasize that treatment for hemangioma also requires good post op care. Generally shrinking of hemangioma takes 1 to 5 years of life.

What are hemangiomas?         

The most common benign tumors or vascular neoplasms that occur during infancy are called as hemangiomas. Hemangiomas are formed due to the abnormal collection of blood vessels. Infantile hemangiomas are generally characterized by early proliferation and involution of blood vessels.  Hemangiomas appear in varying size - small to large. Larger sized hemangiomas grow gradually into lesions which may require surgical removal. Hemangioma cells multiply to grow and thicken though they are considered as noncancerous lesions. They are different from cancerous lesions as they stop growing with time.

What causes hemangiomas in infants?
The reason for the occurrence of hemangiomas in infants is unknown. However certain known facts about hemangiomas are as follows;

  • More common in girls
  • Mostly seen in Caucasian children
  • Observed in babies born before their due date

What are the types of hemangiomas in infants?              
There are three types which include -   

  • Hemangiomas which occur on the outer layers of the skin are called superficial hemangiomas. They appear purple to bright red in color
  • Hemangiomas which grow under the skin of the fat is called as deep hemangiomas which are characterized by blue or purple in color.
  • The components of both deep and superficial hemangiomas are called mixed hemangiomas.

What are the sites at which hemangiomas develop?

  • Cutaneous hemangiomas- 60% of cutaneous hemangiomas occurs in the head and neck region. About 25% on the trunk and 15% on the extremities (legs and hands).
  • Extracutaneous hemangiomas- The sites at which extracutaneous hemangiomas occurs are; Liver, Pancreas, Gallbladder, Lymph nodes, Spleen, Urinary bladder, Lung, Thymus, Central nervous system, Larynx, Adrenal glands, Gastrointestinal tract

What are diffuse hemangiomas?

If more than 10 cutaneous hemangiomas are present they will be classified as diffuse hemangiomas.  Diffuse neonatal hemangiomas are characterized by raise in visceral lesions. Diffuse hemangiomas are life threatening conditions which can cause congestive heart failure due to raised vascular volume. Diffuse hemangioma mostly affects liver and gastrointestinal tract. Diffuse hemangioma can be treated with corticosteroids, interferon –α and conventional surgery.

What are the characteristic features of infantile hemangiomas?

Slow involution and rapid growth are important characteristics of infantile hemangiomas.

  • The most characteristic hallmark of infantile hemangiomas are rapid growth during birth to 4 weeks. This is called the proliferation stage of hemangioma
  • A very little change in the morphological characteristic of hemangioma which lasts until in 1-2 years old infants is the resting stage of hemangioma
  • Infantile hemangioma is tumoral, plaque-like and dome shaped. Sometimes there are combinations of these morphologies.
  • The growth of infantile hemangiomas occurs during first 4-6 months after birth.
  • After 6-12 months of birth, proliferation of hemangiomas slows considerably.
  • Diminish in the size of hemangioma occurs at the involution phase of hemangiomatosis.
  • About 50% of complete involution occurs at 5 years of age and 70% of complete involution occurs at 7 years of age.
  • Additional 3-5 years of time is required for complete involution to take place.
  • Girls are most commonly affected by hemangiomas when compared to boys
  • Seen mostly in caucasian children
  • Hemangiomas occur for infants who are born before their due date.

What are the symptoms of hemangiomas?

Hemangiomas are generally unnoticed, however when they develop into lager lesions or when multiple hemangiomas occur, they start exhibiting following symptoms which includes;

  • Nausea
  • Loss of appetite
  • Vomiting
  • Weight loss
  • Abdominal distress
  • Feeling oh abdominal fullness

What are the complications of hemangioma?

  • Bleeding
  • Ulceration
  • Interference in function of the organ

What are the treatment options for hemangiomas?

Most of the hemangiomas go away without any treatment, however treatment is required in some cases.

Treatment of hemangiomas depends on the following factors;

  • Age
  • Size of hemangioma
  • The growth of hemangioma
  • Location of hemangioma

Treatment also depends based on location of hemangiomas. Appearance of hemangiomas on the following locations requires quick treatment

  • Hemangiomas located on the airway or liver
  • Disfiguring hemangioma on skin
  • Hemangiomas appearing on ear canal and eye.

Based on the factors and locations of hemangiomas, following treatment options are opted;

  • Surgical removal- In rare cases, surgery is used to remove hemangioma
  • Cortisone can be injected directly into hemangioma or can be taken by mouth.
  • Laser therapy- laser therapy is suggested in the early flat stage of hemangioma. Laser therapy is to target blood vessels directly. Laser therapy is also used to remove scarring, loose skin and to remove fatty lumps which remains after the partial disappearance of hemangioma.

Other treatment options include;

  • Propranolol administration
  • Oral systemic corticosteroids
  • Treatment with gel containing Becaplermin
  • Vincristine treatment
  • Interferon α treatment

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Mahidhar's 1.5 year old daughter suffered from cancer and approached Sakra World Hospital for her treatment. 
Dr. Vineet Gupta and Sakra team's emotional support, alongside the radiation treatment helped her heal and move back into a healthier lifestyle.

Vesicoscopic Ureteric Reimplantation

Vesicoureteric reflux is the abnormal flow of urine from the bladder back up the ureters that connect the kidneys to the bladder. 
In normal condition, urine flows from the kidneys through the ureters down to the bladder which is unidirectional.
This condition is usually diagnosed in children when they presented with urinary tract infection or ultrasound abdomen revealing dilated ureters. it increases the risk of urinary tract infections and if left untreated can lead to kidney damage.

Symptoms of Vesicoureteral reflux?

The signs and symptoms of vesicoureteral reflux include:

  • A strong, persistent urge to urinate
  • A burning sensation when urinating
  • The need to pass urine frequently
  • Cloudy urine
  • Fever
  • Pain in the side of the abdomen

Untreated vesicoureteral reflux in children can lead to bedwetting, constipation, high blood pressure, and protein in the urine.

How is vesicoureteral reflux treated?
 
The treatment of vesicoureteral reflux depend on the severity of the condition. Children with mild cases of vesicoureteral reflux don’t need any surgery or medication. 

For severe vesicoureteral reflux, treatment options include:

Medications: Medicines are given to keep the infection from moving into the kidneys and the children are monitored for as long as he or she is taking medicines.

Surgery: Vesicoureteral reflux surgery is done to repair the defect in the valve between the bladder and each affected ureter. An obstruction in the valve keeps it from closing and preventing urine from flowing backwards. 

Sakra World Hospital pediatric urologists examine each patient thoroughly and exam to fit each patient and family. Sakra World Hospital has a state-of-art pelvic floor rehabilitation program to help cure these conditions.

The surprising link between oral health and pregnancy

Can Oral Health Have an Effect on Pregnancy?

Recent research indicates a link between gum disease and childbirth complications. Pregnant women who have gum disease may be more likely to have a baby that is born too early and too small.

More studies are needed to confirm the exact correlation between gum disease during pregnancy and labor complications, but it appears that gum disease may trigger increased levels of biological compounds that induce labor. Data also suggests that when periodontal disease worsens during pregnancy, there's a higher risk of having a premature baby.

What Can I Do to Ensure I Have a Healthy Pregnancy?

Pregnancy and dental care are important for a healthy baby. Pregnant women and women who plan on getting pregnant should visit their dentist for a checkup and to treat any dental problems before conceiving.

Regular brushing and flossing, eating a balanced diet and visiting your dentist regularly will help reduce pregnancy dental problems.


What Oral Problems Might Develop During My Pregnancy?

Many pregnant women experience pregnancy gingivitis — when dental plaque builds up on the teeth and irritates the gums. Symptoms include red, inflamed and bleeding gums.

Pregnancy gingivitis occurs due to increased levels of hormones that influence the way gums to react to the irritants in plaque.

Keeping your teeth clean, especially near the gum line, will help dramatically reduce or even prevent gingivitis during pregnancy. 

What Can I Expect When I Visit My Dentist During My Pregnancy?

First, be sure to let your dentist know you're pregnant when you schedule your appointment. It's best to schedule your dental visit during the fourth to sixth month of your pregnancy. Avoid seeing a dentist during the first three months of pregnancy, are thought to be of greatest importance in your child's development and the stress of a dental visit may be detrimental to the foetus.

Typically, X-rays, dental anesthetics, pain medications and antibiotics (especially tetracycline) are not prescribed during the first trimester, unless necessary. 

During the last trimester, prolonged sitting in a dental chair can become uncomfortable and a dental examination may be infeasible.

If you need to schedule an emergency visit, let the dentist know about your pregnancy before you arrive. Discuss any relevant medical history, stress factors, past miscarriages and medications you are taking as these can influence your dental care plan and outcomes.


Avoiding A Toothache During Pregnancy

It is recommended by dental specialists that women see a dentist before they plan a pregnancy. This way, the office can do a thorough checkup and cleaning, as well as treat any existing dental problems. Of course, you can also consult a dentist while pregnant.

When you experience a toothache or gum problems during pregnancy, see a dentist as soon as possible for treatment. Dental health issues can adversely affect your pregnancy and early intervention is important for both mother and child.

Avoiding Tooth Decay

Cavities are formed when the bacteria in your mouth use the sugars and carbohydrates present in food to produce acid, which dissolves the enamel on your teeth. 

Pregnant women are at increased risk for developing tooth decay due to a number of reasons: unhealthy food cravings, decrease in brushing and flossing and vomiting as a result of morning sickness can intensify the amount of acid in the oral cavity.

To prevent tooth decay, brush your teeth twice a day, using a soft brush and appropriate toothpaste. Keep sugary snacks to a minimum. Rinse your mouth with water when you aren't able to brush, and floss once a day. 

It's fairly common for an expecting mother to complain about bleeding gums when brushing or flossing. Hormonal changes that come along with pregnancy can cause inflammation, sometimes called pregnancy gingivitis. To keep this condition from developing into more serious gum disease, intensify your dental care routine by using an antibacterial mouthwash and seeing your dentist for more frequent cleanings.

Look Out for Gum Disease

Some pregnant women experience a raw-looking swelling of gum tissue called a "pregnancy tumor" grows between the teeth. These growths bleed easily and may be caused by excessive plaque. Consult a dentist if you suspect you have a pregnancy tumor, even though they are usually benign.

Another uncommon complication of pregnancy is loose teeth. This can develop due to hormones affecting the ligaments that hold the teeth in place.

Pregnancy dental care is an important part of your general health and the health of your baby. This is why, for a safe and healthy pregnancy, dentists and obstetricians encourage women to make their oral health a priority.

Oral hygiene maintenance during pregnancy

Unless it's a dental emergency, plan your dental visits throughout the entire pregnancy. Start by scheduling an appointment prior to becoming pregnant. That way, any necessary procedures can occur before you become pregnant. 

The first trimester isn't ideal for dental treatments as the fetus is in the initial stages of development. Instead, schedule non-emergency visits for the second trimester or early in the third trimester.

There a few experiences in a woman's life as special as being pregnant. Seeing a dentist while pregnant is often overlooked but it is important that you don't forget to maintain good oral health. That includes teeth cleaning while pregnant. 

Brush at least twice each day with a good toothpaste and don't forget to floss, as it complements brushing by removing food particles that stick in places a brush can't reach. Taking care of your mouth ahead of time will allow you to focus on the joyful arrival of your child.

Docs extricate LED bulb from toddler

Infants and babies have their own new ways of exploring everything in the small world around them. Everything is new to them and so is to the new parents. Especially in case of first time parents, everything that the child encounters and experiences for the first time, the parents have their own moments of learning, with lots of surprises, both good and bad. In this whole process of exploring and learning, the dangers that children are prone to are sometimes completely unimaginable for parents. Therefore, it is very essential to understand the potential risks that your child might be exposed to, while doing simple activities like playing, crawling, walking, and even eating.

Foreign body ingestion is one such risk that the parents need to consider at all points of time. Especially for children above the age of 6 months, i.e when they start sitting and crawling and have the ability to move around and  the tendency to approach or pick up almost any object in their reach. Almost every child has the risk of foreign body ingestion in the form of objects like – coins, pins, screws, buttons, batteries, and any kind of toy and toy parts. Although children may also sometimes aspirate food particles but the risks are comparatively lower, unless it is hard food particles like nuts that a baby is unable to chew. The foreign body can enter into the food passage or into the breathing passage, the latter resulting in serious breathing problems.

Recently a 15 month old baby was admitted to the ED of Sakra World hospital when the child accidentally ingested a small LED light, which was actually a part of one of his toys. Certainly the child must have broken that part of the toy while playing and would have put it into his mouth out of curiosity. Now the likelihood of such a thing is purely out of a new parents’ imagination but it seems parents need to become extra cautious nowadays. The incident happened outside Bangalore and the parents had to rush the child driving 3 hours to Bangalore.

The child was admitted immediately to the emergency and an X- Ray was done to identify the foreign body and its location in the breathing passage. A team of doctors including – pediatric surgeons (Dr.Ramachandra.C and Dr.Anilkumar P.L), Anesthesiologist (Dr.Hirachand Mutagi) at Sakra World Hospital got together and discussed the case to decide upon an appropriate line of treatment keeping in mind the best interest of the baby. It is very essential to take the right decision at the right time in such situations and since it is a complicated procedure considering the type of foreign body and its location. Every step needs to be performed carefully to avoid damage to the vocal cords (voice box) and trachea (main breathing passage) further leading to possible blockage of the breathing passage and temporary/permanent disabilities in speaking.

A carefully coordinated challenging anesthesia was induced for completing a successful bronchoscopy to safely retrieve the foreign body from the breathing passage ensuring it did not slip further into lungs nor caused any damage to the breathing passage.  A healthy playful child was discharged and the parents were well informed about future precautions and for ensuring a safe environment for the child to play and explore his surroundings.

Dr. Anil Kumar, Consultant – Pediatric Surgery, Sakra World Hospital – “Foreign body ingestion is a very common and a life threatening condition that infants and babies are highly prone to. The line of treatment and surgeries in such situations are also very complicated as the child often has to be put under general anesthesia and the surgery itself is complicated. Also such surgeries are considered very technique sensitive as the anesthesia is given through the trachea which is also the main site for surgery - Bronchoscopy.   I advise all parents to be very careful especially when they feed the baby with nuts / fruits with seeds. It is always preferable to feed these things under vision and also supervise the child while playing. Parents should seek immediate medical attention whenever child chokes or has continuous cough post feeding.”

Mr. Hari Kirishna Naidu – father of the baby said – “The whole situation came as a complete shock and was like living a nightmare for me and my family.  And I believe that the prompt decisions like taking an X-ray as the first step and deciding on an appropriate line of treatment taken by Dr. Anil Kumar and his team at Sakra World Hospital have played a big role in saving our child. I would also like to advise all parents to be extra careful and never to leave your kids unattended and also make sure that you buy only age appropriate toys for your kids.”

*representative image only and does not represent the actual patient

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