Serum levels of renin, angiotensin-converting enzyme and angiotensin II in patients treated by surgical excision, propranolol and captopril for problematic proliferating infantile haemangioma.

The role of the renin-angiotensin system (RAS) in the biology of infantile haemangioma (IH) and its accelerated involution induced by ß-blockers was first proposed in 2010. This led to the first clinical trial in 2012 using low-dose captopril, an angiotensin-converting enzyme (ACE) inhibitor, demonstrating a similar response in these tumours. This study aimed to compare serial serum levels of the components of the RAS in patients before and after surgical excision, propranolol or captopril treatment for problematic proliferating IH. Patients with problematic proliferating IH underwent measurements of serum levels of plasma renin activity (PRA), ACE and angiotensin II (ATII) before, and 1-2 and 6 months following surgical excision, propranolol or captopril treatment. This study included 27 patients undergoing surgical excision (n = 8), propranolol (n = 11) and captopril (n = 8) treatment. Treatment with either surgical excision or propranolol resulted in significant decrease in the mean levels of PRA. Surgical excision or captopril treatment led to significant decline in the mean levels of ATII. All three treatment modalities had no significant effect on the mean levels of ACE. This study demonstrates the effect of surgical excision, propranolol and captopril treatment in lowering the levels of PRA and ATII, but not ACE, supporting a mechanistic role for the RAS in the biology of IH.

Lack of seasonal variability for recurrent otitis media in very young children.

BACKGROUND: Effective strategies are available to prevent recurrent otitis media (ROM). Because epidemiologic studies have demonstrated marked seasonal variation in acute otitis media (AOM), clinical guidelines often recommend cessation of prophylactic measures during the summer. Unfortunately, those studies did not separately assess seasonal variation in children with ROM, the group most likely to benefit from preventive measures. METHODS: The charts of 648 children who had at least one diagnosis of AOM were reviewed to count AOM rates by calendar month and age. Children with at least three infections in a 6-month period were assigned to a ROM group and analyzed separately. Seasonal variability was statistically assessed using the ranked-sums method of Hewitt. RESULTS: The criterion for ROM was met by 176 children (27%), who had 1096 episodes of AOM and accounted for 52% of all infections. In the ROM group, the monthly infection rate remained above 10% for the first 2 years of life. There was no seasonal variation in the ROM group under 1 year of age. The recurrence risk for those who met the ROM criterion was very high: first month, 32%; second month, 30%; third month, 22%; fourth month, 20%. CONCLUSIONS: The youngest otitis-prone children show a high rate of infection in the summer months and a very high rate of recurrence. In these children, decisions about beginning or continuing preventive measures should not be influenced by the season of the year.

Conduct disordered adolescents from a community sample.

This study reports on a group of adolescents with conduct disorder in a community sample. Utilizing structured interviews for the adolescents and their parents, and strict requirements for caseness, conduct disorder was found to be the most common psychiatric problem (along with anxiety disorders). Various instruments were used. The findings, including approaches to conflict resolution in adolescents and their parents, are discussed.