The role of chemerin in the pathogenesis of cholelithiasis in children and adolescents

BACKGROUND AND AIM

Adipokines and hepatokines are proteins secreted by adipose tissue and the liver. To date, the levels of adipokines and hepatokines in cholelithiasis have only been evaluated in studies in adult patients. The purpose of our research was to assess the levels of circulating adipokines: chemerin, vaspin, progranulin, retinol-binding protein 4 (RBP-4) and hepatokine: fibroblast growth factor 21 (FGF-21) and to compare their concentrations in paediatric patients with and without cholelithiasis.

METHODS

The prospective study included 54 children and adolescents diagnosed with gallstones and 26 controls. Fasting serum levels of adipokines and hepatokine were determined by enzyme-linked immunosorbent assays.

RESULTS

The serum levels of chemerin, FGF-21 and RBP-4 were significantly higher in children and adolescents with gallstones compared to the control group. Elevated levels of triglycerides, RBP-4, and a homeostatic model for assessing insulin resistance (HOMA-IR) were observed in overweight or obese patients compared to patients with normal weight and cholelithiasis. Chemerin concentrations were increased in the normal-weight children and adolescents with cholelithiasis compared to the control group. Children and adolescents with gallstones and abnormal weight had significantly higher levels of chemerin, FGF-21 and RBP-4 than healthy controls.

CONCLUSION

Elevated serum chemerin levels were significantly higher in non-obese patients with cholelithiasis than in non-obese controls, suggesting a potential role of chemerin in the development of cholelithiasis in children and adolescents.

The nutritional status and factors contributing to malnutrition in children with chronic pancreatitis

BACKGROUND/OBJECTIVES

The present study was undertaken to determine the prevalence of malnutrition among children with chronic pancreatitis (CP). Furthermore, we aimed to evaluate the relationship between etiological factors of CP, its clinical characteristics, and the severity of malnutrition.

METHODS

The study included 208 children with CP (113 girls and 95 boys; mean age: 10.8 years, range: 1.6-18 years), hospitalized at our center between 1988 and 2012. The severity of malnutrition was graded on the basis of Cole's ratios, and its prevalence was analyzed according to the etiological factors of pancreatitis. Moreover, the analysis of discrimination was performed to identify the factors contributing to malnutrition among the following variables: age at CP onset, duration of CP, number of CP exacerbations, the number of ERCPs performed, the grade of pancreatic damage documented on imaging, co-occurrence of diabetes, and the results of 72-h fecal fat quantification.

RESULTS

We documented features of malnutrition in 52 (25%) children with CP, including 36 (17.3%) patients with moderate malnutrition, and 2 (0.96%) with severe malnutrition. There was no significant difference in the prevalence of malnutrition between groups of patients with various etiological factors of chronic pancreatitis. The age at CP onset showed the best discrimination ability of malnourished patients: the mean age at disease onset in a subgroup of malnourished children was significantly higher than in children with Cole's index >85%.

CONCLUSIONS

A considerable percentage of children with CP can suffer from clinically significant malnutrition. Later age at CP onset predisposes to development of malnutrition.

Beneficial effect of liver transplantation on bone mineral density in small infants with cholestasis

Reports of bone mineral density in children after liver transplantation are few. Eleven cholestatic children were analyzed before and 6 months after liver transplantation. No changes in serum levels of calcium, alkaline phosphates, or 25OHD were observed before versus after LTx. The serum levels of phosphorus and 1-25(OH)2D3 as well as total bone mass density and Cole index were significantly increased after liver transplantation.

The past and present of the Polish paediatric gastroenterology, hepatology and nutrition

Gastroenterology has emerged from paediatrics as a separate discipline after 1978, due to the development of basic sciences, i.e., biochemistry, immunology, pathomorphology and introduction of miniaturized endoscopic and radiological equipment. This paper describes the most significant achievements in the areas of gastroenterology, hepatology, and nutrition in children in particular medical centres in Poland. It also discusses the role of the Polish Society for Paediatric Gastroenterology, Hepatology and Nutrition, the role of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), and the role of other Scientific Societies and Foundations supporting the development of science and education. The emphasis has been placed upon utilitarian research and education with regard to the management of children with gastrointestinal and hepatic disease.

Further delineation of the classical Smith-Lemli-Opitz syndrome phenotype at different patient ages: clinical and biochemical studies

We present here extensive clinical and biochemical data on thirteen SLOS (type I) patients with proven defect in cholesterol biosynthesis for further delineation of the classical SLOS phenotype at different patient ages.

[Evaluation of nonspecific inflammatory bowel disease in children using disease activity scoring systems]

Scoring systems for assessment of clinical activity of IBD were used to evaluate 62 children with IBD (14 with CD, 35 with CU and 13 with CNS). The PCDAI system was most effective in children with CD. In children with CU, both modified Truelove-Witts and Rachmilewitz indexes are equally effective, however use of the Truelove-Witts scale is simpler. The Rachmilewitz scale is better in distinguishing between UC and CNS.

[Giant-cell hepatitis in a 10-year-old boy]

In this paper we present a 10-year-boy with viral giant-cell hepatitis with a immune component. We observed clinical, biochemical and histological improvement after treatment.

[Changes in the gastrointestinal system of children with inflammatory systemic connective tissue diseases]

Functional and morphological changes of the gastrointestinal system were assessed in patients suffering from juvenile chronic arthritis, juvenile systemic erythematosus and juvenile systemic scleroderma. The results of endoscopic investigation of the gastrointestinal tract showed inflammatory changes and cardiac and pylorus atony. Ultrasonography results suggested hepatic and pancreatic inflammatory changes, steatosis and/or amyloidosis. The above-mentioned changes were confirmed by morphological investigation (biopsy and/or autopsy). The results of the capacity tests performed in JCA (systemic form) patients revealed an impairment of liver detoxication function, and pancreas and bowel functional capacity as well. Additionally, intolerance against lactose, casein and alpha- and beta-lactoglobulin was found in most of the patients. Some symptoms of malnutrition were observed in all of them. Such factors as underlying disease severity, adverse drug effects, environmental factors (infections, nutrition) were taken into consideration as probable causes of the gastrointestinal system damage.

[Preliminary evaluation of the usefulness of passage time along the alimentary tract in the diagnosis of constipation in children]

In children with constipation the usefulness of passage time along the large bowel was assessed, limiting the number of performed rectal enemas. The preliminary results suggest that it is possible to answer the clinician's questions - whether the passage time is prolonged, and if so, to determine in what segment of the large bowel. This method may be treated as a screening test in the diagnosis of constipation in children.

Internal organ involvement in juvenile connective tissue disease

Using noninvasive investigative techniques, cardiac, pulmonary and gastrointestinal abnormalities were found in patients with all types of connective tissue diseases. Impedance rheography suggested impaired myocardial function. Abnormalities of pulmonary function included a decrease in diffusing lung capacity for CO (DL) values followed by restrictive ventilatory defects and mild alveolar hyperventilation. The results of endoscopic investigation of the gastrointestinal tract showed inflammatory changes. Ultrasonography revealed dyskinesis of the ducts of the gallbladder and some hepatic and pancreatic structural changes.

[Recurrent abdominal pain in children]

In the paper the results are presented of an analysis of the causes of recurrent abdominal pain in 294 children hospitalized at the Gastroenterology Department, Childrens Health Centre, and the accepted diagnostic programme is evaluated. The children were referred to the CHC, as a rule with a suggestion of organic causes of recurrent abdominal pain. On the basis of carried out examinations the following was diagnosed: in 111 children organic causes (37.8% of the studied group), in 94 children recurrent abdominal pain of functional aetiology (32%), in 53 children psychological background (18%), and in 36 children mixed organic and functional background. These proportions between those groups is the result of the selection carried out at earlier stages of the diagnostic process. In the paper, the correctness and validity of the accepted diagnostic programme are also demonstrated.

[Clinical-morphologic analysis of children dying of intoxication with Amanita phalloides]

The results were subjected to analysis of 23 autopsies carried out in children dying of intoxication with Amanita phalloides. The correlation of the pathomorphological findings with the clinical picture and biochemical pattern was evaluated. The morphological changes were also presented in organs other than the liver which is recognized as the target organ for Amanita phalloides toxins.

Evaluation of the liver blood flow in the children with portal hypertension

The aim of the study was to evaluate the liver blood flow at different stages of hepatitis B as compared with prehepatic block. The examination was performed on 79 children aged 1-17 years who were divided in two groups. Group 1 consisted of 20 children with HBV chronic active hepatitis B: 10 children with liver efficiency (Gr. 1A) and 10 with liver cirrhosis (intrahepatic block) Gr. 1B. Group 2 comprised 59 children with prehepatic block. The liver blood flow was assessed with the help of a radioisotope liver scintiscan by the first flow technique using 99mTc-DTPA. The ratio of portal to total liver blood flow (HPI) and time of portal blood flow (T1/2) were estimated. In children from group 1A the HPI mean was 57% (N over 75%) and T1/2 was 7-8 sec (N4-7 sec) depending on age. In Group 1B the HPI mean was 25% and T1/2 was 9-13 sec. In most of the children with prehepatic block HPI was low (mean 22%) and was similar to that in children with cirrhosis due to HBV. The arterial blood flow increased while HPI showed a distinct decrease.

["Munchausen syndrome by proxy" as an example of diagnostic error]

A case of the girl who underwent multiple hospitalizations is presented. Gastrointestinal disorders were seen in the infancy together with skin rash of allergic type, hypoglycaemia without any clear reason in the fourth year of age, and polyuria with hyponatremia and hypokalemia since the sixth year of age. Mother's lack of concern was unexplainable in view of the deteriorating child's health. Samples of the urine and faeces supplied by the mother have shown the laboratory findings suggesting that potassium chloride was added to the faeces and natrium hydrocarbonate--to the urine. Urine collected during polyuria contained large quantities of furosemide. Long-term follow-up, numerous examinations and performed tests have led to the diagnosis of the particular form of the ill-treated child syndrome, so-called "Munchausenn by proxy" syndrome.

[Changes in vitamin D metabolism in children following partial intestinal resection]

Six children (five after partial intestinal resection, one after colectomy) were studied with respect to absorption and metabolism of vitamin D. The results showed decreased 25-OH-D3 serum concentrations below 20 ng/ml (in two patients even below 10 ng/ml), possibly due to disturbed enterohepatic circulation of vitamin D metabolites.

[Fiber-optic endoscopy of the lower gastrointestinal tract in children]

Between 1978 and 1985 565 lower gastrointestinal endoscopies were performed in children. In 221 cases the cause of rectal bleeding was explored, in 227 the suspicion of colitis and in 25 of polyposis was verified. To evaluate the results of treatment (polypectomy, surgical procedures and medical therapy in inflammatory bowel disease) 121 examinations were done. With increasing experience the complete colonoscopy was performed more often. In 1985 coecum and ileum terminale was reached in almost all children in whom it was needed (75% of all examinations). The inflammatory changes were revealed on 230 occasions. In 78 cases colon polyps and in 27 vascular changes were found. The most common cause rectal bleeding were colon polyps (66 cases) and inflammatory changes (554 cases). Less common were vascular changes (10 cases). 32% false negative and 16% false positive results of colonoscopy in diagnosis colitis were obtained when the results of visual findings were compared with histopathological findings. Colonoscopy performed by an experienced colonoscopist rather avoiding general anesthesia is a safe and useful procedure in diagnosing lower gastrointestinal tract diseases in children. The evaluation of colitis should be based on visual findings with biopsy confirmation.

Endogenous, cutaneous vitamin D synthesis stimulation as an effective way of improving the vitamin D status in children with hepatobiliary malfunctions

Repetitive (5 days) ultraviolet treatment was used to improve vitamin D status of 26 pediatric patients suffering from different hepatobiliary disorders. The treatment resulted in a significant improvement of patients' vitamin D and 25-hydroxyvitamin D levels regardless of their disease and other factors such as increased blood bilirubin content or jaundice. Presence of a dependence between the increase in 25-hydroxyvitamin D concentrations after treatment and its original levels was confirmed.

Clinical features and computer-aided analysis of chromosome aberration in a case with incontinentia pigmenti

Incontinentia pigmenti (IP) is an X-linked dominant disease, usually lethal to males. IP belongs to rare diseases involving skin pathological findings, together with neurological and ophthalmological disorders. We here report a two-year old girl with typical symptoms of the IP. A hitherto unreported feature is partial deletion of short arms of one of the chromosomes 15, found in the girl and in her mother. Using an automatic chromosome picture analyzer, a densitometric analysis of the aberration was carried out, in order to determine the break point and to compare the normal and deleted chromosomes.

Short- and long-term results of colonoscopic polypectomy in children

Eighty-four colorectal polyps of up to 3.3 cm in diameter were removed with the diathermy snare during 48 colonoscopies on 42 children, aged 2 to 18 years (mean, 7.4 years). Most polyps were juvenile and the majority were located in the sigmoid colon (55%) or rectum (37%). No complications related to medication, colonoscopy, or snare polypectomy were observed. The two presenting symptoms, rectal bleeding and anemia, disappeared soon after polypectomy in all but one patient with adenomatous polyposis coli, subsequently operated upon. Follow-up examinations, including total colonoscopy, performed 4 months to 7 years (mean, 25 months) later did not reveal abnormalities in any of the 37 children whose previously removed polyps were juvenile. The authors conclude that endoscopic snare polypectomy is an effective and safe treatment for colorectal polyps in the pediatric age group.

[Vitamin D metabolism in children with malabsorption syndrome]

In 16 children with malabsorption syndrome, out of which 5 had impaired lipid absorption or diarrhoea, and in 14 children in the control group the concentrations of vitamin D and 25 OH D3 were determined after oral administration of vitamin D in dose of 1200 U/kg.b.wt. or 12000 U/kg.b.wt. No decrease in initial 25 OH D3 concentrations was noted in children with malabsorption syndrome (40,5 +/- 0,7 ng/ml) in comparison with the control group (40,0 +/- 0,4 ng/ml). In children with impaired lipid absorption and diarrhoea the 25 OH D3 concentration was 33,6 +/- 2,4 ng/ml. After oral administration of vitamin D in small doses no differences were noted in the increase in vitamin D and 25 OH D3 concentrations in children with malabsorption syndrome or the control group. After administration of vitamin D in the dose 10 times higher no difference in the increase in vitamin D concentration was noted in children with malabsorption syndrome and the control group. However the increase in 25 OH D3 concentration in children with malabsorption syndrome was 49,8 +/- 1,2 ng/ml and 145,0 +/- 3,5 ng/ml in the control group. In the children with impaired lipid absorption and diarrhoea decreased vitamin D and 25 OH D3 concentrations were noted. This means that physiological doses of vitamin D in children with malabsorption syndrome are sufficient to supply vitamin D. Diarrhoea and impaired lipid absorption however, are indications for stimulation of skin synthesis of vitamin D.

The Saethre-Chotzen syndrome with partial bifid of the distal phalanges of the great toes. Observations of three cases in one family

The authors describe three cases of familial acrocephalosyndactyly (ACS) in two boys (9 and 3 years of age) and in their 7.5-year old sister. In addition, irregularities in skull and limbs were found in the 46-year old father as well as in two other children, i.e., two girls, 14 and 4 years of age. The mother (46 years-old) and the remaining four 4 boys (12-, 9-, and 7-years-old), as well as the youngest child, a son, 1-year-old) did not show any deviations. The diagnosis of the Saethre-Chotzen syndrome in six members of one family was based on the finding of a typical skull deformation (oxybrachycephalia), low hairline, flattened nasofrontal angle, lateral deviation of the nasal septum, facial dysmorphy, prolapse of upper eyelids, antimongoloid placement of palpebral fissures, protruding eyes, hypertelorism, dysmorphy of auricles, imperfect hearing, highly arched palate, improper dentition, and characteristic skin syndactyly of hands and feet. In addition, deformed chest, weight and height deficiency, significant mental retardation, as well as, in the boys, true cryptorchidism were found. Radiological examination showed, in all affected members of the family, intensified digitate impressions within the whole fornix of the skull, large and deep sella turcica, underdeveloped frontal bone and upper jaw bone, untypical syndactyly of hands and feet, and the partial bifid of distal phalanges of the great toes, not described previously in the Saethre-Chotzen syndrome. In the differential diagnosis, other forms of ACS, i.e., Apert, Vogt, Pfeiffer, Summitt, and Herrmann-Opitz syndromes, were not found. Manifestation of the described symptoms transferred autosomally, dominantly, and with a similar degree of expression in 6 of 11 members of one family, leads us to think that they are the consequence of a fresh mutation revealed in the father.