[Treatment of empyema thoracis in children]

Empyema, an accumulation of infected fluid in the thoracic cavity, is commonly secondary to bacterial pneumonia in children. Despite the high prevalence and availability of many medical treatment options, there is no general consensus on the optimal management approach, which would lead to full and rapid recovery. Especially, there are the big differences in treatment options for the child with empyema. Regardless of the differences in the procedures, the ultimate outcomes are good. This article reviews the current literature and discusses the important considerations in managing these patients. This paper describes thoracoscopic and open thoracic surgery procedures in children. The authors present their own observations based on years of experience in the treatment of thoracic empyema.

Persistent organochlorine compounds in human milk collected in Croatia over two decades

The distribution and time trend of organochlorine pesticide (OCP), polychlorinated biphenyl (PCB), and polychlorinated dibenzo-p-dioxin/polychlorinated dibenzofuran (PCDD/PCDF) concentrations in human milk samples from Croatia collected in 1981-2003 are presented. Between 1981/1982 and 1987/1989, the concentrations of HCB, beta-HCH, DDE, and total PCBs decreased about 50%, while for the last decade, the concentrations have been decreasing very slowly. In 2002/2003 the range of PCB congeners and OCPs was from below the limit of determination to 332 ng g(-1) milk fat. PCDD/PCDF concentrations in human milk samples collected in 1981-2000 ranged between 5.2 and 26.7 pg I-TEQ g(-1) milk fat and showed a decreasing trend.

[Hematopoietic stem cell transplantation in children with primary immunodeficiencies]

Hematopoietic stem cell transplantation is the optimal treatment for patients with primary immunodeficiencies. Best results are achieved with stem cells from a HLA-identical donor, but it is only possible in a small number of patients. Until recently, HLA-mismatched/haploidentical hematopoietic stem cell transplantation was reserved exclusively for patients with severe combined immunodeficiency (SCID). However, as there are many haploidentical donors, it has become the treatment of choice for many other severe primary immunodeficiencies. Apart from appropriate choice of the donor, treatment of infections and pre-transplantation patient conditioning have major impact on transplantation outcome in patients with primary immunodeficiencies.

Met-enkephalin effects on histamine-induced bronchoconstriction in guinea pigs

We investigated the effects of the neuropeptide met-enkephalin on histamine-induced bronhoconstriction in an experimental model of asthma. Classic Konzett and Rössler's method of whole body plethysmography modified by Gjuris, was applied in the study. This method represents a standard experimental model of bronchoconstriction, suitable for the evaluation of peptide effects on the histamine-induced bronchoconstriction. The results of the measurements implicate a dose-related modulatory effect of met-enkephalin on the bronchoconstrictor action of histamine. Met-enkephalin doses of 1 mg/kg and 10 mg/kg, respectively, caused statistically significant reduction of the histamine-induced bronchoconstriction. Estimated ED50 dose was 0.235 mg/kg. Further studies are needed to define practical and therapeutical use of the presented observations in respiratory pharmacology.

Adherence ability of Pseudomonas aeruginosa strains isolated from patients with cystic fibrosis to two different epithelial cell lines

The ability of 59 wild-type strains of Pseudomonas aeruginosa to adhere to the HeLa and Buffalo Green Monkey Kidney (BGMK) cells was investigated. Twenty strains were isolated from sputa of cystic fibrosis patients, while 19 strains were isolated from tracheal aspirates and 20 from bronchial secretions of patients without cystic fibrosis, and they were used as a control group of strains. The statistically significant difference between adherence ability of strains was observed (p < 0.01). While most of the tracheal and bronchial isolates were hyperadhesive (51-110 bacteria per cell) most of the cystic fibrosis isolates adhered poorly to the HeLa and BGMK cells (1-10 bacteria per cell). The bacterial binding to the cells was blocked when bacteria were incubated at 80 degrees C for 20 min before the adherence assay. These results indicate that alginate is not involved in the adherence of P. aeruginosa to the used epithelial cell lines, and, because of that, mucoid strains isolated from persistently colonized cystic fibrosis patients showed poor adherence ability.

[Sideropenic anemia in infants and toddlers]

Iron-deficiency anemia is the most common anemia in infants. In the routine pediatric care this problem is encountered every day. Numerous factors in infancy (low birth weight, rapid growth, insufficient nutrition) are involved in the development of iron-deficiency anemia, and they must be considered when establishing diagnosis, counselling parents, and prescribing oral iron preparations. Data on 119 patients aged up to two years treated in the Division of Gastroenterology and Nutrition, Pediatric Department, University Hospital Centre Zagreb Salata between 1994 and 1999, were analyzed. We were prompted to do so because of great frequency of iron-deficiency anemia as one of associated diagnoses, and unfortunately often the only diagnosis requiring hospitalization. Out of 119 patients with iron-deficiency anemia, nine (7.7%) patients (four premature newborns and three from twin pregnancy) had to receive transfusion of erythrocyte concentrate due to very bad general condition and low red blood count, accompanied by clinical signs of anemic hypoxia. We also analyzed prenatal and perinatal history, socioeconomic living conditions of these children, i.e. their nutrition, and if they had previously received oral iron preparations. Some of the results, such as inadequate alimentation with flour, as well as insufficient prophylaxis of iron deficiency, which were found in most cases of severe anemia, point to the need of paying greater attention to this problem, better parents education, and more adequate screening for iron deficiency anemia.

Organochlorine pesticides and PCBs in human milk collected from mothers nursing hospitalized children

Organochlorine compounds in milk were analyzed in samples collected over a nine-year period (1987-1995) from nursing mothers (N = 139) whose children were hospitalized for various disorders. All samples contained p,p'-DDE and PCBs; the median concentrations were 318 micrograms/kg milk fat and 220 micrograms/kg milk fat resp. Higher levels were found in mothers (N = 12) nursing neonates with impaired neurodevelopmental competencies or an inappropriate arousal reaction. No difference was observed between mothers nursing children with respiratory or gastrointestinal diseases, urinary tract infections or other infectious diseases, anemias, prolonged neonatal hyperbilirubinaemias or when children were with dermatological findings, congenital malformations or healthy.

[The intestinal immune system in children and their disorders]

The specificities of arrangement and normal function of the intestinal immunological system are presented, and non-immunological and immunological gastrointestinal defense mechanisms are described. Of immunological defense mechanisms, cellular and humoral mechanisms are described separately, and their characteristics in childhood are highlighted. After a general survey of the intestinal immunological system disorders and their role in various diseases, three most frequent such diseases are described in detail: food intolerance, gluten enteropathy and chronic inflammatory bowel disease.