Sport activities for children and adolescents: the Position of the European Academy of Paediatrics and the European Confederation of Primary Care Paediatricians 2023-Part 1. Pre-participation physical evaluation in young athletes

The European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP) emphasize the importance of promoting healthy lifestyles within the pediatric population. Many health professionals have questions concerning adequate levels of physical activity for both the healthy pediatric population and for those who may have specific complications. Unfortunately, the academic literature that provides recommendations for participation in sport activities within the pediatric population that have been published during the last decade in Europe is limited and is mainly dedicated to specific illnesses or advanced athletes and not toward the general population. The aim of part 1 of the EAP and ECPCP position statement is to assist healthcare professionals in implementing the best management strategies for a pre-participation evaluation (PPE) for participation in sports for individual children and adolescents. In the absence of a uniform protocol, it is necessary to respect physician autonomy for choosing and implementing the most appropriate and familiar PPE screening strategy and to discuss the decisions made with young athletes and their families. This first part of the Position Statement concerning Sport Activities for Children and Adolescents is dedicated to healthy young athletes.

Infant with Parotid Sialoblastoma and Nevus Sebaceous, Treated with Surgery and Adjuvant Chemotherapy

Sialoblastoma is an extremely rare embryonal tumor derived from salivary gland primordial cells. Treatment usually consists of surgery alone; however, in some cases, chemotherapy is required and is administered with good response. We present a case of a 5-week-old girl diagnosed with a parotid gland tumor and co-existing nevus sebaceous on the face. Initial tumorectomy was microscopically non-radical and histopathology revealed sialoblastoma. The patient received adjuvant chemotherapy consisting of vincristine, actinomycin, and cyclophosphamide. Due to imaging studies being inconclusive regarding response and possible residual disease, a second surgery (total parotidectomy) was performed. The histopathology results showed fields of necrosis in the parotid gland but no neoplastic cells in the material. The patient remains under watchful observation and there is no evidence of relapse 12 months after the second surgery. The adjuvant chemotherapy regimen with vincristine, actinomycin, and cyclophosphamide is a viable option of treatment in children with sialoblastoma.

Childhood Obesity: Position Statement of Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes, the College of Family Physicians in Poland and Polish Association for Study on Obesity

Childhood obesity is one of the most important problems of public health. Searching was conducted by using PubMed/MEDLINE, Cochrane Library, Science Direct, MEDLINE, and EBSCO databases, from January 2022 to June 2022, for English language meta-analyses, systematic reviews, randomized clinical trials, and observational studies from all over the world. Five main topics were defined in a consensus join statement of the Polish Society of Pediatrics, Polish Society for Pediatric Obesity, Polish Society of Pediatric Endocrinology and Diabetes and Polish Association for the Study on Obesity: (1) definition, causes, consequences of obesity; (2) treatment of obesity; (3) obesity prevention; (4) the role of primary care in the prevention of obesity; (5) Recommendations for general practitioners, parents, teachers, and regional authorities. The statement outlines the role of diet, physical activity in the prevention and treatment of overweight and obesity, and gives appropriate recommendations for interventions by schools, parents, and primary health care. A multisite approach to weight control in children is recommended, taking into account the age, the severity of obesity, and the presence of obesity-related diseases. Combined interventions consisting of dietary modification, physical activity, behavioral therapy, and education are effective in improving metabolic and anthropometric indices. More actions are needed to strengthen the role of primary care in the effective prevention and treatment of obesity because a comprehensive, multi-component intervention appears to yield the best results.

Adolescents With Eating Disorders in Pediatric Practice - The European Academy of Paediatrics Recommendations

In the face of the growing number of adolescents suffering from eating disorders (EDs) and access to psychiatric care limited by the epidemiological and demographic situation, the primary care pediatrician's role in diagnosing and treating EDs is growing. The European Academy of Paediatrics (EAP) decided to summarize knowledge about EDs and formulate recommendations to support European pediatricians and improve care for adolescents with EDs.

A tendency to worse course of multisystem inflammatory syndrome in children with obesity: MultiOrgan Inflammatory Syndromes COVID-19 related study

BACKGROUND

A new disease entity called multisystem inflammatory syndrome in children (MIS-C) is a rare consequence of COVID-19 infection. The pathophysiology and risk factors of MIS-C are still unclear, and the clinical manifestation ranges from milder forms to cases needing intensive care unit treatment. Based on available data, obesity is linked to pro-inflammatory stimulation. Moreover, several studies showed that obesity could play a role in COVID-19 severity and its comorbidities among the adult and children's populations. This study aimed to investigate the influence of overweightedness/obesity in childhood for the course of MIS-C in Poland.

METHODS

This study presented data from the national MultiOrgan Inflammatory Syndromes COVID-19 Related Study (MOIS-CoR) collected between 4 March 2020 and 20 February 2021. Of the 371 patients that met the Polish MIS-C criteria, 306 were included for further analysis.

RESULTS

Children who are obese (OB with body mass index (BMI) ≥95th percentile) and overweight (OV with BMI ≥85th percentile but <95th percentile) (28 and 49 patients, respectively) represented 25.1% (n=77) of all recruited patients. Complete recovery at the time of discharge presented in 93% of normal body weight (NW) participants and 90% of OV children (p>0.05). Among OB children, 76% recovered fully, which differed from the NW group (p=0.01). Calculated odds ratio (OR) of incomplete recovery for OB children was 4.2. Irrespective of body weight, there were no differences (p>0.05) in the length of hospitalization and the duration of symptoms (for OB, 13 and 16.5 days; for OV and NW, 10 and 14 days, respectively), as well as in the frequency of cardiovascular abnormalities, necessity of oxygen therapy (OB, 26.9%; OV, 23.9%; and NW, 20.7%), and intravenous immunoglobulin and glucocorticosteroid (GCS) treatment.

CONCLUSION

The higher risk of incomplete recovery and observed tendency toward a worsening course of MIS-C in patients with obesity suggest the need for further studies to confirm and understand our findings.

COVID-19 in pediatric cancer patients is associated with treatment interruptions but not with short-term mortality: a Polish national study

Background

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) currently constitutes the leading and overwhelming health issue worldwide. In comparison with adults, children present milder symptoms, with most having an asymptomatic course. We hypothesized that COVID-19 infection has a negative impact on the continuation of chemotherapy and increases nonrelapse mortality.

Material and methods

This study was performed to assess the course of SARS-CoV-2 among children with hematological or oncological malignancies and its impact on cancer therapy. Records of SARS-CoV-2 infection in 155 children with malignancies from 14 Polish centers for pediatric hematology and oncology were collected and analyzed.

Results

SARS-CoV-2 replication was observed in 155 patients. Forty-nine patients were symptomatic, with the following being the most common manifestations: fever (31 patients), gastrointestinal symptoms (10), coryza (13), cough (13) and headache (8). In children who were retested, the median time of a positive PCR result was 16 days (range 1–70 days), but 12.7% of patients were positive beyond day + 20. The length of viral PCR positivity correlated with the absolute neutrophil count at diagnosis. Seventy-six patients did not undergo further SARS-CoV-2 testing and were considered convalescents after completion of isolation. Antibiotic therapy was administered in 15 children, remdesivir in 6, convalescent plasma in 4, oxygen therapy in 3 (1—mechanical ventilation), steroids in 2, intravenous immunoglobulins in 2, and heparin in 4. Eighty patients were treated with chemotherapy within 30 days after SARS-CoV-2 infection diagnosis or were diagnosed with SARS-CoV-2 infection during 30 days of chemotherapy administration. Respiratory symptoms associated with COVID-19 and associated with oxygen therapy were present in 4 patients in the study population, and four deaths were recorded (2 due to COVID-19 and 2 due to progressive malignancy). The probability of 100-day overall survival was 97.3% (95% CI 92.9–99%). Delay in the next chemotherapy cycle occurred in 91 of 156 cases, with a median of 14 days (range 2–105 days).

Conclusions

For the majority of pediatric cancer patients, SARS-CoV-2 infection does not result in a severe, life-threatening course. Our data show that interruptions in therapy are common and can result in suboptimal therapy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13045-021-01181-4.

Impact of Selected Behavioral and Environmental Factors on the Antibiotic Therapy in Polish Children With Upper Respiratory Tract Infections

Antibiotic therapy must be carried out consistently and according to the guidelines. Viruses are the dominant cause of upper respiratory tract infections (URTIs) in children, as has been shown in many previous studies. Unnecessary antibiotic therapy should be avoided so that it does not affect patients' health and lead to the development of resistant bacterial strains. Here we report a national survey conducted in a group of 4,389 children to assess the impact of selected behavioral and environmental factors on antibiotic therapy in patients with URTIs. We found that selected environmental factors influenced the type of treatment. The place of residence, having siblings, an absence of vaccinations, the presence of allergies, and attendance at educational institutions were conducive to antibiotic therapy. These factors also influenced the frequency of hospitalization of children and their absence from nurseries, kindergartens, and schools, as well as the absence of their guardians from work.

Healthcare for children and adolescents in Poland

Despite the constant tendency to decrease the number of births, children and adolescents account for one-fifth of the Polish population. Healthcare for children is free and it is organized similarly to the care for adult patients. In primary healthcare, children can be under the medical care of general practitioners, family physicians or pediatricians. In secondary and tertiary care, pediatricians or physicians with pediatric subspecialties provide medical services. The number of pediatricians and nurses is not sufficient and still differs from the European average. Nonetheless, population health indicators (e.g. infant mortality rate) are constantly improving, and despite the strong influence of the anti-vaccine movements, 90% of children are vaccinated according to the schedule.

Atopic dermatitis. Interdisciplinary diagnostic and therapeutic recommendations of the Polish Dermatological Society, Polish Society of Allergology, Polish Pediatric Society and Polish Society of Family Medicine. Part I. Prophylaxis, topical treatment and phototherapy

Atopic dermatitis is a chronic and recurrent inflammatory dermatosis with concomitant intensive pruritus, and is diagnosed both in children and adults. Atopic dermatitis-patients are predisposed to have bacterial, viral and fungal skin infections; they also suffer from an increased risk of developing food allergies (especially, at an infantile age), allergic rhinitis, or bronchial asthma (a so-called atopic march). Currently, an increasing atopic dermatitis incidence constitutes a serious medical problem that regards not only dermatology and allergology, but also paediatrics, and family medicine. The basis for atopic dermatitis treatment and prophylaxis is restoration of epidermal barrier functions by means of tailored emollients. Atopic dermatitis therapies should effectively eliminate clinical symptoms of the disease, prevent exacerbations as well as complications, and improve patients' quality of life.

The Effect of Intracoronary Infusion of Autologous Bone Marrow-Derived Lineage-Negative Stem/Progenitor Cells on Remodeling of Post-Infarcted Heart in Patient with Acute Myocardial Infarction

Introduction: Regenerative capacity of the heart is limited, and the post-infarct left ventricle (LV) dysfunction is associated with poor prognosis. Administration of stem/progenitor cells (SPCs) is a promising approach for cardiac regeneration. Objectives: In the study, we assessed LV function and post-infarcted remodeling in patients with ST-elevated myocardial infarct (STEMI) who received autologous lineage-negative (LIN^-) SPCs. Patients and methods: Patients with STEMI and one-vessel coronary artery disease treated with percutaneous revascularisation were divided into study group (LIN^- group, 15 patients) that received standard therapy and autologous BM-derived LIN^- SPCs and control group (standard therapy group, 19 patients). The cells were administered intracoronary 24 hours after STEMI. The follow-up was 12 months with subsequent non-invasive tests and laboratory parameter evaluation on days 1^st, 3^rd, and 7^th as well as at 1^st, 3^rd, 6^th and 12^th month after STEMI. Results: All procedures related to SPCs administration were well tolerated by the patients. In 12-month follow-up, there were no major adverse cardiac events connected with LIN^- SPCs administration. During 12-month follow-up, 9 patients from LIN^- group (Responders) achieved an improvement in LV ejection fraction (>10% after 12 months) with no signs of unfavorable LV remodeling. Laboratory parameters analysis showed that Troponin T levels were significantly lower until day 7^th in the Responders group, while brain natriuretic peptide (BNP) level remained significantly lower from day 3^rd to 12^th month respectively. Conclusions: Intracoronary infusion of autologous BM-derived LIN^- stem/progenitor cells is feasible and safe for patient. Improvement in LV function and prevention of unfavorable remodeling in the 60% of study group seems relatively promising. Stem cell-based therapy for cardiac regeneration still needs more accurate and extensive investigations to estimate and improve their efficacy.

Articulation recovery in ALS patients after lineage-negative adjuvant cell therapy - preliminary report

Background: Amyotrophic lateral sclerosis (ALS) is one of the most frequently occurring neurodegenerative diseases affecting speech and swallowing. This preliminary study aimed to investigate whether an autologous lineage-negative stem/progenitor cell therapy applied to ALS patients affects the level of selected trophic and proinflammatory factors, and subsequently improves the articulation. Methods: We enrolled 12 patients with sporadic ALS, who underwent autologous bone marrow-derived lineage negative (LIN^-) cells administration into cerebrospinal fluid (CSF). We evaluated patients' articulation using the Frenchay Dysarthria Assessment on days 0 and 28 following the LIN^- cells administration. Concentrations of various factors (BDNF, NGF, ANGP-2, VEGF, PDGF-AA, PEDF, COMP-FH, CRP, C3, C4) in CSF were quantified by multiplex fluorescent bead-based immunoassays in the samples collected on the day of LIN^- cells administration and 28 days later. On top of this, we assessed levels of BDNF and NGF in the patients' plasma on the day of the injection, three, seven days and three months after the treatment. Results: Of the 12 patients who received the LIN^- cell therapy 8 showed short-termed improvement in articulatory functions (group I), which was particularly noticeable in better phonation time, lips and soft palate performance, swallowing reflex and voice loudness. Four patients (group II) did not show substantial improvement. CSF concentrations of BDNF, ANGP-2 and PDGF-AA in group I decreased significantly 28 days after LIN^- cells administration. The highest concentration levels of BDNF in group II and NGF in both groups in blood plasma were observed on day 3 following the injection. Conclusions: The outcomes of the LIN^- cell application in ALS treatment of articulatory organs are promising. The procedure proved to be safe and feasible. A short-lasting trophic effect of autologous LIN^- administration could encourage repeated cell's application in order to sustain their beneficial effects, however this approach needs further investigation.

Vitamin D Supplementation Guidelines for General Population and Groups at Risk of Vitamin D Deficiency in Poland-Recommendations of the Polish Society of Pediatric Endocrinology and Diabetes and the Expert Panel With Participation of National Specialist Consultants and Representatives of Scientific Societies-2018 Update

INTRODUCTION

Vitamin D deficiency is an important public health problem worldwide. Vitamin D deficiency confers a significant risk for both skeletal and non-skeletal disorders and a number of lifelong negative health outcomes. The objectives of this evidence-based guidelines document are to provide health care professionals in Poland, an updated recommendation for the prevention, diagnosis and treatment of vitamin D deficiency.

METHODS

A systematic literature search examining the prevention and treatment strategies for vitamin D deficiency was conducted. Updated recommendations were developed using the Grading of Recommendations, Assessment, Development and Evaluation system describing the strength of the recommendation and the quality of supporting evidence. Twenty-seven contributors representing different areas of expertise and medical specialties, including pediatricians, geriatricians, endocrinologists, epidemiologists, nephrologists, gynecologists and obstetricians evaluated the available published evidence related to vitamin D, formulated the goals of this document and developed a common consolidated position. The consensus group, representing six national specialist consultants and eight Polish and international scientific organizations/societies, participated in the process of grading evidence and drawing up the general and specific recommendations.

RESULTS

The updated recommendations define the diagnostic criteria for the evaluation of vitamin D status and describe the prevention and treatment strategies of vitamin D deficiency in the general population and in groups at increased risk of the deficiency. Age- and weight-specific recommendations for prevention, supplementation and treatment of vitamin D deficiency are presented, and detailed practice guidance is discussed regarding the management in primary and specialized health care.

CONCLUSION

Vitamin D deficiency remains still highly prevalent in Poland, in all age groups. Currently, there is a great necessity to implement a regular supplementation with recommended doses and to develop an effective strategy to alleviate vitamin D deficiency in the population. These updated recommendations are addressed to health professionals and the authorities pursuing comprehensive health policies and should also be included in public health programs aimed at preventing a broad spectrum of chronic diseases.

Evidence for the efficacy of immunotherapy in children with high-risk neuroblastoma

Neuroblastoma is the most common extra-cranial malignancy of childhood, with the highest incidence in children younger than 4 years. The prognosis depends on many factors, such as age at diagnosis, stage of disease and molecular genetic subtype. More than 50% of children who present with the disease are deemed to have high-risk neuroblastoma. The standard therapy for children with high-risk neuroblastoma consists of intensive chemotherapy, surgery, radiotherapy, myeloablative consolidation with autologous haematopoietic stem cell rescue followed by the treatment of minimal residual disease with 13-cis-retinoic acid. Unfortunately, more than half of the patients relapse regardless of the treatment intensity. Combined therapy with monoclonal antibodies (anti-GD2), intravenous interleukin-2 (Il-2), intravenous granulocyte-macrophage colony-stimulating factor (GM-CSF) and oral 13-cis-retinoic acid have been proved to be effective in some randomised trials. A better understanding of the underlying immunological processes in therapy with anti-GD2 antibodies will allow its success to be evaluated more accurately and direct future endeavours. Nevertheless, the long-term benefit of this treatment approach needs to be established.

Clinical factors in relapses of Wilms' tumor--results for the Polish Pediatric Solid Tumors Study Group

BACKGROUND

The risk factors responsible for recurrences of Wilms' tumor (nephroblastoma) are still under discussion. The aim of the study was to analyze the relationship between relapses of Wilms' tumor and the patients' clinical history.

MATERIAL AND METHODS

Clinical data from children registered in the Polish Pediatric Solid Tumors Study Group were analyzed. The clinical stages (CS), pathology variants (high risk: HR, intermediate risk: INT, and low risk: LOW) and chemotherapy regimens were correlated with the outcomes.

RESULTS

Recurrences developed in 34 out of 288 (11.8%) patients with Wilms' tumor treated in accordance with International Society for Pediatric Oncology 2001 (SIOP 2001) protocols. Of these 34 patients, 11 initially had CS I, seven were at CS II, four were at CS III, 11 were at CS IV and one had CS V. There were eight patients with second recurrences; of these, seven were in the INT risk group and one in the high histological risk group. There was no correlation between age (p=0.256) or gender (p=0.538) and the risk of tumor recurrence. In the study group, seven out of 10 patients with local recurrences are alive; as are 13 out of 22 patients with distant recurrences (p=0.703). Those who died due to disease progression comprised six out of 26 patients with a first recurrence (four HR, two INT), and seven out of eight with a second recurrence (one HR, six INT).

CONCLUSIONS

The prognosis after relapse in initially metastatic patients did not differ from that in patients who had primarily localized disease. The pathology variants probably had more significance.

How have advances in our understanding of the molecular genetics of paediatric leukaemia led to improved targeted therapies for these diseases?

The term "leukaemia" refers to a large and heterogenous group of diseases, with treatment response and outcome dependent on the specific type of malignancy. New molecular methods allow us to specifically evaluate the type of disorder, and provide treatment of necessary intensity. The aim of this review is to provide insight into the progress in leukaemia treatment that had been possible due to advances in molecular genetics over the last few decades. Those new sophisticated diagnostic methods have allowed us not only to predict patients' prognosis but also to provide a specific therapy depending on the molecular and genetic characteristics of patients. Our review is based on 25 articles regarding novel diagnostic and therapeutic methods as well as prognostic factors, released between 1992 and 2011. Those articles focus mostly on molecular and cytogenetic testing allowing revolutionary methods of patient classification and individual therapy for this highly heterogeneous group of disorders. Implementation of molecular genetic testing to evaluate the type of leukaemia allowed paediatric oncologists and haematologists to adjust the intensity of treatment, improve outcome, minimize toxicity of therapies and considerably lower the risk of side effects. In the last few decades there has been a great improvement in survival among children suffering from haematopoietic malignancies. Progress made in molecular genetics allowed the creation of new treatment protocols that are designed to maintain a high cure rate for children with leukaemia while reducing toxicity.

First-line immunosuppressive treatment in children with aplastic anemia: rabbit antithymocyte globulin

Immunosuppressive therapy is the treatment of choice in children with acquired severe aplastic anemia (AA) and no HLA-matched family donor. The paper presents results of a multicenter study of 63 children with AA treated with rabbit antithymocyte globulin (r-ATG) and cyclosporine A as the first line treatment in the years 1996-2012. Therapeutic effects were evaluated at Days 112, 180, and 360. At Day 112, remission was achieved in 28 out of the 63 patients (44.4 %), complete remission in 10 patients (15.9 %), and partial remission in 18 (28.5 %). At Day 180, 31 patients (49.2 %) were in remission including 15 cases in complete (23.8 %), and 16 cases in partial remission (25.4 %). One year after therapy onset, 34 patients (64.9 %) were in remission including 24 patients (38.0 %) in complete and 10 (15.9 %) in partial remission. Relapse occurred in 4 patients, from 8 months up to 2 years and 2 months after remission. One child, 5 years after remission, was diagnosed with paroxysmal nocturnal hemoglobinuria. The estimated 10-year overall survival rate and 10-year event-free survival rate were 67 % and 57 %, respectively.

Will therapies that target tumour suppressor genes be useful in cancer treatment?

Human cancers represent one of the biggest challenges for modern societies. By 2020, cancer deaths worldwide could reach 10 million. Therefore, one of the important aims of science research is the improvement of anti-malignant treatment options to mitigate cancer-related morbidity and mortality. This essay summarises current trends and future directions of target tumour suppressor genes therapies based on an example of one of the most promising targets, p53.

Incomplete expression of Klippel-Trenaunay syndrome

Klippel-Trenaunay syndrome (KTS) is a rare, congenital vascular anomaly, defined as a triad including a port-wine stain, underlying bone and soft tissue hypertrophy and varicose veins and/or venous malformations.

AIM

Our aim is to present the case of a 13-year-old girl with a delayed proper diagnosis of incomplete expression of KTS presenting with a port-wine stain of her left lower extremity associated with hypertrophy of the affected limb (upon the moment of diagnosis no varicose veins were observed). The patient did not experience any pain in the affected limb, nor was she diagnosed with neuropathy - both of above mentioned symptoms are often a significant issue. To ensure proper diagnosis, the patient underwent a broad spectrum of diagnostic tests, including physical examination with anthropometric measuring, biochemical tests, as well as radiological examinations including CT scan, Doppler vein ultrasound and bone X-ray. Based on physical examination and test results we were able to establish the diagnosis of incomplete expression of Klippel-Trenaunay syndrome.

SUMMARY

The authors aim to emphasise the very rare incidence of KTS, as well as the low level of awareness of the described disease, which resulted in the significantly delayed final diagnosis in the presented case. Establishing the diagnosis of KTS before the onset of severe vascular complications, regular check-ups in the Outpatient Clinic of Haemangioma Care and compression dressing may help avoid/diminish the severity and significantly delay the development of venous failure of the affected limb.

[Mucoepidermoid cancer of parotid gland in 14-years-old girl--case report]

INTRODUCTION

Malignant tumors of salivary glands are rare, especially in children.

MATERIAL AND METHOD

We present a case report of 14-years-old girl affected by mucoepidermoid cancer of parotid gland.

RESULTS

Patient was admitted to our Department in May 2007 due to small, hard, moveable tumor localized in right mandibular angle. The VII nerve function was normal. Fine needle aspiration revealed inflammatory cells without atypical cytologic features. Intraoperative tumor was hard, with irregular surface, surrounded by capsule, connected with the main trunk of facial nerve and cartilaginous part of external auditory meatus. Tumor was excised together with superficial part of parotid gland and surrounding lymph nodes. After operation no signs of facial nerve damage were observed. Postoperative histopathological examination revealed mucoepidermoid cancer, in 2 out of 6 specimens neoplasmatic cells were seen in border of excised tissue. In June 2007 the second operation was performed. Remain part of parotid gland was removed with right facial nerve and conservative lymph node resection. Facial nerve and its branches were reconstructed with sural and great auricular nerve as donor grafts. The symptoms of nerve damage were observed in early postoperative days adequate to 5th degree of House-Brackman scale (HB5). 4 years after operation function of facial nerve is estimated on HB3. The girl is under regular oncological and laryngological control free of neoplasm recurrence.

CONCLUSIONS

Diagnostics and treatment of malignant parotid tumors in children are difficult and clinical picture must be always taken into consideration as the most important factor.

The rationale behind hypofractionated high-dose intensity-modulated radiotherapy in patients with localized prostate cancer: short review

The use of improved technology has fostered increasing interest in hypofractionated radiation therapy for prostate cancer. There also is convincing evidence that an unusual aspect of prostate cancer radiobiology allow a different approach to dose escalation that is radiobiological in nature. The aim of this paper is to explain the rationale behind hypofractionated high-dose intensity-modulated radiotherapy in patients with localized prostate cancer.

Dynamic renal scintigraphy with 99mTc-DTPA for the assessment of renal function after therapy of acute lymphoblastic leukemia in children

INTRODUCTION

Acute lymphoblastic leukemia (ALL) and its treatment may lead to impairment of kidney function. The aim of the present study was to evaluate kidney function in children after treatment of ALL. We used our 99mTc-DTPA (diethylene triamine pentaacetic acid labeled with 99mTc) dynamic scintigraphy protocol.

MATERIAL AND METHODS

The study group consisted of 48 ALL patients, aged 79-275 months, in complete remission (mean duration 51 months). Treatment was according to the guidelines of the Berlin Frankfurt Münster (BFM) BFM 86 and BFM 90 protocols in 36 (75%) and 12 (25%) children, respectively. Follow-up after treatment was up to 12 months in 10 (21%) children (group I), 12-60 months in 21 (44%) children (group II), and more than 60 months in 17 (35%) children (group III). 99mTc-DTPA dynamic renal scintigraphy was done in all patients. The glomerular filtration rate (GFR) was determined according to Gates and the diuretic test was done after 18 minutes of the examination.

RESULTS

The glomerular filtration rate at the end of the 5-year follow-up was less than 80 mL/min/1.73 m2 (p < 0.002) in 3 (25%) children treated with the BFM 86 protocol. In the remaining 45 (94%) patients, GFR exceeded 80 mL/ min/1.73 m2. Normal renogram curves were obtained in 40 (83%) patients. Eight (17%) children had cumulative curves with normal clearance. This finding was interpreted as non-obstructive uropathy. There was no statistical correlation between outflow disorders seen during dynamic scintigraphy, type of chemotherapy protocol, and assignment to risks group.

CONCLUSIONS

1. There was no clinically significant kidney function impairment in children after treatment of ALL. 2. Dynamic renal scintigraphy can be a valuable and non-invasive method for the assessment of kidney function in patients with a risk factor in the form of previous potentially nephrotoxic antitumor treatment.

Thiopurine S-methyltransferase (TPMT) polymorphisms in children with acute lymphoblastic leukemia, and the need for reduction or cessation of 6-mercaptopurine doses during maintenance therapy: the Polish multicenter analysis

BACKGROUND

6-Mercaptopurine (6-MP) is used for the treatment of pediatric acute lymphoblastic leukemia (ALL). Mutations in the TPMT gene may influence the efficacy and safety of 6-MP treatment. This multicenter study investigated the association between TPMT genotype, 6-MP dose adjustments, and the incidence of adverse effects in patients.

PROCEDURE

A total of 203 ALL children were genotyped using PCR/allele-specific amplification and PCR/RFLP. The control group consisted of 394 healthy volunteers.

RESULTS

The TPMT*3A variant allele was found in 16 patients (15 TPMT*1/*3A, 1 TPMT*3A/*3A) and the TPMT*3C (A719G) allele in 1 patient. No TPMT*2 (G238C) or TPMT*3B (G460A) alleles were detected in the study group. TPMT*3A, TPMT*1 (wild-type), and TPMT*3C alleles were detected at frequencies of 3.94%, 95.81%, and 0.25%, respectively. The genotype and allele distributions were similar in the ALL and control groups. The 6-MP dose was reduced more frequently in patients with TPMT*3A and TPMT*3C alleles, compared with wild-type alleles (P = 0.042). Reductions because of leucopenia with respiratory tract infection, or because of leucopenia, anemia and/or thrombocytopenia were four (P = 0.007) and five (P = 0.03) times more common, respectively. The groups differed with regard to the rates of 6-MP dose reduction (P = 0.028). 6-MP was discontinued more often in patients with TPMT*3A and TPMT*3C alleles (14-fold) as a result of leucopenia, anemia, and/or thrombocytopenia (P = 0.004).

CONCLUSIONS

The results indicate that TPMT genotype influences the safety and efficacy of ALL treatment and genotype information may therefore be useful for optimizing 6-MP therapy.

Two histologically different tumours in a neonate born from an assisted reproductive technology pregnancy

The first case of a female neonate born from an in vitro fertilization with embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI) (IVF-ET (ICSI) with two histologically different tumours (craniopharyngioma and hepatoblastoma) is described. Anti-neoplasmatic therapy was abandoned due to the significant extent of the disease (craniopharyngioma, 15 x 12 cm in diameter with active internal hydrocephalus; and right liver lobe hepatoblastoma, 5 cm in diameter) and the severely impaired general condition of the neonate. The neonate died on the 30th day of life due to cerebellar and brainstem herniation, followed by circulatory and respiratory failure.

Static renal scintigraphy with 99mTc-DMSA for the assessment of renal damage after therapy for acute lymphoblastic leukemia in children

INTRODUCTION

Acute lymphoblastic leukemia (ALL) and its treatment may adversely affect kidney function. The aim of the present study was to determine whether 99mTc-DMSA static renal scintigraphy can be used to disclose kidney damage at the end of therapy for ALL in children.

MATERIAL AND METHODS

The study group consisted of 48 ALL patients aged 6.6-22.9 years, with a mean time of continuous complete remission of 51 months. Static renal scintigraphy with 99mTc-DMSA was performed in all patients.

RESULTS

Minor scars in the renal cortex were diagnosed with scintigraphy in 6 (13%) patients. A significant correlation was found between renal scarring and a history of urinary tract infection.

CONCLUSIONS

No clinically significant kidney damage was found after completion of treatment of ALL. Static renal scintigraphy may be a valuable noninvasive method for visualization of renal cortex pathology.

[Some aspects of molecular bases of keloid formation]

Keloid scarring, also known as keloid disease, is a benign, locally aggressive fibroproliferative scar overgrowth that expands with involvement of adjacent healthy skin. The pathogenesis of keloid disease has not been fully elucidated. In recent years, many reports have been published that unequivocally reveal genetic predispositions to keloid formation. Basing on the available literature, the authors present the most recent research on some aspects of molecular bases of keloid scarring.

Cadmium--is there something to fear?

Cadmium (Cd, cadmium in Latin) is a heavy metal widely present in nature. Like Hg, Pb, and As, cadmium belongs to elements with an unknown physiopathologic role. The progress of civilization, urbanization, and industrialization may lead to significant risk of cadmium pollution in the natural environment. The authors draw attention to the likely causes and effects of environmental pollution with cadmium and its effects on human health. Environmental and occupational exposures are discussed. Strong correlations between cadmium dose, exposure time, tissue concentration, and clinical symptoms in humans are emphasized.

Thymic carcinoma in children: a report from the Polish Pediatric Rare Tumors Study

BACKGROUND

Invasive thymomas and thymic carcinomas are rare tumors jointly accounting between 0.2% and 1.5% of malignancies in adults. They are usually at an advanced stage when diagnosed and have both high recurrence and poor survival rates. In this report, the aim is to explore our experience in the treatment of thymic carcinomas in Polish children.

PROCEDURE

The clinical data of nine children with thymic carcinomas, treated between 1992 and 2008 in the Polish oncological and surgical centers was retrospectively analyzed.

RESULTS

In five cases, presenting symptoms resulted from the compression of the respiratory ways by the mediastinal tumor. In two children paraneoplastic autoimmune syndromes were associated with thymic carcinoma. In accordance with the Masaoka classification, two patients had stage II, five had stage III, and two had stage IV of the disease. Diagnostic biopsy of mediastinal tumor was performed on eight patients and one underwent complete primary resection and subsequently received radiotherapy; he has passed 11 years since the conclusion of therapy. Six patients received multi-drug chemotherapy with or without steroids. Delayed surgery was performed in four children (R0-2, R1-1, and R2-1). After complete resection, one child received chemotherapy. In three patients, chemotherapy and radiotherapy was administered. Seven patients died, including six due to progression of the disease with the other as a result of complications following chemotherapy; only two patients classed at stage II remain alive.

CONCLUSIONS

Most thymic tumors in pediatric patients are inoperable at diagnosis, which results in poor prognosis. Improved chemotherapy approaches are needed.

Congenital nasolacrimal duct mucocele--a case report

Congenital nasolacrimal duct mucocele (CNDM) is a very rare condition in newborns. Prolapse or expansion of the mucocele into the nose may lead to respiratory distress and difficulty in feeding. The triad of cystic medial canthal mass, dilatation of the nasolacrimal duct and a contiguous sub-mucosal nasal mass on computed tomography (CT) is indicative in the diagnosis of CNDM. The case of a five-week-old girl with infected CNDM is described. The authors aim to emphasize the very rare incidence of CNDM in Polish newborns, delayed diagnosis in the case described and the paramount importance of CT of the head for the correct diagnosis and treatment.

Fatal outcome of spontaneous cerebral and intraventricular hemorrhage in a child with idiopathic thrombocytopenic purpura (ITP)--case report

BACKGROUND

Idiopathic thrombocytopenic purpura (ITP) is the most prevalent acquired hemorrhagic diathesis in children characterised by antibody-mediated destruction of platelets. ITP is generally a self-limiting benign disorder but despite this good prognosis, ITP carries the risk of severe bleeding (mainly intracranial) that may threaten the child's life.

CASE REPORT

We describe a case of a 5-year-old girl with idiopathic thrombocytopenic purpura in the course of EBV infection with massive cerebral and intraventricular hemorrhage and fatal outcome.

CONCLUSION

This extremely rare case of intracranial haemorrhage in a child with ITP coexisting with EBV infection (a likely additional risk factor for hemorrhage) deserves attention considering the fatal outcome despite intensive treatment.

[Results of immunosupressive therapy in children with severe aplastic anaemia. Report of the Polish Paediatric Haematology Group]

INTRODUCTION

Bone marrow transplantation from HLA identical family donors is the treatment of choice for children with severe aplastic anaemia (SAA). When there is no donor available, combined immunosuppressive therapy is given.

AIM

evaluation of results of immunosupressive therapy in children with severe aplastic anaemia.

MATERIAL AND METHODS

SAA was diagnosed in 105 children (42 girls, 73 boys), aged 2-18 years, in the eleven haematological centres in Poland, between 1993-2007. All patients received the Severe Aplastic Anaemia Working Party of the EBMT protocol which included: antilymphocyte globulin or antithymocyte globulin, cyclosporin A, prednisolone. Granulocyto- or granulocytomacrophagic-cell stimulation factor was additionally administered during deep neutropenia. Haematological response was evaluated on day 84 or 112 and 180 of the therapy.

RESULTS

complete remission occurred in 53 patients (51.5%), partial remission in 27 (24.7%), no response was obtained in 25 children (23.8%) on day 180, of the therapy. Period of observation was from 12 months to 12.5 years. During this time relapse occurred in 10 patients (9.5%). We observed 22 deaths: 8 early, during the first 3 months of IS and 14 after the first 3 months of immunosuppresive therapy (IS). At present 70 children (66.6%) are in first remission with lasts from 12 months to 12.5 years. The survival at 12.5-years is 78.6%. During the 12.5 years of follow-up we had two cases with a late clonal complication (PNH and MDS). Transformation to acute nonlymphoblastic leukaemia was observed in two of our patients.

CONCLUSIONS

1. Immunosuppresive therapy (IS) in children with SAA, without bone marrow family donors, is more effective after introduction of combined IS (12.5 years survival in this study was 80% for children with very severe aplastic anaemia (v SAA). 2. In our studies among the children followed up after IS therapy, there were: 1 case of periodic nocturnal haemoglobinuria (PNH), 1 case of myelodysplastic syndrome (MDS) and 2 cases of myeloid leukaemia (probability of incidence was 3.8%).

Angiomyolipomas, renal manifestation of tuberous sclerosis complex in 17-year-old boy--a case report

INTRODUCTION

Tuberous sclerosis complex (TSC) is a genetic disorder characterised by lesions affecting brain, skin, eyes and internal organs--kidneys, heart, liver and lungs. Renal involvement in individuals with TSC is common and potentially serious, includes angiomyolipomas and cystic lesions. There may also be an increased risk of renal cell carcinoma.

CASE REPORT

A case of 17-year-old boy with delayed diagnosis of tuberous sclerosis complex with angiomyolipomas and cysts of the kidneys has been described.

CONCLUSION

The authors would like to underlina a very rare incidence of tuberous sclerosis complex and associated renal angiomyolipomas in children, the possibility to maintain normal kidney function for prolonged time despite intensified renal pathology, the need for periodic abdominal imaging and significantly delayed diagnosis in the described case.

[Vesicoureteric reflux: it all depends on the genes?]

Vesicoureteric reflux (VUR) defined as reversed urine flow from the urinary bladder to ureter(s) and frequently to kidneys is associated with abnormal structure and/or malfunction of one or both ureterovesical junctions. In the pediatric practice, VUR constitutes an important problem not only because of prevalence but also because of the role it plays in pathogenesis of urinary tract infections, reflux nephropathy and chronic renal failure in children. Recent reports confirm genetic background of vesicoureteric reflux. Vesicoureteric reflux is inherited as a dominant autosomal disease (with possible incomplete gene(s) penetration). The Authors present a review of recent literature with focus on key role of candidate genes in the development of VUR in children.

Hodgkin's disease--the rare cause of nephrotic syndrome in children

PURPOSE

Hodgkin's disease (HD) is a potentially curable malignant lymphoma with distinct histology, biologic behavior and clinical characteristics. Renal involvement in HD is rare, but it may be underestimated because renal lesions are not the major manifestation of the disease. The pathogenesis of proteinuria in HD remains unknown.

CASE REPORT

The case of a 17-year-old girl suffering from Hodgkin's disease and nephrotic syndrome has been described.

CONCLUSION

The authors would like to underline the very rare coincidence of Hodgkin's disease and nephrotic syndrome, the lack of remission after routine prednisone administration and disappearance of nephrotic proteinuria after anticancer therapy.

[Thymoma and thymic carcinoma--review of literature and clinical characteristics based on the Polish Paediatric Solid Tumours Study Group experience]

Thymomas and thymic carcinomas are rare neoplasms derived from the epithelial tissue of thymus, very infrequently developing in young adults and children. The estimation of thymomas' invasiveness has been the matter of discussion for many years reflected by numerous clinical and histological classifications. In 1999 the WHO classification was created, joining all the most important issues present in previously used systems. It is believed that histological structure is the most important prognostic factor in thymic carcinomas while in less aggressive types of thymomas the clinical stages influence the outcome. Staging of thymomas is most commonly based on the Masoka classification. Independent evaluation of the stage and histological aggressiveness are necessary to predict the clinical course and outcome in thymomas. Thus the term 'malignant thymoma' has been replaced by 'invasive thymoma' in clinical practice. The treatment strategy depends on the clinical stages of thymoma. Complete resection of the tumour is the treatment of choice with supplementing radiotherapy in more advanced clinical stages. Chemotherapy in invasive thymomas has been reported to play an increasingly important role as induction, supplementing and palliative therapy. It has been proved that combined treatment improves the outcome in invasive thymomas, especially in thymic carcinomas. This paper reviews the literature data concerning the histology, clinical issues and treatment of thymomas and thymic carcinomas. The clinical data on nine children with thymic carcinomas treated between 1992 and 2006 in the Polish oncological and surgical centres were also analysed and presented. Based on multicentre data we were able to conclude the following: 1. Thymic carcinomas in children are very rare and that is why early diagnosis is often difficult. 2. At diagnosis most cases are already inoperable, which results in poorer prognosis. 3. Complex adjuvant chemo- and radiotherapy in childhood thymic carcinomas seem to prolong overall survival. 4. Further detailed analysis in all the cases of thymic carcinomas in children is recommended in order to estimate the optimal strategy of treatment.

[Results of immunosuppressive therapy in children with severe aplastic anaemia. Report by the Polish Paediatric Leukaemia and Lymphoma Study Group]

INTRODUCTION

Bone marrow transplantation from HLA identical family donors is the treatment of choice for children with severe aplastic anaemia (SAA). When no donor is available, combined immunosuppressive therapy is given.

AIM

Evaluation of results of immunosuppressive therapy in children with severe aplastic anaemia.

MATERIAL AND METHODS

SAA was diagnosed in 85 children (31 girls, 54 boys) aged 2-17.5 years in the eleven centres of the Polish Paediatric Leukaemia and Lymphoma Study Group (PPLLSG) in Poland between 1993-2003 years. All patients received protocol of the Severe Aplastic Anaemia Working Party of the Europe Bone Marrow Transplant (EBMT): antilymphocyte globulin or antithymocyte globulin, cyclosporin A, prednisolone and granulocyto- or granulocyto-macrophagic-cell stimulation factor was additionally administered during deep neutropenia. Haematological response was evaluated on day 84, 112 or 180 of the therapy.

RESULTS

complete remission occurred in 43 patients (50.5%), partial remission in 22 (25.4%), no response was obtained in 20 children (23.7%) in 180 day of the therapy. Period of observation was from 12 months to 10.5 years. During this time relapse occurred in 6 patients (7%). We observed 16 deaths: 7 early during the first 3 months of immunosuppressive therapy (IS) and 9 after the first 3 months of IS.

CONCLUSION

the actual survival at 10-years, after immunosuppressive therapy is 81.2% in our group. Transformation to leukaemia or myelodysplastic syndrome (MDS) was not observed in any of our patients. We observed one case with paroxysmal nocturnal haemoglobinuria (PNH).

[Diagnosis and treatment of thyroid cancer in children in the multicenter analysis in Poland for PPGGL]

INTRODUCTION

Differentiated thyroid carcinoma (DTC) in children presents different biological behavior in comparison to adults. Authors presents preliminary results of multicenter analysis concerning incidence, diagnostics and treatment of DTC in children.

MATERIAL AND METHODS

The study is a retrospective analysis of 107 pediatric patients from 14 academic centers based on the data from 2000 to 2005 obtained by questionnaire in hospitals involved in the treatment of DTC in children.

RESULTS

Papillary thyroid cancer was diagnosed in 83 children, follicular thyroid cancer in 10 children and medullary thyroid cancer in 14 children. Incidence of DTC in children was estimated between 18 and 23 cases per year. The biggest group of patients consisted of children between 11 and 15 years of age, with girls to boys ratio 3.3 : 1. Clinically DTC in children presented most often as solitary thyroid nodule. Cervical lymphadenopathy was observed in 42% of patients. Intraoperative verification indicated metastatic nodes in 50% of children. Low stage DTC predominated (T1 in 36% and T2 in 26% of children). One step surgery was performed in 65% of children with DTC, two step surgery in 25% of patients. I131 therapy was undertaken in 80% of children. Lung metastases were indicated in post therapeutic studies in 14% of children with DTC. Prophylactic thyroidectomies were performed in 79% of children in the group of patients with MTC and RET gene mutations.

CONCLUSIONS

The necessity of introduction of unified therapeutic standard in children with DTC in Poland is underlined.

[Soft tissue sarcomas of bladder and prostate in children treated according to the CWS-96 protocol--report of the Polish Paediatric Solid Tumours Study Group]

AIM

analysis of the course, outcome and therapy complications in bladder/prostate soft tissue sarcomas (STS) in children treated from I'1997 to II'2003 according to CWS-96 protocol in Poland.

MATERIAL AND METHODS

22 children (M/F: 17/5, age: 8 months - 17 years 2 months; median 5,3y). Histopathology: RMS-20 patients (RME-14), non-RMS-2 patients.

RESULTS

96% presented with advanced neoplasm (III - 14, IV - 7). In 18 patients (82%) primary tumour exceeded 5cm; in 17 (77%) extended beyond site of origin. Lymph nodes metastases were stated in six (27%), distant metastases in seven patients (32%). No patient underwent primary complete tumour excision. All received chemotherapy for high risk group. Response to chemotherapy after three cycles was favourable in eight and unfavourable in eight children. Delayed resections were performed in 11 patients (mutilating - 7) proving complete in only five. Radiotherapy (32-50,4Gy) was given to 16 patients, mainly after delayed incomplete surgery. Five patients developed local relapse, four--continual disease progression. None of these nine patients had ever complete tumour resection. Nine patients died: seven due to neoplasm progression, two of therapy complications (septic shock, ARDS). Thirteen patients are alive (59%) with mean follow-up of 42 months. Eight children had bladder removed with continent ileal pouch formed in four.

CONCLUSIONS

1) Advanced stages of bladder/prostate sarcomas in children suggest the necessity of earlier diagnosis. 2) Due to adjuvant chemo- and radiotherapy approximately 60% of patients with this diagnosis may be nowadays cured of bladder/prostate sarcomas without mutilating surgical procedures.

[Rare tumours--are they really rare in the Polish children population?]

Clear statement that pediatric neoplasms are really rare is not easy. Thus the incidence of rare tumours in children has not been defined so far. The paper efforts to assess the topic of rare tumours of childhood in the Polish population. Following two categories are proposed: tumours typical for adults, but possible in children (neoplasms of epithelial origin--mainly carcinomas, melanomas, carcinoids) and paediatric tumours consisting less than 10% of cases in corresponding clinical groups according to the ICCC classification. Data on 317 patients aged 0-18 years treated in centres associated in the Polish Paediatric Group for Solid Tumours (PPGST) were analysed. Classical adult malignancies were registered in 130 patients: carcinomas in 90 (mean age 12.6 +/- 4.5 years), melanomas in 25 (mean age 9.4 +/- 4.9) and carcinoids in 9 (mean age 14.5 +/- 1.2 years). Non epithelial neoplasms were registered in 187 patients (mean age 10.4 +/- 5.5). That group included rare tumours of soft tissue, CNS, bones and other organs. Treatments of certain groups were specified by separate therapeutic protocols within PPGST. Rare malignancies of adult-type among children under 18 years of age in Poland comprised 1.5% of all pediatric neoplasms. The incidence of adult-type neoplasms increased with age until 14 years. In patients over 15 years of age the number of registered cases decreased. It may suggest a first peak of incidence in early adolescence or an underestimation of number of patients with carcinoma aged over 15 years. In the analyzed group, the mean age of patients with carcinomas and other epithelial and unspecified tumours significantly exceeded the age of children with rare neoplasms of non-epithelial origin (12.1 +/- 4.7 vs 10.4 +/- 5.5 years; p<0.05). A very young age at diagnosis of malignant melanomas (mean 9.4 years) and numerous cases of carcinomas affecting the digestive tract (n=24; 27% of all carcinomas), especially those located in colorectal region (n=10), seem surprising. The preliminary analysis of the collected data on rare neoplasms in Poland encourage to undertake a prospective study, meant to link the epidemiology and characteristics of rare epithelial tumours in childhood with diagnostic and therapeutic suggestions for these types that are not coordinated within Polish Paediatric Group of Solid Tumours.

[Evaluation of the immune system following splenectomy in childhood: preliminary study]

The authors would like to point out a possibility of immune system disturbances (especially lymphocyte T), severe infection occurring in patients following splenectomy. Five children following splenectomy due to severe spherocytosis were studied. In all children serum level of IgA, IgG, IgM immunoglobulins, phagocytic index, Hamburger count and lymphocyte antigen surface expression CD3, CD4 CD10, CD19, CD20, CD29, CD45RA, CD56 were evaluated. In comparison to control group, median numbers of lymphocyte T CD3 (p < 0.05), lymphocyte CD4 (p < 0.05), lymphocyte T CD4CD29 (p < 0.001) and percentage of cells reacting with z CD4CD45RA (p < 0.001) were significantly lower in splenectomized children, whereas number of NK cells occurred to be noticeable higher (p < 0.001). Immunoglobulins' levels, Hamburger count, phagocytic index and percentage of lymphocyte CD8, CD19 and CD20 did not differ between groups. On the basis of the results, the authors recommend the necessity of routine vaccination in this group of patients against most common pathogens.

[Acute renal failure as complication of neoplastic disease in children]

Three cases of acute renal failure (ARF) requiring renal replacement therapy (RRT) in the course of neoplastic disease were presented. 7.5-yr-old girl admitted with postrenal failure during palliative radiotherapy had metastases in retroperitoneal space. Improvement followed percutaneous placement of nephrostomy catheters. 16-yr-old boy with acute myeloid leukemia was effectively treated with hemodialysis for prerenal and renal ARF mediated by vasomotor, infectious and toxic factors. In 11-yr-old boy ARF was the first clinical presentation of non-Hodgkin's lymphoma. Chemotherapy brought restoration of renal function. As a conclusion we emphasize complex etiology of ARF in such patients as well as the necessity of early introduction of RRT and thorough diagnosis and proper management of the causes of impaired renal function.

[Embryonal rhabdomyosarcoma of the nasopharynx in a 3-year old girl]

A case of rhabdomyosarcoma embryonal of the nasopharynx in a 3-year-old girl has been described. Clinical manifestations and initial diagnostic difficulties resulting in delay of proper diagnosis were discussed. Division of RMS, etiology, differentiation of the most often applied clinical sign and modern therapeutic opportunities depending on the location, histopathological type, the disease advancement level and the patient's age were described. Late outcome and the initially positive results of the employed treatment were emphasized in the presented case. The authors would like to underline the necessity to apply all imaging methods available (CT scan and MRI), in order to determine the exact site and extensiveness of malignancy which is crucial for evaluation of appropriate treatment and therapy.

[The I/D polymorphism of the ACE gene in children with Henoch-Schoenlein purpura]

The study group consisted of 24 children with Henoch-Schoenlein purpura (HSP) (13 girls and 11 boys, aged 66-233 months) who were treated in the Ist Pediatric Department between 1980 and 1998. The I/D polymorphism of ACE gene was determined by PCR amplification of genomic DNA with primers flanking the polymorphic region. Our preliminary results suggest lack of association between ACE genotype and kidney function. However, further follow-up studies based on sufficient number of participants are necessary to elucidate the role of ACE polymorphism in appearance and progression of renal symptoms in HSP.

[Prognostic value of the reaction to steroids in the treatment of acute lymphoblastic leukemia in children]

Relationship between the result of therapy in 48 cases of the acute lymphoblastic leukemia in childhood and character of response to corticosteroids, classified according to BMF group, has been assessed. Follow up period ranged from 13 to 75 months (mean 36 months, median 39 months). In was found, that the probability of survival free from any events, probability of complete remission persistence, and probability of survival after diagnosis have been statistically significantly higher in the group of patients with positive response to corticosteroids in comparison with patients non-responding to these agents. However, there was no significant difference in the number of recurrencies with the involvement of CNS. Authors share the opinion that their results confirm an opinion of Riehm et al. that the response to corticosteroids is of prognostic value in the acute lymphoblastic leukemia in childhood.