Gastrointestinal Comorbidities Associated with Atopic Dermatitis-A Narrative Review

The current understanding of atopic dermatitis (AD) seems to be extending beyond a skin-confined condition frequently associated with allergic comorbidities, as in a number of epidemiological studies, the prevalence rate of a range of illnesses has been determined to be greater in patients with AD, or inversely. In most cases, the reasons for this are vague. A subset of these conditions are gastrointestinal disorders, including food sensitization (FS) and food allergy (FA), eosinophilic esophagitis (EoE) (it is of mixed background, both IgE-dependent and independent), food protein-induced enterocolitis syndrome (FPIES) (it exemplifies an IgE-independent food allergy), Crohn's disease (CD), colitis ulcerosa (CU), celiac disease, irritable bowel syndrome (IBS), and gastroesophageal reflux disease (GERD). In this review, we performed a comprehensive search of the literature using the PubMed database. We addressed the epidemiology of the increased co-occurrence of these diseases with AD and discussed potential causes for this subject. Multiple gastroenterological comorbidities appear to be more common in patients with AD, according to our review. The mechanisms that underlie this phenomenon are largely unknown, highlighting the need for further study in this field.

Can Lactose Intolerance Be a Cause of Constipation? A Narrative Review

Lactose intolerance and constipation are common in children and impact everyday life, not only for patients but also their families. Both conditions can be comorbid with other diseases or form a part of their clinical presentation, but constipation is not usually associated with lactose intolerance. The typical symptoms of lactose intolerance include abdominal pain, bloating, flatus, diarrhoea, borborygmi, and less frequently nausea and vomiting. In approximately 30% of cases, constipation can be a symptom of lactose intolerance. Constipation is characterized by infrequent bowel movements, hard and/or large stools, painful defecation, and faecal incontinence, and is often accompanied by abdominal pain. This paper provides a narrative review on lactose intolerance, its epidemiology, pathogenesis, the correlation between lactose intolerance and constipation in children, and potential mechanisms of such association.

Changes in Air Pollution-Related Behaviour Measured by Google Trends Search Volume Index in Response to Reported Air Quality in Poland

Decreased air quality is connected to an increase in daily mortality rates. Thus, people’s behavioural response to sometimes elevated air pollution levels is vital. We aimed to analyse spatial and seasonal changes in air pollution-related information-seeking behaviour in response to nationwide reported air quality in Poland. Google Trends Search Volume Index data was used to investigate Poles’ interest in air pollution-related keywords. PM₁₀ and PM_2.5 concentrations measured across Poland between 2016 and 2019 as well as locations of monitoring stations were collected from the Chief Inspectorate of Environmental Protection databases. Pearson Product-Moment Correlation Coefficients were used to measure the strength of spatial and seasonal relationships between reported air pollution levels and the popularity of search queries. The highest PM₁₀ and PM_2.5 concentrations were observed in southern voivodeships and during the winter season. Similar trends were observed for Poles’ interest in air pollution-related keywords. Greater interest in air quality data in Poland strongly correlates with both higher regional and higher seasonal air pollution levels. It appears that Poles are socially aware of this issue and that their intensification of the information-seeking behaviour seems to indicate a relevant ad hoc response to variable threat severity levels.

Mediator-Related Symptoms and Anaphylaxis in Children with Mastocytosis

Mastocytosis is characterized by the pathological accumulation of mast cells (MC) in various organs. In these patients, MC may degranulate and thereby contribute to clinical symptoms, especially when a concomitant allergy is present. However, MC activation can not only be induced by high-affinity receptors for IgE, but also by anaphylatoxins, neuropeptides, IgG immune complexes, complement-components, drugs, products of bacteria or parasites, as well as physical factors such as heat, cold, vibration, stress, sun, or physical effort. Symptoms due to mediators released by activated MC may develop in adults suffering from systemic mastocytosis, but also evolve in children who usually have cutaneous mastocytosis (CM). Clinically, CM is otherwise characterized by typical brown, maculopapular skin lesions or mastocytoma associated with a positive Darier's sign. Pruritus and flushing are common and blistering may also be recorded, especially in diffuse CM (DCM). Pediatric patients with mastocytosis may also have gastrointestinal, respiratory, and neurologic complaints. Although anaphylaxis is not a typical finding, pediatric patients with massive skin involvement and high tryptase levels have a relatively high risk to develop anaphylaxis. This paper reviews MC mediator-related symptoms and anaphylaxis in children with mastocytosis, with special emphasis on risk factors, triggers, and management.

Molecular Background, Clinical Features and Management of Pediatric Mastocytosis: Status 2021

Pediatric mastocytosis is a heterogeneous disease characterized by accumulation of mast cells in the skin and less frequently in other organs. Somatic or germline mutations in the KIT proto-oncogene are detected in most patients. Cutaneous mastocytosis is the most common form of the disease in children. In the majority of cases, skin lesions regress spontaneously around puberty. However, in few patients, mastocytosis is not a self-limiting disease, but persists into adulthood and can show signs of systemic involvement, especially when skin lesions are small-sized and monomorphic. Children with mastocytosis often suffer from mast cell mediator-related symptoms. Severe hypersensitivity reactions can also occur, mostly in patients with extensive skin lesions and blistering. In a substantial number of these cases, the triggering factor of anaphylaxis remains unidentified. Management of pediatric mastocytosis is mainly based on strict avoidance of triggers, treatment with H1 and H2 histamine receptor blockers, and equipment of patients and their families with epinephrine auto-injectors for use in severe anaphylactic reactions. Advanced systemic mastocytosis occurs occasionally. All children with mastocytosis require follow-up examinations. A bone marrow investigation is performed when advanced systemic mastocytosis is suspected and has an impact on therapy or when cutaneous disease persists into adulthood.

Before-and-after online community survey on knowledge and perception of COVID-19 pandemic

BACKGROUND

COVID-19 pandemic impacts many communities worldwide. In this study the Poles' knowledge about COVID-19 as well as people's behaviours, attitudes and fears during the pandemic were assessed. Changes in these between the outset of the pandemic and the imposition of the strictest lockdown measures in Poland were investigated.

METHODS

Physicians, nurses, students of medicine-oriented faculties, non-medical professionals, students of non-medicine-oriented faculties and secondary school students were surveyed by an anonymous online questionnaire two times: at the onset of the pandemic and in the second week of the strictest lockdown. Statistical analyses were performed using non-parametric tests - Pearson Chi Square, Kruskal-Wallis tests.

RESULTS

In total 2618 responses were collected. At the beginning people knew that the respiratory system was attacked (97.9%); correctly identified the major symptoms of COVID-19 (95.0%) and ways to prevent infection: hand washing (99.8%), covering mouth (85.9%) and the need to call sanitary-epidemiological services if one experienced COVID-19-like symptoms (92.1%). The biggest changes between the first and second phase of the study concerned behaviours: more people wearing facial masks (+ 37.5%) and staying at home (+ 66.1%). Respondents in the second wave of the survey were also more scared of the pandemic (+ 19.6%), economic crisis (+ 64.1%), and worried about their families (+ 26.5%). However, they were less afraid of the quarantine (lockdown) (- 18.2%). Nurses and physicians were the most worried groups.

CONCLUSIONS

The study showed that even at the outset of the pandemic Polish population had a good initial knowledge about symptoms, transmission, and preventive behaviours regarding COVID-19. People revealed more short-term concerns, such as the worries about coping with quarantine and isolation. After a month, the knowledge and the concerns among the respondents changed. A shift towards long-term pandemic management issues was observed. Respondents reported to experience more fears concerning the pandemic in general, as well as economic and healthcare crises. Medical professionals reported higher level of fear of the pandemic than other groups included in this study. This study uses before-and-after approach which highlights the changes in people's knowledge and perception of the COVID-19 pandemic during the pandemic's progression.

New Approach to Paediatric Mastocytosis: Implications of KIT D816V Mutation Detection in Peripheral Blood

is missing (Short communication).

Serum Neopterin in Differential Diagnosis of Bacterial Diarrhea in Pediatric Patients

Background: Neopterin, regarded as a marker of cellular immune activation, has been used in diagnosis of infection caused by intracellular pathogens. We have aimed to evaluate the clinical usefulness of serum neopterin (NPT) in acute bacterial diarrhea caused by group C enteropathogenic Escherichia coli (EPECs) and group D Salmonella spp.

Methods: Serum concentration of NPT was determined by ELISA. The study group included 47 children with diagnosis of bacterial diarrhea: 32 caused by group C enteropathogenic Escherichia coli (EPECs) and 15 by group D Salmonella spp. 105 healthy children constituted the control group.

Results: Serum concentration of NPT in children infected with group D Salmonella spp. turned out to be higher than in the other groups. The fraction of Salmonella-infected patients with serum neopterin above 11 nmol/l proved higher as compared to children with diarrhea caused by group C EPECs or to the healthy controls. The prevalence of a C-reactive protein (CRP) to NPT ratio of greater than 1 did not differ significantly between children with diarrhea of various etiology.

Conclusions: Neopterin can be used as a non-specific marker differentiating between bacterial diarrhea of various etiology.

Immune response against HtrA proteases in children with cutaneous mastocytosis

Mast cells play an important role in both, the innate and adaptive immunity, however, clonal proliferation of abnormal mast cells in various organs leads to mastocytosis. A skin variant of the disease, cutaneous mastocytosis (CM) is the most frequent form of mastocytosis in children. HtrA proteases are modulators of important cellular processes, including cell signaling and apoptosis, and are related to development of several pathologies. The above and the observation that mast cells constitutively release the HtrA1 protein, prompted us to investigate a possible involvement of the HtrA proteins in pediatric CM. Levels of the serum autoantibodies (IgG) against the recombinant HtrA proteins (HtrA1-4) in children with CM (n=36) and in healthy controls (n=62) were assayed. Anti-HtrA IgGs were detected using enzyme linked immunosorbent assay (ELISA) and Western-blotting. In the CM sera, levels of the anti-HtrA1 and anti-HtrA3 autoantibodies were significantly increased when compared to the control group, while the HtrA protein levels were comparable. No significant differences in the anti-HtrA2 IgG level were found; for the anti-HtrA4 IgGs lower levels in CM group were revealed. In healthy children, the IgG levels against the HtrA1, -3 and -4 increased significantly with the age of children; no significant changes were observed for the anti-HtrA2 IgG. Our results suggest involvement of the HtrA1 and HtrA3 proteins in pediatric CM; involvement of the HtrA4 protein is possible but needs to be investigated further. In healthy children, the autoantibody levels against HtrA1, -3 and -4, but not against HtrA2, increase with age.

Peripheral regulatory T cells and anti-inflammatory cytokines in children with juvenile idiopathic arthritis

BACKGROUND

Juvenile idiopathic arthritis (JIA) is a chronic, heterogenous inflammatory disease of unclear pathogenesis. JIA is hypothesized to be linked to a defective immune regulation. Anti-inflammatory cytokines belong to the best known regulatory factors. T-regulatory cells are a crucial cellular component of immune tolerance. One of their functions is synthesis of interleukin 10 (IL-10) and transforming growth factor beta1 (TGF-β1). The aim of this study was to determine the proportion of T-regulatory cells (CD4⁺CD25^highFOXP3⁺) in peripheral blood, and serum levels of TGF-β1 and IL-10 in patients with JIA.

METHODS

The study included 25 patients with newly diagnosed JIA: oligoarthritis (n=17) and polyarthritis (n=8). The control group was comprised of 17 healthy children. CD4⁺CD25^highFOXP3⁺ T cells in peripheral blood were quantified by means of three-color flow cytometry. Serum concentrations of TGF-β1 and IL-10 were estimated with ELISA.

RESULTS

The proportion of peripheral CD4⁺CD25^highFOXP3⁺ cells in patients with JIA was significantly higher than in the controls (p=0.04). The two groups did not differ significantly in terms of their TGF-β1 and IL-10 concentrations.

CONCLUSIONS

At the time of diagnosis, children with JIA presented with an elevated proportion of T-regulatory cells (CD4⁺CD25^highFOXP3⁺) in peripheral blood. Anti-inflammatory cytokines, IL-10 and TGF-β1, are not upregulated in the serum of patients with JIA, and therefore should not be considered as biomarkers of this condition.

Association between uridin diphosphate glucuronosylotransferase 1A1 (UGT1A1) gene polymorphism and neonatal hyperbilirubinemia

OBJECTIVE

To assess the prevalence of UGT1A1*28 and UGT1A1*60 polymorphisms of UGT1A1 gene and their association with hyperbilirubinemia.

STUDY DESIGN

The study was performed at a single centre - at the Department of Obstetrics of the Medical University of Gdansk in Poland. DNA was isolated from Guthrie cards of 171 infants. Only full term newborns (gestational age 38-42 weeks) were included in the study. Fluorescent molecular probes were used for UGT1A1 promoter variation analysis. The presence of UGT1A1*28 polymorphism was detected with a dual-probe system, and UGT1A1*60 with a SimpleProbe™.

RESULT

Homozygous UGT1A1*28 and UGT1A1*60 genotypes were detected in 14.6% and 20.5% of the newborns, respectively. Homozygous (G/G) genotypes of UGT1A1*60 polymorphism were found in all of the UGT1A1*28 (i.e. (TA)₇/(TA)₇) homozygotes. More than 80% (55/66) of the children with "wild" type UGT1A1*28 genotype (where no polymorphism was detected) (i.e. (TA)₆/(TA)₆) carried the "wild" (T/T) genotype of UGT1A1*60 as well. The UGT1A1*28 polymorphism was detected more often among neonates with elevated bilirubin. Hyperbilirubinemia was diagnosed more frequently in boys.

CONCLUSION

Polymorphisms of the UGT1A1 gene frequently co-exist in neonates. The presence of UGT1A1*28 polymorphism and male gender seem to predispose to neonatal hyperbilirubinemia.

Indoleamine 2,3-dioxygenase and regulatory t cells in intestinal mucosa in children with inflammatory bowel disease

Impaired immune regulation has been suggested as an underlying mechanism of inflammatory bowel disease. Indoleamine 2,3-dioxygenase (IDO) and regulatory T cells expressing FOXP3 are crucial elements of immune regulation. Conversion of FOXP3- lymphocytes to Tregs is one of the functions of IDO. The aim of this study was to evaluate the number of cells expressing FOXP3 and IDO in the lamina propria of intestinal mucosa and to evaluate correlations between these parameters and disease activity. Sixty-six children newly diagnosed with inflammatory bowel disease (41 patients with ulcerative colitis and 25 patients with Crohn’s disease) were included in the study. Clinical activity of the disease was assessed by the Pediatric Ulcerative Colitis Activity Index and the Pediatric Crohn’s Disease Activity Index. Histopathological activity was scored according to the system described by Geboes. The infiltration of FOXP3+ and IDO+ cells was evaluated by immunohistochemistry. Sixteen patients with a diagnosis of irritable bowel syndrome (IBS) served as a control group. Lamina propria demonstrated a significantly higher infiltration of FOXP3+ and IDO+ cells in inflammatory bowel disease compared to the control group (p=0.001, p=0.004, respectively). The number of IDO+ and FOXP3+ cells correlated with clinical and histopathologic activity of Crohn’s disease. A positive correlation between the number of IDO+ and FOXP3+ cells was found in both types of inflammatory disease but not in patients with IBS. We conclude that indoleamine dioxygenase and FOXP3+ cells are upregulated in the intestinal mucosa of children with inflammatory bowel disease. IDO mediated conversion of FOXP3 -T cells to Tregs predominantly occurs in inflammation.

Peripheral and Intestinal T-regulatory Cells are Upregulated in Children with Inflammatory Bowel Disease at Onset of Disease

BACKGROUND/AIMS

To determine the proportion of T-regulatory cells (CD4⁺CD25^highFOXP3⁺ cells) in peripheral blood and the number of FOXP3⁺ cells in intestinal mucosa of children with inflammatory bowel disease (IBD), and to verify whether these parameters correlate with the activity of the disease.

MATERIAL AND METHODS

24 patients newly diagnosed for IBD were included in the study: ulcerative colitis (UC; n = 13) and Crohn's disease (CD; n = 11). Seventeen healthy controls (HC) and 16 patients with irritable bowel syndrome (IBS) served as a control group for peripheral and intestinal Tregs assessment, respectively. The disease activity was assessed by Pediatric Ulcerative Colitis Activity Index (PUCAI) and Pediatric Crohn's Disease Activity Index (PCDAI). Quantification of regulatory T cells of CD4⁺CD25^highFOXP3⁺ phenotype in peripheral blood was based on three-color flow cytometry. Mucosal Tregs represented by FOXP3⁺ cells were evaluated using immunohistochemistry.

RESULTS

Median proportion of CD4⁺CD25^highFOXP3⁺ cells among CD4⁺ T cells in peripheral blood (5.1%, range 1.7-84% vs. 4.3%, range 2-8.1%, p = 0.023) and median number of intestinal FOXP3+ cells (115.33 per high-power field, hpf, range 39.33-375.67 vs. 10.16 per hpf, range 5-30, p = 0.0001) were significantly higher in children with IBD than in the controls. The proportion of circulating Tregs and the number of intestinal FOXP3+ cells did not correlate with clinical activity of the disease, as well as with endoscopic and histopathologic scoring. No significant correlation was found between the percentage of peripheral CD4+CD25^highFOXP3+ cells and the number of intestinal FOXP3+cells.

CONCLUSIONS

Children with IBD likely do not present with a quantitative deficiency of circulating and intestinal Tregs at the moment of diagnosis.

Diagnosis of Mastocytosis in Children and Adults in Daily Clinical Practice

Mastocytosis comprises a heterogeneous group of disorders characterized by clonal, neoplastic proliferation of mast cells accumulating in one or multiple organs. In the majority of cases skin involvement is the first clinical manifestation of the disease. Clinical work-up consists of a combination of morphological, immunohistochemical, flow cytometric immunophenotyping and molecular examination. Cutaneous mastocytosis predominates in children, whereas systemic mastocytosis is the most common form of the disease in adults. Therefore, different diagnostic algorithms have to be applied in adult patients and children with suspected mastocytosis. This comprehensive review presents currently defined variants of the disease and recommendations to facilitate diagnostic work-up in children and adults with suspected mastocytosis in daily clinical practice.

Fecal lactoferrin, a marker of intestinal inflammation in children with inflammatory bowel disease

The aim of this study was to analyze the usefulness of fecal lactoferrin in the diagnosis and monitoring of inflammatory bowel disease (IBD) in children. The study included 52 children with IBD (24 with Crohn's disease and 28 with ulcerative colitis) aged between 0.92 and 18 years, and 41 IBD-free controls of similar age. Fecal concentration of lactoferrin was determined with a quantitative immunoenzymatic test. Fecal concentration of lactoferrin in children with IBD was significantly higher than in the controls. The cut-off value of fecal lactoferrin concentration optimally distinguishing between the children with IBD and the controls was identified as 13 μg/g. The sensitivity and specificity of this cut-off value equaled 80.7% and 92.7%, respectively, and its positive and negative prognostic values were 96.8% and 63.3%, respectively. Patients diagnosed with moderate Crohn's disease had significantly higher fecal concentrations of lactoferrin than children with the mild or inactive disease. Similarly, children with moderate ulcerative colitis showed significantly higher fecal concentrations of lactoferrin than individuals with the mild condition. No significant relationship was found between the fecal concentration of lactoferrin and the severity of endoscopic lesions. Patients with IBD and a positive result of fecal occult blood test were characterized by significantly higher concentrations of lactoferrin than the individuals with IBD and a negative result of this test. In conclusion, fecal concentration of lactoferrin seems to be a useful parameter for diagnosis and monitoring of IBD in children.

Clinical usefulness of serum neopterin in children with juvenile idiopathic arthritis

The aim of this study was to analyze the usefulness of the serum concentration of neopterin (NPT) as a marker of juvenile idiopathic arthritis (JIA). The study included 67 children with JIA (36 girls and 31 boys), aged between 3.8 and 17.9 years (mean 13.7±3.4 years), and 105 healthy controls (47 girls and 58 boys) of similar age, with no evidence of acute or chronic inflammation. Serum NPT was determined immunoenzymatically. The median serum concentration of NPT and prevalence of elevated serum NPT (>11 nmol/L) were significantly higher in children with JIA than in the controls: 6.044 vs. 4.734 nmol/L (p<0.001) and 30% vs. 5% (p<0.001), respectively. The serum concentration of NPT did not correlate with body temperature (R=0.00, p=0.97), erythrocyte sedimentation rate (R=0.09, p=0.47), leukocyte count (R=−0.05, p=0.70), C-reactive protein (R=−0.14, p=0.25), and procalcitonin levels (R=0.07, p=0.56). Furthermore, serum NPT was not associated with the type of JIA. However, children with exacerbation of JIA presented with significantly higher median serum level of NPT (10.912 vs. 4.471 nmol/L, p<0.001) and higher prevalence of serum NPT >11 nmol/L (50% vs. 0%, p<0.001) than did patients with remission. These data suggest that elevated serum concentration of NPT is an accurate marker of JIA exacerbation.

Human breast milk concentration of neopterin at various stages of lactation and during a single feeding

The aim of this work was to determine the physiological level of neopterin in human breast milk, and to study its variability depending on the duration of a single feeding and the lactation stage. Breast milk samples from 74 women were collected between 2 and 4 days after delivery, and at 15, 30, and 90 days after delivery. Additionally, breast milk samples from eight women were collected before and after 7 and 15 min of breastfeeding. The concentration of neopterin in breast milk was determined by an immunoenzymatic assay. The range of breast milk neopterin concentration at various stages of lactation amounted to 15.4–19.2 nmol/L at 2–4 days after delivery, 20.2–23.0 nmol/L at day 15, 20.8–24.5 nmol/L at day 30, and 16.9–20.4 nmol/L at day 90. The level of neopterin 2–4 days after delivery was significantly lower than that at days 15 and 30; moreover, the concentration of neopterin at day 30 was significantly higher than that at day 90. No significant differences were documented between neopterin concentrations at various phases of a single feeding. While the breast milk concentration of neopterin changes depending on the stage of lactation, it remains stable throughout a single feeding.

Coexistence of type 1 diabetes mellitus and spinal muscular atrophy in an 8-year-old girl: a case report

The spinal muscular atrophy is a rare autosomal recessive genetic disease characterized by the progressive loss of muscular strength. In its natural course the disease leads to death. Diabetes mellitus type 1 is an autoimmune metabolic disorder characterized by the disturbed insulin synthesis. This is a case report of an 8-year-old girl suffering from Werdnig Hoffman disease in whom DM1 was diagnosed. The unspecific clinical manifestation and diagnostic difficulties are presented in this paper. To the authors' knowledge, this is the first publication concerning the co-existence of these two medical conditions.

Evaluation of clinical usefulness of serum neopterin determination in children with bacterial infections

Neopterin (NPT) (6-D-erythro-trihydroxypropyl pteridin) is one of the indicators of the immune system activity. Elevated neopterin concentration occurs in diseases mostly involving stimulation of cellular immunity. The determination of neopterin concentration, usually in blood serum and urine but also in many other bodily fluids, has already been applied in many areas of medicine, such as transfusiology, transplantology, oncology, infectious diseases and autoimmunological diseases.

OBJECTIVE

The aim of this work is to evaluate clinical usefulness of serum neopterin determination in children with urinary tract infections of confirmed bacterial etiology.

MATERIAL

The study involved 56 children with bacterial urinary tract infections - patients of the Clinic of Paediatrics, Paediatric Gastroenterology, Hepatology & Paediatric Nutrition of Medical University of Gdańsk in the years 2012-2013. The control group included 105 healthy children.

RESULTS

The values of NPT concentration in blood serum obtained in the group of children with urinary tract infections did not significantly differ from the values obtained in the control group.

CONCLUSIONS

The determination of neopterin concentration in children with bacterial urinary tract infections is not a clinically useful parameter.

Reorganization of nutritional therapy can markedly reduce the rate of catheter-related blood stream infections in pediatric patients receiving parenteral nutrition - a 7-year prospective follow-up study

BACKGROUND

Implementation of hygienic measures and simple changes in the structure of medical team may considerably reduce the rate of catheter-related bloodstream infections (CRBSIs) in parenterally nourished patients.

AIM

To analyze the effects of organizational changes in parenteral nutrition services on the CRBSI rates in pediatric patients.

METHODS

We compared the CRBSI rates documented prior to, during and after the implementation of the organizational changes (introduction of a nutritional support team and related procedures, medical staff training).

FINDINGS

A total of 260 courses of parenteral nutrition were offered to 141 pediatric patients during the analyzed period. Thirty CRBSIs were documented during this period. The most frequent etiological factors were staphylococci (21/30), followed by Klebsiella pneumoniae, Escherichia coli and Candida albicans (2/30 each). The reorganization was reflected by more than 8-fold reduction of the CRBSI incidence rate: from the initial value of 10.14 to 6.89 per 1000 catheter days and 1.17 per 1000 catheter days during and after the reorganization, respectively.

CONCLUSION

Introduction of a nutritional support team, accompanied by extensive training of medical staff, can result in a marked reduction of CRBSI rate in pediatric patients nourished parenterally in a hospital setting.

Graves' disease, Celiac disease and liver function abnormalities in a patient--clinical manifestation and diagnostic difficulties

Autoimmune diseases due to probable common pathogenesis tend to coexist in some patients. Complex clinical presentation with diverse timing of particular symptoms and sophisticated treatment with numerous side effects, may cause diagnostic difficulties, especially in children. The paper presents diagnostic difficulties and pitfalls in a child with Graves' disease, celiac disease and liver function abnormalities.

Graves' disease, Celiac disease and liver function abnormalities in a patient--clinical manifestation and diagnostic difficulties

Autoimmune diseases due to probable common pathogenesis tend to coexist in some patients. Complex clinical presentation with diverse timing of particular symptoms and sophisticated treatment with numerous side effects, may cause diagnostic difficulties, especially in children. The paper presents diagnostic difficulties and pitfalls in a child with Graves' disease, celiac disease and liver function abnormalities.

Serum Concentrations of Tryptase in Children

Background: Mast cells are dispersed in many tissues, especially in digestive and respiratory-tract mucosal membranes. Tryptase, considered a marker of mast-cell activity, is the most important protease released from these cells during degranulation. Tryptase concentration is mainly accessed in anaphylaxis and mastocytosis, being one diagnostic criteria of this disease. There are no data concerning tryptase activity in healthy children in the current literature. Aim: The aims of this study were the analysis of concentrations of serum tryptase in healthy children, and determining reference values of the enzyme at different developmental ages. Materials and methods: The investigated group consisted of 131 healthy children (75 girls, 56 boys) aged 3 months-18 years. The concentration of tryptase in the studied samples was evaluated by the fluoro-immuno-enzymatic method with UniCAP. Results: The mean concentration of serum tryptase in the studied group was 2.8±2.2 ng/dL: 2.5±2.2 ng/dL in girls and 3.2±2.1 ng/dL in boys. Conclusion: The upper reference limit of 7.2 ng/dL was lower than in adults.

Clinical Usefulness of Determining the Concentration of Neopterin

Neopterin is one of biochemical markers of immune activity, which seems to be useful in monitoring inflammatory diseases. Increased serum concentration of neopterin is observed in conditions with cell-mediated immune response involvement. In clinical practice, neopterin evaluation is applied in medical conditions such as: infectious diseases, oncology, rheumatology, transplantology, transfusiology, cardiology, neurology and many others. Neopterin can be detected in serum, urine, cerebrospinal fluid, synovial fluid, saliva, ascitic fluid, bile, pancreatic juice and gastric juice. In recently published studies, various non-specific indicators of inflammation such as neopterin, C-reactive protein, procalcitonin were compared and proved to be independently useful.

Reference Standard of Serum Neopterin Concentration in Healthy Children

Introduction: Increased neopterin concentrations are observed in many diseases in which cell immunity is stimulated. A quick and sensitive method for monitoring the changes in immune system can be useful for understanding etiopathogenesis of the disease and choosing the appropriate treatment. There are only few known data concerning normal serum neopterin value in children, therefore the wide clinical use of this parameter is limited.

Aim: to evaluate the referential neopterin concentration in serum in healthy children according to age and gender.

Patients and methods: 105 healthy children, 47 girls and 58 boys, aged 1 month - 17.9 years were examined. Clinical examinations and laboratory test including whole blood count, serum C-reactive protein, urea, and creatinine level, were conducted. The serum neopterin level was analyzed by ELISA (BRAHMS, Hennigsdorf/Berlin, Germany). The results were used for reference standard evaluation of serum neopterin level in healthy children. Results: The serum neopterin concentrations in children were 2.87 - 14.78, mean 5.47 ± 2.58 nmol/L. No significant correlation was found between children's age and serum neopterin level. There were also no differences among serum neopterin level in different age groups: under 5, 5 to 10, and over 10 years, and between girls and boys. The estimated cut-off value 11 nmol/L of serum neopterin level for whole group of children made the 94.3% test sensitivity.

Conclusion: Serum neopterin concentration is lower than 11 nmol/L in healthy children after neonatal period, and is independent of childrens' age or gender.

Serum Neopterin Concentration in Children with Viral Gastroenteritis

Increased neopterin concentrations are observed in many diseases in which cellular immunity is stimulated. Gastroenteritis is still a major cause of childhood morbidity and mortality worldwide. Over 75% of all cases are caused by viral infections. Therefore a non-specific, quick, sensitive, cheap and easy-to-perform marker of viral infection, such as neopterin concentration in serum, would be a cost-effective method of identifying patients with gastroenteritis into probable viral etiology and therefore it would optimize treatment and reduce inappropriate antibiotic treatment.

This study evaluated whether serum neopterin concentration can be a reliable marker of viral etiology of gastroenteritis in children. The study group consisted of 67 children: 29 girls and 38 boys, aged from 0.1 to 16.1 years with symptoms of gastroenterits and with confirmed rotavirus or adenovirus infection; the control group consisted of 105 healthy children. Clinical examinations and laboratory test including whole blood count, serum C-reactive protein, procalcitonin, and creatinine concentration were conducted. The serum neopterin level was analyzed by Elisa.

Serum neopterin concentration in the study group varied from 6.03 to 171 nmol/L (median 23.7 nmol/L) and it was significantly higher than in the control group (from 2.88 to 14.8 nmol/L; median 4.73 nmol/L) (P <0.001). Neopterin concentration was above the normal value (>11 nmol/L) in 58 children from the study group and only in 6 from the control group (86.6% sensitivity and 94.3% specificity). Serum neopterin concentration did not differ significantly between children with rotavirus and adenovirus infection (P = 0.47). The correlation between serum neopterin and C-reactive protein concentrations was of borderline significance (rs = 0.23, p = 0.06); and there was no correlation between serum concentrations of neopterin and procalcitonin, white blood count, lymphocytes count, monocytes count or the body temperature. Serum neopterin concentration is highly increased in children suffering from viral gastroenteritis, regardless of the virus type. When a cut-off of 11.0 nmol/L neopterin was applied, comparison yields 86.6% sensitivity and 94.3% specificity for the diagnosis of viral gastroenteritis in pediatric patients. Further studies are necessary for other etiological agents of gastroenteritis.

Transforming growth factor β1 protein and mRNA levels in inflammatory bowel diseases: towards solving the contradictions by longitudinal assessment of the protein and mRNA amounts

Previously published studies on levels of the transforming growth factor-β1 (TGF-β1) protein and mRNA of the corresponding gene in patients suffering from inflammatory bowel diseases (IBD) gave varying results, leading to contradictory conclusions. To solve the contradictions, we aimed to assess longitudinally TGF-β1 protein and mRNA levels at different stages of the disease in children suffering from IBD. The study group consisted of 19 pediatric patients with IBD at the age between 3.5 and 18.4 years. The control group consisted of 42 children aged between 2.0 and 18.0 years. The plasma TGF-β1 concentration was measured with ELISA. mRNA levels of the TGF-β1 gene isolated from samples of the intestinal tissue were assessed by reverse transcription and real-time PCR. Levels of TGF-β1 protein in plasma and corresponding mRNA in intestinal tissue were significantly higher in IBD patients than in controls. TGF-β1 and corresponding transcripts were also more abundant in plasma and intestinal tissue, respectively, in patients at the active stage of the disease than during remission. In every single IBD patient, plasma TGF-β1 level and mRNA level in intestinal tissue was higher at the active stage of the disease than during remission. Levels of TGF-β1 and corresponding mRNA are elevated during the active stage of IBD but not during the remission. Longitudinal assessment of this cytokine in a single patient may help to monitor the clinical course of IBD.

Clinical parameters of inflammatory bowel disease in children do not correlate with four common polymorphisms of the transforming growth factor β1 gene

Transforming growth factor β1 (TGF-β1) is a cytokine affecting cell proliferation and development, which also has an immunomodulatory activity. Correlations between polymorphisms of the TGF-β1 gene and clinical parameters of inflammatory bowel disease (IBD) were reported previously in adults. Here, we tested whether such correlations occur in pediatric patients suffering from IBD. One hundred and four pediatric IBD patients were involved in this study. Among them, 36 were diagnosed with Crohn's Disease (CD) and 68 were diagnosed with ulcerative colitis (UC). The control group consisted of 103 children, in which IBD was excluded. TGF-β1 levels were determined in plasma and intestinal mucosa samples. The presence of the TGF β1 protein and the amount of TGF β1 mRNA were estimated in intestinal mucosa by immunohistochemistry and reverse transcription Real-Time PCR, respectively. Four common polymorphisms of the TGF-β1 gene were investigated: -800G/A, -509C/T, 869T/C and 915G/C. No significant correlation between TGF-β1 genotypes and (i) TGF-β1 levels in plasma and tissue samples, (ii) TGF-β1 gene expression efficiency in intestinal mucosa, (iii) IBD clinical parameters and (iv) inflammatory activity could be detected in children suffering from IBD. We conclude that, contrary to previous suggestions, the four common polymorphisms of the TGF-β1 gene do not influence the susceptibility to or clinical parameters of IBD in the tested population of children.

Clinical parameters of inflammatory bowel disease in children do not correlate with four common polymorphisms of the transforming growth factor β1 gene

Transforming growth factor β1 (TGF-β1) is a cytokine affecting cell proliferation and development, which also has an immunomodulatory activity. Correlations between polymorphisms of the TGF-β1 gene and clinical parameters of inflammatory bowel disease (IBD) were reported previously in adults. Here, we tested whether such correlations occur in pediatric patients suffering from IBD. One hundred and four pediatric IBD patients were involved in this study. Among them, 36 were diagnosed with Crohn's Disease (CD) and 68 were diagnosed with ulcerative colitis (UC). The control group consisted of 103 children, in which IBD was excluded. TGF-β1 levels were determined in plasma and intestinal mucosa samples. The presence of the TGF β1 protein and the amount of TGF β1 mRNA were estimated in intestinal mucosa by immunohistochemistry and reverse transcription Real-Time PCR, respectively. Four common polymorphisms of the TGF-β1 gene were investigated: -800G/A, -509C/T, 869T/C and 915G/C. No significant correlation between TGF-β1 genotypes and (i) TGF-β1 levels in plasma and tissue samples, (ii) TGF-β1 gene expression efficiency in intestinal mucosa, (iii) IBD clinical parameters and (iv) inflammatory activity could be detected in children suffering from IBD. We conclude that, contrary to previous suggestions, the four common polymorphisms of the TGF-β1 gene do not influence the susceptibility to or clinical parameters of IBD in the tested population of children.

[Utility of fecal markers of inflammation in the diagnostics of inflammatory bowel diseases]

Many reports from recent years indicate the important role of fecal markers of inflammation. These are proteins produced by neutrocytes, monocytes and hepatocytes. The concentration of these proteins increases in the process of inflammation. These parameters are very sensitive because changes in their levels particularly reflect inflammatory conditions in the intestines. In this study we discuss the role of measurements of proteins such as: alpha 1-antitrypsin, myeloperoxydase, lactoferrin, calprotectin, S100A12 protein and pyruvate kinase in stool. The largest number of studies indicating the usefulness in the diagnosis and monitoring the course of inflammatory bowel diseases concerns stool lactoferrin and calprotectin.

Preferential immunoglobulin oxidation in children with juvenile idiopathic arthritis

OBJECTIVE

Juvenile idiopathic arthritis (JIA) is a rare chronic inflammatory disorder of the joints. There is strong evidence that oxidative damage occurs in rheumatoid diseases, including JIA. The increased level of protein oxidation products in total plasma proteins has recently been reported in children with diagnosed JIA. The objective of this study was to find out which fraction of plasma proteins is mostly damaged by oxidative stress and whether the damaging effect correlates with certain clinical or laboratory parameters.

METHODS

A new approach to estimate the carbonyl content of plasma protein fractions was developed, based on two-stage electrophoresis and immunochemical detection of the carbonyl derivatives of the proteins. This method allowed us to detect and quantitate carbonyl groups in the albumin, alpha-2, beta and gamma-globulin fractions. Sera of 25 children with JIA and 13 healthy controls were tested.

RESULTS

Albumin and gamma-globulins were found to be most modified by oxidation. In a group of children with systemic JIA, both albumin and gamma-globulins were oxidized while plasma gamma-globulin fraction damage was prevalent in pauciarticular JIA.

CONCLUSIONS

Among plasma proteins of children with JIA, gamma-globulins were preferentially oxidized, whereas most of the other proteins did not seem to be affected. Oxidative modification of plasma proteins was correlated with the type of JIA. These findings may allow the use of carbonyls as clinical markers of inflammatory process activity in patients with different types of JIA. It is also a potential tool for monitoring oxidative protein damage in other diseases and therapies.

Serum Neopterin Concentration in Children with Ulcerative Colitis

To further evaluate the clinical usefulness of serum neopterin measurement as a parameter monitoring disease activity in children with ulcerative colitis, serum neopterin concentrations were evaluated using immunoenzyme assay (ELISA) in 48 patients suffering from ulcerative colitis with different disease activity. Statistically significant differences in serum neopterin concentration depending on disease activity (according to Truelove-Witts score) as well as statistically significant positive correlation between these variables were observed. We conclude that serum neopterin measurement can be clinically valuable as the parameter monitoring disease activity in children with ulcerative colitis.

[Blood culture analysis in children with central venous catheter]

We analyzed 99 blood cultures taken from 28 children with central venous catheter. Children were hospitalized in pediatric, pediatric surgery and pediatric intensive care department. All samples were collected from peripherial vein. Positive blood cultures were obtained more frequently from children with central venous catheter than from children without central venous catheter (57.5% vs. 7.4%). Staphylococcus epidermidis was the most frequently obtained bacteria. The other bacterial species were obtained less frequently. The highest percentage of multi resistant straines was isolated from blood samples collected from intensive care department patients. In each departments in which coagulase-negative Staphylococci were isolated, metycillin-resistant straines dominated.

[Evaluation of selected immunocompetent cells expression in gastric mucosa in children with Helicobacter pylori infection before and after eradication treatment--a preliminary study]

INTRODUCTION

Helicobacter pylori infection activates local immunological response and causes mononuclear cells infiltration in the gastric mucosa. On this account the studies on lymphocyte subpopulations in the gastric mucosa in children during Helicobacter pylori infections are inconsistent. It has been shown that the morphological status of gastric mucosa in children with Helicobacter pylori infection is different than in adult patients. THE AIM OF THE STUDY was the evaluation of chosen immunocompetent cells expression in gastric mucosa in children before and after eradication treatment.

MATERIAL AND METHODS

Forty-nine children with chronic abdominal pain was enrolled in the study. They were divided into the following groups: 22 children without infection (negative urease test and absence of Helicobacter pylori antigen assessed by immunoenzymatic and immunofluorescent methods) and 27 with Helicobacter pylori infection. Part of the children (11) from the second group had a follow-up endoscopy after eradication therapy. The tissue samples from the gastric antrum and fundus were obtained for morphological and immunohistochemistry assays by direct immunofluorescent and immunoenzymatic methods.

RESULTS

There were negative Helicobacter pylori tests in group I. In the group of infected children superficial colonisation of pathogen dominated In analysed groups percentage of patients with superficial antigens and cytokines (CD3, CD4, CD8, CD20, IL-4, IL-6, INF-gamma) characteristic for each lymphocytes subpopulations were established. In infammatory infiltrations T lymphocytes CD4 and B lymphocytes CD20 dominated localised mainly in the lamina propria of the gastric mucosa. Expression of above lymphocytes subpopulations diminished after eradication treatment. After treatment the total eradication of Helicobacter pylori was observed in 5 children and in 6 patients the pathogen persisted.

CONCLUSIONS

The dominant role in local response during Helicobacter pylori infection in children is played by T CD4 and B CD20 lymphocytes localised mainly in lamina propria of gastric mucosa. Degree of T cells CD4 and CD20 expression decreases after eradication treatment.

[Serum neopterin level in children with lower respiratory tract infections]

THE AIM OF THE STUDY

was to determinate the serum neopterin concentration in children with lower respiratory tract infections.

MATERIAL AND METHODS

eighty-seven children with lower respiratory tract infections, aged from 1 month to 8 years, were analyzed. The control group consisted of 105 children without infection. The serum C-reactive protein level and whole blood count with differential white blood count were estimated The serum neopterin concentration was evaluated using the immunoenzyme assay (ELISA).

RESULTS

statistically significantly higher serum neopterin concentration was observed in the studied than in the control group. The sensitivity of serum neopterin concentration evaluation in children with lower respiratory tract infection was 90.5% and specificity 55.2%. No correlation was found between serum neopterin concentrations and commonly evaluated inflammatory markers.

CONCLUSIONS

serum neopterin concentration is elevated in children with lower respiratory tract infections and may be of clinical value as the marker of a viral infection.

[Vitamin B12 deficiency in a one-year-old, exclusively breast fed child]

Vitamin B12 deficiency is a rare condition in children. The most frequent cause is vegetarian diet. In infants it can happen in breast fed children whose mother is on this diet. The clinical feature of the disease presents with megaloblastic anemia and symptoms such as: weakness, refusing to eat, hypotonia, paraesthesia, delayed or regressed development. We present a case report of vitamin B12 deficiency in a one-year-old, exclusively breast fed child. The mother's diet during pregnancy and breast-feeding were normal.

CONCLUSIONS

The quality of the mother's diet and her haematological status during pregnancy and breast-feeding should be carefully monitored. It is necessary to introduce a variety of foods to expand the infant's diet at the proper time. The diagnosis of anaemia in the mother and/or in the child requires a careful investigation.

[Prevalence of ESBL strains in urinary tract infections in children in 1996 and 2004]

Ethiological agents in urinary tract infections and prevalence of bacterial strains producing extended spectrum of beta-lactamases isolated from urine of children with urinary tract infections were compared. Patients were hospitalized in Department of Pediatry, Pediatric Gastroenterology and Oncology of Medical University of Gdańsk in 1996 and 2004. Seventy bacterial strains isolated from urine in 1996 and 113 strains isolated in 2004 were analyzed. In both years Enterobacteriaceae were the most frequently encountered with Escherichia coli predominance. Proteus spp. (10.9%), Enterobacter spp. (7.1%), Klebsiella spp. (4.4%), and Enterococcus spp. (9.3%) were isolated rarely. Among bacteria isolated in 1996 there were no ESBL strains while in 2004 ESBL strains accounted for 11.5% of all urinary bacteria. Klebsiella oxytoca (25%) and Klebsiella pneumaniae (20%) produced ESBL most frequently. ESBL production was less frequent in Escherichia coli (13.2%) and Proteus mirablilis (10%). In conclusion, among bacteria isolated from urine of children with urinary tract infections G(-) strains producing ESBL were encountered only in recent years.

[Antibiotics in lower respiratory tract infection]

THE AIM OF THE STUDY

Comparison of clinical outcome of lower respiratory tract infections in small children treated or not treated with antibiotics.

MATERIAL AND METHODS

Eighty seven children aged from 2 months to 5 years admitted to hospital with mild to moderate bronchitis and/or pneumonia were randomly allocated to one of two groups: group A children were treated with antibiotics and group B patients were not. The children remained under close clinical observation. The clinical outcome was considered good if symptoms of the disease decreased after 72 hours. In case of no clinical improvement or worsening, the children from group B received antibiotics and in children from group A antibiotic therapy was changed.

RESULTS AND CONCLUSIONS

There were no significant differences between the two groups in the course of the disease, the frequency of pulmonary complications and recurrence during one month of follow-up.

[Clinical value of neopterin. Part I]

Neopterin concentration can be used to detect the activation of the cellular immune system. Neopterin synthesis is the sum of all positive and negative regulating factors on the monocyte/macrophage populations activated by interferon-gamma, which is mainly produced by activated T lymphocytes. Neopterin can be determined in serum, plasma and other body fluids such as urine, cerebrospinal fluid, saliva, synovial fluid, ascitic fluid. The normal range of the neopterin concentration in serum or plasma is below 10 nmol/l. The applications for neopterin as a laboratory parameter for clinical diagnosis are: infections, autoimmune diseases, malignant diseases, posttransplant monitoring, blood transfusions, immunomodulatory therapy and treatment monitoring. Our own research results will be presented in part II of this study.

[Rickets prophylaxis under current recommendations]

AIM OF THE STUDY

We analysed the compliance of current recommendations concerning rickets prevention in Poland.

MATERIAL AND METHODS

The study group consisted of 65 infants hospitalised because of emergency problems. In each case, the medical history included prophylaxis of rickets and feeding pattern. In most cases (80%) we measured calcium, phosphate, and alkaline phosphatase in the serum.

RESULTS

Vitamin D3 was overdosed in 70% of infants. 14% of children were diagnosed as rachitic in outpatient department before hospitalisation, but neither the clinical symptoms nor the laboratory test confirmed the diagnosis. This confirms the observation, that rickets is diagnosed too often, usually on the basis of isolated craniotabes in young infants.

CONCLUSION

In the context of changing recommendations for prophylaxis of rickets, we recommend more careful prescribing of vitamin D3 preparations.

[Erythema nodosum of tuberculous etiology in a 18 months old girl]

The authors report a case of an 18-months old girl with primary tuberculosis, where erythema nodosum was the main symptom. She received BCG vaccination on the first day of life according to the Polish vaccination programme. Although there was no postvaccinal scar when she was 12 months old, she was not revaccinated. On hospitalisation, the tuberculin skin test was strongly positive. The girl had a confirmed contact with tuberculosis. On the base of the anamnestic data and the clinical course, Erythema nodosum of tuberculous etiology was diagnosed and treatment was introduced. Erythema nodosum is not specific for tuberculosis but in the differential diagnosis tuberculosis should be taken into consideration.

[Undernutrition in hospitalised children. Part I]

THE AIM OF THE STUDY

Determination of the incidence of undernutrition among children on admission to hospital.

MATERIAL AND METHODS

In 818 patients aged l week to 20 years admitted to Paediatric Department from January to May 2004, the height and body mass was recorded and body mass index (BMI) was calculated. The incidence of undernutrition in this population was calculated.

RESULTS

Body mass below 10th percentile was found in 158 children (19.3%). including 96 with body mass <3 percentile. Undernutrition was more frequent in children below 5 year of age (22.16%) than in the older ones (16.74%).

CONCLUSIONS

Undernutrition among children admitted to hospital is relatively frequent and can make treatment more difficult and expensive.

Heterogeneity of extraparenchymal primitive neuroectodermal tumors within the craniospinal axis

Four cases of primitive neuroectodermal tumors (PNETs) with unusual localization (three intraspinal extramedullary and one pontocerebellar) are reviewed. Histologically, they were small round blue cell tumors with diverse patterns. Immunohistochemically, all tumors were positive for at least two neuronal markers, two cases were Mic-2 positive and one showed glial differentiation. The paraffin-embedded tumor specimens were examined by interphase FISH using dual-color probes specific for EWS, HER-2 and BCR loci. Molecular cytogenetic study revealed the presence of EWS rearrangement in two cases and the presence of i(17q) in one tumor. Three tumors exhibited 22 disomy and one was 22 polyploid. Extraparenchymal PNETs within craniospinal axis are heterogeneous from the clinical, histological, immunohistochemical and molecular point of view. These PNETs can be of a central or peripheral type. Multidisciplinary approach is of a basic importance in differential diagnosis of such cases.

A unique occurrence of a cerebral atypical teratoid/rhabdoid tumor in an infant and a spinal canal primitive neuroectodermal tumor in her father

This report describes the clinical, pathological, immunohistochemical and genetic data of two rare malignant neoplasms of the central nervous system (CNS)--a cerebral atypical teratoid/rhabdoid tumor (AT/RT) in a 5-month-old girl and a spinal canal primitive neuroectodermal tumor (PNET) in her father. Despite aggressive treatment, both tumors were fatal, displaying extensive local recurrence and diffuse neoplastic dissemination. The paraffin-embedded tumor tissue samples were analyzed using a dual-color FISH with a locus specific LSI22q (BCR) probe. In the AT/RT tissue, a loss of BCR locus was observed in a significant proportion of the cells in contrast to the PNET specimen where the majority of nuclei did not reveal any loss of the BCR region. No mutations in exon 5 and no changes in SNP of intron 5 of hSNF/INI1 gene were found. In addition, analysis of loss of heterozygosity (LOH) was performed using a panel of 15 microsatellite markers of chromosome 22. No LOH were found in both tumor tissues. In both cases no constitutional mutations of gene TP53 were found. Analysis of the TP53 mutations in the tumor tissues revealed that the PNET, not the AT/RT tumor, was homozygous for a missense mutation at codon 175 (CGC ==> CAC). Thus, our findings emphasize the genetic differences between the two specimens and suggest that the occurrence of these two aggressive tumors of CNS in one family could be coincidental.

[Atypical picture of osteosarcoma situated in fibula of a 14-year-old boy]

This paper presents the case of osteogenic sarcoma, situated in fibula of 14-year-old boy. The X-ray picture of this tumor was typical of unicameral cyst, but histopathological examination showed traits of osteosarcoma. Only magnetic resonance suggested the presence of malignant neoplasm.

[Ethyol (amifostine): application trial in pediatric oncology]

Myelotoxicity is one of the major chemotherapeutic side effects. In some adult and paediatric studies it has been shown that amifostine protects bone marrow from toxic effects of alkylating agents and platinum compounds without reduction in overall cytotoxic action.

AIM OF THE STUDY

To test an efficacy of amifostine as a myeloprotectant in multiagent chemotherapy containing alkylating agents or platinum analogues. Amifostine was used in 8 children from 3 to 15 yrs of age treated with chemotherapy (CHT) for cancers. It made total number of 28 courses. Amifostine was administered every other CHT course in a dose of 750 mg/m2. The degree of myelotoxicity measured at nadir was compared between with- and without amifostine CHT courses. Anaemia, leucopenia and thrombocytopenia of WHO grades I and II were qualified as mild toxicity while grades III and IV were recognized as severe.

RESULTS

Severe anaemia, leucopenia and thrombocytopenia were found after 3/14 (21%), 8/14 (57%) and 6/14 (43%) courses with amifostine. Proportion of these side effects in identical CHT courses without amifostine in the same pts. was as followed: 1/14 (7%), 7/14 (50%) and 9/14 (64%). Differences among both groups were statistically significant (p = 0.025). Mild side effects (nausea, vomiting, transient hypotension) accompanied amifostine administration in 29% of courses (4/14).

CONCLUSION

Preliminary results suggest that amifostine decreased the number of severe thrombocytopenias after CHT. The drug was well tolerated by children.

Transforming growth factor β1 protein and mRNA levels in inflammatory bowel diseases: towards solving the contradictions by longitudinal assessment of the protein and mRNA amounts

Previously published studies on levels of the transforming growth factor-β1 (TGF-β1) protein and mRNA of the corresponding gene in patients suffering from inflammatory bowel diseases (IBD) gave varying results, leading to contradictory conclusions. To solve the contradictions, we aimed to assess longitudinally TGF-β1 protein and mRNA levels at different stages of the disease in children suffering from IBD. The study group consisted of 19 pediatric patients with IBD at the age between 3.5 and 18.4 years. The control group consisted of 42 children aged between 2.0 and 18.0 years. The plasma TGF-β1 concentration was measured with ELISA. mRNA levels of the TGF-β1 gene isolated from samples of the intestinal tissue were assessed by reverse transcription and real-time PCR. Levels of TGF-β1 protein in plasma and corresponding mRNA in intestinal tissue were significantly higher in IBD patients than in controls. TGF-β1 and corresponding transcripts were also more abundant in plasma and intestinal tissue, respectively, in patients at the active stage of the disease than during remission. In every single IBD patient, plasma TGF-β1 level and mRNA level in intestinal tissue was higher at the active stage of the disease than during remission. Levels of TGF-β1 and corresponding mRNA are elevated during the active stage of IBD but not during the remission. Longitudinal assessment of this cytokine in a single patient may help to monitor the clinical course of IBD.