Nieinwazyjna diagnostyka zmian zapalnych błony śluzowej jelita w nieswoistych zapaleniach jelit u dzieci

To achieve clinical remission was the primary target in medical therapy of both types of inflammatory bowel diseases (IBD): ulcerative colitis (UC) and Crohn's Disease (CD). Currently, however, it is mucosal healing to be the most important factor in beneficial change of natural history of IBD. Mucosal healing is associated with sustained clinical remission, reduced rate of hospitalization and surgical procedures. Therefore, assessment of the grade of intestinal inflammation is important to establish and to monitor a proper medical treatment.     

Uchyłek Meckla u dzieci – ocena trudności diagnostycznych na podstawie doświadczeń własnych

Introduction

Abdominal pain is a common symptom encountered in medical practice. In some situations a diagnosis of abdominal pain requires close collaboration of a pediatrician and a pediatric surgeon, especially when the Meckel's diverticulum is suspected.

Aim of study

The aim of the study is to present diagnostic difficulties in patients suffering from the Meckel's diverticulum on the basis of own experience.

Materials and methods

An analysis was conducted on the basis of medical documentation of patients hospitalized at the Paediatric Surgery Department of the Provincial Specialist Hospital in Radom in the period from 2004 to 2011. The analysis included clinical, laboratory, imaging and endoscopic examination.

Results

The Meckel's diverticulum was diagnosed in 61 children out of 1021 patients who underwent laparotomy. It did not show any symptoms in 39 patients, but it caused abdominal pain in 22 of them. Within the group of 22 patients subject to the analysis, abdominal pain accompanied diverticulitis in 11 patients. In 9 children, Meckel's diverticulum caused mechanical occlusion of the alimentary tract whereas in 2 patients it co-existed with intensive bleeding from the lower alimentary tract.

Conclusions

A considerable changeability of clinical manifestation in patients with diagnosed Meckel's diverticulum can be observed. Interview and physical examination of a patient was of great significance in differential diagnosis of acute inflammation occurring within the abdominal cavity, which might be caused by Meckel's diverticulum. However, the final diagnosis was determined during an operation.     

Czy u dzieci z nadmiarem masy ciała mogą występować zaburzenia struktury i mineralizacji kości?

The aim of this study was to analyse the quality of bone, determined on the basis of ultrasound in children with excess body weight.     

Choroby i zaburzenia gruczołów piersiowych u dzieci

Disorders of the breast in children and adolescents, especially breast enlargement, concern both parents and pediatricians. Serious breast diseases requiring immediate diagnostic and therapeutic intervention are relatively rare in girls and boys. Each case with alarming symptoms, such as a tumor or premature breast enlargement, needs exclusion of organic changes. The aim of this study is to review the most common breast pathologies in children and adolescents. This article can help pediatricians and general practitioners carry out proper diagnostics and make the decision whether to refer the patient to the appropriate specialist: gynecologist, surgeon, endocrinologist or oncologist.     

Ocena żywności oferowanej w sklepikach szkolnych i kupowanej przez dzieci z krakowskich szkół podstawowych

Aim

The aim of the present study was to determine the impact of food advertising in primary schools on the food purchasing habits of children from primary schools in Krakow.

Methods

50 randomly selected primary schools in Krakow, Poland were included to the investigation in 2011/2012; 12 400 children are in primary and secondary schools in this city. Schools were visited by one of the members of the research team, who filled in a questionnaire regarding the type of food products displayed or advertised in the school shop window and recorded the presence of direct corporate advertising in the proximity of the school shop. Shop owners were asked to fill in a form describing food purchases by students within the week preceding the visit. The school principal (or one of teachers) completed a form describing the school's policy regarding food advertising and the sponsorship of school activities by food companies.

Results

Studies have shown that less than half of the shops selling children healthy foods such as sandwiches, yogurt, fruit. The largest number of offered products in the surveyed shops accounted for mineral water, carbonated soft drinks and pastries. Taking into account all the shops regardless of the type of school, the most exposed commodity are non-carbonated beverages (33.33%); snacks, candy bars and wafers, juice and chocolate bars take second place. Students often buy bagels (26.19%), less snacks (19.05%), followed by sweet carbonated beverages (11.9%), juices and jellies (7.14%) and sandwiches, sweets and pastries (4,75%).

Conclusions

Educational programmes should be introduced in schools with the aim of improving the understanding of nutritional principles among pupils, teachers and parents.     

Zespół hemofagocytarny u dzieci

Hemophagocytic lymphohistiocytosis (HLH) also known as hemophagocytic syndrome is a severe, life threatening inammation, caused by ineffective, prolonged immune response. It may occur as a primary (genetic) or secondary (acquired) disease. Primary HLH is divided into familiar HLH (FHLH) and other genetically determined conditions. In familiar form, HLH is the only manifestation of the disease. In other genetic forms, HLH is one of clinical manifestations. Secondary HLH may arise in a course of severe infections, autoimmune diseases, neoplasms, metabolic diseases, immunosuppressive therapy and after organ transplantation. The prognosis in HLH is inferior. Lack of proper treatment leads to death in primary HLH and in most cases of secondary HLH.     

Testy wysiłkowe u dzieci

Physical activity is one of the most important aspects of healthy life style and stimulates normal growth and development of children. Properly selected physical training is important in the prevention of somatic, motor, mental and social disorders. Restrictions of natural physical activity of children result in serious consequences and lowering of quality of life.The authors describe exercise physiology in children, indications, contraindications and protocols of stress testing in children.     

Rodzaje i wskazania do stałej stymulacji serca u dzieci

The permanent cardiac pacing in children constitutes an important challenge for paediatric cardiologist and for surgeons performing implantation procedures. This task involves not only a necessity for establishing indications but also a need for a specific selection of the pacing leads and pacemaker, and the implantation technique. The number of paediatric patients who need a pacemaker implantation is increasing, including not only patients with congenital atrioventricular conduction disorders and fewer cases of sick sinus syndrome but also the patients after congenital heart diseases surgery. The main concept in electrotherapy in children remains the same as in adults: the prevention of a significant symptomatic bradycardia as well as the provision of an undisturbed physical growth and intellectual development. A physician responsible for therapeutic decision-making should be aware of life-long consequences in this age group, where pacing will be continued usually for several decades.     

Przebieg kliniczny i odległe następstwa zespołu Guillaina-Barrégo u dzieci

IntroductionGuillain-Barré syndrome (GBS) is an autoimmune disorder of peripheral nervous system causing progressive weakness and areflexia. The process leads to acute flaccid paralysis of the two or four limbs and cranial nerves dysfunction. Epidemiologic studies have reported an annual incidence of 1:100000 children under 15.AimThe aim of study was to analyse the clinical course and long-term evaluation of GBS in children.Material and methodsEighteen children with classic form of Guillain-Barré syndrome were enrolled. In the first part of study we retrospectively reviewed the clinical course of disorder. In the second part we analysed the children's recovery, basing on the inquiry studies.ResultsIn the analysed group all children developed the paralysis of lower limbs, 38.9% – sphincter and bladder dysfunction, 72% – tetraparesis, 22.2% – respiratory tract insufficiency. Upper respiratory tract infections were the most common preceding GBS. Under performed treatment all children started to walk in first 6 months after GBS but they learned to run and climb the stairs more than one year. The efficiency of upper limbs was coming back faster than the lower limbs, 83% children could dress themselves and carry the heavier objects in half of the year. More than the half of group suffered from the subjective symptoms: limbs pains, hyperesthesia, and fatigability. These signs disappeared in the year after GBS. We reported the late effects of GBS, which were detected in analysed group after 12 month from GBS. There were: slowly running, fatigability, inability of dressing, climbing the stairs, hyperesthesia, tingling hands.     

Zespół hemolityczno-mocznicowy u dzieci w latach 1971–2010; doświadczenia jednego ośrodka dializ dla dzieci

Hemolytic uremic syndrome (HUS) is thrombotic microangiopathy witch recognized by hemolytic anemia, thrombocytopenia and acute renal failure. In 90% of children HUS is a consequence of enteral infection caused by, most commonly verotoxin, producing Escerichia coli. In remaining 10% of cases not preceded by diarrhea atypical HUS is recognized.AimAim of the study was to assess the frequency and clinical course of HUS in 140 children hospitalized in years 1971–2010 in the Department of Pediatrics and Nephrology, Medical University of Warsaw.Material and MethodsThe patients were analyzed in 2 groups: hospitalized in years 1971–1992 (group I; n=94) and 1993–2010 (group II; n=46). The division was based on the change of mode of therapy, because since 1993 plasmaphereses have been used in the treatment of atypical and severe cases of HUS.ResultsAge of children was significantly higher in group II compared to group I (4.48±4.46 vs 1.43±1.97 year, p<0.0001). In this group also atypical HUS was diagnosed more commonly (26% vs 6.38%; p<0.02). In both groups the incidence of atypical HUS was significantly higher in winter. In treatment red blood cell transfusions and plasma infusions were used. 87% of children from group I and 56% from group II required renal replacement therapy. The result of the treatment of acute phase of the disease was recovery of normal renal function in 65.7% of children from group I and 95.6% from group II. 6.6% of children from group I and 2.2% from group II required chronic dialysis. Unfavourable outcome (death) was observed in 27.7% from group I and 2.2% from group II.ConclusionThe treatment with plasmaphereses and plasma infusions improved outcome and decreased the requirement for chronic renal replacement therapy in children hospitalized with HUS in years 1993–2010.     

Zespół Costello jako przykład rzadkich zaburzeń funkcji szlaku sygnalnego Ras-MAPK: obraz kliniczny i diagnostyka molekularna choroby

Costello syndrome (CS) is a rare congenital disorder with multiple anomalies including characteristic dysmorphic craniofacial features, short stature, failure to thrive, developmental delay, skin anomalies, cardiac and musculoskeletal defects and an increased risk of malignancy. It has been demonstrated that de novo missense mutations in the protooncogene HRAS resulting in increased activation of Ras-MAPK pathway cause Costello syndrome.This paper presents the results of clinical and molecular analysis of Polish CS patients in relation to the worldwide observations. We introduce a group of five unrelated Polish patients aged from 7 months to 17 years with clinical diagnosis of CS. Mutation analysis of HRAS gene revealed heterozygous missense substitutions affecting amino acid 12 of the protein product: c.34G>A (p.G12S) in two and c.35G>C (p.G12A) in three patients. Analysis of the available parental DNA confirmed the mutations as de novo in four cases.The evaluated group represented relatively homogenous Costello phenotype with no significant differences from the classic symptoms of the disease. The most important distinction was the lack of occurrence of malignancies among our patients, which probably results from their young age. Interestingly, in one study case the coexistence of Turner and Costello syndrome was observed.Our results deliver the first important information on the molecular basis of Costello syndrome in Polish population. They indicate that the identified missense mutations in HRAS are known substitutions responsible for CS cases worldwide and confirm that the molecular analysis of HRAS provides a reliable diagnostic test for Polish patients clinically diagnosed with Costello syndrome.     

Wrodzona łamliwość kości (Osteogenesis imperfecta; OI) u dzieci – zasady postępowania interdyscyplinarnego

Brittle bone disease (Osteogenesis imperfect; OI) is a group of disorders related to collagen type 1 defect. Patients suffering from OI experience not only an increased number of fractures due to minor injuries, but also suffer from multiple co-morbidities that require help from different specialists. It is crucial to involve interdisciplinary child care from the moment of the diagnosis. In many countries, guidelines for pediatricians and family physicians help to understand the disease and to provide appropriate management for patients with OI. The aim of this article is to summarize the current knowledge on the pathogenesis, symptoms, diagnostic methods and treatment of brittle bone disease in children.     

Czy szczepienie przeciwko meningokokom jest potrzebne? Charakterystyka meningokokowych zapaleń opon mózgowo-rdzeniowych u dzieci – doświadczenia własne

Trying to answer a question who needs meningococcal vaccination, we have performed a retrospective review of case notes of children hospitalized with meningococcal meningitis. A total of 36 children were admitted to the infectious diseases ward in the St Joseph Children's Hospital between January 2008 and July 2014 with meningococcal meningitis. The diagnosis of meningococcal meningitis was confirmed by isolation of NM in blood or cerebrospinal fluid, and/or positive soluble bacterial antigenes. A PCR technique was used for the identification of the etiological agent directly from clinical materials in the case of a negative culture. Inflammatory markers, associated symptoms, and severity of the disease were analysed. Ages ranged from 4 months to 17 years, with a mean age of 76.6 months. Mean CRP value was 234.9 mg/l. General health status on admission was assessed as severe in 18 children (50%) and 15 (41.7%) of them required admission to ICU. Meningococcal etiology was confirmed by positive cerebro-spinal fluid culture in 13 people (36.1%). Neisseira meningitidis was cultured from blood in 3 patients. In one case, diagnosis was confirmed with fast latex test.     

Nowe techniki kariotypowania molekularnego przydatne w rozpoznawaniu mikroaberracji chromosomów u dzieci z zespołami wad,opóźnieniem psychoruchowym i niepełnosprawnością intelektualną

Precise cytogenetic diagnostics (e.g. FISH) in patients harboring chromosomal microaberrations is difficult, mostly due to a manifestation of similar clinical symptoms. Possible cost of the diagnosis could be increased to an unacceptable extent which results in resignation from further analyses. However these patients might account for the large number of people in genetic counselors’ offices; therefore they demand precisely anomaly-oriented further diagnostics. These problems could be usually solved by introduction of molecular karyotyping techniques (e.g. Real-time PCR, multiplex ligation-dependent probe amplification, BACs-on-Beads™), which allow detection of different chromosomal microaberrations in a single DNA sample required for final diagnosis of genetic syndrome, and thus seem to be very useful in patients suspected of harboring such an aberration.     

Pieczywo z odroczonego wypieku. Badanie dostępności i składu

Aim

The aim of study was to analyze the assortment of bake-off bread in selected supermarkets and discount stores and preliminary assessment of safety of consuming bake-off products, especially in terms of pediatric.

Wykładniki metabolizmu tlenowego u dzieci i młodzieży z refluksem żołądkowo-przełykowym

Gastroesophageal reflux disease is a consequence of backward movement of the stomach content to the esophagus. The symptoms are caused by irritation of esophageal mucosa by acidic ingestant. Various factors cause disorders of cellular defense mechanism that lead to significant increase of oxygen-derived free radicals concentration and as a consequence to pathological damage of tissues and development of inflammation.     

Zakażenia układu moczowego u dzieci

Urinary tract infection (UTI) is a frequently occurring clinical problem in childhood. As many as 1–3% girls and 1% boys will be diagnosed with UTI in first 5 years of live. Several guidelines exist on UTI in children. All the available guidelines underline the importance of a correct diagnosis of febrile UTI to allow a more rational use of antibiotics and imaging. High body temperature, abdominal pain, back pain and high procalcitonin levels (>0.5 ng/ml) during the acute phase of disease are suggestive of severe inflammation in kidney (pyelonephritis). Children with UTI are at risk of renal scarring, which may lead to impaired renal function and hypertension. The role of family doctor and pediatricians in early diagnosis and treatment of UTI is of particular importance.     

Wpływ zanieczyszczenia powietrza ozonem na układ oddechowy u dzieci

Ozone is an important component of air pollution. This review presents the negative impact of ozone air pollution on the respiratory system in children, including the induction and maintenance of inflammation in the airways and exacerbation of respiratory diseases. The relationship between the occurrence of exposure to elevated ozone concentrations and the prevalence of asthma in the context of selected genetic polymorphisms also are described. The possibilities of interventions to reduce exposure to ozone are discussed.