Interleukin-6 and lipopolysaccharide-binding protein in acute appendicitis in children.

The aim of the study was to evaluate the diagnostic accuracy of interleukin-6 (IL-6) and lipopolysaccharide-binding protein (LBP) in children with acute appendicitis (AA) and to compare this with the diagnostic accuracy of routinely used C-reactive protein (CRP) and white blood cell (WBC) count. Eighty-two consecutive children admitted to our Department because of suspected AA were enrolled in this prospective study and classified into two groups: group 1 (49 children who underwent surgery for AA) and group 2 (33 children with no surgery with diagnosis of non-specific abdominal pain or sonographic mesenteric lymphadenitis). There were no negative appendectomies during the time of the study. The patients were further classified into three subgroups: subgroup 1A (43 patients with advanced AA), subgroup 2A (11 patients with mesenteric lymphadenitis) and subgroup 2B (10 patients with non-specific abdominal pain). The perforation rate was 32.7 %. WBC count and serum CRP, IL-6 and LBP were measured on admission. Area under receiver operating characteristic (ROC) curve (AUC), sensitivity, specificity and predictive values were evaluated. Serum IL-6 and LBP were significantly higher in group 1 than in group 2. The highest AUC for AA was that for IL-6 (0.776), followed by WBC count (0.684), CRP (0.637) and LBP (0.635). In conclusion, only IL-6, determined on admission, showed medium diagnostic accuracy, while other laboratory markers showed low diagnostic accuracy for AA in children. The new laboratory markers therefore do not significantly improve the diagnosis of AA.

Cavernous hemangioma in the junction between the left atrium and the aorta: case report.

We present a case of an asymptomatic cavernous hemangioma, located in the junction area between the left atrium and aorta, and our experience of diagnosis and surgical treatment of the tumor.

September 2000: 15 year old girl with intracranial lesion.

The September COM: We reported the case of a 15 year old white girl with solitary brain cortical lesion clinically mimicking meningioma. Microscopic examination revealed histiocytic lesion with foamy and giant cells predominately of Touton type. Subsequent clinical examination did not reveal any similar lesion in the skin or in other location. Expression of S-100 protein in histiocytes is unusual finding, but has been reported recently in juvenile xanthogranulomas (JXG). The only specific ultra-structural finding differing JXG from histiocytic neoplasm of Langerhans' cells histiocytosis type seems to be Birbeck granules.

Infantile hemangioendothelioma of the liver in a neonate. Immunohistochemical observations.

The study documents the immunohistochemical features of a case of infantile hemangioendothelioma (IHE) of the liver, which was found incidentally at autopsy in a 44-day-old girl. A precardial apical systolic murmur and hepatomegaly were found on day 4 of life. The tumor was multifocal and histologically composed of vascular channels lined by endothelial cells that were positive for von Willebrand factor, CD31, vimentin, and Ulex europaeus agglutinin 1, and that were invested in a continuous basement membrane (BM) on the antiluminal border. The endothelial cells, especially in the region of intravascular buds, showed intracytoplasmic synthesis of BM components (laminin and collagen IV). Underlying the endothelial cells were cells with cytoplasm that was positive for alpha-smooth muscle actin and antimuscle actin and negative for desmin, and that were enveloped with BM. The immunophenotype, appearance, and location of these cells are characteristic of pericytes. We found neither signs of endocrine secretion nor hepatitis B virus in the tumor tissue. The appearance of this tumor in the neonatal period supports a fetal origin of IHE.