No significant increase within a 3-year interval in the prevalence of atopic dermatitis among schoolchildren in Baranya County, Hungary.

BACKGROUND: The prevalence of atopic dermatitis (AD) in children has significantly increased worldwide in the past decades. Although it is well known that the number of AD patients has also been growing in Hungary, there are only a few published prevalence studies that allow international comparisons. OBJECTIVES: The aim of this study was to estimate the prevalence of AD among schoolchildren in Baranya County in 2005 and to compare the data with those from 2002. METHODS: The data from the 1454 children (771 girls, 683 boys) surveyed in 2002, and 1454 children (760 girls, 694 boys) surveyed in 2005, respectively, aged 7-14 years were analysed. The distinct populations of the 7- to 9-year-old age groups were separately compared in relation to their lifetime AD prevalence. RESULTS: The prevalence of AD accounted for 15.1% in 2002, and 16.1% in 2005. In the compared distinct 7- to 9-year-old populations the prevalence rates were 17.0% in 2002 and 17.1% in 2005. There were no statistically significant differences between the data of the two surveys. CONCLUSIONS: The results indicate the high prevalence rate of AD nearly approaching the markedly high values registered in the welfare countries, and could indicate that AD has reached a plateau in Hungary.

Familiar and environmental factors influencing atopic dermatitis in the childhood.

BACKGROUND: The increase in the incidence of atopic dermatitis (AD) in developed countries has been related to familiar and environmental factors. This survey was undertaken to investigate the family background, birthweight and the home environment of children suffering from AD in order to point out the possible factors that provoke the development of the disease. METHODS: The study uses data collected by means of self-administered questionnaires and discusses 461 cases of children (age 0-12) with active skin signs of AD. The control group comprised of 343 children (age 0-12) with no skin signs or positive lifetime history of AD. Associations between familiar and various home environmental factors and the risk of AD were calculated by means of odds ratios. RESULTS: There were statistically significant positive associations between atopic eczema symptoms and higher birthweight, small households, wall-to-wall carpets, as well as indoor-kept pets. Day-nursery attendance, heating system and indoor smoking, however, did not significantly alter the risk of the disease. CONCLUSIONS: Because of the limitations of a retrospective questionnaire study, further research is needed to confirm these associations and clarify whether they are causative.

Metabolic findings after colocystoplasty in children.

OBJECTIVES: To investigate whether colocystoplasty has resulted in metabolic changes in the growing child during long-term follow-up according to whether cecum with ascending or sigmoid colon was used. METHODS: Twenty-eight patients (mean age at surgery 11 years) were included in the study and divided into two groups: group 1, cystoplasty with cecum and ascending colon (12 patients) and group 2, sigmoid cystoplasty (16 patients). Patients' linear growth, body mass index, and the following parameters were estimated before surgery and at 3, 6, and 12 months, and then yearly after surgery: blood and urine electrolytes (sodium, potassium, chloride, calcium, phosphorus, magnesium), creatinine, urea, blood gases, blood pH, urine pH, and blood alkaline phosphatase (ALP). All the data were statistically analyzed. RESULTS: In group 1, the blood ALP increased significantly (P = 0.026) during follow-up. Severe metabolic acidosis with or without hyperchloremia was found in 7 patients. In group 2, the serum sodium and serum calcium levels decreased significantly (P = 0.014 and P = 0.003, respectively); however, the blood ALP, urine sodium, and urine phosphorus levels increased significantly (P = 0.033, P = 0.027, and P = 0.026, respectively) during follow-up. A statistically significant decrease in blood pH (P = 0.022) was found after surgery. Severe metabolic acidosis with or without hyperchloremia was detected in 5 patients. The average linear growth decreased significantly (P = 0.001 and P = 0.016, respectively) 1 and 2 years postoperatively. CONCLUSIONS: The statistically significant increase in blood ALP and decrease in serum calcium indicate bone demineralization after colocystoplasty. Our investigations in children suggest that bone demineralization is more frequent after sigmoid cystoplasty than after the use of cecum and ascending colon.

Complete recovery from juvenile pemphigus vulgaris.

A 10-year-old boy with vesicles and eroded lesions on his labia, oral mucosa, and trunk was diagnosed as having pemphigus vulgaris. The diagnosis was confirmed by histopathologic and immunofluorescence studies. The patient was successfully treated systemically with methylprednisolone and azathioprine. After 4.5 years the therapy was discontinued and the patient has had no relapse over the last 4 years.

[Occurrence of X-linked ichthyosis along with atopy]. / X-kromoszómához kötött ichthyosis és atopiás betegségek együttes elófordulása.

The cases of children indicate suffering from X-linked ichthyosis accompanied by atopic diseases (bronchial asthma, allergic rhinitis, allergic conjunctivitis, atopic dermatitis) which developed in infancy. The examinations revealed microdeletion of the steroid sulfatase region (Xp22.3), increased total IgE value and polysensibilization. It seems that the steroid sulphatase deficiency in ichthyosis played a role in the development of the atopic diseases. The present study suggests the commencement of a strict diet and antihistamine therapy, already in its infancy, in order to prevent the development of the accompanying atopic diseases.

Two cases of musculoskeletal syndrome associated with acne.

We report two cases of musculoskeletal syndrome (myalgia, arthralgia, arthritis, hyperostosis) that developed in male adolescents who had severe acne (acne conglobata and acne fulminans). In both patients the hyperostosis of the right clavicle aroused the suspicion of a bone tumor or osteomyelitis, which was excluded by histologic examination. Radiologic and laboratory characteristics of musculoskeletal syndrome associated with acne conglobata and acne fulminans are reviewed as well as isotretinoin therapy. The problems of differential diagnosis are also discussed.

Urinary glycosaminoglycan excretion in healthy and stone-forming children.

Both in vivo and in vitro studies suggest that macromolecules excreted in the urine, e.g. glycosaminoglycans (GAGs) may be inhibitors of kidney stone formation. We evaluated urinary GAG excretion in 22 children with calcium oxalate stones [8 with absorptive hypercalciuria, 6 with renal hypercalciuria (RH), 8 with normocalciuria], and in 20 age-matched controls. There was no significant difference between the two groups in the total urinary GAG level. In terms of the various GAG fractions, patients with RH excreted considerably less keratan sulphate and considerably more dermatan sulphate than the other patients and healthy controls. There was no difference between the two groups in condroitin sulphate, heparan sulphate and hyaluronic acid excretion. We conclude that there is no significant correlation between the formation of calcium oxalate stones and urinary GAG excretion.

Asymmetric periflexural exanthem of childhood and viral examinations.

We report on an asymmetric maculopapular exanthem of early childhood. One hundred eighty seven patients (111 girls, 76 boys) were examined over a four-year period, mainly in winter and spring. The first skin lesions appeared on the trunk or in the large flexures of the limbs. They spread centrifugally, often to the contralateral side, over two to four weeks, and disappeared with slight itching and moderate desquamation within another two to four weeks. Virologic studies were carried out in 34 cases; parainfluenzavirus 2, parainfluenzavirus 3, and adenoviral infection were diagnosed in two patients each. The chances of a causal relation between the viral infection and the skin symptoms were slight; only an incidental connection is likely to exist between the skin disorders and the viral infection.

Family investigations in idiopathic hypercalciuria.

We analysed some genetic and environmental factors influencing renal (RH) and absorptive hypercalciuria (AH) the main subtypes of idiopathic hypercalciuria (IH). Their distinction is essential in the prevention and treatment of urolithiasis. Twenty-one children admitted for renal stones had IH (8 RH and 13 AH). Their families were investigated with the participation of a total of 68 family members including 62 first-degree relatives. They were all normocalcaemic. Their urinary calcium excretion was measured on at least two occasions, and they underwent a calcium restriction--calcium loading test. Each subject was interviewed with reference to medical history, drug administration, social conditions, and nutritional habits. Pedigree analysis suggested a higher rate of familiarity and autosomal dominant inheritance of RH whereas no such pattern was found among the relatives of patients with AH. The interviews disclosed a distinct preference for calcium-rich foods in subjects with AH, while RH and normocalciuric individuals preferred a low-calcium diet. We conclude that the subtypes of IH are genetically different. RH is most probably inherited as an autosomal dominant trait (or has at least an autosomal dominant form), whereas AH is more likely to be associated with nutritional factors.

[Normal body height in hypercalciuric children]. / Normális testmagasság hypercalciuriás gyermekekben.

The body height of 132 children, aged 3-16 years, with idiopathic hypercalciuria was within the Hungarian normal limits in each case. The type of hypercalciuria could be determined in 54 cases: no difference between height values of children with renal and absorptive form was found.

[Family studies in idiopathic hypercalciuria]. / Családvizsgálatok idiopathiás hypercalciuriában.

Increased urinary calcium excretion was found in 20 of 42 family members of 14 children with idiopathic hypercalciuria. Analysis of questionnaires on environmental factors and of pedigrees suggested that familial occurrence of absorptive hypercalciuria was mainly due to common alimentary practice. At the same time, the existence of an autosomal dominant form of renal hypercalciuria seems to be very likely, the mechanism of which is not yet understood.

Hypercalciuria in children with diabetes mellitus.

Seventeen of 75 diabetic children without nephropathy had urinary calcium excretion of more than 4 mg/kg/day. Neither diurnal variation in calciuria, nor correlations between calcium excretion and glucose excretion as well as HbA1 levels were observed. The findings suggest that about one quarter of diabetic children is at risk for hypercalciuria and may be for renal damage due to hyperexcretion of calcium.

Severe hypertension in a ten-year-old boy secondary to an aldosterone-producing tumour identified by adrenal sonography.

Severe hypertension discovered incidentally in a 10 year-old boy was associated with persistent hypokalaemia and metabolic alkalosis. Primary hyperaldosteronism was diagnosed by demonstrating elevated plasma aldosterone levels and increased urinary aldosterone excretion with concomitant depressed plasma renin activity. Adrenal sonography identified a left adrenal adenoma which was removed surgically; normotension and normalization of plasma renin and aldosterone values ensued. This appeared to be the first use in children of sonography to identify adrenal adenoma and it is suggested to be the first step in the differential diagnosis of primary hyperaldosteronism.