[The incidence of neuropathy in patients with diabetes type 1]. / Wystepowanie neuropatii u pacjentów z cukrzyca typu 1.

The aim of the study was to evaluate the incidence of diabetic neuropathy. The examined group consisted of 32 patients (14 boys, 18 girls) 16 to 19 years old with diabetes duration of 5 till 17 years, treated actually with multiple injections of human insulin. Diabetic neuropathy was observed in 56% of patients. The incidence of neuropathy was higher after 15 years of diabetes duration, in patients with bad metabolic control - HbA1c>8%, multiple ketoacidosis (p=0.003) and higher total cholesterol levels (p=0.003), with microalbuminuria (64.3%) and macroalbuminuria (83.3%) and in patients with systolic and diastolic blood pressure equal and/or above 90 % percentyle.

Nodular goiter and thyroid carcinoma in children and adolescents in a moderate endemic area (lower Silesia-Sudeten endemia) in the last twelve years.

Although thyroid carcinoma is more common in the adult population, the risk of a nodule being malignant is greater in children. The aim of our present investigation was to ascertain the percentage of malignancy in nodular goiter observed in patients from the Lower Silesia region in the last 12 years. The examination included 60 children (12 boys and 48 girls) treated in our clinic from 1987 to June 1998. Age varied from 7 to 18 years (mean 14.8 +/- 2.4), most of them in the age group between 13 and 18 years. The following investigations were performed: TSH, T3, T4, thyroid ultrasonography, fine needle aspiration biopsy and Tc99 scintigraphy of the thyroid. Most of the patients were euthyroid; two children demonstrated pressure symptoms. All the patients were treated by operation. Histological examinations revealed the following: nodular goiter in 19 patients, cystic nodular goiter in 5, follicular adenoma in 20, fetal adenoma in 3, nodular goiter and follicular adenoma in 6, papillary carcinoma in 6, and follicular carcinoma in 1 patient. We concluded that an increased incidence of thyroid cancer has been noted in children with nodular goiter in Lower Silesia during the last 12 years. Thyroid cancer was observed mostly in patients with single nodules and was associated with a high risk of malignancy.

Definitive diagnosis of enzymatic deficiencies of steroidogenesis in at-risk newborns and infants by urinary marker analysis using GC/MS-SIM.

A simplified urinary marker analysis for diagnosis of congenital adrenal hyperplasia (CAH) and 5alpha-reductase deficiency in infancy by GC/MS-SIM is introduced. The analysis was performed in 161 patients aged 3-90 days, 99 females and 62 males. CAH due to 21-hydroxylase deficiency was diagnosed in 61 patients (42 females and 19 males; in 10 cases simple virilizing form and in 51 patients salt-wasting form) and CAH induced by 3beta-hydroxysteroid dehydrogenase deficiency without salt loss in 1 female patient. In 2 full-term newborns and 6 preterm infants, a false-positive diagnosis of CAH, which had been based on serum steroid evaluation, was made. In these cases, increased excretion of fetal adrenal zone steroids was confirmed as a possible source of false-positive serum 11-deoxycortisol and 17alpha-hydroxyprogesterone values. Lack of fetal adrenal zone steroid metabolites in 2 male newborns with salt loss symptoms led to the diagnosis of adrenal insufficiency due to X-linked adrenal hypoplasia and adrenal hemorrhage. A single analysis of urinary CAH markers by the very sensitive and selective GC/MS-SIM method can replace numerous assays of various steroids that must be carried out for positive diagnosis of abnormal steroidogenesis in infancy.

[Thyroid anti-membrane antibodies and antithyroglobulin antibodies of children in the city and province of Wroclaw]. / Przeciwciala przeciwblonowe tarczycy i przeciwtyreoglobulinowe u dzieci miasta Wroclawia i województwa Wroclawskiego.

The purpose of the work was an assessment of thyroid function and determination of the development of antithyroid autoantibodies in children undergoing iodine prophylaxis after Chernobyl disaster. The level of T3 and T4 was determined by the RIA method, that of TSH by th immunoenzymatic method using Abbott kit, while antimembrane and antithyroglobulin antibodies were determined by the immunoenzymatic method using HTL-Plastomed kit. The studies were carried out in 844 children (433 boys and 411 girls) aged from 4 to 16 years, the selection of whom was described in our earlier report (12). Our studies demonstrated an increased level of T3 in 15.6% of the studied children and increased level of T4 in 12.7% of the cases. In most children the levels of hormones and TSH in the serum were normal. The antimembrane antibodies ATMA were present in 1.9% of the children (0.5% of the boys and 3.4% of the girls), while antithyroglobulin antibodies were found in 2.2% of the studied population (0.9% of the boys and 3.4% of the girls). No correlation was found between clinical picture, size of goitre, hormone level and the presence of thyroid autoantibodies. The studies indicate that radioactive contamination and iodine prophylaxis failed to cause permanent thyroid function disturbances in the studied population. The children in whom autoantibodies or abnormalities in hormone levels were found require further observation.

Goiter prevalence in children in Lower and Middle Silesia (Wroclaw--coordinating center).

As a part of the programme concerning iodine deficiency and iodine prophylaxis in Poland, 2518 children of age between 6 and 13 years, living in Lower and Middle Silesia, were studied. The anamnesis was based on a questionnaire answered by parents of the investigated children. The physical examination included measurements of body height and mass, clinical symptoms of thyroid functions as well as size and compactness of the thyroid gland on the basis of WHO classification. Urinary concentration of iodine was measured. The majority of children with goiter were inhabitants of mountainous villages. The goiter was most frequent in the age group 9-10 years. No significant differences in goiter incidence could be found between children consuming and not consuming iodized kitchen salt. The urinary concentration of iodine was low in all children examined. It was concluded that the territory of Lower and Middle Silesia is still a region of moderate endemic goiter. The urinary iodine concentrations is low in children living in Lower and Middle Silesia. The present system of iodine prophylaxis is not adequate and new measures should be urgently introduced.

[Goiter prevalence in children and adolescents in Lower Silesia in the years 1985-1990]. / Czestosc wystepowania wola u dzieci i mlodziely Dolnego Slaska w latach 1985-1990.

Investigations of the goiter prevalence in children, aged from 0 to 18 years of age living in Lower Silesia were performed. The children were our clinic outpatients in the years 1985-1990. A separate analysis of children from each of the four districts was made because of a different geographical structure. The highest number of goiter was observed in the Wroclaw district. In the year 1983-1989 an increase number of newly diagnosed goiter was cases observed in all analyzed districts, than from 1989 to 1990 a decrease, tendency in goiter prevalence was noticed except in Wroclaw district where the number of cases was stable. In the adolescent period the number of cases with newly diagnosed goiter increased with higher frequency among the girls.

[True precocious puberty in girl. Therapy with LHRH analogs]. / Echte Frühreife bei Mädchen. Eine Therapie mit LHRH-Analogen.

The authors observed an occurrence of pubertas praecox vera by 42 girls from 8 months to 7 years of age. The purpose of the investigations was to elucidate the possible causes of the precocious symptoms and to estimate the effect of the therapy with various LHRH-analogues. Only in 2 children a cranial tumor was found. In the remaining cases an idiopathic precocious puberty was diagnosed. These children received a therapy with LHRH-analogues: Relefact, Busserelin or Decapeptyl. The authors obtained the best results with the slow releasing Decapeptyl.

[Further studies of diabetic microangiopathy in children with insulin-dependent diabetes mellitus. Electron microscopy studies]. / Weitere Forschungen zur diabetischen Mikroangiopathie bei Kindern mit insulinabhängigem Diabetes mellitus. Elektronenmikroskopische Untersuchungen.

Electronmicroscopy examinations of the skin vessels were performed in 20 well compensated children with insulin-dependent diabetes mellitus (14 girls and 6 boys ages from 4 to 18 years). The results were compared with 10 healthy ones. In 17 patients the electron-microscopic picture was pathologic, with varying of intensity. Structurally, the most relevant changes were represented by thickening of the basal membrane (in some cases with its multiplication), swelling of endothelial cells, decrease in number of pinocytic vesicules and presence of deposits with increased electron density in the pericarion and the perivascular space. Vascular disturbances may develop very early, sometimes in the first month after manifestation of the disease. The authors suggest, that further investigations are necessary to elucidate the nature of the observed changes. An intensification of insulin therapy would be also considered.