The incidence of metabolic syndrome in obese Czech children: the importance of early detection of insulin resistance using homeostatic indexes HOMA-IR and QUICKI.

Common alimentary obesity frequently occurs on a polygenic basis as a typical lifestyle disorder in the developed countries. It is associated with characteristic complex metabolic changes, which are the cornerstones for future metabolic syndrome development. The aims of our study were 1) to determine the incidence of metabolic syndrome (based on the diagnostic criteria defined by the International Diabetes Federation for children and adolescents) in Czech obese children, 2) to evaluate the incidence of insulin resistance according to HOMA-IR and QUICKI homeostatic indexes in obese children with and without metabolic syndrome, and 3) to consider the diagnostic value of these indexes for the early detection of metabolic syndrome in obese children. We therefore performed anthropometric and laboratory examinations to determine the incidence of metabolic syndrome and insulin resistance in the group of 274 children with obesity (128 boys and 146 girls) aged 9-17 years. Metabolic syndrome was found in 102 subjects (37 %). On the other hand, the presence of insulin resistance according to QUICKI <0.357 was identified in 86 % and according to HOMA-IR >3.16 in 53 % of obese subjects. This HOMA-IR limit was exceeded by 70 % children in the MS(+) group, but only by 43 % children in the MS(-) group (p<0.0001). However, a relatively high incidence of insulin resistance in obese children without metabolic syndrome raises a question whether the existing diagnostic criteria do not falsely exclude some cases of metabolic syndrome. On the basis of our results we suggest to pay a preventive attention also to obese children with insulin resistance even if they do not fulfill the actual diagnostic criteria for metabolic syndrome.

The use of growth hormone in the treatment of extensive burns: a case report.

Growth hormone is an anabolic hormone that causes increased cell growth, positive nitrogen and calcium balance, lipolysis, hyperglycemia, and promotes protein synthesis. Its beneficial effect in burn treatment was proven particularly in children, by Herndon's group. The authors report The case of a 12-year-old boy with an electrical arc burn of 81% of the BSA, 60% of the BSA being full thickness loss. Recombinant human growth hormone (Norditropin, Novo Nordisk) was administered at daily doses of 0.52 i.u./kg starting on day 19 post-burn for 15 consecutive days. The treatment was well tolerated except for mild insulinoresistance, which could be easily corrected by slightly increasing the insulin added to glucose solutions. After 56 days of intensive care treatment and several excision and grafting procedures, the majority of burns were healed.

Fluid resuscitation in thermally injured pediatric patients.

More than two-thirds of critical burns in special burn units are children. The burned child continues to represent a special challenge, since resuscitation therapy must be more precise than that for an adult with a similar burn. Children have a limited physiologic reserve and the pediatric fluid replacement therapy is based on the principle of separate calculation of physiological and pathological losses. We have reviewed the most widely accepted pediatric isotonic fluid protocols. All these protocols calculate for replacement of pathological losses with a need of 2 ml/kg/% BSAB (body surface area burn) or 4 ml/kg/% BSAB. We choosed the formulas of two Shriner's Burns Institutes--the Cincinnati and the Galveston Unit as representatives, and calculated the fluid therapy for model burn children weights of 10 kg, 30 kg with 20, 40, 60, 80% BSAB. The results of calculations where compared with physiologic parameters of children. In conclusions we could show, that the 4 ml/kg/% BSAB formulas do replace all theoretically predicted pathophysiologic losses due to burns. However, the 2 ml/kg/% BSAB formulas are more practical as a guideline for resuscitation of pediatric patients because of greater therapeutical range and better clinical response of children threatened by burn shock. It is important to remember that all formulas are only guides to fluid therapy, they should be modified according to individual needs and clinical status of the patient. Only successful restoring and maintaining perfusion pressures leads to optimal oxygenation of injured and noninjured tissues, which promotes spontaneous healing, prevents wound conversion, minimise bacterial colonisation, and prepares the injured areas for early grafting.

[Reconstruction in head and neck area with microvascular forearm flap and pectoralis major flap in Bulgaria. Experiences and results]. / Rekonstruktionen im Kopf-Hals-Bereich mit mikrovaskulären Unterarmlappen und Pectoralis-major-Lappen in Bulgarien. Erfahrungen und Ergebnisse.

The results of 13 single-stage reconstructions of large and complex defects in the head and neck by using eight free radial forearm flaps as well as five pectoralis major myocutaneous flaps were analyzed. No complete flap loss occurred in any case. The results with radial forearm flap reconstructions proved to be better functionally and aesthetically. Due to the time needed for the microvascular anastomoses, the length of the operations was sometimes prolonged. Pectoralis major flaps were found to be more difficult to handle and were used in those cases in which the application of free radial forearm flaps was expected to produce higher risks.