Updated 24-year trend of Type 1 diabetes incidence in children in Poland reveals a sinusoidal pattern and sustained increase.

AIMS: To present the incidence trend for Type 1 diabetes in Polish children aged 0-14 years, updated using data collected during 2005-2012, and assess the reliability of the predictive model constructed previously using the 1989-2004 database. METHODS: Children aged < 15 years with newly diagnosed Type 1 diabetes are recorded prospectively (EURODIAB criteria) in several regional registers in Poland. Age- and gender-standardized incidence rates for Type 1 diabetes were calculated per 100 000 persons/year. Incidence rates were analysed in terms of the dependency on age, gender, geographical region and population density. Incidence rate trends over time were modelled using generalized linear models. RESULTS: The mean standardized incidence for 1989-2012 was 12.72 per 100 000 persons/year [95% confidence interval (CI), 11.35 to 14.21]. Over the 24-year observation period, the incidence increased from 5.36 to 22.74 per 100 000 persons/year. The lowest incidence rate was in children aged 0-4 years (8.35, 95% CI 7.27 to 9.57 per 100 000 persons/year). There was no difference between genders, or urban and rural regions. Incidence rates were higher in northern compared with southern Poland [14.04 (95% CI 12.59 to 15.63) vs. 11.94 (95% CI 10.62 to 13.39) per 100 000 persons/year]. The new data corrected the earlier predictive model by changing the estimates of some factors related to patient age, gender and their interactions with the remaining factors. The incidence rate shows periodic 5.33-year fluctuations. The periodicity component allows for a more accurate prediction of the incidence rate over time. CONCLUSIONS: This cohort study reveals a sustained increase in Type 1 diabetes incidence in Polish children aged 0-14 years with regular, sinusoidal fluctuations and a slight levelling off in past few years. It is of concern that are the highest increases in incidence are found in children aged 0-4 years.

[Tubulointerstitial nephritis related to immunotherapy and immunostimulation: a report of two cases]. / Sródmiazszowe zapalenie nerek zwiazane ze stosowaniem immunoterapii i leków immunostymulujacych--opis 2 przypadków.

Two cases of tubulointerstitial nephritis (TIN) with renal failure related to immunotherapy (case 1) and immunostimulation (case 2) have been described. Case 1: 18 years old male patient with hay fever was admitted because of rapid increase of serum creatinine from 1.1 mg/dl to 5.5 mg/dl, fever, weight loss and anemia which developed during 6 months after second course of immunotherapy. Case 2: 12 years old boy was admitted because of fever, weight loss and rapid progression to renal failure after treatment of pharyngitis with antibiotics and immunostimulant drug. In both patients renal biopsy was performed and TIN with huge lymphocytes T infiltrates was diagnosed. After 6 months treatment with corticosteroids renal function turned back to previous levels in both patients. Pathogenesis and treatment of TIN is discussed.

[Experience in the use of Broviac catheters in children with hematologic neoplastic diseases]. / Doswiadezenia wlasne ze stosowaniem cewników Broviàca u dzieci z chorobami rozrostowymi ukladu krwiotwórczego.

Between 1990 and 1994, 61 Broviac catheters were implanted in 53 children with haematological neoplastic diseases. The mean duration of catheter function was 206 days (range 14-615 days). The total observation time was 12544 days, during which 84 catheter-related complications were recorded, i.e. 6.7 per 1000 catheter use days. Infections occurred with a frequency of 3.8 episodes/1000 cath, days, the majority of which were bacteriemias (2.6/1000 cath, days). Gram-positive and Gram-negative strains were the isolated etiologic agents with equal frequency. Most of infectious episodes (85%) responded well to initial empiric antibiotics treatment without removal of the catheters. Mechanica complications (occlusion, displacement or catheter leakage) occurred significant less frequently and were managed by repairing or replacing the device or clearing the block. No deaths were related to catheter complications. In conclusion indwelling Broviac catheters offer a safe and effective method of long-term venous access. Infections are the most frequent catheter-related complications.

[Efficacy of passive and active immunization against HBV infection in children with neoplastic diseases]. / Skutecznosc bierno-czynnej immunizacji przeciw HBV u dzieci z chorobami nowotworowymi.

The efficacy of 3 schemes of passive and active prevention of HBV infection was evaluated in 47 children with haematologic proliferative diseases. Twenty-six children suffering from leukemia (group I) received passive immunisation (hepatitis B immunoglobulin) in six week intervals during intensive chemotherapy and were vaccinated on maintenance therapy. Thirteen children with Hodgkin or B-non-Hodgkin lymphoma (group II) received active immunisation from the beginning of intensive chemotherapy with two doses of immunoglobulin. Eight children who had completed their therapy (group III) were vaccinated only. Among children who completed vaccinations, 5/8 in group I, 4/7 in group II and 5/5 in group III produced protective anti-HBs levels. Passive/active prophylaxis was successful in most patients suffering from neoplastic diseases and reduced the endemy of HBV infection in our department from 43.3% to 2.56% infected subjects. Among 7 patients vaccinated from the beginning of treatment (group II), 4 of them produced protective levels of anti,-HBs, despite intensive chemotherapy.

[Fever in children with hematologic neoplastic diseases and implanted Broviac-Hickman catheters]. / Goraczka u dzieci chorych na nowotwory krwi z wszczepionymi cewnikami Broviaca-Hickmana.

A safe and effective method of venous access is important in the care and treatment of patients with malignancies. Thirty-seven Broviac-Hickman catheters were inserted in 32 children with haematological neoplastic disease. The mean indwelling time of the catheters was 7014 days. The catheters were used to administer chemotherapy and other drugs, blood products, and as well as to draw blood. Fever occurred 96 times. Forty-three percent of fever episodes were related to clinically documented infections and in 15% of cases, to catheter-related bacteremia caused by Gram-positive and Gram-negative strains in equivalent proportions. Fever was observed with a two fold greater incidence in patients with severe granulocytopenia (< 0.5 G/l).

[Congenital spherocytosis in children]. / Sferocytoza wrodzona u dzieci.

The clinical course and effects of treatment of congenital spherocytosis (CS) were analyzed in 28 children. In 10 cases the disease ran a severe clinical course. Jaundice, anaemia, and splenomegaly were the most frequent clinical signs which were significantly intensified during haemolytic crises. In 14 cases splenectomy was performed, obtaining in all children a regression of jaundice and anaemia. Before the operation two children were vaccinated with Pneumo 23. In asplenic children Debecillin was prophylactically used. Serious infectious complications were observed only in one patient.

[Preliminary evaluation of adverse effects after administration of arabinoside cytosine (Ara-C) in high doses to children with acute myelogenous leukemia]. / Wstepna ocena objawów niepozadanych po podaniu arabinozydu cytozyny (Ara-C) w duzych dawkach dzieciom z ostra bialaczka mieloblastyczna.

Five children with AML were treated with high-doses of Ara-C (2 g/m2) during consolidation. After 17 cycles the toxicity was evaluated. Granulocytopenia (< 0.5 x 10(9)/l) and thrombocytopenia (< 25 x 10(9)/l) were stated after 15/17 and 13/17 cycles respectively. The nadir of bone marrow suppression appeared between day 10 and 14. In one case treatment related death during severe myelosuppression was noted. In individual cases jaundice with elevated activity of aminotransferases, paralytic ileus and pulmonary oedema were observed. All these adverse reactions were reversible. Other toxicities such as nausea/vomiting, stomatitis, diarrhea, infections and drug related fever were transient. No neurologic toxicity was seen. There is a need for developing a new way of the administration of high-dose Ara-C which could substantially reduce toxicity of the drug.

[Histiocytosis X in children--course of the disease and treatment]. / Histiocytosis X u dzieci--przebieg choroby i leczenie.

A clinical analysis was carried out of the course of the disseminated form of the disease in 20 children aged from one month to 8 years (mean age 11 months). Unfavourable prognostic significance was confirmed of such factors as: child's age at the time of falling ill lower than two years, number of the involved organs and their dysfunction, and lacking reaction to treatment during the first three months of the disease.

[Burgdorf's reaction (painful acral erythema) in patients with acute lymphoblastic leukemia following medium-dose methotrexate therapy]. / Reakcja Burgdorfa ("painful acral erythema") po leczeniu posrednimi dawkami methotreksatu chorych z ostra bialaczka limfoblastyczna.

Erythematous changes of the palms with associated oedema, blistering and desquamation were observed in two children during chemotherapy for acute lymphoblastic leukaemia, after methotrexate in doses of 1,000 mg/m2. These changes correspondent to those described in the literature as Burgdorf's reaction. In Poland it was never reported as yet.

[Allergic reactions to teniposide (VM-26) in children with neoplasms]. / Reakcje alergiczne na teniposide (VM-26) u dzieci z choroba nowotworowa.

Allergic reactions of dramatic intensity were observed in 5 children treated with Teniposide (VM-26) for acute lymphoblastic leukaemia and histiocytosis X. In the further treatment this drug was replaced with epoxide, a cytostatic agent which is also a podophyllin derivative but in other chemical formulation. In none of these patients the allergic reaction returned.

[Studies of methotrexate pharmacokinetics in children with neoplasms of the hematopoietic system after administration of different doses of the drug]. / Badania farmakokinetyki metotreksatu u dzieci z nowotworami ukladu krwiotwórczego po podaniu róznych dawek tego leku.

Concentration of MTX was determined in the serum after the infusion of MTX in a dose of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2 to 24 children with ALL/NHL. The mean value of steady-state concentrations of MTX was two-fold greater after the infusion of a dose of 1.0 g/m2 and ten-fold greater after the infusion of a dose 5.0 g/m2 than at dose 0.5 g/m2. Great inpatient and interpatient variations of serum MTX concentrations were observed. Pharmacokinetic analysis of the data revealed biphasic model of the elimination. Statistically significant differences were found between the half-life MTX values (ti/2 alpha) in the first postinfusion day: the higher the dose, the shorter ti/2 was observed. The ti/2 of MTX during the second postinfusion day was significantly longer than that of the first day after infusion, but values for the higher doses were not significantly shorter than those for 0.5 g/m2. Systemic clearance (Cl) of MTX showed inpatient and interpatient variations of the values. However, no statistically significant difference was found between Cl values at doses of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2.

Jaundice following high--dose arabinoside cytosine in a child with acute myelogenous leukemia.

A girl with acute myelogenous leukemia (AML) was treated with high dose arabinoside cytosine during consolidation. She developed jaundice twice after the completion of 3 rd and 4 th cycle of the drug. The jaundice was characterized by conjugated hyperbilirubinemia, elevated aminotransferases and alkaline phosphatase. The histologic study of the liver showed only infiltration by mononuclear cells in portal space and scarce bile pigment in some hepatocytes. In both cases jaundice receded spontaneously. Now the patient has been in complete remission for 36 months and subsequent liver function tests are normal.