Evaluation of articular disc loading in the temporomandibular joints after prosthetic and pharmacological treatment in model studies.

BACKGROUND: Temporomandibular joint dysfunction is often related to excessive load in the stomatognathic system. OBJECTIVES: The objective of the model tests, using numeric calculations, was to assess the articular disc loads in the temporomandibular joints after prosthetic and pharmacological treatment of functional disorders of the masticatory organ. MATERIAL AND METHODS: The study involved 10 patients, aged 21-48 years, of both sexes, randomly selected from a group of 120 patients treated with relaxation occlusal splints (60 patients, group I) and intramuscular injection of botulinum toxin type A (60 patients, group II), suffering from temporomandibular joint dysfunction with the dominant muscle component. In all subjects, a specialized functional examination was carried out. Treatment groups: occlusal splint therapy (group I) and intramuscular injection of botulinum toxin type A (group II). An assessment of the loads of 4 disc zones of the temporomandibular joints was carried out based on the results of clinical studies (phase I of the study), and numeric model tests (phase II). In the representatives of the study groups (5 patients in each group), measurements of occlusal forces and an evaluation of tension of the masseter and temporalis muscle were performed. RESULTS: The results of the average load values for all evaluated zones of the right and left articular disc differ in a statistically significant way in favor of group II, with the exception of the external mid part of the discs. In the case of the anterior of the right disc, the load was lower in patients belonging to group I than in those obtained in group II. CONCLUSIONS: Botulinum toxin type A significantly reduces the loads within the temporomandibular joints, generated by masseter muscle hypertonia.

Association between uridin diphosphate glucuronosylotransferase 1A1 (UGT1A1) gene polymorphism and neonatal hyperbilirubinemia.

OBJECTIVE: To assess the prevalence of UGT1A1*28 and UGT1A1*60 polymorphisms of UGT1A1 gene and their association with hyperbilirubinemia. STUDY DESIGN: The study was performed at a single centre - at the Department of Obstetrics of the Medical University of Gdansk in Poland. DNA was isolated from Guthrie cards of 171 infants. Only full term newborns (gestational age 38-42 weeks) were included in the study. Fluorescent molecular probes were used for UGT1A1 promoter variation analysis. The presence of UGT1A1*28 polymorphism was detected with a dual-probe system, and UGT1A1*60 with a SimpleProbe™. RESULT: Homozygous UGT1A1*28 and UGT1A1*60 genotypes were detected in 14.6% and 20.5% of the newborns, respectively. Homozygous (G/G) genotypes of UGT1A1*60 polymorphism were found in all of the UGT1A1*28 (i.e. (TA)7/(TA)7) homozygotes. More than 80% (55/66) of the children with "wild" type UGT1A1*28 genotype (where no polymorphism was detected) (i.e. (TA)6/(TA)6) carried the "wild" (T/T) genotype of UGT1A1*60 as well. The UGT1A1*28 polymorphism was detected more often among neonates with elevated bilirubin. Hyperbilirubinemia was diagnosed more frequently in boys. CONCLUSION: Polymorphisms of the UGT1A1 gene frequently co-exist in neonates. The presence of UGT1A1*28 polymorphism and male gender seem to predispose to neonatal hyperbilirubinemia.

The evaluation of the accuracy of shape imaging of prosthetic abutment.

PURPOSE: The aim of the study was the in vitro evaluation of the accuracy of shape imaging of abutment teeth using different impression compounds. METHODS: To compare the accuracy of the shape of the numerically imaged real prosthetic abutments with the tested models of abutments obtained with the replica technique, the Geomagic Qualify program was applied. Making use of the licensed program Statistica, statistical analysis of the results obtained was conducted. RESULTS: In the research procedures, analyses were conducted for 10 abutment premolars and 10 abutment molars. The tests allowed us to state that the dimensional accuracy of the models of prosthetic abutments obtained with the application of elastic compounds tested ensures comparable shape imaging. CONCLUSIONS: The objective method developed and applied here is suitable for controlling the imaging of the abutment teeth. The Geomagic Qualify program that was used during the research is a reliable tool of 3D analysis for the estimation of procedure of abutment tooth preparation and indication of an error of shape of prepared occlusal surface, lateral surface of abutment and errors of shaping the chamfer zone.

Serum Concentrations of Tryptase in Children.

Background: Mast cells are dispersed in many tissues, especially in digestive and respiratory-tract mucosal membranes. Tryptase, considered a marker of mast-cell activity, is the most important protease released from these cells during degranulation. Tryptase concentration is mainly accessed in anaphylaxis and mastocytosis, being one diagnostic criteria of this disease. There are no data concerning tryptase activity in healthy children in the current literature. Aim: The aims of this study were the analysis of concentrations of serum tryptase in healthy children, and determining reference values of the enzyme at different developmental ages. Materials and methods: The investigated group consisted of 131 healthy children (75 girls, 56 boys) aged 3 months-18 years. The concentration of tryptase in the studied samples was evaluated by the fluoro-immuno-enzymatic method with UniCAP. Results: The mean concentration of serum tryptase in the studied group was 2.8±2.2 ng/dL: 2.5±2.2 ng/dL in girls and 3.2±2.1 ng/dL in boys. Conclusion: The upper reference limit of 7.2 ng/dL was lower than in adults.

Controversies on the position of the mandibular foramen - review of the literature.

Foramen of mandible is the most important point considering the Halsted anesthesia. Position of this foramen seems to be stable, however there are lots of controversies regarded to its position. Based on the current literature authors revised datas from literature considering the location of the mandibular foramen.

Clinical parameters of inflammatory bowel disease in children do not correlate with four common polymorphisms of the transforming growth factor ß1 gene.

Transforming growth factor ß1 (TGF-ß1) is a cytokine affecting cell proliferation and development, which also has an immunomodulatory activity. Correlations between polymorphisms of the TGF-ß1 gene and clinical parameters of inflammatory bowel disease (IBD) were reported previously in adults. Here, we tested whether such correlations occur in pediatric patients suffering from IBD. One hundred and four pediatric IBD patients were involved in this study. Among them, 36 were diagnosed with Crohn's Disease (CD) and 68 were diagnosed with ulcerative colitis (UC). The control group consisted of 103 children, in which IBD was excluded. TGF-ß1 levels were determined in plasma and intestinal mucosa samples. The presence of the TGF ß1 protein and the amount of TGF ß1 mRNA were estimated in intestinal mucosa by immunohistochemistry and reverse transcription Real-Time PCR, respectively. Four common polymorphisms of the TGF-ß1 gene were investigated: -800G/A, -509C/T, 869T/C and 915G/C. No significant correlation between TGF-ß1 genotypes and (i) TGF-ß1 levels in plasma and tissue samples, (ii) TGF-ß1 gene expression efficiency in intestinal mucosa, (iii) IBD clinical parameters and (iv) inflammatory activity could be detected in children suffering from IBD. We conclude that, contrary to previous suggestions, the four common polymorphisms of the TGF-ß1 gene do not influence the susceptibility to or clinical parameters of IBD in the tested population of children.

Polypropylene-polyester cranial prostheses prepared with CAD/CAM technology. Report of first 15 cases.

OBJECTIVES: The authors described a new cranioplastic method where polypropylene-polyester knitwear was shaped according to individual patient's skull 3D model. The material was formed in a customized manner and preoperatively adjusted to the patient needs with modern CAD/CAM techniques. PATIENTS AND METHODS: The procedure consisted of a CT scan with a simple but unorthodox protocol, 3D modeling of the bone defect and planned prosthesis, finally the preparation of the plate itself. Prostheses were used in the 15 cases of cranial defects. RESULTS: Sample cases were shown with preoperative and postoperative CT scans, patient pictures, and 3D models of the prostheses. The size of the defect ranged from 15 to 95 cm(2), and the observation period after the reconstructive operation ranged from 3 to 23 months. The results were very good in all cases of cranioplasties performed after craniectomies of various origins. CONCLUSION: CAD/CAM shaping gave better adjustment to requirements of specific defect than any standard preformed plate. Such method seemed to be a reasonable alternative to other cranioplastic solutions and can be recommended even for cases of large or complicated shape cranioplasties.

[Reliability of self-reported maternal smoking during early lactation period]. / Ocena wiarygodnosci badan ankietowych dotyczacych palenia tytoniu przez kobiety we wczesnym okresie laktacji.

UNLABELLED: Smoking cigarettes is very common among lactating women. The objective evaluation of an exposure to cigarette smoke is needed, as cotinine concentration. On many research a questionnaire is the only determinant of fact and intensification of smoking. The aim of this research was to establish a reliability of the questionnaire concerning cigarette smoking among lactating mothers by analyzing cotinine/creatinine ratio. MATERIAL AND METHODS: In 51 lactating mothers (participants of the research on oxidative stress in Obstetrics Departments on 3rd day post partum) during check-up visit, on 30th day post partum a questionnaire concerning smoking cigarettes before, during pregnancy and after childbirth, and amount of cigarettes smoked was made. Samples of matutinal urine were deep freezed in - 700 till cotinine was evaluated immunoenzymatically. Women were divided into groups: I of non-smokers (32 women), II of smokers (19 women). Statistical analysis was made by means of unparametric test U Mann-Whitney. RESULTS: Average cotinine/creatinine ratio was 33,8 ng/mg in group I; 1275.9 ng/mg in group II. Specificity and sensitivity of data earned by virtue of statement of correspondents was 81% and 89%. Test of cotinine concentration in urine demonstrated 100% sensitivity and 94% specificity compared to the cotinine/creatinine ratio. Directly proportional relationship was stated between amount of cigarette smoked and concentration of cotinine in urine (55.9 ng/ ml cotinine/cigarette). CONCLUSIONS: A questionnaire should not be the only method evaluating smoking among lactating women. The concentration of cotinine shows slightly lower specificity than cotinine/creatinine ratio. Both tests can be dealt equivalent.

[Role of transforming growth factor beta1 (TGF-beta1) in the pathogenesis and clinical course of chronic hepatitis in children]. / Rola transformujacego czynnika wzrostu beta1 (TGF-beta1) w etiopatogenezie i przebiegu klinicznym przewleklych zapalen watroby u dzieci.

UNLABELLED: Transforming growth factor-beta1 (TGF-beta1) is known to play a key role in processes of cell proliferation and differentiation. It also plays an important role in modulation of the immune response. Various diseases may arise both from excessive and insufficient activity of this cytokine. THE AIM OF THE STUDY was to evaluate the role of TGF-beta1 in the pathogenesis of chronic hepatitis (Ch.h.) and to assess whether TGF-beta1 level in plasma or its tissue expression can be useful in diagnosing and monitoring of clinical course of this disease. PATIENTS AND METHODS: Twenty-one children with chronic hepatitis were included in the study and 42 healthy children constituted the control group. Liver function tests and TGF-beta1 plasma levels measured by ELISA method were evaluated in both groups of patients. In liver tissue obtained by needle biopsy, the histopathological grading and staging of hepatitis was evaluated, TGF-beta1 protein was assessed by immunohistochemical methods and TGF-beta1 gene expression was measured by reverse transcription and real-time polymerase chain reaction. RESULTS: In chronic hepatitis group of patients the plasma TGF-beta1 level did not differ from the control group and did not correlate with grading and staging of the liver tissue while positive correlation was observed with gamma-glutamyl transpeptidase activity in the serum. There was no correlation between tissue TGF-beta1 expression and TGF-beta1 plasma level and staging or grading in liver tissue. TGF-beta1 gene expression correlated positively with ESR and ALAT activity but no correlation with TGF-beta1 plasma level, TGF-beta1 gene or protein expression, grading or staging in liver tissue were observed. CONCLUSION: 1. In children with chronic hepatitis, TGF-beta1 plasma level is not related to grading or staging in the liver tissue. This finding may be due to low level of fibrosis observed in the studied children. 2. It appears that local expression of TGF-beta1 in liver tissue should not be used as a sole marker in differentiating and monitoring the course of chronic hepatitis. 3. In children with chronic hepatitis assessment of liver TGF-beta1 gene expression is not helpful in the evaluation of pathological changes in liver tissue. 4. Due to the relatively low number of patients in the analysed groups it seems advisable to perform similar complex studies in larger groups of children with chronic hepatitis.

[Primary sclerosing cholangitis in children - clinical manifestations and diagnostic difficulties]. / Pierwotne stwardniajace zapalenie dróg zólciowych u dzieci - obraz kliniczny oraz trudnosci diagnostyczne.

Primary sclerosing cholangitis is a rare chronic disease of intra- and extrahepatic bile ducts, which causes cholestasis with inflammation and fibrosis ultimately resulting in biliary cirrhosis. The review focuses on clinical manifestations and diagnostic difficulties in primary sclerosing cholangitis in children.

[Outcome of cataract surgery in patients with pigmentary retinal degeneration]. / Wyniki operacji zacmy u chorych ze zwyrodnieniem barwnikowym siatkówki.

PURPOSE: To evaluate the results of cataract surgery in patients with RP because retinitis pigmentosa is one of the disease entities that belongs to tapeto-retinal degenerations. The occurrence of RP appearance is 1:4000 to 1:3000. MATERIAL AND METHODS: Twenty patients with RP (7 women and 13 men, 33 eyes), who underwent cataract surgery were examined retrospectively. Average age in our group was 46.6 years. Visual acuity, intraocular pressure, slip lamp examination, fundus examination, cataract morphology, visual field were taken before surgery and on discharge, on the basis of medical documentation. Control examination was taken, on average, eighty one months after cataract surgery. Nine eyes were operated by phacoemulsification, 24 eyes by means of extracapsular cataract extraction. In the same way control group of 18 patients who underwent cataract surgery without RP (33 eyes) was examined. RESULTS: In RP group in 63.6% patients on discharge from the hospital and in 60.6% patients during the control examination, improvement of visual acuity was revealed. Deterioration was noted in 18.2% of patients on discharge from hospital and in 24.2% of patients during the control examination. In the control group improvement of visual acuity was revealed in 90.9% of patients on discharge and in 97% patients during the control examination, whereas deterioration of visual acuity occurred in 6.1% patients on discharge and in 3% patients during the check examination. CONCLUSIONS: In patients with retinitis pigmentosa cataract occurs earlier then in the control group. Cataract surgery for relatively minor opacities is beneficial in patients with RP, and causes improvement of visual acuity in most of eyes undergoing surgery.

[Retinal pigmentary degeneration--clinical features, diagnostics and possibilities of treatment]. / Zwyrodnienie barwnikowe siatkówki--przebieg kliniczny, diagnostyka i mozliwosci leczenia.

The purpose of this study was to evaluate clinical course of retinitis pigmentosa taking into consideration models of inheritance and possible treatment. Retinitis pigmentosa belongs to heterogeneous group of hereditary disorders, which are connected with gradual loss of the photoreceptor function, firstly rod cells subsequently cones, which is accompanied by the retinal pigmentary epithelium disorder. Retinitis pigmentosa connected with X chromosome is one of the most severe form of this disease that in polish population takes place with frequency at average 10-15% which is similar to ADRP--10-20%. Course of RP, despite many similarities may differ from each other and prognosis depends on model of inheritance. Unfortunately, in spite of many efforts, nowadays medicine do not have successful treatment for patients with RP.

[Chronic hepatitis B in children--is it still a real problem?]. / Przewlekle zapalenie watroby typu B u dzieci--problem nadal aktualny?

Over one million people all over the world die every year due to the complications of HBV infections. This problem is particularly important in Asia, Africa and in the West Pacific region where HBV infection is widely spread (from 5-20% up to 80% of all infected people in the world). In these regions HBV infections are transmitted mostly perinatally or during early childhood. In North America and in West Europe where after introducing anti-HBV vaccinations less than 2% of the population is affected, infections are usually transmitted by intravenous drug abuse, sexual intercourse, or much less frequently by blood transfusions. The immaturity of immune system in young children is responsible for the fact that nearly 90% of HBV infections acquired in infancy and 40-70% of HBV infections before the age of 3 years, result in chronic viral hepatitis. Therefore, the choice of an efficient and safe therapy is one of the most important problems. In this paper current data concerning indications for treatment and side-effects of interferon-alpha and lamivudine therapy in children with chronic viral hepatitis type B are presented.

[Therapy of chronic viral hepatitis type B in children after previous ineffective interferon-alpha treatment]. / Terapia przewleklego wirusowego zapalenia watroby typu B u dzieci po uprzednim, nieskutecznym leczeniu interferonem alfa.

UNLABELLED: THE AIM of this study was to estimate the efficacy of nucleoside analogue (lamivudine) in the therapy of chronic viral hepatitis type B in children, after previous, ineffective treatment with interferon-alpha. PATIENTS AND METHODS: we analyzed 53 children with chronic viral hepatitis type B, who had not responded to Interferon-alpha treatment conducted 1-7,5 years before this study (mean 4,0 +/- 7,5; median 4 years). Inclusive criteria to re-therapy with lamivudine were as follows: increased serum alanine aminotransferase activity, detected at least three times during 6 months before treatment, HBsAg and HBeAg present in the blood, viral HBV DNA detected for at least 6 months before the beginning of lamivudine therapy (above 200 genome copies per mL) and inflammation activity observed in liver biopsy specimen (biopsy performed within previous 24 months). Evaluation of side-effects of lamivudine therapy was based on anamnesis (subjective data) and laboratory tests performed regularly in the time of clinical visits during and after the end of the treatment. RESULTS: all the children concluded the treatment. Before lamivudine therapy, serum alanine aminotransferase activity ranged between 20-590 IU/L. In 28,4% of children it was less than 100 IU/L. In almost all the children moderate staging and grading were observed in liver biopsy specimens. HBV DNA in serum ranged between 200-200000 copies/mL: in 31 children (58,4%) HBV DNA exceeded 200000 copies/mL, in 5 (28,3%) was between 10000 and 200000 copies/mL, and in 7 (13,2% ) was below 10000 copies/mL. Applied treatment resulted in alanine aminotransferase activity normalization in 79,2% of children, mostly after 2-11 months (mean 3,9 +/- 2,7; median 3,8 months). HBeAg/HBeAb seroconversion was achieved in 28,3% of children, usually at the end of lamivudine therapy (approximately after 12 months). Sustained viral response was observed in 24,5% of treated children. There were no undesirable effects of therapy noted. Serum alanine aminotransferase activity increased slightly and temporarily in 4 children between 3rd and 12th month of therapy. In 2 of these children YMDD mutation was detected. CONCLUSIONS: lamivudine is effective, safe and well tolerated in treatment of chronic viral hepatitis type B, following unsuccessful interferon-alpha therapy. Serum alanine aminotransferase activity normalized in most of the patients. HBeAg/HBeAb seroconversion as well as positive viral response is mostly connected with low level of HBV DNA before therapy.

[HBV gene variants and polymerse gene mutations in children with chronic hepatitis B in the course of the antiviral therapy]. / Genotypy HBV oraz mutacje genu polimerazy HBV u dzieci z przewleklym zapaleniem watroby typu B w przebiegu leczenia lamiwudyna.

UNLABELLED: THE AIM OF THE STUDY was to evaluate the occurrence of HBV genotypes and the emergence of polymerase gene mutations in children with chronic hepatitis B in the course of the lamivudine therapy. MATERIAL AND METHODS: eighteen children (aged from 6 to 15 years, mean age 11,8 years, 10 boys and 8 girls) with chronic hepatitis B were included in the study. All patients were treated with 100 mg lamivudine tablets given daily orally for 12-16 months. All amino acid substitutions within HBV polymerase were detected by PCR amplification and direct sequencing HBV genotypes and polymerase gene mutations were determined by comparing the sequences in the overlapping PollS genes with published sequences, available in GenBank. RESULTS: HBVgenotyping showed the presence of genotype A in 17 children and genotype H in one. No change of HBV genotype was noted in any of the studied patients as the sequencing of HBV DNA was repeated during the lamivudine therapy. The presence of lamivudine-resistance mutations involving the YMDD motif was detected in 5 patients. Four children had YVDD mutation, while in one child YIDD mutation was detected. YIDD mutation appeared to be the single one in the viral polymerase gene, while YVDD mutations in four patients were accompanied by other changes at amino acid sequence of the HBV polymerase: rtL180M, rtN124D and rtL164M. CONCLUSIONS: 1) Genotype A was predominant in the studied population of patients. 2) The risk of the emergence of drug-resistant HBV polymerase mutations is high and increases in the course of the lamivudine therapy. 3)Drug-resistant mutations in the YMDD motif are accompanied by other amino acid substitutions in the viral polymerase of unclear clinical significance.

[Vasculitis in children]. / Zapalenia naczyn u dzieci.

Vasculitis is a group of rare diseases of unknown etiology, characterised by inflammation and necrosis of blood vessels, contributing to various clinical consequences. The variety of clinical symptoms and presence of symptoms from various syndromes often make the diagnosis difficult. Until now no causal treatment has been established. In order to achieve a remission of the disease, corticosteroids and immunosuppressive therapy are recommended.

[The presence and polymorphism of genes encoding serine protease autotransporters (spate) among the Escherichia coli isolated in the region of Gdansk from children with diarrhea]. / Wystepowanie oraz polimorfizm genów kodujacych syntezk autotransporterów proteaz serynowych (SPATE) wsród paleczek Escherichia coli wywolujacych biegunki u dzieci w regionie Gdanska.

The group of 96 strains ofEscherichia coli isolated from children with diarrhea were investigated towards the presence and polymorphism of genes encoding autotransporters that belong to the group of proteins named SPATE (Serine Protease Autotransporters ofEnterobacteriaceae). Based on the results of restriction analysis of the products of PCR reaction 8 different types of genes encoding SPATE were detected. It was found that 39 strains contained one gene of SPATE, 15 strains contained two different genes and 3 different genes were detected in the case of 3 strains. The analysis of combination of presence of genes encoding SPATE let us divide the investigated group of strains into 17 different genotypes. The analysis of polymorphism of genes encoding SPATE seems to be very promising tool for exploring the genetic diversity among pathogenic E. coli.

[Congenital extrahepatic biliary atresia as a cause of cholestasis in newborns and infants]. / Wrodzona atrezja dróg zólciowych zewnatrzwatrobowych jako pryczyna cholestazy u noworodków i niemowlat.

UNLABELLED: Congenital extrahepatic biliary atresia (CEBA) is one of the most common causes of cholestasis in newborns and infants. THE AIM OF THE STUDY: was the analysis of clinical presentation, results of laboratory and imaging investigations as well as clinical outcome of children with extrahepatic cholestasis caused by CEBA. MATERIALS AND METHODS: the analyzed group included 15 children aged from 2 weeks to 4 months. Data concerning: pregnancy and delivery, newborn's health condition, faeces color; jaundice onset, manifestation of coagulation disorders coexisting malformations and disorders of other systems were obtained. The following investigations were performed: biochemical tests evaluating the function of the liver and cholestasis (serum bilirubin concentration and fractions, bile acids in serum, AlAT, AspAT, GGTP, FALK activities, serum electrophoresis, prothrombin index). We also performed tests focusing on hepatotropic infections, - metabolic disorders tests and in all children - ultrasound of the abdomen, scintigraphy of the bile ducts - HEPIDA. 14 children had undergone hepatoportoenterostomy, modo Kasai. RESULTS: jaundice, acholic stools and hepatomegaly were present in all children. The serum concentration of bilirubin and its conjugated fraction and bile acids in all children were increased. GGTP and FALK activities were markedly elevated in all children. Aminotransferases activities elevations were observed, more distinctively for AST. Active cytomagalovirus infection was detected in 3 children. Abdominal ultrasound revealed gallbladder in 7 children, whereas intrahepatic bile ducts were described as normal in 12 cases. In all cases the HEPIDA scintigraphy showed no passage of the tracer to the GI tract even after 24 hours delay. Hepatoportoenterostomy was performed in 14 children, 5 of them had liver transplantation. CONCLUSIONS: 1. There is still not one effective and specific diagnostic method in differentiating between the causes of cholestasis in the newborns and infants. Thus many investigation methods should be run simultaneously. 2. Congenital atresia must be definitely excluded before cholestasis with other background is finally diagnosed. 3. The hepatoportoenterostomy should be considered as the first line treatment in children with CEBA. Most cases will need liver transplantation in the future.

[Mesenteric lymphadenopathy - a valid health problem in children]. / Limafadenopatia krezkowa- czesty problem kliniczny wieku dzieciecego.

THE AIM: of the study is to evaluate the reasons of mesenteric lymphadenopathy and its clinical picture in hospitalized children. MATERIAL AND METHODS: the study was performed on 127 children (49 girls and 78 boys age of 8 months to 18 years; mean age 9 years and 3 months) hospitalized in the Department of Paediatrics, and Paediatric Gastroenterology and Oncology, Medical University of Gdansk. Ultrasonography showed enlarged abdominal lymph nodes in all children. According to definition of mesenteric lymphadenopathy, the clinical course of disease was analyzed in children, in whom there were at least three lymph nodes in ultrasonography with the peroneal diameter of 5 mm or more. Inflammatory parameters were examined in all children. In selected cases culture, viral and parasitic, as well as endoscopic examination, were also performed. RESULTS: analyzing accompanying clinical symptoms, it was found, that abdominal pain was the most dominant complaint in children with mesenteric lymphadenopathy; it was observed in 63 children (49.6%). In 33 (26%) of them the pain was the sole complaint, while in the rest vomiting and fever were present. 8 children (6.3%) with generalized lymphadenopathy were diagnosed. Ultrasonographic evaluation demonstrated that numerous enlarged lymph nodes were present the most frequently, in 65 (51.2%), less numerous, in 42 (33.1%), while sparse lymph nodes were seen only in 20 (15.7%) children. In 85 patients (66.9%) long axis of the lymph nodes reached min. 10 mm, in 39 (30.1%) was smaller than 10 mm, in 3 (2.4%) exceed 20 mm. Conglomerates of lymph nodes were described in 9 (7.1%) patients with various diagnosis (acute diarrhea - 3 children, ulcerative colitis - 3 children, celiac disease, cytomegaly, lambliosis). Tendency to invagination was observed in 5 (3.9%) children. In 4 of them acute infection (acute diarrhea, pneumonia) with high inflammatory parameters was diagnosed. Elevated inflammatory parameters were present in 42 (33.1%) patients. Examining the reasons of the abdominal lymph nodes enlargement, it was found that primary mesenteric lymphadenopathy was the most frequent diagnosis; it was recognized in 27 (21.3%) children. In 20 (15.7%) lymphadenopathy was caused by acute diarrhea, in 19 (14.9%) patients - by respiratory tract infection. Cytomegaly was recognized in 4 (3.1%), toxoplasmosis in 3 (2.3%), lambliosis in 9 (7.0%) patients. Both gastritis and colitis were diagnosed in 12 (9.4%) children. In 7 (5.5%) patients generalized lymphadenopathy with unknown etiology was described. In single cases other diseases were diagnosed. CONCLUSIONS: the enlargement of mesenteric lymph nodes frequently causes abdominal pain in children, being an indication for laboratory investigations. Vomiting and fever are the most common other symptoms in these patients. Ultrasonographic examination usually shows large enlargement of lymph nodes, sometimes in conglomerates, with tendency to invagination. Acute diarrhea and respiratory tract infection are the most frequent reasons of the enlargement of abdominal lymph nodes. In about 20% of the children primary mesenteric lymphadenopathy is diagnosed.

[Giardiasis in children - clinical diversity and diagnostic problems based on own experience]. / Zakazenia giardia lamblia u dzieci- zmiennosc obrazu klinicznego i trudnosci diagnostyczne w swietle doswiadczen wlasnych.

UNLABELLED: Parasitosis still remains a significant pediatric health problem, despite improving hygienic conditions and social awareness. THE AIM OF THIS STUDY: was to analyze clinical manifestations of Giardia lamblia infection in children hospitalized in the Department of Pediatrics, Pediatric Gastroenterology and Oncology of Medical University of Gdansk. MATERIAL AND METHODS: studied children included 49 patients aged 2.2 - 17.3 years: group I children below and group II above 5 years of age. The patients were admitted for further diagnosis of unexplained clinical manifestations in outpatient care. Parasitosis was confirmed by immuno-enzymatic technique detecting protein GSA 65; only in one child parasites cysts were found by microscopic technique in faecal samples obtained from infected children. RESULTS: chronic abdominal pain was noted in 16 (72.7%) children in group I and in 22 (81.5%) patients in group II. Chronic diarrhea was observed in 20 (90.9%) children in group I and in 4 (14.8%) in group II. Ultrasound scans revealed mesenteric lymphadenopathy in 42 children (16 in group I and 26 in group II). CONCLUSIONS: chronic and recurrent abdominal pain was the main clinical complain and chronic diarrhea in children under 5 years of age. In few cases hepatobiliary involvement was observed, which might suggest a changing clinical course of giardiasis. Most of the children presented with mesenteric lymphadenopathy, which was confirmed by abdominal ultrasound scan. Thus, this method should be included in the diagnostic algorithm, if parasitosis is considered.