A successful therapy of renovascular hypertension.

Authors describe a rare cause, diagnostic difficulties and successful therapy of renovascular hypertension in a 12 year-old girl caused by anular stenosis of the intrarenal arterial branch. Activation of the system renin-angiotensin (RAS) is found in all forms of renovascular hypertension at the beginning. Etiologically, stenosis in childhood is caused mostly by renal artery dysplasia, affecting mostly media, and fibromuscular dysplasia. Fibromuscular dysplasia affects middle and distal third of renal artery in 60%, more frequently on right, only in 10% of cases affects segmental branches; one quarter of patients are affected bilaterally. This disease is found predominantly in young women. During clinical course, typical signs include sudden onset of severe and poorly controlled hypertension, renal insufficiency, proteinuria and hypertensive retinopathy. From non-invasive diagnostic approaches, color duplex ultrasound, NMR and CT angiography are important, from invasive ones, digital subtractive angiography and the measurement of plasma rennin activity in renal veins. In therapy, it is percutaneous transluminal renal angioplasty, associated with low mortality and morbidity. The net result of angioplasty is dilation of stenosis, complete restoration of artery lumen and flow and decrease of blood pressure. The best results can be achieved in young patients with fibromuscular dysplasia, more then half can recover completely. Using this method, also our patient has recovered (Tab. 2, Fig. 2, Ref. 7).

Protection of newborn organism against effect of oxidative stress.

OBJECTIVE: The aim of the present study was to investigate influence of oxidative stress on newborn organism, in terms of the dynamics of malondialdehyde (MDA) concentration changes and of the activities of selected antioxidants in asphyxial newborns on the 1st and 5th day of life. METHOD: In the group of 62 preterm and term asphyxial newborns, characterized by the presence of asphyxial criteria and admitted within 24 hours of life, the plasma concentration of MDA and level of total antioxidant status (TAS) were followed. RESULTS: Dynamic changes of MDA signalized active process of lipoperoxidation (LP) and values of TAS were decreased in comparison with the capacity of adult patients.

Trisomy 18 mimicking Smith-Lemli-Opitz syndrome in the immediate neonatal period.

The study describes a dysmorphic newborn infant with life-threating anomaly, later diagnosed as trisomy 18, mimicking Smith-Lemli-Opitz syndrome in the immediate neonatal period. The establishment of the correct diagnosis in the first days of life is very important for the decision-making process, because trisomy 18 has a poor prognosis, and treatment is not instituted, whereas cholesterol supplementation may be of benefit to patients with Smith-Lemli-Opitz syndrome. Ultraviolet spectrophotometry showed very easy and rapid method for differentiation of both syndromes, where gas chromatography/mass spectrometry analysis is not available. (Fig. 2, Ref: 18.)

Transformation of the system of education in health care services.

"Nursing" and "Public Health Care" are new study specializations which have been offered by the Faculty of Medicine, Comenius University in Bratislava from the study year 2002/2003 and from the study year 2003/2004 "Midwifery", "Laboratory and examination methods" and "Physiatrics, balneology and rehabilitation" accredited by AK SR have followed. It is the consequence of the transformation of the specialization Nursing and definition of the nurse's qualifications according to the European Strategy of WHO for education of so called regulated non-physician professions nurses and midwife. The government Regulation on further education of health care workers No. 157/2002 of the Statute has brought about new trends in the system of education in health services. As a consequence of these changes Faculty of Medicine of the Comenius University promptly reacted to this public requirement to increase the level of qualification of health care workers. (Ref. 5.)

Children in the focus of the attention of pediatricians and pediatric surgeons.

Children represent the future of humankind. They are the bridge to our immortality. They get the attention of everybody who wants to help and do something for them. It is a common interest of pediatricians and pediatric surgeons to provide ill children with almost care. In the context of historic development of medicine, the author focuses her attention on the development of pediatric and surgical care of children with the emphasis given to the care of critically ill children suffering from inborn heart defects. The author uses the example of co-operation of pediatric cardiologists and cardiosurgeons as the base for her reflections of ethical principles, norms and attitudes to the implementation of modern surgical techniques in the treatment of newborn babies suffering from the syndrome of left-heart hypoplasia. The history of child-care in general and especially that dedicated to newborn babies suffering from inborn heart defects in Slovakia is associated with the personality of Professor Siman, a significant Slovak cardiosurgeon.

[A pediatrician's views on the treatment of extensive hemangiomas in childhood]. / Pohlad pediatra na liecbu rozsiahlych hemangiómov v detskom veku.

Haemangiomas are the most frequent tumours of child age. They are found in 10-12% of infants. The authors summarize contemporary knowledge of the treatment of haemangiomas as well as their own experience with their treatment. They follow-up 18 children with haemangiomas at different sites, incl. ten with extensive haemangiomas. The latter were treated conservatively with prednisone and interferon alpha.

Metabolic cause of Reye-like syndrome.

The most frequent metabolic cause of Reye-like syndrome is medium chain acyl-CoA dehydrogenase (MCAD) deficiency. The authors describe a gypsy boy who was repeatedly hospitalised due to symptoms of Reye-like syndrome (serious hypoglycemia, loss of consciousness, seizures, increased values of aminotransferases, decreased values of free carnitine). The diagnosis of MCAD deficiency was established by analysis of plasmatic acylcarnitines by use of tandem mass spectrometry. DNA analysis proved the most common K329E (G985) mutation in gene for MCAD deficiency in homozygous state. The authors have emphasised the advantage of tandem mass spectrometry in the diagnosis of disorders of fatty acid beta-oxidation. This highly sophisticated method can detect most of these disorders from dry blood spots disregarding the symptoms and type of mutation.

[Atypical mercury poisoning]. / Atypická intoxikácia kovovou ortutou.

A case report documenting rare intravenous intoxication with metal mercury. Because of early diagnosis and treatment only minimal clinical symptoms were detected in the patient.