[Hypothyroidism as the cause of lowered blood pressure during hemodialysis]. / Niedoczynnosc tarczycy przyczyna znacznych obnizen cisnienia tetniczego podczas hemodializy.

We present a case of a 19.5 years old, hemodialyzed, girl with frequent and dramatic episodes of hypotension. She presented slightly expressed symptoms of hypothyroidism, while the serum levels of hTSH, T3, T4 and fT4 were close to the bottom border of norm. The therapy with L-thyroxin (1.75 mg/kg b. w./24h) normalized the arterial blood-pressure and led to subside coexisting symptoms of hypothyroidism.

[Osteopenia and renal calcification in a 4.5 year old child with primary distal renal tubular acidosis treated for idiopathic renal hypercalciuria]. / Osteopenia i wapnienie piramid nerkowych u 4,5-letniego dziecka z pierwotna kwasica cewkowa dystalna leczona jako idiopatyczna hiperkalciuria nerkowa.

We present a case of a 4.5 years old boy suffering from hypercalciuria caused by a not diagnosed distal renal tubular acidosis. In the age of 2.5 years, after a banal infection the routine analysis showed a presence of numerous calcium phosphates in urine. Other diagnostic procedures showed: hypercalciuria, hyperphosphaturia, rather high calcemia and high values of UCa/cr and UPO4/cr ratios. HCO3 in serum 21.2 mmol/l, pH of urine 7.0. Kidneys and urinary tract-usg normal. These results induced the family doctor to make the diagnosis: idiopathic renal hypercalciuria. He advised the therapy with hydrochlorothiazide and limitations of calcium and vitamins D3 oral supply. This decision caused an illusory positive effect: decreased the UCa/cr ratio (to 0.96 mmol/mmol) without any reduction of calcemia. After a period of 12 months the UCa/cr ratio increased up to 1.31 and calcification of renal pyramids appeared. We diagnosed the distal renal tubular acidosis (some medical informations suggested the essential distal renal tubular acidosis) and osteopenia (DXA BMD L1-L4 below -1 s.d.). The therapy with NaHCO3 (about 2.6 mmol/kg) normalized the levels of HCO3a and calcium in serum, decreased the UCa/cr ratio to values 0.09-0.16 mmol/mmol.

[Hypophosphatemic rickets]. / Krzywica hipofosfatemiczna.

Familiar hypophosphatemic rickets (X-linked hypophosphataemia) occurs very rarely, nevertheless it makes a significant medical problem because of the fact that misdiagnosed or late diagnosed leads to physical development retardation and to severe deformities of extremities. In the case of severe deformities the surgical treatment is needed. We present the case of the 5 year old girl with X-linked hypophosphataemia, who was late diagnosed, in spite of appearance of typical clinical symptoms (short stature and deformities of extremities) and typical laboratory findings (severe hypophosphataemia, serum calcium levels at the lower normal range). This girl had been "observed" (by a family doctor) for 3 years because of "varus deformity of legs". Despite considerably abnormal developmental parameters: height and weight << 3rd percentile (height >-3 s.d. for age), length of lower limbs >-3 s.d. for age and abnormalities in X-ray images of lower limbs (at the age of 3 5/12 presence of diaphysial deformations and abnormal metaphyses with zones of inadequate mineralization) the girl had not been diagnosed. After the admission to The Department of Pediatrics, Endocrinology and Disease of Adolescents: TRP 69.1%, PO4- 0.7-0.78 mmol/l, Ca 2.24-2.25 mmol/l, Mg 0.78 mmol/l, normal serum level of 25(OH)D (15.4 ng/ml [n. 11-54]), reduced serum level of 1 alpha 25(OH)2D (5.2 pg/ml [n. 15-70]), PTH 56 pg/ml [n. 10-70], ALP 401 U/l, ACP 9.5 U/l. 24-hour urine: PO4- 0.36-0.60 mmol/kg b.w., Ca 0.021 mmol/kg b.w. Probably, the girl will need surgical treatment because of severe bone deformities.

[Multifocal osteolysis as a result of delayed diagnosis for primary hyperparathyroidism]. / Wieloogniskowa osteoliza, jako wynik pózno rozpoznanej nadczynnosci przytarczyc.

Primary hyperparathyroidism caused by solitary adenomas occurs rarely (especially in children and adolescents). The clinical manifestations are usually subtle and that is why the mentioned disorder is usually late diagnosed and as an effect--late treated. We present the case of a 17 year old girl, an ambulatory patient who had been "observed" for over 12 months because of persistent ostealgia. She had not been properly diagnosed. The first diagnostic investigation of calcium and phosphate balance was provided only when multifocal osteolysis of tibias, hip and metacarpal bones was detected and biopsy of the mentioned osteolytic lesions was done. After the admission to The Department of Pediatrics, Endocrinology and Disease of Adolescents: Ca 3.02-3.06 mmol/l, PO4- 0.32-0.62 mmol/l, ACP 19.4 U/l, ALP 864 U/l, PTH 770 pg/ml [normal values: 10-70]. Densitometry findings: BMD (Neck[L]) 0.636 g/cm2, BMD (Neck[R]) 0.722 g/cm2. The parathyroid adenoma was removed after the exploration and localization with MIBI99mTc (scintigraphy). Clinical diagnosis was verified by histologic findings. 5 months after: BMD (Neck[L]) 0.850 g/cm2, BMD (Neck[R]) 0.741 g/cm2, calcemia 2.38 mmol/l, phosphatemia 1.14 mmol/l, ACP 6.2 U/l, ALP 159 U/l. Radiograms show evident improvement of bone tissue structure.

[Effect of treatment with HDM vaccine on selected immune parameters in children with bronchial asthma]. / Wplyw leczenia szczepionka HDM na wybrane parametry odpornosci u dzieci z astma oskrzelowa.

The purpose of the study was to trace the changes of certain parameters of humoral and cell-mediated immunity in children with asthma who received the HDM Bencard vaccine as specific immunotherapy. Among the immune parameters the levels of IgG, IgA and IgM and the phagocytosis index were determined, the E-rosette test and the HBT reduction test were done before the beginning of the treatment, after 3 months, 9 months and 3 years of desensitization. The results were subjected to statistical analysis, presented in tables and in diagrams. Of the three determined immunoglobulins only the IgG increased significantly, while the titres of IgA and IgM remained unchanged. Before desensitization the values of the per cent of T-cells in the E-rosette test were below the accepted normal level. During HDM desensitization the per cent of T-cells rose. The phagocytosis index and the NBT reduction test were lower in the asthmatic children than in healthy ones but during the treatment with HDM they reached significantly high values. These results confirmed that mechanism of the action of this immunotherapy is a complex one and influences several structures of the immune system. Raised values of the studied parameters during desensitization correlated with an evident improvement of the clinical status and marked reduction of the frequency of asthma attacks. During the treatment with the HFM vaccine no side effects of this therapy were noted.