Successful pregnancy in a patient with medullary cystic disease and severe renal impairment.

We present a successful pregnancy in a 37-year-old women with severe renal impairment due to medullary cystic disease. She presented five years earlier with hypertension and chronic renal failure with creatinine was 2.1 mg/dl (Ccr 35 ml/min). She had had two successful pregnancies in the past, nine and seven years earlier. Diagnosis of medullary cystic disease (MCD) was made based on typical ultrasound appearance, sodium wasting and acidosis out of the proportion to the degree of renal failure. Over the next 5 years, a slow progression of chronic renal failure was observed with creatinine reaching 5.1 mg/dl (Ccr 15,4 ml/min), shortly before she became pregnant in December 2001. Her hypertension remained well-controlled and serum creatinine decreased at the beginning of the second trimester to 3.7 mg/dl with subsequent increase toward the end of the pregnancy. She required increasing doses of erythropoietin and intravenous iron supplementation to maintain hemoglobin levels. The polyhydramnios developed necessitating five procedures of amnio reduction. She was not treated by dialysis. A boy weighing 1,600 g was delivered by cesarean section in the 35th week of gestation. The mother's creatinine rose to 5.2 mg/dl (Ccr 15 ml/min) post partum and her renal function declined only slightly over the next 20 months. Our report illustrates that successful fetal and maternal outcome can be achieved even in cases of advanced renal failure preceding gestation. It appears that the type of renal disease influences the pregnancy course and outcome and thus should be considered in patient counseling and therapeutic decisions.

Tolerance of interferon-alpha therapy in children with chronic hepatitis B.

OBJECTIVE: To assess the side-effects of interferon-alpha (IFN-alpha) therapy in children with chronic hepatitis B. METHODS: This prospective study was performed on one hundred children by interviewing the patients and their parents; clinical examinations and laboratory investigations were performed during and after therapy. RESULTS: The most frequent side-effects of IFN-alpha therapy were fever, flu-like symptoms, and headaches. Lowering of the mean haemoglobin level, leukocyte and platelet count was significant, but transient during INF-alpha treatment. No increase in autoantibody titres or significant alterations in thyroid function was observed. Twelve months after treatment, hepatitis Be antigen (HBeAg) elimination and alanine aminotransferase (ALT) normalization was achieved in 46% of the children; HBeAg and hepatatis B surface antigen (HBsAg) elimination, together with ALT normalization, was achieved in 14% of the cases. CONCLUSION: The side-effects of the IFN-alpha therapy in children such as fever, flu-like symptoms and bone marrow suppression are common, but transient and mild.

Prognostic factors in the treatment of chronic hepatitis B with interferon alpha in children.

One hundred children with chronic hepatitis B, aged 1-17.3 years participated in the study. The results of treatment with interferon alpha (IFN-alpha) were evaluated. An attempt was made to define the factors predicting positive response to treatment. Three million units of IFN-alpha 2a or 2b were given by subcutaneous injections to analysed patients 3 times a week for 20 weeks. Positive treatment outcome reflected in HbeAg elimination was observed in 46% of children. High AlAT activity preceding therapy had a statistically significant effect on positive treatment outcome. The inhibition of HBV replication caused by the treatment was permanent and it coexisted with the normalisation of AlAT activity in blood serum. Full response to therapy with IFN-alpha measured with the elimination of HbeAg and HbsAg was observed in 14% of children. It was favoured by high AlAT activity before treatment and short HBV duration.

Various types of cholestatic jaundice in infants--causes and diagnostic problems.

The purpose of this review was to evaluate possible differentiation between various causes of different types of cholestatic jaundice in children. Analyses were performed in 33 infants from 3 weeks to 3.5 years old with symptoms of cholestatic jaundice. The most frequent causes of cholestasis were congenital atresia of extrahepatic bile ducts (30%) and the CMV infection (20%). On the basis of the performed examinations it should be concluded that in order to differentiate between the causes of cholestatic jaundice it is necessary to do a series of tests as there is no specific diagnostic method which would be effective.

Subdural empyemas--a rare complication of meningococcal cerebrospinal meningitis in children.

Subdural empyemas are a rare, life-threatening complication of cerebrospinal meningitis. Two cases of subdural empyemas which occurred as early complications after cerebrospinal meningitis in infants are presented. Utilization of modern diagnostic methods, such as US and CT allowed to establish an early diagnosis, which made it possible to institute appropriate treatment, involving evacuation of the purulent content with local application of antibiotics followed by intravenous antibiotics well penetrating the fluid-filled compartments of the CNS. Early institution of treatment gave a chance of complete recovery in both presented cases.

Estimation of some agents of humoral and cell-mediated immunological response in the families of children with food allergy.

The humoral and cellular agents involved in allergic reactions were examined in 85 persons from 25 families of children with food allergy. The raised level of immunoglobulin M, the lowered levels of C3 and C4 fractions of complement and the increase in the contents of immunological complexes were the abnormalities most frequently met both in food allergic children and their parents. The incidence of the lowered level of IgA in serum was also significant. However, the abnormal results of cellular tests were more often found in the children with food allergy than in their parents. Especially the normal Helper/Suppressor ratio prevailed in the parents (81.6%) as compared to their children (47.6%).

[Effects of drugs used in high-risk pregnancy on child development]. / Wplyw leków stosowanych u kobiet w ciazy ryzyka na dalszy rozwój dzieci.

The study involved 60 children delivered by the mothers of risk group who were given gestagens and beta-adrenomimetics during pregnancy. Physical, motoric development and morbidity in this group of children with particular relation to respiratory diseases were subject to our study. Thirty eight children delivered by healthy mothers were used as a control group. It was found that there was no developmental abnormalities in children from pregnancies maintained with gestagens and beta-adrenomimetics. Morbidity rate was the same in the tested and control groups.