[Contribution of indicators of sensitized T lymphocytes in the diagnosis of IgE independent and IgE dependent cow's allergy in children]. / Udzial wskazników uczulenia limfocytów T w diagnostyce alergii IgE niezaleznej i IgE zaleznej na bialka mleka krowiego u dzieci.

BACKGROUND: Food allergy is an abnormal response of the immunological system, especially of mucosal immunological system on antigens supplied per os. There are very complicated and still unexplained immunological mechanisms, which lead to hypersensitivity reaction. Most often food hypersensitivity is identified as the effect of atopy, which is connected with humoral response (specific IgE antibody). On the other hand cell immunological response are less investigated, however they can be very important, especially as a significant factor to initiate pathological allergic processes. AIM: To investigate, the usefulness of flow cytometry for estimation of specific sensitization of subpopulation of lymphocytes on food allergens in the allergy diagnosis. PATIENTS AND METHODS: The investigations were performed on 60 children from 6 months to 5 years old: 20 children with CM A IgE dependent, 20 with CM A IgE independent and 20 healthy children. IgE total, sIgE, IgG, IgA, IgM, basic immunological panel, CD 23, CD25, CD26, CD30, CD69, PCNA were measured. RESULTS: We noticed decrease of expression of CD4+CD30+ between I and II examination (p=0.029), between I and III (p=0.009); decrease of expression of CD8+CD26+ between I and III test (p=0.038); decrease of expression of CD19+CD23+ between I and II examination (p=0.012) in I type of hypersensitivity. We observed a decrease of expression of CD4+CD25+ between I and III examine (p=0.026) and decrease of expression of CD4+ CD26+ between I and III examination (p=0.036) in IV type of hypersensitivity. Expression of CD69 was decreased after diet in IgE dependent allergy. Values of expression of PCNA are similar in I and IV type of hypersensitivity in children with CM A. Decrease of expression of PCNA in II examination was observed in both cases. Reintroduced allergen caused increase of expression of PCNA in both types of allergy (p=0.048 and p=0.041). CONCLUSIONS: Our recent research confirms changes of the expression of T lymphocytes activation markers. It is connected with in vivo stimulation to allergen or with allergen elimination. The study of expression of activation markers using flow cytometry in food allergy in children can be helpful in observation of the dynamic progress process, but it cannot be used as a single diagnosis test.

[Limulus amebocyte lysate test use in clinical diagnostic in children with infectious diseases--preliminary report]. / Ocena przydatnosci testu zelizatu lizatu amebocyta Limulus polyphaemus w diagnostyce klinicznej u zakazonych dzieci--doniesienie wstepne.

OBJECTIVE: The aim of this preliminary study was (1) to evaluate the usefulness of the Limulus amebocyte lysate (LAL) test as a diagnostic tool in pediatric clinic, and (2) to examine the serum ET levels in hospitalized patients. MATERIAL AND METHODS: Bacterial blood endotoxin (ET) was measured in 50 children with infections of different etiology and localization. A Limulus amebocyte lysate (LAL) test was used. CONCLUSIONS: The usefulness of LAL test in routine diagnostic procedures in hospitalized children with infections was not proven so far. However, the LAL test appeared useful in the urinary tract infection (UTI) cases in which significant elevation of serum ET levels were demonstrated. Moreover, it was confirmed that LAL test can be performed as well in serum: the mean values of serum ET levels in our patients were comparable with published ET plasma values in adults.

[Gastroesophagopharyngeal reflux in infants and children with recurrent symptoms of the upper respiratory tract]. / Refluks zoladkowo-przelykowo-gardlowy u niemowlat i dzieci z nawracajacymi objawami z górnych dróg oddechowych.

Gastroesophageal reflux (GER) plays an important role in pathogenesis of recurrent/chronic disorders of the respiratory tract. Atypical symptoms of GER can be suggested to be cause of the otorhinolaryngological problems. For these last manifestations no cause-effect relationship has yet been proven. There are many therapeutic studies, in which treatment of GERD is examined for its impact on coexisting respiratory disorders. The aim of our study was to confirm the presence of acid reflux by using 24-hour intraesophageal pH monitoring. From the group of 29 patients with recurrent episodes of the pharyngitis, laryngitis and tracheitis, we evaluated 18 children aged 3 months to 8 years (mean, 4.23 +/- 2.85) with coexisting reflux symptoms. The protocol included a parenteral interview, physical examination, roentgenograms of the chest and larynx, laryngoscopy, as well as 24-hour simultaneous proximal and distal esophageal pH monitoring. The most significant differences between examined patients and control subjects was noted in terms of the lowest pH value, number of reflux episodes and index reflux while pH dropped below 4. Every significant drop under pH 6 recorded in proximal esophagus was simultaneous with reflux episode in distal esophagus. We found increased both sensitivity and specificity of the simultaneous pH monitoring in the distal and proximal part of the esophagus comparing to monitoring by the single probe. We confirmed the presence of gastroesophagopharyngeal reflux in patients with recurrent disorders of pharynx, larynx and/or trachea.

[Bartter's syndrome]. / Zespól Barttera.

Bartter syndrome is an uncommon tubular disorder inherited as an autosomal recessive entity. It is associated with hypokalemic metabolic alkalosis with high renin and aldosterone plasma concentration with low or normal blood pressure. Recent studies have demonstrated genetic heterogeneity in Bartter syndrome. Mutations of two genes encoding the Na/K/2Cl cotransporter and potassium channel ROMK are responsible for clinical features of neonatal Bartter syndrome. Mutations of gen encoding the chloride channel ClC-Kb is identified as being causative for the classic Bartter syndrome. And dysfunction of Na/Cl cotransporter in the distal convoluted renal tubule is described as Gitelman syndrome.

[Long-term clinical observation of infants with gastroesophageal reflux]. / Dlugotrwala obserwacja kliniczna niemowlat z rozpoznanym refluksem zoladkowo-przelykowym.

The aim of the study was long-term observation of patients with gastroesophageal reflux (GER), diagnosed in their infancy, in aspect of spontaneous resolution of this disorder. 290 symptomatic infants aged 5 weeks to 11 months (mean--5.8 months) underwent 24-hour esophageal pH monitoring. In 243 (83.8%) patients, abnormal reflux score was observed. After one year of conservative therapy, follow-up study by esophageal pH-monitoring has been performed in 136 (46.9%) children and still showed pathological GER in 95 (69.8%) subjects. After 2 years, 45 (15.5%) patients has been investigated--14/45 (31.0%) of them had normal reflux score. At the following five-year clinical observation was available group of 28/290 (9.6%) patients. In the 2-3 year of their life, 13 of them had resolved symptoms and had normal acid reflux parameters, whereas 9 patients still had pathological GER. In the following years, basing of results of 24-hour pH monitoring, pathological GER persisted: in 7 children in age 4, in 5 subjects in age 5 and in 3 children over fifth year of life. Long-term clinical follow-up of these children is necessary because of risk of GER complications.

[Dual simultaneous esophageal pH monitoring in infants with gastroesophageal reflux]. / Podwójne monitorowanie pH przelyku u niemowlat z objawami refluksu zoladkowo-przelykowego.

The aim of the current study was to analyse selected parameters of pH monitoring in the proximal and distal parts of esophagus. One hundred and twelve infants aged 1.25 to 18 months (mean = 5.6) with symptoms and signs suggesting gastroesophageal reflux (GER) were evaluated. The results are presented of the measurement of reflux index (RI), the number of reflux episodes and the duration of the longest reflux episode in patients classified into the following groups: group I--39 children with vomiting/excessive regurgitation, group II--29 infants with persistent distress/inconsolable crying, group III--16 children with Apparent Life Threatening Events (ALTE), group IV--28 infants with chronic/recurrent respiratory system diseases. No statistically significant difference was noted between the groups in pH parameters at the distal esophageal level, whereas at the proximal level the differences included only the number of reflux episodes. However, we found, that by using the ANOVA test, the incidence was higher in group IV than in group II. As determined by applying Mann-Whitney rank sum test, reflux episodes occurred most frequently in group IV, than in other groups of patients (including controls). None of the reflux parameters recorded at the proximal level among children presenting with ALTE was statistically significantly different than in other groups.

[Alkaptonuria: a rare metabolic disorder. A report of two cases in siblings]. / Alkaptonuria--rzadka choroba metaboliczna. Rozpoznanie rodzinne u dwojga dzieci.

Alkaptonuria is a rare metabolic condition caused by congenital homogentisate oxidase deficiency of recessive inheritance. Homogentisate polymers are accumulated and cause urine darkening, brown pigmentation of connective tissue, articular cartilage pathology. The authors present clinical picture, pathogenesis, diagnostic and therapeutic possibilities in patients with alkaptonuria. Two siblings with alkaptonuria are described.

[The evaluation of natural anticoagulants in systemic lupus erythematosus in children]. / Ocena naturalnych inhibitorów ukladu krzepniecia w toczniu rumieniowatym ukladowym u dzieci.

Thromboembolic complications in adults with systemic lupus erythematosus (SLE) are described in literature. We intended to investigate the activity of natural anticoagulants, such as C protein. S protein and antithrombin III (AT III) in children with SLE to obtain data concerning activity of the disease and thrombotic complications. The study population consisted of 36 children with SLE and of 51 healthy children serving as a control group. The results showed a significant decrease of S protein activity, with particularly low levels in the group of patients with the presence of anticardiolipin antibodies (aCL), and decrease of C protein activity in patients with higher activity of the disease. They appear to prove the involvement of these inhibitors in inflammation and, on the other hand, the activation of intravascular coagulation, a risk factor of thrombosis.