[Acute renal failure after cardiopulmonary bypass surgery in children with congenital heart disease].

The article presents the research based on data of 30 children with congenital heart disease. The mean age of the patients was 7 months. It was shown that open cardiac surgery caused an expressed but transitory expression of renal biomarkers, creatinine clearance and serum creatinine level. The frequency of occurrences of acute renal failure was 46.6%. Both biomarkers returned to normal values before discharge from the hospital.

Postsplenectomy sepsis in splenectomized, partially splenectomized and non-splenectomized rats after Streptococcus pneumoniae challenge.

INTRODUCTION: Purpose of the study was the evaluation of the role of 1/3 of the spleen in host defense after a challenge with Streptococcus pneumoniae. MATERIALS AND METHODS: Forty Wistar rats divided into four groups underwent splenectomy (SPR), partial splenectomy (PSR) or sham operation (SOR). Healthy rats were used as controls (CGR). Operations were performed under general anesthesia. Ten weeks after operation the rats were challenged with 6 × 107 cfu/ml Streptococcus pneumoniae administered intravenously. All surviving animals were sacrificed 12 days after intravenous injection Interleukin-10, tumor necrosis factor-α and human ß-defensin-2 containing cells were detected in the parenchymatous organs (spleen, lungs, liver and kidneys) of all groups. Kaplan-Meier and Mann-Whitney tests were used for statistical analysis. RESULTS: Survival after Streptococcus pneumoniae challenge was longer in animals with a greater amount of splenic tissue, with mortality increased proportionately to the reduction in splenic tissue. In the SOR group survival was 11.6 ± 1.3 days (10% mortality). In the PSR group survival was 6.0 ± 2.5 days (90% mortality). In the SPR group survival was 1.6 ± 0.8 days (100% mortality). In splenic tissue the levels of HßD-2, IL-10 and TNF-α-containing cells did not differ statistically (z=5.021; p<0.01) and were higher than in other parenchymatous organs (PSR, SOR, CGR). Levels of IL-10-containing cells were higher in parenchymatous organs of the SPR group (z=7.919; p<0.001), similar in the PSR and SOR groups (z=1.020; p=0.308) and lower in the CGR group (z=4.366; p<0.01). There were no statistically significant differences in the levels of IL-10 containing cells in the lungs of all group rats with spleen (z=4.266; p<0.01). Levels of TNF-α-containing cells were similar in PSR and SOR groups (z=1.004; p=0.315). Relative levels of HßD-2 in kidney differed between all groups (z=2.916; p=0.004). CONCLUSIONS: All of the splenectomized animals (100%) and 90% of the partially splenectomized animals died. Partial splenectomy (with 1/3 of splenic tissues remaining) does not offer full protection against Streptococcus pneumoniae sepsis. In all groups, the amounts of HßD-2, IL-10 and TNF-α-containing cells in the spleen were higher than in other parenchymatous organs (lungs, liver and kidneys).

European biliary atresia registries: summary of a symposium.

Biliary atresia (BA) is a rare but potentially devastating disease. The European Biliary Atresia Registry (EBAR) was set up to improve data collection and to develop a pan-national and interdisciplinary strategy to improve clinical outcomes. From 2001 to 2005, 100 centers from 22 countries registered with EBAR via its website (www.biliary-atresia.com). In June 2006, the first meeting was held to evaluate results and launch further initiatives. During a 5-year period, 60 centers from 19 European countries and Israel sent completed registration forms for a total of 514 BA patients. Assuming the estimated incidence of BA in Europe is 1:18,000 live births, 35% of the expected 1488 patients from all EBAR participating countries were captured, suggesting that reporting arrangements need improvement. At the meeting, the cumulative evaluation of 928 BA patients including patients from other registries with variable follow-up revealed an overall survival of 78% (range from 41% to 92%), of whom 342 patients (37%) have had liver transplants. Survival with native liver ranged from 14% to 75%. There was a marked variance in reported management and outcome by country (e.g., referral patterns, timing of surgery, centralization of surgery). In conclusion, EBAR represents the first attempt at an overall evaluation of the outcome of BA from a pan-European perspective. The natural history and outcome of biliary atresia is of considerable relevance to a European population. It is essential that there is further support for a pan-European registry with coordination of clinical standards, further participation of parent support groups, and implementation of online data entry and multidisciplinary clinical and basic research projects.

Nonparasitic splenic cysts in children: a multicentric study.

PURPOSE: Nonparasitic splenic cysts (NPSCs) are uncommon in children. The aim of this multinational and multicentric study was to present the authors' experience as well as the changing trends in the management of NPSCs over the last 25 years. MATERIAL AND METHODS: From 1981 to 2005, 50 children or adolescents were surgically treated for NPSCs in 6 paediatric surgical centres in four European countries. The medical records of these 50 patients with NPSCs were reviewed retrospectively. RESULTS: Twenty-six male and 24 female patients were operated on. Age at surgery ranged from 1 to 17 years (mean 11.9). Seventeen patients were symptomatic. Six total (4 open and 2 laparoscopic) and 26 partial (22 open and 4 laparoscopic) splenectomies were performed. Laparoscopic fenestration or deroofing and open cystectomy was carried out in 9 patients, respectively. Histological findings revealed the lesion to be an epidermoid cyst (n = 28), a pseudocyst (n = 15) or a mesothelial cyst (n = 2). In 5 patients haemangioma or lymphangioma was the pathological diagnosis. At a mean follow-up of 2.9 years, residual cysts were found in 8 laparoscopically treated patients, 4 of whom required re-do laparoscopy or open surgery. CONCLUSIONS: Over the last two decades, the surgical treatment of NPSCs has changed from a formerly customary total splenectomy to spleen-conserving procedures, such as total cystectomy with or without partial splenectomy or partial cystectomy. These therapeutic modalities can be performed laparoscopically, if technically possible. Fenestration or deroofing of the cyst resulted in a high recurrence rate (7/9).

Neonatal intrathoracic stomach in Marfan's syndrome: report of two cases.

The authors report experience with 2 neonates with the unusual combination of intrathoracic stomach and Marfan's syndrome.

The first experience with non-operative treatment of hypersplenism in children with portal hypertension.

The register of Latvian children with portal hypertension (PH) includes 34 patients from 2 to 16 years old. In 26 children the PH is caused by a prehepatic obstruction. The most widespread symptoms of PH are variceal bleeding and hypersplenism. The traditional management of hypersplenism has been splenectomy. We have used partial splenic embolization (PSE) as an alternative to splenectomy. From 1998 to 2000 we carried out PSE in 8 patients with PH. A percutaneous femoral artery approach to the splenic artery was used to deliver microspheres with a diameter of 0.3 mm into the spleen, minimizing blood circulation to the organ by 60 - 70 %. In 7 patients symptoms of hypersplenism disappeared and blood tests returned to normal status. In one patient we carried out PSE twice. In one case PSE was not successful and the patient underwent partial resection. Abdominal pain and subfebrility were observed on average 2 weeks after PSE. In 7 patients the 4 - 20 months follow-up period demonstrated the efficiency of the non-operative hypersplenism management method. We conclude that PSE is the method of choice to treat hypersplenism.

The entry of T and B lymphocytes into rat popliteal lymph nodes undergoing a graft-versus-host reaction.

The entry of radiolabeled blood-borne T and B lymphocytes into resting popliteal lymph nodes and popliteal lymph nodes stimulated with semiallogeneic lymphocytes was investigated in rats. Thoracic duct lymphocytes separated into T- and B-lymphocyte populations on nylon-wool columns were radiolabeled with 51chromium and equal numbers of T or B lymphocytes were injected intravenously. While the ratio of T and B lymphocytes in the blood is approximately 3:1 it was found that the ratio of T to B lymphocytes migrating into lymph nodes was approximately 9 T to 1 B lymphocyte in both resting and antigenically stimulated lymph nodes. Since the ratio of T to B lymphocytes in thoracic duct lymph is similar to that of blood, there is a disparity between the number of T cells entering and leaving lymph nodes. These results suggest that some T lymphocytes may return to the blood directly and/or there is increased T lymphocyte death in lymph nodes.