Eosinophilic esophagitis in children: frequency, clinical manifestations, endoscopic findings, and seasonal distribution.

PURPOSE: Eosinophilic esophagitis (EoE) is a chronic disease characterized by eosinophilic infiltration of the esophageal mucosa, which is associated with clinical and endoscopic manifestations. The objective of our study was to determine the frequency of EoE and to outline the clinical manifestations of EoE in Polish children. MATERIAL/METHODS: Ten large regional pediatric gastroenterology centers participated in the study. A database of endoscopy reports from January 2004 till December 2009 was reviewed. A total of 35,631 esophagogastroduodenal endoscopy studies in children, aged from 4 months to 18 years, were performed. Data pertaining to the children's age, gender, indications for endoscopy, clinical findings and histopathology diagnosis were made. RESULTS: In 84 children (20 girls and 64 boys), aged between 4 months and 18 years, EoE was diagnosed. This constituted one case per 424 endoscopic studies. In children with changes in the esophageal mucosa the frequency of EoE was higher and reached one case per 73 children. The most frequent symptoms of EoE differed between the younger (1-6 years old) and older children (aged 13-18 years old). Feeding aversion, vomiting and/or regurgitation were most frequently observed in the younger children, while in older children: abdominal pain, dysphagia and chest pain. Granular mucosa, longitudinal furrows, and mucosal rings belong to the findings most often observed in endoscopic studies. EoE was more frequently diagnosed in the spring (45.2%) and summer (28.5%). CONCLUSIONS: EoE was diagnosed in every age, with frequency of 1/424 gastrointestinal endoscopies, more frequently in boys than in girls.

The frequency of occurrence and clinical picture of celiac disease in the parents of children with the disease.

BACKGROUND: In view of the considerable changes that have taken place in the last 20 years in the clinical picture of celiac disease, epidemiological research is now underway to search for atypical forms, which are appearing with growing frequency; if not treated, they cause a deterioration in the quality of life of these patients. The goal of our research was to identify the frequency of occurrence of celiac disease among the parents of children with the disease and to analyze the clinical picture in these cases. MATERIAL AND METHODS: The research involved 254 persons (127 women, 127 men) ranging in age from 25 to 58 years. The subjects were pairs of parents of randomly selected children with celiac disease diagnosed in accordance with the ESPGHAN criteria in force at the time of diagnosis. The level of total IgA and antiendomysial antibodies in class IgA or IgG were measured in all subjects using the indirect immunofluorescence method. In all those patients with a positive test for the presence of IgAEmA who expressed their consent, a biopsy of the small intenstine was performed, with a histopathological evaluation of the bioptate according to the Shmerling Scale. RESULTS: The IgA level was normal in all subjects. The presence of IgAEmA was indicated in the serum of 5 subjects (2%): 3 men aged 39, 40 and 43, 2 women aged 41 and 43. The level of IgAEmA varied within the limits of +20 to +640 IF. In 4 of these subjects an endoscopic biopsy of the small intestine was performed, providing a basis for the diagnosis of level III/IV or level IV atrophy of the intestinal villi. The clinical symptoms found in the subjects prior to diagnosis were diverse: periodic loose stools (2 persons), short stature (3 men), abdominal pains (3 persons with concomitant inflammatory lesions in the stomach membrane or duodenum), sudden loss of body mass (1 case), hyperexcitability (1 case). One female subject did not report any significant complaints. CONCLUSIONS: Screening tests should be performed In the families of patients with celiac disease in the direction of enteropathy, even in a case when clinical symptoms are absent, weak, or atypical.

Incidence of vesicoureteral reflux in siblings of children with reflux--our own observations.

BACKGROUND: The aim of the study was to evaluate the incidence of primary vesicoureteral reflux in siblings of children with reflux. MATERIAL AND METHODS: Ninety-four subjects aged 2-6, the siblings of children with reflux were examined. Our methods included: urinalysis, urine cultures, ultrasound examination of abdominal cavity in all the examined subjects. Voiding cystography was conducted in selected cases. RESULTS: Primary vesicoureteral reflux was found in the total of 10% of the siblings of children with reflux. The incidence of reflux was the highest in the youngest age group. CONCLUSIONS: The incidence of primary vesicoureteral reflux in the siblings of affected children being at least ten times higher than population risk supports the necessity of screening in this group.

[The outline of diagnostic procedures in the cases of focal lesions in liver]. / Schemat postepowania diagnostycznego w przypadkach zmian ogniskowych w watrobie.

The majority of focal lesions in liver is typified by none or scant clinical symptoms and the first diagnosis is usually made during the ultrasonographic examination (USG). The first examinations usually performed in these cases are: the assignment of neoplastic markers in the serum (alpha-fetoprotein--AFP, carcinoembryonal antigen--CEA), imaging methods (USG, USG using Doppler effect, computer tomography--CT) and isotopic methods. The goal of the study is to present the proposal of outline of diagnostic procedures in the cases of focal lesions in liver based on the data from references. As the first step of diagnostic procedures non-invasive screening examinations are recommended (AFP, CEA, USG, USG using Doppler effect, CT of the abdominal cavity). The increase of the concentration of CEA in serum can suggest the metastatic tumour from the large bowel. The increase of the concentration of AFP makes possible to distinguish hepatocellular carcinoma from other malignant lesions. USG is useful to detect focal lesions which diameter is over 1.5 cm. USG has limited value to qualify the nature of the tumour. On the base of echogenicity of examined lesion we are able to make an initial selection to distinguish single from multiple and cystiform from solid lesions. USG using Doppler effect to detect vessel-signal helps to distinguish sound parenchyma from pathologically changed tissues. CT qualifies focus or dissemination of the disease. After screening examinations we use specialistic or invasive methods which are usually performed in the clinical circumstances. CT connected with angiography has a high sensitivity in detecting hepatocellular carcinoma. Isotopic methods help to confirm the depletion of sound parenchyma of the liver (colloidal scintigraphy) as well as sensitive and specific diagnostics of some types of neoplasms (scintigraphy using labelled erythrocytes to detect angioma). Guided fine-needle biopsy under the USG control makes possible to evaluate the nature of the tumour by means of cytological examination. Diagnosis made by means of sonolaparoscopy and nuclear magnetic resonance (NMR) is described in references, but these examinations have not been used in Poland by this time. Methods which were presented make possible to assign the outline of diagnostic procedures. The outline will help to differentiate precisely and quickly the nature and size of focal lesions in liver.

Enzymatic efficiency of erythrocyte antioxidant barrier and lipid peroxidation in children from families with high risk of early atherosclerosis.

The most important risk factors contributing to the development of atherosclerosis include lipid disorders and the predisposition to early ischaemic heart disease in the family. Atherosclerotic process proceeds with age and it develops as a result of oxide LDL modification at the level of vascular wall. Oxygen-free radicals take part in this process, which may probably be opposed by the antioxidant system of the body. The aim of this study was to compare the intensity of lipid peroxidation and the activity of antioxidant enzymes in children from the families with the risk of early atherosclerosis and in children without such predisposition. The activity of katalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) were determined and the concentration of malonic dialdehyde--a lipid peroxidation marker was established. The study was conducted on 76 children aged 4-17 years, mean age 12 +/- 0.6 years. The risk group consisted of 56 patients with the history of hypercholesterolaemia and early atherosclerosis in the members of their families up to 45 years of age. Control group was formed of 20 subjects without such history. MDA concentration as well as the activity of antioxidant enzymes were determined with the use of adequate methods of spectrophotometry. The results obtained were subject to statistical analysis. The activity of antioxidant enzymes displayed considerable fluctuations in both groups of children, but these differences remained statistically insignificant in all the cases. Higher MDA concentrations in serum and in erythrocytes were observed in the risk group. These differences proved statistically significant (alpha < 0.05). On the basis of the present study and the analysis performed, it was found that the activity of antioxidant enzymes (CAT, SOD, GSH-Px) cannot serve as a parameter differentiating between children from the families with the risk of early atherosclerosis and children without such predisposition. Children with positive family history of hypercholesterolaemia and early atherosclerosis may demonstrate intensive lipid peroxidation, but this hypothesis requires further investigations.

Hepatitis C virus infection in hospitalized children.

AIM: The aim of the study was the estimation of the incidence of HCV infection and the analysis of risk factors for the infection in hospitalized children. MATERIAL AND METHODS: Retrospective analysis of the data of 1263 patients treated in hospital wards of Chair and Department of Gastroenterology and Paediatric Diseases from July 1995 to March 1998; all the patients had hepatitis C virus antibodies determined. Hepatitis C virus antibodies were assessed with the use of enzyme immunoassay. All the positive results were confirmed by means of Lia Tek HCV or PCR HCV RNA method. History data regarding frequency of previous hospitalizations, operations, blood transfusions and invasive diagnostic procedures patients had undergone were included in analysis. RESULTS: HCV infection was diagnosed in 47 children which accounted for 3.7% of the group enrolled in the study. The majority, that is 96.2% of seropositive children had the history of hospitalization, while 73.2% of them underwent intervention procedures disrupting tissue continuity during previous hospitalizations. Physical examination analysis indicates that all the patients with antibodies against HCV could have acquired the infection through parenteral transmission. The data indicating another route of transmission were not obtained (e.g. familial transmission). CONCLUSIONS: 1. Serological tests for HCV infection should be performed on routine basis in frequently hospitalized children. 2. HCV infection resulting from iatrogenic transmission can be suspected in the majority of seropositive children.

Outcomes of conservative treatment of primary vesicoureteral reflux in children.

INTRODUCTION: The purpose of the study was to evaluate the efficacy of conservative treatment of primary vesicoureteral reflux. MATERIAL AND METHODS: Material included 179 children aged 1-15. Methods included voiding cystography in all the patients. Normal result of the examination was assumed as the regression of reflux. RESULTS: Conservative treatment resulted in the regression of 58% of I degree-IV degree refluxes. CONCLUSIONS: The most significant factors determining the efficacy of conservative treatment of primary vesicoureteral reflux are: reflux grade and child's age at diagnosis.

Studies of the effectiveness of interferon alpha treatment for chronic hepatitis C in children.

INTRODUCTION: The significance of hepatitis C infection in Poland, particularly in a pathology of the developmental age still increased. The aim of the study was the analysis of interferon alpha therapy efficacy in children with chronic C hepatitis. MATERIAL AND METHODS: 30 children (aged from 3 years to 15 years, 16 females, 14 males) were included in the study. In each patient HCV infection was confirmed by the serological, molecular (with identification of HCV genotype) and histopathological methods. The duration of observation of HCV-infected children after the diagnosis was made followed for at least 6 months. Transaminase level in each case was 50% higher than normal. The schema of interferon alpha treatment was: 3 MU 3 times a week subcutaneously for 25 weeks. Time of observation started at the beginning of the therapy and finished 1 year after the end of the treatment. RESULTS: The analysis of the HCV genotypes showed the predominance of the genotype 1 (66.7%): subtype 1a was found in 20% patients, subtype 1b--in 43.5% children. Genotype 4 (subtype 4c4d or 4b) was confirmed in 30% patients, genotype 3 (subtype 3a) in 3.3% patients. In the histopathological picture of the liver predominated minimal or moderate inflammation activity (grading: 1--in 50%, 2--in 46.6%, 3--in 3.4%) and little fibrosis (staging: 0--in 80%, 1--in 13.3%, 2--in 6.7%). In many children mild side effects of interferon alpha therapy were observed: pseudoinfluenzal symptoms (in 46.7%), lack of appetite (in 16.7%), abdominal pain (in 10%), thrombocytopenia (in 6.7%), granulocytopenia, hair loss, irritability, itching of the skin (in 3.4%). At the end of therapy in 36.7% patients serum HCV-RNA was undetectable. The percentage of children without serum HCV-RNA decreased 6 months after the end of therapy to 20% patients and a year after the end of therapy to only 13.6% children. In children with HCV-RNA elimination was observed early reduction of ALT level. For the definition of the predictive factors of good prognosis patients were divided into 2 groups: group I (without HCV-RNA elimination at the end of the treatment) and group II (patients HCV-RNA negative a year after the end of therapy). Both group of children were similar in respect of age, disease duration and interferon alpha dosis/m2. At the beginning of the treatment mean ALT level was statistically higher in group II than in group I. IL-2 level was significant higher in group II than at the beginning, after 2 and 4 months of the therapy. There were no significant differences in IL-1 beta, IL-4 and IL-6 level between patients in group I and II. The differences in ALT activity during IFN-therapy between 2 groups of patients were statistically significant; since second month of therapy higher ALT level was observed in a group of patients without HCV-RNA elimination. In the histopathological picture of the liver a year of the end of therapy in 20% children reduction of inflammatory activity and progression of fibrosis in both group of patients was observed. CONCLUSIONS: Because of a little efficacy, high costs, psychological load of young patients and possible following consequences of the interferon alpha therapy it is necessary to manage the further researches to find a new method of treatment of chronic C hepatitis. High ALT activity and elevated IL-2 level before treatment seems to be predictive factors of the good response to interferon alpha therapy.

[Clinical and morphological picture of hepatitis C in children with genotype 4c4d]. / Obraz kliniczno-morfologiczny wirusowego zapalenia watroby typu C u dzieci z genotypem 4c4d.

Actually, HCV genotype 4 is frequent in central Africa and in the Middle East. In contrast, in Europe genotype 4 is uncommon (1-4%). In this study we present 12 children with HCV genotype 4c4d. Clinical picture in this group was asymptomatic, morphological was moderate.

[Own experience in the application of midazolam (Dormicum) before the diagnostic examinations an short surgical procedures in children]. / Doswiadczenia wlasne w zastosowaniu midazolamu (Dormicum) przed badaniami diagnostycznymi i krótkimi zabiegami chirurgicznymi u dzieci.

In this paper the evaluation of midazolam (Dormicum) efficiency in obtaining basic sedative effect in 36 children during diagnostic examinations and short surgical operations was done. In 26 patients good sedative effect was obtained. Forgetfulness was present in 17 from 25 patients above 2 years of life, and partial in the rest 8 patients. Fear reactions were observed in 10 children with lower doses of this medicine. Side effects were observed in 8 patients, and had a transient character and were not dangerous for the patients' life.

[Allergy to cow's milk]. / Alergia na bialko mleka krowiego.

Food allergy is presented with special focus on cow's milk induced reactions. Actual clinical diagnostic and therapeutical problems are discussed.

Selenium supply and glutathione peroxidase activity in breastfed Polish infants.

Selenium (Se) concentration in human milk in Poland is below 10 ng ml-1 and the Se intake by breastfed infants is about 6 micrograms day-1. Supplementation of lactating mothers with selenium-enriched yeast increases rapidly and significantly the Se concentration and glutathione peroxidase activity in maternal blood components. Se concentration in milk is also significantly elevated. After 1 month the mean Se intakes by breastfed infants were greater than the recommended dietary allowance of 10 micrograms day-1 for infants from birth to 6 months of age.

[Evaluation of the effectiveness of Uro-Vaxom in recurrent urinary tract infections in children]. / Ocena skutecznosci Uro-Vaxomu w nawracajacych zakazeniach ukladu moczowego u dzieci.

The aim of the study was to determine the effectiveness of Uro-Vaxom in the treatment in children with recurrent urinary tract infections induced by E. coli. Our investigations confirmed that in the group of children receiving pharmacotherapy and Uro-Vaxom, a significant increase of sIgA in the urine was found, lasting for at least 3 months. During this period no infection appeared in 92% of the examined children. The authors recommend including Uro-Vaxom in the therapy of children, because it is effective and well-tolerated by children.

[Evaluation of the effectiveness of ceftazidime in treatment of nosocomial infections in children]. / Ocena skutecznosci ceftazydymu w leczeniu zakazen szpitalnych u dzieci.

UNLABELLED: Nosocomial infections are a serious problem in treatment because they are caused by bacteria that have developed increased antibiotic resistance. DESIGN: to estimate the efficiency of ceftazidime in nosocomial treatment among children. PATIENTS AND METHODS: We treated 20 children aged 1-20 months, mainly in their first three months of life. They were hospitalized because of some other illness or diagnosis. During hospitalization they contracted a nosocomial infection: 16 urinary tract infections (mainly E. coli), 4 others pneumonia. Ceftazidime was the choice for empirical antibiotic therapy, before we obtained the patients' microbiological results. RESULT: We did not observe progress of pathologies which had been present when the nosocomial infection had begun, either during or after therapy. CONCLUSION: Ceftazidime is an efficient and safe antibiotic in treatment of nosocomial infection in young children.

[Arrhythmias in children with mitral valve prolapse syndrome]. / Zaburzenia rytmu serca u dzieci z zespolem wypadania platka zastawki dwudzielnej.

The aim of the study is analysis of arrhythmia in children with mitral valve prolapse syndrome. The study includes 45 children with MVP, 16 boys and 29 girls from the district of Bydgoszcz. Their age ranged from 9 to 16 with an average of 12.4. The diagnosis was based on clinical examination, and results of noninvasive examinations of the cardiovascular system with decisive, echocardiographic imaging of the heart. Arrhythmia was analyzed with Holter monitoring using Hewlett-Packard equipment and the New Wave Holter program. The record was made over a 24-hour period. The control group was chosen from children with negative symptoms relating to cardiologic disease, in good general health, and normal ECG readings. During ECG monitoring in both groups, no complex arrhythmia forms were discovered (according to the Lown scale, above class 3). Individual signs of premature heart chamber stimulation were diagnosed in about (40% of both groups. Additional heart chamber stimulations (VEB) were registered in children with MVP (approximately 62%). Moreover, the children with MVP showed higher maximum heart activity.

[Acute gastrointestinal hemorrhage in a 12-month-old child following treatment with panadol]. / Ostre krwawienie z przewodu pokarmowego u 12-miesiecznego dziecka spowodowane stosowaniem Panadolu.

After the treatment of a twelve-month-old child with a small dose of Panadol, we observed an acute gastro-intestinal hemorrhage which required aggressive and ongoing medical intervention. This event should be taken into consideration when antipyretic agents are given to infants and small children.

Influence of Uro-Vaxom on sIgA level in urine in children with recurrent urinary tract infections.

We have examined the influence of Uro-Vaxom on secretory IgA (sIgA) level in urine of children with recurrent urinary tract infections. In the group of children treated with antibiotics and Uro-Vaxom, a significant increase of sIgA in the urine was found which persisted for at least 3 months. During this period no infection appeared in 92% examined children.