Klinika Pediatrii

Warsaw, Poland

Klinika Pediatrii

Warsaw, Poland
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The aim of this paper was to provide information on the first observations of maternal phenylketonuria syndrome. 60 years ago, in 1957, CE Dent's and GA Jervis's discussion of a paper by Dr MD Armstrong "The relation of the biochemical abnormality to the development of the mental defect in phenylketonuria" was published. Moreover, scientific and clinical work, as well as impressive biography of Charles E. Dent, was reviewed. Dent was always looking for new techniques and new ideas to apply to inherited errors of metabolism. He was elected Fellow of the Royal Society in 1962.Role of communications during conferences and case reports may vary according to the clinical specialty. Undoubtedly, such reports will help communicate detailed aspects of a clinical observation in rare inborn errors of metabolism. © 2017 Polish Pediatric Society.

The presence of obesity and the features of metabolic syndrome plays a predictive role in cardiovascular diseases (CVD) in adults. It seems reasonable to seek new risk factors in the development of CVD. Defining the genetic background of obesity could help to select patients from a high risk group and help to introduce prevention and treatment, which, in consequence, lead to the lowering of morbidity and mortality. One of the genes probably related to the body weight is the Fat Mass and Obesity Associated Gene (FTO). of the study was an attempt to assess the relationship between the FTO polymorphism rs9939609 and body mass index in children from Podlaskie voievodship. 405 children aged 4-18 were selected for the study. The examination included body mass index, waist circumference, blood pressure and lipid profile analysis. FTO rs9939609 polymorphism was assessed using a discrimination allele method with the application of ABI 7900HT Fast Real-Time PCR System. FTO rs9939609 polymorphism was related to the standarized body mass index and the AA genotype carriers had a higher risk of obesity. This polymorphism was also associated with waist circumference, systolic blood pressure and triglycerides concentration. It was not correlated with diastolic blood pressure and total HDL- and LDL-cholesterol concentrations. Our results demonstrate that rs9939609 FTO gene polymorphism is related to the body mass index in children. Our results should be confirmed in studies on a large cohort of healthy Polish children.

Neurofibromatosis type 1 (NF1) called also von Recklinghausen's disease is an autosomal dominant genetic disorder with a  complex clinical course. Clinical signs and symptoms concern mainly skin (with pigmentation abnormalities- café au lait macules, axillary/groin freckling and neurofibromas) and central nervous system (cognitive impairment, epilepsy, attention deficit hyperactivity disorder and gliomas). However, pathologic changes may also affect other organs and systems, including skeletal system (scoliosis, hypostature, osteoporosis, pseudoarthrosis and sphenoid wing dysplasia) or cardiovascular system (hypertension, inherited cardiovascular malformations). Another characteristic abnormality, which is an important diagnostic criterion of the disease, is the presence of Lisch nodules- hamartomatic changes of the iris. The development of NF1 is a consequence of inactivation of NF1 gene. The gene, located on chromosome 17, has one of the greatest frequencies of spontaneous mutation in the whole human genome. Gene product, a cytoplasmic protein called neurofibromin, is a tumor suppressor, with expression detected in various cells, mainly in malanocytes, neurons, Schwann cells and glial cells. Due to its anti-tumoral function, inactivation of NF1 protein leads to the growth of several neoplasms, concerning mainly skin and central nervous system (CNS). Skin tumors are actually malignances of the peripheral nervous system (PNS) and include cutaneous, subcutaneous and plexiform neurofibromas. In the CNS the most frequently occurring tumors are gliomas located in the optic pathway, followed by those developing in other parts of CNS. Histologically, CNS tumors are usually a  benign pilocytic astrocytoma, consisting of malignant-transformed astrocytes.

INTRODUCTION: Effectiveness of enteral nutrition therapy is not only connected with improvement of the nutritional status of the patient, but also with its strong anti-inflammatory activity. Angiogenic growth factors play an important role in the early stage of inflammation. Vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-beta 1) stimulate the angiogenesis and healing processes. The objective of our study was to assess the influence of the enteral nutrition therapy on the vascular endothelial growth factor (VEGF) and transforming growth factor beta 1 (TGF-beta 1) concentrations in serum in children with different diseases of gastro-intestinal tract, in which enteral nutrition therapy is effective method of treatment. MATERIAL AND METHODS: Sixty two children (29 boys, 33 girls, mean age: 12.5 yrs, range: 6-18 yrs) and 25 healthy controls were included into the study. The Crohn's disease group (CD) consisted of 25 patients, ulcerative colitis group (UC)-18 patients, acute pancreatitis (AP) group-12 patients and severe malnutrition (N) group-7 patients. Serum VEGF and TGF-beta 1 concentrations were assessed at baseline, before starting and after 2 and 4 weeks of enteral nutrition therapy using ELISA immunoassays (R and D Systems, USA). RESULTS: Before starting enteral nutrition, we found increased VEGF concentration in CD group (Me = 600 pg/ml) compared to UC group (266.9 pg/ml), AP group (552.6 pg/ml), N group (238.5 pg/ml) and controls (172 pg/ml) (p < 0.05). We found decrease of VEGF concentrations during enteral nutrition in CD, UC and N group and increase in AP at the beginning, followed by decrease to the initial values. Assessing TGF-beta 1, we found its concentration increased before starting enteral nutrition in UC group (37.5 ng/ml) compared to CD group (29.7 ng/ ml) and controls (24.8 ng/ml) (p < 0.05). During enteral nutrition we observed decrease of TGF-beta 1 concentration in UC group and increase in CD group (32,7 ng/ml) and AP group (26,6 ng/ml) (p < 0.05) The best improvement of nutritional status was observed in CD patients compared to N and AP patients. CONCLUSIONS: Differentiation of serum VEGF and TGF-beta 1 concentrations, what was observed in various gastro-intestinal diseases, reflects different mechanisms of enteral nutrition therapy acting on the inflammatory process. The most efficient therapeutic effect was seen in CD, where stimulation of TGF-beta 1 production was observed.

of this study was to assess the incidence and the cause of hospitalization of children with cholecystolithiasis. Material and methods: A retrospective analysis was carried out using medical data of children and adolescents treated in the Department of Pediatrics, Gastroenterology, and Pediatric Allergology of Bialystok Medical University. The analysis included causes of hospitalization, its course and accompanying illnesses. During the 4 years of analysis, 47 children (17 boys, 30 girls), aged from 7 months to 18 years, with the diagnosis of cholecystolithiasis were treated. The comprised 1.18% of children hospitalized with gastrointestinal disorders. Cholecystolithiasis without complications was diagnosed in 29 children (61.7%), with cholecystitis in 13 (27.7%), choledocholithiasis was diagnosed in 5 children (10.6%). In 11 children (23.4%) the complication presented in form of acute pancreatitis. In 23 children (48.9%) factors predisposing to chorocholelithiasis were identified. In 20, the following were considered to be a possible significant factor: in 7 children there was a positive family history (14.9%), in 6 children (12.8%) - it was obesity, in 3 children (6.4%) lipid metabolic errors: prematurity and parenteral feeding in 2 children (4.3%) and spherocytosis in 2 children (4.3%). Apart from the above, cholelithiasis was diagnosed in two children with hypothyreosis and in two with Down's Syndrome. In treatment of 20 children (42.6%) antibiotics were prescribed and in 4 children (8.5%) endoscopic sphincterotomy was performed. 25 children (53.2%) were referred for laparoscopic cholecystectomy. In 16 children (34.0%), treatment with ursodeoxycholic acid was recommended. Cholecystolithiasis is a rare cause of hospitalization in pediatric departments. However, it occurs in even the youngest children. It usually runs without complications, but there is a certain risk of serious complications. In the differential diagnosis of abdominal pain, cholelithiasis should be taken into account, even in the youngest children. Special consideration should be given to the premature, with low birth weight and extremely low birth weight.

Szajewska H.,Klinika Pediatrii
Przeglad Gastroenterologiczny | Year: 2012

Not all probiotics are created equal. The efficacy and safety of each probiotic microorganism has to be evaluated separately. This paper aims to systematically evaluate the effectiveness and safety of Saccharomyces boulardii in children and adults. The MEDLINE and The Cochrane Library (both up to June 2012) were searched for randomized controlled trials or their metaanalyses relevant to S. boulardii. Available evidence documents that S. boulardii is effective in treating acute gastroenteritis in children and preventing antibiotic-associated diarrhoea in children and adults treated with antibiotics for any reason. S. boulardii is probably effective in preventing Clostridium difficile infection and for the prevention of traveller's diarrhoea. In patients with Helicobacter pylori infection, there is evidence to recommend the use of S. boulardii along with standard triple therapy as an option for increasing the eradication rates and decreasing overall therapy-related side effects, particularly diarrhoea.

Januszek-Trzciakowska A.,Klinika Pediatrii | Malecka-Tendera E.,Klinika Pediatrii
Postepy Higieny i Medycyny Doswiadczalnej | Year: 2013

Subclinical hypothyroidism (SH) is defined as an elevated thyroid stimulating hormone (TSH) associated with normal levels of free thyroxine. In obese persons prevalence of SH is signifi-cantly higher than in general population. SH is of particular interest in children with respect to the crucial role of thyroid hormones in the development of central nervous system and linear growth. Currently there is no general consensus on the treatment of SH with L-tyro-xine. It is suggested that this hormonal state is rather a consequence that the cause of the overweight status.

Phenylketonuria is one of the best-known examples of inherited metabolic diseases. It is widely considered as a triumph of western medicine. Untreated phenylketonuria manifests as mental retardation, epilepsy, light complexion, eczema, and a "mousy" odour. This review gives some insight into history of the use of the disease's name, which was probably coined by the biochemist J.H. Quastel and focuses on the contributions of the first medical investigators in the area of abnormal phenylalanine metabolism - I.A. Følling, L.S. Penrose as well as G.A. Jervis. The story of the first family with children diagnosed to have phenylketonuria is presented. © 2016 Polish Pediatric Society.

The study aimed to compare the concentrations of triglycerides, total cholesterol and its fractions and apolipoproteins in cord blood serum in newborns and in blood serum in older children. The influence of gender, intrauterine development, nutritional status and diet on lipid parameters was also assessed. The longitudinal study was performed in three stages. During stage I the tests were carried out in 137 newborns after birth. Stage II of the study included 41 children aged 18-30 months, and stage III covered 47 children aged 5-6 years. Due to the long-term and multi-stage study, in the evaluation of the results, only 41 children were included; they were only the ones who participated in all three stages, and the test results of whom were complete. In newborns, the gestational age and the birth weight were evaluated. In the older children, the nutritional status was rated by measuring the Body Mass Index and the skin folds thickness as well as the nutrition from birth was assessed. In all of the studied children the concentration of triglycerides, total cholesterol and its fractions: HDL, LDL and VLDL cholesterol and apolipoproteins (AI and B) were measured. The concentrations of lipids, lipoproteins and apolipoproteins in serum increase during the first years of children's life as compared with the values of cord blood serum (p<0.001). Differences in the concentration of lipids and lipoproteins in cord blood serum in the newborns were noticed with relation to gender and birth weight. No fundamental statistical differences were shown between the studied parameters in older children with relation to the gender, nutritional status and the method of feeding after the birth. Based on the long-term studies in this group of children, one may conclude that the gender and birth weight have the largest effect on the lipid parameters in the cord blood. However, the gender, the nutritional status and the method of feeding after birth were not related with lipid metabolism. It seems advisable to continue further studies in the same group of children in order to assess the impact of environmental factors on selected parameters of lipid metabolism.

Vein thrombosis is a rare disorder diagnosed in childhood. The principal causes of this illness are inborn thrombophilias, essential thrombocytosis, neoplasms, autoimmunologic diseases and pathologic reaction to certain drugs. Budd-Chiari syndrome, a hepatic vein occlusion is an atypical manifestation of vein thrombosis. Due to the abundant symptomatology, interdisciplinary diagnostic procedures and serious prognosis the Budd-Chiari syndrome is a challenge for contemporary medicine. We present a 16 years old girl with essential thrombocytosis, the complicated by hepatic vein thrombosis.

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