Fecal lactoferrin, a marker of intestinal inflammation in children with inflammatory bowel disease.

The aim of this study was to analyze the usefulness of fecal lactoferrin in the diagnosis and monitoring of inflammatory bowel disease (IBD) in children. The study included 52 children with IBD (24 with Crohn's disease and 28 with ulcerative colitis) aged between 0.92 and 18 years, and 41 IBD-free controls of similar age. Fecal concentration of lactoferrin was determined with a quantitative immunoenzymatic test. Fecal concentration of lactoferrin in children with IBD was significantly higher than in the controls. The cut-off value of fecal lactoferrin concentration optimally distinguishing between the children with IBD and the controls was identified as 13 µg/g. The sensitivity and specificity of this cut-off value equaled 80.7% and 92.7%, respectively, and its positive and negative prognostic values were 96.8% and 63.3%, respectively. Patients diagnosed with moderate Crohn's disease had significantly higher fecal concentrations of lactoferrin than children with the mild or inactive disease. Similarly, children with moderate ulcerative colitis showed significantly higher fecal concentrations of lactoferrin than individuals with the mild condition. No significant relationship was found between the fecal concentration of lactoferrin and the severity of endoscopic lesions. Patients with IBD and a positive result of fecal occult blood test were characterized by significantly higher concentrations of lactoferrin than the individuals with IBD and a negative result of this test. In conclusion, fecal concentration of lactoferrin seems to be a useful parameter for diagnosis and monitoring of IBD in children.

Evaluation of clinical usefulness of serum neopterin determination in children with bacterial infections.

UNLABELLED: Neopterin (NPT) (6-D-erythro-trihydroxypropyl pteridin) is one of the indicators of the immune system activity. Elevated neopterin concentration occurs in diseases mostly involving stimulation of cellular immunity. The determination of neopterin concentration, usually in blood serum and urine but also in many other bodily fluids, has already been applied in many areas of medicine, such as transfusiology, transplantology, oncology, infectious diseases and autoimmunological diseases. OBJECTIVE: The aim of this work is to evaluate clinical usefulness of serum neopterin determination in children with urinary tract infections of confirmed bacterial etiology. MATERIAL: The study involved 56 children with bacterial urinary tract infections - patients of the Clinic of Paediatrics, Paediatric Gastroenterology, Hepatology & Paediatric Nutrition of Medical University of Gdansk in the years 2012-2013. The control group included 105 healthy children. RESULTS: The values of NPT concentration in blood serum obtained in the group of children with urinary tract infections did not significantly differ from the values obtained in the control group. CONCLUSIONS: The determination of neopterin concentration in children with bacterial urinary tract infections is not a clinically useful parameter.

The mRNA level of the transforming growth factor ß1 gene, but not the amount of the gene product, can be considered as a potential prognostic parameter in inflammatory bowel diseases in children.

PURPOSE: Transforming growth factor ß1 (TGF-ß1) plays a role in cell proliferation and differentiation, and it can modulate immune response. In this work, we asked whether levels of either TGF-ß1 or mRNA of the corresponding gene in plasma or tissue can be useful in diagnosing and/or monitoring of the clinical course of inflammatory bowel diseases (IBD). METHODS: The study group consisted of 104 pediatric patients with IBD: 36 with Crohn's disease (CD) and 68 with ulcerative colitis (UC); 42 children represented the control group. TGF-ß1 levels in plasma and intestinal mucosa were estimated by ELISA and immunohistochemistry (IHC), respectively. Levels of TGF-ß1 mRNA were determined by reverse transcription and real-time PCR. RESULTS: In patients with IBD, and in subgroups with CD and UC, no significant differences in the TGF-ß1 level in plasma and tissue were found relative to the control group. These variables were not dependent on the stage of the disease, its activity or severity of endoscopic and histopathological findings. TGF-ß1 mRNA levels were significantly higher in tissue samples withdrawn during the relapse of the disease than in those taken during the remission or in the control group. However, no correlation between TGF-ß1 plasma levels and TGF-ß1 mRNA amount in the intestinal mucosa was observed. CONCLUSIONS: The TGF-ß1 mRNA level, but not the amount of the gene product, was significantly increased in the pathologically changed tissue during the relapse of IBD. We suggest that this parameter might be considered as a potential prognostic value when assessing IBD in children.

Cytokine profile of mature milk from smoking and nonsmoking mothers.

We verified whether smoking during lactation influences breast milk cytokine (interleukin [IL]-1α, IL-1ß, IL-6, IL-8, IL-10, and tumor necrosis factor-α) levels 30 to 32 days after delivery. The study group comprised 24 postpartum women who declared smoking >5 cigarettes per day. The control group included 45 nonsmoking postpartum women. Compared with nonsmoking women, smokers were characterized by significantly higher breast milk concentrations of IL-1α (P = 0.04), whereas no significant intergroup differences were observed in terms of remaining analyzed cytokines. Moreover, both groups were characterized by a similar fraction of women with detectable cytokine levels.

Transforming growth factor ß1 protein and mRNA levels in inflammatory bowel diseases: towards solving the contradictions by longitudinal assessment of the protein and mRNA amounts.

Previously published studies on levels of the transforming growth factor-ß1 (TGF-ß1) protein and mRNA of the corresponding gene in patients suffering from inflammatory bowel diseases (IBD) gave varying results, leading to contradictory conclusions. To solve the contradictions, we aimed to assess longitudinally TGF-ß1 protein and mRNA levels at different stages of the disease in children suffering from IBD. The study group consisted of 19 pediatric patients with IBD at the age between 3.5 and 18.4 years. The control group consisted of 42 children aged between 2.0 and 18.0 years. The plasma TGF-ß1 concentration was measured with ELISA. mRNA levels of the TGF-ß1 gene isolated from samples of the intestinal tissue were assessed by reverse transcription and real-time PCR. Levels of TGF-ß1 protein in plasma and corresponding mRNA in intestinal tissue were significantly higher in IBD patients than in controls. TGF-ß1 and corresponding transcripts were also more abundant in plasma and intestinal tissue, respectively, in patients at the active stage of the disease than during remission. In every single IBD patient, plasma TGF-ß1 level and mRNA level in intestinal tissue was higher at the active stage of the disease than during remission. Levels of TGF-ß1 and corresponding mRNA are elevated during the active stage of IBD but not during the remission. Longitudinal assessment of this cytokine in a single patient may help to monitor the clinical course of IBD.

Maternal smoking does not influence vitamin A and E concentrations in mature breastmilk.

OBJECTIVES: The aim of this study was to analyze the effects of maternal smoking on the total antioxidant status (TAS) and the concentrations of vitamins A and E in human breastmilk. METHODOLOGY: The study group (n=20) comprised postpartum women who declared smoking more than five cigarettes per day (confirmed by urinalysis of the cotinine concentration). The control group included 25 nonsmoking postpartum women. Breastmilk samples were collected between day 30 and day 32 after delivery. TAS was determined by Rice-Evans and Miller method, whereas the amount of vitamins A and E was measured by high-performance liquid chromatography. RESULTS: No significant differences were observed between breastmilk samples from smoking and nonsmoking mothers in terms of TAS and vitamin A and E concentrations. Additionally, no significant correlations were found between urinary cotinine and TAS (R=0.35, p=0.144) or vitamin A (R=0.14, p=0.571) and vitamin E (R=0.31, p=0.228) concentrations in breastmilk samples from smoking mothers. CONCLUSIONS: Maternal smoking is not reflected by decreased TAS and vitamin A and E concentrations in mature milk.

Longitudinal study of vitamins A, E and lipid oxidative damage in human milk throughout lactation.

BACKGROUND: Little is known about the intensity of oxidative damage in human milk resulting from maternal oxidative stress. The aim of our study was to explore the changes in Total Antioxidant Status (TAS) and concentrations of antioxidative vitamins and isoprostanes (markers of oxidative stress) in human colostrum and mature milk. METHODS: The study included 49 postpartum women with normal, spontaneous full term delivery. The exclusion criteria included active and passive smoking, acute and chronic disorders, and pharmacotherapy other than vitamin supplementation. Colostrum samples were collected on the 3rd day after delivery and breast milk samples between the 30th and the 32nd day after delivery. TAS of colostrum/breast milk was determined by Rice-Evans and Miller method. The amount of vitamins A and E was measured by HPLC. Isoprostane concentrations in colostrum/mature milk and urine were determined immunoenzymatically. RESULTS: No significant differences were observed in maternal dietary intakes of vitamins A and E determined prior to the colostrum and mature milk sampling. The TAS of mature milk was significantly higher compared to colostrum (P=0.002), while vitamin A and E concentrations were significantly lower (P=0.003 and P=0.001). Although the isoprostane concentration of mature milk was significantly higher than the colostrum concentration, this difference was not significant (P=0.129). CONCLUSION: Human milk is a source of antioxidative vitamins and their concentrations decrease throughout the lactation, while their total antioxidative properties increase. The phase of lactation does not affect the degree of human milk's lipid oxidative damage.

Clinical parameters of inflammatory bowel disease in children do not correlate with four common polymorphisms of the transforming growth factor ß1 gene.

Transforming growth factor ß1 (TGF-ß1) is a cytokine affecting cell proliferation and development, which also has an immunomodulatory activity. Correlations between polymorphisms of the TGF-ß1 gene and clinical parameters of inflammatory bowel disease (IBD) were reported previously in adults. Here, we tested whether such correlations occur in pediatric patients suffering from IBD. One hundred and four pediatric IBD patients were involved in this study. Among them, 36 were diagnosed with Crohn's Disease (CD) and 68 were diagnosed with ulcerative colitis (UC). The control group consisted of 103 children, in which IBD was excluded. TGF-ß1 levels were determined in plasma and intestinal mucosa samples. The presence of the TGF ß1 protein and the amount of TGF ß1 mRNA were estimated in intestinal mucosa by immunohistochemistry and reverse transcription Real-Time PCR, respectively. Four common polymorphisms of the TGF-ß1 gene were investigated: -800G/A, -509C/T, 869T/C and 915G/C. No significant correlation between TGF-ß1 genotypes and (i) TGF-ß1 levels in plasma and tissue samples, (ii) TGF-ß1 gene expression efficiency in intestinal mucosa, (iii) IBD clinical parameters and (iv) inflammatory activity could be detected in children suffering from IBD. We conclude that, contrary to previous suggestions, the four common polymorphisms of the TGF-ß1 gene do not influence the susceptibility to or clinical parameters of IBD in the tested population of children.

Helicobacter pylori increases expression of proapoptotic markers Fas and FasL on CD4 lymphocytes in children.

The pathomechanism of Helicobacter pylori action upon gastric mucosa and its role in the pathogenesis of gastritis have not been fully elucidated. The aim of this study was to evaluate the most prevalent lymphocyte subpopulations of the gastric mucosa in gastritis in children, as well as to evaluate the expression of Fas and Fas ligand receptors (FasL), periapoptotic markers of gastric mucosa lymphocytes before and after H. pylori eradication. Forty nine patients aged 6 to 17 years, investigated due to chronic abdominal pain, were studied. The obtained tissue samples were analysed by immunohistochemistry. Different lymphocyte subsets were quantified on the basis of surface antigen expression (CD3, CD4, CD8, CD20), secreted cytokines (IL-4, IL-6, IFNgamma) and Fas and FasL proteins in the gastric mucosa. B and T helper lymphocytes were found to play a major role in the inflammatory infiltration in the gastric mucosa in children during H. pylori infection. Their expression was found to decrease after eradication. The enhanced expression of Fas receptor on lymphocytes before treatment and a decrease of this expression after eradication of H. pylori were shown. It was demonstrated that there is a correlation between CD4 and Fas receptor expression that may induce apoptosis of the helper lymphocytes in infected children.

[Role of transforming growth factor beta1 (TGF-beta1) in the pathogenesis and clinical course of chronic hepatitis in children]. / Rola transformujacego czynnika wzrostu beta1 (TGF-beta1) w etiopatogenezie i przebiegu klinicznym przewleklych zapalen watroby u dzieci.

UNLABELLED: Transforming growth factor-beta1 (TGF-beta1) is known to play a key role in processes of cell proliferation and differentiation. It also plays an important role in modulation of the immune response. Various diseases may arise both from excessive and insufficient activity of this cytokine. THE AIM OF THE STUDY was to evaluate the role of TGF-beta1 in the pathogenesis of chronic hepatitis (Ch.h.) and to assess whether TGF-beta1 level in plasma or its tissue expression can be useful in diagnosing and monitoring of clinical course of this disease. PATIENTS AND METHODS: Twenty-one children with chronic hepatitis were included in the study and 42 healthy children constituted the control group. Liver function tests and TGF-beta1 plasma levels measured by ELISA method were evaluated in both groups of patients. In liver tissue obtained by needle biopsy, the histopathological grading and staging of hepatitis was evaluated, TGF-beta1 protein was assessed by immunohistochemical methods and TGF-beta1 gene expression was measured by reverse transcription and real-time polymerase chain reaction. RESULTS: In chronic hepatitis group of patients the plasma TGF-beta1 level did not differ from the control group and did not correlate with grading and staging of the liver tissue while positive correlation was observed with gamma-glutamyl transpeptidase activity in the serum. There was no correlation between tissue TGF-beta1 expression and TGF-beta1 plasma level and staging or grading in liver tissue. TGF-beta1 gene expression correlated positively with ESR and ALAT activity but no correlation with TGF-beta1 plasma level, TGF-beta1 gene or protein expression, grading or staging in liver tissue were observed. CONCLUSION: 1. In children with chronic hepatitis, TGF-beta1 plasma level is not related to grading or staging in the liver tissue. This finding may be due to low level of fibrosis observed in the studied children. 2. It appears that local expression of TGF-beta1 in liver tissue should not be used as a sole marker in differentiating and monitoring the course of chronic hepatitis. 3. In children with chronic hepatitis assessment of liver TGF-beta1 gene expression is not helpful in the evaluation of pathological changes in liver tissue. 4. Due to the relatively low number of patients in the analysed groups it seems advisable to perform similar complex studies in larger groups of children with chronic hepatitis.

[Gene polymorphism of transforming growth factor beta1 (TGF-beta1) in the pathogenesis and clinical course of chronic hepatitis in children]. / Polimorfizm genu transformujacego czynnika wzrostu beta1 (TGF-beta1) w etiopatogenezie i przebiegu klinicznym przewleklych zapalen watroby u dzieci.

UNLABELLED: Transforming growth factor beta1 (TGF-beta1) is a cytokine modulating the immune response. The role of TGF-beta1 gene polymorphisms in the incidence and modification of the clinical course of these diseases has been recently evaluated. THE AIM of the study was to assess the relation between TGF-beta1gene polymorphism and the incidence of chronic hepatitis, the course of the disease, TGF-beta1 level in plasma and TGF-beta1 mRNA expression in liver tissue. PATIENTS AND METHODS: The studied group comprised 21 patients with chronic hepatitis including 10 with HBV infection, 4 with HCV infection and 7 with autoimmune hepatitis (AIH). Forty-two children were included in the control group. Analysis of four studied polymorphisms of TGF-beta1 gene was based on CAPS (Cleaved Amplified Polymorphic Sequence) method, TGF-beta1 level in plasma was estimated using sandwich ELISA. TGF-beta1 mRNA expression was evaluated by reverse transcription and real-time polymerase chain reaction (Real-Time PCR). RESULTS: No correlation between studied polymorphisms and the incidence or clinical course of chronic hepatitis was found. There were no significant differences in TGF-beta1 level in plasma and mRNA expression depending on polymorphisms of TGF-beta1 gene. CONCLUSIONS: 1. The polymorphisms of TGF-beta1 gene do not appear to influence the incidence and clinical course of chronic hepatitis in children. 2. Due to relatively low number of patients in the analysed groups it seems advisable to perform similar complex studies in larger groups of children with chronic hepatitis.

[Periapoptotic markers in children with Helicobacter pylori infection]. / Markery okoloapoptotyczne w zakazeniu Helicobacter pylori u dzieci.

UNLABELLED: Helicobacter pylori (Hp) infection influences cell metabolism and apoptosis in the epithelium and lymphocytes of gastric mucosa. It may cause difficulties in the elimination of bacteria and lead to chronic gastritis. THE AIM OF THE STUDY was to find if there is a relationship between periapoptotic markers such as Fas, FasL and Bcl-2 in gastric mucosa in children with chronic gastritis and with Hp infection. MATERIAL AND METHODS: Forty-nine children with chronic abdominal pain were included in the study. They, were divided into three groups: group I without Hp (22) group II with (27) Hp infection. Eleven children from the second group who had follow-up endoscopy after eradication therapy formed group III. Hp infection was confirmed by 4 different methods. The triple- drug treatment was applied. Tissue samples from the gastric mucosa were obtained, during upper gastrointestinal endoscopy, for microscopic evaluation (according to the Sydney classification) and immunohistochemistry. In the analysed groups the percentage of patients with periapoptotic markers (Fas, FasL, Bcl-2) was established. The Fas antigen was estimated by immunofluorescent and immunoenzymatic methods. The FasL I Bcl-2 receptors were evaluated by the immunoenzymatic method. RESULTS: The expression of FasL and Bcl-2 receptors was found in all children without Hp infection. The expression of Fas antigen was less frequent in this group. The expression of Fas receptor was statistically significantly more frequent (p<0.05) in children with Hp infection. The expression of FasL and Bcl-2 in children with Hp infection was similar to group I (without Hp infection). In group of children after eradication treatment the expression of Fas and Bcl-2 (p<0.05) markers were significantly less frequent. CONCLUSIONS: Helicobacter pylori activates apoptosis by two pathways. It appears that the Fas/FasL pathway is the main one. Only in the case of Fas receptor there is a link between its significantly more frequent expression with Hp infection and its reduction after eradication treatment.

[Blood culture analysis in children with central venous catheter]. / Analiza wyników posiewów krwi u dzieci z zalozonym cewnikiem centralnym.

We analyzed 99 blood cultures taken from 28 children with central venous catheter. Children were hospitalized in pediatric, pediatric surgery and pediatric intensive care department. All samples were collected from peripherial vein. Positive blood cultures were obtained more frequently from children with central venous catheter than from children without central venous catheter (57.5% vs. 7.4%). Staphylococcus epidermidis was the most frequently obtained bacteria. The other bacterial species were obtained less frequently. The highest percentage of multi resistant straines was isolated from blood samples collected from intensive care department patients. In each departments in which coagulase-negative Staphylococci were isolated, metycillin-resistant straines dominated.

[Chronic hepatitis B in children--is it still a real problem?]. / Przewlekle zapalenie watroby typu B u dzieci--problem nadal aktualny?

Over one million people all over the world die every year due to the complications of HBV infections. This problem is particularly important in Asia, Africa and in the West Pacific region where HBV infection is widely spread (from 5-20% up to 80% of all infected people in the world). In these regions HBV infections are transmitted mostly perinatally or during early childhood. In North America and in West Europe where after introducing anti-HBV vaccinations less than 2% of the population is affected, infections are usually transmitted by intravenous drug abuse, sexual intercourse, or much less frequently by blood transfusions. The immaturity of immune system in young children is responsible for the fact that nearly 90% of HBV infections acquired in infancy and 40-70% of HBV infections before the age of 3 years, result in chronic viral hepatitis. Therefore, the choice of an efficient and safe therapy is one of the most important problems. In this paper current data concerning indications for treatment and side-effects of interferon-alpha and lamivudine therapy in children with chronic viral hepatitis type B are presented.

[Therapy of chronic viral hepatitis type B in children after previous ineffective interferon-alpha treatment]. / Terapia przewleklego wirusowego zapalenia watroby typu B u dzieci po uprzednim, nieskutecznym leczeniu interferonem alfa.

UNLABELLED: THE AIM of this study was to estimate the efficacy of nucleoside analogue (lamivudine) in the therapy of chronic viral hepatitis type B in children, after previous, ineffective treatment with interferon-alpha. PATIENTS AND METHODS: we analyzed 53 children with chronic viral hepatitis type B, who had not responded to Interferon-alpha treatment conducted 1-7,5 years before this study (mean 4,0 +/- 7,5; median 4 years). Inclusive criteria to re-therapy with lamivudine were as follows: increased serum alanine aminotransferase activity, detected at least three times during 6 months before treatment, HBsAg and HBeAg present in the blood, viral HBV DNA detected for at least 6 months before the beginning of lamivudine therapy (above 200 genome copies per mL) and inflammation activity observed in liver biopsy specimen (biopsy performed within previous 24 months). Evaluation of side-effects of lamivudine therapy was based on anamnesis (subjective data) and laboratory tests performed regularly in the time of clinical visits during and after the end of the treatment. RESULTS: all the children concluded the treatment. Before lamivudine therapy, serum alanine aminotransferase activity ranged between 20-590 IU/L. In 28,4% of children it was less than 100 IU/L. In almost all the children moderate staging and grading were observed in liver biopsy specimens. HBV DNA in serum ranged between 200-200000 copies/mL: in 31 children (58,4%) HBV DNA exceeded 200000 copies/mL, in 5 (28,3%) was between 10000 and 200000 copies/mL, and in 7 (13,2% ) was below 10000 copies/mL. Applied treatment resulted in alanine aminotransferase activity normalization in 79,2% of children, mostly after 2-11 months (mean 3,9 +/- 2,7; median 3,8 months). HBeAg/HBeAb seroconversion was achieved in 28,3% of children, usually at the end of lamivudine therapy (approximately after 12 months). Sustained viral response was observed in 24,5% of treated children. There were no undesirable effects of therapy noted. Serum alanine aminotransferase activity increased slightly and temporarily in 4 children between 3rd and 12th month of therapy. In 2 of these children YMDD mutation was detected. CONCLUSIONS: lamivudine is effective, safe and well tolerated in treatment of chronic viral hepatitis type B, following unsuccessful interferon-alpha therapy. Serum alanine aminotransferase activity normalized in most of the patients. HBeAg/HBeAb seroconversion as well as positive viral response is mostly connected with low level of HBV DNA before therapy.

[Inflammatory bowel disease in children--an analysis of the clinical symptoms and selected biochemical parameters]. / Nieswoiste zapalenia jelit u dzieci--analiza obrazu klinicznego i wybranych parametrów biochemicznych.

AIM OF THE STUDY: an analysis of clinical symptoms and laboratory tests in children with inflammatory bowel disease (IBD). PATIENTS AND METHODS: eighty-nine children with IBD (58 with ulcerative colitis (UC) and 31 with Crohn's disease (CD) diagnosed on the basis of clinical symptoms, endoscopic and histopathological examination, were qualified into the studied group. Disease activity was evaluated by using Truelowe-Witts scale for UC and PCDA9 scale for CD cases. Forty-two children without acute or chronic inflammatory diseases constituted the control group. RESULTS: the frequency of such clinical symptoms as: diarrhea, fever, weight loss, abdominal pain, weakness, constipations, anemia, joints pain, vomits, and jaundice was comparable in children with UC and CD while intestinal bleeding was significantly more frequently observed in patients with UC than with CD (P<0.05). There was no statistically significant difference in BMI between patients with UC and CD. Cole's index was significantly higher in children with UC than with CD (P<0.05). Hemoglobin level and serum iron level were statistically significantly lower in patients with CD than in the control group (P<0.05). Mean leukocyte count in children with CD was significantly higher than in the control group (P<0.05). Neutrophils percentage in patients with UC and CD was significantly higher than in the control group (P<0.05). Platelet count was significantly higher in all children with IBD than in the control group (P<0.05). Mean serum CRP level was significantly higher only in children with CD while ESR was significantly higher in both groups of IBD patients. Mean serum gamma-globulin level was statistically significantly higher in children with UC and with CD but no significant differences were observed in serum IgA, IgG, and IgM levels among the analyzed groups. Serum GT level was higher in children with CD than in the control group while serum ALT and AST level did not differ significantly among the analyzed groups of patients. CONCLUSIONS: 1. Serum C-reactive protein level is one of the most valuable markers for monitoring the course of IBD, especially CD, in children. 2. In patients with IBD systematic monitoring of liver function parameters (especially parameters of cholestasis) is necessary as severe hepatic complications may occur. 3. Further search for new sensitive and specific markers monitoring the course of inflammatory bowel diseases is needed.

[Evaluation of selected immunocompetent cells expression in gastric mucosa in children with Helicobacter pylori infection before and after eradication treatment--a preliminary study]. / Ocena ekspresji wybranych komórek immunokompetentnych w blonie sluzowej zoladka u dzieci zakazonych Helicobacter pylori przed i po eradykacji zakazenia--doniesienie wstepne.

INTRODUCTION: Helicobacter pylori infection activates local immunological response and causes mononuclear cells infiltration in the gastric mucosa. On this account the studies on lymphocyte subpopulations in the gastric mucosa in children during Helicobacter pylori infections are inconsistent. It has been shown that the morphological status of gastric mucosa in children with Helicobacter pylori infection is different than in adult patients. THE AIM OF THE STUDY was the evaluation of chosen immunocompetent cells expression in gastric mucosa in children before and after eradication treatment. MATERIAL AND METHODS: Forty-nine children with chronic abdominal pain was enrolled in the study. They were divided into the following groups: 22 children without infection (negative urease test and absence of Helicobacter pylori antigen assessed by immunoenzymatic and immunofluorescent methods) and 27 with Helicobacter pylori infection. Part of the children (11) from the second group had a follow-up endoscopy after eradication therapy. The tissue samples from the gastric antrum and fundus were obtained for morphological and immunohistochemistry assays by direct immunofluorescent and immunoenzymatic methods. RESULTS: There were negative Helicobacter pylori tests in group I. In the group of infected children superficial colonisation of pathogen dominated In analysed groups percentage of patients with superficial antigens and cytokines (CD3, CD4, CD8, CD20, IL-4, IL-6, INF-gamma) characteristic for each lymphocytes subpopulations were established. In infammatory infiltrations T lymphocytes CD4 and B lymphocytes CD20 dominated localised mainly in the lamina propria of the gastric mucosa. Expression of above lymphocytes subpopulations diminished after eradication treatment. After treatment the total eradication of Helicobacter pylori was observed in 5 children and in 6 patients the pathogen persisted. CONCLUSIONS: The dominant role in local response during Helicobacter pylori infection in children is played by T CD4 and B CD20 lymphocytes localised mainly in lamina propria of gastric mucosa. Degree of T cells CD4 and CD20 expression decreases after eradication treatment.

[Vitamin B12 deficiency in a one-year-old, exclusively breast fed child]. / Niedobór witaminy B12 u rocznego dziecka karmionego wylacznie piersia.

UNLABELLED: Vitamin B12 deficiency is a rare condition in children. The most frequent cause is vegetarian diet. In infants it can happen in breast fed children whose mother is on this diet. The clinical feature of the disease presents with megaloblastic anemia and symptoms such as: weakness, refusing to eat, hypotonia, paraesthesia, delayed or regressed development. We present a case report of vitamin B12 deficiency in a one-year-old, exclusively breast fed child. The mother's diet during pregnancy and breast-feeding were normal. CONCLUSIONS: The quality of the mother's diet and her haematological status during pregnancy and breast-feeding should be carefully monitored. It is necessary to introduce a variety of foods to expand the infant's diet at the proper time. The diagnosis of anaemia in the mother and/or in the child requires a careful investigation.

[Serum neopterin level in children with lower respiratory tract infections]. / Stezenie neopteryny w surowicy u dzieci z infekcjami dolnych dróg oddechowych.

THE AIM OF THE STUDY: was to determinate the serum neopterin concentration in children with lower respiratory tract infections. MATERIAL AND METHODS: eighty-seven children with lower respiratory tract infections, aged from 1 month to 8 years, were analyzed. The control group consisted of 105 children without infection. The serum C-reactive protein level and whole blood count with differential white blood count were estimated The serum neopterin concentration was evaluated using the immunoenzyme assay (ELISA). RESULTS: statistically significantly higher serum neopterin concentration was observed in the studied than in the control group. The sensitivity of serum neopterin concentration evaluation in children with lower respiratory tract infection was 90.5% and specificity 55.2%. No correlation was found between serum neopterin concentrations and commonly evaluated inflammatory markers. CONCLUSIONS: serum neopterin concentration is elevated in children with lower respiratory tract infections and may be of clinical value as the marker of a viral infection.

[The case of gastric and ileal bezoar in a 3 year old boy]. / Przypadek bezouaru zoladka i jelita cienkiego u 3-lentniego chlopca.

The authors report a case of a 3-year-old boy with a gastric and ileal bezoar, in whom severe anaemia and tumor in the epigastrium were the main symptoms. Bezoars are rare foreign bodies of the gut. They contain swallowed hair, different fibres, seeds, nutshells, sweets or drugs. The group of risk factors for bezoar formation includes anatomical defects, motoric disorders of the digestive tract, type of prescribed drugs and other coexisting chronic diseases. Most cases need surgical treatment.