Biochemical markers of bone cell activity in children with type 1 diabetes mellitus.

AIMS: To evaluate bone turnover in children with type 1 diabetes mellitus (DM1) at onset, after 3 and 12 months of treatment, and in children with longer duration of disease, and its association with glycemic control. PATIENTS AND METHODS: 17 children with DM1 at onset, 30 with DM1 of longer duration and 45 controls participated in the study. Tartrate-resistant acid phosphatase 5b (TRACP5b), crosslinked C-terminal telopeptides of type I collagen (CTX) and osteocalcin (OC) were assessed. RESULTS: At onset of DM1 osteocalcin (p < 0.0003) and log CTX (p < 0.003) were lower than in controls but returned to reference levels after 3 months of therapy. TRACP5b in children with DM1 increased gradually and after 12 months was higher than at onset (p < 0.03). OC at onset inversely correlated with HbA1c (r = -0.40, p = 0.03). In children with DM1 of longer duration and HbA1c > 6.5%, sex-dependent differences were found in OC and CTX. Girls with HbA1 > 6.5% had lower OC and CTX than controls (p < 0.005, p < 0.003). Inverse correlations were found between HbA1c and OC and CTX (r = -0.50, p = 0.04; r = -0.49, p = 0.03). CONCLUSIONS: Proper glycemic control has a beneficial influence on bone turnover, which may prevent low bone mass in adulthood.

The role of radioisotopic methods in imaging of intervertebral disc inflammation in children.

The authors present the case of a 17-year-old girl, with pain over lumbar spine area, treated by paediatricians and rehabilitation specialists, discussing diagnostic imaging and laboratory examinations together with clinical observations. Spondylodiscitis was diagnosed after bone scintigraphy with 99mTc-MDP, the course of disease was monitored by immunoscintigraphy amongst other techniques.

[Selected aspects of the epidemiological analysis of celiac disease and diabetes mellitus type 1 coexistance in children and youth]. / Wybrane aspekty analizy epidemiologicznej wspólwystepowania celiakii i cukrzycy typu 1 u dzieci i mlodziezy.

UNLABELLED: Modern serological tests and changed clinical appearance are the causes of more frequent occurrence of celiac disease (CD) in general population, also in risk groups for instance in patients suffering from diabetes mellitus type 1 (DM t. 1). The aim of the study was to estimate the frequency of CD in patients with DM t. 1 and attempt at evaluation of some factors making to incidence. MATERIAL AND METHODS: It was examined 446 patients (titre of anty-endomysial antibodies (anty EMA), endoscopic biopsy in these with titre > 1OIF). The frequency of CD elevated 5.16%, it was sex and duration of DM t. 1 independent. Children with confirmed CD were younger and earlier suffered from DM t. 1 in comparison with these negative anty EMA. RESULTS: Higher frequency of CD in younger children, who suffered from DM t. 1 to the completion of the fourth year was shown. It wasn't stated the relationship between duration of DM t. 1 and frequency of CD. CONCLUSIONS: This study indicates the necessity to perform serological studies of CD in diabetic patients. Annual screening tests of CD in first fourth years of DM t. 1 in children before the completion of the fourth year of life seem to be justified.

Ectopic virilising adrenocortical tumour in the spinal region in an 8 year-old boy: a case report and review of the literature.

INTRODUCTION: The adrenocortical rest tumours are the very rare entity in the pediatric population. They are usually found along the gonadal descent paths (celiac axis, the broad ligamen, the adnexa of the testes or the spermatic cord). They have been also described to occur at rare ectopic sites like intracranial locations, placenta, kidney, pancreas and liver. CLINICAL CASE: Here we present a unusual case of an ectopic, virilising, primary adrenocortical tumour localized in the spinal region in a 8 years-old-boy. DISCUSSION: This is the first case of functional ectopic, adrenocortical tumour localized in the spinal region in a pediatric population. We discuss here the clinical presentation and the diagnostic challenges and provide the review of the literature.

[Analysis of type 1 diabetes mellitus symptoms at admission to hospital]. / Analiza objawów cukrzycy typu 1 u dzieci i mlodziezy w momencie zgloszenia sie do szpitala.

AIM: The aim of study was analysis of type 1 diabetes mellitus symptoms at admission to hospital. MATERIAL AND METHODS: Thirty-seven patients (21 boys and 16 girls) aged from 1.87 to 19.75 years with admitting diagnosis of diabetes mellitus in the year 2000 (the greatest count of patients) were analyzed. In statistical analysis the t-Student test was used. RESULTS: The most frequent symptoms was dry sensation in mouth 95% of patients, polydypsia 84%, polyuria 65%, lose on weight 49%, nocturia - 27% children. Nine children were admitted to hospital in serious ketoacidosis. Twenty-eight children were admitted to hospital in good condition. There were not essential abnormalities in the blood. Observation period in poor general condition group was shortest for children living in the country - on the average 9 days versus patient from cities - 18 days. There was not difference in good general condition group. HbA1c, pH, HCO3 values were statistically significant. In 3 cases diagnosis of diabetes mellitus was preceded by an eliminating others diseases. In 2 children hyperglycemia was established by chance. CONCLUSION: 1) Ketoacidosis symptoms and serious state was observed in 1/4 patient admitted to hospital. 2) It is necessary to take diabetes mellitus into consideration more often in differentiation in pediatric practice. 3) Short observation period of severe ketoacidosis symptoms in-patient from country origin and dismiss preliminary diagnosis may indicate insufficient healthy education - especially in the field of diabetes mellitus. 4) Less than half of patients report to family doctors.

[Epidemiology of type 1 diabetes mellitus in Bydgoszcz region in the years 1997-2002]. / Epidemiologia cukrzycy typu 1 w regionie bydgoskim w latach 1997-2002.

INTRODUCTION: Type 1 diabetes mellitus belongs to the diseases most often appearing in the developmental age. The incidence of this disease is characterized by the constant dynamic increase. AIM: The purpose of this work was to estimate the value and the dynamics of the incidence of type 1 diabetes mellitus in children from Bydgoszcz region and its analysis according to sex, age, place of residence and season of diabetes diagnosis. MATERIAL AND METHODS: In the period from 1997 to 2002 type 1 diabetes mellitus was recognized in 161 children (80 boys and 81 girls) up to the 14th age of life in separate age groups: 0-4 years: 20; 5-9 years: 68; 10-14 years: 73. The incidence was estimated with the help of an index which was the number of new-recognized type 1 diabetes mellitus cases during one year in the population of 100 000. The number of population was taken from Demographic Yearbook of Provincial Office. RESULTS: The average annual index of the incidence for the six-year period being analyzed was 13.55, it balanced in the following years from 9.44 (1997) up to 15.28 (2002). The highest index of incidence (16.34) was noted in 2000 year. The increase in number of falling ill was observed in groups: 5-9 years old and 10-14 years old. Rarely the diabetes was recognized in the youngest children. The diabetes was almost twice more often recognized in children living in towns (16.30) in comparison with those living in the country (8.84). Revelation of the diabetes takes place mainly in the autumn and winter months. The least number of falling ill was noted in June. The seasonal incidence was observed mainly in children over 5 years. CONCLUSIONS: 1. The index of the type 1 diabetes mellitus incidence among 0-14 year old children was 13.55. 2. During the years 1997-2002 this index increased from 9.44 to 15.28. 3. The diabetes was almost twice more often recognized in children living in towns. 4. The number of becoming ill depends on the season of the year.

[Alleles of HLA-DQB1 and familial aggregation of type 1 diabetes]. / Allele genu HLA-DQB1 a rodzinne wystepowanie cukrzycy typu 1.

The HLA complex, located on the short arm of chromosome 6, is the strongest genetic marker for type 1 diabetes (T1DM). In previous study we demonstrated association between genes HLA-DRB1 and HLA-DQB1 and T1DM in the Polish population. There is a strong-independent association of alleles HLA-DRB1*0401 and DQB1*302, despite population linkage disequilibrium among alleles of these genes. The aim of the current study was to verify a hypothesis that some alleles or haplotypes of HLA-DRB1, DQA1 and DQB1 genes increase the risk for familiar aggregation of T1DM. We analysed 507 patients with IDDM derived from 80 multiplex and 325 patients from simplex families. PCR and hybridisation with SSO probes performed HLA typing for DRB1, DQA1 and DQB1 alleles. Genetic analysis demonstrated strong association of allele HLA-DQB1*0302 with T1DM in the Polish population in families with single (DM1) and more numerous cases (DM2) cases, compared with healthy cases (n=103). The HLA-DQB1*302 allele frequencies were 27.8% vs 8.7%; Pc<10(-5); OR(95%CI)=4,03(3.80-4.25) and 16.3% vs 8.7%; Pc<0.04; OR(95%CI)=2.04(1.79-2.89), respectively. The presence of allele HLA-DQB1*0602 has a strong protective effect from T1DM in both studied groups (1.46% vs. 13.6%; Pc<10(-5); OR(95%CI)=0.09(-0.25-0.44) and 0.98% vs. 13.6%; Pc<10(-5); OR(95%CI)=0.06(-0.46-0.58), respectively. Interestingly, HLA-DRB1*04 allele more often co-segregated with DM2 families as comparing the DM1 group (31.0% vs. 15.8%, respectively; Pc<10(-5)). However in both cases differences remain significant as compared to controls: Pc<10(-5), OR (95%CI)=3.52(3.33-3.70) and Pc<10(-5) OR(95%CI)=6.17(5.97-6.37), for DM1 and DM2 respectively. Subtyping of HLA-DRB1*04 alleles demonstrated that the strongest predisposing effect has been identified with DRB1*0401. Moreover, difference in frequencies of the protective allele HLA-DQB1*0301 among DM1 and DM2 group was revealed (8.8% vs. 13.7%, respectively; Pc<10(-5)) and the protective effect of this allele remained only significant in DM1 group: 8.8% vs. 19.9%; Pc<10(-5); OR(95%CI)=0.39(0.19-0.58). The results suggest that it is likely that familial aggregation of T1DM is associated with lower frequency of protective alleles of HLA-DQB1 gene.