[Assessment of the natural history and clinical presentation of acetonemic vomiting]. / Ocena przebiegu i obrazu klinicznego wymiotów acetonemicznych u dzieci.

INTRODUCTION: Ketosis in children may result from physiological adaptation to situations like fasting, fat-rich diet, straining physical activity, as well as from serious endocrine or metabolic disorders. The most frequently diagnosed cause of ketoacidosis are states of acetonemia and acetonuria with vomiting, during airways infections. GOAL: Assessment of the natural history and clinical presentation of acetonemic vomiting in children. PATIENTS AND METHODS: 85 children from 18 months to 12 years of age with acetonemic vomiting were incorporated in this study. Detailed anamnesis, clinical examination, and chosen laboratory parameters were analyzed. RESULTS: In 18% of the children a familial pattern of the disease was observed, 75% of the parents declared that their children had fat-rich meals on a regular basis, in 47% there was a tendency to recurrent respiratory tract. The most frequently observed symptoms were incoercible vomiting with nausea (100%), abdominal pain (87%), headaches (35%) and febrile states (62%). Ketosis triggers were: infections with insufficient fluid and food intake (68%), and child overfeeding with fat-rich products (23%). Observed biochemical disturbances were ketosis (mean J3-hydroxybutyric acid serum concentration--1.03 mmol/l, SD +/- 0.83), acetonuria, hypoglycemia (15%), metabolic acidosis (17%) and dyselectrolytemia (14%). The treatment of the children consisted in intravenous and oral rehydration, managing acid-base and electrolyte disturbances. CONCLUSION: In some children acetonemic vomiting is recurrent, and thus prophylactic management is im- portant in children who are at risk.

Serum TARC and CTACK concentrations in children with atopic dermatitis, allergic asthma, and urticaria.

BACKGROUND: Thymus and activation-regulated chemokine (TARC/CCL17) and cutaneous T cell-attracting chemokine (CTACK/CCL27) belong to the CC chemokine family, which plays an important role in immune-inflammatory processes. It has been demonstrated that serum concentrations of TARC and CTACK are increased in patients with various allergic diseases. AIM: To compare serum TARC and CTACK concentrations between children with different clinical manifestation of mast cell-dependent diseases, such as atopic allergy and urticaria. METHODS: A total of 87 children including 26 with mild to severe atopic dermatitis (AD), 43 children with controlled allergic asthma symptoms (treated and untreated with anti-inflammatory drugs), and 18 children with urticaria were recruited into the study. The control group consisted of 31 healthy non-atopic children. RESULTS: Serum concentrations of TARC and CTACK were significantly higher in children with AD than in healthy controls. No significant differences in serum concentrations of the chemokines between asthmatics, urticaria patients, and healthy controls were found. The severity of AD symptoms significantly correlated with serum CTACK and TARC concentrations. CONCLUSION: These findings, in conjunction with earlier data, indicate that differences may exist in circulating concentrations of TARC and CTACK, between patients with atopic allergy and urticaria.

Cytokine production by peripheral blood CD4+ and CD8+ T cells in atopic childhood asthma.

There are conflicting studies on T cell cytokine production in childhood asthma. In this study intracellular cytokine expression of IL-2, IL-4, IL-10, IL-13, IFN-γ, and TNF-α in CD4(+) and CD8(+) T cells in children with atopic asthma were measured by flow cytometry. Results. A significant increase in the percentage of CD4(+) and CD8(+) T cells producing IL-4 and IL-13 and decrease in the percentage of CD4(+) producing IFN-γ in asthmatic children was found. The percentage of CD4(+)/IL-13(+) was significantly higher in severe asthma than in children with intermittent disease symptoms. Severity of asthma was associated with increased both serum IgE and frequencies of CD4(+)/IL-13(+) T cells, as well as duration of disease. Moreover, a decrease in FEV(1), FEV(1)/FVC was observed in relation to the severity of asthma. Changes in cytokine profile in CD8(+) subpopulation didn't depend on the severity of the disease. Conclusions. Increased production of IL-4 and IL-13 in both CD4(+) and CD8(+) T cells accompanied by decreased IFN-γ expression in CD4(+) T cells may be evidence that both lymphocyte subpopulations are implicated in the pathogenesis of asthma. Relationship of CD4(+)/IL-13(+) T cells with disease activity suggests that this lymphocyte subset may have a prominent role in childhood asthma.

[Periodic fever, aphtosus stomatitis, pharyngitis, cervical adenopathy syndrome (PFAPA syndrome) in 4-years old girl--case report]. / Zespól okresowej goraczki, aftowego zapalenia jamy ustnej, zapalenia gardla oraz limfadenopatii szyjnej (PFAPA) u 4-letniej dziewczynki--opis przypadku.

Characteristic feature of PFAPA syndrome is periodic episodes of fever recurring in 21-28 days in infants and young children. Fever is accompanied by aphtosus stomatitis, pharyngitis and cervical adenopathy. Diagnosis of this syndrome are based on typical clinical manifestations, because there are no characteristic changes in laboratory findings. The reason of this syndrome is unknown. We described a case of 4 years old girl with typical manifestations of this syndrome. We excluded others reasons of periodic fever. PFAPA syndrome passed after 2 years of duration after adenothomy.