Ghrelin, Obestatin and Their Receptors As Well As Metabotropic Glutamate Receptor Assessment in Chronic Functional Constipation in Children.

OBJECTIVES: The aim of this study was to examine the role of ghrelin, obestatin, and glutamate and their receptors in the pathogenesis of children functional constipation. METHODS: Children ages 4-17 were the subject of the study: 121 children with constipation (55 boys and 66 girls), 36 patients of the same age (26 boys and 10 girls) were the controls. Expression of ghrelin, obestatin, and glutamate receptors on gastric and colon specimens taken by endoscopy were assessed. The concentration of the above agents was estimated in serum by the enzyme-linked immunosorbent assay test. RESULTS: The lower median serum concentrations of ghrelin, in the constipated children than in controls were confirmed (1.9 ng/mL vs 2.6 ng/mL, P < 0.05). The expression of the metabotropic receptor 7 for glutamate (mGlu7) RNA was higher in the stomach (32.49 vs 31.47, P < 0.05), and was lower in the rectum in constipated patients compared to the control group (31.76 vs 32.62, P < 0.05). A negative correlation between the concentration of ghrelin in serum and colonic transient time (P = 0.01, rho = -0.23) was shown in the study group.Higher median expression of obestatin receptor G protein-coupled receptor39 in rectal mucosae was found in a constipated group than in the controls (29.9 vs 26.9, P < 0.05). CONCLUSION: Ghrelin, and receptors for ghrelin, obestatin, and glutamate in gastrointestinal mucosa play a role in the pathogenesis of functional constipation in children.

Dyssynergic Defecation and Anal Sphincter Disorders in Children in High-Resolution Anorectal Manometry Investigation.

OBJECTIVES: Dyssynergic defecation is a common disorder in children with functional constipation (FC) because of relaxation disorders of the sphincter apparatus and intra-rectal pressure during defecation. The aim of the study was to determine frequency and type of dyssynergic defecation and to assess pressure in the anal canal poles during simulated evacuation and function of puborectalis muscle in defecation in children with FC. METHODS: Three-dimensional (3D) high-resolution anorectal manometries (3D HRAM) were performed in 131 children with FC. In the manometric test, resting pressure measurements were assessed in 4 measuring poles of the anal canal. RESULTS: One hundred thirty-one children ages 5 to 17 years (mean age 10.2; SD ±â€Š3.8; median 10) were involved in the study (69 girls and 62 boys). Dyssynergic defecation was shown in 106/131 (80.9%) examined children. A statistically significant difference between the age of examined children (P < 0.02) and intrarectal pressures at the anal canal measuring points (left P < 0.009, right P < 0.005, anterior P < 0.01) was found. Correlation between the residual pressure values in lateral anal canal measurement poles and intrarectal pressure was demonstrated in all types of dyssynergy (left: r = 0.69, P < 0.0005; right: r = 0.74, P < 0.0005). In a group of 53/131 (40.5%) children, 3D HRAM showed a rectal pressure increase during simulated defecation, because of the dysfunction of the puborectalis muscle. CONCLUSION: The increase in sphincter pressure in lateral and posterior poles in I and II types of dyssynergia and in lateral poles in other types of dyssynergia may depend on relaxation disorders of the puborectalis muscle during defecation.

Morphological study of the ureterovesical junction in children.

Morphological and morphometric assessment of the elements of the ureterovesical junction in children was performed in the present study in different age groups ranging from 24 weeks of gestation to 16 years old. We tried to answer the question whether, in human ontogenesis, there is a period of anatomical predisposition to primary vesicoureteral reflux. The study included 210 urinary bladders with juxtavesical parts of the ureters that had been obtained from routine autopsies. As a result of the study, we showed that provided the pregnancy is uncomplicated there is no inherited susceptibility that would account for reducing or disturbing the development of ureterovesical junction elements. Based on the analysis of our results concerning the anatomy and morphological changes taking place in the elements of the ureterovesical junction in different age groups, one could put forward a hypothesis that anatomical predisposition to primary vesicoureteral reflux occurs in age group II, i.e. between 28 and 37 weeks of gestation. The parameters that define interrelations between elements of the ureterovesical junction and that are considered essential for normal functioning of antireflux mechanism were still observed in age group VI in our study. This suggests that these relations are not unambiguous in children with normally structured and functionally competent vesicoureteral junction.

Inhaled drug airflow patterns and particles deposition in the paediatric respiratory tract.

PURPOSE: The effectiveness of inhaled drugs is strictly related to areas reachable by drug particles. Unless particles reach the desired part of the bronchial tree, their influence might not meet the expectations. Consequently, the disease progress might not be stopped or even slowed down. Therefore, the primary objective of this research was to analyze the airflow patterns and particle deposition of a standard inhaled drug using computational fluid dynamics. METHODS: The study was devoted to the analysis of the particle diameter influence on their deposition areas within the entire respiratory tract. Two patient-specific respiratory tract models, for 6 and 12-year-old patients, were reconstructed based on the computed tomography examinations. Numerical analyses were carried out as stationary ones with the constant inflow of the particles of various diameters (within the range of 1-50 µm). It was proven that depending on the particle size, their deposition within the respiratory tract varies significantly. RESULTS: The vast majority of the particles with diameters over 20 µm is gathered on the walls of the throat, whereas particles of diameters 5-15 µm are accumulated mainly on the trachea walls, leaving the alveoli insufficiently supplied with the drug particles. CONCLUSIONS: The inhaled drug size cannot be treated as negligible factor during the drug spraying. An improper distribution of the particles might not inhibit the symptoms of the asthma. Numerical simulations may improve drugs selection and visualize their distribution along the airways, which might accelerate asthma treatment personalization.

[Analysis of frequency, clinical course and treatment of Crohn's disease based upon the own material and experience]. / Analiza czestosci wystepowania, przebiegu klinicznego oraz terapii choroby Lesniowskiego-Crohna u dzieci w materiale wlasnym.

AIM OF THE STUDY: a retrospective analysis of Crohn's patients remaining to be taken care in Gastroenterology Department of the Polish Mother's Memorial Hospital, in the period of time between 2002-2007. MATERIAL AND METHODS: A five-year retrospective medical charts of patients with inflammatory bowel disease (IBD) in Gastroenterology Department were studied. The study group with proved CD underwent the analysis according to age, signs, clinical course and activity of the disease, complications, and the type of treatment application. RESULTS: Among 62 children with inflammatory bowel disease 63% (39) patients (aged from 7 months to 18 years) were diagnosed as CD. Most of them were boys (62%), aged above 7 years old, but some cases of very young children (babies) were also noted as Crohn's disease. Among the symptoms most frequently abdominal aches concomitant by loose stools and growth impairment were observed. The most constant laboratory signs of the disease were lower iron concentration in the blood, anaemia and much higher platelets number. Pathology assessment of the biopsy specimens taken from terminal ileus during colonoscopy and the measurements of the thickness of ileum wall on ultrasound examination were the keys in making the final diagnosis, because this part of alimentary tract was most often the localisation of the disease in the study group. High activity index (PCDAI >51) and severe course of the disease were sticking features of most of our patients, especially in younger children. Some severe complications were developed particularly in young patients and in the children with delayed diagnose. CONCLUSIONS: CD in children presents a wide heterogeneity of clinical signs and symptoms, high activity, may revealed at any age, more frequently affecting boys. Early age of the onset of the disease and delayed diagnosis and treatment are the risk factors of CD very severe complications developed.

[Risk of lithiasis and urolithiasis in children with unspecific inflammatory bowel disease]. / Zagroienie kamica i kamica ukladu moczowego u dzieci z nieswoistymi zapaleniami jelit.

UNLABELLED: Urolithiasis is a disease of a complex, often systemic and not fully unequivocal, etiopathological mechanism, resulting in concrement crystallization The aim of study was the evaluation of frequency of occurrences of crystallization risk states and urolithiasis in children with IBD. MATERIAL AND METHODS: The study was conducted on 35 children aged between 12 and 18 with confirmed ulcerative colitis (25 children) and Crohn disease (10 children). In all children regiular urine examination and urine inoculation were conducted, as well as stimation of concrement crystallization risk index in a twenty-four hour urine collection. Urinary tract ultrasound as well as evaluation of erythrocytes in urine sediment in phase contrast microscope,have been performed. Control group consisted of 20 children without digestive tract complains. RESULTS: In 13 (37%) of examined children, urolithiasis occured in family history. The general urine examination revealed in 27 (77%) examined children existence of erytrocyturia of various degree and the evaluation in phase contrast microscope indicated their extraglomucal origin. The ion-creatininal analysis of twenty-four hour urine collection revealed in 29 (82.2%) children risk of oxalate-calcium concrements crystallization and in 6 (17%) children--of oxalate concrements crystallization. USG examination revealed in 4 (11.4%) children existence of single or multiple concrements in urinary system. Analysis of 1 twenty-four hour urine collection indicated the decrease of magnesium ions in 27 (77%) examined children. In control group only in 2 (5.7%) children the risk of occurrence of phosphate-ammonium concrements crystallization, which was significantly lower in examined group (p < 0.01). CONCLUSIONS: Unspecific intestine inflammations have an influence on the occurrence of crystallization risk states, as well as a fully symptomatic urolithiasis.

The role of adhesion molecules in inflammatory bowel disease in children. Assessment of the possible risk of cardiovascular complications.

INTRODUCTION: Inflammatory bowel diseases (IBD) are chronic diseases that proceed with exacerbation and remission phases. Adhesion molecules play a significant role in inflammatory processes. The same adhesion molecules play an important role in atherogenesis. AIM: To assess the risk of atherosclerosis in IBD in children. MATERIAL AND METHODS: The study included 40 patients with IBD (25 with Crohn's disease - CD and 15 with ulcerative colitis - UC) aged 4-17 years. In the study group, concentrations of selected adhesion molecules (intracellular adhesion molecule - ICAM, vascular cell adhesion molecule - VCAM, E-selectin) and selected parameters of lipid metabolism in serum were assessed. RESULTS: No statistically significant differences between CD and UC patients and in the control group, in mean values of selected adhesins were obtained. Average variable VCAM was significantly lower in patients with CD than in patients with UC in the active stage of the diseases. Significantly higher average levels of triglycerides (TG) and high density lipoproteins (HDL) were found in the control group than in patients with CD. Significantly higher levels of total cholesterol (CHL) and HDL were noticed in the control group patients than in the patients with UC. The HDL/CHL was significantly higher in controls than in patients with UC. CONCLUSIONS: No increased risk of developing atherosclerosis was found in children with IBD. Decreased risk in patients during exacerbation of inflammatory bowel disease was revealed, which may result from malnutrition typical for acute disease phase.

[Detrusor pseudohyperactivity syndrome in children with constipation]. / Zespól rzekomej nadreaktywnosci wypieracza u dzieci z zapaciami.

THE AIM OF THE STUDY: was the evaluation of dependencies occurring between constipation and observed nocturia, pressing tenesmus and daytime urinary incontinence. MATERIAL AND METHODS: the studies were conducted in 51 children aged between 3 and 17 years including 25 girls and 26 boys hospitalized in the Clinical Department because of nocturia, pressing tenesmus and daytime urinary incontinence. In all children a complex diagnostic work up of the urinary system and the lower segment of alimentary tract was performed. Results of the examinations were compared to the control group. RESULTS: analysis of the results of the conducted examinations indicates that the overblown rectal ampulla, through the pressure exerted on the urinary bladder, seemingly decreases its volume causing the occurrence of pressing tenesmus, nocturia and daytime urinary incontinence. This process leads to the formation of detrusor hyperactivity syndrome characterized by: chronic constipation, increase of miction frequency and simultaneous decrease of volume of each portion of urine, nocturia and/or daytime urinary incontinence. CONCLUSIONS: chronic constipation disturbs the functional-morphological equilibrium between the end segment of alimentary tract and the urinary bladder. By influencing the process of filling and accumulation of urine in the bladder they lead to the formation of detrusor hyperactivity syndrome.