Primary child health care services in Lithuania: Does it meet the needs of the children?

BACKGROUND: Primary health care is the foundation of a health system and has a strong influence on the efficiency of the health system as a whole. For children in Europe, it is defined by three primary health care models: paediatric; mixed paediatrician and family physician; and family physician. There is much debate in Europe about which model is most appropriate for children. The Lithuanian model is mixed, although health policy is geared towards the promotion of family physicians, with a decline in the number of primary paediatricians in clinical practice. OBJECTIVES: To review the children's primary health care system in Lithuania, compare the indicators of primary care by family physicians and paediatricians in Lithuania, and identify parents' perceptions of the primary health care model for children. METHODS: A retrospective longitudinal study was performed of children's primary health care indicators for quantity and quality in 2014-2018. A representative opinion survey of 1000 adult respondents was conducted. RESULTS: A total of 3.5 million children's visits to primary care physicians (6.7 ± 3 visits for each child) were registered in Lithuania in 2018. During a recent 5-year period (2014-2018), the number of visits did not change significantly. Visits to paediatricians accounted for 41% of all children's visits to primary care physicians in 2018. Visits to Emergency Departments increased by 20%. The results of the survey showed that 72.3% of the respondents would prefer their children be treated by a primary care paediatrician. CONCLUSION: The mixed paediatrician and family physician health care model gives parents the right to choose. The results showed a decreased number of paediatricians in primary care; paediatric primary care is more frequent than family physician care; and parents tend to trust paediatricians more. The study also showed differences in the models of service used and patterns between regions in Lithuania.

First-Time Acute Lateral Patellar Dislocation in Children and Adolescents: What About Unaffected Knee Patellofemoral Joint Anatomic Abnormalities?

Background and Objectives: Acute lateral patellar dislocation (LPD) is the most common acute knee disorder in children and adolescents, and may lead to functional disability. The purpose of this study was to identify key differences and correlations of the patellofemoral joint (PFJ) morphology between intact and contralateral injured knees in a first-time traumatic LPD population aged under 18 years. Materials and Methods: The data were gathered prospectively from a cohort of 58 patients (35 girls and 23 boys). The prevalence and combined prevalence of patella alta (PA) and trochlear dysplasia (TD) in both knees of patients were evaluated using X-ray by two radiologists. Results: The PFJ of patients' intact knees had a lower rate of TD (1.72% vs. 5.2%) and a less common combination of PA with shallow femoral sulcus (SFS) (22.4% vs. 44.8%) but more frequent PA (62.1% vs. 41.4%) compared with their injured knees. We noted statistically significant positive correlations (SSPCs) between the femoral sulcus angle (FSA) and PA in patients with intact (r = 0.37; p < 0.005) and contralateral injured knees (r = 0.33; p < 0.05). Conclusion: There were SSPCs between the FSA and PA in both gender and age groups of patients with intact and contralateral injured knees. The SSPCs between the FSA and PA of intact knees were higher in the patients with a more dysplastic PFJ anatomy (PA and TD) of the injured knees as compared to patients with only PA of the injured knees.

Two Lithuanian Cases of Classical Galactosemia with a Literature Review: A Novel GALT Gene Mutation Identified.

Galactosemia is a rare autosomal recessive genetic disorder that causes impaired metabolism of the carbohydrate galactose. This leads to severe liver and kidney insufficiency, central nervous system damage and long-term complications in newborns. We present two clinical cases of classical galactosemia diagnosed at the Lithuanian University of Health Sciences (LUHS) Kaunas Clinics hospital and we compare these cases in terms of clinical symptoms and genetic variation in the GALT gene. The main clinical symptoms were jaundice and hepatomegaly, significant weight loss, and lethargy. The clinical presentation of the disease in Patient 1 was more severe than that in Patient 2 due to liver failure and E. coli-induced sepsis. A novel, likely pathogenic GALT variant NM_000155.4:c.305T>C (p.Leu102Pro) was identified and we believe it could be responsible for a more severe course of the disease, although further study is needed to confirm this. It is very important to suspect and diagnose galactosemia as early in its course as possible, and introduce lactose-free formula into the patient's diet. Wide-scale newborn screening and genetic testing are particularly crucial for the early detection of the disease.

Retraction Note to: Stromal vascular fraction cells for the treatment of critical limb ischemia: a pilot study.

The Editor-in-Chief and the publisher have retracted this article [1]. An investigation by the Lithuanian Bioethics Committee concluded that, contrary to the statements in the article, the study described was not conducted in the Vilnius City Clinical Hospital and the Commission of Medical Ethics did not issue any approval for such a study.

Stromal vascular fraction cells for the treatment of critical limb ischemia: a pilot study.

BACKGROUND: Cell-based therapy is being explored as an alternative treatment option for critical limb ischemia (CLI), a disease associated with high amputation and mortality rates and poor quality of life. However, therapeutic potential of uncultured adipose-derived stromal vascular fraction (SVF) cells has not been evaluated as a possible treatment. In this pilot study, we investigated the efficacy of multiple injections of autologous uncultured adipose-derived SVF cells to treat patients with CLI. METHODS: This study included 15 patients, from 35 to 77 years old, with rest pain and ulceration. SVF cells were injected once or twice in the ischemic limb along the arteries. Digital subtraction angiography was performed before and after cell therapy. The clinical follow up was carried out for the subsequent 12 months after the beginning of the treatment. RESULTS: Multiple intramuscular SVF cell injections caused no complications during the follow-up period. Clinical improvement occurred in 86.7% of patients. Two patients required major amputation, and the amputation sites healed completely. The rest of patients achieved a complete ulcer healing, pain relief, improved ankle-brachial pressure index and claudication walking distance, and had ameliorated their quality of life. Digital subtraction angiography performed before and after SVF cell therapy showed formation of numerous vascular collateral networks across affected arteries. CONCLUSION: Results of this pilot study demonstrate that the multiple intramuscular SVF cell injections stimulate regeneration of injured tissue and are effective alternative to achieve therapeutic angiogenesis in CLI patients who are not eligible for conventional treatment. Trial registration number at ISRCTN registry, ISRCTN13001382. Retrospectively registered at 26/04/2017.

Unscheduled return visits to a pediatric emergency department.

BACKGROUND AND OBJECTIVE: Return visits (RVs) to a pediatric emergency department (ED) within a short period after discharge have an influence on overcrowding of the ED and reveal some weaknesses of the health care system. The aim of this study was to determine the rate of RVs and factors related to RVs to the pediatric ED in Lithuania. MATERIALS AND METHODS: A retrospective study in an urban, tertiary-level teaching hospital was carried out. Electronic medical records of all patients (n=44097) visiting the ED of this hospital between 1 January and 31 December 2013 were analyzed. Demographic and clinical characteristics of patients who return to the ED within 72h and those who had not visited the ED were compared. Factors associated with RVs were determined by multivariable logistic regression. RESULTS: Of the overall ED population, 33889 patients were discharged home after the initial assessment. A total of 1015 patients returned to the ED within 72h, giving a RV rate of 3.0%. Being a 0-7-year old, visiting the ED during weekdays, having a GP referral, receiving of laboratory tests and ultrasound on the initial visit were associated with greater likelihoods of returning to the ED. Patients who arrived to the ED from 8:01a.m. to 4:00p.m. and underwent radiological test were less likely to return to the ED within 72h. Diseases such as gastrointestinal disorders or respiratory tract/earth-nose-throat (ENT) diseases and symptoms such as fever or pain were significantly associated with returning to the ED. The initial diagnosis corresponded to the diagnosis made on the second visit for only 44.1% of the patients, and the highest rate of the congruity in diagnosis was for injuries/poisoning, surgical pathologies (77.2%) and respiratory tract diseases (76.9%). CONCLUSIONS: RVs accounted for only a small proportion of visits to the ED. RVs were more prevalent among younger patients and patients with a GP referral as well as performed more often after discharging from the ED in the evening and at night.

Associations between NOD2, IRGM and ORMDL3 polymorphisms and pediatric-onset inflammatory bowel disease in the Lithuanian population.

BACKGROUND AND OBJECTIVE: Recent GWAS and meta-analyses have revealed about 200 susceptibility genes/loci for inflammatory bowel diseases (IBD). However, only a small number of studies were performed in early-onset IBD. The aim of this study was to assess the association between NOD2, IL23R, ATG16L1, IRGM, IL10, NKX2-3 and ORMDL3 variants and early-onset IBD. MATERIALS AND METHODS: A total of 76 affected individuals (30 with Crohn's disease [CD] and 46 with ulcerative colitis [UC]) at the age of ≤17 years and 158 matched controls recruited in Lithuania were genotyped for the known genetic susceptibility variants in NOD2 (Arg702Trp (rs2066844), Gly908Arg (rs2066845) and Leu1007insC (rs2066847)), IL23R (rs11209026), ATG16L1 (rs2241880), IRGM (rs4958847), IL10 (rs3024505), NKX2-3 (rs11190140) and ORMDL3 (rs2872507) genes. RESULTS: Variants in NOD2 (Leu1007insC) and IRGM genes increased risk for CD (OR=6.56, 95% CI: 2.54-16.91, P=1.21×10-5 and OR=2.32, 95% CI: 1.05-5.14, P=0.033; respectively); whereas a variant in ORMDL3 gene was strongly associated with UC (OR=1.99, 95% CI: 1.23-3.20, P=4.15×10-3). CONCLUSIONS: The results confirmed that polymorphisms in NOD2 (Leu1007insC) and IRGM genes are associated with increased risk of CD; whereas the ORMDL3 variant is associated with susceptibility to UC in the Lithuanian early-onset IBD population.

Early development of endocrine and metabolic consequences after treatment of central nervous system tumors in children.

BACKGROUND AND OBJECTIVE: Survival after childhood cancer has dramatically improved during last few decades, implying the need for evaluation and correction of late consequences of the disease and its treatment. The aim of this study was to characterize endocrine and metabolic late effects after treatment of brain tumors in children. MATERIALS AND METHODS: Late complications were analyzed in 51 children treated for brain tumors at the Hospital of Lithuanian University of Health Sciences during 2000-2011. Data on late endocrine and metabolic effects were collected from medical records. Most frequently patients suffered from low-grade glioma (n=17, 33.3%) and medulloblastoma (n=13, 25.5%). The majority (n=42, 82.4%) of the patients underwent surgery; 29 (56.9%) received radiotherapy (RT); 26 (51.0%), chemotherapy; and 17 (33.4%), combined treatment. RESULTS: The median follow-up was 21 months (range 0.25-10.6 years). Most common endocrine consequence was low serum insulin-like growth factor (IGF-I) levels (58.3%), found on average in 30.7 months after cancer treatment. Short stature was observed in 34.6% (mean time to development, 47.7 months), and hypothyroidism in 40.7% of patients (mean time to development, 63.6 months). Low bone mineral density was found in 50.0% of the cases after 44.5 months and overweight in 30.0% after 49.9 months of follow-up. CONCLUSIONS: Survivors of brain tumors suffer from numerous endocrine and metabolic consequences, majority of them developing within the first 5 years after brain tumor therapy. An active follow-up aiming for early diagnosis and therapy is essential for improvement of quality of life in these patients.

Rare refractory Kawasaki disease in an adolescent boy with cardiac and diffuse coronary artery involvement.

Kawasaki disease is an acute multisystemic vasculitis occurring predominantly in infants and young children and rarely in adolescents and adults. At elderly age, Kawasaki disease may remain unrecognized with a subsequent delay in appropriate therapy and an increased risk of coronary artery aneurysms. We report a case of intravenous immunoglobulin- and aspirin-resistant Kawasaki disease and severe cardiovascular damage in an adolescent boy. The article discusses major issues associated with the management of refractory Kawasaki disease.

A mediastinal mass mimicking asthma symptoms.

Extramedullary myeloid sarcoma is a rare form of myelogenous leukemia. It can involve any anatomical body part. Mediastinal involvement is reported in only few cases. We report on a case of extramedullary myeloid sarcoma presenting as a mediastinal mass in a previously healthy nonleukemic male teenager with primary asthmatic complaints and the signs of superior vena cava syndrome.

Factors associated with breastfeeding duration.

BACKGROUND AND OBJECTIVE: The assessment of the factors associated with breastfeeding duration helps in creation of a national policy according to the World Health Organization strategy and recommendations. The objective of the study was to identify the factors associated with breastfeeding duration. MATERIAL AND METHODS: These analyses are based on a sample of mothers with babies attending one family health center in Kaunas, Lithuania. Completed questionnaires were obtained from 195 mothers (response rate, 97.5%). One year later, the same respondents, who had 1-year-old children, answered questions of the second questionnaire. RESULTS: Half (53.8%) of the surveyed women breastfed for 3-5 months, 29.7% for 6 months and more, and 16.5% of the respondents breastfed for less than 3 months. The oldest (31-40 years) women breastfed their babies significantly longer than the youngest (<20 years) mothers. The mothers with a higher education breastfed their babies significantly longer than the less educated mothers. The married women breastfed longer than single or living with a partner. The mothers who did not give extra fluids and pacifiers breastfed significantly longer than the women who gave them. The majority of the mothers who had sore nipples, milk stasis, and mastitis breastfed for only up to 3 months. CONCLUSIONS: Mothers at risk of short breastfeeding duration should be targeted as a group for breastfeeding promotion early in the pregnancy. The education of healthcare professionals who provide prenatal and postnatal care allows them to choose women who need additional breastfeeding support.

Diagnosis and treatment of conduct disorder related to frontal lobe syndrome in a 16-year-old girl.

Conduct disorders are the most frequent psychiatric diagnosis in the pediatric and adolescent population, with different etiology and difficult to treat. Delinquent, aggressive, and impulsive behavior, lack of empathy and inability to predict possible consequences of the behavior lead to significant desadaptation and danger for these patients. In clinical practice, focus is usually given on social and psychological causes of conduct disorders ignoring possible biological factors in etiology and pathophysiology. A clinical case described in this article shows the linkage between frontal brain dysfunction and behavioral symptoms. The first clues of organic brain disorder were multiple and severe symptoms of disinhibition resistant to treatment with dopaminergic drugs and the results of neuropsychological testing. Computed tomography, magnetic resonance imagining, and single-photon emission computed tomography findings were minor and not supported by associated neurological symptoms. However, the location of alterations of brain structure and perfusion significantly correlated with psychopathology. Clarification of the organic cause of the conduct disorder allowed choosing an effective strategy of psychopharmacologic treatment. A positive clinical effect was achieved after switching the treatment from dopaminergic antipsychotic drugs to carbamazepine, which modulates the GABAergic system. Presenting this clinical case, we intended to emphasize the importance of careful attention to the findings of neurovisual and neuropsychological testing diagnosing conduct disorders and individually choosing the most effective psychopharmacologic treatment.

The evaluation of knowledge and activities of primary health care professionals in promoting breast-feeding.

UNLABELLED: The objective of this study was to evaluate the knowledge and activities of Kaunas primary health care center professionals in promoting breast-feeding. MATERIAL AND METHODS: A total of 84 general practitioners and 52 nurses participated in the survey, which was carried out in Kaunas primary health care centers in 2006. Data were gathered from the anonymous questionnaire. RESULTS: Less than half of general practitioners (45.1%) and 65% of nurses were convinced that baby must be exclusively breast-fed until the age of 6 months, but only 21.6% of general practitioners and 27.5% of nurses knew that breast-feeding with complementary feeding should be continued until the age of 2 years and longer. Still 15.7% of general practitioners and 25% of nurses recommended pacifiers; 7.8% of general practitioners advised to breast-feed according to hours. Half of the health professionals recommended additional drinks between meals; one-third of them--to give complementary food for the babies before the age of 6 months. One-third (29.6%) of the health professionals surveyed recommended mothers to feed their babies more frequently in case the amount of breast milk decreased. CONCLUSIONS: The survey showed that knowledge of medical personnel in primary health care centers about the advantages of breast-feeding, prophylaxis of hypogalactia, and duration of breast-feeding was still insufficient.

Significance of dietotherapy on the clinical course of atopic dermatitis.

UNLABELLED: The aim of this study was to determine the efficiency of individual balanced replacement diet in treatment of children with atopic dermatitis, to compare the course of atopic dermatitis and gastrointestinal disorders, as well as the data of skin patch test after a one-year period of dietary treatment. PATIENTS AND METHODS: The study group included 154 children (their age varied from 6 months to 18 years) with atopic dermatitis, for whom food allergens were determined by allergic skin tests (skin prick and patch). These children were recommended an individual balanced replacement diet, where possible food allergens were replaced by other products that do not cause allergic reactions. After a one-year dietary treatment, 109 (70.8%) children (such number came for the second study) were tested repeatedly. The following aspects were evaluated for all these children: clinical course of atopic dermatitis (children's mothers provided answers about exacerbation of allergic rash during the last 12 months, gastrointestinal disorders, and used medicines), severity of the progress of atopic dermatitis (SCORAD index). Besides, skin patch test with 25 food allergens was carried out. RESULTS: Children who followed dietary recommendations were younger than children who failed to follow dietary recommendations because of a variety of reasons (P=0.01). Even 49 (62.8%) patients who followed dietary recommendations have shown the following results during the second test: allergic rash disappeared and they did not have to take medicines against allergy anymore. Patients who followed their individual dietary recommendations more rarely suffered from severe allergic rash problems during a 12-month period (P=0.01) and they had to take fewer medicines against allergy, compared to children who did not follow their dietary recommendations (P=0.001). Clinical course of atopic dermatitis in children who followed individual dietary recommendations was easier compared to children who did not follow such recommendations (P=0.001). During a one-year dietary treatment, 28.2% of children with atopic dermatitis became more tolerant to earlier food allergens. After the comparison of skin patch test results (before dietary treatment and after a one-year period), it was determined that only skin patch tests against buckwheat, oat, beef, and cacao did not change statistically significantly. Results of skin patch tests against other food products were found to be positive more rarely. Besides, children who followed their dietary recommendations suffered from gastrointestinal disorders more rarely as compared to children who did not follow their dietary recommendations (P=0.01). They suffered less from abdominal pain (P=0.01), abdominal distention (P=0.044), and constipation (P=0.035). CONCLUSIONS: Individual balanced replacement diet for children with atopic dermatitis helped to fully control nutrition of sick children from various age groups and had a positive effect on the clinical course of atopic dermatitis. Patients who followed their individual dietary recommendations suffered from severe allergic rash more rarely and they had to take fewer medicines against allergy as compared to children who did not follow dietary recommendations. Clinical course of atopic dermatitis in children who followed individual dietary recommendations was easier as compared to children who did not follow such recommendations. One-third of children with atopic dermatitis became more tolerant to earlier food allergens during a one-year period. After a one-year dietotherapy treatment, positive patch test reactions to many food products appeared to be more rarely, except for buckwheat, oat, beef, and cacao. Besides, children who followed their dietary recommendations suffered from gastrointestinal disorders (abdominal pain, abdominal distention, and constipation) significantly more rarely as compared to children who did not follow their dietary recommendations.

Prognostic value of reticulocyte hemoglobin content to diagnose iron deficiency in 6-24-month-old children.

OBJECTIVE: The aim of our study was to evaluate the prognostic value of reticulocyte hemoglobin content for diagnosis of iron deficiency in 6-24-month-old children. MATERIAL AND METHODS: Children aged 6 to 24 months were consulted for suspected iron deficiency in the outpatient department in 2006-2007. Criteria for inclusion into the study were normal birth time and weight, no infection during the last two weeks before blood sampling (C-reactive protein <5 mg/L), no iron supplements 1 month before the study. Red blood cell, reticulocyte indices and biochemical tests were analyzed. A total of 180 children were enrolled in our study. Iron deficiency was diagnosed when at least two of four parameters (ferritin, transferrin, transferrin saturation, and soluble transferrin receptors) reflected iron deficiency. RESULTS: According to our criteria of iron deficiency, patients were divided into two groups: 116 had iron deficiency and 64 had normal iron stores. The iron deficiency group had significantly lower hemoglobin, mean corpuscular hemoglobin, mean corpuscular volume, reticulocyte hemoglobin content, ferritin, soluble transferrin receptors, iron and higher red cell distribution width, transferrin, and transferrin saturation (P<0.05) compared with the normal iron store group. Reticulocyte hemoglobin content, ferritin, and transferrin saturation had the highest sensitivity and specificity (76.6% and 78.4%, 81.3% and 81.9%, 85.9% and 87.9%, respectively). CONCLUSION: Reticulocyte hemoglobin content is comparable test with ferritin and transferrin saturation and can be used to detect iron deficiency in 6-24-month-old children.

[Relevance of examination and treatment of the most common gastrointestinal disorders in children in Lithuania during the last decade]. / Dazniausiu vaiku virskinimo sistemos sutrikimu tyrimo ir gydymo aktualijos Lietuvoje per pastaraji desimtmeti.

In the last decade, scientific studies in the field of children's gastroenterology performed in Lithuania explored different problems: pathology of Helicobacter pylori infection and food allergy. Our studies revealed that children with atopic dermatitis had gastrointestinal complaints (abdominal pain, diarrhea, distension and unstable stool, which appeared with the exacerbation of skin rash) more often as compared to nonallergic children of the control group. Abdominal pain in children with atopic dermatitis with local rash was more frequent and lasted longer than in control group children, whereas children with extended rash had stools more frequently. Gastrointestinal disorders in children with atopic dermatitis statistically significantly did not depend on the extent of skin rash and severity of atopic dermatitis. In our scientific research on the importance of H. pylori infection on children's gastrointestinal system, children with chronic dyspepsia were examined. Endoscopy, rapid urease test, biopsies from antrum and corpus of stomach and their histological examination as well as serologic tests were done. According to the results obtained, we recommend to examine children with chronic dyspepsia in a complex way: not only endoscopic examination, but H. pylori diagnostic tests should be performed as well. Serologic test is not suitable for screening H. pylori infection in children. Considering this, we recommend to use no fewer than two different methods to diagnose this infection. The highest frequency of H. pylori infection was found in children with duodenal ulcer; histological changes in their gastric pylorus and corpus mucosa were greatest. More than half of children with nonulcer dyspepsia were infected with H. pylori. After eradication of H. pylori infection, the prevalence of dyspepsia in children with duodenal ulcer decreased.

[The quality of life of children suffering from oncologic diseases in Lithuania]. / Onkologinemis ligomis serganciu vaiku gyvenimo kokybe Lietuvoje.

Nearly 80 new cases of pediatric cancer are diagnosed in Lithuania each year. Since 2005, we have been conducting a study evaluating the quality of life of children suffering from cancer in Lithuania. The participants were children between the ages of 2 and 18 years, diagnosed with oncologic diseases during the period from March 2005 to March 2006, and their parents. The PedsQL (Pediatric Quality of Life Inventory(TM)) was used. This questionnaire is specifically designed for investigating the quality of life in children between the ages of 2 and 18 years. The PedsQL questionnaire is designed according to the level of cognitive activity of children and applied to children of four age groups: 2-4, 5-7, 8-12, and 13-18 years of age. The questionnaires were completed by children between the ages of 8 and 18 years in addition to parents of children from all age groups. The families of 63 children suffering from cancer participated in the study. A total of 44 children and teenagers between the ages of 5 and 18 years and 53 parents (mother, father, close relative) filled out the questionnaire. Data from the study showed that children suffering from cancer (irrespective of their age) in addition to their parents evaluated their physical health as being worse than their psychosocial health. The parents had the opinion that children from all age groups experienced negative emotions: the younger children were afraid of giving blood for tests, whereas the older children were worried about the future. In the oldest age group of participants (13-18 years), children felt disease-related fatigue more often than their younger counterparts.

The results of the treatment of childhood medulloblastoma with radiotherapy at Kaunas University of Medicine Hospital in 1994-2000.

UNLABELLED: Medulloblastoma, a primitive neuroectodermal tumor growing in cerebellum, is one of the most sensitive to radiation therapy childhood brain tumors, therefore, this method of treatments is justly considered to be the standard for the treatment of medulloblastoma. The outcome of this malignant brain tumor differs in standard and high-risk groups of patients. The aim of the work was to evaluate the survival rate for children with medulloblastoma according to two risk groups. PATIENTS AND METHODS: Eighteen patients aged from 3 to 18 years with histological proven medulloblastoma treated with standard craniospinal and additional posterior fossa radiotherapy were investigated in our study. Nine patients with disseminated and partial removed medulloblastoma were assigned to the high-risk group and other 9 patients with local ant totally removed medulloblastoma were allocated to the standard risk group. RESULTS: Radiological response of medulloblastoma to the radiation therapy was observed in 15 (83.3%) out of 18 patients: complete radiological response was observed in 6 (67%) out of 9 standard-risk patients and in only 1 (11.1%) out of 9 high-risk patients (p<0.05). Medulloblastoma progressed in 15 (83.3%) patients treated with radiation therapy: relapse rate in the high-risk group was 100% and in the standard-risk group--66.7% (p>0.05). The mean time to progression for all patients was 18.2 months: 28.9 months in standard and 7.4 months in high-risk group (p=0.02). The overall survival for all investigated patients was 25.8 months: 37.2 and 14.3 months in the standard and high-risk groups, respectively (p=0.01). Five years progression-free and overall survival rate for all patients was 16.7%: 0% in the high-risk group and 33.3 % in the standard-risk group (p>0.05). CONCLUSION: In our study the difference in survival rate between standard and high-risk patients with medulloblastoma was shown. We observed a statistically significant longer time to progression and better overall survival in the standard-risk group. However, we did not find any significant differences in other survival indices (response, relapse rates, mortality, five years progression- free and overall survival) between those two risk groups.

Gastrointestinal disorders in children with atopic dermatitis.

UNLABELLED: The aims of this study were to analyze the peculiarities of allergies to food; to determine gastrointestinal disorders, endoscopic signs of mucosal damage and histological lesions of the mucosa and to establish their relation to the extent of atopic dermatitis and its degree of severity. MATERIAL AND METHODS: A total of 164 children (86 boys and 78 girls) suffering only from atopic dermatitis were examined. Atopic dermatitis was diagnosed using standard diagnostic criteria; extent of disease (the Basic Clinical Scoring System (BCSS)) and the severity (Scoring Atopic Dermatitis (SCORAD) index), total serum IgE levels were determined; skin prick and patch tests with the main food allergens were performed. Using questionnaire gastrointestinal disorders with the symptoms of atopic dermatitis were ascertained. In children with atopic dermatitis suffering from chronic dyspepsia esophagealgastroduodenoscopy was performed and biopsy samples from the antrum of the stomach and duodenum were taken. RESULTS: The age of patients ranged from 6 months to 18 years. According to extent of atopic dermatitis and degree of severity localized, mild atopic dermatitis prevailed. Analysis of the changes in total Ig E levels showed different degree of sensitization of the children examined. Considering the type of allergic reaction, immediate-type allergic reactions dominated only in 11.6% of children with atopic dermatitis, whereas delayed-type allergic reactions manifested in 44.5% of children. No food allergy was present in one-fifth of children with atopic dermatitis. One hundred four (63.4%) children complained of gastrointestinal disorders. Of these 104 patients, 17 children (mean age 6.9 years) who underwent esophagealgastroduodenoscopy with biopsy had no pathology; however, histological examination of mucosa revealed eosinophilic infiltration in the gastric antrum and duodenum in three children. CONCLUSIONS: The most common gastrointestinal disorders are: abdominal pain vomiting, diarrhea, abdominal distention, and constipation. The incidence of gastrointestinal disorders does not depend on the extent and severity of atopic dermatitis. Gastrointestinal disorders manifest independent of the type of allergic reactions inducing atopic dermatitis. The most common food allergens, such as soy, milk, peanuts, corn, carrots, rye, wheat, white of the egg, cod, and chicken were determined by skin patch test. According to our data, no pathology was found in children with atopic dermatitis during endoscopic examination. Our data showed that allergic-like changes in gastric and duodenal mucosa were present only in older (7-10-year-old) children.

The humoral immuneresponse to Helicobacter pylori infection in children with gastrointestinal symptoms.

The prevalence of Helicobacter pylori is high in Eastern Europe. The purpose of this study was to estimate the prevalence of H. pylori in symptomatic Lithuanian children and to identify the infection by clinicopathological and serological analyses. One hundred sixteen symptomatic children (age 8-16) with gastritis and duodenal ulcer were included. Biopsies were histologically assessed according to the Sydney-System. Serum IgG antibodies against H. pylori were detected by an enzyme-linked immunosorbent assay (ELISA), using low molecular mass antigen. The western blot technique was used to detect serum antibodies against the cytotoxin-associated protein (CagA) using whole cell antigen. Histologically the prevalence of H. pylori infection was 79% and not influenced by demographic factors. Mucosal inflammation and atrophy were associated with a H. pylori infection. Intestinal metaplasia was found in eight children, suggesting early H. pylori acquisition in life. Increased levels of IgG antibodies were detected in 57% of children. The prevalence of IgG antibodies was significantly higher in patients with duodenal ulcer compared to children with gastritis. Forty-four (67%) H. pylori-seropositive children had antibodies against CagA. Low molecular weight-ELISA and whole cell-western blot results were significantly associated with histopathology, the presence of duodenal ulcer and the CagA status. A high number of false seronegative cases were due to poor immunological responses in children and poor locally validated tests. The prevalence of H. pylori infection in Lithuanian children is higher compared to Western Europe. The infection is acquired in early life. Diagnosing H. pylori infection, serology is helpful, but endoscopy/histology remains as gold standard.