[Kawasaki disease--personal observations]. / Choroba Kawasaki--obserwacje wlasne.

The aim of the study was to analyse two cases of Kawasaki disease--the first one with myocardial infarction and the second with positive outcome. Kawasaki disease is a fever disease usually occurring in very young children. Vasculitis is a characteristic feature of Kawasaki disease. Etiology of this disease is unknown. Diagnosis is based on typical clinical symptoms such as: fever, rash, conjunctivitis, lymphadenitis colli, inflammation of the mucous membranes, erythema of the hands and feet. The treatment can prevent thrombosis, myocardial infarction which are the most serious complications of the disease. Kawasaki disease is treated with intravenous gamma--globulin therapy and high dosage acetylsalicylic acid at the beginning of the disease. Such a treatment of Kawasaki disease prevents the coronary vessel lesions.

Risk of HCV infections among children with cancer and health-care workers in children's hospitals.

After the outbreak of an endemy of HCV infections in the paediatric haematology and oncology wards, epidemiological analysis was performed for cancer children, health-care workers and controls. The study included a total of 639 persons, divided into four groups. The results were as follows: 1) The number of infected paediatric cancer patients was 100/237 (42.4%). 2) Of the 44 health-care workers in the haemato-oncology ward none was infected with HCV. 3) In the other parts of the hospital, five out of 258 (1.9%) permanently employed staff at risk of occupational exposure to blood and other body fluids were infected with HCV; however, the infection rate included only nurses (5/125, i.e. 4%). 4) One hundred adults consecutively tested for anti-HCV antibodies before a planned surgical procedure were not infected with HCV (control group). This study shows that complex nonspecific prophylaxis and full awareness in everyday work has helped to prevent transmission of HCV from highly contagious patients to medical personnel, particularly to nurses who have the highest occupational risk.

[Own experience in the application of midazolam (Dormicum) before the diagnostic examinations an short surgical procedures in children]. / Doswiadczenia wlasne w zastosowaniu midazolamu (Dormicum) przed badaniami diagnostycznymi i krótkimi zabiegami chirurgicznymi u dzieci.

In this paper the evaluation of midazolam (Dormicum) efficiency in obtaining basic sedative effect in 36 children during diagnostic examinations and short surgical operations was done. In 26 patients good sedative effect was obtained. Forgetfulness was present in 17 from 25 patients above 2 years of life, and partial in the rest 8 patients. Fear reactions were observed in 10 children with lower doses of this medicine. Side effects were observed in 8 patients, and had a transient character and were not dangerous for the patients' life.

[The lack of parental acceptance of the stress associated with neoplastic disease of the child as a cause of treatment failure]. / Brak akceptacji rodziców wobec stresu zwiazanego z choroba nowotworowa dziecka jako przyczyna zaniechania leczenia.

Three unsuccessful cases of neoplastic diseases in children were described. No parents cooperation with treatment center led after good initial response to the progression of disease and the death of children. The reason of such parents' decisions was incapability to manage the stress caused by child's disease.

[Diagnosis of infectious mononucleosis in children]. / Rozpoznanie mononukleozy zakaznej u dzieci.

Clinical course of infectious mononucleosis was analysed in 36 children. Heterophilic antibodies were found in 27.8% of children at the age of six or less, and in 72.2% of older ones, mainly between 5-15 day of disease. Mild, mainly haematological complications occurred in 13.8% of cases.

[Study on behavior of thyroid gland hormones in Bydgoszcz province children and teenagers with simplex struma]. / Badania nad zachowaniem sie hormonów tarczycy u dzieci i mlodziezy województwa bydgoskiego z rozpoznanym wolem prostym.

Struma caused by iodine deficit is an endemic disorder in specified regions. The purpose of the study was a biochemical characteristic of struma simplex in children from Bydgoszcz province and evalued correlation between laboratory exponents of thyroid gland function, size of the gland and kind of the struma. It was confirmed that neutral struma of children generally takes a course with euthyroidism. In children with struma were confirmed significant lower values of T4 and no significant higher values of T3. Value of TSH was no different in comparison with the control group. Proved was that hormonal thyroid activity is lower when struma is getting bigger.

[Efficacy of passive and active immunization against HBV infection in children with neoplastic diseases]. / Skutecznosc bierno-czynnej immunizacji przeciw HBV u dzieci z chorobami nowotworowymi.

The efficacy of 3 schemes of passive and active prevention of HBV infection was evaluated in 47 children with haematologic proliferative diseases. Twenty-six children suffering from leukemia (group I) received passive immunisation (hepatitis B immunoglobulin) in six week intervals during intensive chemotherapy and were vaccinated on maintenance therapy. Thirteen children with Hodgkin or B-non-Hodgkin lymphoma (group II) received active immunisation from the beginning of intensive chemotherapy with two doses of immunoglobulin. Eight children who had completed their therapy (group III) were vaccinated only. Among children who completed vaccinations, 5/8 in group I, 4/7 in group II and 5/5 in group III produced protective anti-HBs levels. Passive/active prophylaxis was successful in most patients suffering from neoplastic diseases and reduced the endemy of HBV infection in our department from 43.3% to 2.56% infected subjects. Among 7 patients vaccinated from the beginning of treatment (group II), 4 of them produced protective levels of anti,-HBs, despite intensive chemotherapy.

[Concurrence of HBs antigen and anti-HBs antibodies in children infected with HBV]. / Wspólistnienie antygenu HBs i przeciwcial anty-HBs u dzieci zakazonych HBV.

Two cases of concurrence of HBs antigen and antibodies in boys, who acquired HBV infection within the first two years of life are described. Authors discuss possible explanation of that fact.

[Spontaneous pulmonary hemosiderosis in a 4-year old boy]. / Samoistna hemosyderoza pluc u 4-letnieg Chlopca.

A case is presented of spontaneous pulmonary haemosiderosis in a four-year-old boy. During three years of follow-up a severe disease episode occurred in the child, requiring treatment in Intensive Therapy Unit. Good therapeutic effect was achieved after combination of corticosteroid treatment with imuran.

[Preliminary evaluation of adverse effects after administration of arabinoside cytosine (Ara-C) in high doses to children with acute myelogenous leukemia]. / Wstepna ocena objawów niepozadanych po podaniu arabinozydu cytozyny (Ara-C) w duzych dawkach dzieciom z ostra bialaczka mieloblastyczna.

Five children with AML were treated with high-doses of Ara-C (2 g/m2) during consolidation. After 17 cycles the toxicity was evaluated. Granulocytopenia (< 0.5 x 10(9)/l) and thrombocytopenia (< 25 x 10(9)/l) were stated after 15/17 and 13/17 cycles respectively. The nadir of bone marrow suppression appeared between day 10 and 14. In one case treatment related death during severe myelosuppression was noted. In individual cases jaundice with elevated activity of aminotransferases, paralytic ileus and pulmonary oedema were observed. All these adverse reactions were reversible. Other toxicities such as nausea/vomiting, stomatitis, diarrhea, infections and drug related fever were transient. No neurologic toxicity was seen. There is a need for developing a new way of the administration of high-dose Ara-C which could substantially reduce toxicity of the drug.

[Histiocytosis X in children--course of the disease and treatment]. / Histiocytosis X u dzieci--przebieg choroby i leczenie.

A clinical analysis was carried out of the course of the disseminated form of the disease in 20 children aged from one month to 8 years (mean age 11 months). Unfavourable prognostic significance was confirmed of such factors as: child's age at the time of falling ill lower than two years, number of the involved organs and their dysfunction, and lacking reaction to treatment during the first three months of the disease.

[Burgdorf's reaction (painful acral erythema) in patients with acute lymphoblastic leukemia following medium-dose methotrexate therapy]. / Reakcja Burgdorfa ("painful acral erythema") po leczeniu posrednimi dawkami methotreksatu chorych z ostra bialaczka limfoblastyczna.

Erythematous changes of the palms with associated oedema, blistering and desquamation were observed in two children during chemotherapy for acute lymphoblastic leukaemia, after methotrexate in doses of 1,000 mg/m2. These changes correspondent to those described in the literature as Burgdorf's reaction. In Poland it was never reported as yet.

[Studies of methotrexate pharmacokinetics in children with neoplasms of the hematopoietic system after administration of different doses of the drug]. / Badania farmakokinetyki metotreksatu u dzieci z nowotworami ukladu krwiotwórczego po podaniu róznych dawek tego leku.

Concentration of MTX was determined in the serum after the infusion of MTX in a dose of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2 to 24 children with ALL/NHL. The mean value of steady-state concentrations of MTX was two-fold greater after the infusion of a dose of 1.0 g/m2 and ten-fold greater after the infusion of a dose 5.0 g/m2 than at dose 0.5 g/m2. Great inpatient and interpatient variations of serum MTX concentrations were observed. Pharmacokinetic analysis of the data revealed biphasic model of the elimination. Statistically significant differences were found between the half-life MTX values (ti/2 alpha) in the first postinfusion day: the higher the dose, the shorter ti/2 was observed. The ti/2 of MTX during the second postinfusion day was significantly longer than that of the first day after infusion, but values for the higher doses were not significantly shorter than those for 0.5 g/m2. Systemic clearance (Cl) of MTX showed inpatient and interpatient variations of the values. However, no statistically significant difference was found between Cl values at doses of 0.5 g/m2, 1.0 g/m2 and 5.0 g/m2.

[Cerebrospinal fluid methotrexate level in children treated with medium-high and high doses of the drug]. / Stezenie metotreksatu w plynie mózgowo-rdzeniowym u dzieci leczonych srednio duzymi i duzymi dawkami leku.

Concentrations of MTX were determined in the cerebrospinal fluid (csf) and serum after intravenous infusion of MTX at intermediate dose (0.5-1.0 g/m2) and at high dose (5.0 g/m2) to 20 children (33 infusions) with ALL/NHL. The cytotoxic concentrations of MTX in csf (> 1.0 microM/l) were reached in half of the cases after the infusion of MTX at intermediate dose and in all patients after the infusion of 5.0 g/m2. Great inpatient and interpatient variations of MTX concentrations in csf were observed. No statistically significant difference was found between mean systemic clearance of MTX in patients with MTXcsf concentrations > 1.0 microM/l and < 1.0 microM/l after infusion of MTX at intermediate dose.

Jaundice following high--dose arabinoside cytosine in a child with acute myelogenous leukemia.

A girl with acute myelogenous leukemia (AML) was treated with high dose arabinoside cytosine during consolidation. She developed jaundice twice after the completion of 3 rd and 4 th cycle of the drug. The jaundice was characterized by conjugated hyperbilirubinemia, elevated aminotransferases and alkaline phosphatase. The histologic study of the liver showed only infiltration by mononuclear cells in portal space and scarce bile pigment in some hepatocytes. In both cases jaundice receded spontaneously. Now the patient has been in complete remission for 36 months and subsequent liver function tests are normal.

[Lyell's syndrome--possibly drug-induced epidermal necrolysis in a 7-year-old boy]. / Zespól Lyella--prawdopodobnie polekowa martwica naskórka u 7-letniego chlopca.

In a 7-year-old child Lyell's syndrome was observed with extensive bullous epidermal necrolysis with a very severe clinical course. The disease could have been explained as a toxic-allergic reaction to sefril and aspirin taken for pharyngitis.