Maternal smoking decreases antioxidative status of human breast milk.

OBJECTIVE: To evaluate the influence of maternal smoking on antioxidative capacity and intensity of oxidative damage in breast milk. STUDY DESIGN: The study group (n=30) was comprised of postpartum women who declared smoking more than five cigarettes per day during pregnancy and lactation (confirmed by the urinalysis of cotinine concentration), and their newborns. Control group included 29 non-smoking postpartum women and their newborns. Colostrum samples were collected on the 3rd day after delivery and breast milk samples between the 30th and the 32nd day after delivery. Morning maternal and neonatal urine samples were obtained on the day of the mature milk sampling. Isoprostane concentrations in colostrum/mature milk and urine were determined immunoenzymatically. Total Antioxidant Status (TAS) of colostrum/breast milk was determined by Rice-Evans and Miller method. RESULT: Colostrum TAS in smokers was significantly lower than in non-smokers (P=0.006). In both groups, the TAS of mature milk was higher compared with colostrum, but significant differences were observed amongst smokers only (P=0.001). In smokers the isoprostane concentration of mature milk was significantly higher than the colostrum concentration (P=0.001). Significant inverse correlation between maternal urinary isoprostane concentration and the TAS of mature breast milk was observed in smokers (R=-0.525, P=0.023), but not in non-smokers (R=0.161, P=0.422). CONCLUSION: This study revealed that maternal smoking triggers harmful effects on an infant by impairing pro-oxidant-antioxidant balance of breast milk.

Serum gastrin concentration and changes in G and D cell densities in gastric antrum in children with chronic gastritis.

BACKGROUND: Elevated gastrin concentration leading to gastritis is explained as the effect of change in the density of D and G cells. The aim of the study was to determine and compare fasting serum gastrin concentrations, G and D cell densities in gastric antrum mucosa in children with chronic gastritis and in children with no gastritis or Helicobacter pylori infection. MATERIAL AND METHODS: A total of 184 patients aged 6-18 years, with chronic abdominal pain underwent endoscopic examination. We created three groups: I--patients with chronic gastritis and H. pylori infection; II--patients with chronic gastritis but no H. pylori infection; III--patients with neither gastric mucosal abnormalities nor H. pylori infection. G and D cell densities were determined in the biopsy specimens (using Rbalpha H Gastrin & Somatostatin antibodies). Fasting serum gastrin concentrations were measured using a Beckmann gamma-counter and a GASK-PR kit. RESULTS: The mean serum gastrin concentration in group I was higher when compared with group II (p = 0.04) and group III (p = 0.019). No statistically significant differences were found between groups II and III (p = 0.91). There were no statistically significant differences in G and D cell densities between groups. CONCLUSION: The mean G/D cell ratios in groups I and III were almost identical. The mean fasting serum gastrin concentration was higher in children with both chronic gastritis and H. pylori infection compared with patients without infection or without antral inflammation. No difference in the G cell density or D cell density in children was found, regardless of the presence or absence of gastritis or H. pylori infection.

Tolerance of interferon-alpha therapy in children with chronic hepatitis B.

OBJECTIVE: To assess the side-effects of interferon-alpha (IFN-alpha) therapy in children with chronic hepatitis B. METHODS: This prospective study was performed on one hundred children by interviewing the patients and their parents; clinical examinations and laboratory investigations were performed during and after therapy. RESULTS: The most frequent side-effects of IFN-alpha therapy were fever, flu-like symptoms, and headaches. Lowering of the mean haemoglobin level, leukocyte and platelet count was significant, but transient during INF-alpha treatment. No increase in autoantibody titres or significant alterations in thyroid function was observed. Twelve months after treatment, hepatitis Be antigen (HBeAg) elimination and alanine aminotransferase (ALT) normalization was achieved in 46% of the children; HBeAg and hepatatis B surface antigen (HBsAg) elimination, together with ALT normalization, was achieved in 14% of the cases. CONCLUSION: The side-effects of the IFN-alpha therapy in children such as fever, flu-like symptoms and bone marrow suppression are common, but transient and mild.

Multicenter retrospective analysis of various primary pediatric malignant hepatic tumors--management in a series of 47 Polish patients (1985-1995).

Forty-seven children treated in various Polish centers between 1985 and 1995 for primary malignant liver tumors were retrospectively analyzed. Hepatoblastoma (HB) prevailed--it was found in 39 cases. There were 6 hepatocarcinoma (HCC) cases and 2 cases of undifferentiated sarcoma (UDS). In 44% of HB patients the tumor involved both liver lobes. 18% of children with HB presented with pulmonary metastases at diagnosis. Chemotherapy was applied in 92% of cases (preoperatively in 67%). Tumor resection was performed in 56% of HB patients. Overall survival of patients with hepatoblastoma was 43.6%, while it was 50% for hepatocarcinoma and 100% for undifferentiated sarcoma (2 cases only). Mean observation time was 58 months. The hepatoblastoma subgroup, being the largest (83% of all cases), was analyzed separately for prognostic factors. Completeness of tumor excision strongly influenced survival. Involvement of both lobes of the liver and multifocality of the tumor were other adverse prognostic factors.

Prognostic factors in the treatment of chronic hepatitis B with interferon alpha in children.

One hundred children with chronic hepatitis B, aged 1-17.3 years participated in the study. The results of treatment with interferon alpha (IFN-alpha) were evaluated. An attempt was made to define the factors predicting positive response to treatment. Three million units of IFN-alpha 2a or 2b were given by subcutaneous injections to analysed patients 3 times a week for 20 weeks. Positive treatment outcome reflected in HbeAg elimination was observed in 46% of children. High AlAT activity preceding therapy had a statistically significant effect on positive treatment outcome. The inhibition of HBV replication caused by the treatment was permanent and it coexisted with the normalisation of AlAT activity in blood serum. Full response to therapy with IFN-alpha measured with the elimination of HbeAg and HbsAg was observed in 14% of children. It was favoured by high AlAT activity before treatment and short HBV duration.

Protein carbonyl groups' content as a useful clinical marker of antioxidant barrier impairment in plasma of children with juvenile chronic arthritis.

The purpose of our study was to find out the intensity of free radical reactions in pediatric patients with different forms of juvenile chronic arthritis (JCA) on the basis of carbonyl groups' content in plasma proteins, evaluated with the use of Levine's method. We examined a population of 52 children with diagnosed JCA of different types and activities in the study. The carbonyl groups' content in plasma proteins of ill children was significantly higher than in healthy group (1.36 +/- 0.68 vs. 0.807 +/- 0.16 nmol/mg of protein). The carbonyls increased parallell with the activity of the disease; their content was significantly higher in children with high-disease activity than in children with medium- or low-disease activity. Moreover, children with oligoarthritis had carbonyls level 1.09 +/- 0.59 nmol/mg of protein, vs. 1.62 +/- 0.82 in children with systemic type of JCA. The values of carbonyls in children with polyarthritis were and 1.36 +/- 0.50 nmol/mg of protein. Correlation between the carbonyl groups content and the activity or the type of JCA may allow use of carbonyls as a clinical marker of antioxidant barrier impairment in this group of patients. This aspect of the disease may undergo pharmacologic modification in future.

Epidemiological and clinical characteristics of rotaviral diarrhoea in children from Gdansk, Gdynia and Sopot.

The aim of the present work was to analyse clinical picture of rotaviral diarrhoea and its incidence in children from Tri-city. The study was conducted on 773 children aged 1 month-11 years, who were treated in selected hospitals in 1997 due to acute diarrhoea. Apart from physical examination and collecting patients' medical history, each child was subjected to routine laboratory investigations in accordance with clinical indications. Rotaviral aetiology of the infection was confirmed in 275 out of 773 patients with acute diarrhoea. In 80.7% cases, the disease affected children aged 7-36 months old and it was more frequent in boys than in girls. Acute diarrhoea was diagnosed mainly during cold months of the year, and the increase of its incidence was recorded between March and May. The duration of the disease usually did not exceed 3 days and its symptoms included fever, vomiting and dehydration which normally required parenteral administration of fluids. Statistical analysis was performed in order to estimate the differences in the incidence and intensity of the symptoms of rotaviral and bacterial diarrhoea. The present study showed that clinical picture of rotaviral diarrhoea in children from Tri-city was similar to that reported in literature on the subject, but there were differences regarding the seasonal occurrence of the infection which was probably related to the climate of analysed region.

Various types of cholestatic jaundice in infants--causes and diagnostic problems.

The purpose of this review was to evaluate possible differentiation between various causes of different types of cholestatic jaundice in children. Analyses were performed in 33 infants from 3 weeks to 3.5 years old with symptoms of cholestatic jaundice. The most frequent causes of cholestasis were congenital atresia of extrahepatic bile ducts (30%) and the CMV infection (20%). On the basis of the performed examinations it should be concluded that in order to differentiate between the causes of cholestatic jaundice it is necessary to do a series of tests as there is no specific diagnostic method which would be effective.

Bleeding from alimentary tract in pseudo Zollinger-Ellison syndrome.

The report describes a case of a four-month-old infant, who developed acute gastric ulcer while being hospitalised because of pneumonia. One year's observation of the patient, additional tests, especially gastroscopy with histopathological evaluation of biopsy specimen, determination of gastrin level in blood serum, and therapy analysis allow to establish a diagnosis of pseudo Zollinger-Ellison syndrome.

Association of inflammatory pseudotumor of the liver and Papillon-Lefevre syndrome--case report.

A case of hepatic inflammatory pseudotumor mimicking malignancy in a 4-year-old girl with the Papillon-Lefevre syndrome (PLS) is reported. Only recently, an association between this inherited syndrome and liver abscesses has been found. Its possible pathogenesis is discussed and immunologic defects resulting from the Papillon-Lefevre syndrome are presented. The development of inflammatory pseudotumor of the liver might be caused by immunologic disturbances and staphylococcal infection. The picture of the hepatic tumor on imaging in patients with PLS should be attributed rather to inflammatory than neoplastic process.

Clinical and pathological importance of cagA-positive Helicobacter pylori strains in children with abdominal complaints.

BACKGROUND: The aim of this study was to assess the correlation between the prevalence of Helicobacter pylori strains possessing cytotoxin-associated gene A (cagA) in children and the intensity of clinical complaints and morphological changes of the gastric mucosa. MATERIALS AND METHODS: A group of 80 children with gastrointestinal complaints was included in this study. Pathologists examined mucosal biopsy specimens from these patients. The urease test and multiplex polymerase chain reaction (MPCR) were used to identify H. pylori strains. RESULTS: In the group of children infected with cagA-positive H. pylori strains, fourth-degree gastritis was more frequent than in the group with cagA-negative H. pylori colonization. In histopathological assessment, infection with cagA-positive H. pylori was associated also with higher grades of inflammatory intensity and activity. CONCLUSIONS: Marked inflammation of the antral mucosa was significantly more frequent in children infected with cagA-positive H. pylori than in those infected with cagA-negative H. pylori, as assessed endoscopically and histopathologically. No specific symptoms for cagA-positive and cagA-negative H. pylori infection were observed.

Duodenogastric reflux: clinical and therapeutic aspects.

BACKGROUND: Duodenogastric reflux is believed to cause damage to gastric mucosa. Most reports on this disorder concern adult patients. PATIENTS AND METHODS: 1120 children with abdominal pain were studied; endoscopic features of duodenogastric reflux were found in 92 patients. To confirm the diagnosis of duodenogastric reflux, cholescintigraphy (Tc99-HEPIDA) was performed. Children with confirmed duodenogastric reflux by scintigraphy were given a prokinetic drug (cisapride). RESULTS: Endoscopic features of duodenogastric reflux were found in 92 children; the diagnosis was confirmed by scintigraphy in 59 patients. There was no significant difference in the severity of inflammation in gastric mucosa compared with the control group, whereas significantly fewer of these patients were infected with Helicobacter pylori. There was no correlation between regions of isotope accumulation and inflammatory lesions in the stomach. The prokinetic drug (cisapride) helped eliminate or greatly reduce duodenogastric reflux in children. CONCLUSIONS: When endoscopic features of duodenogastric reflux are found the final diagnosis should be based on an examination that does not itself influence the motility of the gastrointestinal tract: cholescintigraphy seems to be a useful method. However, because the use of milk as a test meal affects the scintigraphic image, there was no correlation between the area of isotope accumulation and the localisation of inflammatory lesions in the stomach. Duodenogastric reflux seems to be less important as a cause of inflammatory lesions than other factors (such as genetic predisposition, stress, etc). Prokinetic drugs have a beneficial influence on treatment results in children with inflammatory lesions of gastric mucosa with duodenogastric reflux.

[Carbonyl groups content on the basis of protein peroxidation analysis with total antioxidant status in blood of children with cancers]. / Ocena aktywnosci reakcji wolnorodnikowych na podstawie analizy peroksydacji bialek w powiazaniu z calkowita obrona przeciwutleniaczowa krwi u dzieci z choroba nowotworowa.

Toxic oxygen free radicals have been implicated as important pathologic mediators in carcinogenesis. Several reports have found antioxidants and enzymes related to the antioxidants function at increased or decreased levels in blood of patients with cancers. In previous publications we observed that antioxidant barrier can be different in healthy children and children with cancers. This time we were looking for a stable marker of damaging effect of free radicals reactions in association with antioxidant barrier in blood. Carbonyl group level in proteins has been introduced as a good marker of oxidative stress damage. For this study we selected 60 children at the age of 3 to 16, who had been diagnosed as suffering from cancers: malignant (m) bone tumors (t) (n = 25), m. brain t. (n = 20), lymphoma malignum (n = 5), m. liver t. (n = 5) and m. germ cell t. (n = 5). The control group consisted of 40 age-matched healthy children (22 boys and 18 girls). We investigated the concentration of carbonyl groups (CG) in serum spectrofotometrically, according to the method of Levine. Plasma total antioxidant status (TAS) was estimated colorometrically with radical cation ABTS (2,2'-Azino di-[3-ethylbenzthiazoline sulphonatel]), erythrocyte glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) activities were assessed according to the method of Paglia & Valentine and Minami & Yoshikawa respectively (Kits of Randox Laboratories Ltd.). In this study the content of CG in plasma proteins has shown a significant increase (1.60 +/- 0.77 vs 0.78 +/- 0.15 nmol/mg protein, p < 0.001) and erythrocyte GSH-Px activity has shown a significant decrease (16.3 +/- 7.9 vs 25.1 +/- 15.8 U/gHb, p < 0.02) in children with malignant tumors. No differences were observed in SOD activity and TAS between sick and healthy children. A possible interpretation of this data suggests an inadequate antioxidants' protection in children with cancers. The relationship between the oxidative damage and carcinogenesis requires further investigations.

[Ethyol (amifostine): application trial in pediatric oncology]. / Ethyol (Amifostyna)--próba zastosowania w onkologii pediatrycznej.

UNLABELLED: Myelotoxicity is one of the major chemotherapeutic side effects. In some adult and paediatric studies it has been shown that amifostine protects bone marrow from toxic effects of alkylating agents and platinum compounds without reduction in overall cytotoxic action. AIM OF THE STUDY: To test an efficacy of amifostine as a myeloprotectant in multiagent chemotherapy containing alkylating agents or platinum analogues. Amifostine was used in 8 children from 3 to 15 yrs of age treated with chemotherapy (CHT) for cancers. It made total number of 28 courses. Amifostine was administered every other CHT course in a dose of 750 mg/m2. The degree of myelotoxicity measured at nadir was compared between with- and without amifostine CHT courses. Anaemia, leucopenia and thrombocytopenia of WHO grades I and II were qualified as mild toxicity while grades III and IV were recognized as severe. RESULTS: Severe anaemia, leucopenia and thrombocytopenia were found after 3/14 (21%), 8/14 (57%) and 6/14 (43%) courses with amifostine. Proportion of these side effects in identical CHT courses without amifostine in the same pts. was as followed: 1/14 (7%), 7/14 (50%) and 9/14 (64%). Differences among both groups were statistically significant (p = 0.025). Mild side effects (nausea, vomiting, transient hypotension) accompanied amifostine administration in 29% of courses (4/14). CONCLUSION: Preliminary results suggest that amifostine decreased the number of severe thrombocytopenias after CHT. The drug was well tolerated by children.

[Atypical picture of osteosarcoma situated in fibula of a 14-year-old boy]. / Nietypowy obraz miesaka kosciopochodnego kosci strzalkowej u 14-letniego chlopca.

This paper presents the case of osteogenic sarcoma, situated in fibula of 14-year-old boy. The X-ray picture of this tumor was typical of unicameral cyst, but histopathological examination showed traits of osteosarcoma. Only magnetic resonance suggested the presence of malignant neoplasm.

[Results of conservative treatment for regressive vesicoureteral reflux in childhood]. / Wyniki postepowania zachowawczego we wstecznych odplywach pecherzowo-moczowodowych u dzieci.

The study involved 112 children with 169 confirmed vesicoureteric reflux grades I, II, III. During anti-bacterial treatment which lasted at last two years, spontaneous regression occurred in 82% of the vesicoureteral reflux. Renal scars were observed in 8% of the cases. Initially urinary tract infection was diagnosed in 84% of the children. This figure was reduced to 8% after anti-bacterial treatment. 54% of the observed children had associated diseases (anaemia, chronic enteropathy, bronchitis and pneumonia). The results confirmed the efficiency of anti-bacterial treatment in children with vesicoureteral reflux grades I, II, III.

[Selenium, glutathione peroxidase and TBARS in plasma of children with malignant diseases of the hematopoietic system]. / Selen, peroksydaza glutationowa i zwiazki TBA-reaktywne w osoczu dzieci z chorobami rozrostowymi ukladu krwiotwórczego.

The selenium and TBARS concentrations and glutathione peroxidase activity were measured in the plasma of children with leukemia, lymphoma and histiocytosis X. A group of fifty-four children aged 1 to 16 years was divided into the following age groups: 1-3, 3-7, 7-16 years. In the patients aged 3-7 and 7-16 years, plasma selenium concentration and glutathione peroxidase activity were significantly lower than in age-matched healthy children.

Cholescintigraphy in the diagnosis of duodenogastric reflux in children, preliminary report.

The gastroduodenal reflux is considered, to be one of the important factors in the pathogenesis of gastritis and gastric ulcers. Endoscopic features suggesting bile reflux are not fully objective and may be a reason for false diagnosis of gastroduodenal reflux. The following study was established to verify the endoscopically diagnosed bile reflux by a scintigraphical test. In 30 of the 350 patients we showed bile reflux endoscopically, but 21 of them had duodenogastric reflux confirmed by cholescintigraphy. The autors maintain that cholescintigraphy seems to be a very useful method in the proper diagnosis of bile reflux.

[Evaluation of gonadal hormone function in adolescent girls after antineoplastic therapy]. / Ocena funkcji hormonalnej gonad u dziewczat po przebytym leczeniu przeciwnowotworowym.

In 17 girls after the complex anti-neoplasm therapy we estimated the state of genital organs and the course of menorrhagia cycle together with plasma levels of beta-estradiol, progesterone and prolactin assessed by RIA. We found the secondary lack of menorrhagia together with lowered progesterone and beta-estradiol levels in 3 girls, in whom the abdominal cavity was irradiated. In other 3 girls the transient lack of menorrhagia was stated in the course of chemotherapy.