Association between uridin diphosphate glucuronosylotransferase 1A1 (UGT1A1) gene polymorphism and neonatal hyperbilirubinemia.

OBJECTIVE: To assess the prevalence of UGT1A1*28 and UGT1A1*60 polymorphisms of UGT1A1 gene and their association with hyperbilirubinemia. STUDY DESIGN: The study was performed at a single centre - at the Department of Obstetrics of the Medical University of Gdansk in Poland. DNA was isolated from Guthrie cards of 171 infants. Only full term newborns (gestational age 38-42 weeks) were included in the study. Fluorescent molecular probes were used for UGT1A1 promoter variation analysis. The presence of UGT1A1*28 polymorphism was detected with a dual-probe system, and UGT1A1*60 with a SimpleProbe™. RESULT: Homozygous UGT1A1*28 and UGT1A1*60 genotypes were detected in 14.6% and 20.5% of the newborns, respectively. Homozygous (G/G) genotypes of UGT1A1*60 polymorphism were found in all of the UGT1A1*28 (i.e. (TA)7/(TA)7) homozygotes. More than 80% (55/66) of the children with "wild" type UGT1A1*28 genotype (where no polymorphism was detected) (i.e. (TA)6/(TA)6) carried the "wild" (T/T) genotype of UGT1A1*60 as well. The UGT1A1*28 polymorphism was detected more often among neonates with elevated bilirubin. Hyperbilirubinemia was diagnosed more frequently in boys. CONCLUSION: Polymorphisms of the UGT1A1 gene frequently co-exist in neonates. The presence of UGT1A1*28 polymorphism and male gender seem to predispose to neonatal hyperbilirubinemia.

Graves' disease, Celiac disease and liver function abnormalities in a patient--clinical manifestation and diagnostic difficulties.

Autoimmune diseases due to probable common pathogenesis tend to coexist in some patients. Complex clinical presentation with diverse timing of particular symptoms and sophisticated treatment with numerous side effects, may cause diagnostic difficulties, especially in children. The paper presents diagnostic difficulties and pitfalls in a child with Graves' disease, celiac disease and liver function abnormalities.

The mRNA level of the transforming growth factor ß1 gene, but not the amount of the gene product, can be considered as a potential prognostic parameter in inflammatory bowel diseases in children.

PURPOSE: Transforming growth factor ß1 (TGF-ß1) plays a role in cell proliferation and differentiation, and it can modulate immune response. In this work, we asked whether levels of either TGF-ß1 or mRNA of the corresponding gene in plasma or tissue can be useful in diagnosing and/or monitoring of the clinical course of inflammatory bowel diseases (IBD). METHODS: The study group consisted of 104 pediatric patients with IBD: 36 with Crohn's disease (CD) and 68 with ulcerative colitis (UC); 42 children represented the control group. TGF-ß1 levels in plasma and intestinal mucosa were estimated by ELISA and immunohistochemistry (IHC), respectively. Levels of TGF-ß1 mRNA were determined by reverse transcription and real-time PCR. RESULTS: In patients with IBD, and in subgroups with CD and UC, no significant differences in the TGF-ß1 level in plasma and tissue were found relative to the control group. These variables were not dependent on the stage of the disease, its activity or severity of endoscopic and histopathological findings. TGF-ß1 mRNA levels were significantly higher in tissue samples withdrawn during the relapse of the disease than in those taken during the remission or in the control group. However, no correlation between TGF-ß1 plasma levels and TGF-ß1 mRNA amount in the intestinal mucosa was observed. CONCLUSIONS: The TGF-ß1 mRNA level, but not the amount of the gene product, was significantly increased in the pathologically changed tissue during the relapse of IBD. We suggest that this parameter might be considered as a potential prognostic value when assessing IBD in children.

[Reliability of self-reported maternal smoking during early lactation period]. / Ocena wiarygodnosci badan ankietowych dotyczacych palenia tytoniu przez kobiety we wczesnym okresie laktacji.

UNLABELLED: Smoking cigarettes is very common among lactating women. The objective evaluation of an exposure to cigarette smoke is needed, as cotinine concentration. On many research a questionnaire is the only determinant of fact and intensification of smoking. The aim of this research was to establish a reliability of the questionnaire concerning cigarette smoking among lactating mothers by analyzing cotinine/creatinine ratio. MATERIAL AND METHODS: In 51 lactating mothers (participants of the research on oxidative stress in Obstetrics Departments on 3rd day post partum) during check-up visit, on 30th day post partum a questionnaire concerning smoking cigarettes before, during pregnancy and after childbirth, and amount of cigarettes smoked was made. Samples of matutinal urine were deep freezed in - 700 till cotinine was evaluated immunoenzymatically. Women were divided into groups: I of non-smokers (32 women), II of smokers (19 women). Statistical analysis was made by means of unparametric test U Mann-Whitney. RESULTS: Average cotinine/creatinine ratio was 33,8 ng/mg in group I; 1275.9 ng/mg in group II. Specificity and sensitivity of data earned by virtue of statement of correspondents was 81% and 89%. Test of cotinine concentration in urine demonstrated 100% sensitivity and 94% specificity compared to the cotinine/creatinine ratio. Directly proportional relationship was stated between amount of cigarette smoked and concentration of cotinine in urine (55.9 ng/ ml cotinine/cigarette). CONCLUSIONS: A questionnaire should not be the only method evaluating smoking among lactating women. The concentration of cotinine shows slightly lower specificity than cotinine/creatinine ratio. Both tests can be dealt equivalent.

[Pleiotropic action of vitamin D3 with particular stress on its role in gastrointestinal diseases in children]. / Plejotropowe dzialanie witaminy D3 ze szczególnym uwzglednieniem jej roli w chorobach ukladu pokarmowego u dzieci.

This review presents aspects of pleiotropic actions of vitamin D3, in particular amongst the development period population. It describes the relationship between vitamin D3andgastrointestinal diseases (inflammatory bowel disease, celiac disease, liver and pancreas pathologies), central nervous system and cardiovascular diseases. Moreover, we underline the role of vitamin D3 in the epidemiology and pathogenesis of malignancies and autoimmune diseases.

[Role of transforming growth factor beta1 (TGF-beta1) in the pathogenesis and clinical course of chronic hepatitis in children]. / Rola transformujacego czynnika wzrostu beta1 (TGF-beta1) w etiopatogenezie i przebiegu klinicznym przewleklych zapalen watroby u dzieci.

UNLABELLED: Transforming growth factor-beta1 (TGF-beta1) is known to play a key role in processes of cell proliferation and differentiation. It also plays an important role in modulation of the immune response. Various diseases may arise both from excessive and insufficient activity of this cytokine. THE AIM OF THE STUDY was to evaluate the role of TGF-beta1 in the pathogenesis of chronic hepatitis (Ch.h.) and to assess whether TGF-beta1 level in plasma or its tissue expression can be useful in diagnosing and monitoring of clinical course of this disease. PATIENTS AND METHODS: Twenty-one children with chronic hepatitis were included in the study and 42 healthy children constituted the control group. Liver function tests and TGF-beta1 plasma levels measured by ELISA method were evaluated in both groups of patients. In liver tissue obtained by needle biopsy, the histopathological grading and staging of hepatitis was evaluated, TGF-beta1 protein was assessed by immunohistochemical methods and TGF-beta1 gene expression was measured by reverse transcription and real-time polymerase chain reaction. RESULTS: In chronic hepatitis group of patients the plasma TGF-beta1 level did not differ from the control group and did not correlate with grading and staging of the liver tissue while positive correlation was observed with gamma-glutamyl transpeptidase activity in the serum. There was no correlation between tissue TGF-beta1 expression and TGF-beta1 plasma level and staging or grading in liver tissue. TGF-beta1 gene expression correlated positively with ESR and ALAT activity but no correlation with TGF-beta1 plasma level, TGF-beta1 gene or protein expression, grading or staging in liver tissue were observed. CONCLUSION: 1. In children with chronic hepatitis, TGF-beta1 plasma level is not related to grading or staging in the liver tissue. This finding may be due to low level of fibrosis observed in the studied children. 2. It appears that local expression of TGF-beta1 in liver tissue should not be used as a sole marker in differentiating and monitoring the course of chronic hepatitis. 3. In children with chronic hepatitis assessment of liver TGF-beta1 gene expression is not helpful in the evaluation of pathological changes in liver tissue. 4. Due to the relatively low number of patients in the analysed groups it seems advisable to perform similar complex studies in larger groups of children with chronic hepatitis.

[Gene polymorphism of transforming growth factor beta1 (TGF-beta1) in the pathogenesis and clinical course of chronic hepatitis in children]. / Polimorfizm genu transformujacego czynnika wzrostu beta1 (TGF-beta1) w etiopatogenezie i przebiegu klinicznym przewleklych zapalen watroby u dzieci.

UNLABELLED: Transforming growth factor beta1 (TGF-beta1) is a cytokine modulating the immune response. The role of TGF-beta1 gene polymorphisms in the incidence and modification of the clinical course of these diseases has been recently evaluated. THE AIM of the study was to assess the relation between TGF-beta1gene polymorphism and the incidence of chronic hepatitis, the course of the disease, TGF-beta1 level in plasma and TGF-beta1 mRNA expression in liver tissue. PATIENTS AND METHODS: The studied group comprised 21 patients with chronic hepatitis including 10 with HBV infection, 4 with HCV infection and 7 with autoimmune hepatitis (AIH). Forty-two children were included in the control group. Analysis of four studied polymorphisms of TGF-beta1 gene was based on CAPS (Cleaved Amplified Polymorphic Sequence) method, TGF-beta1 level in plasma was estimated using sandwich ELISA. TGF-beta1 mRNA expression was evaluated by reverse transcription and real-time polymerase chain reaction (Real-Time PCR). RESULTS: No correlation between studied polymorphisms and the incidence or clinical course of chronic hepatitis was found. There were no significant differences in TGF-beta1 level in plasma and mRNA expression depending on polymorphisms of TGF-beta1 gene. CONCLUSIONS: 1. The polymorphisms of TGF-beta1 gene do not appear to influence the incidence and clinical course of chronic hepatitis in children. 2. Due to relatively low number of patients in the analysed groups it seems advisable to perform similar complex studies in larger groups of children with chronic hepatitis.

[Primary sclerosing cholangitis in children - clinical manifestations and diagnostic difficulties]. / Pierwotne stwardniajace zapalenie dróg zólciowych u dzieci - obraz kliniczny oraz trudnosci diagnostyczne.

Primary sclerosing cholangitis is a rare chronic disease of intra- and extrahepatic bile ducts, which causes cholestasis with inflammation and fibrosis ultimately resulting in biliary cirrhosis. The review focuses on clinical manifestations and diagnostic difficulties in primary sclerosing cholangitis in children.

Acute acalculous cholecystitis of viral etiology--a rare condition in children?

Acute acalculous cholecystitis (AAC) comprises 5% to 10% of all cases of acute cholecystitis in adults and appears to be even less frequently diagnosed in children. The diagnosis of AAC is established upon some clinical, laboratory, and ultrasonographic findings, which may sometimes be ambiguous and confusing especially in children. Diagnostic difficulties may result in either delayed diagnosis or unnecessary surgical intervention. Acute cholecystitis owing to viral infectious factors is reported to be extremely rare. The aim of the article is to demonstrate 2 cases of AAC as a clinical presentation of both Epstein-Barr virus and cytomegalovirus infection in children.

[Reactive oxygen species and antioxidative barrier in asthma]. / Reaktywne formy tlenu i bariera antyoksydacyjna w astmie.

Reactive oxygen species (ROS) participate in chronic inflammation, e.g. asthma. Augmented ROS production and deteriorated antioxidative barrier on the other hand leads to oxidative stress and increased oxidative damage as a result. Therefore antioxidants may be used in therapy of asthma.

[Chronic hepatitis B in children--is it still a real problem?]. / Przewlekle zapalenie watroby typu B u dzieci--problem nadal aktualny?

Over one million people all over the world die every year due to the complications of HBV infections. This problem is particularly important in Asia, Africa and in the West Pacific region where HBV infection is widely spread (from 5-20% up to 80% of all infected people in the world). In these regions HBV infections are transmitted mostly perinatally or during early childhood. In North America and in West Europe where after introducing anti-HBV vaccinations less than 2% of the population is affected, infections are usually transmitted by intravenous drug abuse, sexual intercourse, or much less frequently by blood transfusions. The immaturity of immune system in young children is responsible for the fact that nearly 90% of HBV infections acquired in infancy and 40-70% of HBV infections before the age of 3 years, result in chronic viral hepatitis. Therefore, the choice of an efficient and safe therapy is one of the most important problems. In this paper current data concerning indications for treatment and side-effects of interferon-alpha and lamivudine therapy in children with chronic viral hepatitis type B are presented.

[Therapy of chronic viral hepatitis type B in children after previous ineffective interferon-alpha treatment]. / Terapia przewleklego wirusowego zapalenia watroby typu B u dzieci po uprzednim, nieskutecznym leczeniu interferonem alfa.

UNLABELLED: THE AIM of this study was to estimate the efficacy of nucleoside analogue (lamivudine) in the therapy of chronic viral hepatitis type B in children, after previous, ineffective treatment with interferon-alpha. PATIENTS AND METHODS: we analyzed 53 children with chronic viral hepatitis type B, who had not responded to Interferon-alpha treatment conducted 1-7,5 years before this study (mean 4,0 +/- 7,5; median 4 years). Inclusive criteria to re-therapy with lamivudine were as follows: increased serum alanine aminotransferase activity, detected at least three times during 6 months before treatment, HBsAg and HBeAg present in the blood, viral HBV DNA detected for at least 6 months before the beginning of lamivudine therapy (above 200 genome copies per mL) and inflammation activity observed in liver biopsy specimen (biopsy performed within previous 24 months). Evaluation of side-effects of lamivudine therapy was based on anamnesis (subjective data) and laboratory tests performed regularly in the time of clinical visits during and after the end of the treatment. RESULTS: all the children concluded the treatment. Before lamivudine therapy, serum alanine aminotransferase activity ranged between 20-590 IU/L. In 28,4% of children it was less than 100 IU/L. In almost all the children moderate staging and grading were observed in liver biopsy specimens. HBV DNA in serum ranged between 200-200000 copies/mL: in 31 children (58,4%) HBV DNA exceeded 200000 copies/mL, in 5 (28,3%) was between 10000 and 200000 copies/mL, and in 7 (13,2% ) was below 10000 copies/mL. Applied treatment resulted in alanine aminotransferase activity normalization in 79,2% of children, mostly after 2-11 months (mean 3,9 +/- 2,7; median 3,8 months). HBeAg/HBeAb seroconversion was achieved in 28,3% of children, usually at the end of lamivudine therapy (approximately after 12 months). Sustained viral response was observed in 24,5% of treated children. There were no undesirable effects of therapy noted. Serum alanine aminotransferase activity increased slightly and temporarily in 4 children between 3rd and 12th month of therapy. In 2 of these children YMDD mutation was detected. CONCLUSIONS: lamivudine is effective, safe and well tolerated in treatment of chronic viral hepatitis type B, following unsuccessful interferon-alpha therapy. Serum alanine aminotransferase activity normalized in most of the patients. HBeAg/HBeAb seroconversion as well as positive viral response is mostly connected with low level of HBV DNA before therapy.

[HBV gene variants and polymerse gene mutations in children with chronic hepatitis B in the course of the antiviral therapy]. / Genotypy HBV oraz mutacje genu polimerazy HBV u dzieci z przewleklym zapaleniem watroby typu B w przebiegu leczenia lamiwudyna.

UNLABELLED: THE AIM OF THE STUDY was to evaluate the occurrence of HBV genotypes and the emergence of polymerase gene mutations in children with chronic hepatitis B in the course of the lamivudine therapy. MATERIAL AND METHODS: eighteen children (aged from 6 to 15 years, mean age 11,8 years, 10 boys and 8 girls) with chronic hepatitis B were included in the study. All patients were treated with 100 mg lamivudine tablets given daily orally for 12-16 months. All amino acid substitutions within HBV polymerase were detected by PCR amplification and direct sequencing HBV genotypes and polymerase gene mutations were determined by comparing the sequences in the overlapping PollS genes with published sequences, available in GenBank. RESULTS: HBVgenotyping showed the presence of genotype A in 17 children and genotype H in one. No change of HBV genotype was noted in any of the studied patients as the sequencing of HBV DNA was repeated during the lamivudine therapy. The presence of lamivudine-resistance mutations involving the YMDD motif was detected in 5 patients. Four children had YVDD mutation, while in one child YIDD mutation was detected. YIDD mutation appeared to be the single one in the viral polymerase gene, while YVDD mutations in four patients were accompanied by other changes at amino acid sequence of the HBV polymerase: rtL180M, rtN124D and rtL164M. CONCLUSIONS: 1) Genotype A was predominant in the studied population of patients. 2) The risk of the emergence of drug-resistant HBV polymerase mutations is high and increases in the course of the lamivudine therapy. 3)Drug-resistant mutations in the YMDD motif are accompanied by other amino acid substitutions in the viral polymerase of unclear clinical significance.

[Vasculitis in children]. / Zapalenia naczyn u dzieci.

Vasculitis is a group of rare diseases of unknown etiology, characterised by inflammation and necrosis of blood vessels, contributing to various clinical consequences. The variety of clinical symptoms and presence of symptoms from various syndromes often make the diagnosis difficult. Until now no causal treatment has been established. In order to achieve a remission of the disease, corticosteroids and immunosuppressive therapy are recommended.

[Congenital extrahepatic biliary atresia as a cause of cholestasis in newborns and infants]. / Wrodzona atrezja dróg zólciowych zewnatrzwatrobowych jako pryczyna cholestazy u noworodków i niemowlat.

UNLABELLED: Congenital extrahepatic biliary atresia (CEBA) is one of the most common causes of cholestasis in newborns and infants. THE AIM OF THE STUDY: was the analysis of clinical presentation, results of laboratory and imaging investigations as well as clinical outcome of children with extrahepatic cholestasis caused by CEBA. MATERIALS AND METHODS: the analyzed group included 15 children aged from 2 weeks to 4 months. Data concerning: pregnancy and delivery, newborn's health condition, faeces color; jaundice onset, manifestation of coagulation disorders coexisting malformations and disorders of other systems were obtained. The following investigations were performed: biochemical tests evaluating the function of the liver and cholestasis (serum bilirubin concentration and fractions, bile acids in serum, AlAT, AspAT, GGTP, FALK activities, serum electrophoresis, prothrombin index). We also performed tests focusing on hepatotropic infections, - metabolic disorders tests and in all children - ultrasound of the abdomen, scintigraphy of the bile ducts - HEPIDA. 14 children had undergone hepatoportoenterostomy, modo Kasai. RESULTS: jaundice, acholic stools and hepatomegaly were present in all children. The serum concentration of bilirubin and its conjugated fraction and bile acids in all children were increased. GGTP and FALK activities were markedly elevated in all children. Aminotransferases activities elevations were observed, more distinctively for AST. Active cytomagalovirus infection was detected in 3 children. Abdominal ultrasound revealed gallbladder in 7 children, whereas intrahepatic bile ducts were described as normal in 12 cases. In all cases the HEPIDA scintigraphy showed no passage of the tracer to the GI tract even after 24 hours delay. Hepatoportoenterostomy was performed in 14 children, 5 of them had liver transplantation. CONCLUSIONS: 1. There is still not one effective and specific diagnostic method in differentiating between the causes of cholestasis in the newborns and infants. Thus many investigation methods should be run simultaneously. 2. Congenital atresia must be definitely excluded before cholestasis with other background is finally diagnosed. 3. The hepatoportoenterostomy should be considered as the first line treatment in children with CEBA. Most cases will need liver transplantation in the future.

[Mesenteric lymphadenopathy - a valid health problem in children]. / Limafadenopatia krezkowa- czesty problem kliniczny wieku dzieciecego.

THE AIM: of the study is to evaluate the reasons of mesenteric lymphadenopathy and its clinical picture in hospitalized children. MATERIAL AND METHODS: the study was performed on 127 children (49 girls and 78 boys age of 8 months to 18 years; mean age 9 years and 3 months) hospitalized in the Department of Paediatrics, and Paediatric Gastroenterology and Oncology, Medical University of Gdansk. Ultrasonography showed enlarged abdominal lymph nodes in all children. According to definition of mesenteric lymphadenopathy, the clinical course of disease was analyzed in children, in whom there were at least three lymph nodes in ultrasonography with the peroneal diameter of 5 mm or more. Inflammatory parameters were examined in all children. In selected cases culture, viral and parasitic, as well as endoscopic examination, were also performed. RESULTS: analyzing accompanying clinical symptoms, it was found, that abdominal pain was the most dominant complaint in children with mesenteric lymphadenopathy; it was observed in 63 children (49.6%). In 33 (26%) of them the pain was the sole complaint, while in the rest vomiting and fever were present. 8 children (6.3%) with generalized lymphadenopathy were diagnosed. Ultrasonographic evaluation demonstrated that numerous enlarged lymph nodes were present the most frequently, in 65 (51.2%), less numerous, in 42 (33.1%), while sparse lymph nodes were seen only in 20 (15.7%) children. In 85 patients (66.9%) long axis of the lymph nodes reached min. 10 mm, in 39 (30.1%) was smaller than 10 mm, in 3 (2.4%) exceed 20 mm. Conglomerates of lymph nodes were described in 9 (7.1%) patients with various diagnosis (acute diarrhea - 3 children, ulcerative colitis - 3 children, celiac disease, cytomegaly, lambliosis). Tendency to invagination was observed in 5 (3.9%) children. In 4 of them acute infection (acute diarrhea, pneumonia) with high inflammatory parameters was diagnosed. Elevated inflammatory parameters were present in 42 (33.1%) patients. Examining the reasons of the abdominal lymph nodes enlargement, it was found that primary mesenteric lymphadenopathy was the most frequent diagnosis; it was recognized in 27 (21.3%) children. In 20 (15.7%) lymphadenopathy was caused by acute diarrhea, in 19 (14.9%) patients - by respiratory tract infection. Cytomegaly was recognized in 4 (3.1%), toxoplasmosis in 3 (2.3%), lambliosis in 9 (7.0%) patients. Both gastritis and colitis were diagnosed in 12 (9.4%) children. In 7 (5.5%) patients generalized lymphadenopathy with unknown etiology was described. In single cases other diseases were diagnosed. CONCLUSIONS: the enlargement of mesenteric lymph nodes frequently causes abdominal pain in children, being an indication for laboratory investigations. Vomiting and fever are the most common other symptoms in these patients. Ultrasonographic examination usually shows large enlargement of lymph nodes, sometimes in conglomerates, with tendency to invagination. Acute diarrhea and respiratory tract infection are the most frequent reasons of the enlargement of abdominal lymph nodes. In about 20% of the children primary mesenteric lymphadenopathy is diagnosed.

[Bone mineral density in inflammatory bowel diseases in children]. / Mineralizacja kosci u dzieci z wrzodziejacym zapaleniem jelita gruego i choroba lesniowskiego-crohna.

OBJECTIVE: determination of bone mineral density in children treated because of inflammatory bowel diseases. MATERIAL AND METHODS: 42 patients were included: 21 with ulcerative colitis and 21 with Crohn's disease. The duration of illness was from 2.0-24.0 months. Glucocorticoid therapy was applied in 92.9% of patients with the duration from 4-1680 days. The cumulative doses of glucocorticoids were from 160 to 25900 mg. Bone mineral density (BMD) and z-score of L1-L4 were assessed by dual-energy X-ray absorptiometry (DEXA). The mean BMD of L1-L4 were measured in g/cm2 and compared with referential values for gender and age. Osteopenia (ope) mean z-score from -1 to -2 SD, osteoporosis (opo) < -2 SD were accepted. RESULTS: BMD values varied from 0.531 to 1.301 g/cm. Z-score values varied from 0.9 to -5.6 SD. Bone mineral disturbances occurred in 57.2% of cases and it was equally both in 28.6% of cases osteoporosis and osteopenia. In ulcerative colitis osteopenia was predominant (23.8%), while in Crohn's disease osteoporosis occurred more often (23.8%). There was no significance in the duration time of the disease and BMD and z-score. The significant difference was found in the duration of steroid therapy and z-score. No association was found among cumulative dose of steroids and z-score. No significant differences were found in BMD and z-score of lumbar spine in ulcerative colitis and Crohn's disease. CONCLUSIONS: 1. Bone mineral disturbances often complicate inflammatory bowel diseases in children. 2. The association among the duration time of steroid therapy and bone mineral density was confirmed. 3. No significant differences were found in bone mineral density among colitis ulcerasa and Crohn's disease cases.

[Giardiasis in children - clinical diversity and diagnostic problems based on own experience]. / Zakazenia giardia lamblia u dzieci- zmiennosc obrazu klinicznego i trudnosci diagnostyczne w swietle doswiadczen wlasnych.

UNLABELLED: Parasitosis still remains a significant pediatric health problem, despite improving hygienic conditions and social awareness. THE AIM OF THIS STUDY: was to analyze clinical manifestations of Giardia lamblia infection in children hospitalized in the Department of Pediatrics, Pediatric Gastroenterology and Oncology of Medical University of Gdansk. MATERIAL AND METHODS: studied children included 49 patients aged 2.2 - 17.3 years: group I children below and group II above 5 years of age. The patients were admitted for further diagnosis of unexplained clinical manifestations in outpatient care. Parasitosis was confirmed by immuno-enzymatic technique detecting protein GSA 65; only in one child parasites cysts were found by microscopic technique in faecal samples obtained from infected children. RESULTS: chronic abdominal pain was noted in 16 (72.7%) children in group I and in 22 (81.5%) patients in group II. Chronic diarrhea was observed in 20 (90.9%) children in group I and in 4 (14.8%) in group II. Ultrasound scans revealed mesenteric lymphadenopathy in 42 children (16 in group I and 26 in group II). CONCLUSIONS: chronic and recurrent abdominal pain was the main clinical complain and chronic diarrhea in children under 5 years of age. In few cases hepatobiliary involvement was observed, which might suggest a changing clinical course of giardiasis. Most of the children presented with mesenteric lymphadenopathy, which was confirmed by abdominal ultrasound scan. Thus, this method should be included in the diagnostic algorithm, if parasitosis is considered.

[Immune components of human milk]. / Skladniki mleka kobiecego wspomagajace uklad odpornosciowy dzieci karmionych piersia.

Many benefits of breast-feeding have been generally accepted. In the article the constituents of human milk supporting the immune system of breast fed babies are reviewed. The effect of maternal undernutrition on immunological properties of breast milk is also presented.

[Short bowel syndrome in children - own experience]. / Zespól krótkiego jelita u dzieci-obserwacje wlasne.

THE AIM: of this study was to analyze the clinical status of children with short bowel syndrome (SBS) shortly after the resection and during following years. MATERIAL AND METHODS: we reviewed retrospectively 5 children with SBS aged from 2 years and 7 months till 14 years and 5 months, who were on total parenteral nutrition due to intestinal resection. The resection was performed, when they were either newborns or infants. In the analysis we considered somatic development and laboratory tests results. In 4 cases the cause for extensive bowel resection were congenital anomalies of the intestine, in one case it was intestinal necrosis as result of invagination. RESULTS: in all children there was diarrhea, during postoperative period and when oral caloric intake was increased and when loss of weight was observed. Most common complications included hypochromic anaemia and cholestasis. Moreover, in 2 children with resection of distal region of the ileum and ascending colon, we observed vitamin B12 deficiency and recurrent lactic acidosis due to secondary biotin deficiency. Catheter complications were one of the main problems. 3 patients developed sepsis. Occlusion or mechanic damage of the catheter were also observed. Despite initial severe retardation in somatic development, final anthropometric evaluation in all children was found to be normal. CONCLUSIONS: 1. Congenital intestinal and mesenteric defects were the most common reasons for SBS in the youngest children. 2. Parenteral nutrition is the cardinal element in the management. It was crucial for survival and further normal somatic development, even in children after extensive intestinal resection. 3. Lactic acidosis due to biotin deficiency must be considered if acid-base balance restoration is complicated in children with SBS. 4 Children with SBS after resection need long-term and multi specialistic medical care.