[Stab wounds in children]. / Bodná poranení u detí.

Injuries are the most serious health risk in children. Injuries are the main cause of death and long term disabilities in children. Fortunately, stab wounds in children are very rare in our country, but they are, in most cases, very serious injuries. Presenting 3 case reports, this article aims to show the danger of stab wounds and how easily sharp objects can penetrate human tissue. In two out of the three case reports, a foreign object was remained inside the wound. When dealing with such injuries, this possibility must be considered the wound must be carefully inspected. When a revision is necessary, it should be carried out using minimally invasive methods in order to save the child from suffering extensive wounding which would result from the classical open approach revision.

Characteristic differences between the growth of man and the other animals.

The method Dynamic Phenotype of Body Mass or of the body height was used for the interpretation of growth in children and adolescents from birth to the age of 18 years. Modelling of the body mass growth curve in boys by means of Dynamic Phenotype of Body Mass is expressed in the form of three individual curves which are compatible with the three I, C, P, components of Karlberg's body height growth curve. However the Dynamic Phenotype of Body Mass is based on the direct use of the measured biological values as input parameters of the simulated growth curve e.g. body mass in the origin of the growth curve (GO, kg), the genetic limit of body mass (GLi, kg) inherited from parents and the inherited physiological potency to produce the appropriate body mass increase (dG max, kg/d) in conditions of adequate nutrition and in convenient environment. The components I, C, P, of children and adolescents growth curve do exhibit principal difference in comparison with the growth curves of the other mammals. This difference is characterized by the long lasting (C) component with extremely slow body mass increase indicating the very low growth velocity of body mass growth. This long lasting (C) component of childhood postpones the puberty component (P) from the infancy component (I). This phenomenon makes the principal difference between the body mass growth in man and that of other mammals where immediately after the short episode of postnatal growth follows puberty, sexual and corporeal maturity. Some primates carry out the body mass growth similar to man. The method of Dynamic Phenotypes may be helpful for investigation of the brain's function ontogeny in relation to neural and humoral regulatory mechanisms of body mass growth during childhood and transition into puberty.

[History of foster care in the Czech Republic]. / Z dejin pestounské péce v Ceských zemích.

"The enlightment period" in the second half of the 18th century brought new view on the negative results of the institutional care in orphanages. The aim to improve the care of orphans and unattended children in the region of former Austrian Empire resulted in the year 1789 in the new law about the foster care. The law incorporated ten principles how to provide, control and finance the foster care in our region.

Multiple fibroepithelial polyps of the upper ureter in a 17-year-old boy--case report and review of the literature.

Benign tumours and primary malignant tumours of the ureter are uncommon in adults and extremely rare in children. The clinical symptoms are flank pain, urinary tract infection, and macro/micro-haematuria. There is an incomplete ureteral obstruction and filling defect on intravenous urography (IVU). Optimum treatment of this lesion results in renal preservation. Uretero-renoscopy is currently the best method available for the identification and histological diagnosis of ureteral polyps. Recommended operative procedures are pyeloureteric junction (PUJ) resection with Anderson-Hynes pyeloplasty, ureteric resection with end-to-end anastomosis or with uretero-cysto-neoanastomosis (UCNA), ureteric resection with renal autotransplantation. Ureteronephrectomy is not indicated. A case of ureteral polyps in a 17-year-old boy with the chief complaint of left flank pain is reported here. The excretory urogram and renal scan showed left hydronephrosis. Resection of the pyeloureteral junction, partial resection of the upper ureter containing the lesions--multiple branching 30-40 mm long polyps with a common basis--and Anderson-Hynes pyeloplasty were performed. The pathological diagnosis was benign fibroepithelial polyps of the ureter. Convalescence was uneventful and after 4 years of follow-up, excretory urogram and ultrasonography showed good renal function and improvement of hydronephrosis.

The long-term effects of using a higher amount of iodine supplement on the efficiency of laying hens.

1. Two different levels of dietary iodine supplement (K + 0, 3.57 mg/kg; K + I, 6.07 mg/kg) were used in a 52-week experiment using 32 ISA Brown laying hens. 2. The greater iodine content in the diet impaired the egg production (K + 0, 319.9 +/- 1.31 eggs/hen; K + I, 312.4 +/- 4.19 eggs/hen), the egg weight (K + 0, 64.4 + 0.66 g; K + I, 63.1 +/- 0.61 g) and the food to egg mass ratio (K + 0, 2.13 +/- 0.023 kg/kg; K + I, 2.22 +/- 0.030 kg/kg). 3. The greater dietary iodine content had significant (P<0.05) negative effects on Haugh units, yolk index and eggshell weight.

[Late manifestations of congenital diaphragmatic hernia]. / Pozdní manifestace vrozené bránicní kýly.

The aim of the work was to evaluate clinical and anatomical features in children with late manifestations of inborn diaphragma hernia after the newborn period. The group included 11 boys and 7 girls at the age of two to 78 months during the time of diagnosis. The diaphragma hernia was diagnosed in 15 children during non-acute manifestations and in three children affected by emergencies. A posterior-lateral defect of diaphragma was on the left side in 11 children and in 7 children on the left. A hernia sac was found in 11 children. Organs protruding into thorax included intestinal loops in 12 children, liver in 7 subjects, spleen in 6 individuals, stomach in five and kidney, pancreas and omentum in one each. The defect in diaphragma was occluded by a primary plasty in 17 children, while a patch from Goretex was used once. An intestinal strangulation required resection of necrotic part of intestine, but the boy died one month later for a multi-organ failure despite long-term resuscitation care. The other children were cured up without complications. The inborn diaphragma hernia should be considered in differential diagnosis of every child with unusual respiratory or gastrointestinal symptoms and abnormal X-ray picture of thorax. Acute strangulation of inborn diaphragma hernia after the newborn period is a life-threatening disease, where the gastrointestinal obstruction is combined with respiratory and circulation failure.

[Treatment of hypospadias in childhood]. / Lécba hypospadie v detském veku.

The aim of the paper is to compare different techniques of correction of hypospadias with the author's own group of patients and to compare the results with those achieved at other departments. Between 1992-1999 at the Department of Paediatric Surgery, Teaching Hospital Motol 348 operations were made in 219 boys. A plastic operation with a distal shift of the urethra a and conization of the glans in 112 patients predominated. Other methods included in 39 patients the creation of a ventral circumference of the urethra from the inner laver of the prepuce while preserving the urethral plate ("onlay island flap") and a parameatally everted flap according to Mathieu in 11 patients. A plastic operation by complete tubulization of the inner laver of the prepuce was used in 19 patients, in 2 boys the method of Duplay-Byars tubulization of the urethral plate. In one patient the urethra was replaced by a free flap as described by Nove Josserand. Another 129 operations included formerly used and now abandoned two-stage operations to straighten the penis, operations to reconstruct the prepuce and operations on account of complications. The latter comprised 16.4% fistulae, 9.58% dehiscences and 1.36% strictures.

[Mediastinal teratomas in children]. / Mediastinální teratomy u detí.

The objective of the work is a clinical and histopathological retrospective study of rare mediastinal teratomas in children. The authors present their experience with the treatment of eight children within the range from neonates to the age of 15 years with a histologically confirmed diagnosis of mediastinal teratoma. In two neonates the first symptom was postnatal dypnoea, teratomas in older children were diagnosed along with symptoms of acute respiratory infection. Complete resection of the tumor was performed in all patients, in neonates emergency operations were involved. Four tumors were histologically classified as mature teratomas, three as differentiated teratomas with an immature component and one as a malignant teratoma. The malignant teratoma contained mature tissues as well as tissues of embryonic carcinoma and a yolk sac tumor. Seven children with a mature or differentiated teratoma are without signs of disease 5-15 years after surgery. During the follow-up of the 15-year-old boy with the malignant teratoma the elevated alpha-fetoprotein serum level was evidence of a relapse of the disease after termination of comprehensive treatment. From the results ensues that radical extirpation is sufficient treatment for mature and differentiated teratomas. Malignant teratomas are indicated for primary resection and postoperative chemotherapy. Long-term follow up of alpha-fetoprotein and human beta-choriogonadotropin levels, clinical controls and controls by imaging methods are indicated in children with an immature or malignant component of the tumor.

[Renal transplantation in children in the Czech Republic]. / Wyniki przeszczepiania nerek u dzieci w Republice Czeskiej.

The aim of the study is to review results of pediatric renal transplantation in center in Prague, Czech Republic. Results are compared with the registry data from Europe and United States. Patients, who underwent RTx at the University Hospital Motol, Prague (Czech Republic) between 1977 and the end of 1999, were analyzed. Since 1977 128 Rtx from cadaveric donors were performed in children in mean age 12.8 +/- 4.1 years. In 1977-1987, patients were treated with prednisone and azathioprine, and since 1988, cyclosporine A, added to prednisone and azathioprine. Sequential quadruple immunosuppression was used only in few highly sensitized patients. Acute graft rejections were treated with methylprednisolone pulses, antithymocyte globulin and monoclonal antibodies OKT3, in selected cases. In 1988 and 1999 cyclosporine A was replaced by tacrolimus as initial immunosuppression in some patients. The number of Tx ranged between 5 and 13 per year. Patients and graft survival were significantly lower in the first time period 1977-1987 with a median patients 5-year survival rate of only 50% and graft survival 30%. In the last period (1988-1999) 5-year patients survival is 90% and 5-year graft survival is 68% (p = 0.01). Two cases of posttransplant lymphoproliferative disease were diagnosed so far. One of them died several months after RTx, the other received cytostatic therapy for Hodgkin tumor and graft function was maintained. Main causes of graft failure were chronic rejection followed by acute steroid resistant rejections, severe cytomegalovirus infections, noncompliance, vascular thrombosis, and recurrence of original disease.

The Miami pediatric quality of life questionnaire: parent scale.

Because there were limited measures available to assess health-related quality of life (HRQL) in children with chronic illnesses, this study was initiated to develop an empirically derived questionnaire for use in evaluating HRQL issues in children treated for cancer. Extensive interviews were conducted with 30 families of children with cancer, 10 of pre-school age, 10 of school age and 10 of adolescent age. Responses were videotaped and transcribed, then categorized to develop a pool of 56 items, which were administered to 132 children with cancer and to their parents. This report focuses on parental responses to objective items and ratings of importance of each of these items. Three primary categories, Self-Competence, Emotional Stability and Social Competence, were identified, each of which had solid internal consistency, sensitivity and reliability across 1-month intervals. The measure demonstrated the ability to discriminate between children with different types of cancer, offers an alternative to measures relying on expert judgment to assess HRQL and may lead to greater inclusion of psychological and social concerns as primary factors in determining HRQL in children participating in clinical trials.

[Lactate acidosis in childhood]. / Laktátová acidóza v detském veku.

BACKGROUND: Secondary lactate acidosis is found in children with hypoxaemia, with impaired tissue perfusion, in hepatic and renal failure or in intoxications. Primary lactate acidosis is usually caused by hereditary metabolic disorders. The objective of the trial was to analyze the causes which lead in childhood to the development of primary hyperlactacidaemia. METHODS AND RESULTS: The authors examined during 1995-1996 the lactate and pyruvate concentration in 479 children referred by paediatric and neurological departments with a suspect hereditary metabolic disturbances. A raised lactate in blood or cerebrospinal fluid > 2.3 mmol/l was found in 230 children incl. 49 where a metabolic disorder was detected. Ten children had impaired cytochrome c oxidase, two children had a combined deficience of NADH dehydrogenase and cytochrome c oxidase, three children had a deficience of the pyruvate dehydrogenase (PDH) complex, one child had a deficience of ATP synthase and seven children suffered from impaired beta-oxidation. Glycogenosis type I, III or IX was found in 13 children. In three children organic aciduria was found, two children had an impaired urea cycle and three children impaired fructose metabolism. In five children a low level of free and total carnitene was found as a result of valproate treatment. A significant increase of the lactate level by more than 1 mmol/l during an oral glucose load was found in 11 of 16 children with impairment of the respiratory chain or PDH complex. In 58 children concurrently lactate in blood and cerebrospinal fluid assessed but no correlation of lactate levels was found. CONCLUSIONS: In patients with suspect hereditary metabolic disorders examination of lactate, pyruvate and alanine levels can be considered a screening test for detection of mitochondrial disorders. It remains difficult to reveal the cause of hyperlactacidaemia in a sick child even if a wide range of laboratory methods are used which contribute to the diagnosis of hereditary metabolic disorders.

[Surgical methods in the treatment of retroperitoneal neuroblastoma]. / Chirurgická taktika v lécbe neuroblastomu retroperitonea.

The authors submit their experience with the surgical treatment of retroperitoneal neuroblastoma, which is one of the most frequent solid tumours of child age. They describe the principles of the surgical technique with emphasis on radical removal of the tumour even in the area of large blood vessels. They emphasize the advantage of using an ultrasonic surgical aspirator (CUSA, Valleylab Co., Pfizer) which makes it possible to remove residues of the tumour without damaging the large blood vessels. During the period between 1987-1992 they treated at the Motol Faculty Hospital 69 children with retroperitoneal neuroblastoma. Of these 60 were operated. In the first stage of the disease 9 patients were operated, all survive. In the second stage 4 patients were operated, 75% survive, in the third stage 24 patients 50% survive, in the fourth stage 20 of 29 patients were operated and 11 (38%) survive. In stage IV--S three patients were operated, one survives. The total survival of patients during the investigation period is 52%.

[Surgical treatment of pectus excavatum and pectus carinatum]. / Chirurgické lécení pectus excavatum a pectus carinatum.

The authors present their experience with surgery of deformities of the chest wall in childhood. In the course of 1986 to 1992 they operated 93 children with the diagnosis of pectus excavatum. This number comprised 66 boys and 27 girls. The mean age of the operated children was 10.5 years. During the same period 17 patients (12 boys and 5 girls) were operated on account of pectus carinatum. The mean age of the latter group of patients was 13.5 years. 23% of the patients with a pectus excavatum had before operation mild scoliosis, two patients suffered from severe scoliosis. 76 patients after operation of pectus excavatum were followed up for more than one year after operation. In 44 patients the result was excellent (58%), in 31 patients the result was good. One patient developed a relapse. Fifteen patients after operation for pectus carinatum were followed up for more than one year. In 12 patients (80%) the result of the operation is excellent, in three patients (20%) the result is good. From the group as a whole seven patients had dehiscence of the wound after surgery, four patients developed a seroma in the surgical wound, three patients developed pneumothorax after operation and in one instance an abscess developed in the surgical wound. In the course of 1987 the authors changed the surgical technique in pectus excavatum from Jensen's to Holcomb jun. operation.

Pathologic and serologic characterization of a variant of duck hepatitis type I virus.

A duck hepatitis virus (DHV), isolated from ducks on a farm in Virginia in 1963, was shown to be only partially related to DHV type I (DHV-I) in cross-neutralization and in cross-protection tests. The virus, named DHV-Ia, apparently is a serologic variant of DHV-I; both viruses are serologically distinct from DHV type III. Pathologic responses to DHV-Ia were similar to those described for DHV-I infection.

[Phosphoethanolamine in the blood and urine in sick children]. / Fosfoetanolamin v krvi a moci nemocných detí.

The phosphoethanolamine (PEA) concentration in morning urine was assessed by liquid chromatography in 866 patients examined because of suspected impaired aminoacid metabolism. In 763 patients the blood was also examined. A serum concentration of PEA above 10 mumol/l was recorded in 2.1%. The concentration of PEA in urine above 10 mmol/mol creatinine was recorded in 42%. The authors revealed a significant relationship between urinary PEA excretion and the patient's age. The urinary PEA concentrations are higher during the first weeks and months of life, in older children and during adolescence its excretion declines and this trend was recorded also in the author's group of patients. In a group of 111 infants with impaired function of the CNS, in 66 infants with systemic skeletal affections and in 73 infants with hepatopathies a significantly higher mean urinary PEA concentration was found that in the control group of healthy infants. In children aged 3-14 years and in the group of older children the mean PEA concentration was elevated only in patients with systemic skeletal affections, even after elimination of patients with hypophosphatasia. Long-term or intermittently increased PEA excretion is a manifestation of specific metabolic disease only in hypophosphatasia. In other diseases it can be interpreted as a secondary finding conditioned by an impaired phospholipid metabolism at the level of cellular membranes in the CNS, liver or skeleton.

Normal blood values of an adult male Perodicticus potto with comparative data from other primates.

The hemogram and blood chemistry profile of a 20-year-old male Perodicticus potto are presented. Comparative data from other primates are included so that P. potto infomation may be viewed in proper perspective. With noted exceptions, the values are reminiscent of other prosimians.

[The effect of pregnancy order on various biochemical and hematological values in sows]. / Vliv poradí brezosti na nekteré biochemické a hematologické hodnoty u prasnic.

The following blood indices were determined in the blood of 34 pregnant sows of the Large White breed under standard feeding conditions: haemoglobin, haematocrit, leucocytes, and--in the blood serum, --total protein, glucose, urea, bilirubin, cholesterol, enzyme activity (AP, GOT, GPT, GGTP) and mineral concentrations (Ca, P--inorg., Mg, Na, K, Fe, Cu, Zn, Mn). The blood was sampled in the first and third pregnancy at an average live weight of 165.12 and 197.36 kg, at an average age of 318 and 630 days and at an about the same average length of pregnancy in the time of both samplings (59 days). In younger, still growing gilts (first pregnancy) a significantly (P less than 0.05) lower content of total protein, magnesium, iron and copper was revealed, as compared with adult sows. The content of glucose, calcium, potassium and manganese in the blood serum of the gilts was significantly (P less than 0.05) higher than in sows in their third pregnancy. The adult sows showed a significantly (P less than 0.05) lowered activity of alkaline phosphatase and gamma-glutamyl transpeptidase, as distinct from gilts.