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The decreased immunity which occurs frequently in severely intoxicated patients may led to sepsis. The sepsis may be caused by bacterial toxins in unconscious patients with toxic coma which generate decreased immunity. Apart from the wide spectrum antibiotic therapy, crystalloids, colloids, vasopressin and corticosteroids, the renal replacement therapy may be useful in treatment of sepsis due to its complexes pathophysiology. Taking into account the role of cytokines in sepsis pathomechanism, the trials of treatment using high cut-off (HCO) membranes were performed in the recent years. These membranes remove molecules with mass up to 60 kDa, including cytokines typical for severe sepsis. The usefulness of continuous veno-venous hemodialysis--CVVHD with HCO dialyzer in the treatment of patient in septic shock and multiorgan damage--including damage caused by cardiac arrest was presented in the study. The concentration of IL-1P, IL-2, IL-4, IL-6, IL-10, IL-12, INF-alpha, INF-gamma, TGF-alpha in blood were determined before and after the 24-hours procedure. After the procedure the most evident decrease was observed for IL-4, 6, 10, 12 (17.3%, 31.8%, 83.4% i 22.3% respectively). During the following days the general status of patient improved gradually. The patient was discharged from the hospital after 20 days of hospitalization. His general condition was good, the values of inflammatory parameters were normal and the renal function was correct. There are very few studies describing HCO membranes effectiveness and they were performed on limited populations of patients. The presented case study may contribute to the discussion on the usefulness of dialysis with HCO membranes in the treatment of severely intoxicated patients complicated by serious sepsis resistant to standard antibiotic therapy.

Introduction: Smoking is a commonly recognized risk factor of civilization diseases. The number of damaging compounds, including carcinogenic, inhaled by a smoker and exhaled, is directly proportional to a number of smoked cigarettes. Health promotion and prevention are bases of fighting strategy with health risk connected with smoking. The aim of the study was to contrast the number of sold cigarettes in one year in Poland, calculated per capita in selected years of 20th century and at the beginning of current century. The details, which are analysed in the study considering a total number of cigarettes sold in Poland, come from The Statistical Yearbooks and The Demographical Yearbooks of the Central Statistical Office. The analysis showed that in the year 2003 the number of cigarettes sold in Poland, calculated per capita were 4.3 times larger in comparison to the number of cigarettes sold in Poland, calculated per capita in the year 1923. In fact, the difference of the number of sold cigarettes is more unfavorable because the details which concerned cigarettes disposal do not include significant illegal cigarettes import. The highest number of cigarettes sold in Poland, calculated per capita in the analysed period of time, was noticed in the years: 1979--2741 cigarettes, 1980--2679 cigarettes and in 1987--2671 cigarettes, and the lowest was at the beginning of the analysed period: in 1923--450 cigarettes, in 1938--600 cigarettes and in 1949--893 cigarettes. Smoking spread in Poland at the beginning of current century which is measured by the number of sold cigarettes and noticed changes in statistics, calculated per capita, although downward trend is still on the high level.

Unlabelled: The aim of the study was to assess the effect of IFN-alpha and ribavirine combined therapy of chronic hepatitis C in children. The study comprised 37 children (22 boys and 15 girls) aged between 4 and 18 years (mean 12 years and 6 months) with chronic hepatitis C, diagnosed on the basis of serological, virological and histological criteria. The treatment included Intron A (Schering Plough) administered subcutaneously 3 M.U. 3 times a week and ribavirin (Rebetol-Schering Plough) orally 15 mg/kg body weight daily for the period of 12 months. In all children liver biopsy was performed before the beginning of treatment. Tests for the presence of HCV RNA in serum were performed after 12-weeks therapy (EVR), after 6-months therapy, immediately on its completion (ETR) and 6 months afterwards (SVR), after the end of treatment. In the course of applied treatment, ALT activity, hemoglobin levels, leukocyte and trombocyte counts in the peripheral blood were determined every 4 week. EVR was obtained in 25 children and in these chidren genetic material of HCV in serum of blood was not observed both, after 6-months therapy, as well after the end of treatment. In this group a sustained virological response (SVR) was observed in 21 children. In 12 children without EVR, the elimination of HCV RNA was not achieved in the course of further treatment., Conclusions: 1. Twelve-months of combined IFN-alpha and ribavirine therapy enables to obtain a sustained virological response in about 56% of the treated children. 2. The frequency of recurrences of HCV infection in children amounts to 16%. 3. During the combined IFN-alpha and ribavirine treatment numerous side effects were observed, which in individual cases were the reason for treatment modification.

A growing number of data suggest the role of reactive oxygen species (ROS) in the pathogenesis of chronic type c hepatitis. Activated neutrophils, macrophages and Kupffer cells are basic sources of ROS in the course of the inflammatory process in the liver. The aim of the study was to assess the metabolism of neutrophil oxygen in children with chronic hepatitis C., Material and Methods: The study comprised 14 children with chronic hepatitis C (group 1), 4 children with positive serum anti-HCV antibodies and negative HCV RNA as well as normal ALT activity (group II) and 6 healthy children 9 (group III). Production of reactive oxygen species by neutrophils using the method of chemiluminescence (CL) with luminol (MLX Microtitier Plate Luminometr, Dynex, USA) was assessed. We estimated chemiluminescence response (CL max and CL total) of neutrophiles both unstimulated and stimulated by formyl-methionyl-leucyl-phenyloalanine (fMLP), opsonized zymosan (OZ), phorbol-myristate-acetate (PMA) without and after priming with tumor necrosis factor alpha (TNF-?) was estimated., Results: CL max f MLP stimulated without preactivation was significantly lower in group I and II than in group III (p<0.04, p<0.06, respectively). CL max OZ stimulated was significantly higher in group I in comparison to group II (p<0.04) and it tended to be higher in group I than in group III. CL max PMA stimulated was lower in group I compared to group III (p<0.08). CL total fMLP stimulated was lower in group II (p<0.07) compared to group I and it tended to be lower in group I and II compared to group III. CL total OZ stimulated was significantly higher in group I than in group II (p<0.05) and group III (p<0.03). CL max and CL total OZ stimulated and preactivated with TNFalpha was significantly lower in group I compared to group III (p<0.02 and p<0.04, respectively)., Summing Up: In the course of chronic hepatitis C in children, both neutrophil preactivation and inhibition of neutrophil release of reactive oxygen species, which occur as a result of different mechanisms, are observed.

Unlabelled: The importance of carbohydrate metabolism in the pathogenesis of chronic hepatitis C has been recognized in recent years. The aim of the study was to assess carbohydrate metabolism in children with chronic HCV-related hepatitis., Material and Methods: The study was comprised of 16 children with chronic hepatitis C and 16 healthy controls. In all the children anthropometric data and, after overnight fasting, serum levels of glucose and insulin were investigated and insulin resistance index HOMA IR was calculated. In the study group biopsy specimens were assessed., Results: Macrovesicular steatosis in numerous hepatocytes was found in 3 children. Mean values of body mass, height, body mass index (BMI), levels of glucose, insulin and HOMA IR did not differ significantly between the two groups. We found correlation between serum levels of glucose and fibrosis (r=0.64, p<0.01) or staging (r= 0.7, p<0.004) in children with chronic hepatitis C., Conclusion: Neither obesity, which is recognized as a risk factor for diabetes mellitus and steatosis was found in children with HCV-related hepatitis. Correlation between serum levels of glucose and fibrosis or staging in children with chronic hepatitis C suggests the participation of carbohydrate metabolism in the pathogenesis of this disease and the risk, existing already in such young patients, of developing hepatic fibrosis with its consequences.

Lyme borreliosis has become a serious diagnostic and therapeutic problem of modern medicine. The occurrence of the disease in Europe, and also in Poland, has recently increased. Diagnostic problems with Borrelia burgdorferi infection result from non-characteristic course of the disease in children, without the 1 st stage of the disease (erythema migrans), negative history forwards tick bite, lack of seasonal changes in occurrence and difficulties with interpretation of serological tests results. Direct laboratory investigations are also of little relevance.

The objective of this paper was to evaluate potential beneficial effects of combined treatment with slow-release nitrates and angiotensin converting enzyme inhibitors (ACE) on left ventricular remodeling and exercise capacity in patients after acute myocardial infarction. In this study, 141 patients (aged 34 to 74, mean 56.6 years) with sufficient circulation received combined treatment with 24 hour nitroglycerin infusion followed by oral nitrates (isosorbide mononitrate 50 mg OD) from day 2 day 42 after myocardial infarction and ACE inhibitor (captopril 25 mg BID or enalapril 5 mg BID versus placebo) from day 10 to day 42. On days 10 and 42, echocardiographic examination was carried out and recorded on an optical disc. Simultaneously, on the same days, the treadmill exercise test (modified Bruce protocol) was performed. In the echocardiographic study the left ventricular endodiastolic and endosystolic volumes (biplane Simpson formula), ejection fraction, left ventricular wall motion score and left ventricular mass index were analyzed. Treadmill test criteria, used in the study, included exercise duration time and workload (METS). For each patient the data obtained examination II and I were measured and the differences in their values were classified. The obtained results were analyzed with one-way and three-way ANOVA test. A Kruskal-Wallis test was also used in one variable analysis. Results were analyzed after repartition of patients into groups according type of treatment (angiotensin converting ing enzyme inhibitor or placebo), infarct location (anterior or inferior wall) and enzyme level (CPK < 2000 IU/L or CPK > 2000 IU/L). A p value < 0.1 was considered statistically significant. In a single factor analysis ANOVA proved that the patients treated with nitrates and captopril showed greater improvement in exercise capacity (in METS) than patients treated with enalapril or placebo (+1.26 captopril, +0.2 enalapril and +0.29 placebo, p = 0.043). In addition, a decrease in left ventricular mass index was evident only in patients treated with angiotensin converting enzyme inhibitor (placebo +7.37 gm/m2, captopril -12.17 gm/m2, enalapril -10.14 gm/m2, p = 0.0032). The triple factor analysis ANOVA test revealed that the change in endodiastolic left ventricular volume depends on combination of three factors: infarct location, type of treatment and level of cardiac enzymes (p = 0.009). A decrease in left ventricular endodiastolic volume between day 42 and 10 was observed only in patients with inferior wall infarct and CPK level < 2000 IU/L, irrespective of treatment type and in patients with inferior wall infarct and CPK level > 2000 IU/L treated with angiotensin enzyme inhibitor. We noticed also that heart failure, considered as contraindication to randomization, was in addition the most frequent (up to day 10) cause for study termination and initiation of treatment with angiotensin enzyme inhibitor.

Unlabelled: Mycoplasma pneumoniae is a common etiological factor in atypical pneumonia in children. The course of the disease is usually mild, but in some cases, especially in extrapulmonary localisation, it can pose significant diagnostic and therapeutic problems. The aim of this study was evaluation of extrapulmonary manifestations of Mycoplasma pneumoniae infections in children., Material and Methods: Among 21 children with Mycoplasma pneumoniae infection hospitalised in the III Pediatric Clinic, ICZMP in Lodz, between 2001 and 2002 three children with extrapulmonary manifestations of the disease were qualified for the study. The diagnosis was based on a test (from Biotest company) detecting specific IgM, IgG and IgA antibodies., Results: In the analysed cases the manifestations of the disease were as follows: exudative gonitis (I), pain in the hip and knee joints (II) and abducens nerve paresis (III). In I case: IgM 1/250; 1/350, IgG- > 1/1000, 1/350; IgA 1/100, negative; in II case: IgM > 1/1000, IgG > 1/1000, IgA negative. In III case IgM 1/450, 1/130; IgG > 1/1000, > 1/1000, IgA 1/300, 1/130. In all the children there were no symptoms form the respiratory tract. In both articular forms, the disease was preceded by Borrelia burgdorferi infection localised in the same joints. Only in case of exudative gonitis an increase in the inflammatory process indexes was noticed., Conclusions: Mycoplasma pneumoniae infection should be considered also in case of extrapulmonary symptoms, with no coexisting infection in the respiratory tract. The forms of extrapulmonary manifestations, in particular concerning the joints and the nervous system, require prolonged and specific antibiotic treatment. Articular manifestation of Mycoplasma pneumoniae infection preceded by articular form of Borrelia burgdorferi infection is noteworthy, and may be caused by abnormal response form the immunological system.