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In recent years commensal microorganisms are not just “passive occupants”, but important element of homeostasis. There are numerous reports documenting the composition and role of the gut, skin or vagina microbiome but the role of commensal organisms living in the lungs is relatively unknown. Pulmonary microbiome impact on the immune response of the host organism and may indicate new therapeutic directions. Lung microbiome, by modulating the expression of innate immunity genes, causes an increase in the concentration of IL-5, IL-10, IFNγ and CCL11, affects the TLR4 dependent response of pulmonary macrophages and modulate the production of antibacterial peptides contained in the mucus. It is documented that disorders of the lung microbiome contribute to asthma or chronic obstructive pulmonary disease. However it is known that pulmonary dysbiosis also occurs in critically ill patients. It is possible, therefore, that microbiota-targeted therapy may constitute the future therapeutic direction in ICU.

The Sylvian arachnoid cyst is a common benign disease, however sometimes leads to subdural or intracystic hemorrhage without major trauma. The reason of easy bleeding of the arachnoid cyst is not fully understood. A decision to employ surgical treatment of arachnoid cysts complicated by coexisting subdural hematoma and/or bleeding to the lumen of the cyst should be reached in close correlation with clinical symptoms. Although surgical therapeutic modality is commonly recognized in such situations, yet due to the risk of postoperative complications, should be reserved for cases with repeated bleedings and intracranial hypertension. A surgical intervention in the case of mild bleeding without coexisting intracranial hypertension should be considered with extreme caution, since instances of spontaneous resolution of bleeding have been known. The presented here cases of arachnoid cysts complicated by bleeding required surgical interventions in view of clinical and radiological symptoms of intracranial hypertension.

Background: Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin’s lymphoma. Standard first-line treatment for this aggressive subtype comprises the anti-CD20 antibody rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone. If patients receiving such treatment have an early relapse, or their disease is initially refractory to such treatment, standard salvage regimens may not be effective. There is therefore a high unmet clinical need for new targeted agents that might improve the outcome for such patients. CD19 is a B-lymphocyte lineage-specific cell surface antigen that is expressed by most B-cell non-Hodgkin's lymphomas. MOR208 is an fragment-crystallizable engineered humanized monoclonal antibody with enhanced antitumor activity that targets CD19 and that may consequently have clinical utility in this setting. Case presentation: We describe the case of a 33-year-old Caucasian man who presented with a 3-month history of general symptoms and who was admitted to our pulmonology ward with dyspnea due to pneumonia and severe anemia. A histopathological examination of an enlarged right suprasternal lymph node confirmed a diagnosis of T-cell/ histiocyte-rich large B-cell lymphoma, an uncommon morphological variant of diffuse large B-cell lymphoma. Our patient had a complete response to first-line rituximab combined with cyclophosphamide, doxorubicin, vincristine, and prednisone, but had an early relapse 5 months after the end of treatment. After intensive salvage therapy consolidated with an autologous stem-cell transplant, our patient again had an early relapse and was subsequently enrolled in a phase IIa trial of single-agent MOR208. Following a scheduled 3 months of weekly treatment, a partial response was confirmed and MOR208 was continued as maintenance therapy, with administration every second week. Positron emission tomography-computed tomography confirmed a complete response 9 months later. This response is ongoing, with a duration of 24 months. MOR208 was well-tolerated by our patient and his quality of life and performance status remain high. No hospitalizations were required and our patient engaged in full-time work and physical activities. Conclusion: Third-line single-agent therapy with the CD19 antibody MOR208 was highly effective in this patient, despite a history of early relapse after standard first-line and second-line treatment regimens. These data provide support for future randomized studies of MOR208.

Hereditary haemorrhagic telangiectasia (HHT) is an autosomal dominant, rare and severe disease that results from vascular dysplasia. It is characterised by recurrent epistaxis, teleangiectasias of skin and mucosa and arteriovenous malformations in: lungs, brain, liver, gastrointestinal tract and spinal cord. Diagnosis of HHT is rarely done in early childhood, because of the gradual appearance of vascular malformations. Patients with HHT require complex, multidisciplinary management, because of heterogeneity of clinical manifestations, risk of potentially life-threatening complications and poor prognosis especially in case of multiple visceral teleangiectasia. Here we report a case of severe HTT with diffuse pulmonary arteriovenous malformations in 13-month-old child with negative family history, who presented with polyglobulia and development retardation. On the basis of literature review we present current recommendations for diagnosis and management in HHT, in particularly in the case of diffuse pulmonary arteriovenous malformations, disqualified from any interventional procedures and associated with a poor prognosis.

Solitary rectal ulcer syndrome (SRUS) is a rare disorder of childhood, which usually presents with any of the manifestations of anorectal disease, bowel habit alteration and abdominal pain. It is commonly accepted that pathogenesis is associated with disturbances of defecation. We describe a 13-year-old boy with attention deficit hyperactivity disorder (ADHD) and SRUS. He complained of increased stool frequency associated with the passage of blood and mucus, tenesmus, sensation of incomplete defecation and abdominal pain. Circumferential ulcer and flat lesion extending up to the sigmoid colon with typical microscopic findings were revealed upon colonoscopy. Defecography showed an opacified small bowel invaginating into the rectal wall, the pictures consistent with enterocele. Conservative treatment, including reassuring the patient and his mother of the benign nature of the disease, recommendation to avoid straining defecation and use of a high-fiber diet to prevent constipation, was applied. The macroscopic appearance of rectal lesions in SRUS are much more variable than is usually realized. An early diagnosis requires a high index of suspicion both for clinicians and the pathologist. Streszczenie Zespol samotnego wrzodu odbytnicy (solitary rectal ulcer syndrome – SURS) jest rzadkim schorzeniem u dzieci i mlodziezy. Zwykle objawia sie zaburzeniami oddawania stolca i bolami brzucha. Powszechnie uwaza sie, ze w patogenezie tego schorzenia odgrywają role zaburzenia defekacji. W niniejszej pracy przedstawiono opis przypadku 13-letniego chlopca z zespolem nadpobudliwości psychoruchowej i SURS. Glownymi objawami, ktore zglaszal pacjent, byly: zwiekszona czestośc oddawania stolca z obecnością śluzu, okresowe krwawienia z odbytnicy, uczucie parcia na stolec i niepelnego wyproznienia oraz bole brzucha. W badaniu kolonoskopowym stwierdzono okrezne owrzodzenie i uniesioną, nieregularną zmiane siegającą esicy z typowym dla SURS obrazem mikroskopowym. Defekografia uwidocznila typowy dla enterocele obraz wpuklenia sie petli jelita cienkiego w ściane prostnicy. Chlopcu i jego matce wyjaśniono lagodny, chociaz przewlekly, charakter schorzenia. Leczenie zachowawcze obejmowalo zalecenie unikania wysilkowego od dawania stolca oraz stosowanie diety bogatoblonnikowej, aby zapobiegac zaparciom. W SURS obraz zmian makroskopowych jest bardziej roznorodny, niz powszechnie sie uwaza. Ustalenie wlaściwego rozpoznania zalezy w duzej mierze od wnikliwości zarowno klinicysty, jak i patologa.

Central nervous system (CNS) involvement in the course of neuroblastoma (NBL) in children is relatively rare. However, it seems to become serious clinical problem in the group of patients from high risk group. They presently achieve longer time of survival caused by employment of more intensive treatment modalities. The aim of the study was clinical evaluation of the patients over 1 year of age with stage 4 NBL with CNS involvement, both at diagnosis and at relapse. From 1997 to 2007, 117 patients (age 0.2-13.5 years) started NBL treatment. In 58 children over 1 year, stage 4 of disease was diagnosed. In 4 (6.9%) cases the CNS involvement was found at diagnosis. In 5 patients (8.6%) the isolated relapse in brain was diagnosed. The clinical symptoms caused by increased intracranial pressure were observed in all patients at relapse. In the case of initial involvement no neurological symptoms were observed. All 5 children with CNS involvement as isolated relapse did not present with infiltration of skull bones, whereas at initial diagnosis the brain lesions were continuous with bone metastases. Among 5 patients with isolated relapse 4 died because of NBL progression. Among 4 children with initial CNS involvement 1 died due to haemorrhage to CNS. Probably brain involvement at initial NBL diagnosis is not an additional negative prognostic factor. Because of extremely poor prognosis in patients with CNS relapse it should be advised to consider possible implementation of preventive treatment. It is also necessary to invent new more effective treatment methods.