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Introduction: Changing clinical picture of newly diagnosed celiac disease (CD) has been reported for several last years. Despite of this fact, many patients are diagnosed late, after a long period of atypical symptoms. Aim of the study was to analyze the clinical picture of newly diagnosed celiac disease in children treated at our Department from 2003 to 2009. Material and methods: The study group comprised 36 children (18 females and 18 males) with diagnosed - according to up-to date criteria - celiac disease. The group of 36 children was divided into classic and atypical CD patients. Age of the onset, type and duration of preliminary symptoms, also somatic development parameters and laboratory findings were carefully analyzed. Results: 15 children were diagnosed as classic CD, and 21 as atypical form. Mean age at diagnosis was 4 y 6 mths, 8 children were younger than 3. In atypical group mean age was 8 years 8 months and only one child was younger than 3. Differences between the groups were statistically significant. The duration of the disease before establishing diagnosis was significantly longer in atypical CD group than in classic CD group (26.5 months vs. 11.5 months). In children with classic CD diarrhea and iron deficiency anemia were leading symptoms at the beginning of the disease. The remaining differences in clinical picture were insignificant. Conclusions: 1. Atypical CD is dominating among patients diagnosed during last years. 2. Age of the diagnosis is significantly lower in classic CD. [ABSTRACT FROM AUTHOR]

Introduction. Studies assessing cytokine expression in children with different clinical manifestation of atopy are rare and data are conflicting. Differences in serum cytokine levels could indicate distinctions in the immunopathogenesis of both diseases. Aim of the study. The study aimed at assessing serum cytokine levels in children with atopic diseases. Material and methods. 19 children with AD and 37 children with atopic asthma were enrolled in the study. The control group consisted of 18 healthy children. S.aureus was found in the skin lesions in 89.5% examined children with AD. Serum cytokine levels were measured using ELISA (Quantikine human, R&D system Europe, UK). Results. Serum IL-13 level was signifi cantly higher in AD and asthma than in healthy ones (p=0.002, p=0.0003, respectively). Serum INF-γ level in AD was significantly lower in AD than in healthy and asthma (p=0.0006, p=0.001; respectively), but were similar between asthma and controls. The Severity of AD assessed by SCORAD index and the severity of asthma were correlated with serum IL-10 level. Duration of ICS treatment was inversely correlated with serum IL-13 level. Conclusions. IL-13 plays the key role in the immunopathogenesis of AD and asthma. INF-γ deficit is vital for pathogenesis of AD and may be relevant to propensity to skin infections. [ABSTRACT FROM AUTHOR]

The role of CD4+ T cells in the immunopathogenesis of asthma is well documented. Little is known about the role of CD8+ T cells. The aim of this study was to assess peripheral blood subsets of CD4+ and CD8+ T cells expressing naive/memory markers (CD45RA+/RO+) and the activation marker (CD25+) in children with allergic asthma. Peripheral blood mononuclear cells were isolated from children with allergic asthma and healthy children. T cell subsets were analyzed by flow cytometry for the expressions of CD45RA, CD45RO, and CD25. In this study, some differences in the memory compartment of peripheral blood T cells between asthmatic children and healthy controls were detected. The absolute number of CD8+ T cells expressing CD45RO was significantly elevated and the percentages of CD3+ T cells expressing activation marker CD25 and of CD4+ T cells expressing memory marker CD45RO were significantly lower in children with asthma compared with controls. No correlation was found between severity of asthma and peripheral blood lymphocyte subsets. There were some differences in the memory compartment of peripheral blood T cells between asthmatic children and healthy controls. The increase in the number of CD8+ T cells expressing the memory marker (CD45RO) in children with allergic asthma may indicate that CD8+ T cells play a role in the pathogenesis of asthma. [ABSTRACT FROM AUTHOR]

The role of the type-2 T helper (Th2) cell-mediated immune response in the immunopathogenesis of atopic dermatitis (AD) is well documented. Whether polarized immunoresponse is confined to antigen-specific T cells or is distributed among all T cell subsets is still controversial. We investigated frequencies of interleukin-2 (IL-2), IL-4, interferon-gamma (IFN-gamma), and tumor necrosis factor-alpha (TNF-alpha) producing CD3(+) and CD4(+) T cells in peripheral blood from children with atopic dermatitis and healthy subjects with and without in vitro stimulation. Children with severe AD had a significantly lower percentage of CD4(+) T cells spontaneously expressing IL-4 compared with healthy controls (p <0.01). Polyclonal stimulation significantly increased cytokine production in both AD patients and healthy individuals. Frequencies of CD3(+) and CD4(+) producing IL-2, IL-4, IFN-gamma, and TNF-alpha after in vitro stimulation with phorbol-12-myristate 13-acetate (PMA) + ionomycin were comparable in the AD and control groups. In response to PMA/ionomycin, children with AD and asthma symptoms had a significantly lower percentage of CD3(+) T cells producing TNF-alpha. We failed to demonstrate evidence of an imbalance with respect to type-2 cytokine productions in children with AD. Comparable induction of Th1 and Th2 cytokines in polyclonally stimulated peripheral CD3(+) and CD4(+)T cells from AD patients and controls puts into question the polarized Th2 immune response as a general characteristic of T cells in children with atopic dermatitis. [ABSTRACT FROM AUTHOR]

Unlabelled: Staphylococcus aureus skin colonization in atopic dermatitis (AD) patients exacerbates disease activity. Nasal and throat S. aureus carriage may be also implicated in the clinical course of allergic rhinitis and asthma. The aim of the study was to evaluate the frequency of skin, nasal, throat S. aureus colonization in patients with AD and asthma and assess if presence of this bacteria on the skin may be related with degree of sensitization., Material and Methods: Swabs for microbiological analysis were taken from affected skin, anterior nares and throat from 40 children with AD, 59 children with asthma and 56 healthy controls. Following lymphocyte subsets: CD3+, CD4+, CD8+, CD3+CD25+, CD4+CD25+ were measured using flow cytometry., Results: Nasal and throat S. aureus colonization was more frequent in atopic children. S. aureus was found in the skin lesions in 97.5% examined children with AD. Percentage of CD8+ was decreased but the number of CD4+, and CD4+CD25T+ cells was elevated compared with healthy. Total IgE and sIgE Der. pteronyssinus and Der. farinae as well SPT (Skin Prick Test) wheel size were higher in AD children compared to asthma. SCORAD was correlated with total and sIgE (mite, pollen) and number of S. aureus and increasing skin reactivity skin. The degree of sensitization was correlated with patient's age, duration of AD and asthma and number of CD3+, CD4+ and percentage of CD4+CD25+ only in AD patients. Severity of asthma was correlated with FEV1 and total IgE., Conclusions: Staphylococcus aureus skin colonization in AD children increases disease activity and degree of sensitization measured by SPT wheel size and results in imbalance of peripheral blood T cells.

Abdominal migraine is a rarely recognized functional intestinal disorder, manifesting as recurrent paroxysmal abdominal pain of neurogenic origin. The authors describe the 9-years old girl referred to the hospital because of chronic paroxysmal abdominal pain. She did not improve after medication used commonly in functional abdominal disorders (drotaverine, mebeverine, trimebutine). On the ground of various investigations organic causes of abdominal pain were excluded. Carefully completed anamnesis, as well as precise description of the clinical picture of abdominal pain attacks, has lead to the diagnosis of abdominal migraine. According to advice of neurologist the treatment with amitriptyline was introduced. Thereafter a significant improvement was observed. Abdominal migraine has to be taken in to account when diagnosing chronic abdominal pain in children.

Clinical symptoms, IgE, and eosinophil counts are insufficient for establishing diagnosis of asthma in young children. It has been suggested that other serum markers might be useful for supporting diagnosis. The aim of the study was to determine serum levels of IL-4, IL-10, and IL-12 in young children with recurrent wheezy bronchitis. We investigated if there was a relationship between those markers and the maintenance clinical symptoms during a 2-year follow-up period. The study involved 30 young children (average age--22.5 months) with recurrent wheezy bronchitis. Control group consisted of 15 healthy children at the same average age. The serum levels of IL-10 (p<0.0006) and IL-12 (p<0.000005) were significantly increased and the serum level of IL-4 was significantly decreased (p<0.00009) in children with wheezing compared with healthy control. However the serum level of IL-10 (p<0.004, R=0.5) and IL-12 (p<0.001, R=0.54) was positively correlated with a number of episodes wheezing in the past. Children with wheezing and skin rash showed a significantly higher level of IL-4 (p<0.02) and lower levels of IL-10 (p<0.0008) and IL-12 (p<0.005) compared with children without skin rash. No statistically significant differences in serum levels of IL-4, IL-10, and IL-12 were observed between children with persistent wheezing during a 2-year follow-up period and children without respiratory symptoms. This study suggested a potential role cytokines in recurrent wheezing, but follow-up of the children is needed to evaluate the prognostic value of serum cytokines for development asthma in later childhood.

Autosomally inherited Jarcho-Levin syndrome is an illness leading to death usually in the foetal, neonatal or infantile period or in early childhood. The children rarely survive to the age of adolescence. Hardly 130 cases of the syndrome were described up to now. There are two types of the syndrome: milder spondylocostal dysplasia (SCD) and more severe spondylothoracic dysplasia (STD)--the proper Jarcho-Levin syndrome. The authors present a case of coexistence of Jarcho-Levin syndrome with syringomyelia and osteoporosis in a 15 years old boy. His disease manifested itself in developmental anomaly of structure and segmentation of vertebrae, occult cervicothoracic spina bifida and characteristic crablike deformation of thorax. These anomalies led to kyphoscoliosis and considerable shortening of trunk as well as to the growth which increased the proportions of limbs length to the trunk and body height. The syndrome was accompanied by the syringomyelia in C5-Th1 segment and osteoporotic skeleton with significantly decreased bone density (in the L2-4 segment Z = -5.17). According to the best of our knowledge the presented case is the first description of the coexistence of Jarcho-Levin syndrome, syringomyelia and osteoporosis in world literature. The anomaly diagnosed as STD has also the features of SCD. The verification of the classification principles of Jarcho-Levin syndrome may take place in future basing on bigger number of observation and on genetics development.

Asphyxiating thoracic dysplasia (Jeune's Syndrome) is a genetically determined dysplasia of thoracic bones usually leading to death during intrauterine life or in early childhood. Other osseous dysplasias as well as renal, hepatic and pancreatic failure may coexist with Jeune's syndrome. About one hundred cases of the syndrome were reported till now. The aim of the study is to describe the disease in a 15-year-old boy observed till the age of 20. The disease started in the second year of life and was manifested by limitation of thorax development and respiratory tract infections. At the age of 15 he was hospitalized due to dyspnoea. Short stature, weight deficiency and long, flat chest with significant stenothorax as well hypoxemia, pulmonary restriction and obstruction were found on admission. Moreover symmetrical decline in isoptic marker uptake without regional ventilatory disturbances were detected by ventilation--perfusion scintigraphy. The lack of bronchial epithelium and basement membrane thickening with present in and under the membrane numerous collagen fibres and fibroblasts were revealed in electron microscopy. As it is the first in literature description of bronchial mucosa electronogram in Jeune's syndrome we cannot have an unequivocal attitude to the described microscopic changes. The increase of body weight, height and some anthropometric parameters of the thorax as well as the maintenance of pulmonary restriction and obstruction, respiratory failure stagnation and circulatory failure deterioration were observed after 6 years of follow-up.

The aim of the study was to show the growing problem of poisoning with easily accessible shrub Datura stramonium among children and young people. 21 children with the symptoms of poisoning with this plant were treated in The Silesian Centre for Children's Diseases in Zabrze in the years 1999-2001. The majority of patients were boys (18 cases) at the age between 15-17 years (15). These were intentional consumptions except for one case of a 3-year-old boy. Cumulative poisoning was also present. The patients came mainly from full families with 2 children where either both parents were unemployed or only one of them worked. In most cases hospitalisation was initiated in the first 12 hours after ingesting the plant. On admission consciousness limitation (15), psychomotor agitation (11), mumbling speech (11), visual hallucinations (7) and aggression (6) were noted. The symptoms subsided quickly, however, only in one patient agitation and limited logical contact were still present for 2 days. Physical examination showed dilated pupils (20), dryness of mucous membrane (10) and skin redness. Toxicological examination confirming poisoning was carried out in 4 cases. It included one child out of 6 belonging to the group of cumulative poisoning. In the remaining children the diagnosis was based on taking a history and clinical picture. Treatment was based mainly on intravenous hydration. 8 children required hydration in the second day of hospitalisation and 2 in the next 2 days. One child was treated in the Intensive Care Unit. The average hospitalisation period was 3.8 days.