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BACKGROUND: In view of the considerable changes that have taken place in the last 20 years in the clinical picture of celiac disease, epidemiological research is now underway to search for atypical forms, which are appearing with growing frequency; if not treated, they cause a deterioration in the quality of life of these patients. The goal of our research was to identify the frequency of occurrence of celiac disease among the parents of children with the disease and to analyze the clinical picture in these cases. MATERIAL AND METHODS: The research involved 254 persons (127 women, 127 men) ranging in age from 25 to 58 years. The subjects were pairs of parents of randomly selected children with celiac disease diagnosed in accordance with the ESPGHAN criteria in force at the time of diagnosis. The level of total IgA and antiendomysial antibodies in class IgA or IgG were measured in all subjects using the indirect immunofluorescence method. In all those patients with a positive test for the presence of IgAEmA who expressed their consent, a biopsy of the small intenstine was performed, with a histopathological evaluation of the bioptate according to the Shmerling Scale. RESULTS: The IgA level was normal in all subjects. The presence of IgAEmA was indicated in the serum of 5 subjects (2%): 3 men aged 39, 40 and 43, 2 women aged 41 and 43. The level of IgAEmA varied within the limits of +20 to +640 IF. In 4 of these subjects an endoscopic biopsy of the small intestine was performed, providing a basis for the diagnosis of level III/IV or level IV atrophy of the intestinal villi. The clinical symptoms found in the subjects prior to diagnosis were diverse: periodic loose stools (2 persons), short stature (3 men), abdominal pains (3 persons with concomitant inflammatory lesions in the stomach membrane or duodenum), sudden loss of body mass (1 case), hyperexcitability (1 case). One female subject did not report any significant complaints. CONCLUSIONS: Screening tests should be performed In the families of patients with celiac disease in the direction of enteropathy, even in a case when clinical symptoms are absent, weak, or atypical.

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The aim of the study was to estimate somatic development of children who recovered from secondary malabsorbtion syndrome. We examined 24 children 2.5-13 years old. Their weight when diagnosed was between 10-3 percentiles. Patients were treated with gluten free diet 8-36 month. After recovery (normal mucose in biopsy) 20 children (83.3%) had normal somatic development and 4 (16.7%) abnormal development. This abnormal development was caused by infantile cerebral palsy and Silver-Russel syndrome. Therapy by elimination diets gave villi regeneration and normal development in most of our patients.

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In this study we have presented the diagnostic difficulties in a child with cystic fibrosis recognised basing on the clinical picture of the disease, together with two elevated values of sweat chloride tests. The diagnosis was confirmed by an identification of delta F 508 mutation on both cystic fibrosis chromosomes. Normal sweat test results in a first stage of diagnosis performed twice in a newborn period were a factor which delated the diagnosis.

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INTRODUCTION: The aim of the study was estimation of antioxidant defence state in children with chronic viral hepatitis. MATERIAL AND METHODS: We examined 100 children with chronic viral hepatitis who have serological and molecular markers of HBV or HCV infection. In all patients catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities in erythrocytes were assayed. RESULTS: We observed statistically significant decrease of CAT and SOD activities and increase of GSH-Px activity in children with chronic hepatitis B and C. CONCLUSIONS: Our data suggest the possibility of insufficiency of antioxidant barrier in children with chronic viral hepatitis.

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INTRODUCTION: The significance of hepatitis C infection in Poland, particularly in a pathology of the developmental age still increased. The aim of the study was the analysis of interferon alpha therapy efficacy in children with chronic C hepatitis. MATERIAL AND METHODS: 30 children (aged from 3 years to 15 years, 16 females, 14 males) were included in the study. In each patient HCV infection was confirmed by the serological, molecular (with identification of HCV genotype) and histopathological methods. The duration of observation of HCV-infected children after the diagnosis was made followed for at least 6 months. Transaminase level in each case was 50% higher than normal. The schema of interferon alpha treatment was: 3 MU 3 times a week subcutaneously for 25 weeks. Time of observation started at the beginning of the therapy and finished 1 year after the end of the treatment. RESULTS: The analysis of the HCV genotypes showed the predominance of the genotype 1 (66.7%): subtype 1a was found in 20% patients, subtype 1b--in 43.5% children. Genotype 4 (subtype 4c4d or 4b) was confirmed in 30% patients, genotype 3 (subtype 3a) in 3.3% patients. In the histopathological picture of the liver predominated minimal or moderate inflammation activity (grading: 1--in 50%, 2--in 46.6%, 3--in 3.4%) and little fibrosis (staging: 0--in 80%, 1--in 13.3%, 2--in 6.7%). In many children mild side effects of interferon alpha therapy were observed: pseudoinfluenzal symptoms (in 46.7%), lack of appetite (in 16.7%), abdominal pain (in 10%), thrombocytopenia (in 6.7%), granulocytopenia, hair loss, irritability, itching of the skin (in 3.4%). At the end of therapy in 36.7% patients serum HCV-RNA was undetectable. The percentage of children without serum HCV-RNA decreased 6 months after the end of therapy to 20% patients and a year after the end of therapy to only 13.6% children. In children with HCV-RNA elimination was observed early reduction of ALT level. For the definition of the predictive factors of good prognosis patients were divided into 2 groups: group I (without HCV-RNA elimination at the end of the treatment) and group II (patients HCV-RNA negative a year after the end of therapy). Both group of children were similar in respect of age, disease duration and interferon alpha dosis/m2. At the beginning of the treatment mean ALT level was statistically higher in group II than in group I. IL-2 level was significant higher in group II than at the beginning, after 2 and 4 months of the therapy. There were no significant differences in IL-1 beta, IL-4 and IL-6 level between patients in group I and II. The differences in ALT activity during IFN-therapy between 2 groups of patients were statistically significant; since second month of therapy higher ALT level was observed in a group of patients without HCV-RNA elimination. In the histopathological picture of the liver a year of the end of therapy in 20% children reduction of inflammatory activity and progression of fibrosis in both group of patients was observed. CONCLUSIONS: Because of a little efficacy, high costs, psychological load of young patients and possible following consequences of the interferon alpha therapy it is necessary to manage the further researches to find a new method of treatment of chronic C hepatitis. High ALT activity and elevated IL-2 level before treatment seems to be predictive factors of the good response to interferon alpha therapy.

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The work presents 3 members of a family of 4, who were diagnosed to have coeliac disease (one classic and two latent forms of the disease). Genetic investigation regarding all three patients revealed the existence of HLA DQ A1*0501 allele associated with susceptibility to coeliac disease. Due to a much more frequent occurrence of atypical forms of coeliac disease in family members, than in general population, and due to risks resulting from tardy diagnoses and the lack of treatment, it is recommended that patients should be subjected to tests determining the presence of antiendomysial antibodies, as well as to genetic investigation with regards to latent coeliac disease.

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In this study we present a 12-year-old girl with chronic C hepatitis coinfected with HGV, in which severe life-threatening side effects from alfa interferon therapy occurred after 3 months of injection and required definite IFN withdrawal. It seems, that infection HGV may predispose patients with chronic C hepatitis treated with alpha interferon to this severe side effect.

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Actually, HCV genotype 4 is frequent in central Africa and in the Middle East. In contrast, in Europe genotype 4 is uncommon (1-4%). In this study we present 12 children with HCV genotype 4c4d. Clinical picture in this group was asymptomatic, morphological was moderate.

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Report a case of a girl with HGV-RNA in the serum, which was detected during the treatment of autoimmune hepatitis. Infection HGV may cause aminotransferases abnormalities because they were elevated despite of the 2.5-year immunosuppressive therapy.

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