The main method of treatment of adrenocortical tumours is surgery. The efficacy of the mitotane therapy is still controversial with many serious side effects of the therapy. Moreover, patients receiving mitotane should be carefully monitored for adrenal insufficiency and usually require long-term hormone replacement therapy. We present a rare case of normalisation of the contralateral adrenal function after long-term mitotane therapy as a post-surgical treatment of the adrenocortical tumour.
Objectives: To assess the physical fitness of short-statured boys aged 7 - 20 years by applying fitness norms established for the Polish population in relation to calendar or growth age.
Material and methods: The results of EUROFIT fitness tests recorded in 3517 short-statured (below percentile 10 for body height) boys, aged 7-20 years, selected from a large (n=37 000) representative male cohort, were analysed.
Results: Individual results were confronted with the respective percentile norms related to calendar age (CA) or growth age (GA), since body height deficiency at given CA could have affected the results of fitness tests expected for that CA. The percentages of subjects below, the percentile 3 or above percentile 97 for given fitness test and CA or GA for the Polish population, were determined. No differences between the percentages computed for CA and GA were noted in case of the following tests: sit-and-reach (SAR) and bent-arm hang (BAH). Significant differences in percentages for both percentiles were found for the following tests: standing broad jump (SBJ), endurance shuttle run (ESR), handgrip (HGR) and plate tapping (PLT). In case of sit-ups (SUP) significant differences in percentages between CA and GA norms were found below the percentile 3, and in case of shuttle run (SHR) and flamingo balance (FLB) -- above percentile 97.
Summary and conclusions: Fitness tests were classified into two categories according to the differences between the results related to norms for calendar or growth age: those independent of whether CA or GA norms were applied (SAR and BAH), and those susceptible to the kind of norm (SBJ, HGR, PLT, SHR, FLB and SUP). The results of tests from the latter category should thus be evaluated by confronting them with the norms established for the growth age, and not calendar age.
Fibrous dysplasia of bone is a rare congenital bone disease, usually coming out before the age of 30. It is 2.5% of all bone tumours and 7.5 % of benign tumours of bones. The authors present a case of a 12-years old girl with fibrous dysplasia of bone admitted to the Department with hyperparathyroidism suspicion. Pathological changes were localized in the orbital cavity and sinuses. The diagnosis was established on the basis of the clinical course, imaging and histopathological examinations. The therapy with pamidronian acid was applied.
Background: The problem of body height deficiency, being the effect of undernutrition of children in developing countries, is widely described in the literature, whereas very little attention is devoted to the estimation of the nourishment of children and adolescents with a simple body height deficiency in developed countries.
Aim of the study: The purpose of the study was to estimate the nourishment of short-height girls and boys, with special regard to the realisation of the norms of daily demand for basic nutrients.
Material and methods: The investigation included 60 subjects in two age groups: 10.5 and 13.5 years old. The body height of the investigated children was below 10 centile in relation to the development norms for a given age and gender. Estimations of nourishment were made with the use of an interview about the consumption in the last 24 hours.
Results: In 22% of the investigated, energy intake was found to be lower than 75% of the daily demand. The percentage of the realisation of the norm for mineral components amounted on average to: 38.6-56.7% for calcium; 49.2-77.4% for iron; 50.1-93.2% and 45.9-72.2% for zinc and copper, respectively. Hypovitaminosis was relatively much less marked in comparison with the deficiency of mineral components. A lower consumption of animal protein and vitamin C was noted among adolescents from rural areas.
Conclusion: Among short girls and boys a frequent occurrence of deficiency of energy and mineral components (calcium, zinc, copper and iron) was found. The irregularly balanced diet could be the cause of a smaller body height in relation to peers among a considerable percentage of the investigated adolescents.
Background: Apoptosis, one of the forms of programmed cell death, is a physiologic process of cell death that is central to normal development and occurs in response to a variety of physiologic and pathophysiologic stimuli. In the thyroid, abnormal apoptotic activity may be involved in a variety of diseases such as Hashimoto thyroiditis and Graves disease. The aim of this study was to estimate the expression of chosen apoptotic molecules CD95 (Fas) and CD95L (FasL) on the surface of thyroid follicular cells in application of mouse monoclonal antibodies #64 which recognized B antigen regions of thyroid peroxidase (TPO) and infiltrating inflammatory cells.
Material and methods: The investigation was performed on thyroid cells isolated from surgically treated thyroid tissues of 15 patients with Graves' disease (GD), 15 patients with a nontoxic multinodular goiter (NTMG) and 15 aspirates obtained by FNAB from patients with Hashimoto thyroiditis (HT). The thyrocytes were identified by an indirect method: in the first stage we added mouse monoclonal autoantibodies specific for TPO (mAb #64) regions and in the second stage we conjugated this complex with rabbit anti-mouse antibodies IgG (Fab')2 with FITC. In the next step the cellular suspension was completed with suitably well-chosen two-colour monoclonal antibodies marked (PE or PerCP) (Becton Dickinson) directed against suitable apoptotic (Fas/FasL) molecules. All investigations were performed by flow cytometry using Coulter EPICS XL apparatus.
Results: The percentages of thyroid cells were estimated with expression of region B antigenic TPO in reference to individual apoptotic molecules. The analysis of Fas and FasL expression in thyroid tissues revealed significantly increased percentage of intrathyroidal T cells with CD95+ (p<0.005, p<0.001), CD95L+ (p<0.02, p<0.01) and both CD95/CD95L (ns, p<0.05) expression in comparison to percentages of T cells in patients with HT and NTMG. In addition, on the surface of thyroid follicular cells in patients with GD (p<0.01, p<0.01) and NTMG (p<0.001, p<0.004) we observed a lower percentage of thyrocytes with CD95 and CD95L molecules than in cases with HT. The expression of both apoptotic molecules on thyroid cells was higher (18%) in patients with HT in comparison to the percentages of positive cells in patients with GD (p<0.02, p<0.002) and NTMG, 8% and 1%, respectively.
Conclusions: We conclude that alterations in the expression of death receptors and their ligands on the surface of thyroid follicular cells may play a role in the regulation of apoptosis in thyroid autoimmune disorders.
Introduction: The cytotoxic T lymphocyte antigen-4 (CTLA-4) is a molecule present on T cells that plays a critical role in the down regulation of antigen-activated immune responses. Its gene polymorphism is a strong candidate gene for conferring susceptibility to thyroid autoimmunity. THE AIM of the study was to analyse the frequency of CTLA-4 exon 1 polymorphism (A49G) in children with Hashimoto's thyroiditis.
Material and methods: Blood samples from 68 children were analysed: 30 with Hashimoto's thyroiditis and 38 healthy, age-matched controls, mean age: 13.6 years. CTLA-4 exon 1 polymorphism (A49G) was defined by the PCR method and single-strand conformational polymorphism analysis and confirmed by using BbvI enzyme. Statistical analysis was performed using the t- test and Chi-square test.
Results: Polymorphism analysis showed that statistically significant more patients with Hashimoto's thyroiditis were homozygous for G (Ala), and G allele frequency was significant higher than in the control group.
Conclusion: The results confirmed the association between CTLA-4 exon 1 polymorphism (A49G) and Hashimoto's thyroiditis in polish children.
The epidemic of obesity concerns also children and adolescents. Excess weight increases the risk of metabolic complications, diabetes type 2, hypertension, cardiovascular disease, pulmonary and musculoskeletal disorders, psychosocial problems. Simple obesity leads to secondary endocrine disturbances. Long lasting insulin resistance and proinflammatory state induced by cytokines, which are produced in adipose tissue, play the main role in the development of obesity associated complications. Many disturbances can be reversed at the early stage, if even small weight loss is achieved.
In the last two decades the problem of arterial hypertension in patients in the developmental age gained an increasing interest. The frequency of arterial hypertension in children was estimated at the level of 1-5% of the population. It was demonstrated that hypertension is observed in patients with type 1 diabetes over two-three times more frequently than in the general population. Arterial hypertension is a significant risk factor for cardio-vascular complications. The coexistence of diabetes type 1 and arterial hypertension predisposes to ischemic heart disease, stroke and premature death. Normal range of arterial tension for children was established during the Task Force on Blood Pressure Control study in children. Models depending on age and sex were created. Measurements above the 95 percentile for age and sex were referred to as significant hypertension and above the 97 percentile as heavy hypertension. For the development of arterial hypertension in patients with type 1 diabetes, which is the dominant type in children and adolescents, apart from the genetic predisposition, the coexistence of nephropathy is important. In children and adolescents almost exclusively secondary nephrogenic hypertension is observed, which develops usually 2 years after microproteinuria. Seldom in children and adolescents with type 1 diabetes essential hypertension or hypertension of other causes, as for example contraction of the nephrotic artery, may be observed. A particular form of arterial hypertension is lack of pressure decrease during the night, with a maintenance of the normal rhythm during the day. Recently the state called "pre-hypertension", considered as a precursor of hypertension and a predictor of excessive cardiovascular risk, has gained increasing interest. The pharmacological therapy of arterial hypertension in patients with diabetes type 1 may be taylored individually, depending on the degree and form of diabetes, and also on its late complications. In case of an unfavourable course dialysis may be considered and transplantation of the kidney, as hemodialysis in children with type 1 diabetes is connected with frequent complications. It is crucial to consider the transplantation of the kidney at early stages, when the creatinine level is above 5 mg/dl. It has been proved that the results of transplantation in patients with diabetes are similar to those in patients without diabetes.
Objectives: To learn the attitudes and opinions of girls with Turner's syndrome about physical education classes and to determine the level of physical activity of those girls by applying the MVPA (moderate-to-vigorous physical activity) index.
Material and methods: A group of 36 girls with Turner's syndrome, aged 10-19 years, participants of a summer camp at the sea shore in 2004, were subjected to a questionnaire study. The resulting MVPA index served as an indicator of the degree of physical activity.
Results: About one-fourth of girls were chronically disqualified by physicians from physical education (PE) classes, 69% declared they "liked" or "liked very much" PE classes, but only 29% stated that the degree of difficulty of PE activities matched the abilities of schoolchildren. Mean MVPA value in those girls amounted to 3.5 days a week and only 19% of girls met the recommended level of 5 or more days a week.
Summary and conclusions: The girls with Turner's syndrome had good opinions of their PE teachers but the participation of those girls in physical activities was unsatisfactory. The teachers ought to seek efficient ways to motivate schoolchildren for increasing their physical activities and their participation in various forms of sport and leisure activities.
Introduction: In the last years it has been proved that matrix metalloproteinases participate in the development of all stages of atherosclerotic process. It has been suggested that plasma levels of metalloproteinases can be a novel, inflammatory marker of atherosclerosis. THE AIM OF THE STUDY was to evaluate plasma levels of selected matrix metalloproteinases (MMP-2 and MMP-9) in obese children and adolescents.
Material and methods: We studied 45 children and adolescents with simple obesity aged 15+/-1.8 years. The control group comprised 28 healthy, slim children aged 14.5 years. The obese children were studied according to coexistence of hypertension, hyperlipidemia, positive family history of cardiovascular diseases and insulin resistance. Levels of matrix metalloproteinases were assessed by use of ready ELISA kits (R&D Systems).
Results: MMP-9 level in the study group equaled 553.5+/-311 ng/ml and was significantly higher compared to the control group: 400.4+/-204 ng/ml, p=0.02. MMP-2 level in the study group was significantly lower compared to the control group: 211+/-37 ng/ml vs. 258+/-56 ng/ml, p<0,0001. In obese children with coexisting hypertension we found higher levels of MMP-9 when compared to children with obesity only: 635+/-308 ng/ml vs. 450+/-289 ng/ml (p=0,04), MMP-2 levels remained similar in both groups.
Conclusions: Different levels of plasma matrix metalloproteinases in obese and hypertensive children compared to healthy, slim controls can indicate an altered metabolism of the extracellular matrix (ECM) of vessels and heart muscle. Changed metabolism of ECM may be of significant importance in enhancing the atherosclerotic process in this young patients.
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