INTRODUCTION: The aim of our study was to assess the influence of cardiovascular complications on the occurrence of late ventricular potentials (LP) in children with diabetes mellitus type 1. MATERIALS AND METHODS: 72 children (36 boys and 36 girls), with average course of diabetes type 1 of 6.5+/-2.8 years, were included into the study. Standard physical examination, blood pressure measurements, signal-averaged electrocardiogram (SAECG), autonomic test, 24-h Holter monitoring, and Doppler echo investigations were performed. The control group consisted of 55 sex- and age-matched healthy children. We utilised nonlinear logistic regression analysis to assess the effect of disease duration, albuminuria, insulin demand, cardiac autonomic neuropathy (CAN), heart rate variability (HRV) indices, diabetes complication score, metabolic control, systolic and diastolic blood pressure, left ventricular parameters, and ventricular arrhythmias on LP occurrence. RESULTS: LP was discovered in 12 patients with diabetes and in 1 from the control group (P<.014). Diabetic children with LPs had thicker left ventricular posterior wall (LVPW) and longer diabetes duration time than children without LP (P<.045 and.031, respectively). Nonlinear regression model shows that duration of diabetes, CAN, and LVPW were the strongest independent parameters of LP occurrence (P<.001,.01 and.005, respectively). CONCLUSIONS: Diabetes type 1 is associated not only with increased occurrence of abnormal SAECG but also with LP presence. The disease duration, posterior wall thickness, and CAN are independent predictors of LP appearance in diabetes type 1 children. The presence of cardiovascular complication has no influence on LP occurrence in diabetic children.

Age of Onset↗

PubMedDate not supplied

[Femur-fibula-ulna (FFU) complex in the 33rd week of gestation: ultrasonography, radiology, pathology and differential diagnosis. Case report].

We present a case of a 27 year old I. gravida, I. para. Despite of regular ultrasonographic examination the diagnosis of skeletal malformation at the fetus was not before 33. weeks of gestation. It was the rare type of a bothside femur-fibula-ulna (FFU) complex. The FFU-complex is a no lethal malformation with typical unilateral combination from defects of femur and fibula, with contralateral defect of ulna. Dependent to involvement of malformated limbs the FFU-complex is classifiable in four groups. Only in 10 % all limbs are affected. Our case (type IV) showed a peromelia of both upper limbs with stumps of humeri, bothside aplasia of fibula and missing from 4. and 5. toes. There fetus were without nonlimb congenital abnormalities. The etiology of FFU-complex is unknown, the occurrence sporadic. There are never found genetic abnormalities. Familial recurrence is not described. There is no maternal or paternal age effect on FFU-complex. The differential diagnosis must include malformations with reduction anomalies of extremities, like thalidomide syndrome, splenogonadal fusion with limb malformations, Roberts syndrome, oroacral complex or acheiropodia. Mark off are amniotic band too.

Abnormalities, Multiple↗

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[Stüve-Wiedemann syndrome in two siblings: focusing on a male patient with the longest actual survival rate].

BACKGROUND: We report on two siblings with Stüve-Wiedemann syndrome (SWS). The older patient, a 16-year-old boy, is -- as to our knowledge -- the longest-term survivor of this syndrome worldwide. The younger sister with the same clinical and radiographic findings died at the age of 10 months. DEFINITION: Characteristic clinical symptoms are: muscular hypotonia, camptodactyly; respiratory insufficiency, swallowing difficulties; reduced sweating with heat intolerance, episodes of hyperthermia. Typical radiographic findings are: progressive bone bowing, unusual bone fractures, abnormal trabecular pattern, middle face hypoplasia. GENETICS: The SWS is identical with the Schwartz-Jampel syndrome (SJS) type 2, which is gene-located on chromosome 1. So far further genetic details of the SWS can be expected in the near future. The genetic transmission is autosomal recessive. In inbred high risk populations the occurrence of the SWS is increased. THERAPY: For the present only symptomatic therapy is available: extended intensive care during infancy, supportive pediatric orthopedics later on.

Abnormalities, Multiple↗

PubMedDate not supplied

Evaluation of urinary 1-hydroxypyrene, S-phenylmercapturic acid, trans,trans-muconic acid, 3-methyladenine, 3-ethyladenine, 8-hydroxy-2'-deoxyguanosine and thioethers as biomarkers of exposure to cigarette smoke.

The objective was to evaluate the utility of urinary 1-hydroxypyrene (1-OHP), S-phenylmercapturic acid (S-PMA), trans,trans-muconic acid (t,t-MA), 3-methyladenine (3-MeAd), 3-ethyladenine (3-EtAd), 8-hydroxy-2'-deoxyguanosine (8-OHdG) and thioethers as biomarkers for assessing the exposure in adult smokers who switched from smoking conventional cigarettes to candidate potential reduced exposure products (PREP) or who stopped smoking. Two electrically heated smoking systems (EHCSS) were used as prototype cigarettes that have significant reductions in a number of mainstream smoke constituents as measured by smoking machines relative to those from conventional cigarettes. Urine samples were collected from a randomized, controlled, forced-switching study in which 110 adult smokers of a conventional cigarette brand (CC1) were randomly assigned to five study groups. The groups included the CC1 smoking group, a lower-tar conventional cigarette (CC2) smoking group, EHCSS1 group, EHCSS2 group and a no smoking group that were monitored for 8 days. Biomarkers were measured at baseline and day 8. The daily excretion levels of these biomarkers were compared among the groups before and after switching, and the relationships between the daily excretion levels of these biomarkers and cigarette smoking-related exposure were investigated using Pearson product-moment correlation and multiple regression analyses. It was concluded that under controlled study conditions: (1) 1-OHP, S-PMA and t,t-MA are useful biomarkers that could differentiate exposure between smoking conventional and EHCSS cigarettes or between smoking conventional cigarettes and no smoking; between S-PMA and t,t-MA, the former appeared to be more sensitive; (2) 3-MeAd could only differentiate between smoking conventional cigarettes and no smoking; the results for 3-EtAd were not conclusive because contradictory results were observed; (3) 8-OHdG had a questionable association with smoking and therefore the utility of this biomarker for smoking-related exposure could not be established; and (4) urinary excretion of thioethers as a biomarker lacked sensitivity to demonstrate a clear dose-response relationship in conventional cigarette smokers, although it could differentiate the excretion levels between those subjects who smoked a conventional cigarette and those who stopped smoking.

8-Hydroxy-2'-Deoxyguanosine↗

PubMedDate not supplied

Serum levels of adhesion molecules in children and adolescents with immune and non-immune thyroid diseases.

Serum levels of sICAM-1, sVCAM-1 and sP-selectin were determined in patients with Graves' disease before and after 8 weeks and 24 months of methimazole therapy, in levothyroxine suppressed patients with non-toxic nodular goiter, and in a group of healthy controls, to elucidate the relationship to circulating antithyroid antibodies and possible role of soluble adhesion molecules as markers of inflammatory activity. sICAM-1, sVCAM-1, and sP-selectin in patients with untreated hyperthyroidism were markedly elevated compared with controls. After 8 weeks of methimazole treatment, the concentrations of these molecules dropped, but were still significantly higher than in healthy children. In patients with clinical and biochemical remission after 24 months of therapy, sICAM-1 values were on the verge of significance, but still higher than in the control group, whereas serum levels of sVCAM-1 and sP-selectin had normalized. Slightly higher serum sICAM-1 values were observed in patients with non-toxic nodular goiter compared with healthy children.

Adolescent↗

PubMedDate not supplied

Filmless digital radiology--feasibility and 20 month experience in clinical routine.

We present the clinical experiences of PACS based on 20 months routine operation of the first filmless radiology department worldwide. PACS planning and implementation strategies for potential vendors are discussed. The actual implementation status of this major teaching hospital with currently 560 acute-care beds comprises three computed radiography systems, five digital fluoroscopic units, eight ultrasound machines, five mobile units, three angio suites and two CT's interconnected with a PACS, a RIS, which is coupled with three voice-recognition systems for report generation during nights, and a HIS. Primary diagnosis is performed on 16 workstations with two to six high-resolution, high-contrast monitors. Twenty-six peripheral viewing stations provide image display on the wards and in outpatient clinics. During the first 20 months 586.047 images have been acquired, resulting in 1.3 Tbyte of data stored on optical disks. Currently the daily data production is 5-6 Gbyte, the network traffic 15-18 Gbyte. Benefits of PACS primarily are reliable access to image information, speeding up report cycle time, which contributes to the reduction of the average patient length of stay (LOS). The LOS in our hospital is the shortest (6.4 days) of all Austrian hospitals. So it may be stated that PACS improves the quality of health care.

Artificial Intelligence↗

PubMedDate not supplied

Composition of phospholipid fatty acids in erythrocyte membranes of children with chronic juvenile arthritis: clinical and biochemical correlations.

Systemic diseases of connective tissue, including chronic juvenile arthritis are associated with a number of metabolic disorders such as e.g. lipid disturbances. The purpose of the present work was to analyse the composition of fatty acids in erythrocyte phospholipids of children with juvenile chronic arthritis and to determine a correlation between the composition of these acids and patients' clinical status. The study was conducted on 47 children with juvenile chronic arthritis (jca) and 29 healthy subjects. The following fractions of phospholipids were obtained with the help of thin-layer chromatography: phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, phosphatidyloinositol, cardiolipin, sphingolipin. Fatty acids were analysed with the use of gas chromatograph (Hewlett-Packard 5890). Saturated fatty acids as well as mono- and polyunsaturated (n-3 and n-6) fatty acids were identified. The decrease in the percentage of linolenic acid, PUFA n-6 and PUFA n-3 was found in all the phospholipid fractions in children with jca when compared with control group. There was a concurrent increase in saturated fatty acids, mainly stearic and palmitic acids. The differences in the distribution of fatty acids in erythrocyte phospholipids were observed at early stage of the disease and they became more conspicuous as inflammatory process proceeded.

Adolescent↗

PubMedDate not supplied

Association of lipid metabolism with subclinical diabetic cardiomyopathy in children and adolescents with type 1 diabetes.

UNLABELLED: Nowadays, it is known that atherosclerosis is not a disease affecting elderly people but that it starts as early as in childhood. Children with diabetes mellitus are particularly prone to early development of atherosclerosis. It seems advisable to evaluate the behaviour of lipoprotein (a), apolipoprotein B (atherogenic factors), and apolipoprotein A-I in this group of patients as possible causal or preventive factors of the developing diabetic cardiomyopathy. The purpose of this study was to evaluate the effect of the intensification of lipid metabolism disorders on systolic-diastolic parameters of heart ventricles in children and adolescents with insulin-dependent diabetes mellitus. The study was performed on 19 children and adolescents (11 boys and 8 girls) at the age of 8.4-18.5 (x = 14.2) who have had insulin-dependent diabetes mellitus for 1.5 to 14 years (x = 7.9 years). Control group consisted of 17 healthy children. All patients were subjected to full echocardiographic examination which measured the systolic-diastolic activity of both heart ventricles, and to examinations determining the presence of complications (including the subclinical ones). Additionally, patients had their lipid metabolism parameters defined, i.e.: Lp(a), apo A-I, apo B, triglycerides, cholesterol and its LDL and HDL fractions. CONCLUSIONS: 1. Children and adolescents with type 1 diabetes mellitus have higher concentration of Lp(a) and apolipoprotein B irrespective of the degree of diabetes control, which makes them prone to premature development of atherosclerosis. 2. Lipid metabolism disorders do not have direct influence on the development of diabetic cardiomyopathy in young patients with type 1 diabetes mellitus.

Adolescent↗

PubMedDate not supplied

Elevated concentrations of homocysteine in children and adolescents with arterial hypertension accompanying Type 1 diabetes.

BACKGROUND: Ischemic heart disease is the primary cause of morbidity and mortality among diabetics, especially those who became ill at a young age. In evaluating the risk of the development of atherosclerotic changes, especially when occurring prematurely, increasing attention is being paid to new, unconventional risk factors. One of many such new factors, and one whose role in the development of atherosclerotic changes currently seems to be beyond dispute, is homocysteine. The purpose of this article is to evaluate the concentration of homocysteine in children and youth with Type 1 diabetes, and to attempt to determine the dependence between homocysteine and the degree of metabolic control, the duration of the illness, the age at onset, the insulin dose, the appearance of complications, and a family history of ischemic heart disease. MATERIAL AND METHODS: Our research involved 103 children and youth (average age 13.3 years) with Type 1 diabetes, with an average duration of illness of 5.3 years. The control group consisted of 44 healthy, non-obese children. The concentration of homocysteine was measured using the AXIS homocystein EIA immunoenzymatic method with a set of reagents from the Bio Rad company. RESULTS: The average homocysteine concentration in the experimental group was 5.6 micromol/L, which did not constitute a significant difference from the control group's 6.1 micromol/l. No statistically significant differences were discovered in the concentration of homocysteine depending on the degree of metabolic control, age at onset, method of insulinotherapy, or family history. A significant increase in the concentration of homocysteine was found in children who had been ill for a long time (more than 10 years): 6.1 micromol/L, as against 5.1 micromol/l in children who had been ill for a shorter period of time, and a significantly higher concentration of Hcy in children with diabetic complications (6.1 vs 5.3 micromol/L) and in children with arterial hypertension. CONCLUSIONS: The significant increase in the concentration of homocysteine in children with Type 1 diabetes and arterial hypertension indicates that this group is particularly exposed to early atherosclerotic changes, independently of metabolic control and the parameters of lipid metabolism, and requires the implementation of treatment aimed at reducing the blood concentration of homocysteine.

Adolescent↗