Browsing by Author "Stojšić, Zorica (22942162500)"

Introduction Idiopathic ulcerative colitis (IUC) represents a rare disease of childhood. It usually occurs at age over 10 years, and below that exceptionally rarely. Objective The aim of the paper was to analyze the clinical signs, symptoms and therapeutic procedures in children with IUC. Methods The aims of the paper were based on a sample of 17 children (11 male and 6 female, mean age 11.90±3.50 years; range 3.8-17.5 years) with IUC. The disease diagnosis was based on characteristic endoscopic and pathohistological findings. Results The basic signs of the disease involved chronic mucosal haemorrhagic diarrhoea which was confirmed in 16 of 17 patients, with body weight deficiency (10), recurrent abdominal pain (6), fever (5), slowed-down maturation (5), marked anorexia (4), and tenesmus (3). Two patients had recurrent aphthous stomatitis, 2 anal fissures, 2 arthralgia, one autoimmune hepatitis and one pyoderma gangrenosum. None of the children had longitudinal growth retardation. Elevated sedimentation rate and C-reactive protein in blood were registered in 11, sideropenia in 10, anaemia in 6 and hypoalbuminemia in 3 patients. The remission of proctosigmoiditis and left-sided colitis was achieved with aminosalicylates, and of pancolitis with the combination of aminosalicylates and glucocorticoids, except in cases of steroid-dependent colitis, which additionally required azathioprine. Conclusion The main signs of IUC in children are chronic mucous haemorrhagic diarrhoea, body weight loss and sideropenic anaemia, while the basic therapy consists of aminosalicylates, and in more severe cases of the disease the initial use of glucocorticoids and later azathioprine.

Introduction: Coeliac disease (CD) is a permanent intolerance of gluten, i.e. of gliadin and related proteins found in the endosperm of wheat, rye and barley. It is characterized by polygenic predisposition, autoimmune nature, predominantly asymptomatic or atypical clinical course, as well as by high prevalence in patients with Down's syndrome (DS) and some other diseases. Outline of Cases: We are presenting a girl and two boys, aged 6-7 (X̄=6.33) years with DS and CD recognized under the feature of sideropenic anaemia resistant to oral therapy with iron. Beside mental retardation, low stature and the morphological features characteristic of DS, two patients had a congenital heart disease; one ventricular septal defect and the other atrioventricular canal. In two patients, trisomy on the 21st chromosome pair (trisomy 21) was disclosed in all cells, while one had a mosaic karyotype. All three patients had classical laboratory parameters of sideropenic anaemia: blood Hb 77-89 g/l (X̄=81.67), HCT 0.26-0.29% (X̄=0.28), MCV 69-80 fl (X̄=73), MCH 24.3-30 pg (X̄=26.77) and serum iron 2-5 μmol/L (X=4.0). Beside anaemia and in one patient a mild isolated hypertransaminasemia (AST 67 U/l, ALT 62 U/l), other indicators of CD were not registered in any of the children. In addition, in all three patients, we also detected an increased level of antibodies to tissue transglutaminase (atTG) of IgA class (45-88 U/l) so that we performed endoscopic enterobiopsy in order to reliably confirm the diagnosis of CD. In all three patients, the pathohistological finding of the duodenal mucosa specimen showed mild to moderate destructive enteropathy associated with high intraepithelial lymphocyte infiltration, cryptic hyperplasia and lympho-plasmocytic infiltration of the stroma. In all three patients, the treatment with a strict gluten-free diet and iron therapy applied orally for 3-4 months resulted in blood count normalization and the correction of sideropenia. Serum level of the atTG-IgA, repeated after a 12-month diet, was also normal. Conclusion: CD should be taken into consideration in all cases of sideropenic anaemia resistant to iron oral therapy in children with DS. The diagnosis of CD implicates corresponding pathohistological confirmation, while the treatment of sideropenic anaemia and its complications, beside iron preparations, also requires compliance with a gluten-free diet.

Introduction: Gluten-free diet (GFD) presents the basis of coeliac disease (CD) treatment. If strictly applied, the disorders of the small bowel mucosa and other disease signs rapidly resolve. Objective: The goal of the study was to evaluate the effect of GFD on the growth and nutritional status of children with the classical form of CD. In addition, we analyzed the differences between these parameters with the duration and the patients' compliance with GFD. Methods The study goals were achieved on a sample of 90 children, 56 female and 34 male, aged 0.5-7.5 (1.53±1.05) years, with the classic CD diagnosed on the basis of typical pathohistological findings of the small bowel mucosa and clinical recovery of patients on GFD. The duration of the patients' follow-up was 1.08-8.75 (3.03±1.14) years, i.e. until the age of 2.5-15 (4.59±1.78) years. The initial and control values of body height (BH) in relation to matched values for age and gender were expressed in percentiles, while the deviation in body weight (BW) for the matched values of height and gender was expressed in percentages. The referent haemoglobin (Hb) rate in blood, as a laboratory indicator of nutritional status in children aged up to 5 years was ≥110 g/L, and for those aged above 5 years it was ≥115 g/L. Compliance with GFD was based on the pathohistological findings of the small bowel mucosa or determination of tissue transglutaminase. Results: Over the studied period, the effect of GFD was highly significant, both on the increase of BH percentiles (37.62±26.26 vs. 57.22±25.29; p<0.001), and on the decrease of BW deficit 11.58±10.80 vs. 0.89±8.194; p<0.001). After the treatment period, none of the children showed slowed growth rate or BW deficit above 20%, while BW deviation ranging between 10-20% in relation to the referent values was registered in 17 (18.19%) and the excess of over 20% in 2 patients. In 86 (95.56%) patients, control Hb values in blood were normal, while mild anaemia was registered in 4 patients, all compliant with GFD. The difference between the compliant and non-compliant patients with GFD was not detected either in BH percentiles (p=0.586) or in BW percentage deviation as compared to standard values (p=0.516) or in blood Hb values (p=0.445). In addition, differences between the children on GFD lasting over and below 3 years were not detected either in BH percentiles (p=0.915) or in BW deviation percentages in relation to the ideal rate (p=0.476). Conclusion: GFD applied for 1-3 years has a highly significant effect on the growth rate and nutritional status of children with the classical form of CD. Significant differences in these parameters of the disease were not detected between strictly compliant and non-compliant patients on GFD.

Objectives: The aims of this study were to evaluate the morphometric and structural characteristics of abdominal aortic aneurysms (AAA), and to form a morphometric model of the AAA that could be applicable in the development of mathematical and computation models for rupture risk assessment. Material and Methods: The following morphometric parameters significant for biomechanical stability and compliance of the aortic wall were analyzed: the thickness of the wall, the thickness of the media and the thickness of the adventitia. Morphometry was performed with the Olympus BX 41 microscope and the Olympus C - 5060 wide zoom digital camera with an application of the Olympus DP-soft Image Analyzer program. The media-to-wall and adventitia-to-wall ratios were calculated. Parameters were correlated with the diameters of the aneurysms (established by MSCT angiography), the patients' age and gender, the presence of a thrombus and the grade of inflammation. Results and Discussion: Our results showed that an increase in the AAA diameter affected the structure of the aortic wall in the following ways: 1. the thickness of the aortic wall significantly increased, with the greatest increase for aneurysms with diameters between 41 and 60 mm (ANOVA F=268.561; p<0.001); 2. the thickness of the adventitia and its proportion in the wall thickness significantly increased, in the same group (ANOVA F=376.727, p<0.001); 3. the thickness of the media and its proportion in the wall thickness significantly decreased, with the greatest increase for aneurysms with diameters >60mm (ANOVA F=265.865; p<0,001). The supposed influence of the latter two factors reduced the adaptability of the vascular wall and augmented the rupture risk since the aortic wall media is responsible for the elastic properties of the blood vessels, while increased and fibrotic adventitia did not provide sufficient compliance. We confirmed, by means of the Univariate Analysis of Variance, that the increase of the adventitia and destruction of the media were even greater in aneurysms with inflammation and in patients over 65 years old. Female patients with small aneurysms (d<40mm) are at a special rupture risk. They have a significantly thinner wall (F=35.164; p<0.001), with a significantly thinner media (F=35.473; p<0.001) and a significantly thicker adventitia (F=21.146; p<0.001) than male patients. Small-diameter aneurysms with a thrombus are also under special rupture risk. Destruction of the media was advanced in this group, with an exceptionally small medial thickness compared to larger aneurysms with a thrombus (F=237.770; p<0.001). Conclusions and Clinical Relevance: A correction of AAA computation models with histomorphometric data is necessary for an accurate prediction of rupture risk. Parameters used in computation models are based on CT scans, but not all parameters are easily assessed with a CT scan (i.e., the wall thickness). Most of the computation models operate under the assumption that aneurysms are homogenous structures, which is not the case. On the contrary, aneurysms are heterogeneous, with extreme variations of structure among patients and in different parts of the same aneurysm. Some data are not uniquely defined and recognized, (i.e., the influence of a thrombus on the wall structure). Hence, the goal of morphometric models is to provide sufficient data for the construction of an improved and adjustable model for rupture risk prediction that will combine many different factors and enable a tailored decision making process for each patient. © 2009 Nova Science Publishers, Inc.

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