Patients who came to harm as a result of the medical mistake made by the doctor in the process of the diagnostic-therapeutic processes, are more and more frequently appealing for the compensation. It results from the financial character of the civil liability. This publication explains the essential issues needed to be fulfilled to make civil liability of the doctor come into being, how the form of practicing influences the diversifying the civil liability and, finally, what insurance contracts should or must a medical doctor conclude depending on the form of practicing and kinds of granted medical benefits.In the article current legal regulations, concerning medical doctors’ civil liability, position of the judicature on the medical mistakes, as well as practical tips concerning the type of CL insurance contracts were analyzed.

This article clarifies why confrontation with the Münchausen Syndrome by Proxy (MSBP) is so challengingfor a paediatrician. It also presents the explanatory models for MSBP and proposes guidelines for recognition and management of MSBP.

Dietary supplements means food stuffs the purposeof which is to supplement the normal diet and which are concentrated sources of nutrients or other substances with a nutritional or physiological effect. Food supplements can be used to supplement daily diet with vitamins and minerals, if the diet can not cover consumers’ nutrition requirements. During the past few years the food supplements marketis increasing very rapidly. In Poland about 20% of people claims that they use food supplements. This has raised questions about safe intake of food supplements. Most of the components of dietary supplement may cause pharmacokinetic interactions with drugs i.e. affect the absorption, bio availability or metabolism of drugs.

Interpretation of DXA measurements in children and adolescents is difficult, mostly due to growth and maturation. Usually, reference data in children are presented according to chronological age. However, it is known that some parameters are highly related to a body size of a child. Reference data are usually presented as a mean ± standard deviation (categorized data). This approach is easy to use but may causemis interpretation, especially when patient’s age issituated near the bound of groups. Small difference in date of measurement may change patient’s adherence to reference related to age group. To avoid this source of errors preparation of continuous reference data is needed. The aim of this study was to establish continuous normative data for bone density, body composition parameters and their relation in boys and girls by age, gender, weight and height. It is stated that established continuous normative data allow to avoid misinterpretation conducted with categorized normative data. Continuous bone density and body composition reference data enable proper interpretation of both single and serial measurements in children and adolescents. Established continuous normative data according to age, weight and heightenable interpretation of measurement of a given child with respect to mechanostat theory.

Primary intestinal lymphangiectasia is a very rarecondition, where local or systemic lymphatic vesselsare affected. It is often related to any pathology ofthe lymphatic system in the human body. Here bywe present a case report of a patient with an extremely extend type of this disease. Dietary treatment, including replacement of long-chain fatty acids with medium-chain triglicerydes, is often the only wayof treatment for patients with primary intestinallym phangiectasia.

Inravenous lipid emulsions are integral components of properly managed parenteral nutrition. In this article basic facts about composition and function of intravenous lipid emulsions along with recommendation of safe dosing and administering of lipids in pediatric population are presented.

Amino acids play a crucial place in human nutrition. The dose of amino acids demanded for parenterally fed patients is lower than in enteral nutrition due too mitting the intestinal pass which consume about 50%of delivered amino acids. The need for conditionally essentialamino acids depends on the clinical condition of patients. The dose of parenterally delivered amino acids in children is different according to age and clinical state of the patient. Inventing the amino acids solution suitable for every clinical situation seems tobe impossible.

Authors present application of anorectal manometry in diagnostic and therapeutic procedures in defecation disorders in children.

The authors presents the principles of therapy in children with constipation. The basic role of therapeutic team consisted of pediatrician, dietetician, psychologist, surgeon and nurse was underlined. The role of soluble and non-soluble dietary fiber in colon motility regulation was discussed. The basic groups of medicines used in constipation therapy were presented. The essentialrole of osmotic drugs (lactulose macrogols) in children was emphasized.The behavioural therapies including biofeedback and surgical options were discussed. The doctor’s cooperation with family and the essential role of compliance regarding dietary and pharmacological prescriptions isthe key to therapeutic success.

Authors present simple and practical guidelines for easy and quick diagnosis of children with Hirschsprung’s disease. Characteristic clinical symptoms are the most important at the beginning of the diagnostic work-up, which is summarized at the end of the paper in the diagnostic scheme including various symptoms and age of children.

Chronic, often latent at the beginning complications of long-term parenteral nutrition are complex. The aetiology of these side effects is multifactorial and often not understood. The most important are long-term metabolic complications: liver steatosis, cholestatic liver disease, renal impairment, hypoglycaemia, nutrient deficiencies. Long-term parenteral nutrition, recurrent central line infections, not adequate monitoring, specificity of underlying disease and its treatment and other unknown, problematical factors play role in latent at first sight complications of parenteral nutrition.

The paper describes the activity of particular antimicrobial agents against clinical isolates of microorganisms, often with multiple resistance mechanisms, responsible for hospital infections. Different resistance mechanisms against the same group of antibiotics, for example b-lactamsare encountered among Gram positive and Gram-negative bacteria. The most important mechanisms of resistance found among bacterial isolates of clinical significance, which clinician can meet everyday during his work are characterized. Furthermore, other factors which determine an effective antibiotic therapy as pharmacokinetic parameters were mentioned. The aim of this paper was to pay special attention on the very serious problem of antibiotic resistance, which meets clinicians in the whole world. The prudent and rational antibiotic therapy can slow down this process. Furthermore, the periodical with drawal of a particular group of antibiotics from therapy can reverse its clinical efficiency.

Diagnostics of periodic fevers can be a longitudinalprocess. They are caused by acute or chronic infections in more than 90 percent. Exclusion of viral, bacterialand parasitological infections, as well as designation of infectious foci is difficult; it requires a good laboratory base and diagnostic radiology. These expensive diagnostic procedures should be started by a general practitioner, supplementary laboratory examinations should be carried out by regional hospitals and advanced tests – by highly-specialized hospitals. Therest causes of periodic fevers comprise autoimmunological disorders, immunodeficiency syndromes and malignancy. Diagnostics of periodic fevers is the last stage in diagnostics of these rare diseases. Our report presents the proposal of diagnostics standards, basedon reported files of more than 60 children with periodic fever, diagnosed in Department o Immunology, Children’s Memorial Health Institute and Department of Paediatrics and Developmental Disorders of Children and Adolescents Medical University in Białystok.

Recommendations of nursing central vein catheters used for long-term parenteral nutrition are presented, on the basis of experience gained in our Pediatric Department. Blood sampling and blood and blood derivates transfusion are also mentioned.

The author presents indication and implantation rules for central venous catheters in children.

Malnutrition appears to be the one of the main clinical problems in children with inflammatory bowel disease. Nutritional support as a basic method of treatment is adjusted to the severity of inflammation. Caloric supplementation, oral dietary supplements, enteral feeding via gastrostomy or nasogastric tube, as well as parenteral nutrition, remains an important therapeutic approach for children unable to consume an adequate diet.

Antimicrobial resistance has become a global problem. Coordinated iniciatives should be undertaken by the community to stop this phenomenon. According to pharmaco-epidemiological studies, majority of antimicrobial agents are used in the primary care, of which more than ¾ are used in the tratment of respiratory tract infections. It does not correlate with self-limitingnature of these infections, mainly caused by viruses. Changes in liberal use of antibiotics in the treatment of respiratory tract infections should be supported by evidence based recommendations and algorytms prepared by independent experts.

Recent verdicts of the Nobel Committee, awarding prizes for physiology/medicine and chemistry are becoming some what confusing for supporters of clear-cut borderlines between traditional scientific disciplines. However, the issue of unity of life sciences and the need for interdisciplinary approach to medical knowledge is by no means a contemporary problem. Approximately 80 years ago, an unknown substance ofplant and animal origin, named anti-scorbutic factor, became within few years of heroic research endeavor, well defined chemical entity and extremely popular medicinal agent – namely, the vitamin C. Among hundreds of researchers involved in this transformation, majority of them chemists by profession, we singleout Thadeus Reichstein (1897–1995), of Polish origin, as a shining example of an inventive scientist, whose knowledge and perseverance led to outstanding and lasting achievements in chemistry (industrial synthesis of vitamin C) and medicine (discovery of cortisone andaldosterone). For the latter achievement, in 1950 thisgreat researcher was honored with the Nobel Prize in physiology and medicine discipline.