A broad spectrum of adverse events is reported following human vaccination, but such reactions are considered to be relatively rare. A variety of mechanisms has been proposed for such adverse events. Other adverse events directly associated with the vaccine include: reversionto virulence of attenuated vaccine strains of organisms or contamination of the vaccine product.A variety of allergic and autoimmune diseases havebeen suggested to be triggered by vaccination, but ingeneral, the evidence for such associations remain slargely anecdotal. Finally, many reported non-specificeffects of vaccination and adverse events are simplychance instances of infection or disease on set around the time of vaccination and are not causally associated with administration of vaccine.

Skin reactions in the diaper area are the most common dermatologic problem in infancy. Such eruptionscan be subdivided into primary diaper dermatitis (anacute inflammation of the diaper area of multifactorial etiology) and secondary diaper dermatitis that encompasses eruptions in the diaper area with defined etiology (pediatric and dermatological diseases). Secondary diaper dermatitis can be divided into inflammatory and infectious categories. It is very important to distinguishirritant contact dermatit is from other skin conditions that may develop in this sensitive area.

Vitamin D receptors have a broad tissue distribution that includes vascular smooth muscle cells (VSMCs), endothelium, cardiomyocytes, limfocytes B and T andantigen presenting cells such as macrophags. In vitrohormonaly active vitamin D metabolite (1,25(OH)2D) directly suppresses renin gene expression, regulates the growth and proliferation of vascular smooth musclecells and cardio myocytes, and inhibit cytokine release from lymphocytes. Studies in knockout mice confirm that the absence of vitamin D receptor activation leads to tonic upregulation of the renin-angiotensinsystem, with the development of hypertension andleft ventricular hypertrophy. Clinical studies have raported associations between low vitamin D levels and plasma renin activity, blood pressure, coronary arterycalcification and prevalent cardiovascular diseases. The prospective, community-based data evidenced that vitamin D deficiency is associated with increased cardiovascular risk. In small clinical trials, vitaminD supplementation has promoted reduction in blood pressure, left ventricular hypertrophy and inflammatorycytokines. The hypothesis that the relation between 25(OH)Dand cardiovascular risk is nonlinear are not properly evidenced. The higher risk associated with vitamin Ddeficiency was particularly evident among individuals with hypertension, in whom 25(OH)D levels <15 ng/mlwere associated with a 2-fold increase of risk of cardiovascular events.

Diabetes type 1 and 2 dominates discussion about hyperglycemia. This is justified looking on the epidemiologic aspects of the diseases. Nevertheless we should not forget about rare causes of diabetes, these depending on insulin release defects and mutations in insulin receptorgene. In this article rare causes of hyperglycemia are described with connection to hyperinsulinism. Pathophysiology of both phenomena is common.

Lyme borreliosis is a multisystem disease, involving many organs. As a rule – borreliosis is a clinical diagnosis. However misdiagnosis can occur because clinical presentations are not unique for Lyme disease. Therefore she is called “the great imitator”. Microbiological findings can be helpful and they are indicated in all cases of clinically suspected borreliosis. Antibiotic therapy cures about 90% of the patients. In some cases therapy is unsuccessful. Despite increasing knowledge about borreliosis many aspects of pathomechanisms of persistence Borrelia in tissues, diagnostic and treatment resistance are still the challenge for scientists.

Upper airways infectious diseases still present difficulties on the diagnostic and therapeutic process. Subsequently, there is still neither standardized classification nor unified guidelines for management. There are several publications, recommendations, opinions of great authorities treating about antibiotic therapy in sinusitis and otitis media in literature, that reveal multiple similarities and differences in series results through out the countries, continents and particular medicalcenters. It is not only due to varying methodology of each research but also because of distinctive featuresof microorganisms. Nevertheless the etiology of acute infections remains constantly the same. That means first of all viruses and afterwards bacteria, particularly S. pneumoniae, H. influenzae, M. catarrhalis. Gram negative and anaerobic bacteria are encountered in chronic infectious diseases of upper airways. Eventually, pharmacology maintains fundamental management of acute sinusitis or otitis, as well as surgery in chronic states of these structures.

Immunological type I diabetes mellitus is the most common form of childhood diabetes. At least 15–30% of diabetic children have cutaneous changes. The mechanism of skin involvement is not fully understood. Thepart of cutaneous lesions may be related to metabolicalteration, mainly hyperglycemia and others seem to bemanifestation of microvascular disease. Some of skin changes (necrobiosis lipoidica, diabetic dermopathy, cheiroarthropathy) are characteristic for diabetes and have diagnostic value, and some (bacterial and fungal infections, eruptive xanthoma, acanthosis nigricans) appear more frequently in diabetic persons than ingeneral population. The recognition of skin manifestations in diabetic children may be of practical value for the early diagnosis and treatment of the disease.

Upper respiratory tract obstruction is an important clinical problem. Its most common cause is a viralcroup. Various treatment methods of croup have been verified recently. It has been proven that the most effective treatment of viral croup are oral corticosteroids. In more severe cases the nebulized epinephrine may be additionally indicated. Epiglottitis is nowadays a rare cause of airflow obstruction, mostly due to the obligatory vaccination against Haemophilus influenzaetype B. Nevertheless, epiglottitis still requires a quick diagnosis and treatment. In this article the current data concerning diagnosis and treatment of these two entities were discussed.

Pharyngitis and tonsilitis are very frequent infectious diseases in children. Various agents are responsible for the development of pharyngitis and tonsillitis. Viralinfections require only symptomatic treatment where as bacterial disease should be treated with antibiotics. The objective of diagnostic procedures is to identify whether antibacterial therapy in the specific inflammatory process is necessary. This paper is a review of tonsillitis and pharyngitis in children – their most frequent etiologic agents, clinical symptoms, diagnostic methods and current treatment guidelines.

Feeding disorders in children are a complex problem that require a broad diagnostic approach. The etiology of feeding disorders is diverse and most often organic disease or basic neurological disorders appear together with behavioral issues. Every patient should be assessed by a nutritionist, psychologist, speech pathologist, pediatrician and occupational therapist. This way of a complex medical approach will result in an optimal nutritional, pharmacological and psychological care.

Lymph vessels malformation is a rare developmental disorder and it poses about 5% of benign tumors in children. In pathogenesis it has been considered as a genetic disorder of organogenesis, obstructive mechanism secondary to cardiovascular disturbances and congenital infections. Clinical symptoms may represent the local or generalized dysplasia. Lymphangiectasia may be associated with nonimmunehy drops fetalis, pleural effusions, peripheral ascites. Lymphatic malformations may be a part of multiplecon genital anomalies syndromes or coexist with other congenital failures. Congenital pulmonary lymphangiectasia may be present at birth as a severe respiratory distress syndrome – a diagnosis which was associated with a highmortality rate in the past. Recent advances in intensive neonatal care changed the poor outcome and patients who remained in a good condition throughout the infancy have a good prognosis. The chronic lung diseaseis observed in patients during follow up. In this article the infant with congenital pulmonary lymphangiectasia, chylothorax, nevus sebaceous of Jadassohn and multiple developmental anomalies was described.

Hypertrophic cardiomyopathy is the most common cause of sudden cardiac death (SCD) in children and young adults.

Aim:
The aim of study was to evaluate the risk factors for SCD in children with HCM and to identify patients who are at increased risk for SCD.

Materials and methods:
The analysis was performedin 76 pts, mean age 10,7±5,1 yrs with HCM hospitalized in Pediatric Cardiology Department from 1991 to 2008. In all patients the following examinations were performed and analyzed: family history, presence of clinical symptoms as syncope, chest pain, palpitations, cardiacarrest in the past and comprehensive cardiological examinations. Data from all patients have been analyzed regarding the presence of major risk factors for SCD according to ACC/AHA/ESC recommendations.

Results:
Among 76 analyzed patients in 31 (41%) children the major risk factors for SCD were present (groupI) and in 45 (59%) the major risk factors did not occur (group II). Among 31 children with the major risk factors for SCD 17 (22%) pts had one major risk factor, 11 (14%) children had two, 2 (2,6%) pts had three risk factors,1(1,3%) pt had five risk factors for SCD.

Conclusions:
High-risk patients with HCM ought to be prospectively identified with non invasive tests. Regular clinical risk stratification for sudden cardiac death is of vital importance in children with hypertrophic cardiomyopathy and in high-risk patients it should be doneat least every 12 months.

Living donor transplantation is now a common practice in many countries as a way of relieving organ shortage. In this article autor discusses some ethical concerns about moral boundaries and reasonable risk of living donors.

The paper relates to the issue of the medical records that are necessary in case of organ transplantation from the deceased donor. This problem is complicated due to lack of the legal regulations and model documents, such as operation protocol, donor or a recipient card. The paper presents key issues concerning the transmission of transplant information to the transplant-coordinator, responsibilities of the regional and hospital coordinators concerning medical records, as well as issues concerning proper models of the documents.

The act on profession of doctor and dentist forces to implement or continue treatment based on medicinal products marketed in the country. Exceptions of this rule are pharmaceutical/medical materials and devices registered outside Poland. Import of a medicinal product from abroad for a particular patient, the so-called target import, is possible after fulfilling the specific conditions and formal procedures. This article answer sessential questions concerning the target import of medicinal products.