Cholecystolithiasis (ChL) is recently more often diagnosedin children probably due to increasing access toultrasonography as well as increased morbidity in children. It is asymptomatic in 20% and usually is detected incidentally during ultrasonographic diagnosis. ChL isa multifactoral disorder, in 30% it is determined by geneticfactors. The most common symptoms include: biliary attack and abdominal pain in the right upperquadrant of the abdomen with radiation to the scapula (in older children), or non-specific localized pain (inyounger children), nausea, vomiting, abdominal distension, constipation and obstructive jaundice. The conservative treatment is based on low-cholesterol diet andlong-term ursodeoxycholic acid therapy (UDCA), which reduces risk of biliary pain and acute cholecystitis. Only children with noncalcifying gallstones, smaller than

Anaemia is a very late symptom of iron deficiency. Iron deficiency itself adversely affects the neurodevelopment in children and some of these effects maybe long-term and irreversible. The most common and new laboratory measurements used to describe ironstatus are presented in this paper. Authors discussabout iron-deficiency risk groups in Poland and present new recommendations of American Academy of Pediatrics from 2010 (diagnosis and prevention of iron deficiency and iron-deficiency anaemia in children 0–3 years of age).

Pediatric Experts Group on Immunization Programme was established in January 2007 as a advisory Group tothe Ministry of Health. The main objectives of Group’s activity are to established the priorities and perspectives to the National Immunization Programme. Thepriorities depend on current epidemiological data as well as evidence of the effectiveness and efficiency ofvaccines. Since 2007, the main objective is to include pneumococcal vaccination in the routine vaccination schedule in children under 2 years of age. Vaccination schedule of the Ministry of Health doesnot include universal pneumococcal vaccination this year. However, there is a plan to include pneumococcal vaccination programme for the high risk groups, targeting those groups of children in epidemiological situations of risk. In the paper we would like to presentrange of our activities connecting with the realization of the obligatory schedule of immunization in thehigh risk group. For many individuals from this group, the vaccination is an important part of the therapeutic strategies. If it is possible, we should start this procedureduring hospitalization. “Cocoon Strategy” is crucialin preventing of infection diseases in hospital and at home. We encourage other hospitals for starting such strategy.

Patients with anatomic or functional asplenia are at a significant risk of overwhelming infection particularly involving the encapsulated bacteria S. pneumoniae, H. influanzae and N. meningitidis. Preventive strategies include a combination of immunization, antibiotic prophylaxisand education. We introduce a recommendation for the prevention and treatment of infections in children with absent or dysfunctional spleen.

Because it is present in many very important tissues such as brain, retina, neurons, as well as a precursor of inflammatory and immune mediators, blood vesselwall cells, and others, docosahexaenoic acid (DHA), anω-3 fatty acid, has become a very relevant nutritional supplement. Although DHA is not an essential fatty acid in that it can be converted from α linolenic acid, this process is not very efficient. DHA can be found in marine fish but this can result in excessive mercury intake because of contamination of the waters by this heavy metal. DHA has been recognized by the European Food safety authority (EFSA) as a valid support for visual development. DHA supplementation has been shown to have a positive effect on infants’ neurodevelopment, prevention of premature deliveries, age related cognitive decline, regularizing serum triglycerides, and others. This paper describes the basic characteristics of these fatty acids and some of the areas of clinical application.

In the article mechanism of growth disturbances ingrowth hormone deficient children is discussed, as wellas the possibility of treatment with the human recombinant growth hormone according to the National Health Program. The process of diagnosis, inclusion and exclusion criteria to the treatment program are presented.

In the article possible use of recombinant growth hormonein treatment of short stature in children with raredisorders and genetic syndromes is discussed. Present views and current opinions on growth hormone therapyin Noonan syndrome, Silver-Russel syndrome, Kabukisyndrome, Blackfan-Diamond syndrome are shown. It is also underlined, that in some rare disorders with short stature growth hormone therapy is not used.

Clinical efficacy of HPV vaccines in prevention of cervical dysplasia and cervical cancer as well as vulvar premalignant and malignant lesions and other HPV-associateddiseases (genital warts) are summarized. Also, data on safety of the vaccines, significance of HPV6/HPV11 components in the vaccine, as well as efficacy of vaccines in older groups and in men are presented.

Because of growing resistance to antibiotics, the current method of H. pylori eradication is now being widely discussed. In this article authors present indications foreradication and methods of treatment in children andadults, putting stress to a new strategy of eradication, so called sequential therapy. This kind of treatment seems to be more effective than triple therapy in thisage groups.

Central nervous system damage, with various defects of suction/chewing and swallowing, may result in nutrient deficiencies and progressive cachexia. The concomitant gastro-esophageal reflux may hinder implementation of a nutritional plan. Overestimation of the volume of administered food and underestimation of nutritional requirements are common, especially when feeding is cumbersome and/or time-consuming for care-givers. Assessment of the patient’s nutritional requirements combined with defining his abilities to be fed orally and with evaluation of post-feeding volume of lost food, as well as determination of the ability of care-giversto effectively feed the patient, constitute the first stepin developing the nutritional strategy. Also selection of an appropriate diet and the method of its administration should be considered in every patient with dysphagia. An appropriate feeding strategy prevents progressive cachexia, decreases the risk of complications and improves the quality of life of the patientand his care-givers.

Parenteral nutrition is an established method of therapy in intensive care, surgical, oncological, neonatologicaland pediatric units. The number of children with permanent intestinal failure who need long-termhome parenteral nutrition has been growing for last years. The most common complications of parenteral nutrition are infections related to central vein catheter. It is the most frequent cause of hospitalization in children who are parenterally fed at home. There are three types of infectious complications. Catheter related sepsis, mostly caused by Staphylococcus epidermidis, is a severe, life-threatening complication occurring with a frequency of 1–12/1000 days HPN. Infectionof the catheter is a localized type of infection, with no general symptoms present. Local skin and subcutaneous tissue infections around the external exit of the central catheter subcutaneous tunnel, phlegmonof the catheter tunnel is the second of the possible infectious complications associated with long-termparenteral nutrition. The most common pathogen of this complication is a Staphylococcus aureus. The need for frequent antibiotic use in patients on chronic parenteral nutrition is associated with the selection of antibiotic-resistant strains, which are an increasing problem in clinical practice. Either phlegmon of catheter’ssubcutaneous tunnel or sometimes catheter related sepsis can be associated with the need of the catheter removal and subsequently loss of vascular access. The aim of this paper is to present current prophylactic and treatment methods in infectious complications of parenteral nutrition according to the literature and own experience.

Abdomen ultrasound is the most common imaging examination in children. It may be done as a screening examination as well as in emergency state in various diseases of alimentary and urogenital tract. It is a safe, repeatable and cheap technique; is relatively short, lasting about 30 minutes and does not requirea special preparation. Patients who are scheduled foran abdominal ultrasound are asked to fast some hour sand drink water to keep the bladder full prior to the examination. This allows improve the imaging quality of abdomen organs.

The tuberous sclerosis (Bourneville’a-Pringle’a disease) is a rare disease, in which the cardiac tumors are present. The most common histological type of cardiac tumorsin children is rhabdomyoma. In the most cases it is diagnosed by fetal echocardiography in the prenatal period. The tuberous sclerosis is still a very important diagnostic and therapeutic problem.

Natural feeding is the most optimal and recommended method of nourishing newborns, especially premature babies. However, breastfeeding of very low and extremely low birth weight infants is not possible. Thus, it is necessary to stimulate lactation and express breast milk in order to give it to children appropriately to their maturity level and state of health. Expressing breast milk, regardless of the method, may result in bacterialand fungal contamination leading to the development of infection. Therefore, it is important to introduce detailed procedures describing proceeding with milke xpression which will not allow its contamination.

Hearing disorders in school age children should be detectedas early as possible to allow early diagnosis, treatment and rehabilitation. It is recommended to conduct hearing screening in school age children, especially in areas without well developed health care system, however, there is still debate concerning methods and organization of such screening program. In 2008, a hearing screening program was conductedin seven eastern provinces of Poland. It was aimed to detect cases of hearing dysfunctions in children from primary schools, and to raise the awareness of consequences of delayed detection of hearing disorders and possibilities of early therapeutic intervention among parents and teachers. The hearing screening programconducted in 2010 was a continuation of that programand was addressed to primary school children in ruralareas in western part of Poland. Examinations were conducted in schools; standard battery of tests included: air conduction pure tone audiometry for frequencies ranging from 250 to 8 kHz, GDTand DDT tests to assess central auditory functions and audiological questionnaire completed by parents. During four months 183 testers examined 95 411 childrenin 4041 schools. Results of the pure tone audiometry screening test show that 14,4 % of children have hearing loss (hearing threshold above 20 dB HL). Basedon the analysis of tests and questionnaires, performed by specialists audiologists and otolaryngologists, 45,9% children with wrong results of hearing screening examination shave been referred for diagnostic evaluationand treatment to audiological centers. The results of this program have confirmed the importance of hearing screening in all children starting their school education. Standing education about the prophylaxis of hearing disorders, especially noise-preventioncampaign, is essential.

Continuous development of science and medical knowledge often involves the need to implement orcontinue the interdisciplinary treatment process. Theability to quickly communicate with their doctors of different specialties are requested to use a telecommunications or computer media. This is of particular importance when the specialists, whose participationis necessary in a particular treatment process, are separated from one another in the center. In practice, manyare concerned the possibility of granting the samehealth care benefits on the basis of teleconsultation or telediagnostyic, as well as the nature and responsibilities of doctors for the negative consequences forthe patient’s life or health arising from the provision of healthcare services based on telemedical media.These issues are not addressed explicitly by applicable law, which relate to the provision of healthcare services.In order to answer questions concerning the admissibilityof telediagnostic and teleconsultation and responsibilities of a doctor, the authors of this work focusedon the analysis and interpretation of regulations that even indirectly relate to the provision of healthcare services „distance”.

Vitamin D3 and its metabolites as well as synthetic analog shave been used for a long time in pediatric and adult patients for regulation of calcium and phosphatehomeostasis. Vitamin D3, photosynthesized in the skinfrom steroid precursor, is a typical pro-hormone which is biologically inactive. The pro-hormone is hydroxylatedin a two-step enzymatic procedure, in the liver andin the kidney, to form the most active hormonal form of vitamin D3. These physiological processes might be disrupted in a number of pathological states and during extensive dialyses thus creating a need for the supplementation with vitamin D3 or its metabolite. Vitamin D3as a seco-steroid nuclear hormone also inhibits the excessive proliferation of a number of cancer cells and proliferation of epidermal keratinocytes, stimulates the differentiation of cancer cells and shows pro-apoptotic and anty-angiogenic function. Some dihydroxylated derivatives of vitamin D3 are used in the therapy ofa number of dermatological disorders. Epidemiological trials on large populations revealed a strict correlationbetween prolonged vitamin D3 deficiency not only with some metabolic disorders but also with the increased risk of cancer. Vitamin D3 hormone and some synthetic analogs increase the efficacy of cytostatics in the anti-cancer treatment of breast, prostate and colorectal cancers in animal models and in clinical trials and therefore might be applied in chemotherapy and chemoprevention of cancer.