ITP in childhood is a very various disease with different prognosis. There are several international recommendations about diagnosis and treatment, however no clear clinical algorithm exists. In this work we summarize our national and international experiences and information about childhood ITP. A useful clinical guideline is worked out and presented here.

The incidence of childhood inflammatory bowel disease is permanently increasing. The main difference in the clinical signs between childhood and adulthood inflammatory bowel disease is growth retardation, which was detected in 10 to 40% of children and adolescents with Crohn’s disease. The pathogenesis of growth retardation is multifactorial (genetic factors, reduced energy intake, malnutrition, long term steroid therapy). The main causes of disruption of linear growth are chronic malnutrition and cytokines released from the inflamed intestine. Long term, high dose systematic steroid therapy can enhances growth retardation too. There are limited data available of other hormonal changes than altered GRF-GH-IGF-I axis in Crohn’s diease. Clinical studies detected dysfunction of GnRH-gonadotropgonad axis and there are data of altered hormonal secretion of the thyroid and adrenal gland. Osteopenia is frequently associated with childhood Crohn’ disease. Therapeutic strategies, as up-to-date medicine therapy, optimizing nutrition status and surgical interventions can not only decrease inflammatory process itself but can also optimize linear growth and pubertal process. Exclusive enteral therapy and use of biologic agents as monoclonal antibody against TNF-a hold promise of growth enhancement for patients with childhood onset Crohn’s disease. In case of severe growth retardation or delay of puberty administration of growth hormone or testosterone may help to decrease somatic retardation.

Background: Intestinal alkaline phosphatase (iAP) might be an important factor in the maintenance of the intestinal barrier integrity. iAP binds lipopolysaccharide (LPS), the ligand of Toll-like receptor4 (TLR4) and detoxifies its activity. However, there is no previous study on determination of iAP protein level in the intestinal mucosa of patients with inflammatory bowel disease (IBD). Patients and methods: The iAP protein level was determined by Western-blot in colonic biopsy samples from inflamed and noninflamed mucosa of 15 children with IBD compared with 10 healthy controls. Tissue localization of iAP and TLR4 were investigated by
immunofluorescent staining. Results: The protein level of iAP in the inflamed mucosa of children with Crohn’s disease (CD) and ulcerative colitis (UC) was
decreased by 22% and 20%, respectively, compared with controls. Significant decrease in iAP protein level in the involved mucosa in CD and UC was observed in comparison to uninvolved mucosa in CD. Immunofluorescent staining revealed iAP and TLR4 colocalization and restriction to the epithelial surface in all groups studied. Conclusion: According to our study the iAP protein level is decreased in the colonic mucosa of children with IBD. The diminished iAP may contribute to the increased expression of TLR4 and augmented activation of LPS which may strengthen the inflammatory process.

Although a number of treatment options are available for the management
of childhood ITP currently there is no widely accepted standard-of-care due to lack of international consensus. With the publication of our observations we intend to contribute to the establishment of such consensus. In a retrospective analysis we assessed the clinical outcome, the efficacy and side effect profile of the treatments applied in 108 children diagnosed
with ITP between 1998 and 2009 at the 2nd Department of Pediatrics. The mean follow up period was 19 months. 72 patients (66.7%) had acute ITP, 20 (18.5%) patients had a diagnosis of chronic ITP while acute recidivous ITP was found in 16 cases (14.8%). No significant difference in efficacy has been identified between the applied treatment regimens. Complete remission could be achieved in 68% of patients (23/34) receiving glucocorticoid treatment, while IVIG therapy proved to be successful in 63% of patients (25/40). However, IVIG therapy has been associated with fewer and milder
side effects. According to our observations clinical outcome is more favourable in children aged £6 years compared to children ³12 years. 70% of our patients (76/108) recovered without any complications. No primary treatment was necessary in 23% of them. We can conclude that though treatment with IVIG is associated with higher costs it seems to be more advantageous in young children when compared to glucocorticoid therapy.

Background and objective: With the advent of human and synthetic insulin analogues, allergic reactions to insulin are now less common, but can have serious consequences in children with type 1 diabetes mellitus. We report a case of insulin allergy in a 14-yearold child, in whom the insulin desensitization was accomplished by insulin pump therapy. During the diagnostic tests and laboratory investigations another autoimmune condition, an inflammatory bowel disease was recognized. Method and results: A 14-year-old boy with type 1 diabetes mellitus on a basal-bolus insulin regimen developed progressive allergic skin reactions to insulin. Similar skin reactions developed after using other available brands of insulin. He had eosinophilia and high total IgE level. Inhalative and food specific IgE were negative. The Prick skin test, the Hungarian standard intradermal test, the intradermal skin tests with Novo allergy kits and the LTT were all negative. In an attempt to desensitize the patient, we introduced a rapid acting insulin analogue regimen consisting of five small premeal bolus injections of insulin aspart. This resulted in some, but still unsatisfactory improvement, which prompted us to start treatment with continuous subcutaneous insulin administration using a portable pump. The small basal infusion rate served as a kind of desensitization and the allergic skin reactions gradually disap d. Unexpectedly, a few weeks later, he developed peri proctal abscess. The subsequent gastrointestinal and immunological investigations suggested inflammatory bowel disease, possibly Crohn’s disease and appropriate treatment was started. Conclusion: Our case report demonstrated that continuous sub - cutaneous insulin infusion therapy with a portable insulin pump can be successfully used for insulin desensitization in selected children with serious skin allergy to insulin. The slow continuous infusion of insulin provided by the pump may be an ideal means to
achieve insulin desensitization.

In Hungary the number of children (with age 0–19) is continuously decreasing because of the constantly low level of the number of live-born children. The ratio of the low birth weight infant is very high, which is an important factor of infant mortality. Infant mortality shows a steady decline, which is partly the consequence of the high quality perinatal care system. Regional values of infant mortality are very different, with maximal value above 10‰ in Borsod- Abaúj-Zemplén county.