Background Nowadays, we can distinguish more than two types of diabetes mellitus. Due to blood glucose measurement and genetic tests, different types of diabetes (such as autoimmune, monogenetic, atypical) can be detected. Despite the constantly updated recommendations and the progress of diagnostic tests, making a diagnosis may be difficult. Case report A 23-year old patient was admitted to the Department of Endocrinology due to diagnosed diabetes mellitus to determine its primary cause. Elevated blood glucose level was identified during periodic medical test and was confirmed by OGTT test. In the patient’s medical history: Ollier’s disease with multiple enchondromas, treated surgically in childhood, no typical symptoms and risk factors of hyperglycaemia.  During hospitalization the laboratory tests showed decreased level of C-peptide, nevertheless the patient represented acceptable levels of glycaemia following only by diet restriction. MODY, LADA and diabetes due to Ollier’s disease was speculated. Due to suspicion of autoimmunological cause the diagnostic was extended by testing antibodies: IAA, IA2, GAD, IC, which confirmation allowed to recognise untypical diabetes mellitus type 1. The patient objected to insulin treatment, limited it only to a diet and maintained normoglycemia for 15months. However, after an increase in glycaemia and in HbA1c, insulin therapy was introduced. Disscussion with conclusion Atypical course of diabetes should be considered in patients with a known disorder or with comorbidities associated with diabetes and without typical symptoms of hyperglycaemia. Atypical forms of diabetes are uncommon and require etiology-specific therapies.

Primary sclerosing cholangitis-an insidious enemy of the liver -case report.

Background Childhood ischemic stroke (AIS) is a relatively rare disease with an estimated incidence of 1.3-13/100,000/year. It most commonly affects children under the age of 5. Major risk factors include arteriopathies, heart disease, hypercoagulable states and infections. Case report A 2-year-old patient was admitted to the Department of Neurology at the University Children's Hospital in Lublin after suffering a head injury 3 days earlier. Neurological examination revealed features of left hemiparesis. A CT scan revealed an uncharacteristic hypodense, poorly demarcated area, an indication for further diagnostics. MR imaging revealed diffuse ischemic lesions. Angio-MR showed a lack of signal within the branches of the right posterior cerebral artery. Based on the clinical picture and additional examinations, a diagnosis of ischemic stroke was made and pharmacological treatment was implemented. To determine the cause of the stroke, an echocardiogram was performed, which showed flaccid atrial septal tissue with a defect and a trace left-right leak. Genetic testing for congenital thrombophilia confirmed a 4G/4G polymorphism in the PAI-1 gene. Conclusions Ischemic stroke is a life-threatening condition that requires prompt diagnosis and appropriate treatment. The relatively rare occurrence among children and nonspecific symptoms may result in difficulties in making a definitive diagnosis. Each case of stroke in children requires a comprehensive diagnosis including neuroimaging studies and identification of specific risk factors.

Chylothorax is an accumulation of chyle in the pleural cavity. It is a relatively rare cause of pleural effusion in children and its annual incidence is 14 cases per 100 000 children in Europe.  The pleural fluid triglyceride level greater than 110 mg/dl with a cholesterol level lower than 200 mg/dl confirms the diagnosis of chylothorax. Medical imaging are also necessary such as a non-invasive and easily accessible lung ultrasound. Symptoms of this disease are tachypnea, dyspnea, and in some cases dry cough. This review aims to summarize the current literature regarding chylothorax in children, analyze its possible etiologies and treatments. The causes of chylothorax are varied. It may appear after surgical interventions, traumas, infections and also be congenital. Iatrogenic factors are the most common cause of chylothorax in children with cardiothoracic surgeries. Management of chylothorax can be quite complex and highly variable, depending on patient’s condition and their response to the introduced treatment. Conservative treatment consisting of nutrition therapy, chest drain, and pharmacotherapy is typically a first-line of treatment. Diet modification consist in dietary supplements enriched with medium chain triglycerides (MCT) or starting the patient on a total parenteral nutrition (TPN). In most of the analyzed cases the conservative treatment alone proved sufficient in the management of chylothorax. In case of its failure, surgical treatment was a secondary therapy choice. One of the most common surgical procedures for pleural effusion is a thoracic duct ligation (TDL) or pleurodesis and both of these methods are highly effective therapy for chylothorax. This review of the literature reveals a wide variety of causes and methods of treatment of chylothorax. There are no clear standards of management and the therapy is adjusted to the clinical condition of the patient.