We report the case of a 14-year-old boy with pectus excavatum who developed a metal allergy to stainless steel bar as a late-onset complication after the Nuss procedure. He did not have atopic diathesis. Treatment with oral steroids was effective and the metal bar was successfully removed 2 years later.

bridging therapy. Subsequently, according to ACR guidelines, a therapy with TNF-alpha inhibitor, adalimumab, was initiated. Within a month, a substantial reduction of the low back pain was noted, with a decrease in juvenile spondyloarthritis disease activity score (jSpADA).Low back pain often begins in childhood, with the prevalence in adolescence being similar to that in adulthood. Among many possible causes, inflammatory etiology should be thoroughly considered due to irreversible damage if not treated adequately. Therefore, children and adolescents complaining of a back pain, especially in the presence of other signs of arthritis, should be referred to pediatric rheumatologist for a further work-up and treatment.

BACKGROUND: Glutathione S-transferase (GST) enzymes are involved in detoxifying chemotherapy agents and clearing reactive oxygen species formed by radiation. In this study, we explored the relationship between the host GSTP1-105 polymorphism (rs1695), tumor GSTpi protein expression, and clinical outcomes in pediatric medulloblastoma. We hypothesized that the GSTP1-105 G-allele and increased tumor GSTpi expression would be associated with lower progression-free survival and fewer adverse events. METHODS: The study included 106 medulloblastoma/primitive neuroectodermal tumor (PNET) patients seen at Texas Children's Cancer Center. Genotyping was performed using an Illumina HumanOmni1-Quad BeadChip and tumor GSTpi expression was assessed using immunohistochemistry. We used the Kaplan-Meier method for survival analyses and multivariable logistic regression for toxicity comparisons. RESULTS: Patients with a GSTP1-105 AG/GG genotype or who had received a higher dose of craniospinal radiation (median 36 Gy) had a greater risk of requiring hearing aids than their respective counterparts (OR 4.0, 95%CI 1.2-13.6, and OR 3.1, 95%CI 1.1-8.8, respectively). Additionally, there was a statistically significant interaction between the two variables. Compared with the lowest risk group (GSTP1-105 AA-lower dose radiation) patients with a GSTP1-105 AG/GG genotype who received a higher dose radiation were 8.4 times more likely to require hearing aids (95%CI 1.4-49.9, p-trend ¼ 0.005). When adjusted for age, gender, and amifostine use, the association remained. CONCLUSIONS: The GSTP1-105 G-allele is associated with permanent ototoxicity in pediatric medulloblastoma/PNET and strongly interacts with radiation dose. A possible mechanism for this finding is that the GSTP1-105 G-allele leads to reduced GSTpi free radical detoxification in the setting of multimodality therapy including cisplatin and radiation. Patients with this allele should be considered for clinical trials employing radiation dose modifications and more targeted cytoprotectant strategies than are currently being used with amifostine.

Uvod: Poznato je da tjelesna aktivnost snižava arterijski tlak (AT) i smanjuje kardiovaskularni rizik putem brojnih mehanizama. No, visoki AT je često odstupanje na sistematskim pregledima sportaša. Usprkos tome, podaci o prevalenciji arterijske hipertenzije (HTN) u sportaša nedostaju, osobito u mladih sportaša. Studijom smo ispitali prevalenciju visokog AT u adolescentnih sportaša na sportskom sistematskom pregledu. Obzirom da se uz porast prevalencije, debljina u djece sve više prepoznaje kao jedan od najvažnijih rizičnih čimbenika za razvoj HTN, analizirali smo i povezanost visokog AT s prekomjernom tjelesnom masom (TM) u grupi mladih, zdravih sportaša. Ispitanici i metode:U istraživanju su sudjelovala 64 muška adolescentna sportaša i to 37 nogometaša i 27 sportaša borilačkih vještina. Medijan dobi sportaša je bio 16,5 godina (raspon 14-18 godina). Intenzitet treniranja i duljina treniranja među sportašima su bili različiti. Antropometrijski pokazatelji i AT su mjereni prema standardnim protokolima na probirnom pregledu u sportskoj ambulanti, od strane licenciranog specijaliste sportske medicine. Arterijski tlak je mjeren validiranim živinim manometrom. U slučaju izmjerenog povišenog AT, mjerenje je ponovljeno, a sistolički AT (SAT) i dijastolički AT (DAT) su zabilježeni kao prosjek dvaju mjerenja. Prema preporukama International Pediatric Hypertension Association (IPHA), vrijednosti AT su kategorizirane kao centile za spol, dob i tjelesnu visinu. Povišeni AT je definiran sistoličkom i/ili dijastoličkom vrijednošću jednakom ili većom od 90. centile. Prekomjerna TM je definirana indeksom tjelesne mase (ITM) jednakim ili većim od 85. centile. Podaci su analizirani deskriptivnom statistikom i Pearsonovim χ 2 testom za nezavisne uzorke, a za zavisne uzorke je korištena Yatesova korekcija.Rezultati: Prevalencija povišenog AT u nogometaša je bila 40,5 % (15/37), a u sportaša borilačkih vještina 55,6 % (15/27). Prekomjerna TM nađena je u 13,5 % (5/37) nogometaša i 33,3 % (9/27) sportaša borilačkih vještina (χ 2 = 3,588; p=0,058). Nađena je pozitivna povezanost između prekomjerne TM i povišenog AT (χ 2 = 10,23; p=0,0014).Zaključak: Djelatnici koji rade s djecom i adolescentima trebaju biti upozoreni da je debljina jedan od glavnih rizičnih čimbenika za visoki AT. Imajući na umu zdravstvene rizike povezane s preuhranjenošću i debljinom, tjelesna masa se ne bi trebala promicati i podrazumijevati na način kako je to uobičajeno u određenim sportovima i pozicijama u timu. Maja Batinica