Background: Many efforts have been made to find diagnostic tools that would help select children with clinical signs of acute appendicitis that would need immediate appendectomy and to find tools that would reduce the numbers of negative appendectomies. Aim: We aimed to show the association between leukocyte count, level of C-reactive protein and interleukin-6 in peripheral blood on the one side and the degree of histological findings on appendix after appendectomy on the other side in children with high clinical probability for appendicitis (Alvarado score>7). Methods: We analyzed 80 patients of both genders, younger than 15 years, with Alvarado score>7, which underwent open appendectomy with subsequent histological analysis of removed appendices. We sampled 20 consecutive cases without signs of inflammation (group I), 20 cases with pathological signs of incipient inflammation (group II), 20 cases with signs of phlegmonous inflammation (group III) and 20 cases with signs of perforated appendix (group IV). Prior to appendectomy, a peripheral blood was sampled and sent for analysis of leukocyte count and C-reactive protein and interleukine-6 level. We compared values of all 3 measured parameters according to histological findings; we also used Receiver Operating Characteristics (ROC) analysis in order to evaluate diagnostic thresholds for detecting the histological signs of appendicitis. Results: The lowest values of all observed parameters were found in group of negative appendicitis while highest were observed in the group of perforated appendicitis. We have observed a significant between group differences in values of all three parameters according to the degree of histological inflammation (p<0.001). ROC analysis demonstrated that interleukine-6 had the best diagnostic performance in detecting patients with histological signs of appendicitis (AUROC=0.99; 95% CI=0.99-1.00) when compared to CRP and leukocyte count (p<0.05). There was no significant difference in diagnostic performance between CRP and leukocytes counts (p=0.35). Conclusion: Leukocyte count, CRP and interleukine-6 are very useful markers which may help in diagnostics and differentiation of phlegmonous and perforated appendicitis. In patients with high probability of appendicitis, measurement of interleukine-6 may help in better patient selection.

All conventional immunosuppressive tree drugs-protocols are based on Cyclosporine; consisting of low doses of Cyclosporine (CsA), Azathioprine (AZA) or Mycophenolate Mofetil (MMF) and Prednisolone. AZA has been used in clinical transplantation for more than 30 years and was the first immunosuppressive agent to achieve widespread use in organ transplantation. MMF was introduced in clinical practice in 1995 after several clinical trials proved that it was more efficient than AZA for prevention of acute rejection episodes. Our aim was to evaluate influence of AZA and MMF on renal graft function in early post-transplant stage. Study recruited 74 patients who underwent kidney transplantation in University Clinical Centre Tuzla. All patients received CsA and corticosteroid-based immunosuppression, as a part of triple immunosuppressive regiment, 40 patients received AZA and 34 MMF. In order to assess renal graft function, following parameters were evaluated: glomerular filtration rate GFR (ml/min) creatinine clearance (CrCl) (ml/min), 24 h urine output (ml/day), and from the serum potassium, sodium, urea and creatinine (mmol/dm3). Significantly higher average values of 24 hour urine output were recorded during first seven postoperative days in patients receiving MMF compared to those treated with AZA. Serum creatinine values showed statistically significant decrease, starting with the second postoperative day, in MMF vs. AZA group (168,7+/-70,5 vs. 119,9+/-42,6; p<0,0007). GFR was significantly higher in MMF compared to the AZA group of patients. On the first post-transplant day CrCl was higher in AZA group (24,3+/-10 vs. 17,5+/-7,3; p=0,01), next six days situation is reversed CrCl is significantly higher in the MMF group (43,7+/-15 vs. 53, 4+/-22, 8 p=0,006). MMF vs. AZA therapy was associated with protective effect against worsening of renal function in first seven post-transplant days.