BACKGROUND To establish etiology and level of prevalence of lymphadenopathy in children. METHODS One hundred and fifteen children aged 0-15 years with diagnosed lymphadenopathy at the Pediatric Clinic in Sarajevo during 2008 were included in the study. It analyzed age, sex, etiology and distribution and prevalence of lymphadenopathy. RESULTS There was no statistically significant difference (p > 0,05) according to gender and age of children with lymphadenopathy. Leading etiological causes of lymphadenopathy were infections in 95% (62,7 %) and malignancies in 20 (13,3 %) cases. The most frequent isolated microorganisms were viruses in 65 children (65 %) and bacteria in 26 (28%) of children. Most frequent causes of malignant lymphadenopathy were acute lymphoblastic leukemia in 11 children (55 %) and acute myeloid leukemia in two (10%) children. Regional lymphadenopathy was more frequent than generalized lymphadenopathy, in 103 children (68,7%) and 47 (31,3 %) children, respectively. Most frequent localizations of regional lymphadenopathy were neck, axillae and groin, in 83, 8, and 5 (80,5 %, 7,8%, 4,8%) children. CONCLUSIONS The regional and generalized lymphadenopathies in children depend on their etiology and have significant prognostic value for the disease.

In this paper we present study of metabolic control in children suffering from TYPE 1 Diabetes Mellitus (T1DM) who use insulin pump (IP) therapy, and who were treated at Paediatric Clinic in Sarajevo. In retrospective study we followed all T1DM patients with IP therapy introduced in the period from 1st March 2005 to 1st September 2008. We analyzed their age and sex structure, therapy before IP use, and the metabolic control of T1DM represented with glycosylated haemoglobin (HbA1c) value just before and 6 months after IP therapy introducing. The total number of observed patients was 39. There were 24 boys (61,5 %) and 15 girls (38,5 %) with the age range between 12,3 +/- 3,2 years. Most patients were from age group 8-14 years. In the same number of patients 17 (43,6 %) diabetes duration was less than 5 years and 5-10 years. Before IP introduction most patient 61,5 % use therapy with insulin analogues. Mean value of HbA1c before IP therapy introduction was 8,57+/-1,65 % and 6 months after IP therapy introduction HbA1c 7,53 +/- 0,81 % (p = 0,0009). There was significant reduction HbA1c values even 6 month after IP therapy introduced. Therapy with IP in children with diabetes was very efficient in achieving therapeutic goal of T1DM treatment (HbA1c<7,0 %) what will protect patients from appearance and progression of chronic micro vascular complications on eyes, kidneys and peripheral nerves.

Innocent heart murmurs are hearth murmurs that occur in patients with a normal heart structure. They do not represent a disease of the heart and vascular system, and should not be treated as such. Iron-deficiency anaemia often causes, along with other symptoms, systolic heart murmurs and tachycardia. It appears in children of all ages representing a most common haematological paediatric disease. To establish the influence of iron-deficiency anaemia on genesis of innocent murmurs and to compare auscultatory and phono-electrocardiographic findings in patients with anaemia and heart murmurs before and after iron therapy. The study includes 120 patients with innocent heart murmurs that have been auscultated at cardio-rheumatic outpatient department of Pediatric Clinic of the Clinical Center of the University of Sarajevo, during the period from 01/01/2004 to 31/12/2004. Further diagnostic procedure, i.e. laboratory tests, diagnosed iron-deficiency anaemia in 30/120 patients. These patients have been followed in this study. 22/30 patients had systolic murmur I/II intensity of Levin scale; 8/30 patients had II/VI systolic murmurs of intensity by Levin. The highest number of examinees had 0-1 years of age, and in this group the number of boys was higher than the number of girls (M: F = 12:4). During the auscultatory and phono-ECG examinations of murmurs, 6 patients had haemoglobin values less than 95 g/l, which corresponds to an average and severe type of anaemia. 24 patients had haemoglobin values between 95 and 110 g/l, which corresponds to benign type of anaemia. The most numerous were patients aged between 0 - 1 year (3 patients with hemoglobin value Hb < 95 g/l, 13 patients with hemoglobin value Hb 95-110 g/l). All patients were treated with iron medicaments. After three months, clinical and laboratory re-evaluation was performed and it has demonstrated that after iron therapy 24 patients had level of a haemoglobin Hb >110 g/l and 6 patients had haemoglobin levels between 95 and 110 g/l. By auscultatory and phono-ECG examinations, murmurs of a level of intensity I/II was registered in only one child, while in the other 29 patients there were not any registered heart murmurs. Diagnosis of anaemia in the paediatric population group delays definitive diagnosis of heart murmurs. Innocent murmurs in children with sideropenic anaemia occur as its consequence. After adequately conducted iron therapy, i.e. cured anaemia, heart murmurs were not auscultated.

In this paper we present the study of chemotherapy and radiotherapy treatment success in children suffering from Hodgkin's disease (HD) that were treated at Hematology-oncology Department of Pediatric Clinic in Sarajevo. In retrospective study we followed all patients with HD aged 0-15 who were diagnosed with and treated for HD at Pediatric Clinic in Sarajevo over the last 10 years (1st of January 1997 - 31st of December 2006). Until 2000 we used combination of chemotherapy and radiotherapy according to UKCCSG HD 9201 treatment protocol, and after the year 2000 protocol UKCCSG HD 2000 (ChlVPP / ABVD) was applied. The total number of the treated children 33. There were 17 boys (51,51 %) and 16 girls (48,49 %). In 10 patients (30,3 %) we found II A stage of HD, in 4 (12,1 %) II B stage of HD, in 6 children (18,8 %) stage III A, in 4 children (12,1 %) stage III B, in 4 children (12,1 %) stage IV A and in 5 (15,1 %) stage IV B. In 7 patients (21,2 %) relapse occurred, which demanded more aggressive chemotherapeutic treatment and radiotherapy too; while for 4 patients (12,1 %) in combination with bone marrow transplantation. Three patients (9,0 %) died. There are 30 children (91,0 %) who are alive and in either 1st or 2nd remission phase of HD. Secondary malignancies did not occur in any of the patients. Although many patients (58,1%) were diagnosed in an advanced stage of illness (III and IV) the results of HD therapy at Pediatric Clinic in Sarajevo are comparable to those in other European centers.

We report about very rare case of autoimune hemolytic anemia (AIHA) with "warm" antibodies in eight months old boy. Diagnosis was set up according blood picture results, distinct anaemia in blood picture, positive Coombs test (IgG) for "warm" antibodies. Therapy with high doses of corticosteroids, with immunoglobulins, with two exchange transfusions and with frequent transfusions of deplasmatic erythrocytes (DPE) was without good result. Introducing of Rituximab (Mathera) therapy in dose of 375 mg/m2, four times had good effect. For last six months boy has still been in complete clinical and hematologic remission. His his blood picture is normal and his Coombs test is within normal range.

UNLABELLED The aim of the paper is to present the main clinical features of iron-deficiency anemia (IDA) in infants and in small children. IDA is the most frequent anemia in childhood word-wide. In retrospective study we explore go anemic children with Hb < 110 g/l and 30 children with Hb > 110 g/l, aged 6-24 months. RESULTS Paleness of the skin and visible mucosa was present in all children (100%). Presence of of dry and scaly skin was statistically different (p = 0.006) between group with Hb < 95 g/l and control group. Breakable and light hair was statistically significantly frequent (p = 0.003) in children with severe form of anemia (Hb < 95 g/l) than in dose with mild anemia (Hb 95-110 g/l). High statistically significant difference (Hb 95-110 g/l) was present between group with Hb < 95 g/l and control group (Hb > 110 g/l). There was no statistically significant (p > 0.05) growth retardation between explored groups. CONCLUSION clinical features of IDA and hemoglobin level determine severity and treatment directions of IDA.

The paper presents the case of a 4-year-old child who was admitted with the diagnosis Dg: Pleuropneumonia lat. sin, while in the further course as a suspicion due to progressive flow as staphylococcus pneumonia. The illness is complex in terms of treatment. The diagnosis was set based on the history of illness, its clinical course, laboratory findings, radiology tests. The boy was hospitalized in January in current year with symptoms (coughing, vomiting and fever) that have been lingering for the past two days. The boy has been treated with a ternary antibiotic therapy (cephalosporin of third generation parenterally with aminoglycosides, plus anti-staphylococcus therapy). In laboratory findings Sedimentation rate increased 88/134 WBC 75 thousands. Radiologically extended pleuropneumonia on the left side. In sputum staphylococcus aureus was isolated. In the further course of hospitalization, due to the development of progressive form of staphylococcus pneumoniae with a fever of up to 39 degrees, pale aspect and dyspnoic patient with anemia and with complications in the form of cysts, ruptures and pneumothorax, with a thoracic drainage performed. In the further course, the cysts were gradually absorbed, while the thoracic drain was grafted. Clinically, the child was looking better. We continued the anti-staphylococcus therapy (stanicide), to which the child reacted well clinically and radiologically. Auscultatory breathing on the left side was audible. The last follow-up and the last rtg pulmo et cor 6 months after the outbreak of illness with a complete regression of the foregoing changes.

AIM OF INVESTIGATION to present main clinical and hematologic features of pediatric leukemias treated at Hematooncologic department of Pediatric Clinic in Sarajevo during last 7 years. PATIENTS AND METHODS In retrospective study we followed up children with leukemia aged 0-15 who were treated during period of 01.01.1997-31.12.2003. at Hematooncologic department on Pediatric Clinic in Sarajevo. RESULTS A total number of patient with leukemia was 130 of them 112 (83.2%) had acute lymphoblastic leukemia (ALL), 16 (12.3%) of them had acute myeloid leukemia (AML) and 2 (1.5%) patients had chronic myeloid leukemia (CML). There were 84 (64.6%) boys and 46 (35.4%) girls. Median age of newly diagnosed patients was 6 years and 4 months. Dominant clinical signs were: high temperature-72.9%, fatigue and paleness-74.8% and bone pain-87.9%. Most of the children had leucocitosis (51.5%), anemia (56.1%) and trombocitopenia (57.5%). CONCLUSION Most frequent signs at the beginning of the illness are general symptoms like fatigue, unclear febrile state and accented bone pains. Those united signs with complete blood picture finding should be enough reason for suspicion under possible leukemia.

We report about very rare case of ten years old boy with diagnose of acute myeloic leukaemia which was diagnosed in his age of five (March of 2000) at Pediatric Clinic in Sarajevo. In the first phase of the complete remission autologic bone marrow transplantation was done in Italy (Ancona). Just 7 months after transplantation boy had relaps of illness in the form of acute lymphoblastic leukaemia (ALL/L2). Complete therapeutic protocol for acute lymphoblastic leukaemia was done and now boy is in complete clinical and hematologic remission.

We report two cases of very rare congenital hypoplastic anemia (Diamond-Blackfan anemia) in children. Both patients were boys admitted to our Clinic as severe anemia of unknown etiology, and had been previously treated in their Cantonal hospitals. Diagnose of congenital hypoplastic anemia was set up according: anamnesis, clinical picture with dominant features of anemia, cytomorphologic finding of peripheral blood picture, according blood marrow aspirate finding and according erithropoetin level level in blood.

UNLABELLED The aim of this study is to estimate the eficacy of citostatic and radiotherapy in treatment of Hodgkin disease (HD) on Hematology-oncology Department of Pediatric Clinic in Sarajevo (Bosnia and Herzegovina). PATIENTS AND METHODS In retrospective study we followed all patients with HD in the period of 7 years (01.01 1997-31. 12. 2004) Patients were up to 15 years old, and HD was diagnosed and treated at our Clinic. Till 2000 we used UKCCSG HD 9201 protocol treatment with combination of citotstatic and radiotherapy, and after 2000 protocol UKCCSG HD 2000 (ChlVPP / ABVD) was used for treatment HD. RESULTS We treated 24 children with HD (10 boys-41,66%, 14 girls-58,33). In 7 children (29,1%) we found II A stage of HD, in 4 children (16,6%) II B stage of HD, in 5 children (20,8%) stage III A, in 3 children (12,5%) stage III B, in 2 (8,3%) stage IV A and in 3 children (12,5%) stage IV B. In 5 patients (20,8 %) appeared relapse due to which we used more aggresive citostatic and radiotherapy, and in 3 patients (12,5%) in combination with bone marrow transplantation. One patient (4,1%) died. There are 23 children (95,8%) alive in 1st or 2nd remission phase. Secondary malignancies did not occur in any of patients. CONCLUSION Although there were significant number of patients diagnosed in high stage of HD (III and IV) the results of therapy HD on Pediatric Clinic in Sarajevo are good.

Leukemias are the most common malignancies in children. More than 80% leukemias in childhood are acute (non mature) lymphoblastic leukemias (ALL), and the rest are acute myeloid leukemias (AML). Chronic leukemias are very rare, and they are almost always chronic myclogeneous leukemia (CML). Owning to good diagnostic procedures and using very aggressive treatment protocols, usually life threatening, thereis significant progress in curing of this severe disease. Today, about 70% children suffering from acute lymphoblastic leukemia and about 55% children with acute mycloid leukemia could be cured. In this paper we present diagnostic procedures, classification and treatment protocols for leukemias in childhood.

UNLABELLED The aim of this paper is to establish the effect of iron therapy on mental and motor development in children suffering from iron deficiency anaemia by Bayley Scales of Infant Development (BSID). PATIENTS AND METHODS In prospective study were enroled 90 anemic children with Hb < 110 g/l and 30 healthy children with Hb > 110 g/l, all of them 6-24 months of age. RESULTS Indexes of mental development (MDI) before and 3 months after iron therapy for group of patients with severe and mild form of anemia (Hb < 95) did not show statisticaly significant difference (p > 0.05) before and after three months after iron therapy. Before iron therapy there was statisticaly significant difference (p < 0.001) between group with Hb < 95 g/l and group with Hb 95-110 g/l, and also statisticaly significant difference (p < 0.001) between anemic groups and control group. Indexes of psychomotor development (PDI) before and three months after iron therapy were similar to results MDI. CONCLUSION level of Hb < or = 95 g/l had great importance for results BSID test in infants and small chilren up to age of two years.

AIMS To determine the diagnostic and prognostic value the bone marrow aspiration in children with severe deficiency anaemia. PATIENTS AND METHODS In this retrospective study we analysed 75 children 0-4 years of age who were diagnosed and treated from severe anaemia (Hb < 8g/dl) at Haematologic outpatient and hospital department of Pediatric Clinic in Sarajevo in period of 01.01.1999. to 31.12.1999. RESULTS We analyzed totally 75 children--37 (49.33%) boys and 38 (50.67%) girls. Morphologic finding of bone marrow aspirate smear showed: features of ferriprive flora in 24% of analyzed patients; dimorphic bone marrow features in 9.3% of patients; feriprivic flora with dyshematopoesis in 62.7% and megaloblasic anaemia features in 1.3% of analyzed patients. In two children we diagnosed leukemias from bone marrow aspirate; one was ALL/L2 and the second was AML/M2 leukemia. CONCLUSION The most frequent found features of bone marrow aspirate were: feriprivic flora with dyshematopoesis. There was only one case of the megaloblastic bone marrow. But, the finding of dymorphic bone marrow indicated to pluricareny of ethiologic factors for beginning severe nutrititive anaemia. Special value of this paper was discovering of two cases of leukemia by the bone marrow aspirate analysis.

AIM Preventing and successful treatment of infections which are complications during treatment of acute leucosis in children. We analyzed a group of children who were treated at our Clinic in the last five-years period PATIENTS AND METHODS In retrospective study we analyzed children who were treated at our Clinic during last five years. We analysed 56 children, and in 42 of them whole treatment was performed at our Clinic. 14 children were treated for some time in the other European Centers. RESULTS We analyzed 56 patients. In 49 (89%) diagnose was ALL (Leucosis lymphatica acuta), and in 7 of them diagnose was AML (Leucosis myeloblastica acuta). The most frequent infections which were complications during treatment of leucosis: were infections of the mouth, infections of the respiratory tract-Pneumonia, sepsis and infections of urinary tract. The most frequent causes of infections were: Candida albicans- mouth, Staphylococcus epidermidis and Seratia marcenscens-sepsis, Escherichia colli-urinary tract. CONCLUSION According to our investigation we got conclusion is that infections are great problem in treatment of children with acute Leucemia. Prevention, supportive therapy and care are the most important in struggle with this series complication.