Role of renal arterial embolization [rae] in treatment of iatrogenic renal arterial injuries

Background: Trans-catheter renal arterial embolization [RAE] has emerged as a possible alternative to surgery in the management of iatrogenic renal arterial injuries. Objective: To discuss the role of renal arterial embolization in patients with iatrogenically-induced renal arterial injuries

Methodology: All cases were done at the Interventional Radiology Unit, Ain Shams University Hospital

Results: Technical and Clinical success rates of the RAE reached 90% for each, with post procedural complications that only amounted up to 30%, half of which was the post embolization syndrome that presents as fever, leukocytosis and pain and is treated conservatively

Conclusion: Renal artery embolization has proven to be a safe, minimally invasive option in the treatment of iatrogenic renal arterial injuries achieving high technical and clinical success rates

Antiperinuclear and hidden rheumatoid factors in monitoring disease activity of juvenile rheumatoid arthritis

The serological diagnosis of juvenile rheumatoid arthritis [JRA] is difficult, as classical 19S IgM rheumatoid factors [RF] as detected by the latex fixation test [LFT] are usually found in the sera of only 5-10% of JRA children, as compared with 80% of rheumatoid arthritis adults [RA]. Hidden 19S IgM rheumatoid factors [hidden RF], i.e., 19S IgM RF that can be detected in the IgM containing fraction after acid gel filtration of the serum, are found in 59-68% of seronegative JRA patients. This test correlates strongly with the disease activity in JRA patients, but it requires serum separation and is not available in most laboratories. Antiperinuclear factor [APF] has been described in both seropositive and seronegative adult rheumatoid arthritis [RA] patients, but has not been thoroughly evaluated in JRA children The study was conducted on 76 patients, 58 JRA with mean age 12.7 +/- 3.0 years and 18 SLE cases with mean age 10.3 +/- 3.7 years. The group of JRA was subdivided into 2 subgroups, JRA children [mean age 11.5 +/- 2.7 years] and group of adolescents JRA onset [mean age 18.3 +/- 1.1 years]. Thirteen healthy children served as a control group who were matched for age and sex. We tried to evaluate the diagnostic sensitivity and specificity of both antiperinuclear factor and hidden rheumatoid factor in JRA, and their correlation with the disease activity. The levels of erythrocyte sedimentation rate [ESR] and C-reactive protein [CRP] assessed the disease activity. Sera from JRA children, systemic lupus erythematosus [SLE] and control children were tested for the presence of antiperinuclear factor with indirect immunofluorescence technique [IIF] and hidden rheumatoid factor was determined with Rose-Waaler test [RWT] in the IgM-containing fraction of serum after separation by ion exchange chromatography. Thirty-eight of 58 patients [65.5%] showed the presence of hidden 19S IgM RF in their serum, only 3/18 [16.6%] in SLE patients and none was found in the control group. APF was found in 22/58 [38%] JRA, in 2/18 [11%] SLE and was not detected in the control group. The disease activity correlated positively only with hidden RF titers in the evaluated group of JRA, while no positive correlation was found between APF and the disease activity parameters [erythrocyte sedimentation rate and C reactive protein]. As expected both hidden RF and APF tests showed high specificity of 90.3% and 93.5% respectively. Although APF detection technique is indeed easier than hidden RF technique, the detection of APF alone will not be of a good diagnostic value in seronegative cases suspected to have JRA

Human parvovirus B19 infection: its role in acute arthropathies

Viral infections have a number of important effects on the immune system. Infection with human parvovirus B19 [B19] has a diverse range of clinical manifestations including erythema infectiosum, polyarthropathy, transient aplastic crisis, hydrops fetalis and fetal death as well as chronic infection and anemia in immunocompromised hosts. Since its discovery in 1975, it has been noted that HPV B19 frequently causes a self-limiting polyarthritis in adults. It has also been debated whether, in some patients, B19 may act as a trigger for RA. The aim was to determine the incidence and significance of antibodies to the parvovirus B19, we detected the presence of B19 IgM and IgG antibodies in 40 rheumatoid arthritis [RA] patients, 10 SLE patients, 10 osteoarthritis patients and 30 normal adults. B19 IgM was positive in 60% of RA patients. This rate was significantly higher than the control group. They were mostly females [70%], duration of illness was 3 months to one year [68.7%] with polyarthritis, large and small joints were more affected [72.7%] with manifestations of acute inflammation. Rheumatoid factor [RF] was negative in 70% of them. Regarding osteoarthritis patients, B19 IgM antibodies were detected in 40% of them. They were females [60%] with polyarthritis, large and small joints were more affected [75%]. On the other hand B19 IgM antibodies were not detected in SLE patients or in the control group. Parvovirus B19 is important viral agent causing joint manifestations and should be considered in the differential diagnosis of acute arthropathy in adults, as early treatment of these cases results in fewer complications