Quantitative analysis of naturally-occurring regulatory t cells in pediatric patients with systemic lupus erythematosus

Background: There is clear evidence that CD4+CD25[hl] naturally-occurring regulatory T cells [nTregs] are important component of the immune system in controlling tiutoimmunity. These cells exhibit powerful suppressive properties. Objectives: This study was conducted to determine [i] the percentage of CD4CD25[hl] nTregs in pediatric patients with systemic lupus erythematosus [SLE] before and after corticosieroid treatment, and [ii] the correlation between the percentage of nTregs and SLE disease activity index [SLEDAI]. Subjects and Methods: Thirty children with new-onset SLE were enrolled in this study. Patients were divided into 2 groups according to their disease activity. Further 24 children were included as a control group. Flow cytometric analysis was used for evaluation of the percentage of CD4+CD25[hl] nTregs in the peripheral blood of SLE patients, and control subjects

Results: A significant lower percentage ofCD4+CD25[hl] nTreg was detected in children with active SLE compared to those with inactive disease [0.59 +/- 0.27% versus 1.28 +/- 0.35%; p = 0.0001], and control subjects [0.59 +/- 0.27% versus 2.29 +/- 0.39%; p'= 0.0001]. A significant increase in the percentage of CD4+CD25[hl] nTregs was detected after corticosteroid therapy [p = 0.0001], but with no significant difference between patients with active and inactive disease [p >0.05]. Intriguingly, the percentage of nTregs was inversely correlated with SLEDAI [T = -0.6, p 0.001]. Conclusion: These results suggest that the quantitative defect of nTregs in pediatric patients with SLE may play a role in the patho genesis of this autoimmune disorder?

Live-donor kidney transplantation: a source for tuberculosis transmission?

Between 1976 and 1994, 700 live-donor kidney transplants were carried out at our center. Among these, 28 recipients [4%] developed Tuberculosis 13-92 months [mean, 22.25] after transplantation. This study was conducted to find out the source[s] of infection entailing retrospective analysis of peri-operative data [for both recipients and their corresponding donors] as well as screening the donors with Ziehl- Neelsen [ZN] staining of their urine concentrate. Ten donated kidneys were found to be the source of infection which resulted in urinary TB in 7 recipients and disseminated infection in the remaining three. Treatment was initiated for both recipients and donors. Eight recipients developed chronic rejection. Ultimately, TB was controlled in 9 recipients while the last patient died of disseminated TB. Among the survivors, 4 had a functioning graft and the remaining 5 finally returned to dialysis, 3 of them died of unrelated causes. In all donors, TB infection was controlled. One donor required ballon dilatation for a stricture in the pelvic ureter of the remaining kidney. Donating a tuberculous kidney is hazardous to the immuno-compromized recipients as well as donors. Being a substantial source for post-transplantation TB, potential donors should be screened with ZN staining and PCR [polymerase chain reaction] of their urine concentrates

Delayed bleeding after percutaneous nephrolithotomy

2502 patients with renal stones were treated by PCNL at our center over a period of 13 years starting from 1984. Eighty-four patients were readmitted with delayed bleeding [3.4%]. All but 19 patients [0.8%] were treated conservatively. These 19 patients proved to have significant vascular injuries as documented by selective arteriography in the form of pseudoaneurysms and/or arteriovenous fistulae [18 patients] or vascular lacerations [1 patient]. Embolization with platinum microcoils and/or absolute alcohol controlled bleeding in all but one patient. He was explored, and nephrectomy was decided to save him. Follow-up data of up to 78 months [46.2+20.5] revealed that embolization was a safe procedure with minimal late sequelae. Renal function remained stable. Two patients, however, developed hypertension. The study revealed that the incidence of delayed bleeding after PCNL due to a significant vascular lesion was low [0.8%]. Arteriographic embolization is not only a life-saving procedure but also a kidney-sparing technique

Delayed bleeding after percutaneous nephrolithotomy

2502 patients with renal stones were treated by PCNL at our center, over period of 13 years starting from 1984, 84 patients were readmitted with delayed bleeding [3.4%]. All patients were treated conservatively except 19 patients [0.8%]. Those proved to have significant vascular injuries as documented by selective arteriography in the form of pseudoaneurysms and/or arteriovenous fistulas [18 patients] or vascular lacerations [one patient]. Embolization with platinum microcoils and/or absolute alcohol controlled bleeding except in one patient. He was explored and nephrectomy was decided to save him. Follow up data up to 78 months [46.2 + 20.5] revealed that emboilization is a safe procedure with minimal late sequaele. Renal function remained stable. Two patients, however, developed hypertension. The study revealed that, delayed bleeding after PCNL due to significant vascular lesion is low [0.8%]. Arteriographic ambolization is not only a life saving procedure but also a kidney-sparing technique

Histopathological study of rectal mucosa in acute diarrhoea

Acute diarrhea is a major public health problem, however the related aetiology is controversial. This study was done upon 25 patients complaining of acute diarrhea, their age ranges from 20-55 years, all were males. All patients were subjected to clinical microbiological and sigmoidoscopic study Rectal biopsy was taken from every patient and subjected to histopathological examination. The most important change was the vascular lesion which occur in all patient with +ve and -ve stool culture

Percutaneous extraction of renal calculi in patients with solitary kidneys: technique-complications long term follow-up

53 cases with renal stones in solitary kidney were treated by PCNL. The technique was a standard two stage procedure. Complete clearance of the targeted stone [S] was achieved in 92.5%. Residual stones were left in 4 cases. Early complications were reported in 7 cases [13.2%]. Patients were followed up from 12-60 months [average 40 months]. Late sequaele were reported in 5 cases [9.4%]. True stone recurrence was noted in 3 cases [5.6%]. Kidney function showed improvement [28 cases] or stabilization [23 cases]. However,deterioration was documented in two cases.The results achieved suggest that percutaneous removal of renal calculi from patients with solitary kidneys should be considered a viable and effective alternative to open surgery

Percutaneous nephrolithotomy, an endoscopic approach for renal stones extraction

In 18 months period, 152 percutaneous nephrolithotomy have been performed in 150 patients with a great variety of renal stones. Among the stones extracted successfully by this technique are multiple, bilateral, radiolucent and staghorn calculi. Stones in conyenitally abnormal renal unites were successfully removed, such as malrotated, duplex and horsesho kidney. Slipped ureteric stones could be retrieved by percutaneous renal route and or with ureterorenoscope from below. The different technical modalities will be reviewed to explain their individual indications. The success rate and complications were presented and discussed

Post traumatic stricture urethra long term follow up

68 patients with post-traumatic stricture urethra were included in the study. The different methods of scrotal inly urethroplasties utilized in their management are discussed. 40 patients completed the two stages while the remaining 28 patients are waiting for the second stage closure. The technical difficulties and the complications following the first as well as the second stage urethrroplasties are presented. An overall success rate of 85% was obtained with an average of 2. 2 operative procedures per patient that nearly parallels with that given in literature