IgG subclass serum levels in juvenile chronic arthritis

IgG subclass levels of sera from 26 patients with juvenile chronic arthritis (JCA) were determined by means of mouse monoclonal antibodies. Patients were divided into three groups according to clinical activity of the disease: active disease, partial remission, and remission. One hundred and sixty four age matched, healthy children served as controls. IgG subclass concentrations were log transformed, and a robust regression method was applied to obtain expected values for the different ages. We found a significant increase of IgG3 (p less than 0.0001), IgG1 (p less than 0.002), and IgG2 (p less than 0.035) in JCA sera, while IgG4 values did not differ significantly from those of controls. When patients were divided according to clinical activity significant increases of IgG2 and IgG4 were observed in the patients in partial remission. Our data suggest that differential increase of IgG subclasses during the courses of JCA may be of relevance to the pathogenesis of the disease.

Urinary microscopy in the diagnosis of haematuria in Schönlein-Henoch purpura

A 5.5-year-old boy with Schönlein-Henoch purpura presented flank pain, macroscopic haematuria and voiding of blood clots. Radiologic examination showed a stenosing ureteritis. Treatment with prednisone was accompanied by resolution of the urologic manifestations. Ureteritis is a potentially serious complication of Schönlein-Henoch purpura and its incidence is probably underestimated. Less than half of the reported patients have had symptoms suggesting a urologic complication. Microscopic examination of the urinary sediment can be helpful for the precocious diagnosis of ureteritis in the Schönlein-Henoch purpura.

Anuria due to bilateral cystine urolithiasis in an infant

A 10-month-old female presented with anuria due to bilateral cystine urolithiasis. Although bilateral obstruction of the ureters by calculi is very rare in children, it may be the presenting feature of cystinuria even in the first year of life.

[Transient stenosing ureteritis in childhood. A rare complication of rheumatoid purpura]

A case of transient stenosing ureteritis in a boy presenting with the clinical features of Henoch-Schoenlein purpura (diffuse articular swelling, petechiae, abdominal pain) complicated by macroscopic haematuria with blood clots is reported. On urography the right collecting system and the right ureter up to the distal lumbar portion were dilated owing to tight ureteral stenosis at that level. Above the stricture, numerous ring-like functional ureteral wall defects were detectable. On the left a stenosis was evident at the lumbo-sacral level with mild dilatation of the ureter. A small filling defect due to subephitelial haemorrhage was evident in the upper part of this ureter. Three months later, after prednisone therapy, the urography was normal on the right: residual mild stenosis was still evident on the left. Radiological findings in Henoch-Schoenlein purpura and the possible differential diagnosis of this condition are discussed.

Henoch-Schönlein syndrome and selective IgA deficiency

A 9 year old girl presented with clinical manifestations of Henoch-Schönlein syndrome and macroscopic haematuria. Laboratory investigations showed selective IgA deficiency and renal biopsy showed mesangial proliferative glomerulonephritis with diffuse granular deposits of C3 on immunofluorescence. IgA deposits were absent.

[Pediatric digestive endoscopy: personal experience]

Fiberendoscopy has become a diagnostic and therapeutic procedure of the outmost importance also in pediatric gastroenterology. 100 gastrointestinal fiberoscopies have been carried out on 81 patients ranging in age from 1 month to 14 years during a three-year period (November 79 - October 82), using general anesthesia for 9 patients. The 70 upper GI endoscopies, almost always performed with the Olympus GIF P2 instrument, showed acute or chronic, limited or diffuse inflammatory changes in most cases; post-bulbar areas were successfully visualized in 46 patients. The 30 colonoscopies were carried out with the standard adult equipment in most part of cases; in 50% of cases the inspection was extended to the caecum. Inflammatory diseases have been frequently revealed, but more frequently no remarkable changes were found. Indications for "operative" endoscopy were dilatation of an esophageal achalasia and removal of four gastrointestinal bleeding polyps. All procedures gave satisfactory results, and no morbidity occurred to patients.

[Glomus tumors in unusual sites]

Two cases of glomus tumour in unusual sites are described. Their indistinct symptomatology, site and histological polymorphism are made the basis of a general discussion of the histogenesis and possible ongoing pictures of glomus tumours, the classification of which is also felt to be unsatisfactory.

[Nomenclature of angles in the lumbo-sacral region (author's transl)]

Lack of an universally accepted nomenclature of lumbo-sacral angles often leads to misunderstanding. As a basis for a future agreed nomenclature the descriptions of these angles are put in order, wherever possible without introducing new names. Only in one instance - for the differentiation between an anterior and posterior lumbo-sacral angle - was a new name essential. The series of angles also contains a point - the promontory - and a distance - the height of the promontory - which is the second new name.

[The anatomic and radiologic picture of the acetabulum (author's transl)]

The basic shape of the facies lunata shows at the inner margin of each of the three participating bones a dell into which the floor of the acetabulum progresses. These dells originate in nutritive vessels which enter the bone and claim this place. There always are groups of vessels and wide channels which may be visible on radiographs. The so far unexplained picture of a vascular canal in the roof of the acetabulum corresponds to the canal leading into the body of the ilium. Due to its position there is often restructuring leading to filling or covering of the canal. The entrance to this canal is shown as a gap in the arc of the acetabular cavity which would have to be added to that of the "tear figure" known so far. The closed arc, as always drawn, reults only when this entry has been filled up.