Abstract book 6th RMS 16.indd

symptoms, half of our patients needed
DMARDs as well. Unlike other series, we
had no cases of large joint episodic arthritis
or cases of HPOA. Instead, our patient
showed an RA like polyarthritis (small and
large joints) with an age of onset of 25 in
females and 38 in men.
In addition to NSAIDs, DMARDs are often
needed.
There should be a low threshold for referral
to a rheumatologist because the arthritis
and limitation of movement may become
disabling and interfere with mobility,
exercise and chest clearance, all essential
components of CF daily treatment routine.
96
Antiphospholipid Syndrome and
Pregnancy
Olivier Bletry MD (France)
97
Lupus Nephritis at King Hussein
Medical Center
Auasyalah Burgan MD*, Manal Al-Mashalah
MD, Osma Katybah MD, Ala’a Al-Heresh MD
* Rheumatology Division, King Hussein Medical
Center, Royal Medical Services (Jordan)
ausaylah2@hotmail.com
Objectives: Renal involvement is a serious
feature of systemic Lupus Erythmatosus.
It has been shown that the decision to
institute therapy is highly informed by the
results of renal biopsy We present the first
review of lupus nephritis in KHMC, and we
compare our findings with other studies.
Methods: We retrospectively reviewed
medical records and renal slides of 74
patients over a 14 year period (1996‐2009).
the renal biopsy specimens were studied by
light and immunofluorescence microscopy.
Results: 74 patients were reviewed, 69
(93.24%) were females and 5 (6.75%)
were males. The female to male ratio was
(13.8:1).The median age was 26 year.
The indications for renal biopsy were the
presence of proteinuria, defined as a 24 hr
urinary protein excretion on presentation
0.5g and/or the presence of active casts in
the urinary sediment. Diffuse proliferative
glomerulonephritis (class IV) was the
most frequent histopathologic finding in
our patients seen in 30 patients (40.1%).
The frequencies of other histopathologic
findings were as follows: Class III (n=10,
13.5%), Class V (n =7, 9.5%), Class I (n =6,
8.1%), class II (n=1, 1.3%). All the patients
were treated with different combination
of treatment. All patients were followed
up, 2 died . 58 patients had controlled
disease, 11 still having active disease, and
4 patients on chronic hemodiaysis, one of
them had kidney transplant.
Conclusion: Diffuse proliferative GN class
IV was the most frequent type of lupus
nephritis in the world as in this study.
Hall E Session 3
Pulmonology & Thoracic Surgery
98
Flail Chest Wall Stabilization
Michael Mueller MD (Austria)
The morbidity of serial rib fractures is often
underestimated. A retrospective analysis
of 181 331 patients after car accidents
using the US National Trauma Databank
revealed that 55% of patients over 60
years dying after chest trauma had no
more than rib fractures. Patients over the
age of 45 years with more than four rib
fractures are more severely injured and at
increased risk of adverse outcomes. Hence,
efforts to decrease rib fracture morbidity
should focus not only on elderly patients
but those as young as 45 years.
Serial rib fractures have effects on the
chest wall with loss of rigidity, paradoxical
motion and the consequence of ineffective
cough, as well as effects on the lungs
including hypoventilation, contusion and
resulting hypoxemia.
When deciding on the optimal treatment
of serial rib fractures with flail segments
the conservative approach with internal
pneumatic stabilization had been
evaluated as an alternative to surgical
approaches. Relevant recent literature
clearly demonstrates superiority of surgical
stabilization over pneumatic stabilization
regarding incidence of pneumonia, length
of ICU stay, length of mechanical ventilation
and requirement of tracheostomy.
The indication for surgical stabilization
can be considered along with a routine
emergency repair when closing a
thoracotomy, or electively at the presence
of poor pain control, chest wall instability
and the risk for respiratory failure or to
75 www.jrms.gov.jo