Characteristics of thyroid cancer in combination with autoimmune thyroiditis

Remote results of the surgical treatment of 413 patients with carcinoma of the thyroid gland without autoimmune changes and 199 patients with thyroid carcinoma associated with an autoimmune component were studied. Remote results of the surgical treatment and indices of survival in the second group of patients were found to be better than those in patients without autoimmune changes in the thyroid gland.     

Carbohydrate tolerance in autoimmune thyroiditis.

Glucose tolerance tests were carried out on fifty patients with autoimmune thyroiditis of varying duration and severity. Two were floridly diabetic, and a further six showed diabetic abnormalities of glucose tolerance, giving an over-all incidence of 16 per cent. Diabetics were significantly older than nondiabetics, but the two groups did not differ in terms of duration of thyroid disease or frequency of associated disease of probable autoimmune origin. The prevalence of diabetes in patients with autoimmune thyroiditis appears to be the same as that in the population generally.     

Graft-versus-host reactions within the thyroid gland may evoke pari passu autoimmune thyroiditis.

Unilateral, intraorganal injection of parental lymph node cells into thyroid lobes of F1 hybrid rats elicited an intense, local graft-versus-host reaction within the injected lobes containing massive numbers of lymphocytes. Surprisingly, significant mononuclear cell infiltration was also seen within the contralateral (noninjected) thyroid lobes, even when the isthmus had been divided. The local graft-versus-host reaction spread from the injected gland to involve the regional lymph nodes and spleen. Migration of 51-cr-labeled donor lymph node cells was documented in these same tissue sites; lesser numbers of labeled cells were found in distant lymph nodes, including the contralateral cervical nodes. However, no significant label was found in the contralateral thyroid lobes. Microscopic evaluation of noninjected glands revealed intense infiltration of mononuclear cells around and within follicles, reminiscent of lesions induced by immunization with thyroid extract in Freund's complete adjuvant. The absence of donor cells in the inflammatory reactions within noninjected thyroid lobes raises the possibility of an autoimmune rather than graft-versus-host pathogenesis.     

Dermatitis-sympathetic dysfunction in carpal tunnel syndrome. A case report

A 52-year-old woman complained of numbness affecting the thumb, index, and middle fingers of both hands. The patient was managed with night splints with partial relief of symptoms. As a house cleaner, the patient was routinely exposed to water and detergents. About a year later, the patient developed contact dermatitis in the fingertips innervated by the median nerves. Electromyographic studies confirmed the presence of bilateral carpal tunnel syndrome. The temperature of all the fingertips was measured. The median innervated fingertips were warmer than those innervated by the ulnar nerves. The median sympathetic fibers may be compromized by compression in the carpal tunnel. This caused vasodilation, increased finger temperature, and lack of sweating in the median innervated fingers. Due to regular exposure to water and detergents, the susceptible dry fingertips developed contact dermatitis. The patient was managed conservatively, and the rash and numbness disappeared.     

Long-term effects of cyclosporine A in Alport's syndrome

BACKGROUND: In 1991, our initial results of cyclosporine A (CsA) administration in eight patients with Alport's syndrome were published. A significant decrease in or disappearance of proteinuria and apparently good tolerance to CsA were observed in all patients. METHODS: CsA administration has been maintained in these eight patients with the aim of obtaining further information about the clinical course of the disease. The ages of these eight patients currently range from 15 to 27 years, and the mean duration of treatment is from 7 to 10 years (x = 8.4 years). RESULTS: Renal function has remained stable, with no evaluable changes in serum creatinine levels compared with pre-CsA treatment values. Proteinuria in all patients has either remained negative or are values far lower than pretreatment levels. A second renal biopsy was performed in all patients after five years of CsA administration. No aggravation of the lesion present at the first biopsy or lesions typical of cyclosporine intoxication was observed. CONCLUSIONS: After a mean duration of 8.4 years and with no deterioration in renal function, we found possible beneficial effects of the continued treatment of CsA in patients with Alport's syndrome who present evidence of progression to renal insufficiency.     

A case of autoimmune thyroiditis and membranoproliferative glomerulonephritis

Thyroid hormones play an important role in the growth of the kidney and maintenance of its functions. Prolonged hypothyroidism is known to be accompanied by changes in renal morphology such as thickening of the glomerular and tubular basement membranes as well as increased mesangial matrix. Increased transcapillary leakage of plasma proteins leading to proteinuria and generalized edema is also a known complication of hypothyroidism. In particular, autoimmune thyroiditis is associated with proteinuria. Most previous reports of autoimmune thyroiditis with nephrotic syndrome have demonstrated mixed pathological morphology marked by predominant membranous glomerulopathy. Here we present a patient whose initial presentation with profound hypothyroidism and autoimmune thyroiditis was dominated by nephrotic syndrome secondary to type 1 membranoproliferative glomerulonephritis (MPGN). The association of MPGN and autoimmune thyroiditis is very rare.     

Asymptomatic arsine nephrotoxicity. A case report

A completely asymptomatic patient with arsine nephrotoxicity is described. The light and electron microscopic appearances of the kidney biopsy specimen are documented. The pathogenesis of the lesions, the usual manifestations of arsine exposure, and how these differed from those seen in our patient, are discussed.     

No association between Alport's syndrome and antithyroid antibodies.

The presence of circulating antithyroid antibodies in a small number of patients with Alport's syndrome has led some to suggest that the two abnormalities are associated. If confirmed, such an association could have important diagnostic as well as pathophysiological implications. Using sensitive methods, we assessed the prevalence of antithyroid antibodies in 40 patients with Alport's syndrome from 28 families. Antithyroglobulin antibodies were absent in all patients. Antimicrosomal and antithyroperoxidase antibodies were absent in all but one patient. Three patients with Alport's syndrome from the latter family were negative for antithyroid antibodies. In this large number of patients we found no association between Alport's syndrome and antithyroid antibodies. Screening for the presence of such antibodies in patients with Alport's syndrome is thus not warranted. The previously reported coexistence of the two disorders might be fortuitous.     

Preliminary technical report. Epitope-defined monoclonal antibodies against type-IV collagen for diagnosis of Alport's syndrome

Background. Alport's syndrome can be diagnosed by staining the &agr;5 chain of type IV collagen in kidney biopsy specimens with a monoclonal antibody. Because antibodies already established against the &agr;5 chain require denaturation treatment of cryostat sections to expose their epitopes. To save time and effort for staining, a new epitope-defined monoclonal antibody whose epitope is initially exposed on the surface of the molecule was established. Methods. Two monoclonal antibodies against the triple-helical domains of the type IV collagen &agr;2 and &agr;5 chains were established with synthetic peptides as immunogens by the rat lymph node method. Their epitope were EAIQP at the positions of 675-679 of the &agr;2 chain, and IDVEF at the positions of 251-255 of the &agr;5 chain respectively. They were purified with synthetic peptide-coupled affinity columns, and then conjugated with Texas red and FITC, respectively. Results. The mixture of fluorochrome-conjugated antibodies was able to detect the distribution of the &agr;2 and &agr;5 chains in the normal and Alport kidney and skin by direct immunofluorescence staining with and without denaturation treatment of the sections. Conclusions. The direct double immunofluorescence staining of kidney and skin cryostat sections with the fluorochrome-conjugated antibodies is useful, reliable, and convenient for diagnosis of Alport's syndrome. Keywords: Alport's syndrome; diagnosis; kidney biopsy; monoclonal antibodies; skin biopsy; type IV collagen      

自身免疫性甲状腺疾病相关肾病综合征一例报告及文献复习

目的　探讨自身免疫性甲状腺疾病相关肾病综合征的临床与病理特点。方法　通过一例病人的诊治过程结合复习文献对该病的诊治经过、肾活检病理综合分析。结果　自身免疫性甲状腺疾病相关肾病综合征临床并不罕见 ,因甲状腺疾病与肾病综合征发病间隔不同、临床表现不典型 ,极易被忽视 ;肾脏病理多表现为膜性肾病 ;加强甲状腺疾病的治疗并应用激素或细胞毒药物对本病治疗有效。结论　自身免疫性甲状腺疾病可能是继发性肾病综合征的原因之一 ,应引起临床医师的重视。     

Renal pathology and ultrastructural findings in Alport's syndrome

Morphological study of the kidney is generally the first step in the diagnosis of Alport's syndrome. Light microscopy study allows to suggest the diagnosis with the association of focal and segmental glomerulosclerosis, GBM anomalies when studied with silver staining, interstitial foam cells, and negative standard immunofluorescence study. GBM anomalies observed by electron microscopy are nearly specific with thickening splitting and fragmenting of the lamina densa. GBM anomalies are the consequence of a collagen IV disease. Thus, immunohistochemical results obtained with 6 different alpha(IV) are essential and allow to evaluate the mode of inheritance. Schematically, in the X dominant AS form, GBM, distal tubular BM and collecting duct BM do not express alpha3/alpha4, alpha5(IV). In the autosomic recessive AS form, collecting duct BM alone express alpha5(IV) without expression of alpha3(IV) and alpha5(IV) chains along the GBM and distal TBM.     

Asymptomatic thyroid tuberculosis in a multinodular goitre patient: a case report

Thyroid tuberculosis is a very rare disease of the thyroid gland. In recent years, the incidence of extra-pulmonary tuberculosis has been showing a progressive increase. We present the case of a 41-year old female patient, operated for an asymptomatic multinodular goiter, and who had a histopathological diagnosis of thyroid tuberculosis. Thyroid tuberculosis should be kept in mind in the differential diagnosis of thyroid nodules, even in patients with no history and no symptom of tuberculosis disease.     

Familial intracranial aneurysms: report of three families

The problem of intracranial aneurysm causing subarachnoid hemorrhage in several members of three different families is illustrated and discussed in this report.