Minimal-change nephrotic syndrome associated with malignant mesothelioma.

A 68-year-old man presented with nephrotic syndrome. Renal biopsy revealed minimal-change glomerular disease. The proteinuria did not respond to treatment with prednisone and cyclophosphamide. On further workup, the patient was found to have a malignant mesothelioma of the pleura. The proteinuria then improved during treatment with doxorubicin hydrochloride and dacarbazine, without noticeable improvement in the tumor. This case suggests an association between mesothelioma and minimal-change glomerular disease with nephrotic syndrome, previously unreported to our knowledge. Our review revealed only ten previous cases of minimal-change glomerular disease associated with carcinoma.

Improved survival in the treatment of advanced Hodgkin's disease at a nonuniversity institution (1970-1979).

From 1970 through 1979, 89 patients with Hodgkin's disease were treated at the Marshfield Clinic/St. Joseph's Hospital. After the pathologic material was reviewed, the patients were analyzed to compare Group I (1970-1973) with Group II (1974-1979). Demographic characteristics in the two groups were similar. In the decade, 76% of patients achieved complete remission. In advanced-stage disease, 50% of patients achieved complete remission in Group I compared with 68% in Group II. At 5 years, 50% of patients were alive without COPP (cyclophosphamide, vincristine, procarbazine, prednisone) chemotherapy; with this treatment, 75% of patients survived (P = 0.02). There was improved survival comparing Group I (56% at 5 years) with Group II (76% at 5 years) patients with advanced disease (P = 0.004). More aggressive combination chemotherapy (COPP) was related to the improvement in survival (P less than 0.001). The advances in treatment made by cooperative groups and universities are being transferred to nonuniversity institutions, with appropriate improvement in survival of Hodgkin's disease.

Hepatotoxicity associated with ticrynafen--a uricosuric diuretic.

Herein, we describe a patient who had ticrynafen-associated acute hepatitis. This complication has been reported in 57 patients (52 to the manufacturer, four to the Food and Drug Administration, and the current patient) in this country. The mechanism of hepatocellular injury is not known, but from the data to date it seems most likely to result from a hypersensitivity reaction rather than a direct hepatotoxic effect. The histopathological findings are difficult to differentiate from acute viral hepatitis. Removal of this drug from the market resulted from the prompt action of physicians in reporting the complications to the manufacturer and the rapid response of the pharmaceutical firm once the risks became known.

Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism (silent thyroiditis).

Spontaneously resolving hyperthyroidism (SRH) is a transient form of hyperthyroidism characterized by a painless, nontender, normal-sized or slightly enlarged thyroid gland, elevated levels of thyroxine and triiodothyronine, a depressed thyroid radioactive iodine uptake (RAIU), spontaneous resolution in two to five months, and a focal or diffuse lymphocytic thyroiditis on biopsy. Since 1962, 62 episodes of SRH were found in 56 individuals. Twelve thyroid biopsy specimens showed diffuse or focal lymphocytic thyroiditis. Testing of viral antibodies to a wide range of viruses demonstrated only one patient with notable titer change of 18 tested. Resolution of the hyperthyroidism took two to five months. Four patients were treated inappropriately. Lymphocytic thyroiditis with spontaneously resolving hyperthyroidism appears to be a new syndrome that has dramatically increased in frequency in the past ten years. It is difficult to differentiate from common forms of hyperthyroidism unless RAIU is determined.

Fibrosarcoma of the colon.

Fibrosarcomas of the colon are extremely rare. This is the report of a patient with fibrosarcoma of the transverse colon who had perforation and peritonitis.

Chondrosarcoma of the breast. Report of two cases.

The clinical and pathologic findings in two cases of pure chondrosarcoma of the breast are presented. As with other sarcomas, both tumors were large (5.5 and 25 cm in greatest diameter), did not invade the skin or axillary lymph nodes, and occurred in women more than 40 years old. Infiltrating margins, cellular atypism, and high mitotic rates adversely affected the prognosis.

Intraoral extranodal Hodgkin's disease.

A case of extranodal Hodgkin's disease that was limited to the maxillary alveolus has been presented. A team approach was used to diagnose and treat the lesion. After appropriate staging procedures, treatment consisted of local excision and cobalt teletherapy. Follow-up examinations for the past three years have failed to disclose recurrent or new disease.

Benign gastric ulcer in a patient with pernicious anemia.

This is the report of the presence of a benign gastric ulcer in a patient with achlorhydria and documented pernicious anemia. The pernicious anemia was established by a Histalog-fast achlorhydria, a Schilling test of 2.1% excretion of tagges vitamin B12 in a 24-hr urine, and reticulocytosis after administration of cyanocobalamine. Following Histalog (1.5 mg per kg of body weight), the gastric volume was 40 ml, there was no acid, and the pH was 8.1. The ulcer demonstrated by gastroscopy was confirmed at gastrectomy. Histological examination of the ulcer and the remainder of the stomach showed no malignancy. The principal conclusion of this paper is that the patient did not have an acid-produced ulcer, but that bile regurgitation coupled with alcohol ingestion produced the lesion. Surgical investigation of the ulcer seemed mandatory because of the known increased incidence of gastric carcinoma in patients with pernicious anemia.