ABSTRACT
We report on a patient who suffered from psoriasis vulgaris and psoriatic arthritis and developed nephrotic syndrome after long-term therapy with non-steroidal anti-inflammatory drugs. Membranous nephropathy with tubulointerstitial and vascular (intimal hyperplasia) changes were found on renal biopsy using optical, immunofluorescent and electron microscopy. Treatment with methylprednisolone "pulse" therapy (1 g/24 h during 3 days) and continuing with prednisone 0.5 mg/kg/24 h was ineffective and end-stage renal failure developed 6 months after the diagnosis had been established.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Arthritis, Psoriatic/drug therapy , Glomerulonephritis, Membranous/pathology , Kidney/pathology , Adult , Arthritis, Psoriatic/complications , Biopsy , Female , Glomerulonephritis, Membranous/complications , Glomerulonephritis, Membranous/drug therapy , Humans , Kidney Failure, Chronic/etiology , Methylprednisolone/therapeutic use , Microscopy, Electron , Microscopy, Fluorescence , Prednisone/therapeutic use , Time FactorsABSTRACT
Aspiration biopsies were performed on 1536 patients with goiter who showed scintigraphically "cold" nodules. Twelve among them had clinical and cytological positive diagnosis. The remaining 1524 patients had aspiration biopsies without suspicion of the malignant nature of their goiters. Among them, 45 patients had a positive or suspect cytological diagnosis. Fourteen had not been yet operated on. Thirty-one were operated on and 28 malignancies were confirmed histologically. In three patients, cytological diagnosis was false positive. The remaining patients were cytologically negative. Thirty-seven were operated on and four false negative cases were found. The application of aspiration biopsy on every patient with a cold thyroid nodule resulted in the detection and very early diagnosis of clinically unsuspected thyroid neoplasms, the great majority of which were confined to the gland itself without metastasic spread. This fact makes the prognosis better. In addition, it is probable that the early detection of differentiated thyroid neoplasms and their surgical ablation interrupt their natural course towards anaplastic carcinoma, with its grim prognosis.
