Alan V. Richman

Higher Prevalence of HLA-B12 in Patients with IgA Nephropathy

Excerpt With the advent of immunofluorescence and electron microscopy, classification of renal disease has become more complex and sophisticated. One clinicopathologic entity that has become well d...

Minimal-Change Disease and the Nephrotic Syndrome Associated with Lithium Therapy

Excerpt Lithium is widely used in psychiatric practice to treat manic-depressive disorders. A variety of adverse renal manifestations secondary to lithium have been reported, including renal failur...

Acute interstitial nephritis and acute renal failure associated with cimetidine therapy

We are reporting the clinical and pathologic features of severe acute renal failure which developed in a patient after the institution of cimetidine (Targamet) therapy. A renal biopsy specimen revealed an acute interstitial nephritis with numerous plasma cells and eosinophils suggestive of an immunologic reaction. Marked improvement of renal function occurred within three weeks after cessation of the drug therapy. Our clinical and pathologic data strongly suggest an association between acute interstitial nephritis and cimetidine, a suggestion which should be confirmed by additional case studies.

Accuracy of frozen section diagnosis in pelvic lymph node staging biopsies for adenocarcinoma of the prostate.

AbstractIntraoperative frozen section diagnoses were compared to permanent section results in 42 patients with localized prostatic cancer undergoing staging pelvic lymph node biopsies. A Gleason data analysis was compared to conventional histologic classification. The 7 per cent falsely negative rate found in our series compares favorably to the 11 per cent average rate reported previously.

Testicular Seminoma Metastatic to the Orbit

Painful exophthalmos, ophthalmoplegia, and visual loss in the right eye developed in a 28-year-old man four months after he underwent a radical orchiectomy and irradiation for a seminoma of the right testicle. Prednisone therapy failed to relieve the symptoms, and an orbital biopsy found a metastatic testicular seminoma. Orbital irradiation with radioactive cobalt reduced the exophthalmos, reversed the ophthalmoplegia, and improved his visual acuity. Previous cases of nonmetastatic exophthalmos in patients who had testicular seminoma have been reported, but, to the best of our knowledge, this is the first report of a patient who had orbital seminoma metastatic from the testis. Successful irradiation of the orbital focus can minimize ocular morbidity and may improve the prognosis.

Immune complex-mediated renal involvement in relapsing polychondritis

A patient with relapsing polychondritis who presented with rapidly progressive glomerulonephritis is described. This is the fourth case in which this association is reported. Crescentic glomerulonephritis was found on renal biopsy. Evidence for immunologic participation in the pathogenesis of this condition is suggested by the demonstration of circulating immune complexes, immunoglobulin and complement deposition by immunofluorescence, and electron dense deposits by electron microscopy of the kidney. Favorable response followed therapy with prednisone and dapsone.

Repair of Sinus of Valsalva Aneurysm Associated with Aortoventricular Discontinuity

The case of patient with unruptured sinus of Valsalva aneurysm with absence of the intervalvular lamina fibrosa is presented. The association of Valsalva aneurysm and aortic subvalvular defects has been explained as a deficiency of elastic tissue at the aortic root or maldevelopment of the fibrous trigone. Valvular aortic insufficiency with histological evidence of myxoid changes required prosthetic replacement. Myxomatous changes in the fibrous trigone and aortic annulus can explain this unusual, complex anomaly. Accurate preoperative diagnosis may require special views and simultaneous left and right injections at cineangiography. Techniques of repair that have been successful are reviewed, and the essential features of adequate correction are outlined.

An evaluation of the tendency of Avitene to produce periureteral fibrosis in the dog

This study was designed to evaluate whether a microfibrillary collagen hemostatic agent (Avitene) would cause retroperitoneal fibrosis and ureteric obstruction when applied along the side of the ureter and left in situ for a period of 6 months. The contralateral side served as a control. Serial intravenous urograms were obtained and histopathologic studies were conducted to evaluate these effects. No evidence of significant retroperitoneal fibrosis or ureteric obstruction was found either on serial intravenous urograms or on histopathologic examination of the ureter after 6 months.