Introduction. Aberrations in pulmonary function test are present in about 20%
of patients with radiographic stage I sarcoidosis, whereas the pulmonary
function is damaged in 40-80% of patients with ...parenchymal infiltrates
(stages II, III or IV). Discussion and Review of Literature. Reductions in
lung volumes (vital capacity and total lung capacity) are characteristic. The
diffusing capacity of lungs is often reduced, but it is less pronounced in
sarcoidosis than in idiopathic pulmonary fibrosis. Oxygenation is usually
preserved until late in the course of sarcoidosis. Airflow obstruction
(reduced forced expiratory volume in one second and expiratory flow rates)
and bronchial hyper-reactivity occur in 30-50% of sarcoidosis patients with
pulmonary parenchymal involvement. Conclusion. While restrictive spirometry
pattern could easily be explained by fibrous changes in lung parenchyma,
especially in late stages of the lung disease, pathogenesis of airflow
limitation can be attributed mostly to endobronchial involvement
(intraluminal granuloma or fibrous scars formation), airway compression due
to enlarged lymph nodes and to distortion of small airways due to established
pulmonary fibrosis.
Introduction. Sarcoidosis is a multisystem granulomatous disease, whose
unpredictable course has prompted research into biomarkers useful to predict
outcome. Discussion and Review of Literature. ...Chitotriosidase, a chitinase
produced by activated macrophages, has recently been proposed as an indicator
among the potential markers of sarcoidosis. Chitotriosidase is involved in
the defense against pathogens containing chitin. Increased concentrations of
chitotriosidase have been observed in a number of lysosomal storage diseases,
such as Gaucher?s disease, fucosidosis, galactosialidosis, atherosclerosis,
?-thalassemia, Plasmodium falciparum-induced acute malaria, visceral
leishmaniasis and more recently in the cerebrospinal fluid in patients
suffering from multiple sclerosis. Serum chitotriosidase activity in patients
with sarcoidosis was first evaluated by Grosso et al in 2004. The idea to
detect the enzyme in sarcoidosis sprang from evidence of direct involvement
of activated macrophages in the pathogenesis of sarcoidosis and granuloma
formation. Serum chitotriosidase was tested as a biomarker at our department
in 2011, when 217 sarcoidosis patients were examined. Serum chitotriosidase
has proved to differentiate active from inactive form of the disease much
better than angiotensin-converting enzyme, thus adding to its role in the
diagnosis and prognosis of this disease. Conclusion. Chitotriosidase is a
good biomarker of sarcoidosis with good sensitivity and specificity.
Introduction. The most frequent clinical outcomes in sarcoidosis patients are
typically focused on the objective measurements of functions of the involved
organs, but, generally, they do not take ...into account the individual
perception of patients? everyday functioning. The aim of this study was to
determine the type of association between the subjective disease outcomes and
other objective conventional parameters in patients with sarcoidosis.
Material and Methods. In the cross-sectional study including 172 sarcoidosis
patients (122 females), quality of life was measured by a generic instrument,
i.e. fifteen-dimensional measure of health-related quality of life together
with a respiratory specific instrument, i.e. St George?s Respiratory
Questionnaire; symptoms of fatigue were measured by Fatigue Scale and dyspnea
was measured by the Basal Dyspnea Index. Body-mass index and the course of
the disease (acute vs. chronic) were also evaluated. Pulmonary function was
assessed by spirometry. Results. Acute sarcoidosis was present in 48 (28%)
patients. Mean body mass index was 27.01?5.2. Only 20 (12%) patients had
lower forced expiratory volume in one second values (<80%) that indicated the
existance of obstructive ventilatory impairment. Multivariate linear
regression analysis revealed that body mass index, clinical course of disease
and spirometric parameter forced expiratory volume in one second were the
significant predictors (R2=0.929, p<0.01) of sarcoidosis related fatigue
(B=0.061, B=0.406, B=0.452; respectively). Body mass index and forced
expiratory volume in one second were the only parameters that significantly
predicted both patients? quality of life (R2=0.932; B=0.017, B=0.263) and
dyspnea (R2=0.847; B=0.025, B=0.668). Conclusions. It is important to measure
both subjective patient-reported outcomes and objective disease parameters in
sarcoidosis since they represent different aspects of the disease. All
applied measuring instruments for the examined subjective outcomes
demonstrated good measuring properties.
nema
Introduction. The diagnosis of sarcoidosis can be established when there is a
compatible clinical-radiological picture together with pathohistological
evidence of noncaseating epitheloid cell ...granulomas. Novelties in Diagnosis
of Sarcoidosis. Pathohistological specimens can be obtained by conventional
bronchoscopy with endobronchial and transbronchial lung biopsy,
bronchoalveolar lavage, surgical procedures like cervical mediastinoscopy,
diagnostic thoracotomy, video-assisted thoracoscopic surgery, and recently
introduced endoscopic ultrasound techniques (endoscopic ultrasound-guided
fine-needle aspiration and endobronchial ultrasound-guided transbronchial
needle aspiration). Endobronchial ultrasound-guided transbronchial needle
aspiration and endoscopic ultrasound-guided fine-needle aspiration have given
a great contribution to diagnosis of sarcoidosis and present next diagnostic
step after negative bronchoscopy. Conclusion. Reduction of surgical
procedures in diagnosis of sarcoidosis, can be expected (first of all
mediastinoscopy) by introducing endobronchial ultrasound-guided
transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle
aspiration.
Analsysis of frequency of tuberculosis in smokers Skodric-Trifunovic, Vesna; Mihailovic-Vucinic, Violeta; Stjepanovic, Mihailo ...
Medicinski pregled,
2013, Letnik:
66, Številka:
suppl. 1
Journal Article
Recenzirano
Odprti dostop
Introduction. Smoking and tuberculosis are among the most important problems
of public health. Smoking and tuberculosis are responsible for 5 million and
2 million deaths per year, respectively, ...whereas smoking is responsible for
half a million deaths in patients with tuberculosis. Discussion and Review
of Literature. Nicotine is a significant suppressor of function of
macrophages, dendritic cells and T-cells, which explains the
immunosuppressive features of smoking that help develop the infection.
Tobacco smoke contains many substances with immunomodulatory effects,
including nicotine, carbon monoxide, acrolein, peroxynitrite and many
others. The dominant immune and pathophysiological mechanism is the
reduction of synthesis of tumor necrosis factor in lung macrophages, leading
to increased susceptibility of persons who are exposed to tobacco smoke for
developing active tuberculosis after infection and increased susceptibility
to the development of other infections, such as infections of Gram-negative
bacteria. Based on epidemiological studies and studies on this problem in
the past 50 years, the World Health Organization has published the finding
that smoking increases the risk of infection with M. tuberculosis, increases
the risk of progression of infection to active disease and the risk of
death. The prevalence of tuberculosis is higher in smokers and former
smokers than in nonsmokers. The risk of tuberculosis depends on the number
of cigarettes smoked and length of period the person has been a smoker.
Passive smoking accelerates the development of active tuberculosis. in
children who live with persons suffering from active tuberculosis,
Conclusion. Given the multiple consequences of the association between
smoking and tuberculosis, prevention of smoking may be an important measure
in the control of tuberculosis.
Introduction. Sarcoidosis affects the central nervous system more frequently
than it was previously believed. Since the diagnosis of neurosarcoidosis is
often delayed, it may result in serious ...complications. Being non-specific
when present, the symptoms may be subtle and resemble those of other
neurological diseases. While the cranial nerves are most frequently affected,
neurosarcoidosis can involve other nervous system tissues including the
meninges, brain parenchyma (especially the hypothalamic region), spinal cord,
peripheral nerve and muscle. Discussion and Review of Literature. During the
past decade, a significant progress was made in understanding the
epidemiology and pathophysiology of neurosarcoidosis, as well as the
possibility to diagnose and treat this disease. Studies have shown that the
optimal diagnostic imaging modality for neurosarcoidosis is magnetic
resonance imaging with gadolinium because it enhances visualization of
granulomatous infiltration in neural tissue. Subclinical neurosarcoidosis may
not be uncommon in patients with sarcoidosis. It is now evident that
neurosarcoidosis does not invariably present as a catastrophic event. Adverse
effects associated with high-dose systemic corticosteroids, the standard
therapy, have discouraged practitioners from initiating treatment in the
absence of significant symptomatic neurological disease. However, other
immunosuppressive agents as well newer biologic agents have emerged as an
effective, well-tolerated therapeutic alternative to corticosteroids, which
are often effective in corticosteroid- recalcitrant cases. Conclusion.
Neurosarcoidosis, as a localized granulomatous disease, is possible and not
so rare. Early recognition of neurological involvement in patients with
undiagnosed or diagnosed sarcoidosis is crucial to prevent complications,
which can sometimes be life-threatening.
Introduction. Corticosteroid therapy used to be considered a common treatment
for sarcoidosis patients. Discussion and Review of Literature. It is known
that corticosteroids have many side affects, ...and that knowledge called for
other possible treatments, non-steroidal agents that would allow prolonged
treatment of chronic sarcoidosis and avoid side effects of steroids on
metabolism, glicoregulation, increase in body weight, osteoporosis, Cushing
syndrome etc. There is a wide range of medications that can offer alternative
to corticosteroid therapy. So far, none of the agents has been absolutely
perfect. Conclusion. Therefore, it can be concluded that every clinician
should choose the best possible treatment for each sarcoidosis patient.
Atlas of Sarcoidosis Mihailovic-Vucinic, Violeta; Sharma, Om P
2004, 2006-01-15
eBook
Sarcoidosis is a complex multisystem disease. Shortness of breath (dyspnea) and a cough that won't go away can be among the first symptoms of sarcoidosis, but sarcoidosis can also show up suddenly ...with the appearance of skin rashes and other dermatoses.
An Atlas of Sarcoidosis: Pathogenesis, Diagnosis and Clinical Features combines illustrations and clinical images of the authors' extensive practices, so that readers have unparalleled access to a comprehensive collection of sarcoidosis images. The atlas is designed to complement and provide a visual supplement to already existing texts on sarcoidosis. Each organ involvement is dealt in a brief and easy to comprehend manner. Various radiographic and laboratory abnormalities are then linked to the clinical features in order to encourage a smooth and easy practical integration at the bedside and to help practising pulmonologists, dermatologists and other clinicians who require a comprehensive visual encyclopedia of sarcoidosis images.
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