Anneli Poukkula

Course and Outcome of Ocular Sarcoidosis

In a series of 281 patients with histologically confirmed sarcoidosis, 79 initially had ophthalmic sarcoid manifestations. Of 22 patients with uveitis, 21 were seen regularly as long as the inflammation was active, and 71 of the 79 patients (90%) underwent a follow-up study five to 16 years (mean, nine years) later and using the same protocol. In the 21 patients with uveitis, the disease exhibited either a monophasic course (eight patients) with favorable visual outcome or a relapsing course (13 patients) with severe visual loss in five eyes. Thirty-three patients showed chronic ophthalmic changes at the follow-up examination, including conjunctival granulomas (13 patients), lacrimal gland involvement (22 patients), uveitis (four patients), and involvement of lacrimal passages (three patients). In 15 of these 33 patients, the general physical examination and the chest x-ray showed no evidence of systemic sarcoidosis. However, the serum angiotensin converting enzyme level was increased in a significantly greater proportion of these 15 patients than in the patients assessed as totally recovered from sarcoidosis.

Incidence and clinical picture of sarcoidosis in a circumscribed geographical area

The incidence and clinical picture of sarcoidosis were studied on the basis of an unselected series of 354 sarcoidosis patients (168 men, 186 women) in a defined geographical area during the years 1970-81. All the patients were examined in hospital. The mean annual incidence of sarcoidosis was 15 cases per 100 000 population 15 years or older. Sixty-four per cent of the cases began or were diagnosed in the first half of the year (P less than 0.001). The disease was diagnosed in 67% of the male cases and 38% of the females before the age of 35. Sarcoidosis was found by mass chest radiographic survey or by chance in 99 men (59%) and 103 women (55%), but 85 men (51%) and 129 women (69%) had symptoms of the disease. Two hundred and eighteen patients (62%) had bilateral hilar adenopathy upon diagnosis of the disease, 120 (34%) parenchymal changes and three fibrotic radiographic changes. Lung function test results tended to decrease with the radiographic stage and were indicative more of obstruction than restriction.

A New Beclomethasone Dipropionate Multidose Powder Inhaler in the Treatment of Bronchial Asthma

The clinical efficacy, tolerability and acceptability of a new multidose powder inhaler (MDPI) containing beclomethasone dipropionate (BDP) were compared with those of a BDP aerosol administered with a large volume spacer (MDI-spacer) among adult asthmatics currently receiving from 500 to 1,000 µg/day of an inhaled corticosteroid. During the study, the dosage of BDP from both devices was 400 µg twice daily. Ninety-one patients were randomized to the MDPI group and 42 to the MDI-spacer group. The trial was performed as an open, randomized, parallel group multicenter study. The duration of the treatment period was 12 weeks, and the study was preceded by a 2-week run-in period. During the run-in period, the mean morning peak expiratory flow (PEF) was 487 and 466 1/min in the MDPI and MDI-spacer groups, respectively. After the 12-week treatment, the morning PEF was 491 l/min in the MDPI group and 463 l/min in the MDI-spacer group. The evening values were 500 and 479 l/min during the run-in period and 496 and 476 l/min after the 12-week treatment, respectively. Asthma symptom scores and the use of rescue medication were low in both groups, indicating good efficacy of the preparations tested. The median dose of histamine required to decrease forced expiratory volume in 1 s by 15% increased during the study from 800 to 1,098 µg in the MDPI group and from 795 to 960 µg in the MDI-spacer group. The most frequent adverse events in both groups were hoarseness and sore throat. There were no statistically significant differences between the treatment groups in serum cortisol values or in the number of patients with thrush. Seventy-two percent of the patients regarded the MDPI easier to use while 95% considered it more portable. Over 80% of the patients felt that the MDPI was also easier to clean and as easy or easier to learn to use than the MDI-spacer. To conclude, the novel powder inhaler is well tolerated and at least equally effective as the conventional MDI-spacer combination in the treatment of asthma with BDP. However, in everyday use, patients clearly favored the powder inhaler.

Serum Copper, Zinc and Ceruloplasmin Concentrations in Patients with Lung Cancer

Serum copper (SCu), zinc (SZn) and ceruloplasmin (SCP) concentrations were measured in 199 patients with lung cancer and 81 with nonmalignant lung disease. No significant differences were detected between these groups in the mean concentrations or in the SCu:SZn ratio, nor was any correlation found between the histological type or clinical extent of the tumor and the level of SCu, SZn or SCP. SCu and SCP increased significantly in accordance with the symptomatic stages of Feinstein, and in a parallel manner. These measures were also significantly higher in the patients who died within 4 months of diagnosis than in those who lived for 4 months or longer. SZn was similar throughout and was not predictive of the prognosis. It is concluded that SCu, SZn and SCP determinations are of no help in distinguishing malignant from nonmalignant lung disease and are only of limited importance for estimating the extent of the disease or the prognosis of a patient with lung cancer.

Comparison of Fenoterol, Ipratropium Bromide, and Their Combination in Patients with Asthma or Chronic Airflow Obstruction

Berotec (0.4 mg fenoterol hydrobromide, regimen B), Atrovent (0.08 mg ipratropium bromide, regimen A) and Duovent (0.2 mg fenoterol hydrobromide and 0.08 mg ipratropium bromide, regimen D) were administered by metered dose inhalers (MDI) to 12 patients with asthma (regimens D and B only) and 12 patients with chronic airflow obstruction (CAO). The increase in FEV1 was similar after all regimens, but greater in the patients with asthma than those with CAO. In the patients with asthma, the increase in FVC was greater after Berotec than Duovent but the difference may not be clinically important. In the patients with CAO, the increase in FVC was greater after Duovent than after the other regimens. Subjective side effects were commoner after Berotec than the other regimens, hence in the doses used Duovent may offer some clinical advantage as compared with Berotec and Atrovent used alone.

Prognosis for sarcoidosis in a defined geographical area

One hundred and ninety-nine cases of sarcoidosis were diagnosed from July 1970 to December 1976 in a defined geographical area in northern Finland. At the follow-up examination at least 5 years later (range 5-12 years) a chest röntgenogram was obtained from 179 patients (90%) and lung function tests were performed by 169 patients (85%). A normal röntgenogram was achieved by 94 of the 113 patients with stage I sarcoidosis (83%), and by 36 of the 62 patients with stage II (58%). Two patients in the former group (2%) and 14 in the latter (23%) had progressed to the fibrotic stage III, but the fibrosis was usually slight. FEV1 and FVC had increased during the follow-up period, DCO showing the largest number of abnormal results in the final examination. Lung function largely normalized with a normal röntgenogram, whereas the functional outcome was worst where fibrosis had developed. Only two patients had been granted a disability pension because of sarcoidosis. Six patients had died, but none of sarcoidosis. The results show a favourable prognosis for sarcoidosis in this comprehensive series of patients.

GALLIUM67 CITRATE SCANNING IN PATIENTS WITH LACRIMAL GLAND AND CONJUNCTIVAL SARCOIDOSIS: A Report on Three Cases

Gallium citrate Ga67 scanning of the head and thorax of 3 patients with sarcoidosis is presented. Two patients had a progressive pulmonary sarcoidosis of recent onset and in one patient, with a chronic course of the disease, the lung changes had resolved. All 3 patients had a conjunctival sarcoid change confirmed by biopsy and a lacrimal gland affection suggested by clinical examination. A highly increased Ga67 uptake in the lacrimal and parotid glands as well as in the nasopharynx was found in all patients, and an increased lung uptake was found in the newly detected cases. It is concluded that gallium scanning is a sensitive method for detecting minute ophthalmic changes in sarcoidosis. It also reveals chronic localized ocular affection in cases in which the lung changes are no longer detectable. The mechanism and specificity of gallium uptake in sarcoidosis is also discussed.