Harold L. Israel

Course and prognosis of sarcoidosis

Abstract 1. 1. Observations are presented on the course of sarcoidosis in 211 patients, 184 Negroes and twenty-seven Caucasians, observed in Philadelphia for as long as twenty years, with a mean interval of 5.9 years. 2. 2. Survival rates, calculated by the life table method, were 88.8 per cent after 5 years of observation and 84.8 per cent after ten years of observation. Comparison with the life expectancy of normal persons similar in age, sex and race indicates a considerable diminution of survival as the result of sarcoidosis. 3. 3. Complete recovery was observed in 34.6 per cent and improvement in 31.8 per cent, while in 16.1 per cent the condition became worse. The mortality rate was 9.5 per cent, with sixteen deaths due to sarcoidosis, three to tuberculosis, and one to incidental disease. In four other patients tuberculosis developed, one of whom was among the ninety-three patients treated with corticosteroids. In only two instances was recurrence of sarcoidosis observed. 4. 4. The incidence of erythema nodosum was much less frequent than reported in English and Scandinavian studies, and clearing of mediastinal adenopathy occurred less often and less rapidly than in these two countries. With these exceptions, the course of sarcoidosis appears to be similar in Philadelphia and in Northern Europe. 5. 5. Although the prognosis appears to be less favorable in Negro patients and in those patients with many systems involved, analysis indicates that cutaneous involvement is the feature most closely associated with progressive and fatal sarcoidosis.

Recurrent Pulmonary Infiltration and Pleural Effusion Due to Nitrofurantoin Sensitivity

PULMONARY disease with eosinophilia, either transient or chronic, has been observed in patients with and without asthma, often as the result of drug allergy or of parasites. A patient recently encountered is of interest because of several features: there was no history of prior allergic reactions, the lesions recurred in the same pulmonary segments over a five-week period, the clinical and radiologic changes simulated pulmonary embolism, marked eosinophilia was not manifested until the third episode and the cause of the recurrent pneumonias was shown to be nitrofurantoin.‡ Severe reactions to this drug have been reported,1 but it has not previously .xa0.xa0.

Sarcoidosis and aspergilloma

Abstract Ten instances of aspergilloma occurring in patients with chronic pulmonary sarcoidosis are reported. Cystic cavities in the upper lobe are a frequent development in sarcoidosis, and aspergilli in such circumstances will often proliferate to form fungus balls. Invasion of the lung and systemic dissemination are rare, but erosion of the cavity wall is a common cause of pulmonary hemorrhage, which may be fatal. In other cases spontaneous healing occurs. Medical therapy is unlikely to be effective, and resection is indicated for recurrent hemoptysis when the underlying sarcoidosis and consequent impairment of respiratory function permit surgery.

ALTERED IMMUNOLOGIC REACTIONS IN SARCOIDOSIS

Excerpt It is widely accepted that in patients with sarcoidosis tuberculin sensitivity is infrequent or is of a low level and transient in nature. The mechanism responsible for the absence or loss ...

THE VARIED CLINICAL MANIFESTATIONS OF PULMONARY EMBOLISM

Excerpt Pulmonary embolism is a common finding at necropsy. It is nevertheless regarded in many hospitals as an unusual disorder, infrequently considered in the differential diagnosis of cardiopulm...

Passive Transfer of Tuberculin Sensitivity to Patients with Sarcoidosis

STUDIES in various countries agree that approximately two thirds of patients with sarcoidosis fail to react to second-strength tuberculin — 0.005 mg. of Purified Protein Derivative (PPD) or 1.0 mg. of Old Tuberculin (OT).1 2 3 The failure to react is not merely the result of absence of exposure to tuberculous infection, since patients with sarcoidosis proved unable to develop and maintain tuberculin sensitivity in normal fashion after BCG vaccination.2 , 3 This diminished reactivity to tuberculin has been interpreted as evidence both for3 and against1 a tuberculous etiology of sarcoidosis. Two main theories have been proposed to explain this phenomenon: Positive anergy is .xa0.xa0.

Effect of cortisone in sarcoidosis.

ALTHOUGH sarcoidosis is commonly considered a benign condition, it may occasionally be a serious illness, resulting in blindness, respiratory insufficiency or death. In a search for an effective therapeutic agent, many substances have been tried. Fowlers solution and x-ray therapy have been found ineffective.1 More recently, benefit has been reported from the use of calciferol (vitamin D2),2 nitrogen mustard,3 and urethane,4 but in our experience neither these agents nor antibiotics have given consistent results. Because it tends to involve many organs, sarcoidosis bears a clinical resemblance to certain of the disseminated collagen diseases. The hyperglobulinemia characteristic of sarcoidosis is also .xa0.xa0.

Desquamative interstitial pneumonia: relationship to interstitial fibrosis

Patchefsky, A. S., Israel, H. L., Hoch, W. S., and Gordon, Gloria (1973).Thorax, 28, 680-693. Desquamative interstitial pneumonia: relationship to interstitial fibrosis. The clinical course and radiographic and pathological findings in 14 patients having the histological pattern of desquamative interstitial pneumonia (DIP) have been studied. Four deaths occurred from cardiorespiratory failure and two from other diseases, and one patient has severe pulmonary insufficiency. Seven patients had altered immunological reactivity or arthritis. Necropsy of three patients, one who died of respiratory insufficiency and two of other diseases, revealed diffuse pulmonary fibrosis with loss of the desquamative features noted on biopsy. One patient had had industrial exposure to tungsten carbide dust and x-ray diffraction analysis of the post-mortem lung showed high concentrations of this substance. Ultrastructural observation and direct immunofluorescent staining of one specimen demonstrated fibrin in the alveolar space, a feature usually regarded as distinguishing DIP from chronic fibrosing interstitial pneumonia. Our clinical and pathological observations suggest that the histological pattern recognized as DIP may be a non-specific reaction to diverse forms of injury, which is not clearly separable from the usual type of diffuse interstitial fibrosis.

THE DIAGNOSIS OF SARCOIDOSIS WITH SPECIAL REFERENCE TO THE KVEIM REACTION

Excerpt Before considering whether a specific diagnostic test for sarcoidosis is available, it is appropriate for us to inquire whether sarcoidosis is a specific disease. Some writers have question...

Use of Serum Transaminase Levels in the Differentiation of Pulmonary Embolism and Myocardial Infarction

THE diagnosis of pulmonary embolism continues to present a challenge to the clinician. Massive pulmonary embolism is often diagnosed correctly ante mortem and is identified with relative ease by the pathologist at autopsy. However, it is in nonfatal cases that the diagnosis is frequently missed or is in doubt. The correct diagnosis of nonfatal pulmonary embolism is of utmost importance because early recognition and treatment of thromboembolic disease and the correction of frequently present mild unrecognized congestive heart failure provide a means of prevention of fatal embolism, and, secondly, because when thromboembolism is overlooked, treatment may be inappropriately instituted for .xa0.xa0.