Stephen B. Sulavik

Extrapulmonary sites of radiogallium accumulation in sarcoidosis

In an effort to detect extrapulmonary sites of radiogallium accumulation in cases of sarcoidosis, 145 separate Ga-67 citrate studies of 114 patients with biopsy-proven sarcoidosis were examined. The most characteristic extrapulmonary radiogallium uptake pattern was the “panda sign” in 47 patients (41%). The most common site of prominent extrapulmonary radiogallium uptake was the lacrimal glands in 101 patients (88%). Second most common was activity in one or more superficial lymph node regions such as the cervical, axillary, femoral, or inguinal in 19 patients (17%). Other extrapulmonary sites included breast uptake in 6 out of 80 women (8%), prominent splenic and nasal uptake in 9 (8%) patients, periportal accumulation in 7 (6%), and cutaneous/subcutaneous activity in 4 (4%). Because many of these individuals were receiving corticosteroids, the natural (untreated) prevalence of extrapulmonary findings may be even higher. Although the sensitivity and specificity of extrapulmonary radiogallium accumulation has still to be determined, many of the sites may be accessible to biopsy both for diagnostic purposes and to follow the effects of medications. It is therefore suggested that whole-body imaging be performed when radiogallium is administered to patients with suspected or known sarcoidosis.

Effect of Corticosteroids on Lung Volume-Pressure Curves in Bleomycin-Induced Lung Injury in the Rat

In this study we investigated changes in volume-pressure curves at various stages after bleomycin induced lung injury (6 h, and 3, 7, and 28 days) and tested the ability of steroids to influence these changes. The most significant decreases in volume-pressure curves were observed at 3 days post bleomycin, a time point that correlates to the peak period of inflammation. Steroids as drugs of high antiinflammatory potency were used in order to modulate the inflammatory response and possibly the volume-pressure curve changes observed during the natural course of bleomycin induced lung injury. Dexamethasone treatment significantly inhibited the decreases in volume pressure curves observed at 3 days post bleomycin, whereas methylprednisolone did not. Also both steroids significantly inhibited inflammation as measured by histological evaluation and the presence of cells in the bronchoalveolar lavage fluid.

Lupus Pernio. Radiogallium imaging in a patient with chronic cutaneous sarcoidosis

A 37-year-old man with a history of chronic skin sarcoidosis had the classic triad of lupus pernio. Each of the lesions (nose, ears, and hands) revealed avid radiogallium accumulation. In addition, both the panda sign and the lambda sign of hilar-mediastinal lymph node uptake of radiogallium were present, despite normal results of chest radiography. Several other lymph node chains were also involved. The case can serve as a baseline to determine if other instances of lupus pernio have such a wide systemic distribution of radiogallium uptake.

Surfactant and Physiologic Alterations in an Animal Model of Adult Human Lung Disease

The diffuse obstructive and infiltrative lung diseases (e.g. bronchitis, asthmatic bronchitis, fibrosing alveolitis, sarcoidosis) contribute significantly to human morbidity and mortality. Disturbance of ventilation and perfusion represents a major physiologic defect in these diseases, resulting in pulmonary hypertension, cor pulmonale and right heart failure. Immunologic and surfactant alterations play a prominent role in these diseases. There is a growing body of evidence indicating that surfactant is a most important material in maintaining airway patency. General concepts regarding these functions in human adult lung diseases and results of investigations of surfactant in an animal model of bleomycin-induced lung fibrosis are presented.