Personalities of sarcoidosis. Edwin L. Kendig. St. Mary's Hospital, Richmond, Virginia.
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Biomedical subjects
Publications and source records attributed to D G James.
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This review of the radiology of sarcoidosis encompasses intrathoracic involvement, upper respiratory tract sarcoidosis, pleural disease, and involvement of bone, joint, neurological system, heart, kidney and alimentary tract. Attention is drawn to the value of CT scans, magnetic resonance imaging, gallium, and neutron activation analysis.
The family of fluoroquinolones is an attractive group of bactericidal antibiotics with a wide range of activity against Gram-negative organisms and some Gram-positive bacteria. In addition to being highly bactericidal, these antibiotics are effective by mouth, side effects are few and bacterial resistance is minimal. These antibiotics have an assured place in the management of urinary tract infections, gonorrhoea, chlamydial infection, cystic fibrosis, typhoid fever, travellers' diarrhoea, biliary infection and as an alternative agent in respiratory infections. Nalidixic acid was the pioneer quinolone, but has now been succeeded by a whole new family of fluoroquinolones with greater bactericidal activity and a considerably wider antibacterial spectrum. Ciprofloxacin (Ciproxin, Bayer UK Ltd) is joined by norfloxacin (Noroxin, Merck, Sharpe & Dohme), perfloxacin, ofloxacin and enoxacin. This family of fluoroquinolones is attractive because effective treatment can be given by mouth, they are highly bactericidal, side effects are minimal and the spectrum of bacterial resistance seems to be small. There is also an obvious economic advantage over parenterally-administered drugs.
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All aspects of neurosarcoidosis are reviewed, including cranial nerve palsies, neurophthalmology, intracranial lesions, meningitis, cerebellar ataxia, peripheral neuritis, hypothalamus, myopathy, neurophysiology, cerebrospinal fluid, differential diagnosis and treatment.
Hodgkin's Disease may mimic sarcoidosis, as seen in this case report.
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Behçet's disease is a multisystem disorder in which orogenital ulceration is associated with troublesome generalized uveitis, erythema nodosum, pyoderma, dermatographism, seronegative arthritis, and neurologic and cardiovascular symptoms. There is no diagnostic laboratory test; the diagnosis is based on the disorder's multisystem clinical features. A points scoring system is helpful in distinguishing it from other multisystem disorders that mimic it. It occurs most frequently in an area coinciding with the old Silk Route, between latitudes 30 degrees and 45 degrees north, in Asian and Eurasian populations, and it has an HLA-B51 affinity. The cause remains unknown, but a postulated trigger factor is a herpesvirus with cofactors that include ethnic group, human leukocyte antigen affinities, T-cell and autonomic imbalance, circulating immune complexes, autoimmunity, blood viscosity, decreased fibrinolysis, and zinc deficiency. Treatment includes administering corticosteroids, azathioprine, chlorambucil, cyclosporine, and colchicine, and fibrinolytic therapy.
Reports from Yugoslavia, France, Great Britain, Scandinavia, Hungary, and various parts of the United States, make it possible to construct a picture of sarcoidosis in children, its natural history and the influence of corticosteroid therapy.
Twelve patients with active Behçet's uveitis with marked deterioration of visual acuity in at least one eye were treated with cyclosporin A (CyA). An initial improvement in the severity of ocular inflammation and systemic features occurred in all cases and persisted until the dose was reduced or the drug withdrawn when a rapid recurrence of symptoms was noted. The visual acuity also initially improved in ten patients and this was maintained in seven cases until the dose of CyA was reduced. At this time, acuity was unchanged in two patients and was worse in three others-two of the latter as a result of vitreous haemorrhage in the absence of active inflammation. Seven of the 12 patients had therapy stopped because of complications; severe malaise and nausea (three cases), decreased renal function (three cases), and blindness (one case). Cyclosporin A is of value in the control of Behçet's uveitis but toxicity limits its use and the benefits only last while the patient is on this therapy.
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