Biomedical subjects
Publications and source records attributed to G L Baum.
We present a case of pulmonary sarcoidosis associated with Hashimoto's thyroiditis. This association has been reported previously and may be purely coincidental. However, in light of current knowledge about the immunoregulatory defects postulated for sarcoidosis and for Hashimoto's thyroiditis, three other possibilities that may explain this association in our patient, are discussed.
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A case of an asymptomatic solitary pulmonary nodule which proved to be due to sarcoidosis, is described. Only an excisional biopsy can establish the diagnosis. Sarcoidosis, although rare, must be added to the differential diagnosis of asymptomatic solitary pulmonary nodule.
We describe 4 previously healthy patients with non-cavitated pulmonary sarcoidosis, whose presenting symptom was hemoptysis. Despite the presence of pulmonary involvement in about 90% of patients with sarcoidosis, hemoptysis as the presenting symptom is very rare and was described previously, to our knowledge, in only 5 patients.
In order to determine the effect of occupational animal exposure on the occurrence of respiratory disease, we studied 257 active veterinarians and 100 control subjects who had not had occupational animal contact. All participants provided a detailed medical history and underwent spirometry, skin tests, and determination of total serum IgE levels. Asthma was significantly more prevalent in veterinarians (16.3%) than in controls (6%), (P less than .05), as was infectious/obstructive respiratory disease, 10.5% in veterinarians, 3% in controls (P less than .025). Only 13 of 257 veterinarians had respiratory symptoms related to animal contact; of these, seven experienced only allergic rhinitis while six reported both asthma and rhinitis. Animal-related allergic rhinitis was found more frequently in laboratory animal veterinarians than among veterinarians in farm, pet, or poultry practice. No symptoms typical of hypersensitivity pneumonitis were reported in veterinarians, nor were precipitins to animal antigens demonstrable.
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Chest roentgenograms of 85 Jewish patients with biopsy-proven pulmonary sarcoidosis were reviewed. In 25 cases (29%), the initial chest roentgenogram showed one of the following unusual manifestations: large pulmonary nodules in 11, an acinar pattern in 10, right hilar lymphadenopathy in 3 and a large pericardial effusion in one patient. Diagnostic biopsy specimens were obtained by an open lung biopsy in 13 patients, by anterior mediastinoscopy in 4, by transbronchial lung biopsy in 3, by skin biopsy in 3 and by liver and splenic tissue examination in 2 patients. Complete roentgenographic resolution occurred only in 4 out of 20 patients who were followed for more than two years (20%), but the majority of them (83% - 15 out of 18 symptomatic patients), improved clinically irrespective of corticosteroid administration. One patient died in the course of follow-up from a cause attributed to sarcoidosis (5% - one out of the 20 patients who were followed for more than two years).
A case of histologically proven intramedullary spinal cord sarcoidosis diagnosed antemortem is presented. The patient manifested symptoms referable only to the spinal cord simulating a tumor--progressive tetraparesis. The histologic diagnosis of sarcoidosis was established through exploratory laminectomy. Surgical intervention is the only way to rule out a malignant process in case of sarcoidosis limited to the spinal cord.
We present a case of pulmonary sarcoidosis associated with serum and secretory IgA deficiency. This association has only previously been reported in 6 patients and may be coincidental. However, in light of current knowledge of the immunoregulatory defects postulated for sarcoidosis and for patients with selective IgA deficiency, 2 other possible explanations for the association of sarcoidosis and selective IgA deficiency are presented.
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Thirty-eight of 97 asthmatic patients, seven of 26 normal subjects and two of 39 patients with chronic obstructive pulmonary disease (COPD) were found to have antibodies to one or more of the inhalant fungi and candida antigens assayed by both immunodiffusion and counterimmune electrophoresis. Atopy was demonstrated in 33 of the 38 asthmatic patients with antibodies. Eleven asthmatics had anti-alternaria antibodies while only two reacted to aspergillus.
The past 40 years have brought great advances in the knowledge of morphology, immunology and epidemiology of fungal infections in man. Each general advance in the science of medicine has had its counterpart in man's improved facility to deal with these infections therapeutically. Although satisfactory control of fungal infections of man is still lacking, productive paths of investigation seem to have been found and the continued application of rigorous discipline to research efforts should provide even more efficient treatment in the future.
Between 1966 and 1970 we reviewed 46 consecutive patients undergoing resection for primary carcinoma of the lung, in whom mediastinal lymph node metastases were found at operation. There was one operative death. Five of the remaining 45 patients survived five years--one of 10 cases of large cell carcinoma, one of 19 cases of adenocarcinoma, and three of 12 cases of epidermoid carcinoma. We believe that mediastinal lymph node metastases are not per se a contraindication to resection of epidermoid carcinoma of the lung.
We studied 202 cases of bronchogenic carcinoma treated surgically between January 1, 1966 and December 31, 1970. Over all, adenocarcinoma was the most common cell type (36.1 per cent). Of 151 patients whose carcinomas were successfully resected, and who lived for at least 30 days postoperatively, 88 had lymph nodes free of cancer. Not surprisingly, 5-year survival was related to lymph node metatases and cell type. The best over-all 5-year survival rate was for large cell carcinoma; it was 52.0 per cent without nodal involvement. Similar figures for epidermoid carcinoma were 29.0 per cent over all, and 26.3 per cent without lymph node involvement; for adenocarcinoma, 19.3 per cent over all, and 32.0 per cent without nodal involvement. For the entire group of 151 patients, the 5-year survival rate was 27.8 per cent over all, and 36.4 per cent without nodal metastases. Among resected patients with mediastinal lymph nodes positive for cancer, the 5-year survival rates were 1 of 10 patients with large cell carcinoma, 1 of 19 patients with adenocarcinoma, and 3 of 12 patients with epidermoid carcinoma. This suggests that in patients with epidermoid carcinoma, the presence of mediastinal lymph node metastases is not, in itself, an absolute contraindication to resectional therapy.
The ability of the vectorcardiogram to detect mild circulatory abnormalities in patients with chronic obstructive pulmonary disease (COPD) is unclear. Therefore, vectorcardiographic changes were correlated with hemodynamic measurements made at rest and during supine exercise in 32 patients with COPD and no clinical or electrocardiographic evidence of right ventricular hypertrophy. Twelve patients had normal hemodynamic data (group 1), nine had abnormal hemodynamic data only during exercise (group 2), and 11 had abnormal hemodynamic data at rest and during exercise (group 3). The extent of rightward terminal QRS forces noted on the vectorcardiogram was significantly less in group 1 (5.5 +/- 8.7 percent) than in either group 2 (19.0 +/- 10.7 percent) or group 3 (17.8 +/- 14.8 percent). Sixty-five percent (13) of the 20 patients with hemodynamic abnormalities had rightward terminal QRS forces of 15 percent or more, whereas only 8 percent (one) of the 12 patients with normal hemodynamic data had such forces of 15 percent or more. The mean of the rightward terminal QRS forces in 27 age-matched normal subjects was 5.0 +/- 5.4 percent, and only one subject had forces of 15 percent or more. We conclude that hemodynamic abnormalities are frequent in patients with COPD and no clinical evidence of right ventricular hypertrophy and that the vectorcardiogram provides an indirect method of detecting these abnormalities.