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Biomedical subjects

H L Israel

Publications and source records attributed to H L Israel.

At least 37 records · Page 2Linked to original sources
PubMed1988

Sarcoidosis.

The classic chest radiograph, showing bilateral hilar and right paratracheal adenopathy, is found in half of sarcoidosis patients. Pulmonary infiltrates are a major cause of morbidity and mortality. Extrapulmonary disease may be found in the skin, eyes, liver and heart, and in the nervous, musculoskeletal and other systems. Despite myriad pathologic and biochemical abnormalities, the typical patient is asymptomatic. Most patients with symptomatic sarcoidosis benefit from steroid therapy; in some, however, the disease progresses inexorably.

Adrenal Cortex Hormones↗
PubMed1988

Sulfamethoxazole-trimethoprim therapy for Wegener's granulomatosis.

Cyclophosphamide has proved to be the most effective therapy for Wegener's granulomatosis, but mortality remains high at many medical centers, and the necessity for giving this toxic agent for many years to prevent relapses remains a major problem. Successful treatment of this disease with sulfamethoxazole-trimethoprim has been reported by DeRemee et al, and experience in a series of ten patients at Thomas Jefferson University Hospital, Philadelphia, confirms its effectiveness. Nine patients are in remission, and the condition of one patient improved. Relapses occurred in four patients after intervals of remission ranging from four to 30 months, but responded to increased doses of trimethoprim in two patients, while two patients required resumption of therapy with cytotoxic agents. Although the effects of sulfamethoxazole-trimethoprim are suppressive rather than curative, its use represents a major advance in treatment of Wegener's granulomatosis, permitting successful treatment of many patients without high toxic doses of cyclophosphamide and prednisone.

Adolescent↗
PubMed1987

Hypoxemia with normal chest roentgenogram due to Pneumocystis carinii pneumonia. Diagnostic errors due to low suspicion of AIDS.

Three patients encountered in a single month had insidious development of atypical respiratory or systemic symptoms and were found to be hypoxemic. All had normal chest roentgenograms and were perplexing problems in diagnosis. On initial presentation, none had evidence of pulmonary infection or recognized clinical or social features that suggested acquired immunodeficiency syndrome (AIDS). All received corticosteroids for respiratory distress before the correct diagnosis was made, and all died rapidly of Pneumocystis pneumonia secondary to AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Assessment of gallium-67 scanning in pulmonary and extrapulmonary sarcoidosis.

Gallium-67 scans have been widely employed in patients with sarcoidosis as a means of indicating alveolitis and the need for corticosteroid therapy. Observation of 32 patients followed 3 or more years after gallium scans showed no correlation between findings and later course: of 10 patients with pulmonary uptake, 7 recovered with minor residuals; of 18 patients with mediastinal of extrathoracic uptake, 10 had persistent or progressive disease; of 4 patients with negative initial scans, 2 had later progression. The value of gallium-67 scans as an aid to diagnosis was studied in 40 patients with extrapulmonary sarcoidosis. In 12 patients, abnormal lacrimal, nodal, or pulmonary uptake aided in selection of biopsy sites. Gallium-67 scans and serum ACE levels were compared in 97 patients as indices of clinical activity. Abnormal gallium-67 uptake was observed in 96.3% of the tests in active disease, and ACE level elevation occurred in 56.3%. In 24 patients with inactive or recovered disease, abnormal gallium-67 uptake occurred in 62.5% and ACE level elevation in 37.5%. Gallium-67 scans have a limited but valuable role in the diagnosis and management of sarcoidosis.

Chronic Disease↗
PubMed1986

Factors affecting outcome of sarcoidosis. Influence of race, extrathoracic involvement, and initial radiologic lung lesions.

Chest roentgenograms of 152 patients with type 2/3 disease observed 3 or more years were reviewed using modified ILO/UC nomenclature. After a mean length of observation of 9.3 years, clinical recovery was observed in 71.7% and radiologic recovery in 48.0% of the patients. Age; duration of observation; mediastinal adenopathy; and character (xyz, pgr, stu), size, extent, and profusion of pulmonary densities were similar in the 53 white and 99 black patients, who differed significantly only in sex distribution. White patients achieved clinical recovery (84.9%) more often than black patients (64.7%) (p = .05). Factors influencing clinical recovery were analyzed by means of stepwise logistic linear regression. The initial roentgenographic features were unrelated to outcome; only race and extrathoracic disease proved to have significant predictive value. The probability of clinical recovery is estimated to be .894 in white patients with disease limited to the chest, .697 in white patients with extrathoracic disease, and .760 in black patients without and .454 in black patients with extrathoracic sarcoidosis. Recovery appears to be related not to the severity of the initial pulmonary reaction but to racially associated factors that influence extrathoracic dissemination as well as lung damage.

Adult↗
PubMed1984

Hepatic granulomatosis and sarcoidosis. Further observations.

The etiology of hepatic granulomatosis discovered in patients with normal chest roentgenograms is controversial. Among 18 such patients studied in recent years, sarcoidosis was identified as the cause in 15 by demonstration of granulomatous inflammation in extrahepatic tissues, employing a variety of biopsy methods. Serum angiotensin levels were raised in all 10 patients tested and gallium scans were helpful in four of six cases. Prolonged fever was the most common symptom, but three patients had severe right upper quadrant pain, a manifestation of hepatic sarcoidosis not previously described. Improvement on corticosteroids was observed in the 14 treated patients, but incomplete response led to use of cytotoxic drugs in three cases. Sarcoidosis presents with normal chest roentgenograms more often than is appreciated and appears to be a common cause of unexplained persistent hepatic granulomatosis. A firm diagnosis should be established since treatment is long and frustrating. The prognosis is good but treatment for years is required in most cases.

Adolescent↗
PubMed1984

Chest radiograph in lymphomatoid granulomatosis: comparison with Wegener granulomatosis.

A form of angiitis and granulomatosis principally involving the lung was identified as a variant form of Wegener granulomatosis only 15 years ago. Recent experience indicates that the most common form of pulmonary angiitis and granulomatosis is lymphomatoid granulomatosis. Chest radiographs of 16 patients with this condition were reviewed and the findings compared with those of Wegener granulomatosis. The frequency and distribution of nodular masses, cavitation, and migratory lesions were similar in the two disorders, but reticulonodular infiltrates occurred only in lymphomatoid granulomatosis. The study suggests that lymphomatoid granulomatosis and Wegener granulomatosis occasionally can be distinguished by radiographic criteria. Although radiologic patterns will suggest the diagnosis of pulmonary angiitis and granulomatosis, the specific diagnosis of lymphomatoid granulomatosis must rely on clinical, immunologic, and pathologic evidence. Accurate differentiation is essential since treatment of Wegener granulomatosis with cyclophosphamide is highly effective while treatment of lymphomatoid granulomatosis is infrequently successful.

Aged↗
PubMed1983

Severe anemia as a manifestation of metastatic jugular paraganglioma.

A young woman who had a right glomus jugulare paraganglioma had diffuse pulmonary metastases three years after surgical excision of the paraganglioma. Associated with these developments were profound anemia and an extraordinarily rapid ESR. These findings have been previously noted in patients with metastatic paraganglioma and have not as yet, to our knowledge, had a satisfactory explanation. Noteworthy in our patient was a diminished serum erythropoietin level, which may indicate that metastatic paragangliomas inhibit production of or interfere with maintenance of serum erythropoietin. Symptomatic palliation of the severe anemia was attained in this patient by injections of nandrolone decanoate. Follow-up examinations of patients with paragangliomas should include surveillance of the CBCs and ESR, both of which may reflect tumor activity.

Adult↗
PubMed1982

Sarcoidosis and aspergilloma. The role of surgery.

Fibrocystic pulmonary disease is a common sequel of chronic pulmonary sarcoidosis, and the subsequent development of intracavitary aspergillomas is frequent, especially in black patients. Pulmonary hemorrhage from aspergilloma is second only to cardiorespiratory failure as the cause of death in sarcoidosis. Opinions regarding the role of resectional surgery are conflicting. We report observations on 38 patients with biopsy evidence of antecedent sarcoidosis and cultural or serologic identification of Aspergillus species as cause of the fungus balls. Pulmonary fibrosis was bilateral and extensive in most cases, making surgical treatment perilous. Ten patients had moderate impairment of pulmonary function. Seven had surgical resection with six satisfactory results and one death. Three patients in this category have not required surgery. Twenty-eight patients had severely compromised pulmonary function. Surgery was performed in seven because of intractable bleeding; four survived, but three later died of respiratory failure. Of the 21 in this category not treated by surgery, six survived, four died of hemorrhage and 11 of respiratory failure. Of the 37 patients with aspergilloma whose status is known, 19 are dead, 14 survived with positive precipitins and four, all treated surgically, recovered. It is concluded that surgical treatment of aspergilloma in patients with sarcoidosis should be avoided if possible, but is inescapable in a third of cases.

Aspergillosis, Allergic Bronchopulmonary↗
PubMed1981

Late development of mediastinal calcification in sarcoidosis.

Calcification of mediastinal lymph nodes developed in more than 20% of 111 patients with sarcoidosis followed for 10 yr or more. Lymph node calcification appeared in most instances during the second or third decade after the onset of the disease, chiefly in patients who had both mediastinal adenopathy and pulmonary infiltrates. Pre-existent calcification attributable to tuberculosis or histoplasmosis was noted in less than 3% of patients. As a result of the decline in mycobacterial infection, sarcoidosis may be the most common cause of calcified mediastinal and hilar lymph nodes appearing in patients after the age of 30.

Adolescent↗
PubMed1981

Visual evoked potentials in sarcoidosis.

The visual evoked potential to pattern reversal was recorded in 50 patients with sarcoidosis. Abnormalities of latency and amplitude were found in 15 patients (30%), including all 4 patients with clinically evident brain disease and 4 of 17 patients with overt ocular disease. Twenty-nine patients had no clinical evidence of ocular or neurologic disease, and 7 of them (24%) had abnormalities of the VEP, implying subclinical sarcoid lesions in structures at the base of the brain.

Adult↗