Splenic granulomas in Farmer's lund disease. An extrapulmonary manifestation of extrinsic allergic alveolitis.
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Adult↗
Biomedical subjects
O Selroos
Publications and source records attributed to O Selroos.
Cellular immunity during follow-up of patients with sarcoidosis of varying duration.
Cellular immunity was followed up at 3 month intervals for 1 year in 43 patients with sarcoidosis representing three well defined categories of the disease viz acute (12), subacute (20) and chronic (11). Twelve apparently healthy individuals served as controls. Each follow-up included the following tests: total number of blood lymphocytes, T cells, B cells, leucocyte migration tests with PPD, BCG and Kveim test material and stimulation tests of lymphocytes in vitro in the presence of PHA, Con A, PPD and PWM. Statistically, the most abnormal initial findings in all the tests were noted in acute sarcoidosis, followed by the subacute group. The acute group showed the most marked changes also during the follow-up. The smallest changes during the follow-up were seen in the patients with the chronic form of the disease. However, the inter-individual variation was considerable and no definite conclusions could be drawn from findings in a given case. Alterations in cellular immunity occur in sarcoidosis. They differ between different subgroups of patients and vary differently in course of time. Well defined criteria for inclusion of patients in an investigation and repeated studies of included patients will increase the information available from investigations of cellular immunity in sarcoidosis.
Acute Disease↗
Blood monocytes and serum and bone marrow lysozyme in sarcoidosis.
Serum lysozyme (LZM) concentrations were correlated to the number of neutrophils and monocytes in patients with sarcoidosis and nongranulomatous diseases. In sarcoidosis patients with an increased activity of serum angiotensin converting enzyme (ACE), a positive correlation was noted between LZM and blood monocytes. In sarcoidosis patients with normal ACE activity, as well as in patients with non-granulomatous diseases, a correlation was found between blood neutrophils and LZM, but not between blood monocytes and LZM. LZM was found in bone marrow plasma and in serum in a ratio of 1.5 to 1. Sarcoidosis patients had 30% higher LZM levels than healthy controls. The concentration of LZM in bone marrow plasma did not correlate to detectable granulomas in bone marrow specimens. The positive correlation between blood monocytes and LZM in patients with clinically active sarcoidosis is possibly due to recruitment of bone marrow monocytes for the granuloma formation.
Bone Marrow↗
Haematologic findings in patients with renal carcinoma.
Haemoglobin concentration and leukocyte and platelet counts were studied in 122 patients with renal carcinoma, 104 of whom subsequently underwent nephrectomy. In 61 of the operable patients the tumour was located within the renal capsule (group I) and in the other 43 it had invaded the perinephric tissues (group II). Eleven of the group II patients also had distant metastases in one or two sites. Multiple distant metastases precluded renal surgery in 18 patients (group III). Normochromic anaemia (haemoglobin less than 120 micrograms/l) was found in 17% and leukocytosis (greater than 8 x 10(9)/l) in 25% of the group I patients. The corresponding frequencies for group III were 72 and 67%. Severe anaemia was found in patients with localized tumours as well as in patients with extensive metastases. Thrombocytosis (400-800 x 10(9)/l) occurred in less than 20% of the patients in groups I and II, but in 42% in group III. Thrombocytopenia (less than 200 x 10(9)/l), on the other hand, which was present in 31% of the group I patients, was less common in those with metastasizing tumours. Haematologic anomalies in renal carcinoma suggest either bone-marrow metastases of tumour-induced mechanisms such as production of erythropoietin or thrombopoietin and phagocytic and chemotactic effects of tumour cells or auto-immune processes. When uncorrected by nephrectomy in patients without signs of metastases, such haematologic findings suggest concomitant blood disorders.
Adult↗
Angiotensin converting enzyme. V. Serum levels as monitors of disease activity in corticosteroid-treated sarcoidosis.
Serum angiotensin-converting enzyme (ACE) activity was related to clinical markers of disease activity, mainly chest X-rays, pulmonary function tests and serum lysozyme (LZM) in 41 sarcoidosis patients, who received corticosteroid treatment. Increased ACE activity before treatment predicted improvement of diffusion capacity during treatment, whereas chest X-rays improved regardless of the initial ACE value. ACE decreased after initiation of treatment both in sarcoidosis patients and in healthy volunteers. In sarcoidosis most decreases were parallelled by similar LZM changes, which did not occur in volunteers. When an apparently stable state had been achieved, ACE was no longer a reliable monitor of disease activity. It often fluctuated within normal limits without accompanying clinical or LZM changes. It was not dose-dependent during daily medication but increased during alternate day administration. This may reflect decreased suppression of ACE by steroids but may also indicate reactivation of the disease process. Elevated ACE values after cessation of treatment preceded or parallelled a relapse. LZM values did not add to the information provided by ACE measurements before, during or after treatment.
Adrenal Cortex Hormones↗
Circulating immune complexes in sarcoidosis.
Circulating immune complexes (CIC) were detected in 100 out of 112 sera from 33 sarcoidosis patients. Five tests were used representing three different basic principles. All patients had detectable CIC at some stage of their disease. The three platelet tests detecting IgG complexes exhibited the highest positive titres in the acute cases. The ClqB-ELISA test, which detects complement fixing IgG complexes, was the test most frequently positive in the chronic cases. The presence of extra-pulmonary lesions or corticosteroid therapy did not influence the appearance or disappearance of CIC. No positive correlation was found between CIC and elevated levels of serum angiotensin-converting enzyme (ACE) and/or serum lysozyme (LZM). The evaluation of CIC in sarcoidosis requires a battery of different tests carried out at regular intervals during the follow up.
Antigen-Antibody Complex↗
Prognostic significance of lymphopenia in sarcoidosis.
During 1959--67, sarcoidosis were diagnosed in a series of 140 patients. All were followed up and 22 developed chronic sarcoidosis. In 134 patients (20 with chronic course) the initial granulocyte, monocyte and lymphocyte counts were known. No differences in granulocyte values were seen between different groups of sarcoidosis patients. Patients with erythema nodosum had significantly increased monocyte levels. Lymphopenia below 1 000/microliter was seen in only 7.5% of the patients. Lymphocyte counts below 1 500 microliter were a common finding, especially in patients developing chronic sarcoidosis. Significantly decreased lymphocyte values were also seen in patients older than 40 years at the time of diagnosis, in patients negative to 10 TU of PPD and in those with a disease requiring treatment with corticosteroids. A correlation was found between initial lymphopenia and less favourable prognosis, 85% of the patients having a very good prognosis. Patients with initial lymphopenia must be carefully followed up. The initial presence of erythema nodosum does not always guarantee a good prognosis.
Adult↗
Angiotensin-converting enzyme. II. Serum activity in early and newly diagnosed sarcoidosis.
Serum angiotensin-converting enzyme (ACE) was studied in 51 patients with early or newly diagnosed sarcoidosis. Only 45% of these patients had increased ACE activity when their diagnosis was established, which diminishes the diagnostic value of this enzyme measurement. On the other hand, ACE accurately reflected disease activity, and it proved a useful tool for assessing of need for corticosteroid treatment. Patients with acute sarcoidosis associated with erythema nodosum (EN) had low ACE activity compared with the other patients with active, but less acute disease. Serum ACE was not significantly correlated with blood lymphocytes or the immunoglobulins, but there was a positive correlation between the enzyme and serum lysozyme, which strengthens the hypothesis of both enzymes being produced by the epithelioid cells of sarcoid granulomas.
Adult↗
Angiotensin converting enzyme. III. Changes in serum level as an indicator of disease activity in untreated sarcoidosis.
The activity of serum angiotensin converting enzyme (ACE) was repeatedly measured together with serum lysozyme (LZM) in patients with untreated sarcoidosis. Changes in the clinical picture were registered using chest X-ray, forced vital capacity (FVC), diffusing capacity for carbon monoxide (DLCO) and appearance of extrapulmonary lesions. During a clinically unchanged period the highest ACE activity and the corresponding LZM value (not the highest value) were used for the calculation. A statistically significant change in ACE was noted when a normal chest X-ray changed to a stage II lesion or vice versa, and when a signficant change in FVC occurred. All other changes were insignificant. On the other hand, statistically significant changes in ACE were found during stable periods according to chest X-ray, FVC or DLCO. ACE is frequently elevated in serum of patients with active sarcoidosis. The fluctuations in activity mostly parallel the clinical course of the disease. The behaviour and metabolism of the enzyme need further investigation. An increased concentration of serum LZM is frequent in patients with active sarcoidosis. The highest LZM values are not always seen simultaneously with the highest ACE values, indicating that they probably express different dimensions of the disturbances in the sarcoid granuloma.
Adult↗
Angiotensin converting enzyme. IV. Changes in serum activity and in lysozyme concentrations as indicators of the course of untreated sarcoidosis.
The mean values of serum angiotensin-converting enzyme (ACE) activities and lysozyme (LZM) concentrations measured during different phases of sarcoidosis coincided well with the clinical evaluation of the state of the disease. However, both enzymes, especially LZM, decreased before improvement was detected. Changes in these enzymes were in accord with the simultaneous clinical development in three fourths of cases. Incompatibility between clinical observations apnd LZM fluctuations was most frequently seen during active stable or inactive disease. LZM often decreased during the active stable phase and fluctuated irregularly during inactive disease. During the former phase LZM decrements possibly reflect decreasing activity of granulomatous macrophages and, in fact, precede detectable improvement. During inactive disease, on the other hand, cells were not connected with the disease process dominate LZM production. ACE changes paralleled the clinical development more often than corresponding LZM changes during stable sarcoidosis. This may have been misleading and due to a delayed reaction of serum ACE, compared with LZM, inreflecting the activity of granylomatous cells. This delayed reaction was also observed in connection with erythema nodosum. Stable ACE activity during inactive sarcoidosis indicated the usefulness of measurements when trying to predict a relapse. We conclude that ACE may be a secondary feature of sarcoidosis rather than a primary funtion of macrophage activity.
Humans↗
Corticosteroid therapy of pulmonary sarcoidosis. A prospective evaluation of alternate day and daily dosage in stage II disease.
Thirty-nine sarcoidosis patients with pulmonary infiltrations (stage II) of less than 5 years duration and not treated earlier with corticosteroids were randomly allocated for treatment with methylprednisolone for 7 months or for observation without therapy. Every other treated patient was given the drugs daily and every other followed an alternate-day regimen. After 7 months the chest radiographic finding, the forced vital capacity and the diffusion capacity for carbon monoxide were superior in the treated group. There was no difference between the two drug regimens. After 24 and 48 months no statistically significant differences between the untreated and the treated groups were found.
Carbon Monoxide↗
Angiotensin-converting enzyme and lysozyme in silicosis and asbestosis.
Serum angiotensin-converting enzyme (ACE) activity and lysozyme (LZM) concentration in 22 silicosis and 18 asbestosis patients were studied. These patients were compared with 57 untreated and 36 treated sarcoidosis patients. In all groups significantly raised ACE and LZM mean values were noted. Untreated sarcoidosis patients had the highest values. Raised ACE activity in silicosis and asbestosis has not been reported before, and weakens the differential diagnostic value of this enzyme determination for sarcoidosis. The similar patterns of increased ACE and LZM mean values in all three diseases suggest that these enzymes have a common source.
Adult↗
[Serum angiotensin converting enzyme (ACE) activity in sarcoidosis].
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Adolescent↗
Malignant histiocytosis. A clinical and morphological study of four cases.
Four patients with malignant histiocytosis are described. Major clinical signs were fever, lymphadenopathy, hepatomegaly and splenomegaly. Laboratory studies showed leukopenia, thrombocytopenia, low leukocyte alkaline phosphatase (LAP) score, normal erythrocyte sedimentation rate (ESR) and elevated serum triglycerides. There was evidence of bone marrow involvement in all four cases. Typical changes were seen in the histological study.
Adult↗
Immunohistochemical demonstration of lysozyme in the lymph nodes and Kveim reaction papules in sarcoidosis.
Lysozyme (LZM) was demonstrated by an immunoperoxidase method in some but not all epitheloid-cell granulomas, free macrophages and giant cells in the lymph nodes and Kveim reaction papules of patients with sarcoidosis. In inactive disease, LZM staining was weak or absent in fibrotic lymph nodes. The pattern of LZM staining in Kveim reaction papules was similar to that seen in the "active" sarcoid lymph nodes. The presence of LZM in sarcoid tissue explains the high concentration of serum LZM in patients with active sarcoidosis and the extent of LZM distribution in tissues is probably an index of disease activity.
Epithelial Cells↗