Clinical features and prognostic significance of splenic involvement in sarcoidosis

Sarcoidosis is a systemic disease characterized by noncasefied granulomas in various organs. Incidence of splenic disease is variable and is reported to occur in 6.7 to 77 percent of the patients. Firm data establishing the clinical features and the association of splenic involvement with prognosis in sarcoidosis is scant. The aim of our study was to investigate the clinical features and the consequence of splenic involvement on the prognostic outcome of sarcoidosis patients. We evaluated the clinical and laboratory findings in 82 sarcoidosis patients. Forty-two patients with splenic involvement were compared to 48 sarcoidosis patients without splenic disease in regard to laboratory findings, endobronchial disease, extrapulmonary organ involvement, and prognosis. Lung biopsy sample was considered positive if it demonstrated noncaseating granulomas with negative fungal and mycobacterial cultures. Splenic sarcoidosis was identified by ultrasound or computed tomography and was designated as limited, diffuse or without splenic involvement. Extrapulmonary organ sarcoidosis was classified as extensive and limited. Endobronchial disease was categorized as limited or diffuse involvement. The most commonly comprised organ was lung in 95% of the cases followed by lymph nodes, skin, eye, spleen and liver in the order of frequency. Splenic disease was diffuse in 22 patients. Of these patients, 14 had extensive extrapulmonary organ involvement while 16 had diffuse endobronchial disease. There was no significant difference between the three groups for FEV1, FVC, TLC, DLCO/VA, serum and 24h urinary calcium levels. Serum ACE was higher in patients with diffuse splenic involvement (p<0.001). Incidence of persistent chronic disease was significantly higher (p<0.001) in patients with diffuse splenic sarcoidosis. Extensive extrapulmonary organ involvement and diffuse endobronchial disease were more common (p<0.001) in this group. Extensive extrapulmonary organ involvement and diffuse endobronchial disease were more frequent in patients with diffuse splenic sarcoidosis. Patients with diffuse splenic granulomas had a worse prognosis than the patients without splenic involvement or patients with limited splenic disease. Diffuse splenic involvement emerges to be a significant risk factor for persistent chronic sarcoidosis. Extensive granuloma burden in an organ may be the decisive clinical marker for the prognostic outcome of sarcoidosis patients.

The effect of arbuscular mycorrhizal fungi on biological activity and biochemical properties of soil under vetch growing conditions in calcareous soils

Due to soils from arid regions with high lime and low organic matter content, farmers receive low yields along with high costs of agricultural inputs, which causes them to look for a solution. In this context, Arbuscular mycorrhizal fungi (AMF) have great potential to reduce fertilizer use by mediating soil nutrient cycles. However, little is known about studies of AMF inoculum on microbial biomass carbon (C), nitrogen (N), and phosphorus (P) cycling during vetch plant vegetation in calcareous areas. In this study, changes in soil biogeochemical properties related to soil C, N, and P cycling were investigated with five different AMF inoculations under vetch (common Vetch (CV; Vicia sativa L.) and Narbonne Vetch (NV; Vicia narbonensis L.) growing conditions. For the field study, a total of five different mycorrhizae were used in the experiment with the random plots design. AMF inoculation decreased the lime content of the soil, and the highest decrease was observed in NV with Glomus (G.) intraradices + G. constrictum + G. microcarpum inoculation (24.41 %). The highest MBC content was recorded in CV vetch G. intraradices (1176.3 mg C kg 1 1 ) and the highest MBN content in NV vetch G. intraradices + G. constrictum + G. microcarpum (1356.9 mg C kg ). CAT activity of soils was highest in CV vetch G. intraradices (31.43 %) and lowest in NV vetch G. intraradices + G. constrictum + G. microcarpum (72.88 %), urease enzyme activity decreased in all treatments except G. constrictum + Gigaspora sp. and G. mosseae inoculations in CV. The highest DHG activity was detected in GF (15.72 %) AMFs in CV and GI (21.99 %) in NV. APA activity was highest in Glomus constrictum + Gigaspora sp. (23.33 %) in CV and Glomus fasciculatum (10.08 %) in NV. In CV plots, G. intraradices + G. constrictum + G. microcarpum (91.67 %) isolates had the highest and G. intraradices community had the lowest RC% (97.33 %) in mixed mycorrhiza species, while in NV plots G. fasciculatum inoculum had the highest and G. intraradices community had the lowest RC%. This study has important implications for the application of AMF for sustainable agriculture. When the results of the study were evaluated, the most effective AMF isolates in terms of C, N, and P cycles were G. constrictum +

Развитие плеврального выпота туберкулезной этиологии у больного с саркоидозом на фоне кортикостероидной терапии

A 47-year-old man was diagnosed a Lofgren's syndrome and corticosteroid therapy was started. On the seventh month of the therapy a pleural effusion developed. Although no definite diagnosis was made, anti tuberculous therapy was started empirically. Three weeks later mycobacterium growth was detected on Lowenstein-Jensen culture. The patient recovered almost completely in 2 months of the anti-tuberculous therapy. In a well controlled sarcoidosis patient who presents pleural effusion, if other causes are excluded, it would be wise to start anti-tuberculous therapy since sarcoid pleural effusion is a rare form of the disease which accompanies advanced disease and since corticosteroid therapy renders patients susceptible to tuberculosis.47-летнему мужчине был поставлен диагноз синдрома Лефгрена и начата терапия кортикостероидами. На 7-м месяце лечения у него развился плевральный выпот. Была назначена эмпирическая противотубекулезная терапия, несмотря на отсутствие окончательного диагноза. Спустя 3 нед при посеве на среду Левенштейна-Йенсена был получен рост микобактерий. На фоне противотуберкулезной терапии в течение 2 мес больной почти полностью выздоровел. Таким образом, при появлении плеврального выпота у больного с хорошо контролируемым течением саркоидоза при исключении других его причин целесообразно начинать противотуберкулезную терапию, поскольку плевральный выпот является редким проявлением саркоидоза и терапия кортикостероидами повышает риск развития туберкулеза

Clinical and prognostic significance of muscle biopsy in sarcoidosis

The main objective of this study was to evaluate the influence of muscle involvement on the clinical features, prognostic outcome, extrapulmonary organ, and endobronchial involvement in sarcoidosis patients. The second aim was to assess the diagnostic yield of muscle biopsy for the histopathologic identification of sarcoidosis

Clinical and prognostic significance of muscle biopsy in sarcoidosis

The main objective of this study was to evaluate the influence of muscle involvement on the clinical features, prognostic outcome, extrapulmonary organ, and endobronchial involvement in sarcoidosis patients. The second aim was to assess the diagnostic yield of muscle biopsy for the histopathologic identification of sarcoidosis.  Fifty sarcoidosis patients participated in the study. The patients were classified into two groups according to the histopathologic presence of non-caseating granulomatous inflammatory pattern of the muscle biopsy samples and were evaluated retrospectively in regard to clinical features, prognosis, extrapulmonary, and endobronchial disease involvement. Pathologic examination of the muscle biopsy samples revealed non-caseating granulomas in eighteen and myositis in seven patients compatible with sarcoidosis. The diagnostic yield of muscle biopsy for demonstrating non-caseating granulomatous inflammation was fifty percent. Patients with muscle sarcoidosis showed a worse prognosis and a more severe extrapulmonary organ involvement than the patients without muscle disease. Muscle biopsy was not statistically significant to delineate diffuse endobronchial involvement while it was suggestive for endobronchial disease clinically. The results of our study reveal that muscle biopsy appears to be a useful diagnostic tool along with its safety and easy clinical applicability. It is a rewarding utility to predict the prognostic outcome and extrapulmonary involvement in sarcoidosis patients. Positive biopsy on the other hand confirms the identification of sarcoidosis in patients with single organ involvement carrying an equivocal diagnostic clinical pattern. Muscle biopsy may be considered as the initial step for the final diagnosis of sarcoidosis in such cases

Carpal tunnel syndrome associated with sarcoidosis in identical twin patients

Sarcoidosis is a multisystemic disease that may lead to neurologic complications in 10% of the patients. Carpal tunnel syndrome is very rare in sarcoidosis. We present two identical twin sarcoidosis patients with carpal tunnel syndrome. A number of factors may cause carpal tunnel syndrome like wrist anatomy, occupation, diabetes, rheumatoid arthritis, pregnancy and renal failure. Although the above factors do not directly cause carpal tunnel syndrome, they may increase your chances of developing or aggravate median nerve damage as it is in sarcoidosis. Sarcoidosis relevant neuropathy and granulomas may be the primary mechanism of sarcoidosis associated carpal tunnel syndrome

Clinical features and prognostic significance of splenic involvement in sarcoidosis

Sarcoidosis is a systemic disease characterized by noncasefied granulomas in various organs. Incidence of splenic disease is variable and is reported to occur in 6.7 to 77 percent of the patients. Firm data establishing the clinical features and the association of splenic involvement with prognosis in sarcoidosis is scant. The aim of our study was to investigate the clinical features and the consequence of splenic involvement on the prognostic outcome of sarcoidosis patients

Course and Prognosis of Sarcoidosis in a Referral Setting in Turkey; Analysis of 166 Patients

Backround: Clinical manifestations and prognosis of sarcoidosis are heterogenous and the prevalence varies depending on the country, area and race evaluated. Also the organs involved and courses of the disease differ greatly between countries, areas, races and individuals. Aims: To investigate the sociodemographic characteristics, clinical presentation and symptoms and to determine the severity and prognosis of sarcoidosis in Turkey as a referral center. Methods: Between January and July 2003 we retrospectively evaluated the outcome of the patients with sarcoidosis whose first clinical visits were between 1965 and 2003 in the multidisciplinary referral setting RS at Cerrahpasa Medical Faculty of the University of Istanbul. Data collected about each patient included sociodemographic characteristics, clinical presentation, symptoms, date of diagnosis, date and age of onset, method and stage of disease at the date of diagnosis and at the date of last evaluation; the mortality and survival rate were calculated. One hundred and sixty six consecutive patients whose first clinical visits were between 1965 and 2003 in the multidisciplinary RS at Cerrahpasa Medical Faculty were enrolled. We contacted every patient in our cohort by telephone calls or home visits. All those contacted were called back to outpatient clinic for a formal evaluation between June and September 2003. A formal physical examination and thorax radiography were performed in patients who came to the hospital. Their radiological stage, signs, symptoms and associated extrapulmonary manifestations were recorded. Results: At the initial presentation, the mean age of diagnosis was 40.3 years. The 31–40 age group is the group with the highest number of patients. Coughing was the most frequent symptom and erythema nodosum was the most frequent sign in both sexes. Thirty eight percent of patients had extrathoracic involvement. The most frequent extrapulmonary site of involvement was skin. The mortality rate was 11.6% (10.8% in females and 13% in males). Comorbidity was 3% (5 females, 1 male). Females, youngs and patients without extrathoracic involvement had higher survival rates. Conclusion: Clinical characteristics, course and prognosis of sarcoidosis vary in different studies. The results may vary accordingly to ethnic, geographic, social and economic conditions

Association of HLA antigens with the clinical course of sarcoidosis and familial disease

Patients with sarcoidosis usually have a benign course and a favourable prognosis. Although spontaneous remission is common, a progressive disease with a severe prognosis occurs in a small but significant number of patients. The aim of this study was to evaluate the potential significance of HLA antigens as a clinical marker on the outcome of sarcoidosis patients. We conducted a retrospective cohort study for HLA class I and II allels in 74 sarcoidosis patients and 72 healthy transplant donors. Bronchoscopy and bronchial biopsies were performed in each patient. Two or more positive bronchial biopsy samples revealing noncaseified granulomatous inflammation was defined as diffuse while one positive biopsy sample was designated as limited endobronchial disease. Three or more extrapulmonary organ involvement was denoted as extensive and involvement of two or less organs was designated as limited extrapulmonary organ disease. The patients were followed-up at least for eight years. Incidence of progressive disease was significantly high in patients with positive HLA-DRB1*07, DRB1*14 (p<0.05) and DRB1*15 (p <0.001) allels. HLA-DRB1*14 and DRB1*15 were associated with extensive extrapulmonary organ disease (p<0.001). HLA-DRB1 *14 (p<0.05) and DRB1*15 (p<0.001) were significantly more frequent in patients with diffuse endobronchial involvement. Incidence of familial disease was 14.8% with a 6.7% identical HLA typing. Presence of HLA class I and II allels may influence the severity and prognosis of sarcoidosis significantly. Apart from defining genetic susceptibility, HLA class I and class II allels appear to be relevant and crucial markers for the clinical outcome of sarcoidosis. Distinct heterogenity of sarcoidosis may arise from the particular presence of different allels in invidual patients