Sarcoidosis

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Valeyre Dominique

2007-11-01

Full Text Available Abstract Sarcoidosis is a multisystemic disorder of unknown cause characterized by the formation of immune granulomas in involved organs. It is an ubiquitous disease with incidence (varying according to age, sex, race and geographic origin estimated at around 16.5/100,000 in men and 19/100,000 in women. The lung and the lymphatic system are predominantly affected but virtually every organ may be involved. Other severe manifestations result from cardiac, neurological, ocular, kidney or laryngeal localizations. In most cases, sarcoidosis is revealed by persistent dry cough, eye or skin manifestations, peripheral lymph nodes, fatigue, weight loss, fever or night sweats, and erythema nodosum. Abnormal metabolism of vitamin D3 within granulomatous lesions and hypercalcemia are possible. Chest radiography is abnormal in about 90% of cases and shows lymphadenopathy and/or pulmonary infiltrates (without or with fibrosis, defining sarcoidosis stages from I to IV. The etiology remains unknown but the prevailing hypothesis is that various unidentified, likely poorly degradable antigens of either infectious or environmental origin could trigger an exaggerated immune reaction in genetically susceptible hosts. Diagnosis relies on compatible clinical and radiographic manifestations, evidence of non-caseating granulomas obtained by biopsy through tracheobronchial endoscopy or at other sites, and exclusion of all other granulomatous diseases. The evolution and severity of sarcoidosis are highly variable. Mortality is estimated at between 0.5–5%. In most benign cases (spontaneous resolution within 24–36 months, no treatment is required but a regular follow-up until recovery is necessary. In more serious cases, a medical treatment has to be prescribed either initially or at some point during follow-up according to clinical manifestations and their evolution. Systemic corticosteroids are the mainstay of treatment of sarcoidosis. The minimal duration of

Phenotypes of organ involvement in sarcoidosis

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Schupp, Jonas Christian; Freitag-Wolf, Sandra; Bargagli, Elena; Mihailović-Vučinić, Violeta; Rottoli, Paola; Grubanovic, Aleksandar; Müller, Annegret; Jochens, Arne; Tittmann, Lukas; Schnerch, Jasmin; Olivieri, Carmela; Fischer, Annegret; Jovanovic, Dragana; Filipovic, Snežana; Videnovic-Ivanovic, Jelica; Bresser, Paul; Jonkers, René; O'Reilly, Kate; Ho, Ling-Pei; Gaede, Karoline I.; Zabel, Peter; Dubaniewicz, Anna; Marshall, Ben; Kieszko, Robert; Milanowski, Janusz; Günther, Andreas; Weihrich, Anette; Petrek, Martin; Kolek, Vitezslav; Keane, Michael P.; O'Beirne, Sarah; Donnelly, Seamas; Haraldsdottir, Sigridur Olina; Jorundsdottir, Kristin B.; Costabel, Ulrich; Bonella, Francesco; Wallaert, Benoît; Grah, Christian; Peroš-Golubičić, Tatjana; Luisetti, Mauritio; Kadija, Zamir; Pabst, Stefan; Grohé, Christian; Strausz, János; Vašáková, Martina; Sterclova, Martina; Millar, Ann; Homolka, Jiří; Slováková, Alena; Kendrick, Yvonne; Crawshaw, Anjali; Wuyts, Wim; Spencer, Lisa; Pfeifer, Michael; Valeyre, Dominique; Poletti, Venerino; Wirtz, Hubertus; Prasse, Antje; Schreiber, Stefan; Krawczak, Michael; Müller-Quernheim, Joachim

2018-01-01

Sarcoidosis is a highly variable, systemic granulomatous disease of hitherto unknown aetiology. The GenPhenReSa (Genotype-Phenotype Relationship in Sarcoidosis) project represents a European multicentre study to investigate the influence of genotype on disease phenotypes in sarcoidosis. The baseline

Benefits of physical training in sarcoidosis

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Strookappe, B.; Swigris, J.; de Vries, Jolanda; Elfferich, M.D.P.; Knevel, T.; Drent, M.

2015-01-01

Background Sarcoidosis patients suffer from fatigue and exercise limitation. The aim of this study was to establish whether a physical training program improves these and other outcomes important to sarcoidosis patients. Methods From 11/2012 to 9/2014, 201 sarcoidosis patients were referred to the

Orbital and adnexal sarcoidosis

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Prabhakaran, Venkatesh C.; Saeed, Perooz; Esmaeli, Bita; Sullivan, Timothy J.; Mcnab, Alan; Davis, Garry; Valenzuela, Alejandra; Leibovitch, Igal; Kesler, Anat; Sivak-Callcott, Jennifer; Hoyama, Erika; Selva, Dinesh

2007-01-01

To present the clinical features and management in a series of patients with orbital and adnexal sarcoidosis. This multicenter retrospective study included patients with biopsy-proven noncaseating granuloma involving the orbit or adnexa and evidence of systemic sarcoidosis. Clinical records were

Granulomatous lithiasic cholecystitis in sarcoidosis

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Adriana Handra-Luca

2016-03-01

Full Text Available Gallbladder granulomas are exceedingly rare, reported in association with tuberculosis or sarcoidosis. Here we report a case of gallbladder granulomatous cholecystitis occurring in the context of sarcoidosis. A 70-years old man presented with abdominal pain, nausea and vomiting. The medical history revealed sarcoidosis diagnosed more than 20-years previously. 2-years previously the patient showed renal lithiasis, hypercalcemia and, increased angiotensin converting enzyme. The imaging features suggested thoraco-abdominal sarcoidosis. Prednisone was given at 1.2 mg/kg/day initially, than decreased, being at 2.5 mg/day at present. The ultrasound examination showed gallbladder lithiasis. A cholecystectomy was performed. Microscopy showed subacute and chronic cholecystitis with several epithelioid and giant cell granulomas some of them perineural. In conclusion, we report a case of granulomatous cholecystitis occurring in the course of treated sarcoidosis. The perineural location of granulomas may give further insights into the pathogenesis of gallbladder dysmotility.

Common features of tuberculosis and sarcoidosis

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Esmaeil Mortaz

2016-01-01

Full Text Available Tuberculosis (TB is a disease caused by Mycobacterium tuberculosis. Despite the availability of novel therapeutic approaches, TB is considered as one of the leading causes of death due to infectious diseases worldwide. Alveolar macrophages are the first line of defense against M. tuberculosis; they ingest and sequester the bacilli within granulomatous structures. Control and resolution of the infection requires activated T lymphocytes as well as Th1 cytokines. There are two forms of TB: active TB and latent TB. Latent TB is a state in which M. tuberculosis survives in the body without causing overt signs and symptoms. People with latent TB are noncontagious. However, M. tuberculosis can become active in the body, multiply, and cause overt TB. Sarcoidosis, on the other hand, is an autoimmune disease of unknown etiology which can affect multiple systems of the body. Nonspecific constitutional symptoms, such as fever, fatigue, malaise, and weight loss, are present in approximately one-third of patients. Chest X-ray usually shows hilar and mediastinal lymphadenopathy. Although the lungs are the most common sites of inflammation, sarcoidosis can also involve other organs, such as the eyes (intraocular and adnexal, skin, lymph nodes, salivary glands, heart, spleen, liver, and the nervous system. Recent investigations have provided further insights into the genetic basis of sarcoidosis and the way genotype determines the clinical presentation and phenotype of patients. Histopathologic features are usually insufficient for diagnosis of sarcoidosis. Diagnosis of sarcoidosis in endemic areas for TB can become a great challenge. Both TB and sarcoidosis are granulomatous diseases; TB is characterized by caseating granulomas, whereas sarcoidosis is characterized by noncaseating granulomas. New cases of sarcoidosis are increasingly being diagnosed in areas endemic for TB due to increased orientation of physicians and availability of diagnostic modalities

Sarcoidosis in Melanoma Patients: Case Report and Literature Review

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Beutler, Bryce D., E-mail: brycebeutler@hotmail.com [School of Allied Health Sciences, University of Nevada, Las Vegas, 1060 Wiegand Road, Encinitas, CA 92024 (United States); Cohen, Philip R., E-mail: brycebeutler@hotmail.com [Department of Dermatology, University of California San Diego, 10991 Twinleaf Court, San Diego, CA 92131 (United States)

2015-06-15

Sarcoidosis is a systemic inflammatory disease characterized by the development of noncaseating granulomas in multiple organ systems. Many hematologic malignancies and solid tumors, including melanoma, have been associated with sarcoidosis. We describe the clinical and pathologic findings of a 54-year-old man with melanoma-associated sarcoidosis. In addition, we not only review the literature describing characteristics of other melanoma patients with sarcoidosis, but also the features of melanoma patients with antineoplastic therapy-associated sarcoidosis. Sarcoidosis has been described in 80 melanoma patients; sufficient information for analysis was provided in 39 of these individuals. In 43.6% of individuals (17 out of 39), sarcoidosis was directly associated with melanoma; in 56.4% of oncologic patients (22 out of 39), sarcoidosis was induced by antineoplastic therapy that had been administered for the treatment of their metastatic melanoma. The discovery of melanoma preceded the development of sarcoidosis in 12 of the 17 (70.5%) individuals who did not receive systemic treatment. Pulmonary and/or cutaneous manifestations of sarcoidosis were common among both groups of patients. Most patients did not require treatment for sarcoidosis. Melanoma patients—either following antineoplastic therapy or without systemic treatment—may be at an increased risk to develop sarcoidosis. In antineoplastic therapy naive melanoma patients, a common etiologic factor—such as exposure to ultraviolet light—may play a role in their developing melanoma and sarcoidosis.

Laboratory Diagnosis Of Sarcoidosis

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Dutta S.K

2001-01-01

Full Text Available Sarcoidosis is not an uncommon disease. Unfortunately, the awareness amongst clinicians is lacking and due to overwhelming prevalence of tuberculosis, a disease with many similar features, the diagnosis is missed and often delayed. The gold standard investigation finding in the diagnosis of sarcoidosis is the presence of noncaseating tuberculoid granuloma, also known as sarcoid or sarcoid-like granuloma. Some classical chest X-ray findings, clinico-radiological dissociation. Suggestive organ lesions, negative Mantoux test (MT, development of MT site granuloma, hypercalcemia, hypercalciuria and raised serum angiotensin converting enzyme (SACE value and negative tests for tuberculosis are usually hekpful in the diagnosis of sarcoidosis.

[Isolated thyroid gland sarcoidosis and hyperthyroidism].

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Langsteger, W; Lind, P; Beham, A; Költringer, P; Eber, O

1989-04-29

A case of isolated sarcoidosis of the thyroid gland, associated with hyperthyroidism, is reported in a 28-year-old male patient whose thyroid was removed for hyperthyroid multinodular goitre. Histology revealed a regressive adenoma and sarcoidosis in non-adenomatous thyroid residue. Further diagnosis, therapeutic management and a 3-year follow-up did not disclose any specific changes or involvement of other tissues. Isolated thyroidal sarcoidosis with hyperthyroid alterations are extremely rare and mostly chance findings; simultaneous occurrence of thyroid sarcoidosis and hyperthyroidism may be a symptom of gland infiltration for which an adequate explanation is still lacking.

Extensive upper respiratory tract sarcoidosis

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Soares, Mafalda Trindade; Sousa, Carolina; Garanito, Luísa; Freire, Filipe

2016-01-01

Sarcoidosis is a chronic granulomatous disease of unknown aetiology. It can affect any part of the organism, although the lung is the most frequently affected organ. Upper airway involvement is rare, particularly if isolated. Sarcoidosis is a diagnosis of exclusion, established by histological evidence of non-caseating granulomas and the absence of other granulomatous diseases. The authors report a case of a man with sarcoidosis manifesting as a chronic inflammatory stenotic condition of the upper respiratory tract and trachea. PMID:27090537

Early-onset childhood sarcoidosis: a case report

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Lai-San Wong

2011-12-01

Full Text Available Sarcoidosis is a multisystemic granulomatous disease of unknown etiology and it most commonly affects young adults. Childhood sarcoidosis is relatively rare; older children usually present a picture similar to that of adults, with frequent hilar lymphadenopathy and pulmonary infiltration. Early-onset (<4 years of age childhood sarcoidosis is a unique disease and has a different presentation. It is characterized by arthritis, uveitis, and cutaneous involvement. The prognosis of early-onset childhood sarcoidosis varies in different studies due to the rarity of the disease. The treatment of choice in systemic involvement of childhood sarcoidosis is corticosteroids. Methotrexate can also be considered in the long-term treatment due to its safety, effectiveness, and steroid-sparing effect in children.

Laser therapy for cutaneous sarcoidosis: A review

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Teo Soleymani

2016-03-01

Full Text Available Sarcoidosis is a systemic, multi-organ disease of unknown etiology characteristically defined by the development of non-caseating granulomas. The development of sarcoidosis has been associated with a number of environmental and microbacterial factors coupled with genetic susceptibility. Depending on the type, location and distribution of disease, sarcoidosis can cause functional impairment, symptomatic distress, scarring and disfigurement. The advent of lasers as precise, minimally destructive surgical tools has allowed for their development as promising alternatives that minimize the morbidity associated with current therapies.In this paper, we reviewed the role of laser therapy in the treatment of cutaneous sarcoidosis. A comprehensive search of the Cochrane Library, MEDLINE and PUBMED databases was performed to identify relevant literatures investigating the role of laser therapy in the treatment of cutaneous sarcoidosis. In our opinion, laser therapy, particularly PDL, appears to be an effective, safe and generally well-tolerated modality for the treatment of cutaneous sarcoidosis and should be considered in patients with localized cutaneous disease that is refractory to conventional treatments. Less is known about the efficacy and tolerability of ablative laser therapy for the treatment of cutaneous sarcoidosis, though the limited data appears promising as well. With that said, however, the data is limited and warrants a need for additional larger, randomized controlled studies to further investigate the utility and efficacy of laser therapy in the treatment of cutaneous sarcoidosis.

Imaging aspects of the diagnosis of sarcoidosis

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Spagnolo, Paolo [University of Modena and Reggio Emilia, Center for Rare Lung Diseases, Respiratory Disease Unit, Department of Oncology Haematology and Respiratory Diseases, Modena (Italy); Sverzellati, Nicola [University of Parma, Department of Surgical Sciences, section of Radiology, Parma (Italy); Wells, Athol U. [Royal Brompton Hospital, Interstitial Lung Disease Unit, London (United Kingdom); Hansell, David M. [Royal Brompton Hospital, Department of Radiology, London (United Kingdom)

2014-04-15

Sarcoidosis is a systemic granulomatous disorder of unknown aetiology with a wide spectrum of radiological appearances and almost invariably pulmonary involvement. Lung involvement accounts for most of the morbidity and much of the mortality associated with sarcoidosis. Imaging contributes significantly to the diagnosis and management of patients with sarcoidosis. In typical cases, chest radiography may be sufficient to establish the diagnosis with little margin of error and CT is not necessary. However, CT can play a critical role in several clinical settings: atypical clinical and/or radiographic findings; normal or near-normal chest radiograph but clinical suspicion of sarcoidosis; and detection of complications. Moreover, in many patients, CT findings are atypical and unfamiliar to most radiologists (e.g. sarcoidosis mimicking other lung diseases and vice versa), and in these cases histological confirmation of the diagnosis is recommended. CT is also useful in assessing disease extent and may help to discriminate between reversible and irreversible lung disease, thus providing critical prognostic information. This review concentrates on the more difficult imaging aspects of sarcoidosis, in particular differential diagnosis and disease complications. (orig.)

A rare clinical presentation of sarcoidosis; gingivitis.

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Güzel, Aygül; Köksal, Nurhan; Aydın, Davut; Aslan, Kerim; Gören, Fikret; Karagöz, Filiz

2013-10-01

Gingivitis due to sarcoidosis is a relatively rare condition. Gingivitis or isolated gingival involvement may be the first sign of systemic sarcoidosis. We report the case of a 37 year-old woman with isolated gingivitis due to sarcoidosis confirmed by biopsy. Following treatment with a systemic corticosteroid (prednisolone 40 mg/day), all clinical and radiologic findings were completely improved. In cases of chronic and intractable gingivitis, systemic sarcoidosis should be suspected. It should be confirmed with a biopsy, and the patient should be referred to a chest disease clinic to exclude other organ involvement. Copyright © 2013 Elsevier Inc. All rights reserved.

Childhood sarcoidosis: A rare but fascinating disorder

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Gedalia Abraham

2008-09-01

Full Text Available Abstract Childhood sarcoidosis is a rare multisystemic granulomatous disorder of unknown etiology. In the pediatric series reported from the southeastern United States, sarcoidosis had a higher incidence among African Americans. Most reported childhood cases have occurred in patients aged 13–15 years. Macrophages bearing an increased expression of major histocompatibility class (MHC II molecules most likely initiate the inflammatory response of sarcoidosis by presenting an unidentified antigen to CD4+ Th (helper-inducer lymphocytes. A persistent, poorly degradable antigen driven cell-mediated immune response leads to a cytokine cascade, to granuloma formation, and eventually to fibrosis. Frequently observed immunologic features include depression of cutaneous delayed-type hypersensitivity and a heightened helper T cell type 1 (Th1 immune response at sites of disease. Circulating immune complexes, along with signs of B cell hyperactivity, may also be found. The clinical presentation can vary greatly depending upon the organs involved and age of the patient. Two distinct forms of sarcoidosis exist in children. Older children usually present with a multisystem disease similar to the adult manifestations, with frequent hilar lymphadenopathy and pulmonary infiltrations. Early-onset sarcoidosis is a unique form of the disease characterized by the triad of rash, uveitis, and arthritis in children presenting before four years of age. The diagnosis of sarcoidosis is confirmed by demonstrating a typical noncaseating granuloma on a biopsy specimen. Other granulmatous diseases should be reasonably excluded. The current therapy of choice for sarcoidosis in children with multisystem involvement is oral corticosteroids. Methotrexate given orally in low doses has been effective, safe and steroid sparing in some patients. Alternative immunosuppressive agents, such as azathioprine, cyclophosphamide, chlorambucil, and cyclosporine, have been tried in adult cases

How are cancer and connective tissue diseases related to sarcoidosis?

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Chopra, Amit; Judson, Marc A

2015-09-01

Several studies have suggested an association between sarcoidosis and cancer, and between sarcoidosis and connective tissue diseases (CTDs). In this review, we discuss the evidence supporting and refuting these associations. In terms of a cancer risk in sarcoidosis patients, the data are somewhat conflicting but generally show a very small increased risk. The data supporting an association between sarcoidosis and CTD are not as robust as for cancer. However, it appears that scleroderma is the CTD most strongly associated with sarcoidosis. There are several important clinical and research-related implications of the association of sarcoidosis and CTDs. First, rigorous efforts should be made to exclude alternative causes for granulomatous inflammation before establishing a diagnosis of sarcoidosis. Second, the association between sarcoidosis and both cancer and CTDs may yield important insights into the immunopathogenesis of all three diseases. Finally, these data provide insight in answering a common question asked by sarcoidosis patients, 'Am I at an increased risk of developing cancer?' We believe that although there is an increased (relative) risk of cancer in sarcoidosis patients compared with the general population, that increased risk is quite small (low absolute risk).

[Sarcoidosis of the female genital tract].

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Šefčíková, A; Turková, M; Žurková, M

To present the findings of sarcoidosis on female genital tract. Review. Department of Obstetric and Gynecology, Silesian Hospital Opava. Overview of published findings from case studies. Sarcoidosis is a multisystem granulomatous disorder of unclear cause. It typically involves the lymph nodes of mediastinum, predominantly billateral and/or pulmonary infiltrates. We find extrapulmonary involvement in 30-50% of cases. Sarcoidosis of the female reproductive system is a rare, it represent less than 1% cases of sarcoidosis. Lesions there may affect any organ, including the vulva, vagina, cervix, uterus, fallopian tube and ovary, but also for example placenta and breast. There is also recorded the incidence of multiple localization on female genitalia. Since sarcoidosis of this area is so rare, often proceeds asymptomatic and recognized only as an incidental finding, there are mention only the case histories in literature yet.Clinical symptoms may be non-specific, often imitating a tumor, or tend to be specific, depending on the localization of disability such as perineal pain, pain in the scar after the previous birth trauma, persistent pruritus, itching, irritation, dyspareunia, menstrual cycle disorders, menorrhagia, metrorrhagia, postmenopausal bleeding, amenorrhoe, abdominal pain, endometrial polypoid lesions, recurrent or persistent serometra or discharge. The diagnosis is made up of histologically - we are demonstrating noncaseating granulomas.The therapy is difficult, there are no available official guidelines. If the lesions are clinically silent, we can observed them because they may spontaneously disappear. If we are embarking on medical therapy, we start from a local application, and if this is unsuccessful then we approach the systemic administration. Corticosteroids are the drug of choice. If we diagnose the sarcoidosis of the female genital organs we must exclude systemic disease of sarcoidosis. The prognosis of disease is good.

Transient lower esophageal sphincter relaxation and esophageal motor response.

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Schneider, Joachim H; Küper, Markus A; Königsrainer, Alfred; Brücher, Björn L D M

2010-04-01

Gastroesophageal reflux is caused by transient lower esophageal sphincter relaxations (TLESRs) in healthy individuals and in most patients with gastroesophageal reflux disease (GERD). Refluxate is normally propelled by pharyngeally induced swallowing events, but TLESRs may also be accompanied by retrograde esophageal motor responses (EMRs). These contractions have not previously been investigated and their effect on esophageal clearance is not known. The aim of this study was to assess the frequency of EMRs after TLESR in healthy individuals and GERD patients and to develop an animal model for further investigation of EMRs. The frequency of TLESRs and esophageal body contractions after TLESRs was assessed using ambulatory manometry in five healthy individuals and five GERD patients. An animal model was developed for reproducible provocation of TLESRs and subsequent EMRs. Patients with GERD have significantly more TLESRs than healthy individuals. However, post-TLESR EMRs were not more frequent in the GERD group. All post-TLESR EMRs presented as simultaneous contractions of the esophagus. The feline model allowed reproducible initiation of the esophageal motor response after TLESR, showing that EMRs can be induced by external mechanoreceptor stimulation simultaneously with LES relaxation. This experimental design imitates the conditions after fundoplication in humans. The study demonstrated that GERD patients have significantly more TLESRs in comparison with healthy individuals, but these were only incidental to EMRs. Further research is needed to improve our understanding of esophageal motility disorders. The animal model presented offers a feasible tool for investigating TLESR-induced esophageal motility.

Gingival enlargement unveiling sarcoidosis: Report of a rare case

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Sabeeha Abbas Kadiwala

2013-01-01

Full Text Available Sarcoidosis is classified as an acquired systemic granulomatous disease. Because of the fact that sarcoidosis affects multiple tissues and organs, it is characterized by many potential signs and symptoms, as well as by the presence of non-caseating granulomas in the organs involved. Although oral sarcoidosis is relatively rare, it may however, present in the oral cavity. This report presents a rare case of sarcoidosis with the initial presenting symptom as severe generalized gingival enlargement. The gingival enlargement was treated by gingivectomy. After histopathological examination of gingival biopsy and certain special investigations, a diagnosis of sarcoidosis was made.

Sarcoidosis Presenting as Bilateral Vocal Fold Immobility.

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Hintze, Justin M; Gnagi, Sharon H; Lott, David G

2018-05-01

Bilateral true vocal fold paralysis is rarely attributable to inflammatory diseases. Sarcoidosis is a rare but important etiology of bilateral true vocal fold paralysis by compressive lymphadenopathy, granulomatous infiltration, and neural involvement. We describe the first reported case of sarcoidosis presenting as bilateral vocal fold immobility caused by direct fixation by granulomatous infiltration severe enough to necessitate tracheostomy insertion. In addition, we discuss the presentation, the pathophysiology, and the treatment of this disease with a review of the literature of previously reported cases of sarcoidosis-related vocal fold immobility. Sarcoidosis should therefore be an important consideration for the otolaryngologist's differential diagnosis of true vocal fold immobility. Copyright © 2018 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

CT findings in severe thoracic sarcoidosis

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Hennebicque, Anne-Sophie; Brillet, Pierre-Yves; Moulahi, Hassen; Brauner, Michel W.; Nunes, Hilario; Valeyre, Dominique

2005-01-01

Severe thoracic sarcoidosis includes manifestations with significant clinical and functional impairment and a risk of mortality. Severe thoracic sarcoidosis can take on various clinical presentations and is associated with increased morbidity. The purpose of this article was to describe the CT findings in severe thoracic sarcoidosis and to explain some of their mechanisms. Subacute respiratory insufficiency is a rare and early complication due to a high profusion of pulmonary lesions. Chronic respiratory insufficiency due to pulmonary fibrosis is a frequent and late complication. Three main CT patterns are identified: bronchial distortion, honeycombing and linear opacities. CT can be helpful in diagnosing some mechanisms of central airway obstruction such as bronchial distortion due to pulmonary fibrosis or an extrinsic bronchial compression by enlarged lymph nodes. An intrinsic narrowing of the bronchial wall by endobronchial granulomatous lesions may be suggested by CT when it shows evidence of bronchial mural thickening. Pulmonary hypertension usually occurs in patients with end-stage pulmonary disease and is related to fibrotic destruction of the distal capillary bed and to the resultant chronic hypoxemia. Several other mechanisms may contribute to the development of pulmonary hypertension including extrinsic compression of major pulmonary arteries by enlarged lymph nodes and secondary pulmonary veno-occlusive disease. Aspergilloma colonization of a cavity is the main cause of hemoptysis in sarcoidosis. Other rare causes are bronchiesctasis, necrotizing bronchial aspergillosis, semi-invasive pulmonary aspergillosis, erosion of a pulmonary artery due to a necrotic sarcoidosis lesion, necrosis of parenchymal sarcoidosis lesions and specific endobronchial macroscopic lesions. (orig.)

Animal models of sarcoidosis.

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Hu, Yijie; Yibrehu, Betel; Zabini, Diana; Kuebler, Wolfgang M

2017-03-01

Sarcoidosis is a debilitating, inflammatory, multiorgan, granulomatous disease of unknown cause, commonly affecting the lung. In contrast to other chronic lung diseases such as interstitial pulmonary fibrosis or pulmonary arterial hypertension, there is so far no widely accepted or implemented animal model for this disease. This has hampered our insights into the etiology of sarcoidosis, the mechanisms of its pathogenesis, the identification of new biomarkers and diagnostic tools and, last not least, the development and implementation of novel treatment strategies. Over past years, however, a number of new animal models have been described that may provide useful tools to fill these critical knowledge gaps. In this review, we therefore outline the present status quo for animal models of sarcoidosis, comparing their pros and cons with respect to their ability to mimic the etiological, clinical and histological hallmarks of human disease and discuss their applicability for future research. Overall, the recent surge in animal models has markedly expanded our options for translational research; however, given the relative early stage of most animal models for sarcoidosis, appropriate replication of etiological and histological features of clinical disease, reproducibility and usefulness in terms of identification of new therapeutic targets and biomarkers, and testing of new treatments should be prioritized when considering the refinement of existing or the development of new models.

Management of sarcoidosis in clinical practice

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Florence Jeny

2016-06-01

Full Text Available Sarcoidosis is a systemic disease of unknown cause with very diverse presentation, outcome, severity and need for treatments. While some presentations may be very typical, for many patients, the presentation is nonspecific, with shared associations with other diseases at times being by far more frequent or misleading, which can be a cause of significant delay and often several consultations before a diagnosis of sarcoidosis can be confirmed. This is particularly the case when pulmonary manifestations are in the forefront. The diagnosis relies on three well-known criteria. In clinical practice, these criteria are not easily implemented, particularly by physicians without expertise in sarcoidosis, which can lead to a risk of either under- or over-diagnosis. Qualifying the presentation according to sarcoidosis diagnosis is essential. However, it is often not easy to classify the presentation as typical versus compatible or compatible versus inconsistent. Further investigations are needed before any other hypothesis is to be considered. It is important to detect events and to determine whether or not they are indicative of a flare of sarcoidosis. Eventually, treatment needs to be related to the correct indications. The evaluation of the efficacy and safety of treatments is crucial. To address such issues, we present five emblematic cases that illustrate this.

Heredity In Sarcoidosis - A Registry-Based Twin Study

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Sverrild, Asger; Backer, Vibeke; Kyvik, Kirsten Ohm

2008-01-01

BACKGROUND: Sarcoidosis is a multiorgan, granulomatous, inflammatory disease with unknown aetiology. Familial clustering of cases and ethnic variation in the epidemiology suggests a genetic influence on the disease susceptibility. AIM: This paper reports twin concordance and heritability estimates...... of sarcoidosis in order to assess the overall contribution of genetic factors to the disease susceptibility. METHODS: Monozygotic and dizygotic twins enrolled in either the Danish or the Finnish population-based, national Twin Cohorts (61,662 pairs in total) were linked to diagnostic information on sarcoidosis.......012. Compared to the general population we found an 80-fold increased risk of developing sarcoidosis in co-twins of affected monozygotic brothers or sisters. The increased risk in dizygotic twins was on the other hand only 7-fold. Aetiological model fitting gave a heritability of sarcoidosis of 0.66 (95% CI 0...

Sarcoidosis-lymphoma syndrome.

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Brandy-García, Anahy M; Caminal-Montero, Luis; Fernández-García, María Soledad; Saiz Ayala, Angel; Cabezas-Rodríguez, Ivan; Morante-Bolado, Isla

A 65 year-old female with a history of sarcoidosis with pulmonary and joint involvement, who after 5 years of diagnosis begins with central nervous system involvement manifesting as diplopia. She presents normal analysis results. In imaging results, a mass is identified in the right intraconal space; it depends of right optic nerve, and shows multiple lymph node involvement. Biopsy was performed diagnosed with large B-cell lymphoma, an atypical form of tumor associated with sarcoidosis. Copyright © 2015 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Subjective sleep quality in sarcoidosis.

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Bosse-Henck, Andrea; Wirtz, Hubert; Hinz, Andreas

2015-05-01

Poor sleep is common among patients with medical disorders. Sleep disturbances can be a cause of fatigue and poor quality of life for patients suffering from sarcoidosis. Studies on subjective sleep quality or prevalence of insomnia have not been reported so far. The aim of this study was to investigate the subjectively reported sleep quality and its relation to psychological and physical factors in sarcoidosis patients. 1197 patients from Germany diagnosed with sarcoidosis were examined using the Pittsburgh Sleep Quality Index (PSQI), the Medical Research Council (MRC) dyspnea scale, the Hospital Anxiety and Depression Scale (HADS) and the Multidimensional Fatigue Inventory (MFI). 802 patients (67%) had PSQI global scores >5, indicating subjectively poor quality of sleep. The mean PSQI score was 7.79 ± 4.00. Women reported a significantly inferior individual quality of sleep than men. The subjective quality of sleep was lowered significantly with increasing dyspnea for men and women. 294 patients (25%) had PSQI global scores >10 usually found in patients with clinically relevant insomnia. In this group 86% had high values for fatigue, 69% for anxiety, and 59% for depression. The prevalence of known sleep apnea was 8.7% and 15.7% for restless legs. Poor subjective sleep quality in sarcoidosis patients is about twice as common as in the general population and is associated with fatigue, anxiety, depression and dyspnea. Questions about sleep complaints should therefore be included in the management of sarcoidosis. Copyright © 2014 Elsevier B.V. All rights reserved.

Cutaneous sarcoidosis: clinicopathologic study of 76 patients from Lebanon.

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Ishak, Rim; Kurban, Mazen; Kibbi, Abdul-Ghani; Abbas, Ossama

2015-01-01

Sarcoidosis is a multi-system granulomatous disease of unknown etiology. The skin is involved in 25% of cases. Studies on cutaneous sarcoidosis from our region are lacking. This study was conducted to describe clinical and histopathologic findings in all patients diagnosed with cutaneous sarcoidosis at the American University of Beirut Medical Center between 1992 and 2010 and to compare findings with those published in the literature. Clinical charts of patients with cutaneous sarcoidosis were retrospectively reviewed. Extracutaneous lesions were classified by organ involvement. Treatment was documented. Pathology specimens were reviewed. Cutaneous sarcoidosis was diagnosed in 76 Lebanese patients, 79% of whom were women. Mean age at diagnosis was 48 years. A total of 29% of patients had systemic disease that was commonly associated with lupus pernio lesions and subcutaneous sarcoidosis. The most common cutaneous lesions were sarcoidal plaques. The histopathologic features in our series did not differ from those described in the literature, except for the documented presence of a grenz zone. Interestingly, 23% of biopsy specimens contained perineural granulomas, raising the possibility of tuberculoid or borderline tuberculoid leprosy. Foreign bodies were detected in 10% of cases (all had systemic involvement), supporting the opinion that sarcoidosis and granulomatous foreign body reaction are not mutually exclusive. The clinical and histopathologic features of cutaneous sarcoidosis patients in the present series are generally comparable with those published in the literature, with minor differences. Clinically, the most commonly seen lesion was plaque. Microscopically, cutaneous sarcoidosis may exhibit a grenz zone and may show perineural inflammation and foreign bodies. © 2014 The International Society of Dermatology.

The role of pattern recognition receptors in lung sarcoidosis

NARCIS (Netherlands)

Mortaz, Esmaeil; Adcock, Ian M; Abedini, Atefhe; Kiani, Arda; Kazempour-Dizaji, Mehdi; Movassaghi, Masoud; Garssen, Johan

2017-01-01

Sarcoidosis is a granulomatous disorder of unknown etiology. Infection, genetic factors, autoimmunity and an aberrant innate immune system have been explored as potential causes of sarcoidosis. The etiology of sarcoidosis remains unknown, and it is thought that it might be caused by an infectious

Sarcoidosis Presenting Addison's Disease.

Science.gov (United States)

Takahashi, Kentaro; Kagami, Shin-Ichiro; Kawashima, Hirotoshi; Kashiwakuma, Daisuke; Suzuki, Yoshio; Iwamoto, Itsuo

2016-01-01

We herein describe a second Japanese case of sarcoidosis presenting Addison's disease. A 52-year-old man was diagnosed with sarcoidosis based on clinical and laboratory findings, including bilateral hilar lymphadenopathy and elevated levels of serum angiotensin-converting enzyme and lysozyme, as well as the presence of noncaseating epithelioid granulomas. The patient also exhibited general fatigue, pigmentation, weight loss, hypotension and hyponatremia, suggestive of chronic adrenocortical insufficiency. An endocrine examination confirmed primary adrenocortical insufficiency. This case suggests the direct involvement of sarcoid granuloma in the adrenal glands.

Prevalence of sarcoidosis in Switzerland is associated with environmental factors.

Science.gov (United States)

Deubelbeiss, U; Gemperli, A; Schindler, C; Baty, F; Brutsche, M H

2010-05-01

The current study aimed to investigate incidence, prevalence and regional distribution of sarcoidosis in Switzerland with respect to environmental exposures. All sarcoidosis patients hospitalised between 2002 and 2005 were identified from the Swiss hospital statistics from the Swiss Federal Office for Statistics (Neuchâtel, Switzerland). Regional exposure characteristics included the regional distribution of different industrial sectors, agriculture and air quality. Co-inertia analysis, as well as a generalised linear model, was applied. The prevalence of "ever-in-life" diagnosed sarcoidosis, currently active sarcoidosis and sarcoidosis requiring hospitalisation was 121 (95% CI 93-149), 44 (95% CI 34-54) and 16 (95% CI 10-22) per 100,000 inhabitants, respectively. The mean annual incidence of sarcoidosis was 7 (95% CI 5-11) per 100,000 inhabitants. The regional workforce in the metal industry, water supply, air transport factories and the area of potato production, artificial meadows (grassland) and bread grains were positively associated with the frequency of sarcoidosis. The prevalence of sarcoidosis was higher than assumed based on former international estimates. Higher frequency was found in regions with metal industry and intense agriculture, especially production of potatoes, bread grains and artificial meadows.

Variants of clinicoroentgenological manifestations of sarcoidosis of respiratory organs

International Nuclear Information System (INIS)

Borisova, N.K.; Daurov, B.I.

1988-01-01

The paper is concerned with clinicoroentgenological characterization of 275 patients with different stages of intrathoracic sarcoidosis. Different X-ray types of sarcoidosis of the respiratory organs were detected in 67 (24.4%) of them. The number of patients with different types of sarcoidosis increased with progression of disease

Sarcoidosis.

Science.gov (United States)

Martires, Kathryn; Shvartsbeyn, Marianna; Brinster, Nooshin; Ramachandran, Sarika; Franks, Andrew G

2015-12-16

We present a 28-year-old man with a one-year history of cutaneous lesions in old scars and tattoos with concomitant subcutaneous nodules and myopathy. A skin biopsy specimen showed cutaneous sarcoidosis. We discuss the multiple aspects of this case, which represent unique presentations of this systemic disease as well as review isomorphic and isotopic responses.

Hypothalamic digoxin, hemispheric chemical dominance and sarcoidosis.

Science.gov (United States)

Ravi Kumar, A; Kurup, Parameswara Achutha

2004-06-01

The isoprenoid pathway produces three key metabolites: endogenous digoxin (membrane sodium-potassium ATPase inhibitor, immunomodulator and regulator of neurotransmitter/amino acid transport), dolichol (regulates N-glycosylation of proteins) and ubiquinone (free radical scavenger). The role of the isoprenoid pathway in the pathogenesis of sarcoidosis in relation to hemispheric dominance was studied. The isoprenoid pathway-related cascade was assessed in patients with systemic sarcoidosis with pulmonary involvement. The pathway was also assessed in patients with right hemispheric, left hemispheric and bihemispheric dominance for comparison to find out the role of hemispheric dominance in the pathogenesis of sarcoidosis. In patients with sarcoidosis there was elevated digoxin synthesis, increased dolichol and glycoconjugate levels and low ubiquinone and elevated free radical levels. There was also an increase in tryptophan catabolites and a reduction in tyrosine catabolites. There was an increase in the cholesterol:phospholipid ratio and a reduction in the glycoconjugate level of red blood cell (RBC) membrane in this group of patients. The same biochemical patterns were obtained in individuals with right hemispheric dominance. In individuals with left hemispheric dominance the patterns were reversed. Endogenous digoxin, by activating the calcineurin signal transduction pathway of T cells, can contribute to immune activation in sarcoidosis. An altered glycoconjugate metabolism can lead to the generation of endogenous self-glycoprotein antigens in the lung as well as other tissues. Increased free radical generation can also lead to immune activation. The role of a dysfunctional isoprenoid pathway and endogenous digoxin in the pathogenesis of sarcoidosis in relation to right hemispheric chemical dominance is discussed. All the patients with sarcoidosis were right-handed/left hemispheric dominant according to the dichotic listening test, but their biochemical patterns

Side effects of antiviral therapy in hepatitis C virus infection-sarcoidosis - case report.

Science.gov (United States)

Teodor, D; Teodor, Andra; Grigore, Lucia; Jugănariu, Gabriela; Dorobăţ, Carmen Mihaela; Miftode, Egidia; Azoicăi, Doina

2012-01-01

Standard therapy in chronic hepatitis C virus infection is still a combination of peginterferon alfa2a/2b and ribavirin for 48 weeks. As of side effects, there are organic side effects, such as hematologic disorders, and functional side effects, reflected in the quality of life of hepatitis C patients. Up to 30% of the patients develop specific side effects such as headache, fever, fatigue. Sarcoidosis, known as a granulomatous disease of uncertain cause, is an uncommon finding in this category of patients. This cause-effect relation is accounted for by the convergent action of peginterferon and ribavirin of stimulating type 1 T helper cells and reducing type 2 helper T cells activation. We present the case of male patient known with chronic hepatitis C who developed pulmonary sarcoidosis following antiviral therapy. The first manifestation of the disease was unexplained fever accompanied by pulmonary tract disease. The diagnosis was established by immunophenotyping in bronchial aspirate

[Cardiac sarcoidosis: Diagnosis and therapeutic challenges].

Science.gov (United States)

Cohen Aubart, F; Nunes, H; Mathian, A; Haroche, J; Hié, M; Le-Thi Huong Boutin, D; Cluzel, P; Soussan, M; Waintraub, X; Fouret, P; Valeyre, D; Amoura, Z

2017-01-01

Sarcoidosis is a granulomatous disorder of unknown cause characterized by non-caseating granuloma in young adults. Cardiac involvement is rare and range from 2 to 75% depending on diagnostic criteria. Cardiac involvement in sarcoidosis may be asymptomatic or may manifest as rhythm/conduction troubles or congestive heart failure. The diagnosis and treatment of cardiac sarcoidosis may be challenging. However, advances have come in recent years from the use of cardiac MRI and 18 FDG-TEP scanner, as well as from the stratification of the risk of ventricular tachycardia/fibrillation. Due to the rarity of the disease, there is no reliable prospective large study to guide therapeutic strategy for cardiac sarcoidosis. Corticosteroids are probably efficacious, in particular in case of atrio-ventricular block or moderate heart failure. Immunosuppressive drugs have not been largely studied but methotrexate could be helpful. In refractory forms, TNF-α antagonists have been used with success. Copyright © 2016 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Sarcoidosis presenting as penile mass

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Hüseyin Semiz

2017-01-01

Full Text Available Sarcoidosis is an inflammatory disease with unknown cause characterized by noncaseating granuloma formations. It may present with bilateral hilar lymphadenopathy, skin lesions, eye, and musculoskeletal system involvement. Rare involvement of the genital organs (prostate, testis, epididymis has also been reported. However, penile involvement is observed quite rare. In this paper, we report a patient with penile mass who was diagnosed with sarcoidosis on the basis of the laboratory, radiological, and pathological investigations.

Executive Summary of the NHLBI Workshop Report: Leveraging Current Scientific Advancements to Understand Sarcoidosis Variability and Improve Outcomes.

Science.gov (United States)

Maier, Lisa A; Crouser, Elliott D; Martin, William J; Eu, Jerry

2017-12-01

Sarcoidosis is a systemic granulomatous disease that primarily affects the lung; it is associated with significant disparities, more commonly impacting those in the prime of their lives (age 20-50 yr, with a second peak after age 60 yr), black individuals, and women. However, the burden of disease, the ability to diagnose and prognose organ involvement and course, as well as specific treatment options, management options, and disease pathogenesis remain poorly understood. As a result, the National Heart, Lung, and Blood Institute undertook a sarcoidosis workshop, "Leveraging Current Scientific Advancements to Understand Sarcoidosis Variability and Improve Outcomes," to help address these issues by defining the scientific and clinical priorities to improve sarcoidosis care. The overarching recommendations from this workshop are outlined in the following summary and detailed in the accompanying articles. The recommendations included establishing collaborations and networks to conduct research based on consensus definitions of disease phenotypes and standards of care, and to provide clinical outreach to areas with a burden of disease to improve care. These collaborative networks would also serve as the hub to conduct clinical trials of devastating phenotypes (e.g., cardiac, neurologic, and fibrotic disease) not only for treatment but to enhance our understanding of the burden of disease. In addition, the networks would be used to leverage state-of-the-art "omics" and systems biology research, as well as other studies to advance understanding of disease pathogenesis, and development of biomarkers and therapeutic targets, with a goal to translate this information to improve care of individuals with sarcoidosis.

Chronic post-inflammatory fatigue in sarcoidosis : from cytokines to behavior

NARCIS (Netherlands)

Korenromp, I.H.E.

2011-01-01

Sarcoidosis is a systemic inflammatory disorder that is characterized by granuloma formation in different organs. Sarcoidosis patients frequently report fatigue. Even when the clinical symptoms of the inflammatory disease sarcoidosis have resolved, chronic fatigue may persist. In this study 75

Sarcoidosis: radiographic manifestations in the nails and distal phalanges

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Albers, Brittany K.; Garner, Hillary W. [Mayo Clinic, Department of Radiology, Jacksonville, FL (United States); Sluzevich, Jason C. [Mayo Clinic, Department of Dermatology, Jacksonville, FL (United States)

2016-05-15

Sarcoidosis is a granulomatous disease which can affect multiple organ systems. Clinical and radiologic manifestations depend on the organ system involved and the chronicity of disease. Nail involvement in sarcoidosis is rare, but is clinically relevant as it indicates chronic systemic disease. Nail abnormalities can be identified radiographically, and when seen in patients with known or suspected sarcoidosis, should prompt careful evaluation of the underlying bone for osseous involvement. We describe a case of sarcoidosis with radiographic findings in the nails and distal phalangeal tufts, which were indicative of nail and osseous sarcoid involvement and strongly supported the presence of chronic systemic disease. Although the nail findings resolved clinically and on radiographs after treatment, the osseous findings showed only minimal improvement. To our knowledge, the radiographic findings of nail sarcoidosis have not been previously addressed in the literature. (orig.)

Sarcoidosis: radiographic manifestations in the nails and distal phalanges

International Nuclear Information System (INIS)

Albers, Brittany K.; Garner, Hillary W.; Sluzevich, Jason C.

2016-01-01

Sarcoidosis is a granulomatous disease which can affect multiple organ systems. Clinical and radiologic manifestations depend on the organ system involved and the chronicity of disease. Nail involvement in sarcoidosis is rare, but is clinically relevant as it indicates chronic systemic disease. Nail abnormalities can be identified radiographically, and when seen in patients with known or suspected sarcoidosis, should prompt careful evaluation of the underlying bone for osseous involvement. We describe a case of sarcoidosis with radiographic findings in the nails and distal phalangeal tufts, which were indicative of nail and osseous sarcoid involvement and strongly supported the presence of chronic systemic disease. Although the nail findings resolved clinically and on radiographs after treatment, the osseous findings showed only minimal improvement. To our knowledge, the radiographic findings of nail sarcoidosis have not been previously addressed in the literature. (orig.)

Peripheral blood gene expression as a novel genomic biomarker in complicated sarcoidosis.

Directory of Open Access Journals (Sweden)

Tong Zhou

Full Text Available Sarcoidosis, a systemic granulomatous syndrome invariably affecting the lung, typically spontaneously remits but in ~20% of cases progresses with severe lung dysfunction or cardiac and neurologic involvement (complicated sarcoidosis. Unfortunately, current biomarkers fail to distinguish patients with remitting (uncomplicated sarcoidosis from other fibrotic lung disorders, and fail to identify individuals at risk for complicated sarcoidosis. We utilized genome-wide peripheral blood gene expression analysis to identify a 20-gene sarcoidosis biomarker signature distinguishing sarcoidosis (n = 39 from healthy controls (n = 35, 86% classification accuracy and which served as a molecular signature for complicated sarcoidosis (n = 17. As aberrancies in T cell receptor (TCR signaling, JAK-STAT (JS signaling, and cytokine-cytokine receptor (CCR signaling are implicated in sarcoidosis pathogenesis, a 31-gene signature comprised of T cell signaling pathway genes associated with sarcoidosis (TCR/JS/CCR was compared to the unbiased 20-gene biomarker signature but proved inferior in prediction accuracy in distinguishing complicated from uncomplicated sarcoidosis. Additional validation strategies included significant association of single nucleotide polymorphisms (SNPs in signature genes with sarcoidosis susceptibility and severity (unbiased signature genes - CX3CR1, FKBP1A, NOG, RBM12B, SENS3, TSHZ2; T cell/JAK-STAT pathway genes such as AKT3, CBLB, DLG1, IFNG, IL2RA, IL7R, ITK, JUN, MALT1, NFATC2, PLCG1, SPRED1. In summary, this validated peripheral blood molecular gene signature appears to be a valuable biomarker in identifying cases with sarcoidoisis and predicting risk for complicated sarcoidosis.

Role of serum angiotensin converting enzyme in sarcoidosis.

Science.gov (United States)

Khan, A H; Ghani, F; Khan, A; Khan, M A; Khurshid, M

1998-05-01

This study was conducted to determine the role of Serum Angiotensin Converting Enzyme (SACE) as a marker in the differential diagnosis of pulmonary diseases and prognosis of sarcoidosis. A retrospective analysis of 113 medical records of patients at The Aga Khan University Hospital, with laboratory investigation for SACE was performed. Among 113 patients, 51 cases were found to have sarcoidosis, 44 of them had SACE levels greater than 52 IU/L (mean ACE 104.44). SACE levels were also found elevated in other clinical conditions like tuberculosis (mean 58.64 IU/L), but the enzyme level were less (p 0.04) than those found in sarcoidosis (mean (92.97 IU/L). SACE activity was found to be considerably lower in other chronic lung diseases such as, fibrosing alveolitis (mean 43.98 IU/L), interstitial lung disease (mean 42.11 IU/L) and chronic obstructive lung disease (mean 40.85 IU/L). Twenty patients of sarcoidosis, who received steroid treatment subsequently showed a decline in the SACE levels. SACE is a useful marker in differential diagnosis as 37.2% cases of sarcoidosis compared to only 9.09% of tuberculosis had SACE levels greater than 100 IU/L. In addition, our data also suggest that serum ACE is useful for the diagnosis as well as monitoring prognosis in sarcoidosis.

Health-related quality of life in sarcoidosis

NARCIS (Netherlands)

Korenromp, Ingrid H.E.; van de Laar, Mart A F J

2014-01-01

Purpose of review: The review presents an overview of the scientific publications in the field of health-related quality of life (HRQL) in sarcoidosis. Recent findings: Literature on HRQL in sarcoidosis is limited. HRQL was mainly used as a primary or secondary endpoint in intervention studies.

Study of 67Ga scan in sarcoidosis

International Nuclear Information System (INIS)

Han Lijun; Qu Wanyin; Liu Xiuqin

1997-01-01

Gallium scan and serum angiotensin-converting enzyme assay (SACE) were compared in patients with sarcoidosis. The examination of 67 Ga scan, SACE determination, pulmonary function test, chest CT and chest X-ray in 24 cases with sarcoidosis were studied. The results revealed that 4 of 24 cases had obviously high uptake of 67 Ga exceeding hepatic activity (3+) in clinical active stage, 3 patients had resembling the Greek letter lambda, symmetrically located in bilateral hilar lymph nodes, and among them two had an uptake of 67 Ga in the bilateral lacrimal and parotid gland simulating 'Panda Face'. 8 of 20 cases with inactive sarcoidosis had an abnormal 67 Ga scan (1+). In those patients with normal SACE level but increased uptake of 67 Ga, active stage of disease was demonstrated and steroid therapy was indicated. Gallium scan is a valuable method for the staging of its activity and evaluation of the therapeutic effect in the follow-up patients with sarcoidosis

Association of sarcoidosis and myasthenia gravis: Case Report ...

African Journals Online (AJOL)

Whereas the coexistence of different autoimmune or rheumatologic diseases with myasthenia gravis (MG) is well documented, its combination with sarcoidosis is extremely rare. Presented here is an interesting case with coexisting MG and sarcoidosis.

Is sarcoidosis a rickettsiosis? An archival study

DEFF Research Database (Denmark)

Svendsen, Claus Bo; Milman, Nils; Andersen, Claus B

2011-01-01

Based on earlier research, Rickettsia helvetica could possibly be involved in the pathogenesis of sarcoidosis. Rickettsiae are transmitted to humans by a tick vector, Ixodes ricinus; this tick is highly prevalent in Northern Europe. We aimed to investigate the association between evidence...... of rickettsiae and sarcoidosis in histological samples....

Classification of esophageal motor findings in gastro-esophageal reflux disease: Conclusions from an international consensus group.

Science.gov (United States)

Gyawali, C P; Roman, S; Bredenoord, A J; Fox, M; Keller, J; Pandolfino, J E; Sifrim, D; Tatum, R; Yadlapati, R; Savarino, E

2017-12-01

High-resolution manometry (HRM) has resulted in new revelations regarding the pathophysiology of gastro-esophageal reflux disease (GERD). The impact of new HRM motor paradigms on reflux burden needs further definition, leading to a modern approach to motor testing in GERD. Focused literature searches were conducted, evaluating pathophysiology of GERD with emphasis on HRM. The results were discussed with an international group of experts to develop a consensus on the role of HRM in GERD. A proposed classification system for esophageal motor abnormalities associated with GERD was generated. Physiologic gastro-esophageal reflux is inherent in all humans, resulting from transient lower esophageal sphincter (LES) relaxations that allow venting of gastric air in the form of a belch. In pathological gastro-esophageal reflux, transient LES relaxations are accompanied by reflux of gastric contents. Structural disruption of the esophagogastric junction (EGJ) barrier, and incomplete clearance of the refluxate can contribute to abnormally high esophageal reflux burden that defines GERD. Esophageal HRM localizes the LES for pH and pH-impedance probe placement, and assesses esophageal body peristaltic performance prior to invasive antireflux therapies and antireflux surgery. Furthermore, HRM can assess EGJ and esophageal body mechanisms contributing to reflux, and exclude conditions that mimic GERD. Structural and motor EGJ and esophageal processes contribute to the pathophysiology of GERD. A classification scheme is proposed incorporating EGJ and esophageal motor findings, and contraction reserve on provocative tests during HRM. © 2017 John Wiley & Sons Ltd.

ARA290 : a novel treatment for neuropathic pain in sarcoidosis

NARCIS (Netherlands)

Heij, L.

2016-01-01

The general aim of this thesis is to investigate small fiber neuropathy in sarcoidosis and to asses whether ARA290 is a possible new agent to treat the neuropathic complaints in sarcoidosis population. The results of the various ARA290 trials in painful sarcoidosis are discussed. Painful neuropathy

Delayed diagnosis of sarcoidosis is common in Brazil

Directory of Open Access Journals (Sweden)

Mauri Monteiro Rodrigues

2013-09-01

Full Text Available OBJECTIVE: To determine the frequency of and the factors related to delayed diagnosis of sarcoidosis in Brazil. METHODS: We evaluated patients with a biopsy-proven diagnosis of sarcoidosis, using a questionnaire that addressed the following: time since symptom onset and since the first medical visit; and the number and specialty of the physicians visited. We divided the patients by the timeliness of the diagnosis-timely (< 6 months and delayed (≥ 6 months-comparing the two groups in terms of systemic and pulmonary symptoms; extrathoracic involvement; spirometric data; radiological staging; level of education; income; and tuberculosis (diagnosis and treatment. RESULTS: We evaluated 100 patients. The median number of physicians consulted was 3 (range, 1-14. In 11 cases, sarcoidosis was diagnosed at the first visit. In 54, the first physician seen was a general practitioner. The diagnosis of sarcoidosis was timely in 41 patients and delayed in 59. The groups did not differ in terms of gender; race; type of health insurance; level of education; income; respiratory/systemic symptoms; extrathoracic involvement; and radiological staging. In the delayed diagnosis group, FVC was lower (80.3 ± 20.4% vs. 90.5 ± 17.1%; p = 0.010, as was FEV1 (77.3 ± 19.9% vs. 86.4 ± 19.5%; p = 0.024, misdiagnosis with and treatment for tuberculosis (≥ 3 months also being more common (24% vs. 7%, p = 0.032, and 20% vs. 0%; p = 0.002, respectively. CONCLUSIONS: The diagnosis of sarcoidosis is often delayed, even when the imaging is suggestive of sarcoidosis. Delayed diagnosis is associated with impaired lung function at the time of diagnosis. Many sarcoidosis patients are misdiagnosed with and treated for tuberculosis.

Thoracic manifestation of sarcoidosis: CT findings

International Nuclear Information System (INIS)

Kim, Sung Jin; Han, Joon Koo; Im, Jung Gi; Han, Man Chung

1989-01-01

We analysed post enhanced chest CT scans of 5 pathologically proved sarcoidosis patients attempting to differentiate sarcoidosis from other diseases showing multiple lymph node enlargements. The distribution of intrathoracic lymphadenopathy was diffuse and bilateral in all cases. However the largest nodes were located at subcarnial, hilar and right paratracheal group (2R, 4R, 10R). Hilar node involvements were typically bilateral and symmetric. Anterior mediastinal and subcarinal regions, which were previously believed in unusual location, showed enlarged nodes in all cases. The appearances of the nodes were well-defined, homogenous soft tissue mass and the nodes did not show matted appearance. The pulmonary infiltration was bilateral and diffuse reticulonodular pattern. Our observations suggest that in cases of homogenous, discrete lymph node enlargements, particularly when subcarinal, bilateral hilar and right paratracheal node groups are involved, sarcoidosis should be included in the differential diagnosis

Polymorphism of angiotensin-converting enzyme gene in sarcoidosis.

Science.gov (United States)

Arbustini, E; Grasso, M; Leo, G; Tinelli, C; Fasani, R; Diegoli, M; Banchieri, N; Cipriani, A; Gorrini, M; Semenzato, G; Luisetti, M

1996-02-01

Sarcoidosis is the disease in which increased levels of serum Angiotensin-converting enzyme (sACE) are most often detected. It has recently been shown that the deletion (D) or the insertion (I) of a 250bp-DNA fragment in the ACE gene accounts for three main ACE genotypes (i.e., II, ID, and DD) and for 47% of total phenotypic variance in sACE level. The aim of our work was to investigate whether or not patients with sarcoidosis have an increased incidence of those ACE genotypes coding for highest sACE levels and to investigate whether or not sACE level in sarcoidosis is related to ACE genotypes. We studied 61 unrelated patients with sarcoidosis (test group) and 80 unrelated healthy control subjects (control group). The ACE I and D alleles were detected with polymerase chain reaction on genomic DNA. In the control group we found an ACE genotype distribution that agreed with the Hardy-Weinberg proportion. The ACE genotype distribution was not significantly different in the test group. There was no correlation between ACE genotype and roentgenologic stage of sarcoidosis. Plotting the sACE level in the control group against ACE genotype, we found a trend of increasing mean sACE value according to the order II sACE values plotted against roentgenologic stage, according to the order Stage I sACE values in sarcoidosis according to both ACE genotype and roentgenologic stage would suggest that both mechanisms play a role in determining sACE level.

Unilateral Eyelid Edema as Initial Sign of Orbital Sarcoidosis

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Sílvia Miguéis Picado Petrarolha

2016-01-01

Full Text Available Introduction. Sarcoidosis is a rare multisystemic granulomatous inflammatory disease of unknown etiology affecting the respiratory system, skin, and eyes. Sarcoidosis outside the lacrimal gland is rare. The case study concerns a patient with a final diagnosis of orbital sarcoidosis. Case Report. A 37-year-old male patient went to the ophthalmic emergency room complaining of pain in the left eye, diplopia, and decreased visual acuity. An external eye examination showed hard and cold edema of the lower eyelid, ocular motility with limitation of adduction, and discreet ipsilateral proptosis. Magnetic resonance of the orbit showed left eye proptosis and thickening and increase of soft tissues associated with heterogeneous impregnation of contrast in the infralateral region of the left eyelid. A biopsy of the lesion showed a chronic inflammatory process, with numerous compact nonnecrotizing granulomas surrounded by lamellar hyaline collagen, providing histological confirmation of sarcoidosis. Discussion. A biopsy of the orbital tumor is essential for the diagnosis of sarcoidosis, in addition to the search for systemic findings such as hilar adenopathy or parenchymal lung disease found in 90% of patients.

Recognition of distinctive patterns of gallium-67 distribution in sarcoidosis

International Nuclear Information System (INIS)

Sulavik, S.B.; Spencer, R.P.; Weed, D.A.; Shapiro, H.R.; Shiue, S.T.; Castriotta, R.J.

1990-01-01

Assessment of gallium-67 ( 67 Ga) uptake in the salivary and lacrimal glands and intrathoracic lymph nodes was made in 605 consecutive patients including 65 with sarcoidosis. A distinctive intrathoracic lymph node 67 Ga uptake pattern, resembling the Greek letter lambda, was observed only in sarcoidosis (72%). Symmetrical lacrimal gland and parotid gland 67 Ga uptake (panda appearance) was noted in 79% of sarcoidosis patients. A simultaneous lambda and panda pattern (62%) or a panda appearance with radiographic bilateral, symmetrical, hilar lymphadenopathy (6%) was present only in sarcoidosis patients. The presence of either of these patterns was particularly prevalent in roentgen Stages I (80%) or II (74%). We conclude that simultaneous (a) lambda and panda images, or (b) a panda image with bilateral symmetrical hilar lymphadenopathy on chest X-ray represent distinctive patterns which are highly specific for sarcoidosis, and may obviate the need for invasive diagnostic procedures

Sarcoidosis presenting with severe hypocalcaemia.

LENUS (Irish Health Repository)

Saeed, A

2012-01-31

Disorders of calcium metabolism, especially hypercalcemia and hypercalceuria, are common in sarcoidosis. They are caused by extra renal unsuppressed production of 1,25 dihydroxy vitamin D at the level of the sarcoid granuloma. Hormonal changes during pregnancy have a physiological synergistic effect on this mechanism, which is primarily parathyroid hormone (PTH) dependant. However, the combination of primary hypoparathyroidism with hypocalcemia and sarcoidosis is rare. Di George syndrome, is a dysmorphic disorder characterised by aplasia\\/hypoplasia of thymus and parathyroid glands in addition to aortic arch anamolies and facial dysmorphia. After commencing appropriate treatment this lady made excellent recovary.

[Morpheiform sarcoidosis as atypical manifestation of sarcoidosis. Review of the literature and differential diagnosis].

Science.gov (United States)

Castellanos-González, María; Picazo Talavera, María Remedios

2016-09-16

Sarcoidosis is an idiopathic multisystem granulomatous disease that commonly involves the skin in 25% of affected patients. Because lesions assume a vast array of morphologies, a classification dividing them into specific (with presence of typical granulomas in the biopsy) or nonspecific (not containing granulomas) has been proposed. In the first group the variant morpheaform is considered exceptional. We review the cases reported in the literature and describe the possible differential diagnosis. We highlight the importance of recognizing the very atypical presentation of sarcoidosis and its ability to mimic morpheaform or sclerosis diseases in our patients. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Muscular sarcoidosis involving the chest and abdominal walls: case report with MR imaging

Energy Technology Data Exchange (ETDEWEB)

Lee, Seunghyun; Lee, In Sook; Song, You Seon [Pusan National University Hospital, Biomedical Research Institute, Department of Radiology, Busan (Korea, Republic of); Pusan National University School of Medicine, Busan (Korea, Republic of); Mok, Jeongha [Pusan National University Hospital, Biomedical Research Institute, Department of Internal Medicine, Busan (Korea, Republic of); Choi, Kyung-Un [Pusan National University Hospital, Biomedical Research Institute, Department of Pathology, Busan (Korea, Republic of)

2018-03-15

Sarcoidosis is an inflammatory disorder that is characterized by the presence of noncaseating granulomas in tissues, involving many organs and tissues. Extra-pulmonary, especially muscular sarcoidosis is a rare condition. The most common location of the muscular sarcoidosis is known to be the proximal muscles of the extremities; however, there have been no cases of diffuse involvement of the chest and abdominal wall muscles. Here, we report a rare muscular sarcoidosis with infiltrative pattern in the chest and abdominal wall muscles and describe the MR imaging findings that were mistaken as lymphoma at initial diagnosis. Although our case did not show characteristic MR findings of muscular sarcoidosis, clinicians or radiologists who are aware of these imaging features can perform early systemic survey for sarcoidosis. Also muscle biopsy is very important to confirm the sarcoidosis and distinguish it from other tumors. (orig.)

Muscular sarcoidosis involving the chest and abdominal walls: case report with MR imaging

International Nuclear Information System (INIS)

Lee, Seunghyun; Lee, In Sook; Song, You Seon; Mok, Jeongha; Choi, Kyung-Un

2018-01-01

Sarcoidosis is an inflammatory disorder that is characterized by the presence of noncaseating granulomas in tissues, involving many organs and tissues. Extra-pulmonary, especially muscular sarcoidosis is a rare condition. The most common location of the muscular sarcoidosis is known to be the proximal muscles of the extremities; however, there have been no cases of diffuse involvement of the chest and abdominal wall muscles. Here, we report a rare muscular sarcoidosis with infiltrative pattern in the chest and abdominal wall muscles and describe the MR imaging findings that were mistaken as lymphoma at initial diagnosis. Although our case did not show characteristic MR findings of muscular sarcoidosis, clinicians or radiologists who are aware of these imaging features can perform early systemic survey for sarcoidosis. Also muscle biopsy is very important to confirm the sarcoidosis and distinguish it from other tumors. (orig.)

Economic burden of sarcoidosis in a commercially-insured population in the United States.

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Rice, J Bradford; White, Alan; Lopez, Andrea; Conway, Alexandra; Wagh, Aneesha; Nelson, Winnie W; Philbin, Michael; Wan, George J

2017-10-01

Sarcoidosis is a multi-system inflammatory disorder characterized by the presence of non-caseating granulomas in involved organs. Patients with sarcoidosis have a reduced quality-of-life and are at an increased risk for several comorbidities. Little is known about the direct and indirect cost of sarcoidosis following the initial diagnosis. To provide an estimate of the healthcare resource utilization (HCRU) and costs borne by commercial payers for sarcoidosis patients in the US. Patients with a first diagnosis of sarcoidosis between January 1, 1998 and March 31, 2015 ("index date") were selected from a de-identified privately-insured administrative claims database. Sarcoidosis patients were required to have continuous health plan enrollment 12 months prior to and following their index dates. Propensity-score (1:1) matching of sarcoidosis patients with non-sarcoidosis controls was carried out based on a logistic regression of baseline characteristics. Burden of HCRU and work loss (disability days and medically-related absenteeism) were compared between the matched groups over the 12-month period following the index date ("outcome period"). A total of 7,119 sarcoidosis patients who met the selection criteria were matched with a control. Overall, commercial payers incurred $19,714 in mean total annual healthcare costs per sarcoidosis patient. The principle cost drivers were outpatient visits ($9,050 2015 USD, 46%) and inpatient admissions ($6,398, 32%). Relative to controls, sarcoidosis patients had $5,190 (36%) higher total healthcare costs ($19,714 vs $14,524; p economic burden to payers in the first year following diagnosis.

Takayasu Arteritis Associated with Sarcoidosis: A Case Report

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Im, Mi Hye; Woo, Jeong Joo; An, Jin Kyung; Choi, Yun Sun [Dept. of Radiology, Eulji Hospital, Eulji University School of Medicine, Seoul (Korea, Republic of); Lee, Byung Hoon [Dept. of Internal Medicine, Eulji Hospital, Eulji University School of Medicine, Seoul (Korea, Republic of)

2011-11-15

Takayasu arteritis associated with sarcoidosis is very rare with only a few cases reported. We report on a case of a 55-year-old woman who was incidentally diagnosed with sarcoidosis and demonstrated numbness and weakness of the left upper limb and lower extremities associated with Takayasu arteritis.

Laryngeal sarcoidosis: a case report presenting transglottic involvement.

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van den Broek, Emke M J M; Heijnen, Bas J; Verbist, Berit M; Sjögren, Elisabeth V

2013-09-01

Isolated laryngeal sarcoidosis is a very rare disease. In most cases, it will present as a supraglottic pale edematous swelling. In our case, the patient presented with hoarseness and dyspnea during exertion. Laryngeal examination did show not only supraglottic edema but also prominent subglottic swelling and edematous true vocal folds. Histology showed noncaseating granulomas. After excluding other causes and localizations, the patient was diagnosed with laryngeal sarcoidosis and treated with systemic corticosteroid with good result. We describe our case of isolated transglottic sarcoidosis and discuss the disease, its presentation, diagnosis, and therapeutic options. Copyright © 2013 The Voice Foundation. Published by Mosby, Inc. All rights reserved.

Esophageal Intramural Pseudodiverticulosis: A Rare Endoscopic Finding

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Luciana Lopes de Oliveira

2013-01-01

Full Text Available A 76-year-old woman, presenting with a 4-year history of progressive dysphagia, was submitted to endoscopic examination. The upper endoscopy revealed a proximal esophageal stricture and inflammatory mucosa associated with multiples small orifices in the esophageal wall, some of them fulfilled with white spots suggestive of fungal infection. This was a typical endoscopic finding of esophageal intramural pseudodiverticulosis, a benign and rare condition, related to chronic esophagitis and others comorbid states, such as gastroesophageal reflux disease or infectious esophagitis, diabetes mellitus, alcohol consumption, and achalasia. Dysphagia is the predominant symptom and can be accompanied by esophageal stricture in 80% to 90% of patients. The pathogenesis is unknown, and as the pseudodiverticulosis is an intramural finding, endoscopy biopsies are inconclusive. The main histological finding is dilation of the submucosal glands excretory ducts, probably obstructed by inflammatory cells. The treatment consists in management of the underlying diseases and symptoms relief. In this particular case, the patient was submitted to antifungal drugs followed by endoscopic dilation with thermoplastic bougies, with satisfactory improvement of dysphagia.

High resolution CT in pulmonary sarcoidosis

International Nuclear Information System (INIS)

Spina, Juan C.; Curros, Marisela L.; Gomez, M.; Gonzalez, A.; Chacon, Carolina; Guerendiain, G.

2000-01-01

Objectives: To establish the particular advantages of High Resolution CT (HRCT) for the diagnosis of pulmonary sarcoidosis. Material and Methods: A series of fourteen patients, (4 men and 10 women; mean age 44,5 years) with thoracic sarcoidosis. All patients were studied using HRCT and diagnosis was confirmed for each case. Confidence intervals were obtained for different disease manifestations. Results: The most common findings were: lymph node enlargement (n=14 patients), pulmonary nodules (n=13), thickening of septa (n=6), peribronquial vascular thickening (n=5) pulmonary pseudo mass (n=5) and signs of fibrosis (n=4). The stage most commonly observed was stage II. It is worth noting that no cases of pleural effusion or cavitations of pulmonary lesions were observed. Conclusions: In this series, confidence interval overlapping for lymph node enlargement, single pulmonary nodules and septum thickening, allows to infer that their presence in a young adult, with few clinical symptoms, forces to rule out first the possibility of sarcoidosis. (author)

Diffuse bronchiectasis as the primary manifestation of endobronchial sarcoidosis

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Paul D. Hiles

2017-01-01

Full Text Available Sarcoidosis is an idiopathic disease that most commonly involves the lungs and is characterized by granulomatous inflammation. Bronchiectasis is one pulmonary manifestation of sarcoidosis, although it is almost always observed as traction bronchiectasis in the setting of fibrotic lung disease. A 50-year-old woman was evaluated for chronic cough and bronchiectasis with a small amount of peripheral upper lobe honeycombing and no significant pulmonary fibrosis or lymphadenopathy. After an extensive laboratory and imaging evaluation did not identify a cause of her bronchiectasis, bronchoscopy was performed to assess for primary ciliary dyskinesia and revealed a diffuse cobblestone appearance of the airway mucosa. Endobronchial biopsies and lymphocyte subset analysis of bronchoalveolar lavage fluid were consistent with a diagnosis of sarcoidosis. We believe endobronchial sarcoidosis should be included in the differential diagnosis of patients presenting with bronchiectasis.

Utility of angiotensin-converting enzyme activity in aqueous humor in the diagnosis of ocular sarcoidosis.

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Mihailovic-Vucinic, Violeta; Popevic, Ljubica; Popevic, Spasoje; Stjepanovic, Mihailo; Aleksic, Andjelka; Stanojevic-Paovic, Anka

2017-10-01

Many studies include elevated activity of angiotensin-converting enzyme (ACE) in serum in sarcoidosis and in ocular sarcoidosis as well, but there are only a few analyzing ACE activities in aqueous humor. The aim of this study is to illuminate the diagnostic value of ACE in aqueous humor in patients with ocular sarcoidosis. We analyzed twenty patients with ocular sarcoidosis and 18 patients with nonocular involvement. All patients have biopsy-positive sarcoidosis of the lungs and/or mediastinal lymph nodes. Blood samples for ACE serum levels were obtained from all patients. Aqueous humor samples were taken by paracentesis with a 25-gauge needle in local anesthesia. With appropriate statistical tests, we compared ACE activity in serum and aqueous humor in patients with and without ocular sarcoidosis. The majority of our patients with ocular sarcoidosis were female (12/20), also in the group with systemic sarcoidosis and without ocular involvement (12/6). Mean age of the whole analyzed group of sarcoidosis patients was 45 ± 6 years. There is no statistically significant difference in ACE activity in serum between two groups of patients (with and without ocular sarcoidosis). There is statistically significant difference in ACE activity in aqueous humor among patients with ocular and nonocular sarcoidosis. ACE activity in aqueous humor is significantly higher in patients with ocular sarcoidosis. Increased ACE activity in aqueous humor can point to a diagnosis of ocular sarcoidosis, without the need for ocular biopsy.

Treatment of neuro-ophthalmic sarcoidosis.

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Frohman, Larry P

2015-03-01

Because of the rarity of neuro-ophthalmic sarcoidosis, there are no therapeutic guidelines based on evidence-based medicine for this disorder. Review of literature combined with personal experience. Corticosteroids are the preferred initial therapy for neuro-ophthalmic sarcoidosis. If patients cannot tolerate the requisite dose of corticosteroid needed to control their disease, or if corticosteroids fail to adequately control the disease process, the choices of a second agent are based on the consideration of rapidity of clinical response and the safety profile. Although methotrexate and mycophenolate mofetil are the medications that are often selected after corticosteroid failure, more rapidly acting agents that have been used are infliximab and intravenous cyclophosphamide.

Resistant thyrotoxicosis: A case of sarcoidosis of thyroid

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Uday Yanamandra

2013-01-01

Full Text Available Autoimmune endocrinopathies and, less commonly, thyroid autoimmune disease have been reported in patients with sarcoidosis. Similarities exist in the pathogenesis of these two conditions. Concomitant sarcoidosis in the thyroid gland in patients with Graves′ disease may contribute to the resistance to antithyroid drugs and radioiodine therapy. We present the clinical, laboratory, imaging, and pathologic findings of a patient with Graves′ disease who was unresponsive to medical management. This 37-year-old man presented with thyrotoxicosis. Thyroid hormone assays and 99m Technitium findings were consistent with Graves′ disease. He was also found to have hilar lymphadenopathy. Patient failed to achieve remission with high doses of antithyroid drugs and 2 sessions of radioiodine ablative therapy.Histopathology of lymph nodesdisclosed noncaseating granulomas, consistent with sarcoidosis. Patient′s thyrotoxicosis subsided only following steroid administration. The histopathology of the thyroid gland on aspiration and the subsidence of symptoms with steroids reiterate the possibility of thyroid sarcoidosis. This diagnosis needs biopsy for confirmation, which our patient didn′t consent for.

Gallium-67 activity in bronchoalveolar lavage fluid in sarcoidosis

International Nuclear Information System (INIS)

Trauth, H.A.; Heimes, K.; Schubotz, R.; von Wichert, P.

1986-01-01

Roentgenograms and gallium-67 scans and gallium-67 counts of BAL fluid samples, together with differential cell counts, have proved to be useful in assessing activity and lung involvement in sarcoidosis. In active pulmonary sarcoidosis gallium-67 scans are usually positive. Quantitation of gallium-67 uptake in lung scans, however, may be difficult. Because gallium-67 uptake and cell counts in BAL fluid may be correlated, we set out to investigate gallium-67 activity in BAL fluid recovered from patient of different groups. Sixteen patients with recently diagnosed and untreated sarcoidosis, nine patients with healthy lungs, and five patients with CFA were studied. Gallium-67 uptake of the lung, gallium-67 activity in the lavage fluid, SACE and LACE levels, and alpha 1-AT activity were measured. Significantly more gallium-67 activity was found in BAL fluid from sarcoidosis patients than in that from CFA patients (alpha = .001) or patients with healthy lungs (alpha = .001). Gallium-67 activity in BAL fluid could be well correlated with the number of lymphocytes in BAL fluid, but poorly with the number of macrophages. Subjects with increased levels of SACE or serum alpha 1-AT showed higher lavage gallium-67 activity than did normals, but no correlation could be established. High gallium-67 activity in lavage fluid may be correlated with acute sarcoidosis or physiological deterioration; low activity denotes change for the better. The results show that gallium-67 counts in BAL fluid reflects the intensity of gallium-67 uptake and thus of activity of pulmonary sarcoidosis

A Rare Comorbidity: Dermatitis Herpetiformis and Sarcoidosis - A Case Report

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Ivanov Pavlov Stoyan

2016-09-01

Full Text Available Sarcoidosis is an enigmatic, multisystem granulomatous disease of unknown etiology and wide range of clinical presentations. Case report: A 54-year-old female presented with facial rash: polymorphic, round, infiltrated erythematous plaques, 1 - 3 cm in size, disseminated on several areas of the face. The medical history was consistent with dermatitis herpetiformis and persistent intrahepatic cholestasis. The laboratory test results suggested celiac disease (strong positivity of IgA anti-tissue transglutaminase antibodies but upper endoscopy was not performed to confirm it. The skin biopsy revealed noncaseating epithelioid-cell granulomas, and negative direct immunofluorescence showed IgA deposits in the dermis. Sarcoidosis with cutaneous and hepatic involvement was established based on compatible clinical findings and supportive histology. The period between manifestations of Duhring disease and skin manifestations of sarcoidosis was 20 years. Conclusion: Our clinical case supports the hypothesis for common immune pathogenic factors in gluten-sensitive diseases and sarcoidosis. The simultaneous occurrence of celiac disease and sarcoidosis is rare, but should not be under recognized.

Socio-demographic profile of patients with sarcoidosis vis-à-vis tuberculosis.

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Gupta, D; Vinay, N; Agarwal, R; Agarwal, A N

2013-11-25

Sarcoidosis and tuberculosis closely resemble each other and Mycobacterium tuberculosis has been implicated as a causative agent for sarcoidosis. Herein we explore the socio-demographic features of patients with sarcoidosis vis-a-vis tuberculosis. In a prospective case-control design, we studied hundred patients each of newly diagnosed sarcoidosis, bacteriologically confirmed pulmonary tuberculosis and healthy controls. Socio-demographic profile was recorded on a standardized questionnaire. Information about tobacco smoking, exposure to environmental tobacco smoke (ETS) and cooking fuels was also collected. Various parameters were compared among the three groups. Compared to tuberculosis, patients with sarcoidosis were elder, had better body mass index (BMI), higher urban residence (OR 2.19, 95% CI: 1.02-4.69), were better educated (ORs 8.50 to 74.25 for different categories), had higher per capita income (OR 13.33; 95% CI: 6.79-26.19) and belonged to better overall socio-economic status (SES) (ORs 8.57-195.0 for different categories). All these differences were also significant when sarcoidosis patients were compared to healthy controls albeit to a lesser degree. Tobacco smoking, ETS exposure and use of fossil/biomass fuels for cooking were more commonly seen in TB patients. In the multivariate analysis, as compared to TB or controls, sarcoidosis patients had higher odds for a better SES after adjusting for age, gender, BMI, religion, smoking, ETS exposure and cooking fuel. Patients with sarcoidosis are likely to be better educated and more affluent compared to those with tuberculosis and healthy controls and this can be useful in clinical differential diagnosis of the two conditions in populations with high prevalence of TB.

Sarcoidosis: Oral and extra-oral manifestation

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Sanjay Gupta

2015-01-01

Full Text Available Sarcoidosis is a multisystem granulomatous disease, which is usually associated with the formation of noncaseating granulomas in affected tissues and organs. It is mostly present with bilateral hilar lymphadenopathy, pulmonary infiltration, ocular, and cutaneous lesions. Oral manifestations of this disease are relatively rare. The present case report shows a 40-year-old male with lesions in the soft tissue of oral cavity (buccal mucosa, gingiva, and palate and a diagnosis of sarcoidosis was established following hematological, biochemical and pulmonary function tests, chest radiograph, and histopathological investigation.

Serum angiotensin--converting enzyme (SACE) in sarcoidosis and other granulomatous disorders.

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Studdy, P; Bird; James, D G; Sherlock, S

Serum angiotensin-converting enzyme (SACE) activity was significantly higher in 90 patients with sarcoidosis (55 +/- [S.D.] 23 nmol min-1 ml-1) than in 80 healthy controls (34 +/- 9 nmol min-1 ml-1). Steroid therapy modified SACE activity; 60 sarcoidosis patients who were not being treated with steroids had significantly higher enzyme activities (58 +/- 24 nmol min-1 ml-1) than 30 steroid-treated sarcoidosis patients (40 +/- 19 nmol min-1 ml-1). In 50% of the non-steroid treated sarcoidosis patients SACE activity was more than than 2 S.D. above the mean value for the controls. SACE activity was measured in 22 tuberculous patients (38 +/- 14 nmol min-1 ml-1), 20 leprosy patients (34 +/- 9 nmol min-1 ml-1), 31 with primary biliary cirrhosis (44 +/- 20 nmol min-1 ml-1), 26 with inflammatory bowel disease (31 +/- 9 nmol min-1 ml-1), eight with hepatic granulomatous disease, five with Hodgkin's disease, and two with schistosomiasis. The combined false-positive rate for these non-sarcoidosis patients was 10%. Serial SACE assays provide useful information on the course of sarcoidosis and response to steroid treatment.

Serum angiotensin-converting enzyme (SACE) in sarcoidosis and other granulomatous disorders.

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Studdy, P; Bird, R; James, D G

Serum angiotensin-converting enzyme (SACE) activity was significantly higher in 90 patients with sarcoidosis (55 +/- [S.D.] 23 nmol min-1 ml-1) than in 80 healthy controls (34 +/- 9 nmol min-1 ml-1). Steroid therapy modified SACE activity; 60 sarcoidosis patients who were not being treated with steroids had significantly higher enzyme activities (58 +/- 24 nmol min-1 ml-1) than 30 steroid-treated sarcoidosis patients (40 +/- 19 nmol min-1 ml-1). In 50% of the non-steroid treated sarcoidosis patients SACE activity was more than 2 S.D. above the mean value for the controls. SACE activity was measured in 22 tuberculous patients (38 +/- 14 nmol min-1 ml-1), 20 leprosy patients (34 +/- 9 nmol min-1 ml-1), 31 with primary biliary cirrhosis (44 +/- 20 nmol min-1 ml-1), 26 with inflammatory bowel disease (31 +/- 9 nmol min-1 ml-1), 8 with hepatic granulomatous disease, 5 with Hodgkin's disease, and 2 with schistosomiasis. The combined false-positive rate for these non-sarcoidosis patients was 10%. Serial SACE assays provide useful information on the course of sarcoidosis and response to steroid treatment.

Systemic sarcoidosis complicated of acute renal failure: about 12 ...

African Journals Online (AJOL)

The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, ...

Type D or 'distressed' personality in sarcoidosis and idiopathic pulmonary fibrosis.

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Elfferich, M D P; De Vries, J; Drent, M

2011-07-01

Personality factors have shown to be related to mortality, morbidity, and psychological aspects in chronic disorders. Little is known about the effect of personality on disease severity in sarcoidosis and idiopathic pulmonary fibrosis (IPF). The aim of this study was to assess the prevalence of Type D personality and its relation with relevant clinical characteristics in sarcoidosis and IPF patients. The study included 441 sarcoidosis and 49 IPF patients from the outpatient clinic of the ild care team of the MUMC, the Netherlands. They completed the DS14 (Type D questionnaire), the fatigue assessment scale (FAS), the WHO quality of life-BREF (WHOQOL-BREF) and the Centre for Epidemiological Studies-Depression Scale (CES-D). Moreover, relevant clinical data were collected. The control group consisted of 3678 subjects from a general population. Type D personality was found in 25.6% of the sarcoidosis patients compared to 21% in the controls, but only in 18.8% of the IPF patients. No relation with disease severity was found in either of these disorders. Fatigue was a substantial problem in both populations. Depressive symptoms but not Type D personality predicted fatigue and poorer QOL in sarcoidosis and IPF. Prevalence of Type D personality is not higher in sarcoidosis and IPF patients than in the general population and does not explain QOL impairment. Depressive symptoms explain QOL impairment and fatigue substantially. Therefore, in the multidisciplinary management of sarcoidosis and IPF psychological screening and psychological counselling concerning adequate coping strategies should be incorporated.

Ocular sarcoidosis masked by positive IgM for toxoplasmosis

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Murilo Bertazzo Peres

Full Text Available ABSTRACT We report a case of ocular sarcoidosis with positive immunoglobulin (Ig M and IgG serology for toxoplasmosis. The patient was a young female with red painful eyes, bilateral eyelid edema, and panuveitis with periphlebitis. In laboratory testing, she was IgM and IgG positive for toxoplasmosis and anergic in the tuberculin test. Topical treatment for anterior uveitis and oral antibiotics for toxoplasmosis were started, without improvement. Orbit tomography showed increased lacrimal glands bilaterally, and chest X-ray radiographic findings were consistent with pulmonary sarcoidosis, which supported the presumed ocular sarcoidosis diagnosis. The patient was treated with oral prednisone and methotrexate without antibiotics. She showed clinical and vision improvement without recurrences during the 1-year follow-up. Ocular sarcoidosis is an important differential diagnosis requiring careful anamnesis and ophthalmological examinations. Ancillary tests, such as X-ray radiography, tomography, and clinical and laboratory evaluations may help rule out other causes. Treatment mainly consists of corticosteroids and immunosuppression.

Characteristics of patients presenting with erythema nodosum and sarcoidosis.

LENUS (Irish Health Repository)

O'Connor, T M

2012-01-31

We explored the relationship between erythema nodosum (EN) and sex, age, serum angiotensin converting enzyme (ACE), bronchoalveolar lavage lymphocytosis (BAL-I), interstitial granulomas and radiological stage in patients presenting with pulmonary sarcoidosis in Ireland. Sixty-nine patients diagnosed with sarcoidosis between 2003 and 2006 were studied. Forty one patients (59%) were male. Sixteen patients (23%) presented with EN. Forty one patients of 65 (63%) had transbronchial biopsies demonstrating non-caseating granulomas. Patients with sarcoidosis presenting with EN were more likely to be female (p=0.042), younger (p=0.012) and have earlier stage pulmonary disease (p=0.02). There were no correlations between serum ACE, interstitial granulomas and disease stage. BAL-I did however predict increasing disease radiological stage (p=0.042). In this study, one quarter of patients with sarcoidosis presented with EN among their presenting features. These patients were more likely to be young females with early stage radiological disease.

Management of extrapulmonary sarcoidosis: challenges and solutions

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Al-Kofahi K

2016-11-01

Full Text Available Khalid Al-Kofahi,1,* Peter Korsten,2,* Christian Ascoli,3 Shanti Virupannavar,4 Mehdi Mirsaeidi,5 Ian Chang,6 Naim Qaqish,7 Lesley A Saketkoo,8 Robert P Baughman,9 Nadera J Sweiss3,4 1Department of Molecular Biosciences, University of Kansas, Lawrence, KS, USA; 2Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany; 3Division of Pulmonary, Critical Care, Sleep and Allergy, University of Illinois at Chicago, Chicago, IL, 4Division of Rheumatology, University of Illinois at Chicago, Chicago, IL, 5Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, 6Department of Medicine, Michigan State University College of Osteopathic Medicine, East Lansing, MI, 7Department of Gastroenterology, Hepatology and Nutrition, University of Buffalo, Buffalo, NY, 8New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center, Louisiana State University Health Sciences Center, New Orleans, LA, 9Department of Medicine, University Medical Center of Cincinnati, Cincinnati, OH, USA *These authors contributed equally to this work Background: Sarcoidosis is a chronic multisystem disease of unknown etiology characterized by noncaseating granulomas that most often involves the lungs, but frequently has extrapulmonary manifestations, which might be difficult to treat in individual patients. Objective: To review different disease manifestations, focusing on extrapulmonary organ systems, and to provide treatment options for refractory cases. Materials and methods: We performed a literature search using Medline and Google Scholar for individual or combined keywords of “sarcoidosis, extrapulmonary, treatment, kidney, neurosarcoidosis, cardiovascular, gastrointestinal, transplantation, musculoskeletal, rheumatology, arthritis, and skin”. Peer-reviewed articles, including review articles, clinical trials, observational trials, and case reports that were

[Cardiac sarcoidosis: diagnostics, treatment and follow-up].

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Dudziak, Maria; Jankowska, Hanna; Dorniak, Karolina

2018-03-27

Sarcoidosis is a generalised granulomatous disorder of unknown aetiology. Cardiac involvement may affect conduction system, myocardium, valvular apparatus and pericardium. Clinical spectrum ranges from asymptomatic involvement to sudden cardiac death. Patients with biopsy-proven extracardiac sarcoidosis should be screened for cardiac involvement (standard ECG, 24-hour Holter ECG, echocardiography) and in case of any abnormalities found on these tests, more advanced diagnostic methods should be used. Steroid treatment is still the mainstay of therapy in cardiac sarcoidosis. Several immunosuppresive agents are also effective and used in different combinations with steroids, as well as heart failure treatment (including ACE inhibitors, angiotensin receptor blockers, beta-blockers and diuretics). Advanced heart block requires pacemaker implantation, and implantable cardioverterdefibrillator is an effective treatment in primary and secondary prophylaxis of sudden cardiac death. Heart transplantation is considered in advanced, drug-resistant heart failure or incessant ventricular arrhythmias unresponsive to other forms of therapy. © 2018 MEDPRESS.

Laryngeal sarcoidosis: presentation and management in the pediatric population.

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Strychowsky, Julie E; Vargas, Sara O; Cohen, Ezra; Vielman, Rene; Son, Mary Beth; Rahbar, Reza

2015-09-01

Sarcoidosis is a disease characterized by systemic non-necrotizing granulomas of unknown etiology. Laryngeal sarcoidosis is extremely uncommon, especially among pediatric patients. The clinical presentation and management of this entity in the pediatric population are poorly understood. A comprehensive search in PubMed was conducted to identify all cases in the published literature. We also present a case of isolated pediatric laryngeal sarcoidosis and outline the multidisciplinary approach to evaluation and management. A previously healthy 13-year-old female presented with a five-month history of mild dysphonia, dyspnea on exertion, and diffuse supraglottic edema. Biopsy showed non-necrotizing granulomas. Treatment with methotrexate led to marked improvement. The literature search identified seven previously published cases of pediatric laryngeal sarcoidosis, four in which disease was isolated to the larynx. All patients presented with a symptomatic and diffusely edematous supraglottis. Diagnoses were based on supraglottic biopsies showing non-necrotizing granulomas; all other possible etiopathologies were excluded. Three patients responded to corticosteroid therapy alone, one patient to tumor necrosis factor (TNF) inhibitor and methotrexate, and the remainder to a combination of corticosteroid therapy and surgical debulking. Laryngeal sarcoidosis in the pediatric population is challenging to diagnose and manage. When epithelioid granulomas are encountered histologically, other causes of granulomatous inflammation must be ruled out before a diagnosis of sarcoidosis can be made. Corticosteroid therapy alone may be ineffective. Medical therapy with methotrexate alone or in combination with TNF inhibitors versus surgical debulking alone or as part of multimodality treatment should be considered. A multidisciplinary approach with involvement of an otolaryngologist, pathologist, and rheumatologist is suggested. Copyright © 2015 Elsevier Ireland Ltd. All rights

Laryngeal sarcoidosis: a case-control study.

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Duchemann, Boris; Lavolé, Armelle; Naccache, Jean-Marc; Nunes, Hilario; Benzakin, Sylvain; Lefevre, Marine; Kambouchner, Marianne; Périé, Sophie; Valeyre, Dominique; Cadranel, Jacques

2014-10-20

We undertook a study on a series of laryngeal sarcoidosis (LS), a very rare and often threatening localization to better specify laryngeal manifestations, sarcoidosis clinical expression and long-term follow-up. This was a retrospective case-control study. All LS patients from two French centers were included and compared to sarcoidosis patients without laryngeal localization with two controls for one patient. Twelve consecutive LS patients were recruited between 1993 and 2011. LS revealed sarcoidosis in eight cases (67%). The most common symptoms were hoarseness (77%), inspiratory dyspnea (38%) and dysphagia (38%). Epidemiological characterisics were not different. Extrapulmonary localizations were significantly more common in LS patients than in controls (92% vs. 54%, p=0.02), particularly lupus pernio (25% vs. 0%, p=0.03) and nasosinusal involvement (83% vs. 4%, p<0.01) while thoracic involvement was less frequent (58% vs 100%, p < 0.01). Treatment rates were higher in the LS group (92% vs. 58%, p=0.04), and treatment duration was longer (median: 81 vs. 13 months, p=0.04), with frequent long-term treatment (67%, N=8/12). Two patients underwent surgery. One patient needed temporary tracheostomy during the course of the disease; Remission rates were lower in LS patients (9% vs. 58% at 2 years p<0.01). Eventually, there was no death nor definitive tracheotomy. LS is a rare condition that is often associated to other loco-regional localizations. LS are often difficult to manage. Survival is good but may require a medico-surgical approach.

Transcriptional blood signatures distinguish pulmonary tuberculosis, pulmonary sarcoidosis, pneumonias and lung cancers.

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Bloom, Chloe I; Graham, Christine M; Berry, Matthew P R; Rozakeas, Fotini; Redford, Paul S; Wang, Yuanyuan; Xu, Zhaohui; Wilkinson, Katalin A; Wilkinson, Robert J; Kendrick, Yvonne; Devouassoux, Gilles; Ferry, Tristan; Miyara, Makoto; Bouvry, Diane; Valeyre, Dominique; Dominique, Valeyre; Gorochov, Guy; Blankenship, Derek; Saadatian, Mitra; Vanhems, Phillip; Beynon, Huw; Vancheeswaran, Rama; Wickremasinghe, Melissa; Chaussabel, Damien; Banchereau, Jacques; Pascual, Virginia; Ho, Ling-Pei; Lipman, Marc; O'Garra, Anne

2013-01-01

New approaches to define factors underlying the immunopathogenesis of pulmonary diseases including sarcoidosis and tuberculosis are needed to develop new treatments and biomarkers. Comparing the blood transcriptional response of tuberculosis to other similar pulmonary diseases will advance knowledge of disease pathways and help distinguish diseases with similar clinical presentations. To determine the factors underlying the immunopathogenesis of the granulomatous diseases, sarcoidosis and tuberculosis, by comparing the blood transcriptional responses in these and other pulmonary diseases. We compared whole blood genome-wide transcriptional profiles in pulmonary sarcoidosis, pulmonary tuberculosis, to community acquired pneumonia and primary lung cancer and healthy controls, before and after treatment, and in purified leucocyte populations. An Interferon-inducible neutrophil-driven blood transcriptional signature was present in both sarcoidosis and tuberculosis, with a higher abundance and expression in tuberculosis. Heterogeneity of the sarcoidosis signature correlated significantly with disease activity. Transcriptional profiles in pneumonia and lung cancer revealed an over-abundance of inflammatory transcripts. After successful treatment the transcriptional activity in tuberculosis and pneumonia patients was significantly reduced. However the glucocorticoid-responsive sarcoidosis patients showed a significant increase in transcriptional activity. 144-blood transcripts were able to distinguish tuberculosis from other lung diseases and controls. Tuberculosis and sarcoidosis revealed similar blood transcriptional profiles, dominated by interferon-inducible transcripts, while pneumonia and lung cancer showed distinct signatures, dominated by inflammatory genes. There were also significant differences between tuberculosis and sarcoidosis in the degree of their transcriptional activity, the heterogeneity of their profiles and their transcriptional response to treatment.

[Sarcoidosis related pleural effusion: 6 case reports and literatures review].

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Wang, Feng; Tong, Zhaohui; Wang, Zhen; Wang, Xiaojuan; Xu, Lili

2015-02-01

To summarize the clinical features and the diagnosis-treatment points of sarcoidosis related pleural effusion. Six typical sarcoidosis related pleural effusion cases with pathological evidence were reviewed, and the clinical data of these cases were retrospectively analyzed and the related literatures were reviewed. The literature review was carried out respectively with "sarcoidosis", "pleural disease" and "pleural effusion" as the keywords in CNKI and PubMed database by January 2014. Six cases, including 1 male and 5 females, with sarcoidosis related pleural effusions were reported. 3 cases had bilateral effusions, 2 cases had left effusion and 1 case had right effusion. The pleural effusion routine test had a low specificity, which demonstrated that the fluid was exudate and consisted with large number of lymphocytes. 3 of these cases were diagnosed by medical thoracoscopy. Medical thoracoscopy revealed that pleural involvement was variable with multiple nodulespresent in some cases and subtle change in others. A total of 28 literatures and 92 cases with pleural involvement in sarcoidosis were retrieved from CNKI and PubMed database (time range: 2004.1-2014.1), including 59 cases of pleural effusion, 29 cases of pleural thickening, 3 cases of pneumothorax and 1 case of nodules in pleura. Pleural involvement in sarcoidosis was often misdiagnosed or mistreated as tuberculous pleurisy because the routine tests regarding pleural effusion usually had a low specificity. Medical thoracoscopy could provide clinicians with important clues to assist differentiation of the cause for non-conclusive pleural effusion in this situation.

HLA-G polymorphisms and HLA-G expression in sarcoidosis

DEFF Research Database (Denmark)

Hviid, Thomas Vauvert F; Milman, Nils; Hylenius, Sine

2006-01-01

was investigated in granulomas from sarcoidosis patients with the use of immunohistochemistry. RESULTS: The HLA-G*010102/-G*0106 alleles were observed more often in sarcoidosis patients (39.4%) than in controls (26.4%), p = 0.025 (Fisher's exact test); however, not significant after correction (p(c) = 0.15). When...

Coexistence of Sarcoidosis and Gouty Arthritis.

Science.gov (United States)

Semiz, Hüseyin; Kobak, Senol

2017-08-21

Sarcoidosis is an inflammatory disease with unknown cause characterized by non-caseating granuloma formations. It may present with bilateral hilar lymphadenopathy, skin lesions, the involvement of eye and symptoms on the locomotor system. Gouty arthritis is an autoinflammatory disease characterized by hyperuricemia, recurrent arthritis attacks and the deposition of monosodium urate crystals in the joints and the surrounding tissues. We reported the coexistence of sarcoidosis and gouty arthritis in this paper. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.

Central skeletal sarcoidosis mimicking metastatic disease

International Nuclear Information System (INIS)

Talmi, Danit; Smith, Stacy; Mulligan, Michael E.

2008-01-01

Sarcoidosis is a systemic disease that histologically typically shows non-caseating granulomas. The most common radiologic finding is hilar and mediastinal adenopathy. Patients with widely disseminated disease may show involvement of the peripheral appendicular skeleton in 1-13% of such cases. A primary skeletal presentation without other manifestations typical of the disease is rare. We present a case of sarcoidosis in a middle-aged Caucasian man in whom the disease presented with widespread lytic lesions in the axial skeleton and long bones, mimicking metastatic disease. There was no involvement of the peripheral skeleton, skin or lungs. (orig.)

Angiotensin converting enzyme genotype affects development and course of sarcoidosis in Asian Indians.

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Tahir, Mohammad; Sharma, S K; Ashraf, Shazia; Mishra, Hemant K

2007-09-01

Studies of serum angiotensin converting enzyme (SACE) activity and its association with ACE gene insertion/deletion (I/D) polymorphism in relation to sarcoidosis have yielded variable results. This has been attributed to possible ethnic differences. Present study was designed to evaluate the relationship between I/D polymorphism and susceptibility to develop sarcoidosis and its effect on SACE activity and disease course in Asian Indian patients with sarcoidosis. ACE genotyping was performed in 72 consecutive patients with sarcoidosis and 199 controls (96 normal healthy individuals and 103 tuberculosis patients taken as disease controls). SACE activity was determined in all patients with sarcoidosis. Various parameters were compared amongst patients with different genotypes as well as between sarcoidosis and control groups. Gene frequency of I and D in control group was 0.6 and 0.4, whereas in patients with sarcoidosis it was 0.35 and 0.65 respectively (p SACE activity was highest in patients with DD genotype and followed an order of DD > ID > II. Good response to initial corticosteroids was seen in 6 of 6 (100%) patients with II genotype whereas in only 32 of 37 (84%) with ID and 16 of 25 (64%) with DD (p = 0.013). In Asian Indian population 'D' allele is associated with an increased risk for development of sarcoidosis and patients with 'D' allele show poor response to corticosteroids.

PET/CT in sarcoidosis associated with oncological disease

International Nuclear Information System (INIS)

Bianco, C.; Servente, L.; Valuntas, L.; García Fontes, L.; Engler, H.

2017-01-01

Purposes: To describe the radiological findings of sarcoidosis or sarcoid-like reactions in cancer patients being monitored by positron emission computed tomography (PET/CT). Materials and methods: A retrospective analysis was performed on 18 PET/CT studies performed over 3 years in patients with lymphomas and solid tumours who presented with hypermetabolic hiliar-mediastinal adenopathies. The morphological pattern of these adenopathies, the distribution, and in some cases the association with pulmonary nodules, might suggest sarcoidosis as a differential diagnosis. Results: Oncological diseases corresponded to breast (4), prostate (3), ovary (2), and others (9). The adenopathies were classified in 7 of the 18 patients as benign after histological confirmation of sarcoidosis, anthracosis or sarcoid-like reaction. The evolutionary behaviour in 5 patients was compatible with benign lesions. The biopsy of 2 patients indicated secondary lesions and malignancy was confirmed by the evolution of the 4 remaining cases. There was a total of 12 (66%) benign lesions. Discussion: Sarcoidosis must be suspected in the presence of hypermetabolic hiliar-mediastinal adenopathies with a characteristic morphological pattern and pulmonary changes. However, biopsy is required to rule out oncological recurrence. The use of new PET/CT markers for differential diagnosis represents a challenge. Aminoacid synthesis tracers such as “1”8F-fluorothymidine (FLT) and “1”8F-fluoromethyltyrosine (FMT) are useful in the differentiation between malignancy and granulomatous diseases in oncologic patients. Conclusion: The differential diagnosis of sarcoidosis should be considered in the presence of bilateral symmetric mediastinal hilum lymphadenopathies. (authors) [es

Papulo-Nodular Reactions in Black Tattoos as Markers of Sarcoidosis

DEFF Research Database (Denmark)

Sepehri, Mitra; Hutton Carlsen, Katrina; Serup, Jørgen

2016-01-01

BACKGROUND/AIMS: Sarcoidosis is, from historical data, suggested to be more prevalent among patients with tattoo reactions. We aimed to evaluate this association in a systematic study. METHODS: This is a consecutive study of patients with tattoo complications, diagnosed in the "Tattoo Clinic......" at Bispebjerg University Hospital in Copenhagen, Denmark, from 2008 to 2015, based on clinical assessment and histology. From the overall group of 494 tattoo complications in 406 patients, 92 reactions in 72 patients showed a papulo-nodular pattern studied for local and systemic sarcoidosis, since sarcoidosis...

Ocular Manifestations of Biopsy-Proven Pulmonary Sarcoidosis in Korea

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Seung Yong Choi

2018-01-01

Full Text Available Purpose. To investigate the clinical features and ocular manifestations of biopsy-proven pulmonary sarcoidosis in Korea. Methods. 55 patients diagnosed with pulmonary sarcoidosis by bronchoscopic or excisional biopsy were included. By retrospective clinical chart review, we investigated features of uveitis, ocular and systemic treatments, visual acuity, angiotensin-converting enzyme level, chest radiography, and pulmonary function tests. Clinical features were analyzed by presence of uveitis, site of biopsy, and first manifested sign of sarcoidosis. Results. The group with uveitis (n=39 presented with higher systemic (71.8% and immunosuppressive treatment rates (35.9% than the group without uveitis (31.3%, 0%, resp. (P=0.007, P=0.005, resp.. There were no significant differences in clinical features, including systemic treatment rate, by type of biopsy. Of 39 patients with uveitis, the group with ocular manifestation as a first sign of sarcoidosis showed higher systemic and immunosuppressive treatment rates (88.9%, 55.6% compared to the group with pulmonary manifestation as a first sign (57.1%, 19.0% (P=0.037, P=0.018, resp.. Conclusions. In patients with biopsy-proven pulmonary sarcoidosis, the presence of ocular involvement and uveitis as a first sign could be significant factors associated with higher systemic treatment rate, especially with immunosuppressive agents. Biopsy site determined by location and size had no influence on clinical features.

The appearance of 'Lambda' and 'Panda' sign on Ga-67 scintigraphy in sarcoidosis

International Nuclear Information System (INIS)

Yoshimizu, Tazuko; Suga, Kazuyoshi; Orihashi, Norihiro; Soejima, Kyoko; Kaneko, Takafumi; Kawamura, Mitsutoshi; Nakanishi, Takashi; Utsumi, Hiromoto; Yamada, Norimasa

1991-01-01

The lesions of sarcoidosis generally show relatively high Ga-67 uptake and the usefulness of scintigraphy using this agent in the evaluation of lesion activity is well known. In this report, we assessed characteristic uptake of Ga-67 in intrathoracic lymph nodes, the shape of which resembled the Greek letter Lambda (Lambda sign) and a symmetrical accumulation in bilateral lacrimal and salivary glands which resembled a Panda face (Panda sign) in patients with sarcoidosis. Our review of Ga-67 scans obtained from 15 patients with sarcoidosis and 1,779 patients with other disorders during the past 3 years revealed that the simultaneous presence of both Lambda and Panda signs was specific to patients with sarcoidosis and was not found in patients with various other disorders, although one of these signs might be observed in patients without sarcoidosis. When Lambda-like sign was observed, chest radiogram or CT was necessary for the differential diagnosis of sarcoidosis. Panda sign was observed frequently among patients who had previously received irradiation of the neck. Our results confirmed that sarcoidosis must be suspected when both Lambda and Panda signs were observed. (author)

Pulmonary sarcoidosis with and without extrapulmonary involvement: a cross-sectional and observational study in China.

Science.gov (United States)

Li, Cheng-Wei; Tao, Ru-Jia; Zou, Dan-Feng; Li, Man-Hui; Xu, Xin; Cao, Wei-Jun

2018-02-16

Sarcoidosis is a multisystem disease characterised by the formation of granulomas within various organs, mainly the lungs. Several studies from different countries have been undertaken to investigate sarcoidosis with extrapulmonary involvement except from China. The objective of this study is to investigate a comparative clinical analysis in patients with pulmonary sarcoidosis with and without extrapulmonary involvement from China. Data from inpatients diagnosed with sarcoidosis at Shanghai Pulmonary Hospital (Shanghai, China) between January 2009 and December 2014 were retrospectively collected and analysed. Six hundred and thirty-six patients with biopsy-proven sarcoidosis were included in the study, including 378 isolated pulmonary sarcoidosis and 258 pulmonary sarcoidosis plus extrapulmonary involvement. Two hundred and fifty-eight (40.6%) patients with pulmonary sarcoidosis had extrapulmonary involvement. Extrapulmonary localisations were detected mostly in extrathoracic lymph nodes (n=147) and skin (n=86). Statistically significant differences were demonstrated between patients with pulmonary sarcoidosis plus extrapulmonary involvement and patients with isolated pulmonary sarcoidosis for fatigue (16.6%vs8.3%, PSACE) levels (79.0±46.9 IU/L vs 69.7±38.7 IU/L, PSACE levels and more deteriorating HRCT findings, to which clinicians should pay attention. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Low-amplitude distal esophageal spasm as a cause of severe dysphagia for solid food

NARCIS (Netherlands)

Breumelhof, R.; Timmer, R.; van Hees, P. A.; Obertop, H.; Smout, A. J.

1996-01-01

This case report presents a patient with progressive dysphagia, accompanied by weight loss, in the absence of organic disease. Esophageal motility studies initially failed to reveal a diagnosis. At simultaneous manometry and fluoroscopy, with bread/barium boluses, the diagnosis of esophageal spasm

Husband and wife with sarcoidosis: possible environmental factors involved

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Leli Ilaria

2013-01-01

Full Text Available Abstract Sarcoidosis is a granulomatous multisystem disorder of unclear etiology that involves any organ, most commonly the lung and the lymph nodes. It is hypothesized that the disease derives from the interaction between single or multiple environmental factors and genetically determined host factors. Multiple potential etiologic agents for sarcoidosis have been proposed without any definitive demonstration of causality. We report the case of two patients, husband (57 years old and wife (55 years old, both suffering from sarcoidosis. They underwent a lymph node biopsy by mediastinoscopy which showed a “granulomatous epithelioid giant cell non-necrotising chronic lymphadenitis”. They had lived up to 3 years ago in the country in a farm, in contact with organic dusts, animals such as dogs, chickens, rabbits, pigeons; now they have lived since about 3 years in an urban area where there are numerous chemical industries and stone quarries. The aim of this case report was to focus on environmental factors that might be related to the pathogenesis of the sarcoidosis.

Co-existing sarcoidosis and Takayasu arteritis: report of a case

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Hamzaoui Amira

2011-02-01

Full Text Available Abstract Introduction Takayasu arteritis (TA is a chronic vasculitis of unknown origin, affecting mainly the aorta and its main branches. As a result of the inflammation, stenosis, occlusion or dilatation of the involved vessels may occur and cause a wide range of symptoms. It has been described in association with various auto-immune disorders (mainly inflammatory digestive tract diseases. However, only few cases of TA associated with sarcoidosis have been reported, raising the question of an association by chance. Case report We report a case of a 34 year-old woman, with one year history of sarcoidosis, who presented with asymmetric high hypertension revealing inflammatory humeral, axillary and subclavian arteritis related to TA, successfully treated by steroid and immunosuppressive therapy(MethotrexateR. Conclusion TA and sarcoidosis may be related, rising the hypothesis that TA or Takayasu arteritis-like granulomatous vasculitis may be, in fact, a complication of sarcoidosis.

A case of muscular sarcoidosis diagnosed by gallium-67 scintigraphy and magnetic resonance imaging

International Nuclear Information System (INIS)

Sohn, Hyung Sun; Kim, Euy Neyng

1999-01-01

Gallium-67 scintigraphy is helpful in the assessment of active extrapulmonary sarcoidosis. Muscular involvement of sarcoidosis is often asymptomatic or nonspecific, and laboratory examinations do not provide convincing evidence of muscular involvement. We report a case of muscular sarcoidosis, which was detected by gallium-67 scintigraphy. In a patient who was suffering from fever and arthalgia of knee joint, gallium-67 scintigraphy showed mediastinal and hilar involvement of sarcoidosis with unexpected extensive muscular uptake. Magnetic resonance imaging revealed the detailed depiction of intramuscular infiltration of sarcoid granuloma. Gallium-67 scintigraphy is useful in detecting inflammatory muscular involvement of sarcoidosis as well as other multiorgan involvement

Sarcoidosis: assessment of disease severity using HRCT

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Drent, Marjolein [Department of Respiratory Medicine, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Nutrition and Toxicology Research Institute Maastricht (NUTRIM), P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Sarcoidosis Management Center, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Vries, Jolanda De [Department of Clinical Health Psychology, Tilburg University, P.O. Box 90153, 5000, LE Tilburg (Netherlands); Lenters, Merinke; Wouters, Emiel F.M. [Department of Respiratory Medicine, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Nutrition and Toxicology Research Institute Maastricht (NUTRIM), P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Lamers, Rob J.S. [Department of Radiology, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Rothkranz-Kos, Snjezana; Dieijen-Visser, Marja P. van [Nutrition and Toxicology Research Institute Maastricht (NUTRIM), P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Department of Clinical Chemistry, University Hospital of Maastricht, P.O. Box 5800, 6202, AZ Maastricht (Netherlands); Verschakelen, Johny A. [Department of Radiology, Catholic University, 3000, Leuven (Belgium)

2003-11-01

The value of high-resolution computed tomography (HRCT) in diagnosing and assessing inflammatory activity in sarcoidosis is well established. The aim of the present study was to address the intra- and inter-observer agreements of the HRCT score by Oberstein et al. [8], and to evaluate the relationship between HRCT findings and disease severity expressed in respiratory functional impairment in sarcoidosis. The clinical records of 80 known sarcoidosis patients visiting the outpatient clinic between January 2000 and August 2001, who underwent a HRCT as well as lung function tests (including exercise testing), were reviewed. Two readers scored the first 60 HRCT images twice. Weighted kappa and intra-class correlation coefficient were used to assess the reliability of the HRCT scoring system. Spearman's rank correlation coefficients and multiple regression analyses were performed to evaluate the relationship between HRCT findings (first reading, reader A) and respiratory functional impairment. Intra- and inter-reader reliability demonstrated good agreement. All HRCT subscores, except enlargement of lymph nodes, were correlated to the FEV{sub 1}, FVC, DLco, Pao{sub 2}max (all p<0.05) and A-aPo{sub 2}max (p <0.001). Furthermore, HRCT abnormalities, but not the chest radiographic stage, were strongly associated with functional parameters. Abnormal changes of lung parenchyma, established by HRCT features, were associated with respiratory functional impairment in sarcoidosis. Moreover, compared with the radiographic stages, HRCT findings appeared to be much more sensitive in depicting respiratory disability, especially abnormal gas exchange. (orig.)

Sarcoidosis: assessment of disease severity using HRCT

International Nuclear Information System (INIS)

Drent, Marjolein; Vries, Jolanda De; Lenters, Merinke; Wouters, Emiel F.M.; Lamers, Rob J.S.; Rothkranz-Kos, Snjezana; Dieijen-Visser, Marja P. van; Verschakelen, Johny A.

2003-01-01

The value of high-resolution computed tomography (HRCT) in diagnosing and assessing inflammatory activity in sarcoidosis is well established. The aim of the present study was to address the intra- and inter-observer agreements of the HRCT score by Oberstein et al. [8], and to evaluate the relationship between HRCT findings and disease severity expressed in respiratory functional impairment in sarcoidosis. The clinical records of 80 known sarcoidosis patients visiting the outpatient clinic between January 2000 and August 2001, who underwent a HRCT as well as lung function tests (including exercise testing), were reviewed. Two readers scored the first 60 HRCT images twice. Weighted kappa and intra-class correlation coefficient were used to assess the reliability of the HRCT scoring system. Spearman's rank correlation coefficients and multiple regression analyses were performed to evaluate the relationship between HRCT findings (first reading, reader A) and respiratory functional impairment. Intra- and inter-reader reliability demonstrated good agreement. All HRCT subscores, except enlargement of lymph nodes, were correlated to the FEV 1 , FVC, DLco, Pao 2 max (all p 2 max (p <0.001). Furthermore, HRCT abnormalities, but not the chest radiographic stage, were strongly associated with functional parameters. Abnormal changes of lung parenchyma, established by HRCT features, were associated with respiratory functional impairment in sarcoidosis. Moreover, compared with the radiographic stages, HRCT findings appeared to be much more sensitive in depicting respiratory disability, especially abnormal gas exchange. (orig.)

Disseminated nontuberculous infections with Mycobacterium genavense during sarcoidosis

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H. Dumouchel-Champagne

2009-12-01

Full Text Available Sarcoidosis is a chronic disease characterised by the development and accumulation of granulomas in multiple organs. We report two observations of disseminated Mycobacterium genavense infection in patients with proven sarcoidosis. High fever and abdominal pain appeared at 8 and 18 months following the initiation of immunosuppressive therapy. Abdominal computed tomography scans of the patients showed diffuse mesenteric lymphadenitis and splenomegaly. The diagnosis was obtained on bone marrow specimens for both patients with numerous acid-fast bacteria at direct examination and positive specific mycobacterial identification by nucleic acid amplification test. Despite prompt antimycobacterial therapy, occurrence of complications (peritonitis post-splenectomy surgery and lung carcinoma resulted in a fatal outcome for both patients. These cases highlight that opportunistic infections like M. genavense or other nontuberculous mycobacterial infections should be considered for long-standing immunocompromised patients with sarcoidosis.

Analysis of sarcoidosis in the Oporto region (Portugal

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A.V. Cardoso

2017-09-01

Full Text Available Background: Sarcoidosis is a systemic granulomatous disease of unknown etiology. Epidemiological studies of different populations are essential because clinical presentation, organ involvement, disease severity, and prognosis vary significantly according to region and population. The aim of this study was to assess epidemiological and clinical characteristics, staging factors, and clinical course in patients with sarcoidosis from a tertiary hospital in Oporto, Portugal. Methods: A retrospective analysis of patients with sarcoidosis and at least 2 years of follow-up evaluated at the Centro Hospitalar de São João between 2000 and 2014. Results: We identified 409 patients with sarcoidosis (females, 58.9%; mean age at diagnosis, 38.9 ± 13.4 years; smokers, 14.4%]. All the patients were diagnosed according to the ERS/ATS/WASOG consensus statement and 64.1% had evidence of noncaseating epithelioid cell granulomas in biopsy specimens. Bronchoalveolar lavage was performed as part of the diagnostic work-up in 289 patients and 90.2% had lymphocytosis (CD4/CD8 ratio ≥ 3.5 in 60.9% of cases. Exertion dyspnea, cough, and constitutional symptoms were the most common presenting symptoms; 10.1% of patients were asymptomatic, 22.8% had Löfgren syndrome, and 50.5% had extrathoracic involvement. Radiographic stages of disease according to the Scadding criteria were as follows: stage 0 (5.2%, stage I (33.7%, stage II (47.0%, stage III (8.4%, and stage IV (5.7%. Impaired respiratory function was observed in 45.6% patients and was mostly mild. Systemic treatment was administered in 58.6% of cases. Overall, 45.3% of patients experienced disease resolution. Conclusion: The epidemiological and clinical characteristics of this cohort of patients with sarcoidosis from the Oporto region in northern Portugal revealed epidemiological and clinical characteristics that were generally similar to those described in other Western Europe populations and

APPLICATION OF AMINO ACID MIXTURE AGAINST ESOPHAGEAL REFLUX IN CHILDREN WITH COW MILK ALLERGY

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E.A. Vishneva

2008-01-01

Full Text Available The esophageal reflux is quite often accompanied by cow milk allergy in infants. For that matter, the authors recommend to examin all infants with esophageal reflux to be sure if they have allergy or not. The authors represent diagnostic methods for both disorders. Besides the authors represent the results of the research work on effectiveness of amino acid mix for cmatreatment which they used in patients with esophageal reflux.Key words: allergy to the protein of the cow milk, esophageal reflux, amino acid mixture, children.

Rare association of thymoma, myasthenia gravis and sarcoidosis : a case report

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Kurukumbi Mohankumar

2008-07-01

Full Text Available Abstract Introduction The association of thymoma with myasthenia gravis (MG is well known. Thymoma with sarcoidosis however, is very rare. We presented an interesting case with coexisting thymoma, MG and sarcoidosis. Case presentation A 59-year-old female patient with a history of sarcoidosis was admitted to the hospital with a one-day history of sudden onset of right-sided partial ptosis and diplopia. Neurosarcoidosis with cranial nerve involvement was considered, but was ruled out by the clinical findings, and MG was confirmed by the positive tensilon test, electrophysiological findings and positive acetylcholine receptor binding antibodies. On further evaluation, a CT chest scan showed a left anterior mediastinal mass and bilateral lymphadenopathy. Post surgical diagnosis confirmed the thymoma and sarcoidosis in the lymph nodes. Conclusion When two or more diseases of undetermined origin are found together, several interesting questions are raised. It is important to first confirm the diagnoses individually. Immunologic mechanisms triggering the occurrence of these diagnoses together, are difficult to address. Although the coexistence of thymoma, MG and sarcoidosis may be coincidental, it is noteworthy to report this case because of the multiple interesting features observed as well as the rarity of occurrence.

Sarcoidosis in the eastern region of Saudi Arabia

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Al-Khouzaie Thamer

2011-01-01

Full Text Available Aim: To review a general hospital′s experience with sarcoidosis and the clinical pattern of the disease among Saudis. Methods: A retrospective file review was carried out on all patients with a proven diagnosis of sarcoidosis in a general hospital in Eastern Saudi Arabia over a period of 11 years (1998-2008. Results: Sixty-nine patients, of whom 33 cases were included in the analyses, were diagnosed to have sarcoidosis during the study period. There were 18 females and 15 males. The mean age was 44.5 years (SD 17. The most common presentations were cough (48%, dyspnea (21%, joint pain (18%, splenomegaly (12%, hepatomegaly (9%, and lymphadenopathy (5%. The biochemical analysis showed elevated calcium levels in 6% and elevated angiotensin converting enzyme (ACE in 14 (46.7%. The tuberculin skin test was negative in all tested patients (n = 29 except one patient. The patients were classified using the modified Scadding classification system. None of the patients was in stage 0, 39.4% were in stage 1, 45% were in stage 2 and 15% were in stage 3.. The diagnosis in all patients was proven histologically. The outcome was favorable in most patients (85%, and in 6% of the patients, the course was chronic and progressive, although 66% received active treatment. Conclusion: Sarcoidosis does occur in native Saudis. The clinical presentation of these patients was similar to the western pattern of disease with some differences such as relative lack of cardiac, eye, parotid, and central nervous system involvement. The rarity of cardiac and central nervous system involvement was comparable with other Middle Eastern studies. Sarcoidosis, though rare in our community, should still be considered in the differential diagnosis of patients with the typical presentation after excluding tuberculosis.

Computer-assisted sequential quantitative analysis of gallium scans in pulmonary sarcoidosis

International Nuclear Information System (INIS)

Rohatgi, P.K.; Bates, H.R.; Noss, R.W.

1985-01-01

Fifty-one sequential gallium citrate scans were performed in 22 patients with biopsy-proven sarcoidosis. A computer-assisted quantitative analysis of these scans was performed to obtain a gallium score. The changes in gallium score were correlated with changes in serum angiotensin converting enzyme (SACE) activity and objective changes in clinical status. There was a good concordance between changes in gallium score, SACE activity and clinical assessment in patients with sarcoidosis, and changes in gallium index were slightly superior to SACE index in assessing activity of sarcoidosis. (author)

Characteristics of sarcoidosis in Maori and Pacific Islanders.

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Wilsher, Margaret L; Young, Lisa M; Hopkins, Raewyn; Cornere, Megan

2017-02-01

Ethnicity is strongly associated with variable clinical presentation in sarcoidosis but the association between ethnicity and clinical characteristics has not previously been described in patients of Polynesian ancestry, Maori and Pacific Islander (PI). The objective of this study was to describe the clinical characteristics of sarcoidosis in Maori and PI patients and determine if those were different to European patients. A retrospective review of the medical records of 406 patients (69 Maori/PI) attending a specialist interstitial lung disease (ILD) clinic. The population (207 females, mean age at presentation: 36) reflected the current New Zealand census data (2013) with only people of Indian ethnicity over-represented. Parenchymal lung involvement was uncommon in Maori and PI patients (21% Scadding stage 2, 2% stage 3), and no patient had extensive pulmonary fibrosis (stage 4). Computed tomography (CT) patterns of sarcoid parenchymal lung involvement were less commonly reported for Maori/PI. There were no differences in respect of baseline lung function or requirement for treatment. Ocular and skin involvement occurred more frequently in Maori and PI (P = 0.0045, P = 0.03), and erythema nodosum was more common in Caucasians (P = 0.0008). People of Polynesian ancestry appear to have less pulmonary and more extra-pulmonary manifestations of sarcoidosis. This adds to our knowledge that sarcoidosis heterogeneity is influenced by ethnicity. © 2016 Asian Pacific Society of Respirology.

Sarcoidosis in Israel: Clinical Outcome Status, Organ Involvement, and Long-Term Follow-Up.

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Markevitz, Natalia; Epstein Shochet, Gali; Levi, Yair; Israeli-Shani, Lilach; Shitrit, David

2017-08-01

Sarcoidosis is a chronic granulomatous inflammatory disease of unknown etiology with heterogeneous outcomes. This study reviewed the clinical outcome status (COS) and organ involvement of Israeli sarcoidosis patients during a five-year period. Further, we compared our results to the 'World Association of Sarcoidosis and Other Granulomatous Disease' (WASOG) COS and the 'A Case Control Etiologic Study of Sarcoidosis' (ACCESS) instruments in order to evaluate their relevance to the Israeli population. The retrospective study group consisted of 166 sarcoidosis patients for the period of 2010-2015. Data on demographic characteristics, presenting symptoms, co-morbidities, disease duration, lung function tests, treatment program, chest X-ray, and chest high-resolution computed tomography were collected. The median patient age was 62 ± 14, which was significantly higher than the WASOG and ACCESS cohorts (p Israel is a unique and challenging disease with its clinical presentations that differ from previously reported studies.

Anti-TNF: Novel treatment in ocular sarcoidosis

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Escudero Bodenlle, Laura; Olea Vallejo, José Luis; Pons Crespí, Mateu; Aragón Roca, Juan Antonio; Costa-Jordao, Cátia; Tarragó Pérez, Ramón

2017-01-01

Obejtivo: Se pretende demostrar la utilidad de la angiografía con fluoresceína y verde de indocianina en el diagnóstico y manejo de la sarcoidosis ocular, así como la utilidad de los fármacos biológicos en esta patología. Métodos: Para ello, se presenta un caso clínico de sarcoidosis sistémica y ocular tratada durante años con corticoides e inmunomoduladores, con mal control de la enfermedad. La principal afectación era la del segmento posterior del ojo, con numerosos signos en coroides y ret...

The evidence for biologic immunotherapy in Sarcoidosis: A systematic review

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Pooja Shah

2017-09-01

Full Text Available Background Sarcoidosis is a chronic inflammatory disease with a myriad of clinical manifestations. Treatment involves immunosuppression with corticosteroids or steroid-sparing agents. A proportion of patients does not respond to or are intolerant to therapy. Targeted immunotherapy with biologic agents has emerged as a novel approach with plausible mechanistic reasons to warrant study. Aims The aim of this review was to evaluate the evidence for the efficacy of biological therapy in sarcoidosis. Methods We conducted a systematic literature review and meta-analysis of all published randomised-controlled trials (RCT evaluating biological therapy in sarcoidosis, using MEDLINE and Embase databases, through to September 2017. The search terms included sarcoidosis, infliximab, adalimumab, etanercept, golimumab, certolizumab, rituximab, abatacept, tocilizumab, anakinra, ustekinumab, secukinumab. Only articles reporting RCTs were selected. Improvements in respiratory disease were assessed by changes in forced vital capacity (FVC by weighted mean difference (WMD. There were insufficient data on outcome measures in other organ systems to comparatively assess efficacy. Results The search identified 2,324 studies of which only 5 provided relevant and original data. This comprised a total of 364 patients, evaluating pulmonary, cutaneous and ocular sarcoidosis. One study in pulmonary disease and one study in cutaneous disease demonstrated improvements in the primary outcome. In pulmonary disease, meta-analysis of the treatment effect of anti-TNF therapy versus placebo on FVC revealed a WMD of 1.69 per cent (95 per cent confidence interval, 1.44–1.94. Conclusion There are insufficient data to suggest the long-term efficacy of anti-TNFα inhibitors in the treatment of sarcoidosis. This may be due to heterogeneity, small sample sizes and the lack of consistent reporting of outcome measures.

Th17-lineage cells in pulmonary sarcoidosis and Löfgren's syndrome: Friend or foe?

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Miedema, Jelle R; Kaiser, Ylva; Broos, Caroline E; Wijsenbeek, Marlies S; Grunewald, Johan; Kool, Mirjam

2018-02-01

Sarcoidosis, a multisystem granulomatous disorder, has historically been classified as Th1-driven disease. However, increasing data demonstrate a key role of Th17-cell plasticity in granuloma formation and maintenance. In Löfgren's syndrome (LS), an acute and distinct phenotype of sarcoidosis with a favorable outcome, differences in Th17-lineage cell subsets, cytokine expression and T-cell suppressive mechanisms may account for differences in clinical presentation as well as prognosis compared to non-LS sarcoidosis. In contrast with LS, up to 20% of non-LS sarcoidosis patients may progress to irreversible pulmonary fibrosis. In non-LS sarcoidosis patients, IFN-γ-producing Th17.1-cells appear to be more pathogenic and possibly linked to disease progression, while a broader range of cytokines is found in bronchoalveolar lavage fluid (BALF) in LS patients. Differences in Cytotoxic T-lymphocyte antigen 4 (CTLA-4) expression on Th17-cells and regulatory T-cells (Treg) could contribute to Th17-cell pathogenicity and consequently to either disease resolution or ongoing inflammation in sarcoidosis. Furthermore, several genes and SNPs are associated with disease susceptibility and outcome in sarcoidosis, the majority of which are involved in antigen presentation, T-cell activation or regulation of T-cell survival. Novel insights into the role of Th17-cells in the pathogenesis of both LS and non-LS sarcoidosis will unravel pathogenic and benign Th17-lineage cell function and drivers of Th17-cell plasticity. This will also help identify new treatment strategies for LS and non-LS sarcoidosis patients by altering Th17-cell activation, suppress conversion into more pathogenic subtypes, or influence cytokine signaling towards a beneficial signature of Th17-lineage cells. In this review, we summarize new insights into Th17-cell plasticity in the complex pathogenesis of sarcoidosis and connect these cells to the different disease phenotypes, discuss the role of genetic

Sarcoidosis, Celiac Disease and Deep Venous Thrombosis: a Rare Association

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Gökhan Çelik

2011-11-01

Full Text Available Sarcoidosis is a multisystem granulomatous disorder of unknown etiology and it may rarely be associated with a second disorder. Celiac disease is an immune-mediated enteropathy characterized with malabsorption caused by gluten intolerance, and several reports indicate an association between celiac disease and sarcoidosis. In addition, although celiac disease is associated with several extraintestinal pathologies, venous thrombosis has been rarely reported. Herein we present a rare case report of a patient with a diagnosis of sarcoidosis, celiac disease and deep venous thrombosis because of the rare association of these disorders. The patient was admitted with abdominal pain, weight loss, chronic diarrhea and a 5-day history of swelling in her right leg. A diagnosis of deep venous thrombosis was achieved by doppler ultrasonographic examination. The diagnosis of celiac disease was made by biopsy of duodenal mucosa and supported with elevated serum level of anti-gliadin IgA and IgG, and a diagnosis of sarcoidosis was achieved by transbronchial needle aspiration from the subcarinal lymph node during flexible bronchoscopy.

Esophageal motility in eosinophilic esophagitis.

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Weiss, A H; Iorio, N; Schey, R

2015-01-01

Eosinophilic esophagitis (EoE) is characterized by eosinophilic infiltration of the esophagus and is a potential cause of dysphagia and food impaction, most commonly affecting young men. Esophageal manometry findings vary from normal motility to aperistalsis, simultaneous contractions, diffuse esophageal spasm, nutcracker esophagus or hypotonic lower esophageal sphincter (LES). It remains unclear whether esophageal dysmotility plays a significant role in the clinical symptoms of EoE. Our aim is to review the pathogenesis, diagnosis, and effect of treatment on esophageal dysmotility in EoE. A literature search utilizing the PubMed database was performed using keywords: eosinophilic esophagitis, esophageal dysmotility, motility, manometry, impedance planimetry, barium esophagogram, endoscopic ultrasound, and dysphagia. Fifteen studies, totaling 387 patients with eosinophilic esophagitis were identified as keeping in accordance with the aim of this study and included in this review. The occurrence of abnormal esophageal manometry was reported to be between 4 and 87% among patients with EoE. Esophageal motility studies have shown reduced distensibility, abnormal peristalsis, and hypotonicity of the LES in patients with EoE, which may also mimic other esophageal motility disorders such as achalasia or nutcracker esophagus. Studies have shown conflicting results regarding the presence of esophageal dysmotility and symptoms with some reports suggesting a higher rate of food impaction, while others report no correlation between motor function and dysphagia. Motility dysfunction of the esophagus in EoE has not been well reported in the literature and studies have reported conflicting evidence regarding the clinical significance of dysmotility seen in EoE. The correlation between esophageal dysmotility and symptoms of EoE remains unclear. Larger studies are needed to investigate the incidence of esophageal dysmotility, clinical implications, and effect of treatment on

[Esophagobronchial fistula and empyema resulting from esophageal carcinoma].

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Hippo, Y; Kawana, A; Yoshizawa, A; Koshino, T; Toyota, E; Kobayashi, N; Kobori, O; Arai, T; Kudo, K; Kabe, J

1997-05-01

A 59-year-old woman was admitted to the hospital with a one-month history of hemoptysis, generalized fatigue, and a high fever. A chest X-ray film obtained on admission showed a massive right-sided pleural effusion. Examination of an aspirate showed a high level of amylase, and bacteria that were the same as oral bacteria. Closed drainage yielded ichorous pus and food residues, which led us to the diagnosis of empyema caused by esophageal perforation. Esophagography and fiberoptic esophagoscopy revealed that an esophagobronchial fistula related to an advanced esophageal carcinoma had caused the empyema. Surgical resection was done, and the patient was alive at the time of this writing, 7 months after she was first treated. Esophageal carcinoma is sometimes accompanied by esophagobronchial fistula. Patients with this condition usually have severe respiratory symptoms; those presenting with empyema are rare. Esophageal carcinoma must be carefully ruled out as the cause of empyema.

Acute vision loss: a fuzzy presentation of sarcoidosis.

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Austin, Andrea L; Day, Luke T; Bishop, Frank M

2013-04-01

Acute vision loss is a devastating problem for patients and a challenging diagnostic dilemma for Emergency Physicians. This chief complaint is one in which we must be adept at quickly evaluating and initiating either care or referral. This case reviews the approach to acute vision loss and shows the importance of expanding the differential in atypical and complex presentations. A 31-year-old, previously healthy, white woman presented to the Emergency Department (ED) with 1 day of painless right eye vision loss. Ocular ultrasound and slit-lamp examination were unremarkable. Fundoscopic examination revealed retinal hemorrhages and papillitis. Her chest X-ray study was significant for bilateral hilar adenopathy, and subsequent lymph node biopsy confirmed the diagnosis of sarcoidosis. Although sarcoidosis is more common in African Americans, it must be considered in all patients in the appropriate clinical context. Sarcoidosis is an important diagnosis to include on the differential of many chief complaints that present to the ED, including acute vision loss and dyspnea. Published by Elsevier Inc.

Extrapulmonary involvement in patients with sarcoidosis and comparison of routine laboratory and clinical data to pulmonary involvement.

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Zurkova, Monika; Kolek, Vitezslav; Tomankova, Tereza; Kriegova, Eva

2014-12-01

Patients with pulmonary and pulmonary plus extrapulmonary sarcoidosis differ in symptom severity and health status impairment. To date there is no information on differences in clinical and laboratory parameters between these phenotypes and limited information on extrapulmonary involvement in Czech sarcoidosis patients exists. We therefore compared clinical data (age, gender, organ involvement, lung function tests) and laboratory data (blood counts, bronchoalveolar fluid (BAL) cellular profile, serum levels of CRP, SACE, sIL-2R, neopterin) between patients with newly diagnosed pulmonary sarcoidosis (n=107) and those with pulmonary plus extrapulmonary sarcoidosis (n=54). Extrapulmonary sarcoidosis was diagnosed in 33% of patients, mostly affecting lymph nodes and skin and having hypercalciuria. There was no difference in the prevalence of extrapulmonary sarcoidosis between genders. Patients with extrapulmonary sarcoidosis were older and mostly non-smokers when compared to those with limited pulmonary form. X-ray Stage I and erythema nodosum were less frequent in extrapulmonary disease. Serum levels of CRP, SACE, sIL-2R and neopterin and BAL cellular profile did not differ between both phenotypes. We observed lower platelets, FEV1, VC, and BAL CD19+ in females with extrapulmonary involvement than in those with pulmonary disease. Affected lymph nodes, skin and hypercalciuria were the most common in sarcoidosis patients with extrapulmonary involvement. Pulmonary sarcoidosis did not differ in clinical and routine laboratory parameters from pulmonary plus extrapulmonary sarcoidosis. Observation of low platelets, VC, FEV1 and BAL CD19+ in females with extrapulmonary sarcoidosis needs further verification in larger cohort.

A prospective study evaluating the presence of Rickettsia in Danish patients with sarcoidosis

DEFF Research Database (Denmark)

Svendsen, Claus Bo; Milman, Nils; Nielsen, Henrik Winther

2009-01-01

Rickettsia helvetica has previously been proposed as an aetiological agent in sarcoidosis. The purpose of the present study was to detect possible signs of Rickettsia infection in a Danish population of patients with sarcoidosis. Twenty-six patients with newly diagnosed sarcoidosis were...... interview. Evidence of rickettsial infection was assessed by an immunofluorescence assay testing for antibodies towards Rickettsia as well as specific real-time polymerase chain reaction (PCR) on lung biopsy specimens. We performed fluorescent in situ hybridization (FISH) on the biopsies to detect....... There was no difference in the reported frequency of tick bite between patients and controls. In conclusion, we found no evidence of Rickettsia being involved in the pathogenesis of sarcoidosis in Denmark....

Sudden multiple fractures in a patient with sarcoidosis in multiple organs.

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Sada, Mitsuru; Saraya, Takeshi; Ishii, Haruyuki; Goto, Hajime

2014-04-07

A 30-year-old man who incidentally fractured his right olecranon and other multiple phalanges was admitted to our hospital. He had a 2-year history of uveitis and bilateral hilar lymphadenopathy (BHL), and pulmonary sarcoidosis was diagnosed from transbronchial lung biopsy. Right elbow arthrodesis was performed, and biopsied specimens showed non-caseating epithelioid cell granuloma, suggesting osseous sarcoidosis. He was discharged uneventfully without further treatment, but BHL had progressed with the appearance of lung parenchymal lesions 3 months later. At that time, involvement of other organs was also noted on Gallium-67 scintigraphy, showing accumulations in BHL, axillary and inguinal lymph nodes, enlarged liver and spleen and subcutaneous areas. After initiation of steroid therapy, multiple organ involvement improved, and no further bone involvement has been recognised to date. Osseous sarcoidosis complicated by bone fracture is an extremely rare presentation, but should be considered in patients with sarcoidosis, especially when multiple organs are involved.

A case report of sarcoidosis with review of literature

International Nuclear Information System (INIS)

Han, Man Chung; Ha, Sung Whan; Rhie, Byung Chul; Lee, Pil Woo; Kim, Choo Wan; Choo, Dong Woon; Han, Yong Chul; Lee, Moon Ho; Kim, Yong Il

1974-01-01

Sarcoidosis is uncommon not rare disease in western nations. But in Korea there is no case report of this disease yet. Diagnosis of sarcoidosis is considered established when typical radiological findings and consistent clinical features are present with biopsy evidence of noncaseating epitheliod tubercles or a positive Kveim test. The patient is 40 year old Korean female with complaint of visual disturbance. Chest radiograms show bilateral hilar and paratracheal lymphadenopathy and pulmonary parenchymal involvement. Biopsy of nodule at left knee shows non-caseating tuberculoma. Tuberculin skin-test with PPD of 1:2,000 is negative. Sputum smear for A. F. B. are negative for 4 times. Kveim test is positive. We think that more cases will be found in Korea, if we consider the possibility of sarcoidosis when see a chest radiogram with lymphadenopathy with or without parenchymal change

Immune response CC Chemokines, CCL2 and CCL5 are associated with Pulmonary Sarcoidosis

LENUS (Irish Health Repository)

Palchevskiy, Vyacheslav

2011-04-04

Abstract Background Pulmonary sarcoidosis involves an intense leukocyte infiltration of the lung with the formation of non-necrotizing granulomas. CC chemokines (chemokine (C-C motif) ligand 2 (CCL2)-CCL5) are chemoattractants of mononuclear cells and act through seven transmembrane G-coupled receptors. Previous studies have demonstrated conflicting results with regard to the associations of these chemokines with sarcoidosis. In an effort to clarify previous discrepancies, we performed the largest observational study to date of CC chemokines in bronchoalveolar lavage fluid (BALF) from patients with pulmonary sarcoidosis. Results BALF chemokine levels from 72 patients affected by pulmonary sarcoidosis were analyzed by enzyme-linked immunosorbent assay (ELISA) and compared to 8 healthy volunteers. BALF CCL3 and CCL4 levels from pulmonary sarcoidosis patients were not increased compared to controls. However, CCL2 and CCL5 levels were elevated, and subgroup analysis showed higher levels of both chemokines in all stages of pulmonary sarcoidosis. CCL2, CCL5, CC chemokine receptor type 1 (CCR1), CCR2 and CCR3 were expressed from mononuclear cells forming the lung granulomas, while CCR5 was only found on mast cells. Conclusions These data suggest that CCL2 and CCL5 are important mediators in recruiting CCR1, CCR2, and CCR3 expressing mononuclear cells as well as CCR5-expressing mast cells during all stages of pulmonary sarcoidosis.

Immune response CC chemokines CCL2 and CCL5 are associated with pulmonary sarcoidosis.

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Palchevskiy, Vyacheslav; Hashemi, Nastran; Weigt, Stephen S; Xue, Ying Ying; Derhovanessian, Ariss; Keane, Michael P; Strieter, Robert M; Fishbein, Michael C; Deng, Jane C; Lynch, Joseph P; Elashoff, Robert; Belperio, John A

2011-04-04

Pulmonary sarcoidosis involves an intense leukocyte infiltration of the lung with the formation of non-necrotizing granulomas. CC chemokines (chemokine (C-C motif) ligand 2 (CCL2)-CCL5) are chemoattractants of mononuclear cells and act through seven transmembrane G-coupled receptors. Previous studies have demonstrated conflicting results with regard to the associations of these chemokines with sarcoidosis. In an effort to clarify previous discrepancies, we performed the largest observational study to date of CC chemokines in bronchoalveolar lavage fluid (BALF) from patients with pulmonary sarcoidosis. BALF chemokine levels from 72 patients affected by pulmonary sarcoidosis were analyzed by enzyme-linked immunosorbent assay (ELISA) and compared to 8 healthy volunteers. BALF CCL3 and CCL4 levels from pulmonary sarcoidosis patients were not increased compared to controls. However, CCL2 and CCL5 levels were elevated, and subgroup analysis showed higher levels of both chemokines in all stages of pulmonary sarcoidosis. CCL2, CCL5, CC chemokine receptor type 1 (CCR1), CCR2 and CCR3 were expressed from mononuclear cells forming the lung granulomas, while CCR5 was only found on mast cells. These data suggest that CCL2 and CCL5 are important mediators in recruiting CCR1, CCR2, and CCR3 expressing mononuclear cells as well as CCR5-expressing mast cells during all stages of pulmonary sarcoidosis.

Development of a T7 Phage Display Library to Detect Sarcoidosis and Tuberculosis by a Panel of Novel Antigens

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Harvinder Talwar

2015-04-01

Full Text Available Sarcoidosis is a granulomatous inflammatory disease, diagnosed through tissue biopsy of involved organs in the absence of other causes such as tuberculosis (TB. No specific serologic test is available to diagnose and differentiate sarcoidosis from TB. Using a high throughput method, we developed a T7 phage display cDNA library derived from mRNA isolated from bronchoalveolar lavage (BAL cells and leukocytes of sarcoidosis patients. This complex cDNA library was biopanned to obtain 1152 potential sarcoidosis antigens and a microarray was constructed to immunoscreen two different sets of sera from healthy controls and sarcoidosis. Meta-analysis identified 259 discriminating sarcoidosis antigens, and multivariate analysis identified 32 antigens with a sensitivity of 89% and a specificity of 83% to classify sarcoidosis from healthy controls. Additionally, interrogating the same microarray platform with sera from subjects with TB, we identified 50 clones that distinguish between TB, sarcoidosis and healthy controls. The top 10 sarcoidosis and TB specific clones were sequenced and homologies were searched in the public database revealing unique epitopes and mimotopes in each group. Here, we show for the first time that immunoscreenings of a library derived from sarcoidosis tissue differentiates between sarcoidosis and tuberculosis antigens. These novel biomarkers can improve diagnosis of sarcoidosis and TB, and may aid to develop or evaluate a TB vaccine.

Factors signifying gender differences in clinical presentation of sarcoidosis among Estonian population.

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Lill, Hille; Kliiman, Kai; Altraja, Alan

2016-05-01

Sarcoidosis is endemically prevalent in Northern Europe, but gender differences among the sarcoidosis population have not yet been compositely addressed. To reveal independent factors that formulate gender differences in the presentation of sarcoidosis. All Caucasian patients with confirmed sarcoidosis were recruited from the outpatient department of the Lung Clinic of the Tartu University Hospital, Estonia, between February 2009 and April 2011. Data on demographics, complaints, symptoms, clinical presentation, extrapulmonary manifestations, radiographic stage, lung function parameters and sarcoidosis-related laboratory indices were all drawn from patients' clinical records at presentation. Factors characteristic of female gender were estimated using multivariate logistic regression analysis. Of 230 cases included, there were significantly more females (56.5%, P = 0.005). After adjustment for age, females appeared distinguishable from males by older age [adjusted odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02-1.07], less frequent smoking (OR 0.25, 95% CI 0.13-0.49), higher probability of extrapulmonary complaints (OR 2.06, 95% CI 1.16-3.65) and musculoskeletal sarcoidosis (OR 3.22, 95% CI 1.65-6.29), and after adjustment for both age and smoking status lower forced expiratory volume in 1 s and lung carbon monoxide diffusing coefficient % predicted (OR 0.89, 95% CI 0.82-0.97 and OR 0.98, 95% CI 0.96-0.995, respectively), but by higher forced vital capacity % predicted (OR 1.12, 95% CI 1.03-1.22). Women with sarcoidosis are independently characterized by greater airflow obstruction, lower lung diffusing coefficient, older age, less smoking, and more frequent extrapulmonary complaints and musculoskeletal involvement. This may urge special attention when addressing female patients in both differential diagnostic and management settings. © 2014 John Wiley & Sons Ltd.

Vena cava superior syndrome associated with sarcoidosis

International Nuclear Information System (INIS)

Wurm, K.; Walz, M.; Reidemeister, J.C.; Donhuijsen, K.

1988-01-01

We report the first observation of clinical manifestations of vena cava superior syndrome (VCSS) associated with sarcoidosis. Twenty-four years after the first signs of the disease had been noted, mediastinal lymphomas penetrating the wall of the vena cava superior caused complete obstruction. It is most unusual for the vessel wall to be destroyed in this way, which explains why VCSS is often missed in sarcoidosis. The obstructed vessel was resected and successfully replaced by a Gore-Tex prosthesis. The importance of VCSS for the differential diagnosis is pointed out. Two further peculiarities are the simultaneous occurrence of elevated intraocular pressure and VCSS, and the familial incidence. (orig.) [de

PROGNOSTIC ALGORITHM FOR DISEASE FLOW IN PULMONARY AND THORACIC LYMPH NODES SARCOIDOSIS

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S. A. Terpigorev

2014-01-01

Full Text Available Background: Sarcoidosis is a systemic granulomatosis commonly affecting respiratory system. Variable and often unpredictable flow of the disease provides rationale for the development of prognostic algorithm. Aim: To detect predictive parameters in pulmonary and thoracic lymph nodes sarcoidosis; to develop prognostic algorithm. Materials and methods: The results of examination of 113 patients (85 women and 28 men, 19–77 years old with morphologically verified sarcoidosis has been assessed. Clinical manifestations, functional, radiographic (including CT numerical scores and morphological features of the disease were analyzed against 3-year outcomes in prednisolon/hydroxychloroquine-treated or treatment-naive patients. Results: Radiographic stage, CT-pattern scores, several parameters of pulmonary function tests (DLCO, RV, FEV1, FVC and dyspnoe had the greatest prognostic significance for disease flow. Prognostic accuracy was 87.8% and increased to 94.5% after one-year dynamics of symptoms was taken into account. Therapy with systemic glucocorticosteroids did not influence outcomes in sarcoidosis with asymptomatic enlargement of thoracic lymph nodes. Conclusion: We have developed an algorithm for prognosis assessment in pulmonary sarcoidosis. Taking into account the results of patients follow-up significantly improves the accuracy of the prognosis.

Angiotensin-converting Enzyme as a Predictor of Extrathoracic Involvement of Sarcoidosis.

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Yasar, Zehra; Özgül, Mehmet Akif; Cetinkaya, Erdoğan; Kargi, Aysel; Gül, Şule; Talay, Fahrettin; Tanriverdi, Elif; Dincer, H Erhan

2016-01-18

Sarcoidosis is a multisystem disease, with extrathoracic involvement occurring in 25-50% of patients. Multi-organ involvement is often associated with a more chronic and severe course. The value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in diagnosing extrathoracic involvement in sarcoidosis has been demonstrated; however, because of the radiation dose and high cost, indications for its use must be well defined. Angiotensin-converting enzyme (ACE) is produced by active granuloma cells; thus, serum ACE (sACE) levels may reflect the total granuloma load. In this retrospective study, we evaluated the diagnostic value of sACE in the detection of extrathoracic involvement in sarcoidosis. 43 patients with biopsy-proven sarcoidosis underwent FDG-PET/CT during the initial workup. Positive findings were classified as thoracic and/or extrathoracic. The diagnostic value of sACE was estimated using sensitivity, specificity, and area under the receiver operating characteristic curves (AUCs). Of the 43 patients studied, 17 (39.7%) had extrathoracic involvement. In this group, sACE values were higher than in patients without extrathoracic involvement (331 vs. 150, p=0.002) and correlated positively with extrathoracic involvement (R:0.532 p=0.02). Receiver operator characteristic curve analysis revealed an AUC of 0.816 [95% confidence interval: 0.669-0.963, p=0.002], 70.6% sensitivity and 80% specificity at the sACE cut-off value. In sarcoidosis, extrathoracic involvement may be life threatening or indicative of poor outcome. sACE levels are easily determined and may predict extrathoracic involvement. In patients with sarcoidosis, sACE levels can be used to better define those who would benefit from FDG-PET/CT examination to detect extrathoracic involvement.

[Roentgenological semiotics of sarcoidosis].

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Terpigorev, S A; Stashuk, G A; Dubrova, S E

2008-01-01

The aim of this review was to summarize semiotics of X-ray and CT-observable manifestations of intrathoracic sarcoidosis and clarify the role of conventional X-ray examination and CT (including high resolution CT) in the diagnosis of this disease and its complications. Also analysed are changes in pulmonary parenchyma compared with those detected in morphological studies.

Nodular type of muscular sarcoidosis : a case report

International Nuclear Information System (INIS)

Chae, Soo Hyun; Kim, Hong Soo; Park, Sook Hee; Kim, Sung Me

1999-01-01

Muscular involvement of sarcoidosis is rare and occurs in two forms:nodular and myopathic. In the nodular variety, lesions are long and extend along muscle fibers. Axial MR imaging reveals a star-shaped central structure of decreased signal intensity. Sagittal and coronal MR images show three stripes:an inner stripe of decreased signal intensity and outer stripes of increased signal intensity. Longitudinal sonography shows an echogenic inner stripe and hypoechoic outer stripes. We report a case of nodular- type muscular sarcoidosis in a 53-year-old man, describing the findings of MRI and ultrasonography

Insertion/Deletion Polymorphisms and Serum Angiotensin-converting Enzyme Levels in Iranian Patients with Sarcoidosis

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JAVADI, Alireza; SHAMAEI, Masoud; ZAREI, Masoud; REZAEIAN, Lida; KIANI, Arda; ABEDINI, Atefeh

2016-01-01

Background: Sarcoidosis is a multisystem inflammatory disease of unknown origin with characterization of small granulomas. Angiotensin-converting enzyme (ACE) is a pathophysiologic marker of sarcoidosis. We present the ACE insertion/deletion (I/D) polymorphism in correlation with serum ACE level in Iranian patients with sarcoidosis. Methods: From Jan 2014 to Jan 2015, 102 Iranian patients who histopathologically diagnosed for sarcoidosis and 192 healthy age and sex-matched controls were recruited. PCR was used for detection of I/D polymorphism in ACE gene. Results: Frequency of II/ID/DD genotype in sarcoidosis disease was 17%, 35.5%, and 47.1%, respectively. The frequency of D allele was 0.65. A significant association between I/D genotypes and mean of sACE level was seen (DD=85.2±22.9, P<0.001). More frequent genotype in sarcoidosis patients was DD (47%), ID genotype (45.9%) was found more in controls. Logistic regression analysis adjusting age and sex showed that ID to II (OR=0.35, 95%CI=0.17–0.73, P=0.005) and DD to II (OR=2.11, 95%CI=0.98–4.54, P=0.05) could be considered as a predictor factor for the disease activity. No significant model for men in sarcoidosis group was seen, while women with II/ID were associated with a reduced risk for the disease. Conclusion: Although more regional studies with appropriate statistical scale must be done to provide a better diagnosis and prognostic tool for this disease, this study demonstrates that ID and DD genotype could be predictive factors for sarcoidosis. PMID:28032065

Pancreatic sarcoidosis discovered during Whipple procedure.

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Cook, Jonathan; Spees, Tanner; Telefus, Phillip; Ranaudo, Jeffrey M; Carryl, Stephen; Xiao, Philip

2013-04-04

Pancreatic sarcoidosis is a rare variant of systemic sarcoidosis, with cases described in literature as recently as January 2010. We present here a case of pancreatic involvement with non-caseating granulomas discovered on laparotomy in a patient with a preoperative diagnosis of pancreatic carcinoma. Computer tomography scan without contrast revealed a well-marginated smooth-shaped tumor in the head of the pancreas morphologically consistent with malignancy. During Whipple procedure, the mass was found to be a large lymph node that contained numerous non-caseating granulomas. Radiologically and clinically, non-caseating granulomas of the pancreas are often misdiagnosed as malignant tumor. Special attention given to this differential diagnosis by surgeons, pathologists and clinicians can avoid misdiagnosis and unnecessary treatment. Published by Oxford University Press and JSCR Publishing Ltd. All rights reserved. © The Author 2013.

Upregulation of neurokinin-1 receptor expression in the lungs of patients with sarcoidosis.

LENUS (Irish Health Repository)

O'Connor, Terence M

2012-02-03

Substance P (SP) is a proinflammatory neuropeptide that is secreted by sensory nerves and inflammatory cells. Increased levels of SP are found in sarcoid bronchoalveolar lavage fluid. SP acts by binding to the neurokinin-1 receptor and increases secretion of tumor necrosis factor-alpha in many cell types. We sought to determine neurokinin-1 receptor expression in patients with sarcoidosis compared with normal controls. Neurokinin-1 receptor messenger RNA and protein expression were below the limits of detection by reverse transcriptase-polymerase chain reaction and immunohistochemistry in peripheral blood mononuclear cells of healthy volunteers (n = 9) or patients with stage 1 or 2 pulmonary sarcoidosis (n = 10), but were detected in 1\\/9 bronchoalveolar lavage cells of controls compared with 8\\/10 patients with sarcoidosis (p = 0.012) and 2\\/9 biopsies of controls compared with 9\\/10 patients with sarcoidosis (p = 0.013). Immunohistochemistry localized upregulated neurokinin-1 receptor expression to bronchial and alveolar epithelial cells, macrophages, lymphocytes, and sarcoid granulomas. The patient in whom neurokinin-1 receptor was not detected was taking corticosteroids. Incubation of the type II alveolar and bronchial epithelial cell lines A549 and SK-LU 1 with dexamethasone downregulated neurokinin-1 receptor expression. Upregulated neurokinin-1 receptor expression in patients with sarcoidosis may potentiate substance P-induced proinflammatory cytokine production in patients with sarcoidosis.

Use of contrast-enhanced ultrasonography in hepatosplenic sarcoidosis: Report of 2 cases

International Nuclear Information System (INIS)

Grzelak, Piotr; Augsburg, Lukasz; Majos, Agata; Stefanczyk, Ludomir; Gorski, Paweł; Piotrowski, Wojciech; Antczak, Adam

2012-01-01

Sarcoidosis is a multisystemic granulomatous disease of unknown etiology that predominantly affects lungs and intrathoracic lymph nodes; in rare cases (approx. 10%), infiltration of the spleen and liver may be observed. In order to identify hepatosplenic infiltration, MRI/CT of the abdomen and different ultrasound techniques (PD US, US D) are usually performed. Contrast enhanced ultrasound (CEUS) is a new technique in this diagnostic algorithm, but the fact that this is a safe, accurate, and widely available method opens a new perspective for the detection of abdominal lesions in sarcoidosis. We report 2 cases of hepatosplenic sarcoidosis – a 41-year-old woman with splenic lesions and a 46-year-old man with liver infiltration. On the basis of these 2 cases we intended to show the diagnostic potential of contrast enhanced ultrasound for the recognition of focal lesions of the spleen and liver in patients suffering from sarcoidosis

Cryptococcal pyarthrosis and sarcoidosis

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Geller, David S.; Pope, John B. [Albert Einstein College of Medicine, Montefiore Medical Center, Department of Orthopaedic Surgery, Bronx, NY (United States); Thornhill, Beverly A. [Albert Einstein College of Medicine, Montefiore Medical Center, Department of Radiology, Musculoskeletal Radiology, Bronx, NY (United States); Dorfman, Howard D. [Albert Einstein College of Medicine, Montefiore Medical Center, Section of Orthopaedic Pathology, Bronx, NY (United States)

2009-07-15

Cryptococcus neoformans is an infrequent cause of septic arthritis. Cryptococcal infections have been linked to sarcoidosis because of both inherent immunologic consequences of the disease and its typical immune modulating treatments. Cryptococcal infections should be suspected in patients with underlying immune deficiencies, and a high degree of vigilance should be exercised to avoid misdiagnosis, dissemination of infection, and meningitis. (orig.)

Health-related quality of life in adult survivors of childhood sarcoidosis

DEFF Research Database (Denmark)

Milman, Nils; Svendsen, Claus Bo; Hoffmann, Anne Lisbeth

2009-01-01

AIM: To describe health-related quality of life (hrQOL) in adult subjects who had sarcoidosis in childhood. METHODS: Forty-six children (24 boys), all ethnic Danes......AIM: To describe health-related quality of life (hrQOL) in adult subjects who had sarcoidosis in childhood. METHODS: Forty-six children (24 boys), all ethnic Danes...

Acute kidney injury with granulomatous interstitial nephritis and vasculitis revealing sarcoidosis

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Amel Harzallah

2017-01-01

Full Text Available Sarcoidosis is an inflammatory disease that affects mostly the lungs and lymph glands. Renal involvement is rare and especially vasculitis. We report a case who presented an acute kidney failure and had sarcoidosis with vasculitis and nodular splenic involvement. A 35-year-old woman presenting a Lofgren syndrome was hospitalized for acute renal failure with cervical lymphadenopathy without other clinical findings. Laboratory data disclosed elevated angiotensin converting enzyme serum level. Abdominal ultrasound showed a multinodular spleen. Renal histology revealed granulomatous interstitial nephritis with necrotizing vasculitis. Outcome was favorable after the institution of high dose corticosteroids along with cyclophosphamide. Renal involvement is rare in sarcoidosis. However, the diagnostic delay should be avoided to improve the outcome.

Acute kidney injury with granulomatous interstitial nephritis and vasculitis revealing sarcoidosis.

Science.gov (United States)

Harzallah, Amel; Kaaroud, Hayet; Boubaker, Karima; Barbouch, Samia; Goucha, Rim; Hamida, Fethi Ben; Abdallah, Taieb Ben

2017-01-01

Sarcoidosis is an inflammatory disease that affects mostly the lungs and lymph glands. Renal involvement is rare and especially vasculitis. We report a case who presented an acute kidney failure and had sarcoidosis with vasculitis and nodular splenic involvement. A 35-year-old woman presenting a Lofgren syndrome was hospitalized for acute renal failure with cervical lymphadenopathy without other clinical findings. Laboratory data disclosed elevated angiotensin converting enzyme serum level. Abdominal ultrasound showed a multinodular spleen. Renal histology revealed granulomatous interstitial nephritis with necrotizing vasculitis. Outcome was favorable after the institution of high dose corticosteroids along with cyclophosphamide. Renal involvement is rare in sarcoidosis. However, the diagnostic delay should be avoided to improve the outcome.

In-Hospital Disease Burden of Sarcoidosis in Switzerland from 2002 to 2012.

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Pohle, Susanne; Baty, Florent; Brutsche, Martin

2016-01-01

Sarcoidosis is a multisystem disease with an unpredictable and sometimes fatal course while the underlying pathomechanism is still unclear. Reasons of the increasing hospitalization rate and mortality in the United States remain in dispute but incriminated are a number of distinct comorbidities and risk factors as well as the application of more aggressive therapeutic agents. Studies reflecting the recent development in central Europe are lacking. Our aim was to investigate the recent mortality and hospitalization rates as well as the underlying comorbidities of hospitalized sarcoidosis patients in Switzerland. In this longitudinal, nested case-control study, a nation-wide database provided by the Swiss Federal Office for Statistics enclosing every hospital entry covering the years 2002-2012 (n = 15,627,573) was analyzed. There were 8,385 cases with a diagnosis of sarcoidosis representing 0.054% (8,385 / 15,627,573) of all hospitalizations in Switzerland. These cases were compared with age- and sex-matched controls without the diagnosis of sarcoidosis. Hospitalization and mortality rates in Switzerland remained stable over the observed time period. Comorbidity analysis revealed that sarcoidosis patients had significantly higher medication-related comorbidities compared to matched controls, probably due to systemic corticosteroids and immunosuppressive therapy. Sarcoidosis patients were also more frequently re-hospitalized (median annual hospitalization rate 0.28 [IQR 0.15-0.65] vs. 0.19 [IQR 0.13-0.36] per year; p < 0.001), had a longer hospital stay (6 [IQR 2-13] vs. 4 [IQR 1-8] days; p < 0.001), had more comorbidities (4 [IQR 2-7] vs. 2 [IQR 1-5]; p < 0.001), and had a significantly higher in-hospital mortality (2.6% [95% CI 2.3%-2.9%] vs. 1.8% [95% CI 1.5%-2.1%] (p < 0.001). A worse outcome was observed among sarcoidosis patients having co-occurrence of associated respiratory diseases. Moreover, age was an important risk factor for re-hospitalization.

Sarcoidosis: Case Presentation and Literature Review

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Dayana Alomá Fortún

2016-09-01

Full Text Available Sarcoidosis is a systemic disease of unknown etiology in which infectious agents have been implicated, inorganic powders or organic substances, characterized by the presence of necrotizing granulomatous inflammation with no accumulation of CD4 + lymphocytes and monocytes in the affected tissues. It is presented the case of a patient who went to the General University Hospital Dr. Gustavo Aldereguía Lima of Cienfuegos reporting dry cough, fever, chest tightness and slight weight loss three of three months evolution which did not improve despite receiving treatment in his health area. After several studies it was diagnosed a proliferative pulmonary sarcoidosis, systemic granulomatous disease whose etiology remains anonymous. Biopsy remains the basis for definitive diagnosis. As this is a difficult entity to explain and understand, besides being scarcely diagnosed in our area, it is decided to present that clinical case.

Sarcoidosis and multiple myeloma: Concurrent presentation of an unusual association

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Vidya Nair

2016-01-01

Full Text Available Literature on concurrent association of sarcoidosis with lymphoproliferative malignancies other than lymphoma e.g. multiple myeloma is meager. The rarity of the situation prompted us to report this patient who was a 51-year-old woman with a 2-years history of breathlessness, cough with expectoration, chest pain and backache. Initial evaluation revealed mild anemia, increased alkaline phosphatase with chest skiagram showing both lower zone non homogenous opacities with calcified hilar lymph nodes. CECT chest showed mediastinal with bilateral hilar lymphadenopathy, parenchymal fibrosis, traction bronchiectasis, ground glass opacities, septal and peribronchovascular thickening affecting mid and lower lung zones bilaterally. MRI Dorsolumbar spine was suggestive of marrow infiltrative disorder. EBUS FNA of intrathoracic nodes, EBB and TBLB confirmed sarcoidosis. PET CT revealed hyper metabolic activity in lung, multiple lymph nodes and lytic bone lesions. Serum protein electrophoresis and immunofixation revealed a monoclonal paraprotein, immunoglobulin IgG kappa type. Bone marrow biopsy revealed an increase in plasma cells (15%, but no granulomas. Diagnosis of Indolent or multiple myeloma with sarcoidosis was established. 12 cases of sarcoidosis and multiple myeloma have been reported in literature, and mostly preceding the onset of multiple myeloma by many years, in our case both were diagnosed concurrently.

Sarcoidosis in Denmark 1980-1994. A registry-based incidence study comprising 5536 patients

DEFF Research Database (Denmark)

Byg, Keld-Erik; Milman, Nils; Hansen, Stig

2003-01-01

BACKGROUND AND AIM: To evaluate the incidence of sarcoidosis in Denmark 1980-1994. METHODS: Patients with a diagnosis of sarcoidosis were identified from the Danish National Patient Registry. The file contained information about the year in which the diagnosis was reported, gender, age, and resid......BACKGROUND AND AIM: To evaluate the incidence of sarcoidosis in Denmark 1980-1994. METHODS: Patients with a diagnosis of sarcoidosis were identified from the Danish National Patient Registry. The file contained information about the year in which the diagnosis was reported, gender, age......, and residential county. RESULTS: 5536 persons (2816 men) with sarcoidosis were registered. Median age in men was 38 years, in women 45 years. The male/female incidence ratio was 1.06. The incidence (per 100,000 person years) declined gradually from 8.1 in 1980-1984 to 6.4 in 1990-1994. The overall incidence...... (11.0). CONCLUSION: Incidence rates in the present study are lower compared with previous mass-screening surveys showing an incidence rate of 13.8 (in persons examined). Peak incidences occurred at higher ages in both men and women. Previous surveys showed peak incidences at 20-25 years in men...

Distance saturation product predicts health-related quality of life among sarcoidosis patients.

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Bourbonnais, Julie M; Malaisamy, Subramanian; Dalal, Bhavinkumar D; Samarakoon, Priyan C; Parikh, Swapna R; Samavati, Lobelia

2012-06-13

Sarcoidosis is a chronic disease with different phenotypic manifestations. Health-related quality of life is an important aspect in sarcoidosis, yet difficult to measure. The objective of this study was to identify clinical markers predictive of poor quality of life in sarcoidosis patients that can be followed over time and targeted for intervention. We assessed the quality of life of 162 patients with confirmed sarcoidosis in a prospective, cross-sectional study using the Sarcoidosis Health Questionnaire (SHQ) and Short Form-36 Health Survey (SF-36). We evaluated the validity of these questionnaires and sought to identify variables that would best explain the performance scores of the patients. On multivariate regression analyses, the very best composite model to predict total scores from both surveys was a model containing the distance-saturation product and Borg Dyspnea Scale score at the end of a 6-min walk test. This model could better predict SF-36 scores (R² = 0.33) than SHQ scores (R² = 0.24). Substitution of distanced walked in 6 min for the distance-saturation product in this model resulted in a lesser ability to predict both scores (R² = 0.26 for SF-36; R² = 0.22 for SHQ). Both the SHQ and SF-36 surveys are valuable tools in the assessment of health-related quality of life in sarcoidosis patients. The best model to predict quality of life among these patients, as determined by regression analyses, included the distance-saturation product and Borg score after the 6-min walk test. Both variables represent easily obtainable clinical parameters that can be followed over time and targeted for intervention.

Association between angiotensin II receptor gene polymorphism and serum angiotensin converting enzyme (SACE) activity in patients with sarcoidosis.

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Takemoto, Y; Sakatani, M; Takami, S; Tachibana, T; Higaki, J; Ogihara, T; Miki, T; Katsuya, T; Tsuchiyama, T; Yoshida, A; Yu, H; Tanio, Y; Ueda, E

1998-06-01

Serum angiotensin converting enzyme (SACE) is considered to reflect disease activity in sarcoidosis. SACE activity is increased in many patients with active sarcoid lesions. The mechanism for the increased SACE activity in this disease has not been clarified. ACE insertion/deletion (I/D) gene polymorphism has been reported to have an association with SACE levels in sarcoidosis, but no evidence of an association between angiotensin II receptor gene polymorphism and SACE in this disease has been found. A study of the association of angiotensin II receptor gene polymorphisms with sarcoidosis was therefore undertaken. ACE (I/D), angiotensin II type 1 receptor (AGTR1), and angiotensin II type 2 receptor (AGTR2) gene polymorphisms were investigated by polymerase chain reaction (PCR) and SACE levels were measured in three groups of patients: those with sarcoidosis or tuberculosis and normal controls. There was no difference in allele frequency of AGTR1 and AGTR2 polymorphism among the three groups. Neither AGTR1 nor AGTR2 polymorphisms were associated with sarcoidosis. SACE activity was higher in patients with sarcoidosis with the AGTR1 A/C genotype than in others. However, this tendency was not detected in patients with tuberculosis. The AGTR1 allele C is associated with high activity of SACE in patients with sarcoidosis. It is another predisposing factor for high levels of SACE in patients with sarcoidosis and is considered to be an independent factor from the ACE D allele for high levels of SACE in sarcoidosis. This fact could be one of the explanations for the increased SACE activity in sarcoidosis.

Sarcoidosis in a dental surgeon: a case report

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Mattia Daniele

2010-08-01

Full Text Available Abstract Introduction Although the causes of sarcoidosis are still unknown, past and current studies have provided evidence that this disease may be associated with occupational exposure to specific environmental agents. We describe a case of sarcoidosis in a dental surgeon with long exposure to inorganic dusts. To the best of our knowledge, this is the first report of this kind in the literature. Case presentation At the beginning of 2000, a 52-year-old Caucasian man, who worked as a dental surgeon, presented with shortness of breath during exercise, cough and retrosternal pain. After diagnosis of sarcoidosis, a scanning electronic microscopy with X-ray microanalysis of biopsy specimens was used in order to determine whether the disease could be traced to an occupational environmental agent. Results showed the presence of inorganic dust particles within sarcoidotic granulomas, and demonstrated that the material detected was identical to that found in a powder used by our patient for several years. Conclusions Although these results cannot be considered as definitive proof, they do however provide strong evidence that this disease may be associated with material used by dental surgeons.

Vertebral sarcoidosis: long-term follow-up with MRI

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Lefere, M. [University Hospitals Gasthuisberg, Department of Radiology, Leuven (Belgium); Larbi, A.; Malghem, J.; Vande Berg, B.; Dallaudiere, B. [University Hospitals St Luc, Department of Radiology, Brussels (Belgium)

2014-08-15

Vertebral involvement in sarcoidosis is rare and its clinical and imaging features are non-specific. Indeed, because the lesions are hard to differentiate from metastatic disease based on imaging alone, a histological confirmation is advised. Fatty replacement is a well-known finding indicating stabilization and healing in both benign and malignant conditions. It can be used as an indicator of a favorable disease course and response to treatment. We report the case of a 43-year-old woman with multifocal vertebral sarcoidosis lesions and long-term follow-up showing progressive and gradual fatty involution on magnetic resonance imaging (MRI) during 4 years of steroid treatment with a final favorable outcome. (orig.)

Esophagitis dissecans associated with eosinophilic esophagitis in an adolescent

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Marjorie-Anne R. Guerra

2015-03-01

Full Text Available Esophagitis dissecans superficialis and eosinophilic esophagitis are distinct esophageal pathologies with characteristic clinical and histologic findings. Esophagitis dissecans superficialis is a rare finding on endoscopy consisting of the peeling of large fragments of esophageal mucosa. Histology shows sloughing of the epithelium and parakeratosis. Eosinophilic esophagitis is an allergic disease of the esophagus characterized by eosinophilic inflammation of the epithelium and symptoms of esophageal dysfunction. Both of these esophageal processes have been associated with other diseases, but there is no known association between them. We describe a case of esophagitis dissecans superficialis and eosinophilic esophagitis in an adolescent patient. To our knowledge, this is the first case describing an association between esophageal dissecans superficialis and eosinophilic esophagitis.

Sarcoidosis in Ireland: regional differences in prevalence and mortality from 1996-2005.

LENUS (Irish Health Repository)

Nicholson, T T

2010-07-01

Sarcoidosis is a common multisystem disease of unknown cause and Ireland is among the countries with the highest reported prevalence of disease worldwide. Despite this, reports on the geographical distribution of disease and differences in mortality due to sarcoidosis within Northern Ireland (NI) and the Republic of Ireland (ROI) are currently lacking.

The impact of ACE gene polymorphism on the incidence and phenotype of sarcoidosis in rural and urban settings.

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Kieszko, Robert; Krawczyk, Paweł; Powrózek, Tomasz; Szudy-Szczyrek, Aneta; Szczyrek, Michał; Homa, Iwona; Daniluk, Jadwiga; Milanowski, Janusz

2016-12-01

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Current theory on the etiology of this disease involves participation of genetic factors and unknown antigens present in the patients' environment. The aim of the study was to evaluate the prevalence of different polymorphic forms of the ACE gene in healthy individuals and sarcoidosis patients, and to estimate the risk of sarcoidosis in carriers of different ACE genotypes living in rural and urban settings. The study group included 180 patients with pulmonary sarcoidosis. Assessment of the disease was based on clinical features, laboratory and imaging examinations, as well as bronchoscopy with bronchoalveolar lavage (BAL). ACE gene polymorphism was examined in DNA isolated from peripheral blood or BAL fluid (BALF) leukocytes. Incidence of sarcoidosis was not influenced by gender, age or place of residence of the patients. There were no differences in the frequency of particular genotypes in patients with sarcoidosis and in healthy individuals. The risk of disease did not depend on the ACE gene polymorphism. There were no differences in the frequencies of the different genotypes and alleles of the ACE gene in patients with sarcoidosis divided by gender, age and place of residence or by clinical manifestation of sarcoidosis. Our results do not support the previous concept which suggested a higher incidence of sarcoidosis in individuals living in rural areas and in carriers of selected ACE genotypes. It is possible that this is related to the changing environment of rural areas, increasing urbanization and pollution.

Two cases of esophageal eosinophilia: eosinophilic esophagitis or gastro-esophageal reflux disease?

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Ozlem Yilmaz

2014-06-01

Full Text Available Eosinophilic esophagitis (EoE and gastro-esophageal reflux disease are among the major causes of isolated esophageal eosinophilia. Isolated esophageal eosinophilia meeting criteria for EoE may respond to proton pump inhibitor (PPI treatment. This entity is termed proton pumps inhibitor responsive esophageal eosinophilia (PPI-REE. Gastro-esophageal reflux is thought to comprise a subgroup of patients with PPI-REE. According to the latest guidelines, PPI responsiveness distinguishes people with PPI-REE from patients having EoE (non-responders. In this report, two unusual cases with findings belonging to both EoE and PPI-REE are discussed with known and unknown facts.

Acute kidney injury with granulomatous interstitial nephritis and vasculitis revealing sarcoidosis

OpenAIRE

Amel Harzallah; Hayet Kaaroud; Karima Boubaker; Samia Barbouch; Rim Goucha; Fethi Ben Hamida; Taieb Ben Abdallah

2017-01-01

Sarcoidosis is an inflammatory disease that affects mostly the lungs and lymph glands. Renal involvement is rare and especially vasculitis. We report a case who presented an acute kidney failure and had sarcoidosis with vasculitis and nodular splenic involvement. A 35-year-old woman presenting a Lofgren syndrome was hospitalized for acute renal failure with cervical lymphadenopathy without other clinical findings. Laboratory data disclosed elevated angiotensin converting enzyme serum level. A...

Cutaneous sarcoidosis in a patient with severe asthma treated with omalizumab

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Yung, Samuel; Han, Duhyun; Lee, Jason K

2015-01-01

Omalizumab, a monoclonal anti-immunoglobulin E antibody, has been used as an effective treatment for severe asthma associated with atopy over the past decade. Sarcoidosis is an idiopathic granulomatous disorder in which first-line treatment is usually glucocorticoids. To the authors’ knowledge, the present report describes the first case of an association between omalizumab therapy and revelation of cutaneous sarcoidosis with the withdrawal of systemic glucocorticoids. A 56-year-old woman with severe allergic asthma dependent on oral prednisone initiated omalizumab treatment. As her symptoms of asthma improved over the course of a year, her prednisone was gradually tapered. After being off glucocorticoids, she developed skin nodules that had biopsy characteristics of sarcoidosis. The present case illustrates the need to monitor closely for potential unmasking of glucocorticoid-responsive conditions when transitioning from systemic glucocorticoids to omalizumab therapy. PMID:26401982

Papulo-Nodular Reactions in Black Tattoos as Markers of Sarcoidosis: Study of 92 Tattoo Reactions from a Hospital Material.

Science.gov (United States)

Sepehri, Mitra; Hutton Carlsen, Katrina; Serup, Jørgen

2016-01-01

Sarcoidosis is, from historical data, suggested to be more prevalent among patients with tattoo reactions. We aimed to evaluate this association in a systematic study. This is a consecutive study of patients with tattoo complications, diagnosed in the "Tattoo Clinic" at Bispebjerg University Hospital in Copenhagen, Denmark, from 2008 to 2015, based on clinical assessment and histology. From the overall group of 494 tattoo complications in 406 patients, 92 reactions in 72 patients showed a papulo-nodular pattern studied for local and systemic sarcoidosis, since sarcoidosis is expected to be nodular. Of the 92 reactions with a papulo-nodular pattern, 27 (29%) reactions in 19 patients were diagnosed as cutaneous or systemic sarcoidosis, supported by histology; 65 (71%) were diagnosed as non-sarcoidosis due to histology and no clinical sarcoid manifestations. "Rush phenomenon" with concomitant reaction in many other black tattoos, triggered by a recent tattoo with a papulo-nodular reaction, was observed in 70% in the sarcoidosis group and 28% in the non-sarcoidosis group, indicating a predisposing factor which may be autoimmune and linked with sarcoidosis. Agglomerates of black pigment forming foreign bodies may in the predisposed individual trigger widespread reaction in the skin and internal organs. Black tattoos with papulo-nodular reactions should be seen as markers of sarcoidosis. Papulo-nodular reactions may, as triggers, induce widespread reactions in other black tattoos - a "rush phenomenon" - depending on individual predisposition. Sarcoidosis is estimated to be 500-fold increased in papulo-nodular reactions compared to the prevalence in the general population, and the association with black tattoos is strong. © 2017 S. Karger AG, Basel.

Activated alveolar macrophage and lymphocyte alveolitis in extrathoracic sarcoidosis without radiological mediastinopulmonary involvement

International Nuclear Information System (INIS)

Wallaert, B.; Ramon, P.; Fournier, E.C.; Prin, L.; Tonnel, A.B.; Voisin, C.

1986-01-01

Cellular characteristics of BAL were investigated in 18 patients with proved extrathoracic sarcoidosis (that is, sarcoidosis that affected the skin, eyes, parotid glands, stomach, nose, kidneys, or meninges) without clinical or radiological mediastinopulmonary involvement. Computed tomography of the thorax was performed on five patients: four patients were normal, and one had enlarged lymph nodes (these enlargements were not detectable on the patient's chest roentgenogram). The results of pulmonary function tests were normal in all patients. The total BAL cell count did not differ significantly between controls and patients. Abnormal percentages of alveolar lymphocytes (from 18 to 87%) were noted in 15 out of 18 patients. SACE levels were normal in 15 patients. No pulmonary gallium uptake was detected. The chemiluminescence of AM's, whether spontaneous or PMA induced, was increased in five out of seven patients. The percentages of T3+ lymphocytes in sarcoidosis patients did not significantly differ from those in controls. The T4+:T8+ ratio was normal in four patients and slightly increased in one. Follow-up of patients showed that alveolar lymphocytosis is as lasting as extrathoracic involvement. Our data demonstrate increased percentages of lymphocytes and activated AM's in the BAL of patients with extrathoracic sarcoidosis. This may be due to the initial involvement of the respiratory tract in extrathoracic sarcoidosis or to the diffusion of activated macrophages and lymphocytes from an extrathoracic site into the lung

Quantitative evaluation of regional blood flow in pulmonary sarcoidosis with Bull's eye analysis

International Nuclear Information System (INIS)

Akaki, Shiro

1991-01-01

Lung perfusion scintigraphy was performed in 23 patients with pulmonary sarcoidosis and in 11 normal volunteers. Bull's eye analysis was used to analyze regional pulmonary blood flow quantitatively. First, whole lung perfusion images were divided into three regions by three concentric circles. Then radial axes were projected from the center to define 36 x 10deg sectors. The counts for each sector were calculated and a Bull's eye image was displayed. The counts were compared with the lower limit of normal (mean -2SD), and as the indices of reduction in perfusion, extent score (ES) and severity score (SS) were calculated. ES and SS showed significant reduction in perfusion 16 patients (70%) with sarcoidosis. In stage II sarcoidosis, both ES and SS were significantly higher than in stage I sarcoidosis (p 67 Ga scintigraphy findings. In comparison with clinical data, ES had a positive correlation with serum angiotensin-converting enzyme activity (p + /CD8 + ratio (p<0.05). The Bull's eye analysis was considered useful for the quantitative evaluation of regional pulmonary blood flow in pulmonary sarcoidosis, and it was suggested that the mechanism of reduction in perfusion might result mainly in its alveolitis and angitis. Ventilation abnormality, which may happen prior to reduction in perfusion, may be an important factor of reduction in perfusion. (author)

Systemic sarcoidosis complicated of acute renal failure: about 12 cases.

Science.gov (United States)

Mahfoudhi, Madiha; Mamlouk, Habiba; Turki, Sami; Kheder, Adel

2015-01-01

The sarcoidosis is a systemic granulomatosis affecting most frequently the lungs and the mediastinum. An acute renal failure reveals exceptionally this disease. It's a retrospective study implicating 12 cases of sarcoidosis complicated of acute renal failure. The aim of this study is to determine epidemiological, clinical, biological and histological profile in these cases and then to indicate the interest to consider the diagnosis of sarcoidosis in cases of unexplained renal failure. Extra-renal complications, therapeutic modalities and the outcome were determined in all patients. Our series involved 12 women with an average age of 40 years. Biological investigations showed an abnormal normocalcemia in 7 cases, a hypercalcemia in 5 cases, a hypercalciuria in 10 cases and polyclonal hypergammaglobulinemia in 7 cases. An acute renal failure was found in all patients with a median creatinin of 520 umol/L. For all patients, the renal echography was normal however, the kidney biopsy showed tubulo-interstitial nephritis. The extra-renal signs highlighting pulmonary interstitial syndrome in 5 cases, a sicca syndrome in 4 cases, mediastinal lymph nodes in 2 cases, a lymphocytic alveolitis in 3 cases, an anterior granulomatous uveitis in 2 cases and a polyarthritis in 5 cases. Five patients benefited of hemodialysis. The treatment consisted of corticosteroid in all cases. The follow up was marked by complete resolution of clinical and biological signs. The diagnosis of renal sarcoidosis must be done quickly to prevent renal failure.

Incidence of respiratory tract sarcoidosis in southern and northern regions of Ukraine

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Gumenyuk G.L.

2014-06-01

Full Text Available We conducted a comparative survey of incidence and prevalence of pulmonary sarcoidosis in Southern (Crimean AR and Northern (Zhytomyr region regions of Ukraine by means of analysis of self-referred cases and cases, revealed at prophylactic radiological examination in 2011. The incidence of sarcoidosis in Crimea was 1.08 per 100 000 adult inhabitants; the prevalence was 4,59 per 100 000. In Zhytomyr region the incidence value (2,62 per 100 000 exceeded an equivalent value in Crimea by 2,4 times. The prevalence (7,86 per 100 000 was also higher than in Crimea by 1,7 times. Taking into account a significant impact of climate factor on sarcoidosis epidemiology, the incidence and prevalence of disease in Northern and Southern regions should be considered polar as for the regions of Ukraine. This makes it possoble to conclude that mean incidence of sarcoidosis in Ukraine ranges from 1,1 to 2,6 per 100 000 adult population, whereas the prevalence – from 4,6 to 7,9 per 100 000, which is equivalent to the level of Southern European countries.

Unmasking sarcoidosis following surgery for Cushing disease

DEFF Research Database (Denmark)

Diernæs, Jon Erik; Bygum, Anette; Poulsen, Per L

2016-01-01

We present a patient with Cushing disease apparently suppressing sarcoidosis, which was unmasked following surgical resection of a pituitary adrenocorticotropin (ACTH)-producing microadenoma. Case report and a short review of the literature published in this area. A 46-year-old Caucasian woman pr...... successful treatment of Cushing syndrome may have a flare-up or emergence of a corticosteroid-responsive disease.......We present a patient with Cushing disease apparently suppressing sarcoidosis, which was unmasked following surgical resection of a pituitary adrenocorticotropin (ACTH)-producing microadenoma. Case report and a short review of the literature published in this area. A 46-year-old Caucasian woman...... for which the patient underwent transphenoidal resection. Maintenance corticosteroid therapy was implemented, and the signs and symptoms of Cushing disease began to resolve. Three months after surgery, multiple erythematous painful nodules developed on the patient's arms. Erythema nodosum (EN) was diagnosed...

Association between ACE gene I/D polymorphism and clinical presentation and prognosis of sarcoidosis.

Science.gov (United States)

Alía, P; Mañá, J; Capdevila, O; Alvarez, A; Navarro, M A

2005-01-01

Serum angiotensin converting enzyme (SACE) concentration is considered a marker of sarcoidosis activity. This concentration is influenced by an insertion/deletion (I/D) polymorphism of the ACE gene, such that SACE levels follow the pattern DD>ID>II. The aim of our work was to study the relationship between I/D polymorphism and susceptibility to sarcoidosis, as well as the relation between this polymorphism and the clinical presentation and evolution of the disease in 177 sarcoidosis patients. A group of 104 individuals without sarcoidosis was included as control. Genotyping was done by a polymerase chain reaction (PCR) method, and SACE concentration at diagnosis was determined by a kinetic method. No differences were observed in genotype or allele distributions between patients and controls, nor between patients considering the type of presentation (Löfgren versus non-Löfgren) and evolution of the disease (acute versus chronic). As reported for healthy populations, SACE concentrations followed the pattern DD>ID>II in sarcoidosis patients, but significant differences between genotypes existed only in the Löfgren group (p = 0.003) and in acute patients (p = 0.02). SACE concentrations at diagnosis were lower in acute patients (p = 0.05) and in Löfgren's syndrome (p = 0.04), but this seemed to occur only in ID individuals (p = 0.02 and p = 0.01, respectively). No relation was thus found between I/D polymorphism and susceptibility to sarcoidosis, but ACE I/D genotyping may improve the assessment of disease activity, both at diagnosis and during the follow-up of treated and untreated patients.

Esophageal heterotopic gastric mucosa in esophageal atresia

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Lachlan J.R. Harrison

2018-05-01

Full Text Available Heterotopic gastric mucosa (HGM is occasionally found at endoscopy in the proximal esophagus of adults and children, when it manifests as an asymptomatic small island of reddish pink mucosa just below the upper esophageal sphincter. There are few reports of esophageal HGM detected by endoscopy after repair of esophageal atresia (EA with tracheo-esophageal fistula (TEF. We report a child with multiple patches of HGM in the proximal and distal esophagus seen at endoscopy after EA/TEF repair. No obvious symptoms were related to the HGM and she remains under endoscopic surveillance. The incidence of esophageal HGM may be increased in patients with EA and its distribution can be more extensive than a simple “inlet patch”. There is evidence to suggest that esophageal HGM increases the risk of developing Barrett's esophagus and has a malignant potential. Heterotopic gastric mucosa extends the spectrum of potential pathologies affecting the esophagus in patients with EA/TEF and supports current international guidelines for endoscopic surveillance of these patients. Keywords: Tracheo-esophageal fistula, Ectopic mucosa, Esophageal malignancy

Somatostatin receptor scintigraphy in sarcoidosis: relation to selected clinical and laboratory markers.

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Piotrowski, Wojciech J; Bieńkiewicz, Małgorzata; Frieske, Izabella; Marczak, Jerzy; Antczak, Adam; Górski, Paweł; Kuśmierek, Jacek; Płachcińska, Anna

2012-01-01

Discriminating between active and inactive sarcoidosis may be problematic in everyday clinical practice. There are numerous biochemical markers used in the diagnosis and monitoring of sarcoidosis. Somatostatin receptor (SR) scintigraphy with the use of 99mTc-octreotide may be used to estimate disease activity. The aim of the paper was to assess the value of traditional biomarkers (serum angiotensin-converting enzyme [SACE], C-reactive protein, markers of calcium metabolism, bronchoalveolar lavage fluid [BALF] lymphocytes) and a novel biomarker, 8-isoprostane (8-IP) in exhaled breath condensate (EBC), in the assessment of sarcoidosis activity in relation to somatostatin receptor scintigraphy. The study included 32 patients with sarcoidosis. Scintigraphy was performed using somatostatin analogue, 99mTc-HYNIC-TOC; planar and SPECT/CT images were recorded. The study group was divided into a subgroup with positive radiotracer uptake (n = 20) and without a visible uptake (n = 12). 8-IP levels were measured in EBC by an immunoenzymatic assay. RESULTS We observed a significantly higher EBC 8-IP levels in the subgroup with positive uptake compared with those with negative uptake (19.1 ± 19.8 vs. 5.4 ± 3.5 pg/ml, P = 0.02). The levels of SACE and the percentage of BALF lymphocytes were also nonsignificantly elevated. In the group of patients with positive scintigraphy results, a positive correlation was observed between the uptake ratio and SACE (r = 0.44, P = 0.041). The results indicate low value of biochemical markers in the assessment of disease activity. SR scintigraphy may have practical usefulness in the monitoring of sarcoidosis.

The Diversity of Juvenile Sarcoidosis Symptoms

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O. Vougiouka

2012-01-01

Full Text Available We report a case of juvenile sarcoidosis, emphasizing the variety of clinical manifestations. The child had uveitis, which is among the most common manifestations of the disease. However, fever of unknown origin, glomerulonephritis and lymphadenopathy were also noticed, underscoring the diversity of the clinical spectrum of the disease.

Chest computed tomography-based scoring of thoracic sarcoidosis: Inter-rater reliability of CT abnormalities

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Heuvel, D.A.V. den; Es, H.W. van; Heesewijk, J.P. van; Spee, M. [St. Antonius Hospital Nieuwegein, Department of Radiology, Nieuwegein (Netherlands); Jong, P.A. de [University Medical Center Utrecht, Department of Radiology, Utrecht (Netherlands); Zanen, P.; Grutters, J.C. [University Medical Center Utrecht, Division Heart and Lungs, Utrecht (Netherlands); St. Antonius Hospital Nieuwegein, Center of Interstitial Lung Diseases, Department of Pulmonology, Nieuwegein (Netherlands)

2015-09-15

To determine inter-rater reliability of sarcoidosis-related computed tomography (CT) findings that can be used for scoring of thoracic sarcoidosis. CT images of 51 patients with sarcoidosis were scored by five chest radiologists for various abnormal CT findings (22 in total) encountered in thoracic sarcoidosis. Using intra-class correlation coefficient (ICC) analysis, inter-rater reliability was analysed and reported according to the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) criteria. A pre-specified sub-analysis was performed to investigate the effect of training. Scoring was trained in a distinct set of 15 scans in which all abnormal CT findings were represented. Median age of the 51 patients (36 men, 70 %) was 43 years (range 26 - 64 years). All radiographic stages were present in this group. ICC ranged from 0.91 for honeycombing to 0.11 for nodular margin (sharp versus ill-defined). The ICC was above 0.60 in 13 of the 22 abnormal findings. Sub-analysis for the best-trained observers demonstrated an ICC improvement for all abnormal findings and values above 0.60 for 16 of the 22 abnormalities. In our cohort, reliability between raters was acceptable for 16 thoracic sarcoidosis-related abnormal CT findings. (orig.)

Chest computed tomography-based scoring of thoracic sarcoidosis: Inter-rater reliability of CT abnormalities

International Nuclear Information System (INIS)

Heuvel, D.A.V. den; Es, H.W. van; Heesewijk, J.P. van; Spee, M.; Jong, P.A. de; Zanen, P.; Grutters, J.C.

2015-01-01

To determine inter-rater reliability of sarcoidosis-related computed tomography (CT) findings that can be used for scoring of thoracic sarcoidosis. CT images of 51 patients with sarcoidosis were scored by five chest radiologists for various abnormal CT findings (22 in total) encountered in thoracic sarcoidosis. Using intra-class correlation coefficient (ICC) analysis, inter-rater reliability was analysed and reported according to the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) criteria. A pre-specified sub-analysis was performed to investigate the effect of training. Scoring was trained in a distinct set of 15 scans in which all abnormal CT findings were represented. Median age of the 51 patients (36 men, 70 %) was 43 years (range 26 - 64 years). All radiographic stages were present in this group. ICC ranged from 0.91 for honeycombing to 0.11 for nodular margin (sharp versus ill-defined). The ICC was above 0.60 in 13 of the 22 abnormal findings. Sub-analysis for the best-trained observers demonstrated an ICC improvement for all abnormal findings and values above 0.60 for 16 of the 22 abnormalities. In our cohort, reliability between raters was acceptable for 16 thoracic sarcoidosis-related abnormal CT findings. (orig.)

Childhood sarcoidosis in Denmark 1979-1994: incidence, clinical features and laboratory results at presentation in 48 children

DEFF Research Database (Denmark)

Hoffmann, A L; Milman, N; Byg, K E

2004-01-01

AIM: To describe the incidence, clinical presentation and paraclinical findings in childhood sarcoidosis in Denmark, 1979-1994. METHODS: Patients (n = 5536) with a diagnosis of sarcoidosis were drawn from the nationwide Patient Registry; 81 patients were ... examination (glucose, albumin, haemoglobin) was normal in 96% of the patients; the patient with nephrocalcinosis had albuminuria and haematuria. CONCLUSION: The incidence of sarcoidosis in Danish children is low and increases with age. Sarcoidosis in young children may present clinical features...... that are different from the appearance of those in older children and often constitute a diagnostic challenge. In older children, the clinical appearance has many features in common with the presentation in adults....

Childhood sarcoidosis in Denmark 1979-1994: incidence, clinical features and laboratory results at presentation in 48 children

DEFF Research Database (Denmark)

Hoffmann, A L; Milman, N; Byg, K E

2004-01-01

.7-15). In 1979-1994 the incidence was 0.29 per 100000 person-years incidence was 0.06 in children weight loss, abdominal discomfort, respiratory symptoms, lymphadenopathy......AIM: To describe the incidence, clinical presentation and paraclinical findings in childhood sarcoidosis in Denmark, 1979-1994. METHODS: Patients (n = 5536) with a diagnosis of sarcoidosis were drawn from the nationwide Patient Registry; 81 patients were ... examination (glucose, albumin, haemoglobin) was normal in 96% of the patients; the patient with nephrocalcinosis had albuminuria and haematuria. CONCLUSION: The incidence of sarcoidosis in Danish children is low and increases with age. Sarcoidosis in young children may present clinical features...

Sarcoidosis presenting as prepatellar bursitis

International Nuclear Information System (INIS)

Fujimoto, Hajime; Shimofusa, Ryota; Shimoyama, Katsuhito; Nagashima, Ryota; Eguchi, Masanobu

2006-01-01

A 61-year-old woman complained of a subcutaneous mass in her right knee. MR images revealed a well-defined subcutaneous mass in the prepatellar region, containing some fluid and foci of short T2. The lesion showed some marginal contrast uptake after an administration of meglumine gadopentetate (Gd-DTPA), consistent with prepatellar bursitis. The pathological specimen, however, revealed subcutaneous sarcoidosis involving the bursa. (orig.)

Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm.

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Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Manabe, Noriaki; Haruma, Ken; Hirai, Toshihiro

2015-01-01

Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter. We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diverticulum located about 10cm above the esophagogastric junction. High-resolution manometry revealed normal esophageal motility. However, 24-h pH monitoring revealed continuous acidity due to pooling of residue in the diverticulum. An esophageal epiphrenic diverticulum was diagnosed and resected thoracoscopically. Her dysphagia recurred 2 years later. High-resolution manometry revealed diffuse esophageal spasm. The diverticulum in the present case was considered to have been associated with diffuse esophageal spasm. The motility disorder was likely not identified at the first evaluation. In this case, the patient's symptoms spontaneously resolved without any treatment; however, longer-term follow-up is needed. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm

OpenAIRE

Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Manabe, Noriaki; Haruma, Ken; Hirai, Toshihiro

2015-01-01

Introduction: Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter. Presentation of case: We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diver...

The impact of gas exchange measurement during exercise in pulmonary sarcoidosis.

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Kollert, Florian; Geck, Barbara; Suchy, Rolf; Jörres, Rudolf A; Arzt, Michael; Heidinger, Dominic; Hamer, Okka W; Prasse, Antje; Müller-Quernheim, Joachim; Pfeifer, Michael; Budweiser, Stephan

2011-01-01

Pulmonary sarcoidosis shows a remarkable heterogeneity of phenotypes ranging from bihilar lymphadenopathy to progressive fibrosis. Individual disease assessment is demanding and requires sensible, practical measures. We tested whether gas exchange measurements during exercise reflects disease activity and clinical course in sarcoidosis. In 149 patients with proven pulmonary sarcoidosis the alveolar-arterial oxygen pressure gradient (P(A-a)O(2)) during exercise was assessed and compared with chest X-ray typing, pulmonary function, single breath-diffusing capacity for carbon monoxide (DL(CO)), serological markers, cell composition of bronchoalveolar lavage fluid (BALF) and clinical course. Patients were categorized according to thresholds of P(A-a)O(2) during exercise. Chest X-ray typing, pulmonary function, DL(CO) and the need for immunosuppressive treatment differed between the disease categories based on P(A-a)O(2) during exercise (p 1 year), but not DL(CO). About 50% (n = 75) of the study population showed a normal spirometry. Even in this subgroup 23% had an impaired gas exchange during exercise, which correlated with chest X-ray types (p < 0.0001) and the need for immunosuppressive treatment (p < 0.005). Impaired gas exchange during exercise reflects disease activity and its extent and is associated with a prolonged need for immunosuppressive treatment during follow-up in patients with pulmonary sarcoidosis. Copyright © 2010 Elsevier Ltd. All rights reserved.

Some noticeable problems in the radiological diagnosis of thoracic sarcoidosis

International Nuclear Information System (INIS)

Li Tieyi; Li Hui; Ji Jingling

2003-01-01

Objective: To discuss the noticeable problems in the radiological diagnosis of thoracic sarcoidosis through retrospective analysis of misdiagnosis. Methods: Imaging examinations of 32 misdiagnosed cases with thoracic sarcoidosis including chest radiography, CT, and their clinical data were reviewed. The final diagnosis was made by pathology (9 cases) and clinical therapy (23 cases). Results: Enlarged thoracic lymph nodes were detected in all cases. 23 of them presented mediastinal lymph node enlargement associated with bilateral hilar lymph node enlargement, 5 of them had mediastinal lymph node enlargement and unilateral hilar lymph node enlargement, and 4 of them had mediastinal lymph node enlargement without hilar lymph node enlargement. In these cases, 24 had pulmonary abnormalities. 19 of them showed multiple pulmonary nodes, 4 of them had patchy pulmonary shadows, and another 1 had pulmonary fibrosis. Pleural lesions included 2 hydrothorax and 1 multiple pleural nodes, and all of pleural lesions were associated with multiple pulmonary nodes. Conclusion: When the radiological findings of thoracic sarcoidosis are atypical, the diagnosis is difficult and must combine with the clinical findings, or the outcome of the treatment

Is sarcoidosis a rickettsiosis? An archival study

DEFF Research Database (Denmark)

Svendsen, Claus Bo; Milman, Nils; Andersen, Claus B

2011-01-01

Based on earlier research, Rickettsia helvetica could possibly be involved in the pathogenesis of sarcoidosis. Rickettsiae are transmitted to humans by a tick vector, Ixodes ricinus; this tick is highly prevalent in Northern Europe. We aimed to investigate the association between evidence...

Pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis: a case report and literature review.

Science.gov (United States)

Kokuho, Nariaki; Terasaki, Yasuhiro; Urushiyama, Hirokazu; Terasaki, Mika; Kunugi, Shinobu; Morimoto, Taisuke; Azuma, Arata; Usuda, Jitsuo; Gemma, Akihiko; Eishi, Yoshinobu; Shimizu, Akira

2016-05-01

Differentiating low-grade lymphoma from preexisting sarcoidosis is difficult because of their pathological similarity. This article describes a case of pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis. The patient, a 45-year-old Japanese man, presented with a 10-year history of pulmonary sarcoidosis and 5-year history of ocular sarcoidosis with histologic findings. Because only the right S3 lung nodule had gradually enlarged, partial resection was performed. Pathological study revealed noncaseous epithelioid granulomas with lymphoplasmacytic proliferation but also marked lymphoid cell proliferation with lymphoepithelial lesion findings that differed from findings of typical sarcoid lesions. Our lymphoepithelial lesion evaluation via immunohistochemistry and analysis of Ig heavy-chain gene rearrangements with assessment of Propionibacterium acnes-specific antibody reactions allow us to report, for the first time, this case of pulmonary mucosa-associated lymphoid tissue lymphoma associated with pulmonary sarcoidosis in exactly the same location, which may be significant for differentiating these diseases and understanding their pathogenic association. Copyright © 2016 Elsevier Inc. All rights reserved.

Everyday cognitive failure and depressive symptoms predict fatigue in sarcoidosis : A prospective follow-up study

NARCIS (Netherlands)

Hendriks, Celine; Drent, Marjolein; De Kleijn, Willemien; Elfferich, Marjon; Wijnen, Petal; de Vries, J.

2018-01-01

Bachground: Fatigue is a major and disabling problem in sarcoidosis. Knowledge concerning correlates of the development of fatigue and possible interrelationships is lacking. Objective: A conceptual model of fatigue was developed and tested. Methods: Sarcoidosis outpatients (n = 292) of Maastricht

Sarcoidosis and Histoplasmosis: Is One a Consequence of the Other? A Case Report and Review of the Literature

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Anupam Bansal

2015-01-01

Full Text Available Sarcoidosis involves abnormal collections of inflammatory cells (granulomas which may form as nodules in multiple organs. 90% of affected patients have respiratory tract abnormalities. We present a 61-year-old male with sarcoidosis who was admitted for respiratory distress. Fibrosing mediastinitis was seen in the chest computograph. Management was conservative and included steroids, antibiotics, and oxygen therapy. Sarcoidosis and fibrosing mediastinitis are rare. Fibrosing mediastinitis is more commonly seen with histoplasmosis. We explore the clinical similarities between histoplasmosis and sarcoidosis. We also explore the potential cause and effect relationship and workup for each disease entity.

Esophageal motor disorders in adults with eosinophilic esophagitis.

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Moawad, Fouad J; Maydonovitch, Corinne L; Veerappan, Ganesh R; Bassett, John T; Lake, Jason M; Wong, Roy K H

2011-05-01

An association between eosinophilic esophagitis (EoE) and esophageal motility disorders has been described in small studies. The aim of this study was to describe the prevalence of esophageal motor disorders in a large cohort of adults with EoE and examine whether an association exists between esophageal dysmotility and dysphagia. A retrospective review of esophageal manometry studies in adult EoE patients was performed. Tracings were reviewed for abnormalities including nutcracker esophagus and ineffective swallows, defined as low amplitude peristalsis (esophagus was found in three patients. There was no significant difference in eosinophil count among the motility groups: normal 46.5 ± 3.1, mild IEM 56.9 ± 36.9, moderate IEM 45.5 ± 23.7, severe IEM 34.3 ± 12.6 (P = 0.157). In this cohort of EoE patients, the majority had normal esophageal motility studies, although a subset of these patients had some esophageal dysmotility. It is unlikely that esophageal dysmotility is a major contributing factor to dysphagia, although it is reasonable to consider esophageal manometry testing in EoE patients to identify potential abnormalities of the smooth muscle esophagus.

Multi-organ sarcoidosis treatment with fumaric acid esters: a case report and review of the literature.

Science.gov (United States)

Zouboulis, Christos C; Lippert, Undine; Karagiannidis, Ioannis

2014-01-01

Sarcoidosis is a rare, systemic disease that is characterized by the formation of granulomas in various organs, including the skin. As the etiology remains unknown, the treatment of sarcoidosis is challenging. We present a 47-year-old female patient with progressive, multi-organ sarcoidosis who had a complete clinical improvement of the skin lesions, a moderate reduction in pulmonary opacities on chest X-ray, a marked subjective improvement in general status and pulmonary efficiency and a marked reduction in serum angiotensin-converting enzyme and soluble interleukin-2 receptor after 6 months of therapy with fumaric acid esters. The present case and similar reports in the literature highlight the probable efficacy of fumaric acid esters in the treatment of sarcoidosis and other non-infectious, granulomatous diseases. © 2014 S. Karger AG, Basel.

Impaired esophageal motor function in eosinophilic esophagitis.

Science.gov (United States)

Santander, Cecilio; Chavarría-Herbozo, Carlos M; Becerro-González, Irene; Burgos-Santamaría, Diego

2015-10-01

Eosinophilic esophagitis is a chronic immunoallergic inflammatory disease of the esophagus that represents a major cause of digestive morbidity among the pediatric and young adult populations. Despite the fact that key symptoms in adults include dysphagia and food impaction, many patients lack structural changes in the esophagus to account for their complaints, which suggests the presence of underlying motor disorders and esophageal distensibility impairment. In the last few years the esophageal motility of these patients has been studied using various approaches, most particularly high-resolution manometry, ambulatory manometry, and impedance planimetry. This review focuses on the most relevant findings and scientific evidence regarding esophageal motor disorders in eosinophilic esophagitis.

Esophageal microbiome in eosinophilic esophagitis.

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J Kirk Harris

Full Text Available The microbiome has been implicated in the pathogenesis of a number of allergic and inflammatory diseases. The mucosa affected by eosinophilic esophagitis (EoE is composed of a stratified squamous epithelia and contains intraepithelial eosinophils. To date, no studies have identified the esophageal microbiome in patients with EoE or the impact of treatment on these organisms. The aim of this study was to identify the esophageal microbiome in EoE and determine whether treatments change this profile. We hypothesized that clinically relevant alterations in bacterial populations are present in different forms of esophagitis.In this prospective study, secretions from the esophageal mucosa were collected from children and adults with EoE, Gastroesophageal Reflux Disease (GERD and normal mucosa using the Esophageal String Test (EST. Bacterial load was determined using quantitative PCR. Bacterial communities, determined by 16S rRNA gene amplification and 454 pyrosequencing, were compared between health and disease.Samples from a total of 70 children and adult subjects were examined. Bacterial load was increased in both EoE and GERD relative to normal subjects. In subjects with EoE, load was increased regardless of treatment status or degree of mucosal eosinophilia compared with normal. Haemophilus was significantly increased in untreated EoE subjects as compared with normal subjects. Streptococcus was decreased in GERD subjects on proton pump inhibition as compared with normal subjects.Diseases associated with mucosal eosinophilia are characterized by a different microbiome from that found in the normal mucosa. Microbiota may contribute to esophageal inflammation in EoE and GERD.

Esophageal scintigraphy: Applications and limitations in the study of esophageal disorders

International Nuclear Information System (INIS)

O'Connor, M.K.; Byrne, P.J.; Keeling, P.; Hennessy, T.P.

1988-01-01

This study examines the scintigraphic transit pattern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. Condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia, scleroderma, esophageal carcinoma, Barrett esophagus, and reflux esophagitis. We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery. (orig.)

Esophageal scintigraphy: Applications and limitations in the study of esophageal disorders

Energy Technology Data Exchange (ETDEWEB)

O' Connor, M.K.; Byrne, P.J.; Keeling, P.; Hennessy, T.P.

1988-06-01

This study examines the scintigraphic transit pattern in a variety of esophageal disorders. Scintigraphy was performed with a semi solid bolus and the patient in an upright position. Condensed esophageal images were obtained from which we derived the esophageal transit time. The pattern of bolus transit was graded by the duration of transit and by the presence of hold up or retrograde motion. Scintigrams were performed in 11 volunteers and 88 patients whose esophageal function had been confirmed by conventional gastroesophageal techniques. Esophageal disorders examined included achalasia, scleroderma, esophageal carcinoma, Barrett esophagus, and reflux esophagitis. We also examined the effects of gastroesophageal surgery on esophageal function. Transit times distinguished grossly abnormal esophageal function from normal but did not distinguish between different esophageal disorders. Graded transit patterns were a more sensitive indicator of esophageal function and permitted some differentiation between esophageal disorders and allowed evaluation of the effects of gastroesophageal surgery.

Impaired esophageal motor function in eosinophilic esophagitis

Directory of Open Access Journals (Sweden)

Cecilio Santander

2015-10-01

Full Text Available Eosinophilic esophagitis is a chronic immunoallergic inflammatory disease of the esophagus that represents a major cause of digestive morbidity among the pediatric and young adult populations. Despite the fact that key symptoms in adults include dysphagia and food impaction, many patients lack structural changes in the esophagus to account for their complaints, which suggests the presence of underlying motor disorders and esophageal distensibility impairment. In the last few years the esophageal motility of these patients has been studied using various approaches, most particularly high-resolution manometry, ambulatory manometry, and impedance planimetry. This review focuses on the most relevant findings and scientific evidence regarding esophageal motor disorders in eosinophilic esophagitis.

Esophageal bypass after failed chemoradiotherapy for unresectable esophageal cancer

International Nuclear Information System (INIS)

Matono, Satoru; Tanaka, Toshiaki; Mori, Naoki; Nagano, Takeshi; Fujita, Hiromasa; Shirouzu, Kazuo

2013-01-01

Esophageal stenosis and/or fistula often occur after chemoradiotherapy (CRT) for unresectable esophageal cancer. In such patients, an esophageal stent can help achieve oral intake. However an esophageal stent cannot be inserted where there is complete stenosis or where the tumor is located. In such cases, esophageal bypass surgery may be necessary. Here, we investigated the clinical characteristics and outcomes in patients who underwent esophageal bypass surgery in our institution. We reviewed 10 cases of esophageal bypass surgery (gastric tube in 8 cases, colon in 2 cases) after CRT for unresectable esophageal cancer, between 2001 and 2009. There were 5 of stenosis-only cases, 4 fistula-only cases, and 1 case of stenosis and fistula. There were postoperative complications in 5 cases (50%), and all these were treated conservatively and healed. The median survival from surgery to peroral intake was 20 days (range 9-90 days), and the median survival after starting peroral intake was 130 days (range 48-293 days). Esophageal bypass surgery can achieve good performance status and improve peroral intake. (author)

Radionuclide Esophageal Transit Study in the Esophageal Motility Disorders

Energy Technology Data Exchange (ETDEWEB)

Choi, Jae Gol; Lee, Min Jae; Song, Chi Wook [Korea University College of Medicine, Seoul (Korea, Republic of)

1993-07-15

Esophageal motility was evaluated from the analysis of 10 consecutive swallows using liquid bolus containing 0.5 mCi of {sup 99m}Tc tin colloid. We have reviewed our experience of esophageal transit study in the 20 normal volunteers and 55 patients with dysphagia that was not related to mechanical obstruction. The purpose of this study is to measure the esophageal transit in normal subjects and in patients with various esophageal motility disorders. The overall sensitivity and specificity of radionuclide esophageal transit study in detecting esophageal motor abnormality were compared with manometric results as a gold standard, which were 80% and 100% respectively. Radionuclide transit study is a safe, rapid, noninvasive test and suitable as a screening test for esophageal motor disorders.

Radionuclide Esophageal Transit Study in the Esophageal Motility Disorders

International Nuclear Information System (INIS)

Choi, Jae Gol; Lee, Min Jae; Song, Chi Wook

1993-01-01

Esophageal motility was evaluated from the analysis of 10 consecutive swallows using liquid bolus containing 0.5 mCi of 99m Tc tin colloid. We have reviewed our experience of esophageal transit study in the 20 normal volunteers and 55 patients with dysphagia that was not related to mechanical obstruction. The purpose of this study is to measure the esophageal transit in normal subjects and in patients with various esophageal motility disorders. The overall sensitivity and specificity of radionuclide esophageal transit study in detecting esophageal motor abnormality were compared with manometric results as a gold standard, which were 80% and 100% respectively. Radionuclide transit study is a safe, rapid, noninvasive test and suitable as a screening test for esophageal motor disorders.

Arritmias ventriculares como manifestación de sarcoidosis cardiaca primaria

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Jhan Altamar

2017-09-01

Full Text Available La afectación cardíaca en pacientes con sarcoidosis está siendo cada vez más reconocida y se asocia con mal pronóstico. Aunque en su patogénesis están implicados los factores ambientales y genéticos, la etiología de la sarcoidosis cardíaca no es clara. Las manifestaciones clínicas incluyen alteraciones de la conducción aurículo-ventricular, arritmias e insuficiencia cardíaca congestiva. Es una entidad extremadamente difícil de diagnosticar debido a que las manifestaciones clínicas son inespecíficas, y la sensibilidad y la especificidad de las modalidades de diagnóstico son limitadas. El tratamiento cardíaco óptimo no ha sido bien definido, y aunque los corticoides siguen siendo el pilar del manejo, hay poca evidencia de la dosis o la duración de la terapia. Se expone el caso de una paciente con sarcoidosis cardíaca aislada, que debutó con extrasístoles ventriculares y progresó a falla cardiaca y arritmias ventriculares sostenidas.

Diagnostic efficacy of ultrasound-guided core-needle biopsy of peripheral lymph nodes in sarcoidosis.

Science.gov (United States)

Boussouar, S; Medjhoul, A; Bernaudin, J F; Tayebjee, O; Soussan, M; Uzunhan, Y; Nunes, H; Kambouchner, M; Martin, A; Valeyre, D; Brillet, P Y

2015-09-14

Core-needle biopsy guided by ultrasound can be performed for investigating peripheral lymph node (PLN). The aim of this study was to determine the efficacy of this technique in sarcoidosis. Retrospective review of files of all patients in the database of the radiology department of Avicenne university hospital who underwent PLN biopsies guided by ultrasound from January 2008 to June 2011 (n=292). Cases with either granulomas at histology with the procedure or with a final diagnosis of sarcoidosis were included in the study. The histological specimens were adequate in 282 out of 292 cases (96%) showing non-caseating granulomas in 22 cases (n=20 patients with a final diagnosis of sarcoidosis and n=2 patients with tuberculosis). After reviewing clinical files of the 282 patient, 22 were confirmed to have sarcoidosis, at initial presentation (n=19) or later during flare-up or relapse (n=3) with only 2 patients having no granuloma on PLN biopsy. PLN were palpable in 18 cases and only detected by (18F)FDG-PET/CT showing increased PLN uptake in 4 cases. The sensitivity and specificity of adequate biopsy were 91 and 99% and the positive and negative predictive values were 91 and 99%, respectively. Core-needle biopsy guided by ultrasound has a high efficacy for evidencing granulomas in sarcoidosis patients with PLN involvement either clinically palpable or in the presence of (18F)FDG-PET/CT uptake.

Preliminary characterizations of a serum biomarker for sarcoidosis by comparative proteomic approach with tandem-mass spectrometry in ethnic Han Chinese patients

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Zhang Yuan

2013-02-01

Full Text Available Abstract Background The diagnosis of sarcoidosis is still a significant challenge in China because of the need to exclude other diseases including granulomatous infections and malignancies that may be clinically and radiographically similar. The specific aim of the study is to search for serum protein biomarkers of sarcoidosis and to validate their clinical usefulness in differential diagnosis. Methods Serum samples were collected from patients with sarcoidosis (n = 37, and compared to those from patients with tuberculosis (n = 20, other pulmonary diseases (n = 20, and healthy volunteers (n = 20 for determination of sarcoidosis-specific or -associated protein expression profiles. The first part of this study focused on proteomic analysis of serum from patients with sarcoidosis to identify a pattern of peptides capable of differentiating the studied populations using the ClinProt profiling technology based on mass spectrometry. Enzyme Linked Immunosorbent Assay (ELISA was then used to verify corresponding elevation of the serum protein concentration of the potential biomarkers in the same patients sets. Receiver operating characteristic curve (ROC analyses was performed to determine the optimal cutoff value for diagnosis. Immunohistochemistry was carried out to further confirm the protein expression patterns of the biomarkers in lung tissue. Results An unique protein peak of M/Z 3,210 Daltons (Da was found to be differentially expressed between the sarcoidosis and control groups and was identified as the N-terminal peptide of 29 amino acids (94-122 of serum amyloid A (SAA. ELISA confirmed that the serum SAA level was significantly higher in the sarcoidosis group than that of the other 3 control groups (p p  Conclusion This is the first study to investigate serum protein markers in Chinese subjects with sarcoidosis. This study shows that the serum SAA expression profiles were different between the sarcoidosis and non-sarcoidosis

Esophageal Rupture as a Primary Manifestation in Eosinophilic Esophagitis

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Natalia Vernon

2014-01-01

Full Text Available Eosinophilic esophagitis (EoE is a chronic inflammatory process characterized by symptoms of esophageal dysfunction and, histologically, by eosinophilic infiltration of the esophagus. In adults, it commonly presents with dysphagia, food impaction, and chest or abdominal pain. Chronic inflammation can lead to diffuse narrowing of the esophageal lumen which may cause food impaction. Endoscopic procedures to relieve food impaction may lead to complications such as esophageal perforation due to the friability of the esophageal mucosa. Spontaneous transmural esophageal rupture, also known as Boerhaave’s syndrome, as a primary manifestation of EoE is rare. In this paper, we present two adult patients who presented with esophageal perforation as the initial manifestation of EoE. This rare complication of EoE has been documented in 13 other reports (11 adults, 2 children and only 1 of the patients had been previously diagnosed with EoE. A history of dysphagia was present in 1 of our patients and in the majority of previously documented patients. Esophageal perforation is a potentially severe complication of EoE. Patients with a history of dysphagia and patients with spontaneous esophageal perforation should warrant an evaluation for EoE.

Dilemma of diagnosing thoracic sarcoidosis in tuberculosis endemic regions: An imaging-based approach. Part 1

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Ashu S Bhalla

2017-01-01

Full Text Available Sarcoidosis is a multi-systemic disorder of unknown etiology, although commonly believed to be immune-mediated. Histologically, it is characterized by noncaseating granuloma which contrasts against the caseating granuloma seen in tuberculosis (TB, an infectious disease that closely mimics sarcoidosis, both clinically as well as radiologically. In TB-endemic regions, the overlapping clinico-radiological manifestations create significant diagnostic dilemma, especially since the management options are markedly different in the two entities. Part 1 of this review aims to summarize the clinical, laboratory, and imaging features of sarcoidosis, encompassing both typical and atypical manifestations, in an attempt to distinguish between the two disease entities.

Acid reflux directly causes sleep disturbances in rat with chronic esophagitis.

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Kenichi Nakahara

Full Text Available BACKGROUND & AIMS: Gastroesophageal reflux disease (GERD is strongly associated with sleep disturbances. Proton pump inhibitor (PPI therapy improves subjective but not objective sleep parameters in patients with GERD. This study aimed to investigate the association between GERD and sleep, and the effect of PPI on sleep by using a rat model of chronic acid reflux esophagitis. METHODS: Acid reflux esophagitis was induced by ligating the transitional region between the forestomach and the glandular portion and then wrapping the duodenum near the pylorus. Rats underwent surgery for implantation of electrodes for electroencephalogram and electromyogram recordings, and they were transferred to a soundproof recording chamber. Polygraphic recordings were scored by using 10-s epochs for wake, rapid eye movement sleep, and non-rapid eye movement (NREM sleep. To examine the role of acid reflux, rats were subcutaneously administered a PPI, omeprazole, at a dose of 20 mg/kg once daily. RESULTS: Rats with reflux esophagitis presented with several erosions, ulcers, and mucosal thickening with basal hyperplasia and marked inflammatory infiltration. The reflux esophagitis group showed a 34.0% increase in wake (232.2±11.4 min and 173.3±7.4 min in the reflux esophagitis and control groups, respectively; p<0.01 accompanied by a reduction in NREM sleep during light period, an increase in sleep fragmentation, and more frequent stage transitions. The use of omeprazole significantly improved sleep disturbances caused by reflux esophagitis, and this effect was not observed when the PPI was withdrawn. CONCLUSIONS: Acid reflux directly causes sleep disturbances in rats with chronic esophagitis.

[Primary esophageal motility disorders; especially about esophageal achalasia].

Science.gov (United States)

Miyazaki, Tatsuya; Sohda, Makoto; Sakai, Makoto; Tanaka, Naritaka; Suzuki, Shigemasa; Yokobori, Takehiko; Inose, Takanori; Nakajima, Masanobu; Fukuchi, Minoru; Kato, Hiroyuki; Kusano, Motoyasu; Kuwano, Hiroyuki

2011-07-01

Esophageal motility disorders are classified primary and secondary, and primary esophageal motility disorders are classified esophageal achalasia and other diseases by manometry. An esophageal emptying disorder associated with insufficient relaxation of the lower esophageal sphincter (LES) and elimination of peristaltic waves on the esophageal body is the major abnormality of achalasia. Esophagogram, endoscopy, and manometry are used for diagnosis. As pharmacological therapy, administration of a calcium channel blocker or nitrate is useful. The pharmacological therapy is not recommended as long-term basic therapy but as a temporary treatment. At 1st, the balloon dilation method is chosen in treatment of achalasia Surgical treatment is indicated in the following cases: (1) Patients uneffected by balloon dilation, (2) Flask type with grade II to III dilation, and sigmoid type, (3) the gradual progression to the pathophysiological stage, (4) young patients, (5) complicated with esophageal cancer. Laparoscopic Heller-Dor procedure is the most popular surgical procedure, recently. It is somewhat difficult to perform surgical treatment for this functional disease. We should select the most suitable individualized treatment with efficient comprehension of the pathophysiological situation.

Extensive and progressive sarcoidosis of the bone. Compared value of roentgenography and scintigraphy

International Nuclear Information System (INIS)

Dubois, F.; Valeyre, D.; Meyrier, A.; Battesti, J.P.; Vigneron, N.; Chretien, J.

1986-01-01

In a thirty-one-year-old female patient from the French West Indies with osseous sarcoidosis we were able to compare the value of three diagnostic procedures used to evaluate the skeleton: roentgenography. Tc99 m scintigraphy and Ga67 scintigraphy. The lesions of sarcoidosis involved mainly the bones of the hands and feet, but also one ankle, one wrist, both knees and the skull vault. Tc99 m proved the most sensitive procedure. Ga67 evidenced the active foci in the bones and neighboring soft tissues. Roentgenograms of the bones were the least informative. Anomalies in the metabolism of calcium were lacking, as shown by the normal PAK test, a fact that demonstrates that specific bone lesions do not play a significant part in the genesis of the increased urinary calcium excretion and hyper-calcemia found in sarcoidosis [fr

Right ventricular involvement in cardiac sarcoidosis demonstrated with cardiac magnetic resonance.

Science.gov (United States)

Smedema, Jan-Peter; van Geuns, Robert-Jan; Ainslie, Gillian; Ector, Joris; Heidbuchel, Hein; Crijns, Harry J G M

2017-11-01

Cardiac involvement in sarcoidosis is reported in up to 30% of patients. Left ventricular involvement demonstrated by contrast-enhanced cardiac magnetic resonance has been well validated. We sought to determine the prevalence and distribution of right ventricular late gadolinium enhancement in patients diagnosed with pulmonary sarcoidosis. We prospectively evaluated 87 patients diagnosed with pulmonary sarcoidosis with contrast-enhanced cardiac magnetic resonance for right ventricular involvement. Pulmonary artery pressures were non-invasively evaluated with Doppler echocardiography. Patient characteristics were compared between the groups with and without right ventricular involvement, and right ventricular enhancement was correlated with pulmonary hypertension, ventricular mass, volume, and systolic function. Left ventricular late gadolinium enhancement was demonstrated in 30 patients (34%). Fourteen patients (16%) had right ventricular late gadolinium enhancement, with sole right ventricular enhancement in only two patients. The pattern of right ventricular enhancement consisted of right ventricular outflow tract enhancement in 1 patient, free wall enhancement in 8 patients, ventricular insertion point enhancement in 10 patients, and enhancement of the right side of the interventricular septum in 11 patients. Pulmonary arterial hypertension correlated with the presence of right ventricular enhancement (P Right ventricular enhancement correlated with systolic ventricular dysfunction (P Right ventricular enhancement was present in 16% of patients diagnosed with pulmonary sarcoidosis and in 48% of patients with left ventricular enhancement. The presence of right ventricular enhancement correlated with pulmonary arterial hypertension, right ventricular systolic dysfunction, hypertrophy, and dilation. © 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

Quantiferon test for tuberculosis screening in sarcoidosis patients

DEFF Research Database (Denmark)

Milman, Nils; Søborg, Bolette; Svendsen, Claus Bo

2011-01-01

Tumour necrosis factor-alpha (TNF-α) inhibitors have been introduced in the treatment of refractory sarcoidosis. These biologics may reactivate latent tuberculosis infection (LTBI). Despite its known limitations, the tuberculin skin test (TST) is currently used for the diagnosis of LTBI in Danish...

The six-minute walk test in patients with pulmonary sarcoidosis

International Nuclear Information System (INIS)

Alhamad, Esam H

2009-01-01

The 6-min walk test (6MWT) is a useful tool to assess prognosis and functional impairment in various pulmonary diseases. To evaluate functional capacity during various stages of pulmonary sarcoidosis and develop a scoring system clinical radiological physiological score (CRP) that can potentially be used to assess the functional status among patients with sarcoidosis. We performed a retrospective study on 26 patients diagnosed with pulmonary sarcoidosis from 2001 to 2007. All patients completed the 6MWT. The parameters assessed during the test included spirometry, arterial blood gas, 6-min walk distance (6MWD), Borg dyspnea score, and initial and end oxygen saturation. Females covered a significantly shorter distance than males (343 m (223-389) vs. 416.5 m (352-500); P < 0.0001). In addition, females had a significantly lower SpO 2 at the end of the 6MWT than males (90.5 (61-99) vs. 96 (75-98); P < 0.03). The 6MWD was inversely correlated with the final Borg score (r = ?0.603, P = 0.004) and the CRP score (r = -0.364, P = 0.047) and positively correlated with forced expiratory volume in 1 s (FEV 1 ) % (r 0.524, P = 0.006) and forced vital capacity (FVC) % (r = 0.407, P = 0.039). Female gender, FEV 1 %, final Borg score, FVC%, CRP score, and SpO 2 at the end of the 6MWT are associated with reduced 6MWD. It appears that Saudi patients diagnosed with sarcoidosis have a markedly reduced walking distance compared with other races. The effect of race and ethnicity and the utility of the CRP score as a potential marker to assess functional status require further exploration. (author)

Sarcoidosis with Major Airway, Vascular and Nerve Compromise

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Hiroshi Sekiguchi

2013-01-01

Full Text Available The present report describes a 60-year-old Caucasian woman who presented with progressive dyspnea, cough and wheeze. A computed tomography scan of the chest showed innumerable bilateral inflammatory pulmonary nodules with bronchovascular distribution and a mediastinal and hilar infiltrative process with calcified lymphadenopathy leading to narrowing of lobar bronchi and pulmonary arteries. An echocardiogram revealed pulmonary hypertension. Bronchoscopy showed left vocal cord paralysis and significant narrowing of the bilateral bronchi with mucosal thickening and multiple nodules. Transbronchial biopsy was compatible with sarcoidosis. Despite balloon angioplasty of the left lower lobe and pulmonary artery, and medical therapy with oral corticosteroids, her symptoms did not significantly improve. To the authors’ knowledge, the present report describes the first case of pulmonary sarcoidosis resulting in major airway, vascular and nerve compromise due to compressive lymphadenopathy and suspected concurrent granulomatous infiltration. Its presentation mimicked idiopathic mediastinal fibrosis.

Sarcoidosis recurrence in the Allograft of long transplantation for pulmonary sarcoidosis: one case report and literature review%结节病肺移植术后原病复发(附一例报告)

Institute of Scientific and Technical Information of China (English)

陈玉平; 张志泰; 区颂雷; 胡燕生; 宋飞强; 李昕

1997-01-01

1995年2月23日我们为一例终末期肺结节病患者行左单肺移植术,患者已存活二年余,情况良好.术后第11及13个月时经纤支镜活检发现左肺有结节病复发,无症状,胸片左肺(一).除继续用三联(环孢素A、硫唑嘌呤和激素)免疫抑制剂外未加其它治疗.本文复习了有关结节病移植术后原病复发的文献.%A left single lung transplantation was performed for treatment of one case of end stage pulmonary sarcoidosis on Feb 23,1995.The patient has been survived well more than 24 months after operation with good conditions.Recurrence of sarcoidosis in the allograft was found by transbronchial lung biopsies in the 11th and 13th months affteroperation without clinical mani festations and abnormal changes in the chest X-rayilm.Immunosuppressive drugs(CsA,Azathio Prine and Prednisone)were used continuously and no other therapy was given.The literatures about sarcoidosis recurrence after lung transplantation for pulmonary sarcoidosis were reviewed.It was concluded that pulmonary sarcoidosis was the indication of lung transplantation.

[Retrospective evaluation of sarcoidosis patients 1970-1979 at the Bad Berka Central Clinic for Heart and Lung Diseases for the detection of possible heart involvement].

Science.gov (United States)

Kirsten, D; Schaedel, H; Kessler, G

1984-01-01

Cardiac involvement in pulmonary sarcoidosis was found in a higher percentage than formerly reported, by careful observation. In a retrospective analysis of 1 236 patients with pulmonary sarcoidosis we found a possible cardiac involvement in 15.1%. In cases of pulmonary sarcoidosis or lymph node sarcoidosis combined with sarcoid lesions in other organs (liver, eyes, skin etc.) cardiac involvement is possible. Heart sarcoidosis was found in all roentgenographic stages and without sex difference. Patients with possible heart sarcoidosis suffer from dyspnoe , thoracical pain, heart discomfort, or angina pectoris in a higher part than without it. Enlargement of the heart and/or cardiac failure are signs of sarcoid involvement in patient with sarcoidosis, also in elderly patients. There are some difficulties in differential diagnosis of sarcoid cardiac involvement and ischaemic heart disease.

Alopecia: manifestação cutânea rara de sarcoidose Alopecia: an uncommon cutaneous manifestation of sarcoidosis

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Fabiane Mulinari Brenner

2008-10-01

Full Text Available A sarcoidose é doença granulomatosa multissistêmica que geralmente compromete o trato respiratório e os linfonodos hilares. A pele é comumente afetada, mas raramente o couro cabeludo. Dois casos de sarcoidose com lesões no couro cabeludo são relatados: o primeiro, em paciente negra apresentando áreas de alopecia no couro cabeludo associada a outras lesões cutâneas; e o segundo, em paciente branca, portadora de sarcoidose pulmonar, com alopecia como manifestação cutânea isolada. A sarcoidose de couro cabeludo merece especial atenção, pois nos pacientes com essa forma de lesão cutânea existe alta incidência de acometimento sistêmico.Sarcoidosis is a multi-system granulomatous disease that generally affects the respiratory tract and hilar lymph nodes. The skin is also commonly involved, although cutaneous sarcoidosis on the scalp is rare. Two cases of scalp sarcoidosis are reported: the first presented with patchy alopecia, cutaneous sarcoidosis and also systemic disease in a black patient; the second case is related to an uncommon presentation with alopecia as the single cutaneous manifestation in a Caucasian patient with pulmonary sarcoidosis. Scalp sarcoidosis deserves special attention because there is a high incidence of other systemic lesions with this cutaneous manifestation, thus a careful investigation should be performed in these patients.

Laryngeal sarcoidosis: a case report presenting transglottic involvement

NARCIS (Netherlands)

Broek, E.M.J.M. van den; Heijnen, B.J.; Verbist, B.M.; Sjögren, E.V.

2013-01-01

Isolated laryngeal sarcoidosis is a very rare disease. In most cases, it will present as a supraglottic pale edematous swelling. In our case, the patient presented with hoarseness and dyspnea during exertion. Laryngeal examination did show not only supraglottic edema but also prominent subglottic

Systemic sarcoidosis with necrobiosis lipoidica-like scalp lesions

DEFF Research Database (Denmark)

Andersen, Klaus Ejner

1977-01-01

A 78-year-old woman is described, having systemic sarcoidosis for 15 years, involving the lungs, lymph nodes and the skin. Over the last 6 years she developed a progressive cicatricial alopecia with histologic changes of the granulomatous type of necrobiosis lipoidica surrounded by sarcoid...

An Uncommon Cause of Hiccups: Sarcoidosis Presenting Solely as Hiccups

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Lien-Fu Lin

2010-12-01

Full Text Available Common causes of hiccups are over-distension of the stomach, a sudden change in gastrointestinal temperature, excessive alcohol and tobacco ingestion, and sudden excitement or emotional changes. Common presenting symptoms of sarcoidosis include cough, dyspnea, and chest pain. It is very rare for a sarcoidosis patient to present with hiccups. A 48-year-old man presented with hiccups of 2 weeks' duration. He denied having headaches, earache, cough, abdominal pain, fever, or body weight loss history. On physical examination, he had no peripheral lymphadenopathies in the neck, axilla and inguinal regions, no organomegaly in the abdomen and no skin abnormalities. A neurological examination showed normal findings. Laboratory investigations revealed a normal complete blood count, liver function, renal function, serum calcium, and tumor markers. Transabdominal ultrasound was negative, and panendoscopy revealed a small healing duodenal ulcer. Chest radiography showed an enlarged right lung hilum, while computed tomography showed enlargement of multiple mediastinal lymph nodes. Endoscopic ultrasound-guided fine-needle aspiration with a 22-gauge needle and trucut biopsy with a 19-gauge needle (quick-core biopsy needle were performed, and cytology, cell block and histology revealed non-caseating granuloma, with negative tuberculous and fungus cultures. Mediastinal lymph node due to sarcoidosis can be a rare cause of hiccups.

Unmasking sarcoidosis following surgery for Cushing disease.

Science.gov (United States)

Diernaes, Jon E F; Bygum, Anette; Poulsen, Per L

2016-01-01

We present a patient with Cushing disease apparently suppressing sarcoidosis, which was unmasked following surgical resection of a pituitary adrenocorticotropin (ACTH)-producing microadenoma. Case report and a short review of the literature published in this area. A 46-year-old Caucasian woman presented with symptoms of hypercortisolism such as progressive weight gain, Cushingoid appearance, proximal myopathy, easy bruising, and amenorrhea. Blood testing including inferior petrosal sinus sampling uncovered an ACTH-producing microadenoma in the right aspect of the anterior pituitary gland for which the patient underwent transphenoidal resection. Maintenance corticosteroid therapy was implemented, and the signs and symptoms of Cushing disease began to resolve. Three months after surgery, multiple erythematous painful nodules developed on the patient's arms. Erythema nodosum (EN) was diagnosed clinically and a suspicion of underlying sarcoidosis was substantiated by lung imaging and elevated plasma interleukin (IL)-2 receptor. One month later, the lesions spontaneously resolved without therapy other than maintenance glucocorticoid replacement. Physicians should be aware that patients undergoing successful treatment of Cushing syndrome may have a flare-up or emergence of a corticosteroid-responsive disease.

MRI in cardiac sarcoidosis and amyloidosis; MRT bei kardialer Sarkoidose und Amyloidose

Energy Technology Data Exchange (ETDEWEB)

Bauner, K.U. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); Wintersperger, B. [Klinikum der Ludwig-Maximilians-Universitaet Muenchen, Campus Grosshadern, Institut fuer Klinische Radiologie, Muenchen (Germany); University of Toronto, Department of Medical Imaging, Toronto General Hospital, Toronto, ON (Canada)

2013-01-15

Sarcoidosis and amyloidosis are both multisystem disorders, which may involve the heart; however, isolated cardiac disease is rare. Diagnosis of cardiac sarcoidosis and amyloidosis is crucial because the patient prognosis is dependent on cardiac involvement and early treatment. Echocardiography is the first line imaging modality in the diagnostic work-up of both diseases, possibly giving hints towards the correct diagnosis. Besides myocardial biopsy and radionuclide studies cardiac magnetic resonance imaging (MRI) is routinely performed in patients suspect of having infiltrative cardiomyopathy. The T1 mapping procedure is currently being evaluated as a new technique for detection and quantification of global myocardial enhancement, as seen in cardiac amyloidosis. Sensitivities and specificities for detection of cardiac sarcoidosis and amyloidosis can be significantly improved by MRI, especially with late gadolinium enhancement (LGE) imaging. In cardiac sarcoidosis the use of LGE is outcome-related while in amyloidosis analysis of T1-mapping may be of prognostic value. If cardiac involvement in sarcoidosis or amyloidosis is suspected cardiac MRI including LGE should be performed for establishing the diagnosis. (orig.) [German] Die Sarkoidose und Amyloidose sind Multisystemerkrankungen, in deren Verlauf es zu einer kardialen Beteiligung kommen kann. Bildgebend wird als primaeres Verfahren die Echokardiographie eingesetzt. Zur weiteren Diagnostik wird neben der Biopsie und nuklearmedizinischen Verfahren v. a. die MRT herangezogen. Als neuere Technik zur Darstellung globaler diffuser Kontrastmittelanreicherungen, wie sie im Rahmen der Amyloidose vorkommen, wird z. Z. das T1-Mapping evaluiert. Durch den Einsatz der MRT, insbesondere des Late-Gadolinium-Enhancements (LGE), koennen die Sensitivitaet und Spezifitaet in der Diagnostik der kardialen Sarkoidose und Amyloidose entscheidend verbessert werden. Bei der Sarkoidose stellt das Vorhandensein eines LGE einen

Gallium-67 uptake in meningeal sarcoidosis

International Nuclear Information System (INIS)

Ayres, J.G.; Hicks, B.H.; Maisey, M.N.

1986-01-01

A case of sarcoidosis limited to the central nervous system is described in which the diagnosis was suggested by high Ga-67 uptake in the cranial and spinal meninges. The diagnosis was confirmed by meningeal biopsy. Treatment with oral corticosteroids resulted in clinical improvement and marked reduction in Ga-67 uptake in the meninges. This is the first reported case of the central nervous system sarcoid diagnosed by Ga-67 imaging

Novel device to sample the esophageal microbiome--the esophageal string test.

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Sophie A Fillon

Full Text Available A growing number of studies implicate the microbiome in the pathogenesis of intestinal inflammation. Previous work has shown that adults with esophagitis related to gastroesophageal reflux disease have altered esophageal microbiota compared to those who do not have esophagitis. In these studies, sampling of the esophageal microbiome was accomplished by isolating DNA from esophageal biopsies obtained at the time of upper endoscopy. The aim of the current study was to identify the esophageal microbiome in pediatric individuals with normal esophageal mucosa using a minimally invasive, capsule-based string technology, the Enterotest™. We used the proximal segment of the Enterotest string to sample the esophagus, and term this the "Esophageal String Test" (EST. We hypothesized that the less invasive EST would capture mucosal adherent bacteria present in the esophagus in a similar fashion as mucosal biopsy. EST samples and mucosal biopsies were collected from children with no esophageal inflammation (n = 15 and their microbiome composition determined by 16S rRNA gene sequencing. Microbiota from esophageal biopsies and ESTs produced nearly identical profiles of bacterial genera and were different from the bacterial contents of samples collected from the nasal and oral cavity. We conclude that the minimally invasive EST can serve as a useful device for study of the esophageal microbiome.

Esclerose sistêmica e sarcoidose Scleroderma and sarcoidosis

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Fernanda Guidolin

2005-10-01

Full Text Available Os autores descrevem o caso de uma paciente com esclerose sistêmica (ES - forma limitada - com comprometimento pulmonar tipo fibrose intersticial. Após sete anos sem acompanhamento, foram identificados gânglios mediastinais e esplenomegalia. A biópsia de linfonodos mostrou granuloma não caseoso sugestivo de sarcoidose. Estamos mostrando, neste caso, a associação de ES e sarcoidose, para chamar a atenção para esse fato e enfatizar que a sarcoidose deve ser lembrada no diagnóstico diferencial das complicações pulmonares da esclerodermia.The authors describe the case of a patient with limited scleroderma and interstitial lung disease. Follow-up was lost for seven years, when patient returned presenting nodular mediastinal enlargement and splenomegaly. Lymph node biopsy showed granulomatous lesions without caseum suggestive of sarcoidosis. This case is being presented to remind the association of scleroderma and sarcoidosis as a possible differential diagnosis of scleroderma pulmonary complications.

Systemic sarcoidosis with bone marrow involvement responding to therapy with adalimumab: a case report

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Patel Supen R

2009-07-01

Full Text Available Abstract Introduction Sarcoidosis is an inflammatory disorder characterized by the presence of non-caseating granulomas in affected organs. The presence of CD4-positive T lymphocytes and macrophages in affected organs suggests an ongoing immune response. Systemic corticosteroids remain the mainstay of treatment, but therapy is often limited by adverse effects. This is the first report of the use of adalimumab (HUMIRA®, Abbott Laboratories, North Chicago, IL, USA, an anti-tumor necrosis factor monoclonal antibody, in a patient with systemic sarcoidosis with bone marrow involvement. Case presentation A 42-year-old African-American man with a medical history significant for hypertension and diabetes mellitus presented with anemia and thrombocytopenia of two months duration. The patient underwent physical examination, bone marrow aspiration and biopsy, chest X-ray, acid-fast bacilli stain, computed tomography with contrast, and additional laboratory tests. He was diagnosed with systemic sarcoidosis with splenomegaly and bone marrow involvement. Drug therapy included prednisone, which had to be discontinued owing to adverse effects, and adalimumab. Conclusion This is the first report describing the use of adalimumab in a patient with systemic sarcoidosis with bone marrow involvement. Tumor necrosis factor antagonism with adalimumab was efficacious and well-tolerated in this patient and may be considered as a treatment option for similar cases.

Systemic sarcoidosis with bone marrow involvement responding to therapy with adalimumab: a case report.

Science.gov (United States)

Patel, Supen R

2009-07-29

Sarcoidosis is an inflammatory disorder characterized by the presence of non-caseating granulomas in affected organs. The presence of CD4-positive T lymphocytes and macrophages in affected organs suggests an ongoing immune response. Systemic corticosteroids remain the mainstay of treatment, but therapy is often limited by adverse effects. This is the first report of the use of adalimumab (HUMIRA((R)), Abbott Laboratories, North Chicago, IL, USA), an anti-tumor necrosis factor monoclonal antibody, in a patient with systemic sarcoidosis with bone marrow involvement. A 42-year-old African-American man with a medical history significant for hypertension and diabetes mellitus presented with anemia and thrombocytopenia of two months duration. The patient underwent physical examination, bone marrow aspiration and biopsy, chest X-ray, acid-fast bacilli stain, computed tomography with contrast, and additional laboratory tests. He was diagnosed with systemic sarcoidosis with splenomegaly and bone marrow involvement. Drug therapy included prednisone, which had to be discontinued owing to adverse effects, and adalimumab. This is the first report describing the use of adalimumab in a patient with systemic sarcoidosis with bone marrow involvement. Tumor necrosis factor antagonism with adalimumab was efficacious and well-tolerated in this patient and may be considered as a treatment option for similar cases.

Renal sarcoidosis presenting as acute kidney injury with granulomatous interstitial nephritis and vasculitis.

Science.gov (United States)

Agrawal, Varun; Crisi, Giovanna M; D'Agati, Vivette D; Freda, Benjamin J

2012-02-01

Among the various renal manifestations of sarcoidosis, granulomatous inflammation confined to the tubulointerstitial compartment is the most commonly reported finding. We present the case of a 66-year-old man with acute kidney injury, hypercalcemia, mild restrictive pulmonary disease, and neurologic signs of parietal lobe dysfunction. Kidney biopsy showed diffuse interstitial inflammation with noncaseating granulomas that exhibited the unusual feature of infiltrating the walls of small arteries with destruction of the elastic lamina, consistent with granulomatous vasculitis. The findings of granulomatous interstitial nephritis on kidney biopsy, hypercalcemia, and possible cerebral and pulmonary involvement in the absence of other infectious, drug-induced, or autoimmune causes of granulomatous disease established the diagnosis of sarcoidosis. Pulse methylprednisolone followed by maintenance prednisone therapy led to improvement in kidney function, hypercalcemia, and neurologic symptoms. Vasculocentric granulomatous interstitial nephritis with granulomatous vasculitis is a rare and under-recognized manifestation of renal sarcoidosis. Copyright © 2012 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

A clinical assessment of esophageal scintigraphy in patients with esophageal cancer

International Nuclear Information System (INIS)

Tsutsui, Shigeharu; Shibatsuji, Hiroshi; Takahashi, Hitoshi

1987-01-01

In patients with esophageal cancer who were treated with radiation therapy, esophageal motility was quantitatively analyzed by comparing the findings from esophageal scintigraphy with subjective symptoms and fluoroscopic findings. The subjects of this study were 5 healthy adults and 10 patients with esophageal cancer. Patients with esophageal cancer underwent radiation therapy (exposure to 50 or 60 Gy irradiation). Each subject swallowed 2 mCi of 99m Tc-DTPA, diluted in 20 ml of water, in a sitting position. The upper esophagus, the lower esophagus, the whole esophagus and the cardia were designated as regions of interest (ROI). A time activity curve was obtained for each ROI, followed by calculation of peak transit time (PTT), esophageal emptying time (EET) and gastric peak time (GPT). In healthy adults, PTT, EET and GPT averaged 0.6, 0.6 and 2.9 seconds, respectively. In patients with esophageal cancer, PTT, EET and GPT averaged 1.9, 1.8 and 6.5 seconds, respectively. Thus, mean PTT, EET and GPT were higher in the cancer patients than in the volunteers. In patients who were treated with radiation therapy, the value of the parameters determined by esophageal scintigraphy agreed well with the changes in symptoms. In patients, the smoothness of passage through the esophagus correlated better with the minimum bore of the esophagus than with the length of the narrowed area of the esophageal cancer. The results of this study indicate that esophageal scintigraphy is a useful means of esophageal examination, which allows changes in esophageal motility to be quantitatively assessed easily and physiologically. (author)

Bronchoalveolar lavage, serum angiotensin-converting enzyme, and 67Ga scanning in extrathoracic sarcoidosis

International Nuclear Information System (INIS)

Wallaert, B.; Ramon, P.; Fournier, E.; Tonnel, A.B.; Voisin, C.

1982-01-01

Results of bronchoalveolar lavage (BAL), 67Ga scanning, and serum angiotensin-converting enzyme (SACE) assay are compared in the assessment of pulmonary involvement in ten cases of extrathoracic sarcoidosis. Standard clinical, radiologic, and pulmonary function tests detected no pulmonary changes in these patients, but BAL demonstrated an increased alveolar lymphocytosis in eight of ten cases. SACE levels were increased in two cases, and the thoracic gallium uptake was normal in all cases. BAL appears to be the best technique for diagnosing latent pulmonary involvement in extrathoracic sarcoidosis

Preliminary characterizations of a serum biomarker for sarcoidosis by comparative proteomic approach with tandem-mass spectrometry in ethnic Han Chinese patients.

Science.gov (United States)

Zhang, Yuan; Chen, Xianqiu; Hu, Yang; Du, Shanshan; Shen, Li; He, Yifan; Zhang, Yuxuan; Zhang, Xia; Li, Huiping; Yung, Rex C

2013-02-11

The diagnosis of sarcoidosis is still a significant challenge in China because of the need to exclude other diseases including granulomatous infections and malignancies that may be clinically and radiographically similar. The specific aim of the study is to search for serum protein biomarkers of sarcoidosis and to validate their clinical usefulness in differential diagnosis. Serum samples were collected from patients with sarcoidosis (n = 37), and compared to those from patients with tuberculosis (n = 20), other pulmonary diseases (n = 20), and healthy volunteers (n = 20) for determination of sarcoidosis-specific or -associated protein expression profiles. The first part of this study focused on proteomic analysis of serum from patients with sarcoidosis to identify a pattern of peptides capable of differentiating the studied populations using the ClinProt profiling technology based on mass spectrometry. Enzyme Linked Immunosorbent Assay (ELISA) was then used to verify corresponding elevation of the serum protein concentration of the potential biomarkers in the same patients sets. Receiver operating characteristic curve (ROC) analyses was performed to determine the optimal cutoff value for diagnosis. Immunohistochemistry was carried out to further confirm the protein expression patterns of the biomarkers in lung tissue. An unique protein peak of M/Z 3,210 Daltons (Da) was found to be differentially expressed between the sarcoidosis and control groups and was identified as the N-terminal peptide of 29 amino acids (94-122) of serum amyloid A (SAA). ELISA confirmed that the serum SAA level was significantly higher in the sarcoidosis group than that of the other 3 control groups (p biomarker for ruling-out the diagnosis of sarcoidosis in Chinese subjects.

Pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid: a case report.

Science.gov (United States)

Kumagai, Toru; Tomita, Yasuhiko; Inoue, Takako; Uchida, Junji; Nishino, Kazumi; Imamura, Fumio

2015-08-14

Pleural effusion induced by sarcoidosis is rare, and pleural sarcoidosis is often diagnosed by thoracoscopic surgery. The diagnosis of pleural sarcoidosis using thoracentesis may be less invasive when sarcoidosis is already diagnosed histologically in more than one organ specimen. Here we report the case of a 64-year-old woman with pleural sarcoidosis diagnosed on the basis of an increased CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis. This case report is important because it highlights the usefulness of the CD4/CD8 lymphocyte ratio in pleural effusion as an indicator of pleural involvement of sarcoidosis. A 64-year-old Japanese woman visited our hospital with an initial symptom of dyspnea on exertion for a period of 4 months. Chest computed tomography showed bilateral hilar and multiple mediastinal lymphadenopathy, multiple small nodular shadows in her bilateral lungs, small nodular shadows along the interlobar pleura, and bilateral pleural effusion. Her serum angiotensin-converting enzyme and soluble interleukin-2 receptor levels were elevated. Histological analysis of a resected subcutaneous nodule, and biopsy specimens from a right mediastinal lymph node and from her right lung revealed non-caseous epithelioid granulomas. Her bronchoalveolar lavage fluid exhibited a predominance of lymphocytes together with an increase in the CD4/CD8 lymphocyte ratio. The lymphocytic predominance and the increased CD4/CD8 lymphocyte ratio were also detected in the right-sided pleural effusion fluid obtained by thoracentesis. We diagnosed sarcoidosis with pleural involvement. Because pleural effusion did not resolve spontaneously and her symptom of dyspnea on exertion worsened, corticosteroid therapy was initiated, which ameliorated the sarcoidosis and the pleuritis. Analysis of the CD4/CD8 lymphocyte ratio in pleural effusion fluid obtained by thoracentesis may be helpful for the diagnosis of pleural sarcoidosis when the diagnosis is already made

Herpetic esophagitis

International Nuclear Information System (INIS)

Shortsleeve, M.J.; Gauvin, G.P.; Gardner, R.C.; Greenberg, M.S.

1981-01-01

Four patients with herpetic esophagitis were examined. In three of them, the presenting symptom was odynophagia. Early in the course of herpetic esophagitis, shallow round and oval ulcers were seen on barium esophagograms. Later, the ulcers filled with fibrinous exudate, forming nodular plaques that projected into the esophageal lumen. Although these findings are diagnostic of esophagitis, they are not specific for a herpes virus infection. The definitive diagnosis must be established by histologic examination, which demonstrates the cytopathic effect of the herpes virus infection within the squamous epithelium

Skeletal sarcoidosis; Skelettsarkoidose

Energy Technology Data Exchange (ETDEWEB)

Freyschmidt, J. [Klinikum Bremen-Mitte, Beratungsstelle und Referenzzentrum fuer Osteoradiologie, Bremen (Germany); Freyschmidt, P. [Dermatologische Gemeinschaftspraxis, Schwalmstadt (Germany)

2016-10-15

Presentation of the etiology, pathology, clinical course, radiology and differential diagnostics of skeletal sarcoidosis. Noncaseating epithelioid cell granulomas can trigger solitary, multiple or disseminated osteolysis, reactive osteosclerosis and/or granulomatous synovitis. The incidence of sarcoidosis is 10-12 per 100,000 inhabitants per year. Skeletal involvement is approximately 14 %. Skeletal involvement occurs almost exclusively in the stage of lymph node and pulmonary manifestation. Most cases of skeletal involvement are clinically asymptomatic. In the case of synovial involvement, unspecific joint complaints (arthralgia) or less commonly arthritis can occur. Typical skin alterations can be diagnostically significant. Punch out lesions osteolysis, coarse destruction and osteosclerosis can occur, which are best visualized with projection radiography and/or computed tomography. Pure bone marrow foci without interaction with the bone can only be detected with magnetic resonance imaging (MRI) and more recently with positron emission tomography (PET), mostly as incidental findings. There is a predeliction for the hand and trunk skeleton. Skeletal tuberculosis, metastases, multiple myeloma, Langerhans cell histiocytosis and sarcoid-like reactions in solid tumors must be differentiated. The key factors for correct diagnosis are thorax radiography, thorax CT and dermatological manifestations. (orig.) [German] Darstellung von Aetiologie, Pathologie, Klinik, Radiologie und Differenzialdiagnose der Skelettsarkoidose. Nichtverkaesende Epitheloidzellgranulome koennen solitaere, multiple oder disseminierte Osteolysen, reaktive Osteosklerosen und/oder eine granulomatoese Synovialitis ausloesen. Inzidenz der Sarkoidose: 10-12/100.000 Einwohner/Jahr. Skelettbeteiligung ca. 14 %. Skelettbeteiligungen kommen fast ausschliesslich im Stadium einer Lymphknoten- und pulmonalen Manifestation vor. Die meisten Skelettbeteiligungen verlaufen klinisch stumm. Bei synovialer

Combined pulmonary involvement in hereditary lysozyme amyloidosis with associated pulmonary sarcoidosis: a case report.

Science.gov (United States)

McCarthy, Cormac; Deegan, Alexander P; Garvey, John F; McDonnell, Timothy J

2013-12-17

Sarcoidosis is a multisystem inflammatory disorder of unknown cause which can affect any organ system. Autosomal dominant lysozyme amyloidosis is a very rare form of hereditary amyloidosis. The Arg64 variant is extraordinarily rare with each family showing a particular pattern of organ involvement, however while Sicca syndrome, gastrointestinal involvement and renal failure are common, lymph node involvement is very rare. In this case report we describe the first reported case of sarcoidosis in association with hereditary lysozyme amyloidosis.

Gastro-esophageal reflux time parameters and esophagitis in children

International Nuclear Information System (INIS)

Baulieu, F.; Baulieu, J.; Maurage, C.; Casset, D.; Itti, R.

1985-01-01

The aim of this work was to study the correlation between the reflux timing and the presence of esophagitis, an inconstant but serious complication of gastro-esophageal reflux (GER). The hypothesis was that reflux occurring late after meal can be incriminated more than early reflux in esophagitis genesis. 32 children with GER (mean age = 10.5 months, 2 to 30 months) had esophagoscopy and scintigraphy in the same week. The children were classified in two groups according to esophagoscopy: group 1 (n = 18) no esophagitis, group 2 (n = 14) esophaqgitis. The scintigraphy involved the ingestion of 0.5 mCi Tc-99m sulfur colloid milk mixture, followed by esophageal and gastric activity recording (one image per minute for 1 hour). The reflux was assessed from contrast enhanced images and esophageal time activity curves. Reflux intensity was quantitated by reflux index (Re). Mean reflux time was calculated as the mean esophageal activity peaks time (t-bar). Finally a composite parameter was calculated as the mean reflux time weighted by the relative intensity of each reflux peak (t-barw). Re was not found to be different between the two groups. t-bar was significantly higher in group 2: t-bar = 29.6 +- 3.0 mn (mean +- SD) than in group 1: t-bar = 24.5 +- 6.8 mn; rho <0.02. The difference between the two groups was enhanced by intensity weighting: group 1: t-barw = 16.6 +- 6.3 mn, group 2: t-barw = 33.5 +- 7.1 mn rho <0.001. t-barw value was not correlated to esophagitis grade. These results suggest that late reflux is more likely responsible of esophagitis

Endoscopic Assessment of Children with Esophageal Atresia: Lack of Relationship of Esophagitis and Esophageal Metaplasia to Symptomatology

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Julie Castilloux

2010-01-01

Full Text Available BACKGROUND: Late complications of esophageal atresia (EA, particularly esophagitis and Barrett’s esophagus, are increasingly being recognized. With the exception of patients with dysphagia associated with esophageal stricture, it is unknown whether patient symptomatology can predict endoscopic findings.

Fulminant musculoskeletal and neurologic sarcoidosis: case report and literature update

Energy Technology Data Exchange (ETDEWEB)

Sweeney, Ashley; Hammer, Richard; Evenski, Andrea; Crim, Julia [University of Missouri at Columbia, Columbia, MO (United States)

2016-11-15

We report a case of fulminant sarcoidosis in a 28-year-old man presenting with skin nodules, multifocal small and large joint arthralgias, and blurred vision. Characteristic bone, soft tissue, articular, and CNS findings were evident on multimodality imaging. Bony abnormalities included near-complete destruction of a distal phalanx, ''lace-like'' lucent lesions, erosive arthritis, lytic lesions with and without sclerotic margins, and bone marrow replacement visible only on MRI. The extent of bony disease at time of presentation was unusual. We review the widely varying reported prevalence of imaging findings of bony sarcoidosis in the literature, and discuss reasons for this variability. We found that musculoskeletal findings at US and MRI were less specific than radiographic and CT findings, but were useful in quantifying extent of disease. (orig.)

Air trapping in sarcoidosis on computed tomography: Correlation with lung function

International Nuclear Information System (INIS)

Davies, C.W.H.; Tasker, A.D.; Padley, S.P.G.; Davies, R.J.O.; Gleeson, F.V.

2000-01-01

AIMS: To document the presence and extent of air trapping on high resolution computed tomography (HRCT) in patients with pulmonary sarcoidosis and correlate HRCT features with pulmonary function tests. METHODS: Twenty-one patients with pulmonary sarcoidosis underwent HRCT and pulmonary function assessment at presentation. Inspiratory and expiratory HRCT were assessed for the presence and extent of air trapping, ground-glass opacification, nodularity, septal thickening, bronchiectasis and parenchymal distortion. HRCT features were correlated with pulmonary function tests. RESULTS: Air trapping on expiratory HRCT was present in 20/21 (95%) patients. The extent of air trapping correlated with percentage predicted residual volume (RV)/total lung capacity (TLC) (r = 0.499;P < 0.05) and percentage predicted maximal mid-expiratory flow rate between 25 and 75% of the vital capacity (r = -0.54;P < 0.05). Ground-glass opacification was present in four of 21 (19%), nodularity in 18/21 (86%), septal thickening in 18/21 (86%), traction bronchiectasis in 14/21 (67%) and distortion in 12/21 (57%) of patients; there were no significant relationships between these CT features and pulmonary function results. CONCLUSION: Air trapping is a common feature in sarcoidosis and correlates with evidence of small airways disease on pulmonary function testing. Davies, C.W.H. (2000). Clinical Radiology 55, 217-221

Impaired Upper Esophageal Sphincter Reflexes in Patients with Supra-Esophageal Reflux Disease

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Babaei, Arash; Venu, Mukund; Naini, Sohrab Rahimi; Gonzaga, Jason; Lang, Ivan; Massey, Benson; Jadcherla, Sudarshan; Shaker, Reza

2015-01-01

Background & Aims Normal responses of the upper esophageal sphincter (UES) and esophageal body to liquid reflux events prevent esophagopharyngeal reflux and its complications, but abnormal responses have not been characterized. We investigated whether patients with supra-esophageal reflux disease (SERD) have impaired UES and esophageal body responses to simulated reflux events. Methods We performed a prospective study of 25 patients with SERD (19–82 y old, 13 female) and complaints of regurgitation and supra-esophageal manifestations of reflux. We also included 10 patients with gastroesophageal reflux disease (GERD; 32–60 y old, 7 female) without troublesome regurgitation and supra-esophageal symptoms and 24 healthy asymptomatic individuals (controls; 19–49 y old, 13 female). UES and esophageal body pressure responses, along with luminal distribution of infusate during esophageal rapid and slow infusion of air or liquid, were monitored by concurrent high-resolution manometry and intraluminal impedance. Results A significantly smaller proportion of patients with SERD had UES contractile reflexes in response to slow esophageal infusion of acid than controls or patients with GERD. Only patients with SERD had abnormal UES relaxation responses to rapid distension with saline. Diminished esophageal peristaltic contractions resulted in esophageal stasis in patients with GERD or SERD. Conclusions Patients with SERD and complaints of regurgitation have impaired UES and esophageal responses to simulated liquid reflux events. These patterns could predispose them to esophagopharyngeal reflux. PMID:26188682

Late-onset and rare far-advanced pulmonary involvement in patients with sarcoidosis in Taiwan.

Science.gov (United States)

Hsieh, Chia-Wei; Chen, Der-Yuan; Lan, Joung-Liang

2006-04-01

Sarcoidosis is still considered a rare multisystem disorder in Taiwan, and data on the disease course and outcome are limited. We analyzed the clinical manifestations, disease course and complications in Taiwanese patients with sarcoidosis. A retrospective cohort design was used. Fifty-six patients with sarcoidosis diagnosed between 1985 and 2004 were included. Their clinical features, laboratory findings at initial presentation, disease course, and complications were analyzed. Forty-three patients (76.8%) were female. The mean age at symptom onset was 47 years. The most common clinical symptoms were pulmonary (82.1%), cutaneous (23.2%), ophthalmic (19.6%), and articular (17.8%). Only two patients presented with Löfgren's syndrome. There was a seasonal variation in disease onset, with higher incidence in winter and early spring. No advanced pulmonary involvement was noted. Elevated levels of serum angiotensin converting enzyme (sACE) were found in 72.5% (29/40) of patients with active sarcoidosis, and significantly higher levels of sACE were found in patients with lung involvement (27.98+/-1.71 IU/L vs. 18.2+/-2.76 IU/L; psACE levels declined significantly in parallel with clinical remission (24.75+/-1.53 IU/L vs. 16.33+/-1.21 IU/L; psACE might be a marker of pulmonary involvement that is also useful in monitoring disease activity.

Sarcoidosis-associated pulmonary hypertension: acute vasoresponsiveness to inhaled nitric oxide and the relation to long-term effect of sildenafil

DEFF Research Database (Denmark)

Milman, Nils; Svendsen, Claus Bo; Iversen, Martin

2009-01-01

Abstract Background: Severe pulmonary sarcoidosis is often complicated by pulmonary hypertension (PH) caused by different pathophysiological mechanisms. Objectives: To assess the acute vasoresponsiveness in patients with sarcoidosis and PH and the relation to the therapeutic effect of sildenafil...

A Diagnostic Dilemma: Metastatic Testicular Cancer and Systemic Sarcoidosis – A Review of the Literature

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R. Gupta

2011-03-01

Full Text Available Sarcoidosis is a multisystem disease that most commonly involves the lungs and the lymph nodes, but with genitourinary tract involvement, can easily mimic testicular cancer with metastasis to the lungs. We describe the case of a 30-year-old African-American male who presented with complaints of a headache, skin lesions, and a scrotal mass. A computed tomography scan of the head showed lesions in the frontotemporal and pons region, causing obstructive hydrocephalus. An ultrasound of the scrotum showed an enlarged epididymis bilaterally as well as a solid hypoechoic ill-defined mass on the right side, separate from the intact testis. Given the high suspicion for testicular malignancy with brain metastasis, a right orchiectomy was completed. The pathology revealed non-caseating necrotizing granulomas that stained negative for tubercular and fungal organisms, which was consistent with sarcoidosis. Additionally, the patient’s skin and central nervous system (CNS lesions improved on steroids that had been started for cerebral edema. Given the predilection of testicular cancer for CNS metastasis, neurosarcoidosis can also be mistaken for testicular cancer metastasis to the CNS, as seen in our case. Differentiating testicular cancer from genitourinary sarcoidosis is difficult but can be clarified using a combination of clinical presentation, epidemiology, serum markers (ACE, AFP, B-HCG, biopsies from skin/lymph nodes, and sometimes imaging. It is critical to differentiate genitourinary sarcoidosis from malignancy, as a misdiagnosis can lead to unnecessary surgical interventions, which have important implications for future fertility. There can also be a coexistence of as well as an association between testicular cancer and sarcoidosis, which should be recognized by health care providers. Both authors contributed equally to the manuscript.

Esophageal motility in eosinophilic esophagitis

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A.H. Weiss

2015-07-01

Conclusions: Motility dysfunction of the esophagus in EoE has not been well reported in the literature and studies have reported conflicting evidence regarding the clinical significance of dysmotility seen in EoE. The correlation between esophageal dysmotility and symptoms of EoE remains unclear. Larger studies are needed to investigate the incidence of esophageal dysmotility, clinical implications, and effect of treatment on patients with EoE.

Effect of the TNF-α inhibitor adalimumab in patients with recalcitrant sarcoidosis: a prospective observational study using FDG-PET

DEFF Research Database (Denmark)

Milman, Nils; Graudal, Niels; Loft, Annika

2012-01-01

-PET) in patients with recalcitrant sarcoidosis treated with adalimumab. Methods: Prospective 24-week observational study. Patients continued medication with steroids and antimetabolites and received adalimumab 40 mg subcutaneously every other week. Ten patients with biopsy-proven sarcoidosis (two men) were...

Cutaneous annular sarcoidosis developing on a background of exogenous ochronosis: a report of two cases and review of the literature.

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Moche, M J; Glassman, S J; Modi, D; Grayson, W

2010-06-01

Exogenous (cosmetic) ochronosis is caused by the long term use of skin-lightening creams containing hydroquinone. Three cases of systemic sarcoidosis with cutaneous sarcoidal granulomas, which developed on ochronotic skin were last described by Jacyk in 1995. Dogliotti and Leibowitz previously reported cases of granulomatous ochronosis with sarcoid-like histological changes but with no associated systemic sarcoidosis. We report two additional cases of cutaneous sarcoidal granulomas, which developed on a background of cosmetic ochronosis in patients recently diagnosed with systemic sarcoidosis.

Relationship between changed alveolar-capillary permeability and angiotensin converting enzyme activity in serum in sarcoidosis.

OpenAIRE

Eklund, A; Blaschke, E

1986-01-01

The effect of altered alveolar-capillary permeability on angiotensin converting enzyme (ACE) activity in serum (SACE) was studied in 45 patients with sarcoidosis and 21 healthy controls. In sarcoidosis increased albumin concentrations in the bronchoalveolar lavage fluid (L albumin) and increased ratios of L albumin to albumin in serum (S albumin) indicated an increased permeability of the alveolar-capillary membrane. ACE activity in the lavage fluid (LACE) was correlated with the number of al...

[Esophageal motor disorders in cirrhotic patients with esophageal varices non-submitted to endoscopic treatment].

Science.gov (United States)

Flores, Priscila Pollo; Lemme, Eponina Maria de Oliveira; Coelho, Henrique Sérgio Moraes

2005-01-01

The hepatic cirrhosis has as one of the main morbid-mortality causes, the portal hypertension with the development of esophageal varices, the possibility of a digestive hemorrhage and worsening of hepatic insufficiency. It is important to identify causal predictive or aggravating factors and if possible to prevent them. In the last years, it has been observed the association of esophageal motor disorders and gastro-esophageal reflux in cirrhotic patients with esophageal varices. To study the prevalence of the esophageal motility disorders and among them, the ineffective esophageal motility, in patients with hepatic cirrhosis and esophageal varices, without previous endoscopic therapeutic and the predictive factors. Prospectively, it has been evaluate 74 patients suffering from liver cirrhosis and esophagic varices, without previous endoscopic treatment. All of them were submitted to a clinical protocol, esophageal manometry and 55 patients also held the ambulatory esophageal pHmetry. Esophageal motility disorders have been found in 44 patients (60%). The most prevalent was the ineffective esophageal motility, observed in 28%. The abnormal reflux disease was diagnosed through the pHmetry in 35% of the patients. There were no correlation between the manometrical abnormality in general and the ineffective esophageal motility in particular and the esophageal or gastroesophageal reflux disease symptoms, the abnormal reflux, the disease seriousness, the ascites presence and the gauge of the varices. The majority of cirrhotic patients with non-treated esophageal varices present esophageal motor disorders. No predictive factor was found. The clinical relevance of these findings need more researches in the scope to define the real meaning of theses abnormalities.

The Role of Esophageal Hypersensitivity in Functional Esophageal Disorders.

Science.gov (United States)

Farmer, Adam D; Ruffle, James K; Aziz, Qasim

2017-02-01

The Rome IV diagnostic criteria delineates 5 functional esophageal disorders which include functional chest pain, functional heartburn, reflux hypersensitivity, globus, and functional dysphagia. These are a heterogenous group of disorders which, despite having characteristic symptom profiles attributable to esophageal pathology, fail to demonstrate any structural, motility or inflammatory abnormalities on standard clinical testing. These disorders are associated with a marked reduction in patient quality of life, not least considerable healthcare resources. Furthermore, the pathophysiology of these disorders is incompletely understood. In this narrative review we provide the reader with an introductory primer to the structure and function of esophageal perception, including nociception that forms the basis of the putative mechanisms that may give rise to symptoms in functional esophageal disorders. We also discuss the provocative techniques and outcome measures by which esophageal hypersensitivity can be established.

Is it time to scrap Scadding and adopt computed tomography for initial evaluation of sarcoidosis? [version 1; referees: 2 approved

Directory of Open Access Journals (Sweden)

Andrew Levy

2018-05-01

Full Text Available In this review, we argue for the use of high-resolution computed tomography (HRCT over chest X-ray in the initial evaluation of patients with sarcoidosis. Chest X-ray, which has long been used to classify disease severity and offer prognostication in sarcoidosis, has clear limitations compared with HRCT, including wider interobserver variability, a looser association with lung function, and poorer sensitivity to detect important lung manifestations of sarcoidosis. In addition, HRCT offers a diagnostic advantage, as it better depicts targets for biopsy, such as mediastinal/hilar lymphadenopathy and focal parenchymal disease. Newer data suggest that specific HRCT findings may be associated with important prognostic outcomes, such as increased mortality. As we elaborate in this update, we strongly recommend the use of HRCT in the initial evaluation of the patient with sarcoidosis.

Bilateral parotitis as the initial presentation of childhood sarcoidosis.

Science.gov (United States)

Banks, Gretchen C; Kirse, Daniel J; Anthony, Evelyn; Bergman, Simon; Shetty, Avinash K

2013-01-01

The differential diagnosis of bilateral parotid gland enlargement in children includes infectious, inflammatory, and neoplastic disorders. We present the case of a 13-year-old male who presented with a 5-week history of bilateral parotid swelling. On exam, both parotid glands were nontender, smooth, and diffusely enlarged. He had slightly elevated inflammatory markers, but other lab results were normal. A neck CT revealed symmetric enlargement of the parotid, submandibular, and sublingual glands. A chest CT revealed scattered peripheral pulmonary nodules and bilateral hilar adenopathy. A parotid gland biopsy showed multiple noncaseating granulomas with multinucleated giant cells surrounded by lymphocytes, consistent with the diagnosis of sarcoidosis. Special stains for acid-fast and fungal organisms were negative. Using this illustrative case, we discuss the differential diagnosis of bilateral salivary gland enlargement in children and review the etiology, diagnosis, clinical manifestations, and treatment of pediatric sarcoidosis. Copyright © 2013 Elsevier Inc. All rights reserved.

Diabetes insipidus secondary to sarcoidosis presenting with caseating granuloma

Science.gov (United States)

Alam, Taimour; Thomas, Steven

2011-01-01

Diabetes insipidus is a rare complication of sarcoid infiltration of the hypothalamic-pituitary region. Non-caseating granuloma formation is typical of sarcoidosis. Anterior and posterior pituitary function may be affected. MRI coupled with endocrinology assessment is the usual method of investigation. A 25-year-old Caucasian male with no significant medical history presented with polyuria and polydipsia. Water deprivation test confirmed diabetes insipidus. CT scanning of the chest confirmed lymphadenopathy. Lymph node biopsy revealed caseating granuloma. Extensive investigation for tuberculosis was negative. The patient was started on intranasal desmopressin and steroids with marked improvement in symptoms. This is the first reported case of neurosarcoidosis with diabetes insipidus and caseation on histology that we are aware of. Differentiating between caseation due to sarcoidosis and tuberculosis on histology is possible by the use of special stains. Return of normal endocrine function is unusual and the patient is likely to require desmopressin therapy for life. PMID:22707619

Pneumatic Dilation of the Lower Esophageal Sphincter Can Now Be Successfully Performed Without Morbidity.

Science.gov (United States)

Jia, Yi; Bustamante, Marco; Moraveji, Sharareh; McCallum, Richard W

2016-11-01

Patients with dysphagia may be diagnosed with impaired lower esophageal sphincter (LES) relaxation and treated with pneumatic dilation (PD), stretching and tearing LES muscle fibers. Esophageal perforation has been reported to be as high as 10%. We conducted a retrospective study to evaluate the perforation rate of PD when used for impaired relaxation of the LES using current techniques. A chart review was conducted to identify patients referred for esophageal manometry by high-resolution manometry and later received PD from January 2013 to April 2016. The diagnoses of achalasia, gastroesophageal junction outlet obstruction or hypertensive LES with accompanying impaired LES relaxation were based on the Chicago Classification III. Demographic data, clinical findings, treatment approaches and outcomes were explored. A total of 187 patients were referred for dysphagia and had esophageal manometry during this time frame. In all, 62 patients (34 female), mean age of 52 years, met the criteria for incomplete relaxation of the LES and underwent a total of 88 PD procedures. All initial PD procedures used the 30-mm diameter balloon, 18 subsequently required a 35-mm balloon and 8 went on to 40-mm balloon size. No perforations or other complications were documented by esophagogastroduodenoscopy, gastrografin testing immediately postdilation or by subsequent clinical outcome. PD by an experienced gastroenterologist using general anesthesia, fluoroscopic guidance, Rigiflex balloon equipment and a specific repetitive technique can be successfully performed without perforation. Hence, the already known therapeutic efficacy of PD can now be combined with the knowledge that there is essentially no accompanying perforation rate. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Development of sarcoidosis 6-month post discontinuation of etanercept: coincidence or real association?

LENUS (Irish Health Repository)

Haroon, Muhammad

2011-08-01

There have been numerous reports of granulomatous diseases developing in patients receiving anti-tumour necrosis factor (TNF) therapy. Herein, we report a patient who developed sarcoidosis 6 months after discontinuation of etanercept. To date, all reported cases have occurred in patients undergoing ongoing treatment with TNF blockers with resolution on its discontinuation. A 47-year-old man was diagnosed with seropositive rheumatoid arthritis (RA) in 2003. He was initially treated with methotrexate and corticosteroids. In 2005, adalimumab was added due to ongoing disease activity. However, he had persistent low-grade synovitis of bilateral wrist joints and remained oral glucocorticoids dependent. In October 2008, adalimumab was switched to etanercept with marginal benefit; however, etanercept was continued until March 2009. Rituximab was discontinued due to an immediate allergic reaction. In September 2009, he developed bilateral ankle synovitis with erythema nodosum. Further investigations (chest X-ray and CT scan of thorax) revealed new development of bilateral hilar lymphadenopathy and interstitial nodular changes typical of sarcoidosis. His baseline therapy of methotrexate was continued. His recent repeat chest X-ray and CT scan of thorax (March 2010) has shown significant spontaneous resolution of his mediastinal lymphadenopathy and pulmonary nodules. Apart from the initial brief course of NSAIDs, his sarcoidosis resolved spontaneously without requiring any further therapy. For his rheumatoid arthritis, he has been recently commenced on abatacept and his baseline therapy of methotrexate has been continued. It remains speculative as to whether the concurrence of RA and sarcoidosis is purely serendipitous, or is related to an immunodysregulatory state attributable to TNF blockade.

High-resolution esophageal pressure topography for esophageal motility disorders

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Hashem Fakhre Yaseri

2016-04-01

Full Text Available Background: High-resolution manometer (HRM of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed by Pandolfino et al, includes contraction patterns and peristalsis integrity based on integrated relaxation pressure 4 (IRP4. It can be discriminating the achalasia from non-achalasia esophageal motility disorders. The aim of this study was to assessment of clinical findings in non-achalasia esophageal motility disorders based on the most recent Chicago classification. Methods: We conducted a prospective cross-sectional study of 963 patients that had been referred to manometry department of Gastrointestinal and Liver Research Center, Firozgar Hospital, Tehran, Iran, from April, 2012 to April, 2015. They had upper GI disorder (Dysphasia, non-cardiac chest pain, regurgitation, heartburn, vomiting and asthma and weight loss. Data were collected from clinical examinations as well as patient questionnaires. Manometry, water-perfused, was done for all patients. Manometry criteria of the patients who had integrated relaxation pressure 4 (IRP4 ≤ 15 mmHg were studied. Results: Our finding showed that the non-achalasia esophageal motility disorders (58% was more common than the achalasia (18.2%. Heartburn (68.5%, regurgitation (65.4% and non-cardiac chest pain (60.6% were the most common clinical symptoms. Although, vomiting (91.7% and weight loss (63% were the most common symptoms in referring patients but did not discriminate this disorders from each other’s. Borderline motor function (67.2% was the most common, absent peristalsis (97% and the hyper

Patients with established gastro-esophageal reflux disease might benefit from Helicobacter pylori eradication.

Science.gov (United States)

Moschos, John M; Kouklakis, George; Vradelis, Stergios; Zezos, Petros; Pitiakoudis, Michael; Chatzopoulos, Dimitrios; Zavos, Christos; Kountouras, Jannis

2014-01-01

The aim of this study was to investigate the effect of Helicobacter pylori ( H. pylori ) eradication in selected H. pylori -positive patients with a primary diagnosis of gastro-esophageal reflux disease (GERD) by using the 3-h postprandial esophageal pH monitoring. We recruited patients with erosive esophagitis at endoscopy and H. pylori infection at histology, successfully cured following eradication therapy; the selected H. pylori -positive patients had weekly reflux symptoms for at least six months and endoscopically established Grade A or B esophagitis. Twenty-nine eligible patients were initially subjected to esophageal manometry and ambulatory 3-h postprandial esophageal pH monitoring. All patients received H. pylori triple eradication therapy accompanied by successful H. pylori eradication. After successful eradication of H. pylori (confirmed by 13 C urea breath test), a second manometry and 3-h postprandial esophageal pH monitoring were introduced to assess the results of eradication therapy, after a 3-month post-treatment period. All 29 selected H. pylori -positive patients became negative due to successful H. pylori eradication, evaluated by 13 C urea breath test after a 4-week post-treatment period. Post-eradication, 62.1% patients showed similar manometric pattern at baseline; 17.2% showed improvement; 17.2% normalization; and 3.4% deterioration of the manometric patterns. The DeMeester symptom scoring in the 3-h postprandial ambulatory esophageal pH monitoring was improved after eradication of H. pylori (median 47.47 vs. 22.00, Wilcoxon's singed rank; P=0.016). On comparing the pH monitoring studies for each patient at baseline and post-eradication period, 82.8% patients showed improvement and 17.2% deterioration of the DeMeester score. By using 3-h postprandial esophageal pH monitoring, this study showed, for the first time, that H. pylori eradication may positively influence GERD symptoms. Large-scale controlled relative studies are warranted to

Targeted anti-TNF therapy in severe sarcoidosis: towards precision medicine

NARCIS (Netherlands)

Crommelin, H.A.

2018-01-01

Sarcoidosis is a multisystem, granulomatous disorder of unknown etiology. The disease has many clinical phenotypes, ranging from asymptomatic and self-limiting to severe and life threatening disease. Virtually any organ can be involved, but pulmonary involvement is seen in approximately 90% of

Quercetin reduces markers of oxidative stress and inflammation in sarcoidosis

NARCIS (Netherlands)

Boots, Agnes W.; Drent, Marjolein; de Boer, Vincent C. J.; Bast, Aalt; Haenen, Guido R. M. M.

2011-01-01

Oxidative stress and low antioxidant levels are implicated in the aetiology of sarcoidosis, an inflammatory disease. Quercetin is a potent dietary antioxidant that also displays anti-inflammatory activities. Consequently, the aim is to examine the effect of quercetin supplementation on markers of

Esophageal Stenosis Associated With Tumor Regression in Radiotherapy for Esophageal Cancer: Frequency and Prediction

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Atsumi, Kazushige [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Shioyama, Yoshiyuki, E-mail: shioyama@radiol.med.kyushu-u.ac.jp [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Arimura, Hidetaka [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Terashima, Kotaro [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Matsuki, Takaomi [Department of Health Sciences, Kyushu University, Fukuoka (Japan); Ohga, Saiji; Yoshitake, Tadamasa; Nonoshita, Takeshi; Tsurumaru, Daisuke; Ohnishi, Kayoko; Asai, Kaori; Matsumoto, Keiji [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan); Nakamura, Katsumasa [Department of Radiology, Kyushu University Hospital at Beppu, Oita (Japan); Honda, Hiroshi [Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka (Japan)

2012-04-01

Purpose: To determine clinical factors for predicting the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer. Methods and Materials: The study group consisted of 109 patients with esophageal cancer of T1-4 and Stage I-III who were treated with definitive radiotherapy and achieved a complete response of their primary lesion at Kyushu University Hospital between January 1998 and December 2007. Esophageal stenosis was evaluated using esophagographic images within 3 months after completion of radiotherapy. We investigated the correlation between esophageal stenosis after radiotherapy and each of the clinical factors with regard to tumors and therapy. For validation of the correlative factors for esophageal stenosis, an artificial neural network was used to predict the esophageal stenotic ratio. Results: Esophageal stenosis tended to be more severe and more frequent in T3-4 cases than in T1-2 cases. Esophageal stenosis in cases with full circumference involvement tended to be more severe and more frequent than that in cases without full circumference involvement. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. In the multivariate analysis, T stage, extent of involved circumference, and wall thickness of the tumor region were significantly correlated to esophageal stenosis (p = 0.031, p < 0.0001, and p = 0.0011, respectively). The esophageal stenotic ratio predicted by the artificial neural network, which learned these three factors, was significantly correlated to the actual observed stenotic ratio, with a correlation coefficient of 0.864 (p < 0.001). Conclusion: Our study suggested that T stage, extent of involved circumference, and esophageal wall thickness of the tumor region were useful to predict the frequency and severity of esophageal stenosis associated with tumor regression in radiotherapy for esophageal cancer.

Esophageal motility disorders

International Nuclear Information System (INIS)

Hannig, C.; Rummeny, E.; Wuttge-Hannig, A.

2007-01-01

For the better understanding of esophageal motility, the muscle texture and the distribution of skeletal and smooth muscle fibers in the esophagus are of crucial importance. Esophageal physiology will be shortly mentioned as far as necessary for a comprehensive understanding of peristaltic disturbances. Besides the pure depiction of morphologic criteria, a complete esophageal study has to include an analysis of the motility. New diagnostic tools with reduced radiation for dynamic imaging (digital fluoroscopy, videofluoroscopy) at 4-30 frames/s are available. Radiomanometry is a combination of a functional pressure measurement and a simultaneous dynamic morphologic analysis. Esophageal motility disorders are subdivided by radiologic and manometric criteria into primary, secondary, and nonclassifiable forms. Primary motility disorders of the esophagus are achalasia, diffuse esophageal spasm, nutcracker esophagus, and the hypertonic lower esophageal sphincter. The secondary motility disorders include pseudoachalasia, reflux-associated motility disorders, functionally caused impactions, Boerhaave's syndrome, Chagas' disease, scleroderma, and presbyesophagus. The nonclassificable motility disorders (NEMD) are a very heterogeneous collective. (orig.) [de

Quantification of small fiber pathology in patients with sarcoidosis and chronic pain using cornea confocal microscopy and skin biopsies

Directory of Open Access Journals (Sweden)

Oudejans LCJ

2017-08-01

Full Text Available Linda CJ Oudejans,1 Marieke Niesters,1 Michael Brines,2 Albert Dahan,1 Monique van Velzen1 1Department of Anesthesiology, Leiden University Medical Center, Leiden, the Netherlands; 2Araim Pharmaceuticals, Inc., Tarrytown, NY, USA Abstract: Small fiber pathology with concomitant chronic neuropathic pain is a common complication of sarcoidosis. The gold standard of diagnosis of small fiber neuropathy (SFN is the quantification of small nerve fibers in skin biopsies in combination with patient history and psychophysical tests; a new technique is the quantification of small nerve fibers in the cornea using cornea confocal microscopy (CCM. Here, we studied small fiber morphology in sarcoidosis patients with neuropathic pain using skin biopsies, CCM, and quantitative sensory testing (QST. Our aim was to construct specific phenotypes of neuropathic pain in sarcoidosis. Fifty-eight patients with a confirmed diagnosis of sarcoidosis and with moderate-to-severe neuropathic pain were tested. Decreased intraepidermal nerve fiber density (IENFD from skin biopsies was found in 28% of patients, and CCM abnormalities were observed in 45% of patients. There was no correlation between CCM and IENFD abnormalities. Eighty-three percent of patients had abnormal thermal detection thresholds, a sign of small fiber dysfunction. Based on the presence or absence of abnormalities in IENFD and CCM, four distinct phenotypes were identified with a distinct homogeneous pattern of somatosensory symptoms. We argue that these distinct phenotypes have a similar mechanistic construct with specific phenotype-specific treatment options. Additionally, our data suggest the presence of patients with length- and nonlength-dependent SFN within this population of sarcoidosis patients. Keywords: chronic pain, sarcoidosis, small fiber neuropathy

Recurrent hypercalcemia in a patient with acute sarcoidosis

International Nuclear Information System (INIS)

Saavedra Ramirez, Publio Giovanni; Ramirez Palacios, Ivan; Cardona Tapias, Alejandro

2007-01-01

Sarcoidosis is a chronic granulomatous disease of unknown etiology characterized by the presence of noncaseating epithelioid granulomas that can take place in every organ or system of the human body. This disease can be acute or sub acute and self limited in presentation or can have a chronic course characterized by exacerbations and remissions. Hypercalcemia can be detected in 10 to 20 percent of the patients with the disease. It is caused by the over expression of vitamin D-receptor and 25-hydroxyvitamin D 1-? hydroxylase enzyme in monocytes and activated macrophages within the granuloma in a way that is resistant to the natural inhibition driven by high serum calcium Levels. This autonomous enzymatic activity leads to the overproduction of calcitriol which increase intestinal absorption of the calcium present in the diet and also increase the activity of osteoclast with consequent high bone turnover and hypercalcemia. In this report we present the case of a 49 years old man, black race, bilateral parotid gland enlargement, bilateral hilar lymphadenopathy, severe recurrent hypercaIcemia and acute renal failure in which sarcoidosis was documented as the cause of his symptoms

Esophageal stent implantation for the treatment of esophageal strictures: its current situation and research progress

International Nuclear Information System (INIS)

Zhu Haidong; Guo Jinhe; Teng Gaojun

2011-01-01

Esophageal stent implantation has been the most common therapy for the treatment of malignant and benign esophageal stenosis. At present, this technique is widely used in treating advanced esophageal cancerous stricture, refractory esophageal benign stricture and all kinds of esophageal fistulae or perforation. This paper aims to make a comprehensive review of the current situation and research progress of the esophageal stent implantation in clinical practice. (authors)

Management of esophageal disorders

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Hill, L.D.; Mercer, C.D.; McCallum, R.W.; Kozarek, R.

1987-01-01

This book integrates gastroenterology and thoracic surgery to detail the comprehensive management of esophageal disease. It describes radiologic and functional evaluation of the esophagus, endoscopy, medical and surgical treatments, and results and also covers gastroesophageal reflux disease, tumors motility, esophageal replacement, intubation, esophageal diverticula, caustic esophageal injury. It presents Dr. Hill's surgical procedures in detail.

Esophageal Cancer

Science.gov (United States)

... from your throat to your stomach. Early esophageal cancer usually does not cause symptoms. Later, you may ... You're at greater risk for getting esophageal cancer if you smoke, drink heavily, or have acid ...

Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders.

Science.gov (United States)

van Hoeij, Froukje B; Bredenoord, Albert J

2016-01-31

Esophageal high-resolution manometry (HRM) is replacing conventional manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new classification scheme: the Chicago classification. HRM measurements are more detailed and more easily performed compared to conventional manometry. The visual presentation of acquired data improved the analysis and interpretation of esophageal motor function. This led to a more sensitive, accurate, and objective analysis of esophageal motility. In this review we discuss how HRM changed the way we define and categorize esophageal motility disorders. Moreover, we discuss the clinical applications of HRM for each esophageal motility disorder separately.

X-ray CT evaluation of pulmonary involvements of sarcoidosis

International Nuclear Information System (INIS)

Nishimura, Koichi; Izumi, Takateru; Kitaichi, Masanori

1987-01-01

We evaluated high resolution CT in 60 patients with histologically diagnosed pulmonary sarcoidosis and, also, studied the relationship between CT and findings in open lung biopsy specimens in 2 cases. The CT findings were as follows: (1) thickening of bronchial wall shadows (27 out of 60 cases, 45.0 %), (2) irregular enlargement of pulmonary vascular shadows (39 cases, 65.0 %), (3) small or large nodular shadows (24 cases, 40.0 %), (4) local volume loss (14 cases, 23.3 %), (5) slightly increased density of localized lung field areas (24 cases, 40.0 %), (6) pleural or subpleural involvement (27 cases, 45.0 %), (7) lymph node enlargement (59 cases, 98.3 %). X-ray CT in 7 patients revealed no evidence of lung field involvement in patients with histologicall confirmed epithelioid cell granuloma in transbronchial lung biopsy specimens. Lesions located within vessels or in the vascular wall, perivascular sheath or alveoli surrounding blood vessels might cause pulmonary vascular shadows to appear swollen on CT. In a comparative study, we found irregular dilatation of pulmonary vascular shadows corresponding to granulomas in the connective tissue sheath of blood vessels. Also, thickening of bronchial wall shadows corresponded to granulomas in and around the bronchial wall. From the point of histopathological view epithelioid cell granulomas in the bronchovascular sheath were most marked in sarcoidosis, and they apperaed on CT as an irregular enlargement of pulmonary vascular shadows and thickening of the bronchial wall. On the other hand, we reported that collapse of alveoli and fibrosis surrounding blood vessels could cause irregular enlargement of pulmonary vascular shadows on CT in idiopathic pulmonary fibrosis (IPF). Such shadows were seen on CT in both sarcoidosis and IPF but the mechanism of their appearance differed. (J.P.N.)

The potential of photodynamic therapy to treat esophageal candidiasis coexisting with esophageal cancer.

Science.gov (United States)

Qiu, Haixia; Mao, Yongping; Gu, Ying; Zhu, Jianguo; Wang, Ying; Zeng, Jing; Huang, Naiyan; Liu, Qingsen; Yang, Yunsheng

2014-01-05

Photodynamic therapy (PDT) has been used in recent years to deal with fungal infections because of the prevalence of fungi resistance to drugs. However, PDT for gastrointestinal fungal infection has not been reported. This study was conducted to assess the potential of PDT to deal with esophageal candidiasis. Two male patients with histological evidence of esophageal candidiasis coexisting with esophageal cancer were included in this retrospective study. Both patients were treated with PDT. This treatment was repeated at least 1month after the initial PDT if the patient still had residual cancer or esophageal candidiasis. Short-term efficacy was evaluated on the basis of endoscopy and histology findings. Further follow-up data were obtained from endoscopy results or telephone conversation. The esophageal candidiasis located 21-24cm and 25-28cm from the incisors of case 1 reached complete remission after one and two PDT sessions, respectively. The esophageal cancer coexisting with esophageal candidiasis located 21-24cm from the incisors reached complete remission after two PDT sessions. No recurrence was found at a 14-month follow-up. The esophageal cancer located 30-35cm from the incisors reached partial response after three PDT sessions. Both of the esophageal candidiasis and the coexisting esophageal cancer at 23-26cm from the incisors of case 2 reached complete remission and the esophageal cancer at 34-37cm from the incisors reached complete remission after one PDT session. No recurrence was found at a 24-month follow-up. There were no serious adverse events found in either of the two cases. Results of this preliminary study indicate that PDT may be a potential method to deal with esophageal candidiasis. Copyright © 2013 Elsevier B.V. All rights reserved.

Denture Mis-swallowing in the Sliding Esophageal Hiatal Hernia Mimics Esophageal Perforation

Directory of Open Access Journals (Sweden)

Chao-Yang Chen

2008-08-01

Full Text Available Mis-swallowing of a foreign body in the esophagus coexisting with sliding hernia might be misdiagnosed as esophageal perforation with mediastinal abscess. We report an 89-year-old woman, bedridden for a long period in a nursing home after a previous cerebrovascular accident, who was sent to our emergency department in a state of sepsis because she had swallowed a radio-opaque partial denture. The retention of the denture as an esophageal foreign body was complicated with mediastinitis and bilateral pleural effusion. The inability of the patient to give a reliable clinical history delayed the diagnosis. This report highlights the difficulty in precisely locating a partial denture because of conflicting radiologic findings and the coexistence of esophageal sliding hernia, all of which led to a misdiagnosis of possible esophageal perforation. A right posterolateral thoracotomy with gastrostomy was performed to remove the lower esophageal foreign body after esophagoscopy failed. The surgical finding of a coincidental sliding esophageal hiatal hernia correlated well with the clinical presentation. Managing such a complicated esophageal foreign body in this elderly patient was challenging.

Advances in esophageal motor disorders.

Science.gov (United States)

Smout, André Jpm

2008-07-01

Esophageal motor disorders, often leading to dysphagia and chest pain, continue to pose diagnostic and therapeutic problems. In the past 12 months important new information regarding esophageal motor disorders was published. This information will be reviewed in this paper. A number of studies have addressed the issue of heterogeneity in achalasia, the best defined esophageal motility disorder. The spastic esophageal motility disorders nutcracker esophagus and diffuse esophageal spasm may coexist with gastroesophageal reflux disease, which has consequences for the management of patients with these disorders. The entity labelled ineffective esophageal motility is associated with reflux esophagitis, but also with morbid obesity. For the detection of disordered transit caused by ineffective esophageal motility, application of intraluminal impedance monitoring in conjunction with manometry leads to improved diagnosis. New data on the effect of Nissen fundoplication on esophageal motility were published during the last year. Recent knowledge on the heterogeneity of achalasia and the association of spastic esophageal motor disorders and ineffective motility with reflux disease will help the clinician in the management of patients with these disorders.

Broncho-esophageal fistula leading to lung abscess: A life-threatening emergency detected on FDG PET/CT in a case of carcinoma of middle third esophagus.

Science.gov (United States)

Puranik, Ameya D; Purandare, Nilendu C; Agrawal, Archi; Shah, Sneha; Rangarajan, Venkatesh

2013-07-01

Sinister undesirable pathologies often accompany malignancies. Though the entire emphasis is on cancer management, these benign conditions are more life-threatening than the primary malignancy itself. We report an interesting imaging finding of broncho-esophageal fistula leading to lung abscess on (18)F- fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) in large middle esophageal cancer, which due to early detection, was promptly managed.

Fluorine-18 deoxyglucose uptake in sarcoidosis measured with positron emission tomography

International Nuclear Information System (INIS)

Brudin, L.H.; Valind, S.O.; Rhodes, C.G.; Pantin, C.F.; Sweatman, M.; Jones, T.; Hughes, J.M.B.

1994-01-01

Regional pulmonary glucose metabolism (MR glu ; μmol h -1 g -1 ), extravascular lung density (D EV ; g cm -3 ) and vascular volume (V B ; ml cm -3 ) were measured in a single midthoracic transaxial slice (-2 cm thick) using positron emission tomography (PET) in seven patients with histologically proven sarcoidosis. The measurements were repeated 1-7 months later after steroid therapy (in two cases, no treatment) in order to assess MR glu as an index of inflammation and relate it to routine pulmonary function tests, chest radiography and serum angiotensin converting enzyme (SACE) levels. MR glu was computed from serial lung scans and peripheral venous blood samples for 60 min following an i.v. injection of 18 F-2-fluoro-2-deoxy-D-glucose ( 18 FDG). Both MR glu (which was increased in six of seven patients) and elevated SACE levels returned to normal in those patients treated with high-dose steroids. Regional vascular volume was normal in six of seven cases and did not change significantly with therapy. The high tissue density measured in all patients decreased significantly in two of three patients treated with 40 mg prednisolone daily. The abnormal MR glu observed in active sarcoidosis becomes normal pari passu with SACE levels during high-dose steroid therapy. We conclude that MR glu measured with 18 FDG and PET may reflect ''disease activity'' in sarcoidosis in quantitative terms (per gram lung tissue) and in respect of disease distribution. (orig.)

Radioisotope esophageal transit test

International Nuclear Information System (INIS)

Miyazono, Kazuhiro; Fukuda, Kazuo; Toyonaga, Atsushi

1982-01-01

A new technique employed sup(99m)Tc-MAA for the study of esophageal dysfunction and its clinical implication were evaluated in the patients with achalasia, progressive systemic sclerosis, reflux esophagitis and 10 normal controls. To investigate esophageal emptying and gastroesophageal reflux, a homogeneous bolus of sup(99m)Tc-MAA in 15ml of water was swallowed in the upright and supine positions under the collimeter of a gamma camera linked to nuclear medicine data analyser (Shimazu Scinti Pack 1200). This radionuclide transit studies made a quantitative evaluation of the esophageal dysfunction possible in all cases. Comparing the conventional esophageal function test procedures, this test is a safe, noninvasive and more physiological and sensitive in detecting abnormal esophageal emptying and gastroesophageal reflux. (author)

Esophageal tissue engineering: a new approach for esophageal replacement.

Science.gov (United States)

Totonelli, Giorgia; Maghsoudlou, Panagiotis; Fishman, Jonathan M; Orlando, Giuseppe; Ansari, Tahera; Sibbons, Paul; Birchall, Martin A; Pierro, Agostino; Eaton, Simon; De Coppi, Paolo

2012-12-21

A number of congenital and acquired disorders require esophageal tissue replacement. Various surgical techniques, such as gastric and colonic interposition, are standards of treatment, but frequently complicated by stenosis and other problems. Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function. We review the literature of esophageal tissue engineering, discuss its implications, compare the methodologies that have been employed and suggest possible directions for the future. Medline, Embase, the Cochrane Library, National Research Register and ClinicalTrials.gov databases were searched with the following search terms: stem cell and esophagus, esophageal replacement, esophageal tissue engineering, esophageal substitution. Reference lists of papers identified were also examined and experts in this field contacted for further information. All full-text articles in English of all potentially relevant abstracts were reviewed. Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation. When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality. Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration, whilst omental wrapping to induce vascularization of the construct has an uncertain benefit. Decellularized matrices have been recently suggested as the optimal choice for scaffolds, but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution. Results in animal models that have used seeded scaffolds strongly suggest that seeding of both muscle and epithelial cells on scaffolds

Esophageal tissue engineering: A new approach for esophageal replacement

Institute of Scientific and Technical Information of China (English)

Giorgia Totonelli; Panagiotis Maghsoudlou; Jonathan M Fishman; Giuseppe Orlando; Tahera Ansari; Paul Sibbons; Martin A Birchall

2012-01-01

A number of congenital and acquired disorders require esophageal tissue replacement.Various surgical techniques,such as gastric and colonic interposition,are standards of treatment,but frequently complicated by stenosis and other problems.Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function.We review the literature of esophageal tissue engineering,discuss its implications,compare the methodologies that have been employed and suggest possible directions for the future.Medline,Embase,the Cochrane Library,National Research Register and ClinicalTrials.gov databases were searched with the following search terms:stem cell and esophagus,esophageal replacement,esophageal tissue engineering,esophageal substitution.Reference lists of papers identified were also examined and experts in this field contacted for further information.All full-text articles in English of all potentially relevant abstracts were reviewed.Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation.When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality.Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration,whilst omental wrapping to induce vascularization of the construct has an uncertain benefit.Decellularized matrices have been recently suggested as the optimal choice for scaffolds,but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution.Results in animal models that have used seeded scaffolds strongly suggest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a

Abnormalities in iNKT cells are associated with impaired ability of monocytes to produce IL-10 and suppress T-cell proliferation in sarcoidosis.

Science.gov (United States)

Crawshaw, Anjali; Kendrick, Yvonne R; McMichael, Andrew J; Ho, Ling-Pei

2014-07-01

Sarcoidosis is a multisystem granulomatous disorder characterized by marked T-cell expansion of T helper 1 (Th1) cells. The cause of T-cell overactivity is unknown. We hypothesized that interleukin-10 (IL-10) production by a yet undefined cell type might be defective, resulting in loss of regulation of T-cell activity. Focusing on IL-10-producing monocytes, we first showed that monocytes isolated from the peripheral blood of corticosteroid-naïve sarcoidosis patients (n = 51) produced less IL-10 compared to controls, and were less able to suppress T-cell proliferation. In addition, monocytic IL-10 production correlated negatively with disease activity score. As invariant natural killer T (iNKT) cells are known to both interact with monocytes and be reduced in sarcoidosis patients, we then asked whether iNKT-specific defects might be responsible for this reduced IL-10 production. We found that greater numbers of circulating iNKT cells was associated with higher IL-10 production. Moreover, iNKT cells enhanced monocytic IL-10 production in vitro. Defective IL-10 production and T-cell suppression by sarcoidosis monocytes could be restored following their coculture with iNKT cells, in a CD1d- and cell contact-dependent process. We suggest that reduced iNKT-cell numbers in sarcoidosis may lead to impaired monocytic IL-10 production and unchecked T-cell expansion in sarcoidosis. These findings provide fresh insight into the mechanism of sarcoidosis disease, and interaction between iNKT cells and monocytes. © 2014 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

Esophageal lichen planus.

Science.gov (United States)

Oliveira, Janine Pichler de; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira

2015-01-01

Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis.

Radioisotope esophageal transit test. A new technique for esophageal emptying and gastroesophageal reflux

Energy Technology Data Exchange (ETDEWEB)

Miyazono, K.; Fukuda, K.; Toyonaga, A. (Kurume Univ., Fukuoka (Japan). School of Medicine)

1982-06-01

A new technique employed sup(99m)Tc-MAA for the study of esophageal dysfunction and its clinical implication were evaluated in the patients with achalasia, progressive systemic sclerosis, reflux esophagitis and 10 normal controls. To investigate esophageal emptying and gastroesophageal reflux, a homogeneous bolus of sup(99m)Tc-MAA in 15ml of water was swallowed in the upright and supine positions under the collimeter of a gamma camera linked to nuclear medicine data analyser (Shimazu Scinti Pack 1200). This radionuclide transit study made a quantitative evaluation of the esophageal dysfunction possible in all cases. Comparing the conventional esophageal function test procedures, this test is a safe, noninvasive and more physiological and sensitive in detecting abnormal esophageal emptying and gastroesophageal reflux.

Esophageal transit scintigraphy and structured questionnaire in patients with systemic sclerosis with endoscopically proven reflux esophagitis

International Nuclear Information System (INIS)

Nakajima, Kenichi; Inaki, Anri; Hiramatsu, Takashi; Hasegawa, Minoru; Fujimoto, Manabu; Takehara, Kazuhiko; Kinuya, Seigo

2009-01-01

Esophageal complications are common in patients with systemic sclerosis (SSc). The relationship between gastroesophageal reflux (GER) symptoms and dysmotility was examined in endoscopically confirmed patients suspected of having reflux esophagitis. A total of 32 patients with limited and diffuse type SSc (lSSc, dSSc) were examined based on a structured questionnaire score (QS) of GER symptoms, retention fraction of esophageal scintigraphy at 90 s (R 90 ) and gastric emptying time. The QS was significantly higher in the reflux esophagitis group than in the non-esophagitis group (5.4±3.5, 1.4±2.9, P=0.003). When the non-esophagitis group was further divided into lSSc and dSSc groups, R 90 was higher in the reflux esophagitis group (31±18%) and the non-esophagitis group with dSSc (34±32%) than in the non-esophagitis group with lSSc (8±3%, P=0.02). Both high R 90 ≥15% and QS≥4 indicated reflux esophagitis. Conversely, both normal R 90 and QS indicated no reflux esophagitis. A combination of esophageal scintigraphy and structured questionnaire demonstrated different aspects of esophageal dysfunction, namely dysmotility and GER. Patients with high QS and dysmotility may be indicated for further evaluation including endoscopic examination and medical treatment.(author)

Pulmonary sarcoidosis : CT findings and correlation with sACE level and PFT

International Nuclear Information System (INIS)

Ji, Eun Kyung; Song, Koun Sik; Lee, Jin Seong; Kwon, Jin Sook; Park, Kwang Bo; Lim, Tae Whan

1997-01-01

To assess CT findings of pulmonary sarcoidosis and correlate these with sACE level and PFT Between 1989 and 1995, 14 patients (4 men and 10 women, aged between 28 and 55 years) with histologically confirmed pulmonary sarcoidosis were consecutively selected. HRCT scans were performed in 12 patients and conventional CT scans in two. CT findings were reviewed by three radiologists, and were correlated with the index of disease activity based on sACE level and pulmonary function test. Pulmonary parenchymal abnormalities were seen in all patients;small nodules of less than 3mm in diameter were seen in eight. Other abnormalities were nodules of more than 3mm in diameter (n=7), confluent nodules (n=5), ground glass opacity (n=5), patchy areas of consolidation with air bronchogram (n=5), and architectural distortion (n=3). The upper lung zone was more frequently involved than the middle or lower zone. In ten patients, the paripheral interstitum was predominantly involved, while only three patients showed predominant peribronchovascular involvement. Lymphadenopathy was noted in 13. There was no correlation between sACE level, the results of a pulmonary function test and the extent of parenchymal involvement. HRCT is valuable for the identification, characterization, and determination of the extent to which parenchymal lung is involved in sarcoidosis. The extent of this involvement does not correlate with sACE level and pulmonary function test results

Esophageal pH monitoring

Science.gov (United States)

pH monitoring - esophageal; Esophageal acidity test ... Esophageal pH monitoring is used to check how much stomach acid is entering the esophagus. It also checks how well the acid is cleared downward into the ...

Minimally invasive surgery for esophageal achalasia.

Science.gov (United States)

Chen, Huan-Wen; Du, Ming

2016-07-01

Esophageal achalasia is due to the esophagus of neuromuscular dysfunction caused by esophageal functional disease. Its main feature is the lack of esophageal peristalsis, the lower esophageal sphincter pressure and to reduce the swallow's relaxation response. Lower esophageal muscular dissection is one of the main ways to treat esophageal achalasia. At present, the period of muscular layer under the thoracoscope esophagus dissection is one of the treatment of esophageal achalasia. Combined with our experience in minimally invasive esophageal surgery, to improved incision and operation procedure, and adopts the model of the complete period of muscular layer under the thoracoscope esophagus dissection in the treatment of esophageal achalasia.

Osseous sarcoidosis. A case report with scintigraphic consideration

Energy Technology Data Exchange (ETDEWEB)

Tonami, H; Miyamura, T; Okumura, T; Yamamoto, I; Nishiki, T [Kanazawa Medical Univ., Ishikawa (Japan)

1981-12-01

We presented a case of osseous sarcoidosis which demonstrated abnormal uptake on bone scintigram and /sup 67/Ga scintigram and comparative studies between routine radiographs of bone and RI imagings were done. The results showed that bone scintigram is more sensitive than routine radiographs and it was stressed that bone scintigram should precede radiographic skeletal survey. The significance of abnormal uptake on /sup 67/Ga scintigram seems to need further investigation.

Broncho-esophageal fistula leading to lung abscess: a life-threatening emergency detected on FDG PET/CT in a case of carcinoma of middle third esophagus

International Nuclear Information System (INIS)

Puranik, Ameya D.; Purandare, Nilendu C.; Agrawal, Archi; Shah, Sneha; Rangarajan, Venkatesh

2013-01-01

Sinister undesirable pathologies often accompany malignancies. Though the entire emphasis is on cancer management, these benign conditions are more life-threatening than the primary malignancy itself. We report an interesting imaging finding of broncho-esophageal fistula leading to lung abscess on 18 F-fluoro-deoxy-glucose positron emission tomography/computed tomography (FDG PET/CT) in large middle esophageal cancer, which due to early detection, was promptly managed. (author)

Angiotensin-I-converting enzyme and gallium scan in noninvasive evaluation of sarcoidosis

Energy Technology Data Exchange (ETDEWEB)

Nosal, A. (Harbor General Hospital, Torrance, CA); Schleissner, L.A.; Mishkin, F.S.; Lieberman, J.

1979-03-01

Angiotensin-converting enzyme assays and gallium-scan results were obtained from 27 patients with biopsy-proven, clinically active sarcoidosis. Twenty-three of these patients had elevated converting enzyme levels, and 22 had positive gallium-scan results. Three of four patients with normal or borderline-elevated levels of angiotensin-converting enzyme also had positive gallium-scan results. Of 156 nonsarcoid patients (pulmonary and other diseases), 27 were found to have elevated serum converting enzyme levels, and 25 of these had negative gallium-scan results. These results indicate that the combination of an assay of angiotensin-converting enzyme and gallium scan increases diagnostic specificity from 83% to 99% without sacrificing sensitivity. It was concluded that the concurrent use of angiotensin-converting enzyme assay and gallium scan is of value in the diagnosis of sarcoidosis.

Angiotensin-I-converting enzyme and gallium scan in noninvasive evaluation of sarcoidosis

International Nuclear Information System (INIS)

Nosal, A.; Schleissner, L.A.; Mishkin, F.S.; Lieberman, J.

1979-01-01

Angiotensin-converting enzyme assays and gallium-scan results were obtained from 27 patients with biopsy-proven, clinically active sarcoidosis. Twenty-three of these patients had elevated converting enzyme levels, and 22 had positive gallium-scan results. Three of four patients with normal or borderline-elevated levels of angiotensin-converting enzyme also had positive gallium-scan results. Of 156 nonsarcoid patients (pulmonary and other diseases), 27 were found to have elevated serum converting enzyme levels, and 25 of these had negative gallium-scan results. These results indicate that the combination of an assay of angiotensin-converting enzyme and gallium scan increases diagnostic specificity from 83% to 99% without sacrificing sensitivity. It was concluded that the concurrent use of angiotensin-converting enzyme assay and gallium scan is of value in the diagnosis of sarcoidosis

Balloon catheter dilatation of esophageal strictures

Energy Technology Data Exchange (ETDEWEB)

Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon [Kyunghee University College of Medicine, Seoul (Korea, Republic of)

1990-07-15

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures.

Balloon catheter dilatation of esophageal strictures

International Nuclear Information System (INIS)

Kim, Jeung Sook; Yoon, Yup; Sung, Dong Yook; Choi, Woo Suk; Nam, Kyung Jin; Lim, Jae Hoon

1990-01-01

The authors performed 27 fluoroscopically guided balloon dilatation in 12 patients of esophageal stricture during recent 3 years. The causes of esophageal stricture were corrosive esophagitis (N=2) and congenital narrowing (N=1), including postoperative narrowing in achalasia (N=3), esophageal varix (N=3), lye stricture (N=2) and esophageal cancer (N=1). Successful dilatation of the stricture was achieved during the procedure in 10 patients(83%). Major complication such as esophageal rupture was not found. The authors conclude that fluoroscopically guided esophageal balloon dilatation is a safe and effective method for treatment of symptomatic esophageal strictures

Pulmonary hypertension in end-stage pulmonary sarcoidosis: therapeutic effect of sildenafil?

DEFF Research Database (Denmark)

Milman, N.; Burton, C.M.; Iversen, M.

2008-01-01

BACKGROUND: The objectives of this study were to assess the frequency and severity of pulmonary hypertension (PH) and the effect of sildenafil treatment in patients with recalcitrant pulmonary sarcoidosis. METHODS: This investigation was a single-center, retrospective study of all patients (n = 25...

Tenosynovitis of the ankles as onset of sarcoidosis in a patient with ulcerative colitis

Directory of Open Access Journals (Sweden)

F. Cozzi

2011-09-01

Full Text Available Arthritis and tenosynovitis are frequently reported as complications of inflammatory bowel diseases. About 10% of patients with ulcerative colitis presents articular inflammation, usually in the phases of activity of intestinal disease. Tenosynovitis is also a frequent complication of ulcerative colitis. We describe here a case of tenosynovitis of both ankles occurring in a patient affected by ulcerative colitis not in active phase. Chest X-ray and TC showed hilar lymphonode enlargement and transbronchial biopsy confirmed the diagnosis of sarcoidosis. In this disease tenosynovitis is very rare, unlike arthritis that is rather common. In conclusion we observed a case of ankle bilateral tenosynovitis as onset manifestation of sarcoidosis.

The Role of Esophageal PH-metri Test on Gastro-Esophageal Reflux Disease Diagnosis

OpenAIRE

Setyawati, Katharina; Abdullah, Murdani; Syam, Ari Fahrial; Fauzi, Achmad; Makmun, Dadang; Simadibrata, Marcellus; Manan, Chudahman; Rani, Abdul Aziz

2008-01-01

Gastro-esophageal reflux disease is a pathological condition of esophagus which is caused by gastric content reflux into esophagus. There is an increased prevalence of gastro-esophageal reflux disease. The roles of esophageal pH-metry in clinical application include looking for abnormal acid exposure on esophagus with no abnormality found in endoscopy; evaluating patients following the anti-reflux surgery who are being suspected for abnormal esophageal reflux; evaluating patients with normal ...

Development of sarcoidosis during adalimumab therapy for chronic plaque psoriasis.

Science.gov (United States)

Marcella, Stefanie; Welsh, Belinda; Foley, Peter

2011-08-01

A 38-year-old woman developed clinical, biochemical, radiological and histopathological evidence of cutaneous and pulmonary sarcoidosis 5 months after commencing adalimumab for chronic plaque psoriasis. Signs and symptoms resolved within 3 months of cessation of adalimumab. © 2010 The Authors. Australasian Journal of Dermatology © 2010 The Australasian College of Dermatologists.

Sarcoidose cutânea sobre cicatrizes: relato de caso Sarcoidosis on skin scars: a case report

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Sônia Antunes de Oliveira Mantese

2010-12-01

Full Text Available A sarcoidose é uma doença inflamatória sistêmica, de etiologia desconhecida, em que granulomas não caseosos são encontrados nos órgãos acometidos. O envolvimento cutâneo ocorre em 25% dos casos, com grande polimorfismo lesional. O acometimento de cicatrizes é incomum, porém clinicamente característico de sarcoidose cutânea. A maioria dos pacientes com sarcoidose cicatricial tem doença sistêmica. Relata-se o caso de uma paciente de 65 anos, que apresentou nodulações sobre cicatrizes 20 anos, após a realização de procedimentos cirúrgicos, sem manifestações sistêmicas. Salienta-se a importância de se investigar sarcoidose em cicatrizes prévias, com alterações inflamatórias.Sarcoidosis is a systemic inflammatory disorder of unknown origin, in which non-caseating granulomas (small inflammatory nodules are found in the affected organs. Cutaneous involvement occurs in 25% of cases with a wide range of clinical presentation. The onset of scars is unsual although clinically characteristic of cutaneous sarcoidosis. Most patients with scar sarcoidosis have a systemic disease. It is reported the case of a 65 year-old woman that developed scar nodules 20 years after she had had surgical procedures without systemic manifestations. It is worth mentioning the importance of investigating sarcoidosis with inflammatory alterations in praevia scars.

Thoracoscopic Surgery in a Patient with Multiple Esophageal Carcinomas after Surgery for Esophageal Achalasia.

Science.gov (United States)

Yamasaki, Yuki; Tsukada, Tomoya; Aoki, Tatsuya; Haba, Yusuke; Hirano, Katsuhisa; Watanabe, Toshifumi; Kaji, Masahide; Shimizu, Koichi

2017-01-01

We present a case in which we used a thoracoscopic approach for resection of multiple esophageal carcinomas diagnosed 33 years after surgery for esophageal achalasia. A 68-year-old Japanese man had been diagnosed with esophageal achalasia and underwent surgical treatment 33 years earlier. He was examined at our hospital for annual routine checkup in which upper gastrointestinal endoscopy showed a "0-IIb+IIa" lesion in the middle esophagus. Iodine staining revealed multiple irregularly shaped iodine-unstained areas, the diagnosis of which was esophageal carcinoma. Thoracoscopic subtotal esophagectomy was performed. Esophageal carcinoma may occur many years after surgery for esophageal achalasia, even if the passage symptoms have improved. So, long-term periodic follow-up is necessary for detection of carcinoma at an earlier stage.

Relapsing bronchiolitis obliterans organising pneumonia and chronic sarcoidosis in an atopic asthmatic patient.

Science.gov (United States)

Carbonelli, C; Roggeri, A; Cavazza, A; Zompatori, M; Zucchi, L

2008-03-01

Asthma is thought to be a Th2 disease while sarcoidosis is considered a Th1 granulomatous disorder. Organising pneumonia is a histologic pattern of lung injury. When it has no recognisable cause it is defined as cryptogenic organising pneumonia. We herein report the case of a patient with recurrent and steroid sensitive organising pneumonia associated with chronic sarcoidosis in an atopic, moderate persistent asthmatic patient. Each disease has been documented with transbronchial biopsies and recurrence of organising pneumonia was suggested by clinical features and by follow up HRCT which shows distinctive signs even in associated disease. Steroids are the mainstay of therapy for these disorders and especially for the consolidated processes typical of organising pneumonia but prognostic indices for relapse and progression are lacking.

Esophageal Cancer—Patient Version

Science.gov (United States)

The most common types of esophageal cancer are adenocarcinoma and squamous cell carcinoma. These forms of esophageal cancer develop in some parts of the esophagus and are driven by genetic changes. Start here to find information on esophageal cancer treatment, causes and prevention, screening, research, and statistics.

Esophageal hypermotility: cause or effect?

Science.gov (United States)

Crespin, O M; Tatum, R P; Yates, R B; Sahin, M; Coskun, K; Martin, A V; Wright, A; Oelschlager, B K; Pellegrini, C A

2016-07-01

Nutcracker esophagus (NE), Jackhammer esophagus (JHE), distal esophageal spasm (DES), and hypertensive lower esophageal sphincter (HTLES) are defined by esophageal manometric findings. Some patients with these esophageal motility disorders also have abnormal gastroesophageal reflux. It is unclear to what extent these patients' symptoms are caused by the motility disorder, the acid reflux, or both. The aim of this study was to determine the effectiveness of laparoscopic Nissen fundoplication (LNF) on esophageal motility disorders, gastroesophageal reflux, and patient symptoms. Between 2007 and 2013, we performed high-resolution esophageal manometry on 3400 patients, and 221 patients were found to have a spastic esophageal motility disorder. The medical records of these patients were reviewed to determine the manometric abnormality, presence of gastroesophageal symptoms, and amount of esophageal acid exposure. In those patients that underwent LNF, we compared pre- and postoperative esophageal motility, gastroesophageal symptom severity, and esophageal acid exposure. Of the 221 patients with spastic motility disorders, 77 had NE, 2 had JHE, 30 had DES, and 112 had HTLES. The most frequently reported primary and secondary symptoms among all patients were: heartburn and/or regurgitation, 69.2%; respiratory, 39.8%; dysphagia, 35.7%; and chest pain, 22.6%. Of the 221 patients, 192 underwent 24-hour pH monitoring, and 103 demonstrated abnormal distal esophageal acid exposure. Abnormal 24-hour pH monitoring was detected in 62% of patients with heartburn and regurgitation, 49% of patients with respiratory symptoms, 36.8 % of patients with dysphagia, and 32.6% of patients with chest pain. Sixty-six of the 103 patients with abnormal 24-hour pH monitoring underwent LNF. Thirty-eight (13NE, 2JHE, 6 DES, and 17 HTLES) of these 66 patients had a minimum of 6-month postoperative follow-up that included clinical evaluation, esophageal manometry, and 24-hour pH monitoring

[Effects of peroral endoscopic myotomy on esophageal dynamics in patients with esophageal achalasia].

Science.gov (United States)

Zhong, Yun-shi; Li, Liang; Zhou, Ping-hong; Xu, Mei-dong; Ren, Zhong; Zhu, Bo-qun; Yao, Li-qing

2012-07-01

To investigate the effects of peroral endoscopic myotomy(POEM) on esophageal dynamics in patients with esophageal achalasia. From September 2011 to November 2011, 20 cases with esophageal achalasia received POEM at the Endoscopic Center in the Zhongshan Hospital of Fudan University. Pre-operation esophageal dynamics of all the patients were evaluated by high resolution manometry(HRM) system and 3 days after operation the test was repeated. Lower esophagus sphincter resting pressure(LESP), 4-second integrated relaxation pressure(4sIRP), lower esophagus sphincter relax rate(LESRR), lower esophagus sphincter length(LESL), and esophageal manometry were analyzed. After POEM, LESP decreased from(29.1±17.0) mm Hg to(14.6±4.9) mm Hg, and decrease rate was 49.8%(P0.05). Esophageal peristaltic contraction was absent in all the 20 patients preoperatively. After POEM, changes in the esophageal contraction were seen in 7 patients, and peristalsis was noticed but was below normal level. There were no significant changes in peristalsis in the remaining 13 patients. POEM can significantly reduce LESP and 4sIRP in patients with achalasia, but can not affect the contraction of the esophagus.

Thoracoscopic Surgery in a Patient with Multiple Esophageal Carcinomas after Surgery for Esophageal Achalasia

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Yuki Yamasaki

2017-01-01

Full Text Available We present a case in which we used a thoracoscopic approach for resection of multiple esophageal carcinomas diagnosed 33 years after surgery for esophageal achalasia. A 68-year-old Japanese man had been diagnosed with esophageal achalasia and underwent surgical treatment 33 years earlier. He was examined at our hospital for annual routine checkup in which upper gastrointestinal endoscopy showed a “0-IIb+IIa” lesion in the middle esophagus. Iodine staining revealed multiple irregularly shaped iodine-unstained areas, the diagnosis of which was esophageal carcinoma. Thoracoscopic subtotal esophagectomy was performed. Esophageal carcinoma may occur many years after surgery for esophageal achalasia, even if the passage symptoms have improved. So, long-term periodic follow-up is necessary for detection of carcinoma at an earlier stage.

Association between angiotensin II receptor gene polymorphism and serum angiotensin converting enzyme (SACE) activity in patients with sarcoidosis

OpenAIRE

Takemoto, Y.; Sakatani, M.; Takami, S.; Tachibana, T.; Higaki, J.; Ogihara, T.; Miki, T.; Katsuya, T.; Tsuchiyama, T.; Yoshida, A.; Yu, H.; Tanio, Y.; Ueda, E.

1998-01-01

BACKGROUND—Serum angiotensin converting enzyme (SACE) is considered to reflect disease activity in sarcoidosis. SACE activity is increased in many patients with active sarcoid lesions. The mechanism for the increased SACE activity in this disease has not been clarified. ACE insertion/deletion (I/D) gene polymorphism has been reported to have an association with SACE levels in sarcoidosis, but no evidence of an association between angiotensin II receptor gene polymorphism and SA...

Multifactorial Etiology Pulmonary Hypertension in a Patient with Sarcoidosis

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Barreto Ana Terra Fonseca

2016-01-01

Full Text Available Differential diagnosis between pre- and postcapillary pulmonary hypertension (PH in patients with diastolic heart failure (DHF is a challenge in clinical practice. The presence of PH is implicated in worse prognosis in patients with this disease. This case report approaches the process of investigation of pulmonary hypertension in adult patient with DHF, double mitral lesion, and sarcoidosis with poor clinical outcome.

Esophageal lichen planus

OpenAIRE

Oliveira, Janine Pichler de; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira

2015-01-01

Abstract Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen ...

CARD15 single nucleotide polymorphisms 8, 12 and 13 are not increased in ethnic Danes with sarcoidosis

DEFF Research Database (Denmark)

Milman, Nils; Nielsen, Ole Haagen; Hviid, Thomas Vauvert F

2007-01-01

and SNP13, respectively, were performed by capillary electrophoresis single-strand confirmation polymorphism in 53 patients with histologically verified sarcoidosis and in 103 healthy controls. RESULTS: The frequencies of CARD15 mutations in sarcoidosis patients were: SNP8, 4/106 chromosomes (3.8%); SNP12...... with Crohn's disease. OBJECTIVES: To evaluate whether ethnic Danes with sarcoidosis have an increased frequency of CARD15 mutations compared to healthy control subjects. METHODS: Genotyping for CARD15 mutations R702W, G908R, and L1007fsinsC, also designated single nucleotide polymorphism (SNP) SNP8, SNP12......, 2/106 chromosomes (1.9%); SNP13, 2/106 chromosomes (1.9%); SNP8+SNP12+SNP13, 8/106 chromosomes (7.6%). All 8 patients were heterozygous. The frequencies in controls were: SNP8, 9/206 chromosomes (4.4%); SNP12, 2/206 chromosomes (1.0%); SNP13, 4/206 chromosomes (1.9%); SNP8+SNP12+SNP13, 15...

Prevalence of esophageal cancer during the pretreatment of hypopharyngeal cancer patients: Routinely performed esophagogastroduodenoscopy and FDG-PET/CT findings

Energy Technology Data Exchange (ETDEWEB)

Nakaminato, Shuichiro; Toriihara, Akira; Makino, Tomoko; Shibuya, Hitoshi [Dept. of Radiology, Tokyo Medical and Dental Univ., Tokyo (Japan)], Email: S.Nakaminato@gmail.com; Kawano, Tatsuyuki [Dept. of Surgery, Tokyo Medical and Dental Univ., Tokyo (Japan); Kishimoto, Seiji [Dept. of Head and Neck Surgery, Tokyo Medical and Dental Univ., Tokyo (Japan)

2012-05-15

Background. The prevalence of esophageal cancer accompanied by hypopharyngeal cancer (HPC) is high and increasing rapidly in Asia. The purpose of this prospective study was to evaluate the prevalence of esophageal cancer during the pretreatment of HPC patients who were routinely examined using esophagogastroduodenoscopy (EGD) and 18F-fluorodeoxyglucose/computed tomography (FDG-PET/CT) and to discuss the utility of these examinations. Material and methods. Between September 2005 and September 2010, 33 patients with newly diagnosed HPC (all with squamous cell carcinoma) underwent EGD (after a conventional endoscopy, iodine staining was performed) and FDG-PET/CT examinations. We evaluated the prevalence of esophageal cancer among HPC patients according to the EGD findings and determined the sensitivity of FDG-PET/CT for the detection of esophageal primary tumors for each clinical T classification. Results. In 17 of the 33 patients (51.5%), 29 biopsy-proven esophageal squamous cell carcinomas were diagnosed using EGD. In eight of the 17 (47.1%) patients, two or more esophageal cancer lesions were diagnosed. Twenty-four of the 29 (82.8%) lesions were superficial esophageal cancers, and the remaining five (17.2%) lesions were advanced esophageal cancers. In six of the 29 (20.7%) esophageal cancer lesions that were detected using FDG-PET/CT, only one of the 29 (3.4%) lesions was evaluated as being equivocal; the remaining 22 (75.9%) lesions were not detected. The distribution of the clinical T classifications detected using FDG-PET/CT was as follows: T1a, 0/21 (0%); T1b, 1/3 (33%); and T3, 5/5 (100%). Conclusions. The prevalence of esophageal cancer during the pretreatment of HPC patients was 51.5%; this prevalence was higher than that in previous reports. We believe that the increasing proportion of superficial lesions (82.8%) detected using iodine staining and EGD may have led to the relatively high prevalence. FDG-PET/CT detected only 20.7% of the esophageal cancers

Esophageal scintigraphy to quantitate esophageal transit of the achalasia patients after heller's myotomy

International Nuclear Information System (INIS)

Liu Junfeng; Wang Qizhang; Li Wenqi

1995-01-01

To quantitate esophageal transit of the achalasia patients after Heller's myotomy using scintigraphic technique. After a bolus ingestion of 10 ml orange juice containing 185 MBq 99m Tc-DTPA, radioactivity was measured on the esophagus for 5 minutes by SPECT, and esophageal clearance rate was calculated. Forty-two patients and 10 normal controls were included. Esophageal transit was increased significantly after Heller's operation, but it was still lower than normal value. Heller's myotomy can significantly improve esophageal transit in the patients with achalasia, although it does not reach normal level

Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders

NARCIS (Netherlands)

van Hoeij, Froukje B.; Bredenoord, Albert J.

2016-01-01

Esophageal high-resolution manometry (HRM) is replacing conventional manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new

Esophageal trachealization: A feature of eosinophilic esophagitis

International Nuclear Information System (INIS)

AlHussaini, Abdulrahman A; Semaan, Toufic; ElHag, Imad A

2009-01-01

Eosinophilic esophagitis (EE) is an inflammatory condition characterized by intense eosinophilic infiltration of the esophagus. EE is frequently misdiagnosed as gastroesophageal reflux disease. Here, we present a child with EE and a characteristic endoscopic finding, r inged esophagus . An 11-year-old Saudi boy presented with dysphagia for 1 year. He had experienced an intermittent sensation of solid food sticking in his chest, which was relieved by drinking liquids. A barium swallow excluded anatomical causes of dysphagia, but revealed multiple-ringed esophagus. Endoscopy showed a furrowing and trachealizing appearance of the entire esophagus. Hisologically, extensive eosinophilic infiltration was a feature in biopsies obtained from the esophagus. The child responded well to a 2-month course of inhaled fluticasone. Symptoms recurred 3 months after discontinuation of therapy, which necessitated resumption of inhaled fluticasone. The endoscopic appearance of multiple esophageal rings should raise suspicion of EE and be confirmed by esophageal biopsies. (author)

Congenital esophageal atresia with tracheo-esophageal fistula

International Nuclear Information System (INIS)

Rhee, Chung Sik

1970-01-01

Three cases of esophageal atresia with tracheo-esophageal fistula. 1). Case 1: A female infant birth Wt. 1.95 kg , Apgar Score 10, Skeletal anomalies, was delivered after a pregnancy compeicated by hydroamnious on Aug. 17, 1970. The family history was not contributory. 2) Case 2: A male infant birth Wt. 2.8 kg , Apgar Score 8, was forcep delivered after a pregnancy on Feb. 8, 1970. This infant is twin. The family history was not contributory. 3) Case 3: A female infant birth Wt. 2.22 kg , Apgar Score 10, was C-section after a pregnancy on May, 16. 1970. The family history was not contributory. All cases: After 24 hours 5% glucose solution was given and immediately vomited and some of it regurgitating through the nose and mouth with associated cyanosis and dyspnea. A catheter was inserted through the nose into the esophagus under diagnosis of the esophageal atresia

Sarcoidosis and Thyroid Autoimmunity

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Piera Fazzi

2017-08-01

Full Text Available Most of the studies have shown a higher risk for subclinical and clinical hypothyroidism, antithyroid autoantibodies [overall antithyroid peroxidase antibodies (TPOAb], and in general, thyroid autoimmunity, overall in the female gender in patients with sarcoidosis (S. A significantly higher prevalence of clinical hypothyroidism and Graves’ disease was also described in female S patients with respect to controls. Gallium-67 (Ga-67 scyntigraphy in S patients, in the case of thyroid uptake, suggests the presence of aggressive autoimmune thyroiditis and hypothyroidism. For this reason, ultrasonography and thyroid function should be done in the case of Ga-67 thyroid uptake. In conclusion, thyroid function, TPOAb measurement, and ultrasonography should be done to assess the clinical profile in female S patients, and the ones at high risk (female individuals, with TPOAb positivity, and hypoechoic and small thyroid should have periodically thyroid function evaluations and suitable treatments.

Esophageal manometric characteristics and outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication for epiphrenic diverticula.

Science.gov (United States)

Melman, Lora; Quinlan, Jessica; Robertson, Brian; Brunt, L M; Halpin, Valerie J; Eagon, J C; Frisella, Margaret M; Matthews, Brent D

2009-06-01

The purpose of this study is to characterize the esophageal motor and lower esophageal sphincter (LES) abnormalities associated with epiphrenic esophageal diverticula and analyze outcomes for laparoscopic esophageal diverticulectomy, myotomy, and partial fundoplication. The endoscopic, radiographic, manometric, and perioperative records for patients undergoing laparoscopic esophageal diverticulectomy, anterior esophageal myotomy, and partial fundoplication from 8/99 until 9/06 were reviewed from an Institutional Review Board (IRB)-approved outcomes database. Data are given as mean +/- standard deviation (SD). An esophageal body motor disorder and/or LES abnormalities were present in 11 patients with epiphrenic diverticula; three patients were characterized as achalasia, one had vigorous achalasia, two had diffuse esophageal spasm, and five had a nonspecific motor disorder. Presenting symptoms included dysphagia (13/13), regurgitation (7/13), and chest pain (4/13). Three patients had previous Botox injections and three patients had esophageal dilatations. Laparoscopic epiphrenic diverticulectomy with an anterior esophageal myotomy was completed in 13 patients (M:F; 3:10) with a mean age of 67.6 +/- 4.2 years, body mass index (BMI) of 28.1 +/- 1.9 kg/m2 and American Society of Anesthesiologists (ASA) 2.2 +/- 0.1. Partial fundoplication was performed in 12/13 patients (Dor, n = 2; Toupet, n = 10). Four patients had a type I and one patient had a type III hiatal hernia requiring repair. Mean operative time was 210 +/- 15.1 min and mean length of stay (LOS) was 2.8 +/- 0.4 days. Two grade II or higher complications occurred, including one patient who was readmitted on postoperative day 4 with a leak requiring a thoracotomy. After a mean follow-up of 13.6 +/- 3.0 months (range 3-36 months), two patients complained of mild solid food dysphagia and one patient required proton pump inhibitor (PPI) for gastroesophageal reflux disease (GERD) symptoms. The majority of patients

Clinical significance of gallium-67 scintigraphy in assessing pulmonary lesions of sarcoidosis and idiopathic pulmonary fibrosis

International Nuclear Information System (INIS)

Fujishima, Seitaro; Kanazawa, Minoru; Yamasawa, Fumihiro; Kubo, Atsushi; Hashimoto, Shozo; Yokoyama, Tetsuro

1992-01-01

To evaluate whether one can predict the course and prognosis of interstitial lung diseases from lung gallium-67 ( 67 Ga) uptake, we studied 31 subjects with sarcoidosis and 28 with idiopathic pulmonary fibrosis (IPF) retrospectively. We quantified the lung 67 Ga uptake using posterior scans by Line's method, and calculated a visual index (VI). The normal range of 67 Ga uptake was defined as less than 65 VI values, obtained from the 95 percent confidence interval of the control subjects. All subjects with stage I sarcoidosis, having only bilateral hilar lymphadenopathy (BHL) on chest X-ray, revealed normal lung 67 Ga uptake. Fifty percent of patients with stage II sarcoidosis, with both BHL and pulmonary involvement on chest X-ray, showed increased lung 67 Ga uptake. The patients with increased lung 67 Ga uptake showed decreased percent vital capacity and increased alveolar-arterial oxygen tension difference, but none of them showed clinical deterioration during the follow-up period of more than 6 months. Fifty-four percent of subjects with IPF sowed increased lung 67 Ga uptake. But there was no difference between the subgroups with normal and increased lung 67 Ga uptake with respect to the severity of dyspnea, percent vital capacity, arterial oxygen tension, or alveolar-arterial oxygen tension difference. There was also no difference between the two subgroups of IPF in the cumulative percent survival after either the onset of symptoms or the 67 Ga scintigram. We conclude that lung 67 Ga uptake was not able to predict the clinical course or the prognosis of patients with sarcoidosis and IPF. (author)

Primary Esophageal Motility Disorders: Beyond Achalasia.

Science.gov (United States)

Schlottmann, Francisco; Patti, Marco G

2017-06-30

The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders. The Chicago classification introduced new manometric parameters and better defined esophageal motility disorders. Motility disorders beyond achalasia with the current classification are: esophagogastric junction outflow obstruction, major disorders of peristalsis (distal esophageal spasm, hypercontractile esophagus, absent contractility) and minor disorders of peristalsis (ineffective esophageal motility, fragmented peristalsis). The aim of this study was to review the current diagnosis and management of esophageal motility disorders other than achalasia.

Pain and autonomic dysfunction in patients with sarcoidosis and small fibre neuropathy

NARCIS (Netherlands)

M. Bakkers (Mayienne); C.G. Faber (Carin); M. Drent (Marjolein); M.C.E. Hermans; S.I. van Nes (Sonja); G. Lauria (Giuseppe); M.H. de Baets (Marc); I.S.J. Merkies (Ingemar)

2010-01-01

textabstractSmall fibre neuropathy (SFN) has been demonstrated in sarcoidosis. However, a systematic analysis of neuropathic pain and autonomic symptoms, key features of SFN, has not been performed. Clinimetric evaluation of pain and autonomic symptoms using the neuropathic pain scale (NPS) and the

Gastroesophageal scintigraphy and endoscopy in the diagnosis of esophageal reflux and esophagitis

International Nuclear Information System (INIS)

Fung, W.P.; Van der Schaaf, A.; Grieve, J.C.

1985-01-01

The value of gastroesophageal (G/E) scintigraphy in the diagnosis of gastroesophageal reflux was assessed in 51 subjects, who presented with heartburn and had endoscopic evidence of reflux esophagitis. G/E scintigraphy was done using /sup 99m/Tc sulfur-colloid in acidified orange juice. The G/E reflux index was calculated according to previous reports. The mean (+/- SD) G/E reflux index in 18 patients with severe esophagitis and 30 patients with moderate esophagitis were 1.6% (+/- 1.5) and 3.2% (+/- 5.0), respectively. The mean G/E reflux index in 14 control subjects was 2.4% (+/- 1.1). There was no significant difference between the esophagitis and control groups. Furthermore, if 4% was taken as upper limit of normal, this will include almost all the esophagitis patients and controls. It is concluded that the G/E reflux index based on G/E scintigraphy is of little value in the diagnosis of G/E reflux

Chronic xerostomia increases esophageal acid exposure and is associated with esophageal injury

Energy Technology Data Exchange (ETDEWEB)

Korsten, M.A.; Rosman, A.S.; Fishbein, S.; Shlein, R.D.; Goldberg, H.E.; Biener, A. (Gastrointestinal Section, Veterans Affairs Medical Center, Bronx, New York (USA))

1991-06-01

OBJECTIVES: To assess the effects of chronic xerostomia on parameters of gastroesophageal reflux and esophagitis. DESIGN: Observational study of a cohort of male patients with xerostomia and age-matched control subjects. SETTING: Tertiary-care Veterans Affairs Medical Center. SUBJECTS: Sixteen male patients with chronic xerostomia secondary to radiation for head and neck cancers or medications. Nineteen age-matched male control subjects with comparable alcohol and smoking histories. MEASUREMENTS AND MAIN RESULTS: Esophageal motility was similar in patients with xerostomia and controls. Clearance of acid from the esophagus and 24-hour intraesophageal pH were markedly abnormal in patients with xerostomia. Symptoms and signs of esophagitis were significantly more frequent in subjects with xerostomia. CONCLUSIONS: Chronic xerostomia may predispose to esophageal injury, at least in part, by decreasing the clearance of acid from the esophagus and altering 24-hour intraesophageal pH. Esophageal injury is a previously unreported complication of long-term salivary deficiency.

Gastroesophageal scintigraphy and endoscopy in the diagnosis of esophageal reflux and esophagitis

Energy Technology Data Exchange (ETDEWEB)

Fung, W.P.; Van der Schaaf, A.; Grieve, J.C.

1985-04-01

The value of gastroesophageal (G/E) scintigraphy in the diagnosis of gastroesophageal reflux was assessed in 51 subjects, who presented with heartburn and had endoscopic evidence of reflux esophagitis. G/E scintigraphy was done using /sup 99m/Tc sulfur-colloid in acidified orange juice. The G/E reflux index was calculated according to previous reports. The mean (+/- SD) G/E reflux index in 18 patients with severe esophagitis and 30 patients with moderate esophagitis were 1.6% (+/- 1.5) and 3.2% (+/- 5.0), respectively. The mean G/E reflux index in 14 control subjects was 2.4% (+/- 1.1). There was no significant difference between the esophagitis and control groups. Furthermore, if 4% was taken as upper limit of normal, this will include almost all the esophagitis patients and controls. It is concluded that the G/E reflux index based on G/E scintigraphy is of little value in the diagnosis of G/E reflux.

Chronic xerostomia increases esophageal acid exposure and is associated with esophageal injury

International Nuclear Information System (INIS)

Korsten, M.A.; Rosman, A.S.; Fishbein, S.; Shlein, R.D.; Goldberg, H.E.; Biener, A.

1991-01-01

OBJECTIVES: To assess the effects of chronic xerostomia on parameters of gastroesophageal reflux and esophagitis. DESIGN: Observational study of a cohort of male patients with xerostomia and age-matched control subjects. SETTING: Tertiary-care Veterans Affairs Medical Center. SUBJECTS: Sixteen male patients with chronic xerostomia secondary to radiation for head and neck cancers or medications. Nineteen age-matched male control subjects with comparable alcohol and smoking histories. MEASUREMENTS AND MAIN RESULTS: Esophageal motility was similar in patients with xerostomia and controls. Clearance of acid from the esophagus and 24-hour intraesophageal pH were markedly abnormal in patients with xerostomia. Symptoms and signs of esophagitis were significantly more frequent in subjects with xerostomia. CONCLUSIONS: Chronic xerostomia may predispose to esophageal injury, at least in part, by decreasing the clearance of acid from the esophagus and altering 24-hour intraesophageal pH. Esophageal injury is a previously unreported complication of long-term salivary deficiency

Cardiac sarcoidosis and heart transplantation: a report of four consecutive patients

DEFF Research Database (Denmark)

Milman, N.; Andersen, Claus Bøgelund; Mortensen, Sven Aage

2008-01-01

Heart transplantation (HTx) is a well-established treatment for severe cardiac failure. However, HTx for cardiac sarcoidosis is rare; less than 80 patients have been reported worldwide. In many patients, the diagnosis was not made prior to HTx. The aim of this study was to describe the use of HTx...

Cardiac Sarcoidosis or Giant Cell Myocarditis? On Treatment Improvement of Fulminant Myocarditis as Demonstrated by Cardiovascular Magnetic Resonance Imaging

Directory of Open Access Journals (Sweden)

Hari Bogabathina

2012-01-01

Full Text Available Giant cell myocarditis, but not cardiac sarcoidosis, is known to cause fulminant myocarditis resulting in severe heart failure. However, giant cell myocarditis and cardiac sarcoidosis are pathologically similar, and attempts at pathological differentiation between the two remain difficult. We are presenting a case of fulminant myocarditis that has pathological features suggestive of cardiac sarcoidosis, but clinically mimicking giant cell myocarditis. This patient was treated with cyclosporine and prednisone and recovered well. This case we believe challenges our current understanding of these intertwined conditions. By obtaining a sense of severity of cardiac involvement via delayed hyperenhancement of cardiac magnetic resonance imaging, we were more inclined to treat this patient as giant cell myocarditis with cyclosporine. This resulted in excellent improvement of patient’s cardiac function as shown by delayed hyperenhancement images, early perfusion images, and SSFP videos.

Giant esophageal fibrovascular polyp with clinical behaviour of inflammatory pseudotumor: A case report and the literature review

Directory of Open Access Journals (Sweden)

Ćuk Vladimir

2014-01-01

Full Text Available Introduction. Esophageal fibrovascular polyps are rare, benign, intraluminal, submucosal tumor-like lesions, characterized by pedunculated masses which can demonstrate enormous growth. The most frequent symptoms are dysphagia, vomiting and weight loss. Fibrovascular polyps with long stalks can regurgitate into the airways and cause asphyxia. Esophageal inflammatory pseudotumor is extremely rare lesion accompanied with various systemic manifestations as fever, anemia and thrombocytosis. Case report. We presented a 29-year-old man complaining of a long-lasting fever and dysphagia. He was found to have huge pedunculated submucosal tumor of esophagus, surgically completely resected. Histopathological examination showed that this giant tumor, 24 x 9 x 6 cm, was a fibrovascular polyp. The postoperative course was uneventful. The preoperative fever, anemia and thrombocytosis disappeared and did not recur in the postoperative course. Conclusion. We reported a patient with giant esophageal pedunculated tumor with clinical manifestations of inflammatory pseudotumor and histopathological picture of fibrovascular polyp, that we have not found described in the literature before.

Assessment and protection of esophageal mucosal integrity in patients with heartburn without esophagitis.

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Woodland, Philip; Lee, Chung; Duraisamy, Yasotha; Duraysami, Yasotha; Farré, Ricard; Dettmar, Peter; Sifrim, Daniel

2013-04-01

Intact esophageal mucosal integrity is essential to prevent symptoms during gastroesophageal reflux events. Approximately 70% of patients with heartburn have macroscopically normal esophageal mucosa. In patients with heartburn, persistent functional impairment of esophageal mucosal barrier integrity may underlie remaining symptoms. Topical protection of a functionally vulnerable mucosa may be an attractive therapeutic strategy. We aimed to evaluate esophageal mucosal functional integrity in patients with heartburn without esophagitis, and test the feasibility of an alginate-based topical mucosal protection. Three distal esophageal biopsies were obtained from 22 patients with heartburn symptoms, and 22 control subjects. In mini-Ussing chambers, the change in transepithelial electrical resistance (TER) of biopsies when exposed to neutral, weakly acidic, and acidic solutions was measured. The experiment was repeated in a further 10 patients after pretreatment of biopsies with sodium alginate, viscous control, or liquid control "protectant" solutions. Biopsy exposure to neutral solution caused no change in TER. Exposure to weakly acidic and acidic solutions caused a greater reduction in TER in patients than in controls (weakly acid -7.2% (95% confidence interval (CI) -9.9 to -4.5) vs. 3.2% (-2.2 to 8.6), Pheartburn without esophagitis shows distinct vulnerability to acid and weakly acidic exposures. Experiments in vitro suggest that such vulnerable mucosa may be protected by application of an alginate-containing topical solution.

Evaluation of esophageal peristalsis in patients with esophageal tumors. Initial experience with cine MR imaging

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Koyama, Takashi; Kobayashi, Ari; Hiraga, Akira; Umeoka, Shigeaki; Saga, Tsuneo; Watanabe, Go; Tamai, Ken; Shimada, Yutaka; Togashi, Kaori

2005-01-01

We evaluated esophageal peristalsis in patients with esophageal tumors by cine MR using steady-state free precession (SSFP) sequence and correlated the alteration of the esophageal peristalsis with clinical symptoms and tumor stages. Thirteen patients with pathologically proven esophageal tumors, including 12 esophageal cancers and one submucosal leiomyoma, underwent cine MRI using true fast imaging with steady precession (trueFISP) sequence, which is one SSFP sequence, after contrast-enhanced MR scanning for clinical purposes. A total of 120 serial images were obtained within 60 s through the plane along the long axis of the esophagus while patients chewed gum. The serial trueFISP images were evaluated for the presence, frequency, speed of progression, and passage of peristalsis through the tumor. The data from cine MRI were compared with clinical symptoms and tumor stages. Peristalsis was clearly identified in all patients. Seven patients with complete interruption of peristalsis had dysphagia; one with partially impaired peristalsis could intake solid foods with discomfort; and two with partially impaired peristalsis and three with preserved peristalsis remained asymptomatic. Patients with complete or partial interruption of peristalsis had Stage T3 or T4 esophageal cancer. In conclusion, trueFISP cine MR imaging enables direct visualization of esophageal peristalsis in relation to esophageal tumors. Complete interruption of peristalsis causes dysphagia, whereas partial interruption of and preserved peristalsis usually do not cause digestive problems. Interruption of peristalsis may indicate impaired muscle function caused by invasion of advanced esophageal cancers. (author)

Distal Esophageal Duplication Cyst with Gastro-Esophageal Reflux Disease: A Rare Association and a Management Challenge.

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Jan, Iftikhar Ahmad; Al Nuaimi, Asma; Al Hamoudi, Basma; Al Naqbi, Khalid; Bilal, Mohammad

2016-02-01

Esophageal duplication cysts are rare congenital abnormalities of the foregut and may be associated with other conditions. Association of esophageal duplication with Gastro-Esophageal Reflux Disease (GERD) has not been reported in children. We are reporting a case of a 16 months baby who had antenatal diagnosis of diaphragmatic hernia. Postnatal CTchest, however, suggested a distal esophageal duplication cyst and a contrast esophagogram showed grade-IV GER. A thoracoscopy in another hospital excluded esophageal duplication at that time. Later, he presented with hematemesis in our department and was re-evaluated. Repeat CTconfirmed a persistent 2.5 x 1.3 cm cyst in distal esophagus. Upper GI endoscopy suggested grade-II esophagitis with a wide patent gastro-esophageal junction. The child was treated with left thoracotomy, excision of the duplication cyst and thoracic fundoplication. He had an uneventful post-operative recovery and is doing well at 6 months follow-up.

Recovery of normal esophageal function in a kitten with diffuse megaesophagus and an occult lower esophageal stricture.

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Schneider, Jaycie; Ames, Marisa; DiCicco, Michael; Savage, Mason; Atkins, Clarke; Wood, Michael; Gookin, Jody L

2015-06-01

An 8-week-old male domestic shorthair was presented to the Internal Medicine Service at North Carolina State University for regurgitation. Radiographic diagnosis of generalized esophageal dilation and failure of esophageal peristalsis were compatible with diagnosis of congenital megaesophagus. Endoscopic examination of the esophagus revealed a fibrous stricture just orad to the lower esophageal sphincter. Conservative management to increase the body condition and size of the kitten consisted of feeding through a gastrostomy tube, during which time the esophagus regained normal peristaltic function, the stricture orifice widened in size and successful balloon dilatation of the stricture was performed. Esophageal endoscopy should be considered to rule out a stricture near the lower esophageal sphincter in kittens with radiographic findings suggestive of congenital megaesophagus. Management of such kittens by means of gastrostomy tube feeding may be associated with a return of normal esophageal motility and widening of the esophageal stricture, and facilitate subsequent success of interventional dilation of the esophageal stricture. © ISFM and AAFP 2014.

Esophageal motility pattern and gastro-esophageal reflux in chronic obstructive pulmonary disease.

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Gadel, Abil Ali; Mostafa, Mohamed; Younis, Ahmed; Haleem, Magdy

2012-01-01

The association of esophageal motility and gastroesophageal reflux symptoms with respiratory symptoms is not well established in patients with chronic obstructive pulmonary disease (COPD). The aim of this work is to study the abnormalities of esophageal function in COPD patients and study its relation to smoking index, body mass index and indices of hyperinflation. This study included 40 male COPD patients and 10 healthy controls. The patients and controls were subjected to spirometry, body plethysmography, esophageal manometry and 24hr pH-metry. Upper gastrointestinal symptoms were found in 55% of patients, hypotensive upper esophageal sphincter pressure in 65% of patients and hypotensive lower esophageal sphincter pressure in 52.5% of patients. Pathological acid reflux was found in 35% of patients. The severity of GERD increased with increased age, smoking index and body mass index, pesophageal motility disorders in COPD patients, LESP and UESP were significantly negatively correlated to indices of hyperinflation. There was a high prevalence of GERD in COPD patents especially elderly, severe stage of COPD, high smoking index and high body mass index (BMI).

Clinical significance of gallium-67 scintigraphy in assessing pulmonary lesions of sarcoidosis and idiopathic pulmonary fibrosis

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Fujishima, Seitaro; Kanazawa, Minoru; Yamasawa, Fumihiro; Kubo, Atsushi; Hashimoto, Shozo; Yokoyama, Tetsuro (Keio Univ., Tokyo (Japan). School of Medicine)

1992-03-01

To evaluate whether one can predict the course and prognosis of interstitial lung diseases from lung gallium-67 ({sup 67}Ga) uptake, we studied 31 subjects with sarcoidosis and 28 with idiopathic pulmonary fibrosis (IPF) retrospectively. We quantified the lung {sup 67}Ga uptake using posterior scans by Line's method, and calculated a visual index (VI). The normal range of {sup 67}Ga uptake was defined as less than 65 VI values, obtained from the 95 percent confidence interval of the control subjects. All subjects with stage I sarcoidosis, having only bilateral hilar lymphadenopathy (BHL) on chest X-ray, revealed normal lung {sup 67}Ga uptake. Fifty percent of patients with stage II sarcoidosis, with both BHL and pulmonary involvement on chest X-ray, showed increased lung {sup 67}Ga uptake. The patients with increased lung {sup 67}Ga uptake showed decreased percent vital capacity and increased alveolar-arterial oxygen tension difference, but none of them showed clinical deterioration during the follow-up period of more than 6 months. Fifty-four percent of subjects with IPF sowed increased lung {sup 67}Ga uptake. But there was no difference between the subgroups with normal and increased lung {sup 67}Ga uptake with respect to the severity of dyspnea, percent vital capacity, arterial oxygen tension, or alveolar-arterial oxygen tension difference. There was also no difference between the two subgroups of IPF in the cumulative percent survival after either the onset of symptoms or the {sup 67}Ga scintigram. We conclude that lung {sup 67}Ga uptake was not able to predict the clinical course or the prognosis of patients with sarcoidosis and IPF. (author).

Esophageal Dysmotility in Patients following Total Laryngectomy.

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Zhang, Teng; Maclean, Julia; Szczesniak, Michal; Bertrand, Paul P; Quon, Harry; Tsang, Raymond K; Wu, Peter I; Graham, Peter; Cook, Ian J

2018-02-01

Objectives Dysphagia is common in total laryngectomees, with some symptoms suggesting esophageal dysmotility. Tracheoesophageal (TE) phonation requires effective esophagopharyngeal air passage. Hence, esophageal dysmotility may affect deglutition or TE phonation. This study aimed to determine (1) the characteristics of esophageal dysmotility in laryngectomees, (2) whether clinical history is sensitive in detecting esophageal dysmotility, and (3) the relationship between esophageal dysmotility and TE prosthesis dysfunction. Study Design Multidisciplinary cross-sectional study. Setting Tertiary academic hospital. Subjects and Methods For 31 participants undergone total laryngectomy 1 to 12 years prior, clinical histories were taken by a gastroenterologist and a speech pathologist experienced in managing dysphagia. Esophageal high-resolution manometry was performed and analyzed using Chicago Classification v3.0. Results Interpretable manometric studies were obtained in 23 (1 normal manometry). Esophageal dysmotility patterns included achalasia, esophagogastric junction outflow obstruction, diffuse esophageal spasm, and other major (30%) and minor (50%) peristaltic disorders. The sensitivity of predicting any esophageal dysmotility was 28%, but it is noteworthy that patients with achalasia and diffuse esophageal spasm (DES) were predicted. Two of 4 participants with TE puncture leakage had poor esophageal clearance. Of 20 TE speakers, 12 had voice problems, no correlation between poor voice, and any dysmotility pattern. Conclusions Peristaltic and lower esophageal sphincter dysfunction are common in laryngectomees. Clinical history, while not predictive of minor motor abnormalities, predicted correctly cases with treatable spastic motor disorders. Dysmotility was not associated with poor phonation, although TE puncture leakage might be linked to poor esophageal clearance. Esophageal dysmotility should be considered in the laryngectomees with persisting dysphagia or

Esophageal motor disorders: recent advances.

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Dogan, Ibrahim; Mittal, Ravinder K

2006-07-01

The aim of this article is to highlight literature published during the last year in the context of previous knowledge. A number of novel techniques - high-resolution manometry, esophageal electrical impedance and intra-luminal ultrasound imaging - have improved our understanding of esophageal function in health and disease. Several studies address the function of longitudinal muscle layer of the esophagus in normal subjects and patients with motor disorders of the esophagus. Esophageal electrical impedance recordings reveal abnormal transit in patients with diffuse esophageal spasm, achalasia and patients with normal manometry. Loss of the mammalian Sprouty2 gene leads to enteric neuronal hyperplasia and esophageal achalasia. Several studies showed excellent long-term results of medical and surgical treatment of achalasia of the esophagus. For the first time, mechanisms of gastroesophageal reflux in critically ill mechanically ventilated patients are reported. Novel pharmacologic strategies in the treatment of reflux disease are highlighted. Several novel techniques, perfected during recent years, have improved our understanding of esophageal function and dysfunction. A number of important observations, reviewed here, provide important insight into the pathogenesis of esophageal motor disorders and treatment of gastroesophageal reflux disease.

[Extensive interactions between eating and weight disorder, major depression, pain, and sarcoidosis - case 5/2012].

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Schäflein, Eva; Wettach, Irmtraud; Smolka, Robert; Kuprion, Jürgen; Zipfel, Stephan; Teufel, Martin

2012-06-01

We report on a 41-year-old female patient suffering from obesity, binge eating more than twice a week with loss of control, eating rapidly and feeling guilty after eating, dyspnoea and chronic pain in the whole body, especially in her arms, legs and in both ankles. Furthermore, subdued mood, loss of interest and pleasure, fatigue and impaired concentration could be recognized. In the past, weight increase had been observed when corticosteroids were given against exacerbations of sarcoidosis. In the case of our patient, the beginning of sarcoidosis and increase of weight and pain correlated with augmentation of depression and psychosocial stress. Dysfunctional behavioral features and multiple interactions between diseases could be observed. We diagnosed obesity, binge eating disorder, major depression, chronic pain disease with somatic and psychical components and sarcoidosis. The patient was treated in a multimodal therapy program including psychotherapy, pharmacotherapy and psychopharmacotherapy, nutritionist advice and therapeutic exercise. A weight loss of 7.9 kg (5.9 %), well-balanced diet, reduction of binge eating and of pain intensity, mood stabilization as well as perception and expression of emotions and coping strategies in chronic diseases were achieved. Interdisciplinary treatment of patients suffering from psychosomatic, somatic and mental diseases is crucial for a good outcome. © Georg Thieme Verlag KG Stuttgart · New York.

Esophageal 3D Culture Systems as Modeling Tools in Esophageal Epithelial Pathobiology and Personalized MedicineSummary

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Kelly A. Whelan

Full Text Available The stratified squamous epithelium of the esophagus shows a proliferative basal layer of keratinocytes that undergo terminal differentiation in overlying suprabasal layers. Esophageal pathologies, including eosinophilic esophagitis, gastroesophageal reflux disease, Barrett's esophagus, squamous cell carcinoma, and adenocarcinoma, cause perturbations in the esophageal epithelial proliferation-differentiation gradient. Three-dimensional (3D culture platforms mimicking in vivo esophageal epithelial tissue architecture ex vivo have emerged as powerful experimental tools for the investigation of esophageal biology in the context of homeostasis and pathology. Herein, we describe types of 3D culture that are used to model the esophagus, including organotypic, organoid, and spheroid culture systems. We discuss the development and optimization of various esophageal 3D culture models; highlight the applications, strengths, and limitations of each method; and summarize how these models have been used to evaluate the esophagus under homeostatic conditions as well as under the duress of inflammation and precancerous/cancerous conditions. Finally, we present future perspectives regarding the use of esophageal 3D models in basic science research as well as translational studies with the potential for personalized medicine. Keywords: Organotypic Culture, Organoid, Spheroid Culture, Esophageal Disease

Lung inflammation in sarcoidosis: comparison of serum angiotensin-converting enzyme levels with bronchoalveolar lavage and gallium-67 scanning assessment of the T lymphocyte alveolitis

International Nuclear Information System (INIS)

Schoenberger, C.I.; Line, B.R.; Keogh, B.A.; Hunninghake, G.W.; Crystal, R.G.

1982-01-01

Serum angiotensin-converting enzyme (ACE) is elevated in many patients with pulmonary sarcoidosis and has been proposed as a measure of disease activity. The present study was designed to evaluate the possible relationship between serum ACE and direct measures of the intensity of the alveolitis of pulmonary sarcoidosis as measured by bronchoalveolar lavage and gallium-67 ( 67 Ga) scans. To accomplish this, 64 measurements of serum ACE, lavage T lymphocytes, and lung uptake of 67 Ga were performed in 41 patients with biopsy-proven sarcoidosis. Elevations of serum ACE were found on at least one occasion in 17 patients (41%). However, serum ACE was found to be a poor predictor of the intensity of alveolitis in sarcoidosis as assessed by the quantitation of bronchoalveolar lavage cells that were T lymphocytes and by 67 Ga scanning. Elevated serum ACE did not predict which patients would have elevated proportions of lavage T lymphocytes, which patients would demonstrate increased pulmonary uptake of 67 Ga, or which patients would have high-intensity alveolitis as defined by a combination of these criteria. These observations suggest that while serum ACE may be useful in diagnosing sarcoidosis, it does not reflect accurately the intensity of the alveolitis of the pulmonary component of this disease. (author)

High-resolution esophageal pressure topography for esophageal motility disorders

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Hashem Fakhre Yaseri; Gholamreza Hamsi; Tayeb Ramim

2016-01-01

Background: High-resolution manometer (HRM) of the esophagus has become the main diagnostic test in the evaluation of esophageal motility disorders. The development of high-resolution manometry catheters and software displays of manometry recordings in color-coded pressure plots have changed the diagnostic assessment of esophageal disease. The first step of the Chicago classification described abnormal esophagogastric junction deglutitive relaxation. The latest classification system, proposed...

The Changing Face of Esophageal Cancer

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Rachel E. Melhado

2010-06-01

Full Text Available The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.

The Changing Face of Esophageal Cancer

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Melhado, Rachel E., E-mail: raye732001@yahoo.co.uk; Alderson, Derek; Tucker, Olga [Academic Department of Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham (United Kingdom)

2010-06-28

The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction.

The Changing Face of Esophageal Cancer

International Nuclear Information System (INIS)

Melhado, Rachel E.; Alderson, Derek; Tucker, Olga

2010-01-01

The two main histological esophageal cancer types, adenocarcinoma and squamous cell carcinoma, differ in incidence, geographic distribution, ethnic pattern and etiology. This article focuses on epidemiology with particular reference to geographic and temporal variations in incidence, along with a review of the evidence supporting environmental and genetic factors involved in esophageal carcinogenesis. Squamous cell carcinoma of the esophagus remains predominantly a disease of the developing world. In contrast, esophageal adenocarcinoma is mainly a disease of western developed societies, associated with obesity and gastro-esophageal reflux disease. There has been a dramatic increase in the incidence of adenocarcinoma in developed countries in parallel with migration of both esophageal and gastric adenocarcinomas towards the gastro-esophageal junction

Upper Gastrointestinal Symptoms Predictive of Candida Esophagitis and Erosive Esophagitis in HIV and Non-HIV Patients

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Takahashi, Yuta; Nagata, Naoyoshi; Shimbo, Takuro; Nishijima, Takeshi; Watanabe, Koji; Aoki, Tomonori; Sekine, Katsunori; Okubo, Hidetaka; Watanabe, Kazuhiro; Sakurai, Toshiyuki; Yokoi, Chizu; Mimori, Akio; Oka, Shinichi; Uemura, Naomi; Akiyama, Junichi

2015-01-01

Abstract Upper gastrointestinal (GI) symptoms are common in both HIV and non-HIV-infected patients, but the difference of GI symptom severity between 2 groups remains unknown. Candida esophagitis and erosive esophagitis, 2 major types of esophagitis, are seen in both HIV and non-HIV-infected patients, but differences in GI symptoms that are predictive of esophagitis between 2 groups remain unknown. We aimed to determine whether GI symptoms differ between HIV-infected and non-HIV-infected patients, and identify specific symptoms of candida esophagitis and erosive esophagitis between 2 groups. We prospectively enrolled 6011 patients (HIV, 430; non-HIV, 5581) who underwent endoscopy and completed questionnaires. Nine upper GI symptoms (epigastric pain, heartburn, acid regurgitation, hunger cramps, nausea, early satiety, belching, dysphagia, and odynophagia) were evaluated using a 7-point Likert scale. Associations between esophagitis and symptoms were analyzed by the multivariate logistic regression model adjusted for age, sex, and proton pump inhibitors. Endoscopy revealed GI-organic diseases in 33.4% (2010/6.011) of patients. The prevalence of candida esophagitis and erosive esophagitis was 11.2% and 12.1% in HIV-infected patients, respectively, whereas it was 2.9% and 10.7 % in non-HIV-infected patients, respectively. After excluding GI-organic diseases, HIV-infected patients had significantly (P symptom scores for heartburn, hunger cramps, nausea, early satiety, belching, dysphagia, and odynophagia than non-HIV-infected patients. In HIV-infected patients, any symptom was not significantly associated with CD4 cell count. In multivariate analysis, none of the 9 GI symptoms were associated with candida esophagitis in HIV-infected patients, whereas dysphagia and odynophagia were independently (P HIV-infected patients. However, heartburn and acid regurgitation were independently (P symptom scores were reliable in both HIV (α, 0.86) and non-HIV-infected patients

Functional Esophageal Disorders.

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Aziz, Qasim; Fass, Ronnie; Gyawali, C Prakash; Miwa, Hiroto; Pandolfino, John E; Zerbib, Frank

2016-02-15

Functional esophageal disorders consist of a disease category that present with esophageal symptoms (heartburn, chest pain, dysphagia, globus) not explained by mechanical obstruction (stricture, tumor, eosinophilic esophagitis), major motor disorders (achalasia, EGJ outflow obstruction, absent contractility, distal esophageal spasm, jackhammer esophagus), or gastroesophageal reflux disease (GERD). While mechanisms responsible are unclear, it is theorized that visceral hypersensitivity and hypervigilance play an important role in symptom generation, in the context of normal or borderline function. Treatments directed at improving borderline motor dysfunction or reducing reflux burden to sub-normal levels have limited success in symptom improvement. In contrast, strategies focused on modulating peripheral triggering and central perception are mechanistically viable and clinically meaningful. However, outcome data from these treatment options are limited. Future research needs to focus on understanding mechanisms underlying visceral hypersensitivity and hypervigilance so that appropriate targets and therapies can be developed. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Multifocal choroiditis as the first sign of systemic sarcoidosis associated with pembrolizumab

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Qu-Knafo Lise

2017-04-01

Conclusions and importance: Pembrolizumab is an immune checkpoint inhibitor therapy used in the treatment of metastatic melanoma. We report a pembrolizumab-associated sarcoidosis revealed by a panuveitis with multifocal choroiditis. Physicians should be aware of the potential inflammatory and autoimmune disease that may be induced by immunomodulatory therapies.

Impact of esophageal temperature monitoring guided atrial fibrillation ablation on preventing asymptomatic excessive transmural injury

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Kiuchi, Kunihiko; Okajima, Katsunori; Shimane, Akira; Kanda, Gaku; Yokoi, Kiminobu; Teranishi, Jin; Aoki, Kousuke; Chimura, Misato; Toba, Takayoshi; Oishi, Shogo; Sawada, Takahiro; Tsukishiro, Yasue; Onishi, Tetsuari; Kobayashi, Seiichi; Taniguchi, Yasuyo; Yamada, Shinichiro; Yasaka, Yoshinori; Kawai, Hiroya; Yoshida, Akihiro; Fukuzawa, Koji; Itoh, Mitsuaki; Imamura, Kimitake; Fujiwara, Ryudo; Suzuki, Atsushi; Nakanishi, Tomoyuki; Yamashita, Soichiro; Hirata, Ken-ichi; Tada, Hiroshi; Yamasaki, Hiro; Naruse, Yoshihisa; Igarashi, Miyako; Aonuma, Kazutaka

2015-01-01

Background Even with the use of a reduced energy setting (20–25 W), excessive transmural injury (ETI) following catheter ablation of atrial fibrillation (AF) is reported to develop in 10% of patients. However, the incidence of ETI depends on the pulmonary vein isolation (PVI) method and its esophageal temperature monitor setting. Data comparing the incidence of ETI following AF ablation with and without esophageal temperature monitoring (ETM) are still lacking. Methods This study was comprised of 160 patients with AF (54% paroxysmal, mean: 24.0±2.9 kg/m2). Eighty patients underwent ablation accompanied by ETM. The primary endpoint was defined as the occurrence of ETI assessed by endoscopy within 5 d after the AF ablation. The secondary endpoint was defined as AF recurrence after a single procedure. If the esophageal temperature probe registered >39 °C, the radiofrequency (RF) application was stopped immediately. RF applications could be performed in a point-by-point manner for a maximum of 20 s and 20 W. ETI was defined as any injury that resulted from AF ablation, including esophageal injury or periesophageal nerve injury (peri-ENI). Results The incidence of esophageal injury was significantly lower in patients whose AF ablation included ETM compared with patients without ETM (0 [0%] vs. 6 [7.5%], p=0.028), but not the incidence of peri-ENI (2 [2.5%] vs. 3 [3.8%], p=1.0). AF recurrence 12 months after the procedure was similar between the groups (20 [25%] in the ETM group vs. 19 [24%] in the non-ETM group, p=1.00). Conclusions Catheter ablation using ETM may reduce the incidence of esophageal injury without increasing the incidence of AF recurrence but not the incidence of peri-ENI. PMID:26949429

Expert Consensus Contouring Guidelines for Intensity Modulated Radiation Therapy in Esophageal and Gastroesophageal Junction Cancer

International Nuclear Information System (INIS)

Wu, Abraham J.; Bosch, Walter R.; Chang, Daniel T.; Hong, Theodore S.; Jabbour, Salma K.; Kleinberg, Lawrence R.; Mamon, Harvey J.; Thomas, Charles R.; Goodman, Karyn A.

2015-01-01

Purpose/Objective(s): Current guidelines for esophageal cancer contouring are derived from traditional 2-dimensional fields based on bony landmarks, and they do not provide sufficient anatomic detail to ensure consistent contouring for more conformal radiation therapy techniques such as intensity modulated radiation therapy (IMRT). Therefore, we convened an expert panel with the specific aim to derive contouring guidelines and generate an atlas for the clinical target volume (CTV) in esophageal or gastroesophageal junction (GEJ) cancer. Methods and Materials: Eight expert academically based gastrointestinal radiation oncologists participated. Three sample cases were chosen: a GEJ cancer, a distal esophageal cancer, and a mid-upper esophageal cancer. Uniform computed tomographic (CT) simulation datasets and accompanying diagnostic positron emission tomographic/CT images were distributed to each expert, and the expert was instructed to generate gross tumor volume (GTV) and CTV contours for each case. All contours were aggregated and subjected to quantitative analysis to assess the degree of concordance between experts and to generate draft consensus contours. The panel then refined these contours to generate the contouring atlas. Results: The κ statistics indicated substantial agreement between panelists for each of the 3 test cases. A consensus CTV atlas was generated for the 3 test cases, each representing common anatomic presentations of esophageal cancer. The panel agreed on guidelines and principles to facilitate the generalizability of the atlas to individual cases. Conclusions: This expert panel successfully reached agreement on contouring guidelines for esophageal and GEJ IMRT and generated a reference CTV atlas. This atlas will serve as a reference for IMRT contours for clinical practice and prospective trial design. Subsequent patterns of failure analyses of clinical datasets using these guidelines may require modification in the future

Post-inflammatory fatigue in sarcoidosis: personality profiles, psychological symptoms and stress hormones.

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Korenromp, Ingrid H E; Grutters, Jan C; van den Bosch, Jules M M; Heijnen, Cobi J

2012-02-01

Chronic fatigue following inflammatory diseases has been well documented. However, little is known about possible risk factors of chronic post-inflammatory fatigue. The aim of this study was to investigate whether chronic post-inflammatory fatigue after clinical remission of the disease sarcoidosis is associated with specific dimensions of personality, psychological symptoms and baseline levels of stress hormones. Thirty-seven non-fatigued and 33 fatigued patients in clinical remission of sarcoidosis were evaluated with the Temperament and Character Inventory-short form (TCI); the Symptom CheckList-90 (SCL), and the Checklist Individual Strength (CIS). Baseline levels of ACTH and cortisol were measured in plasma. Principal component analysis with orthogonal rotation (varimax) was conducted on all personality, psychological and stress hormone data in order to obtain a smaller set of components. Logistic regression was performed to associate these components with chronic post-inflammatory fatigue. Principal component analyses identified 5 components, of which two components were significantly associated with chronic post-inflammatory fatigue. The first component comprised the personality trait Harm Avoidance and all SCL-subscales except Sleep. The second component consisted of baseline levels ACTH and cortisol, and showed an inverse association with chronic post-inflammatory fatigue. The 3 other components, consisting of respectively SCL-Sleep, TCI-Novelty Seeking-Reward Dependence-Self Transcendence, and TCI-Persistence, were not significantly associated with chronic fatigue. Chronic post-inflammatory fatigue after clinical remission of sarcoidosis is associated with a triad of risk factors: a specific personality profile with profound neurotic characteristics in combination with high levels of psychological distress, and decreased baseline ACTH/cortisol levels. Copyright © 2011 Elsevier Inc. All rights reserved.

Indications and interpretation of esophageal function testing.

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Gyawali, C Prakash; de Bortoli, Nicola; Clarke, John; Marinelli, Carla; Tolone, Salvatore; Roman, Sabine; Savarino, Edoardo

2018-05-12

Esophageal symptoms are common, and can arise from mucosal, motor, functional, and neoplastic processes, among others. Judicious use of diagnostic testing can help define the etiology of symptoms and can direct management. Endoscopy, esophageal high-resolution manometry (HRM), ambulatory pH or pH-impedance manometry, and barium radiography are commonly used for esophageal function testing; functional lumen imaging probe is an emerging option. Recent consensus guidelines have provided direction in using test findings toward defining mechanisms of esophageal symptoms. The Chicago Classification describes hierarchical steps in diagnosing esophageal motility disorders. The Lyon Consensus characterizes conclusive evidence on esophageal testing for a diagnosis of gastroesophageal reflux disease (GERD), and establishes a motor classification of GERD. Taking these recent advances into consideration, our discussion focuses primarily on the indications, technique, equipment, and interpretation of esophageal HRM and ambulatory reflux monitoring in the evaluation of esophageal symptoms, and describes indications for alternative esophageal tests. © 2018 New York Academy of Sciences.

Reflux esophagitis revisited: Prospective analysis of radiologic accuracy

International Nuclear Information System (INIS)

Ott, D.J.; Gelfand, D.W.; Wu, W.C.

1981-01-01

A prospective radiologic-endoscopic study of the esophagogastric region in 266 patients, including 206 normals and 60 with esophagitis, is reported. The endoscopic classification grading severity of esophagitis was grade 1-normal; grades 2. 3. and 4-mild, moderate, and severe esophagitis, respectively. Radiology detected 22% of patient with mild esophagitis, 83% with moderate esophagitis, and 95% with severe esophagitis. Although hiatal hernia was present in 40% of normals and 89% with esophagitis, absence of radiographic hiatal hernia excluded esophagitis with 95% accuracy. The implications of this study regarding the role of radiology in evaluating patient with suspected reflux esophagitis are discussed. (orig.) [de

Eosinophilic Esophagitis (EoE)

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... specific responses in allergy? » Dietary Therapy and Nutrition Management of Eosinophilic Esophagitis: A Work Group Report of the American Academy of Allergy, Asthma, and Immunology » Eosinophilic esophagitis can ...

Primary Esophageal Motility Disorders: Beyond Achalasia

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Schlottmann, Francisco; Patti, Marco G.

2017-01-01

The best-defined primary esophageal motor disorder is achalasia. However, symptoms such as dysphagia, regurgitation and chest pain can be caused by other esophageal motility disorders. The Chicago classification introduced new manometric parameters and better defined esophageal motility disorders. Motility disorders beyond achalasia with the current classification are: esophagogastric junction outflow obstruction, major disorders of peristalsis (distal esophageal spasm, hypercontractile esoph...

Esophageal adenocarcinoma and Barrett esophagus in a neurologically impaired teenager.

Science.gov (United States)

Hwang, Jae-Yeon; Lee, Yeoun Joo; Chun, Peter; Shin, Dong Hoon; Park, Jae Hong

2016-11-01

Esophageal adenocarcinoma (EAC) accompanied by Barrett esophagus (BE) is rare in patients younger than 20 years old. EAC in the upper esophagus is also rare. We report a rare case of EAC with BE that developed in the upper esophagus after chronic, untreated gastroesophageal reflux disease in a neurologically impaired teenager. A 19-year-old neurologically impaired man underwent endoscopy for evaluation of dysphagia and vomiting, and was diagnosed with EAC with BE. He underwent transthoracic esophagectomy, extensive lymph node dissection, and cervical esophagogastric anastomosis, but the prognosis was poor. Pathology indicated poorly differentiated adenocarcinoma with BE. © 2016 Japan Pediatric Society.

Esophageal leiomyoma in a dog causing esophageal distension and treated by transcardial placement of a self-expanding, covered, nitinol esophageal stent.

Science.gov (United States)

Robin, Elisabeth M; Pey, Pascaline B; de Fornel-Thibaud, Pauline; Moissonnier, Pierre H M; Freiche, Valérie

2018-02-01

CASE DESCRIPTION A 10-year-old spayed female Rottweiler was referred for evaluation because of a 2-month history of regurgitation and weight loss, despite no apparent change in appetite. The dog had received antiemetic and antacid treatment, without improvement. CLINICAL FINDINGS Physical examination revealed a low body condition score (2/5), but other findings were unremarkable. Diffuse, global esophageal dilatation was noted on plain thoracic radiographs, and normal motility was confirmed through videofluoroscopic evaluation of swallowing. Transhepatic ultrasonographic and CT examination revealed a circumferential, intraparietal lesion in the distal portion of the esophagus causing distal esophageal or cardial subobstruction and no metastases. Incisional biopsy of the lesion was performed, and findings of histologic examination supported a diagnosis of esophageal leiomyoma. TREATMENT AND OUTCOME In view of numerous possible complications associated with esophageal surgery, the decision was made to palliatively treat the dog by transcardial placement of a self-expanding, covered, nitinol esophageal stent under endoscopic guidance. Two weeks after stent placement, radiography revealed complete migration of the stent into the gastric lumen. Gastrotomy was performed, and the stent was replaced and fixed in place. Twenty-four months after initial stent placement, the dog had a healthy body condition and remained free of previous clinical signs. CLINICAL RELEVANCE Diffuse benign muscular neoplasia should be considered as a differential diagnosis for acquired esophageal dilatation in adult and elderly dogs. In the dog of this report, transcardial stent placement resulted in resolution of the clinical signs, with no apparent adverse effect on digestive function. The described procedure could be beneficial for nonsurgical treatment of benign esophageal tumors in dogs.

Opportunistic esophagitis in AIDS: Radiographic diagnosis

International Nuclear Information System (INIS)

Levine, M.S.; Woldenberg, R.; Herlinger, H.; Laufer, I.

1987-01-01

Between 1983 and 1986, 35 of 90 patients with acquired immunodeficiency syndrome (AIDS) had double-contrast esophagograms to rule out opportunistic esophagitis. The radiographs were reviewed without knowledge of the clinical or endoscopic findings. Candida esophagitis was diagnosed radiographically in 17 patients who had varying degrees of plaque formation and viral esophagitis in three who had discrete ulcers without plaques. All three patients with viral esophagitis (herpes in 2 and cytomegalo virus in one) and 15 of 17 with Candida esophagitis had endoscopic and/or clinical corroboration of the radiographic diagnosis. Thus, the authors' experience suggests that fungal and viral esophagitis can often be differentiated on double-contrast esophagography, so that appropriate antifungal or antiviral therapy can be instituted without need for endoscopic intervention

Evaluation of esophageal motor function in clinical practice.

Science.gov (United States)

Gyawali, C P; Bredenoord, A J; Conklin, J L; Fox, M; Pandolfino, J E; Peters, J H; Roman, S; Staiano, A; Vaezi, M F

2013-02-01

Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper endoscopy is useful in evaluating for structural disorders of the esophagus, barium esophagography, radionuclide transit studies, and esophageal intraluminal impedance evaluate esophageal transit and partially assess motor function. However, esophageal manometry is the test of choice for the evaluation of esophageal motor function. In recent years, high-resolution manometry (HRM) has streamlined the process of acquisition and display of esophageal pressure data, while uncovering hitherto unrecognized esophageal physiologic mechanisms and pathophysiologic patterns. New algorithms have been devised for analysis and reporting of esophageal pressure topography from HRM. The clinical value of HRM extends to the pediatric population, and complements preoperative evaluation prior to foregut surgery. Provocative maneuvers during HRM may add to the assessment of esophageal motor function. The addition of impedance to HRM provides bolus transit data, but impact on clinical management remains unclear. Emerging techniques such as 3-D HRM and impedance planimetry show promise in the assessment of esophageal sphincter function and esophageal biomechanics. © 2013 Blackwell Publishing Ltd.

Esophageal perforation during or after conformal radiotherapy for esophageal carcinoma

International Nuclear Information System (INIS)

Chen Haiyan; Ma Xiumei; Ye Ming; Hou Yanli; Xie Huaying; Bai Yongrui

2014-01-01

The aim of this study was to analyze the risk factors and prognosis for patients with esophageal perforation occurring during or after radiotherapy for esophageal carcinoma. We retrospectively analyzed 322 patients with esophageal carcinoma. These patients received radiotherapy for unresectable esophageal tumors, residual tumors after operation, or local recurrence. Of these, 12 had radiotherapy to the esophagus before being admitted, 68 patients had concurrent chemoradiotherapy (CRT), and 18 patients had esophageal perforation after RT (5.8%). Covered self-expandable metallic stents were placed in 11 patients. Two patients continued RT after stenting and control of infection; one of these suffered a new perforation, and the other had a massive hemorrhage. The median overall survival was 2 months (0-3 months) compared with 17 months in the non-perforation group. In univariate analysis, the Karnofsky performance status (KPS) being ≤ 70, age younger than 60, T4 stage, a second course of radiotherapy to the esophagus, extracapsular lymph nodes (LN) involving the esophagus, a total dose > 100 Gy (biologically effective dose -10 ), and CRT were risk factors for perforation. In multivariate analysis, age younger than 60, extracapsular LN involving the esophagus, T4 stage, and a second course of radiotherapy to the esophagus were risk factors. In conclusion, patients with T4 stage, extracapsular LN involving the esophagus, and those receiving a second course of RT should be given particular care to avoid perforation. The prognosis after perforation was poor. (author)

Diffuse esophageal spasm

International Nuclear Information System (INIS)

Ott, D.J.; Chen, Y.M.; Hewson, E.G.; Richter, J.E.; Wu, W.C.; Gelfand, D.W.; Castell, D.O.

1988-01-01

Radiologic and manometric findings were correlated in 17 patients with diffuse esophageal spasm (DES). All patients initially had chest pain and/or dysphagia and had a manometric diagnosis of DES. Mean percentage of normal peristalsis manometrically was 46% (range, 20%-80%). Based on radiologic examination, an esophageal motor disorder consistent with DES was diagnosed in 12 of 17 patients, and there was one misinterpretation of achalasia. Radiologic detection was not related significantly to the percentage of peristalsis seen on manometric examination. Mean esophageal wall thickness as measured radiographically in patients with DES was 2.6 mm, compared with 2.5 mm in 17 individuals with normal results of manometry

Scintigraphy in esophageal cancer

International Nuclear Information System (INIS)

Shishkina, V.V.; Piperkova, E.N.; Okulov, L.V.

1987-01-01

Esophagoscintigraphy with labelled liquid and solid food was performed in 34 patients disease of the esophagus in the patient history permitting the determination of quantitative and qualitive characteristics of normal motor-evacuatory function of the esophagus and lower esophageal sphincter (LES). A total of 46 patients with esophageal cancer and stomach cancer with the envolvement of the esophagus before treatment were examined. In cancer of the esophagus its function depended on a tumor site and stage. In order to raise diagnostic sensitivity dynamic esophagoscintigraphy should be performed using liquid and solid food because during liquid passage a study with a hard bolus of patients with severe esophageal disfunction showed that in 36.9% of the patients the quantitative and qualitative indices were within normal. Radionuclide methods permit the determination of the level of a pathological focus, a degree of esophageal permeability, quantitative characterization of a degree of disorder of esophageal function in order to raise the functional diagnosis of the esophaeous and LES, and the determination of motor disorders at the earliest stages of tumor development

The problem of the treatment of sarcoidosis: Report of the Subcommittee on Therapy.

Science.gov (United States)

Turiaf, J; Johns, C J; Terstein, A S; Tsuji, S; Wurm, K

1976-01-01

Stage I: Hilar Adenopathy With normal lung function observe, as it often resolves. With reduced lung function observe for 6-12 months. Treat if there is progression or persistence. With erythema nodosum use mild anti-inflammatory agents such as salicylates or like drugs. Stage II: Adenopathy + Pulmonar Infiltrates With normal or slightly reduced lung function observe; treat if it worsens. Treat if there is no remission in 6-12 months. With reduced lung function treat, possibly for many years or a lifetime. Stage III: Pulmonary Infiltrates +/- Fibrosis Without Adenopathy There is reduced lung function. Treat, demonstrate improvement, follow patients with serial measurements of vital capacity at least. Other Indications for Treatment Other indications for treatment include myocardial sarcoidosis, cerebral sarcoidosis (although the outcome is less certain), serious hepatic or renal sarcoidosis, hypercalcemia, persistent systemic symptoms, or other serious organ or functional impairment. Assess each patient individually and completely. Use good clinical judgement. It is clear that treatment that is too little or too late is of little benefit. Even the statistical results form a perfectly controlled study cannot provide absolute direction for the individual patient. As clinicians we are frequently called upon to apply considered judgements without hard data to predict the outcome. We also maintain the flexibility to change our therapeutic programs when circumstances change, either in the patient or in our knowledge. We can be grateful we have a treatment as good as corticosteroids and must try to exercise our best judgement as to when it should be instituted.

Radionuclide Esophageal Transit Scintigraphy in Primary Hypothyroidism.

Science.gov (United States)

Khan, Shoukat H; P, Madhu Vijay; Rather, Tanveer A; Laway, Bashir A

2017-01-30

Esophageal dysmotility is associated with gastrointestinal dysmotility in various systemic and neuroregulatory disorders. Hypothyroidism has been reported to be associated with impaired motor function in esophagus due to accumulation of glycosaminoglycan hyaluronic acid in its soft tissues, leading to changes in various contraction and relaxation parameters of esophagus, particularly in the lower esophageal sphincter. In this study we evaluated esophageal transit times in patients of primary hypothyroidism using the technique of radionuclide esophageal transit scintigraphy. Thirty-one patients of primary hypothyroidism and 15 euthyroid healthy controls were evaluated for esophageal transit time using 15-20 MBq of Technetium-99m sulfur colloid diluted in 10-15 mL of drinking water. Time activity curve was generated for each study and esophageal transit time was calculated as time taken for clearance of 90% radioactive bolus from the region of interest encompassing the esophagus. Esophageal transit time of more than 10 seconds was considered as prolonged. Patients of primary hypothyroidism had a significantly increased mean esophageal transit time of 19.35 ± 20.02 seconds in comparison to the mean time of 8.25 ± 1.71 seconds in healthy controls ( P < 0.05). Esophageal transit time improved and in some patients even normalized after treatment with thyroxine. A positive correlation ( r = 0.39, P < 0.05) albeit weak existed between the serum thyroid stimulating hormone and the observed esophageal transit time. A significant number of patients with primary hypothyroidism may have subclinical esophageal dysmotility with prolonged esophageal transit time which can be reversible by thyroxine treatment. Prolonged esophageal transit time in primary hypothyroidism may correlate with serum thyroid stimulating hormone levels.

[Th17 and Treg cell levels in patients with sarcoidosis and their relation to disease activation].

Science.gov (United States)

Weng, Yue-song; Wang, Hua-ying; Lv, Ding-feng; Fu, Zhong-ming; Yu, Wan-jun

2015-03-01

To investigate the Th17 cell and Treg cell levels in patients with sarcoidosis, and their relation to disease activation and glucocorticoids treatment. Twenty-three sarcoidosis patients admitted in Yinzhou People's Hospital from January 2009 to December 2013 and 25 healthy subjects (controls) were included in this study. The blood samples and bronchoalveolar lavage fluid (BALF) samples were collected in all patients before and after glucocorticoids treatment. The serum angiotensin converting enzyme (SACE) levels were detected. The percentages of Th17 cells and Treg cells in peripheral blood and BALF were determined by flow cytometry, the concentrations of cytokines in serum and supernatants of BALF were measured by enzyme-linked immunosorbent assay (ELISA). The levels of ROR-γt and Foxp3 mRNA transcripts in peripheral blood mononuclear cells (PBMC) were determined by real-time quantitative PCR. The potential correlation between the percentages of Th17 or Treg cells and SACE levels was evaluated. Compared with healthy controls, significantly higher frequencies of Th17 cells (4.34%±0.89% vs 1.60% ± 0.42%), lower frequencies of Treg cells (1.28% ± 0.37% vs 3.39% ± 0.50%) in peripheral blood were observed. Higher level of ROR-γt mRNA (21.31 ± 3.55 vs 3.63 ± 1.00) and lower level of Foxp3 mRNA (1.60 ± 0.24 vs 3.12 ± 0.76) in peripheral blood were detected in sarcoidosis patients in active stage (before glucocorticoids treatment) (all PSACE (r= 0.781). The imbalance of Th17 cells and Treg cells in peripheral blood and airway may be involved in the pathogenesis of sarcoidosis, which was associated with the activity of disease, and the treatment of glucocorticoids may achieve a therapeutic effect by correcting the immune imbalance.

Clinical Application of Esophageal High-resolution Manometry in the Diagnosis of Esophageal Motility Disorders

OpenAIRE

van Hoeij, Froukje B; Bredenoord, Albert J

2016-01-01

Esophageal high-resolution manometry (HRM) is replacing conventional manometry in the clinical evaluation of patients with esophageal symptoms, especially dysphagia. The introduction of HRM gave rise to new objective metrics and recognizable patterns of esophageal motor function, requiring a new classification scheme: the Chicago classification. HRM measurements are more detailed and more easily performed compared to conventional manometry. The visual presentation of acquired data improved th...

The BTNL2 A allele variant is frequent in Danish patients with sarcoidosis

DEFF Research Database (Denmark)

Milman, Nils; Svendsen, Claus Bo; Nielsen, Finn Cilius

2011-01-01

The butyrophilin-like 2 (BTNL2) gene is located on chromosome 6p21.3 close to the HLA-class II genes. An association has been reported between sarcoidosis and a single nucleotide polymorphism in BTNL2, rs2076530, also termed the A allele....

Minimally invasive surgery for esophageal achalasia

OpenAIRE

Bonavina, Luigi

2006-01-01

Esophageal achalasia is the most commonly diagnosed primary esophageal motor disorder and the second most common functional esophageal disorder. Current therapy of achalasia is directed toward elimination of the outflow resistance caused by failure of the lower esophageal sphincter to relax completely upon swallowing. The advent of minimally invasive surgery has nearly replaced endoscopic pneumatic dilation as the first-line therapeutic approach. In this editorial, the rationale and the evide...

Radiological evaluation of esophageal speech on total laryngectomee

International Nuclear Information System (INIS)

Chung, Tae Sub; Suh, Jung Ho; Kim, Dong Ik; Kim, Gwi Eon; Hong, Won Phy; Lee, Won Sang

1988-01-01

Total laryngectomee requires some form of alaryngeal speech for communication. Generally, esophageal speech is regarded as the most available and comfortable technique for alaryngeal speech. But esophageal speech is difficult to train, so many patients are unable to attain esophageal speech for communication. To understand mechanism of esophageal of esophageal speech on total laryngectomee, evaluation of anatomical change of the pharyngoesophageal segment is very important. We used video fluoroscopy for evaluation of pharyngesophageal segment during esophageal speech. Eighteen total laryngectomees were evaluated with video fluoroscopy from Dec. 1986 to May 1987 at Y.U.M.C. Our results were as follows: 1. Peseudoglottis is the most important factor for esophageal speech, which is visualized in 7 cases among 8 cases of excellent esophageal speech group. 2. Two cases of longer A-P diameter at the pseudoglottis have the best quality of esophageal speech than others. 3. Two cases of mucosal vibration at the pharyngoesophageal segment can make excellent esophageal speech. 4. The cases of failed esophageal speech are poor aerophagia in 6 cases, abscence of pseudoglottis in 4 cases and poor air ejection in 3 cases. 5. Aerophagia synchronizes with diaphragmatic motion in 8 cases of excellent esophageal speech.

Regulation and dysregulation of esophageal peristalsis by the integrated function of circular and longitudinal muscle layers in health and disease.

Science.gov (United States)

Mittal, Ravinder K

2016-09-01

Muscularis propria throughout the entire gastrointestinal tract including the esophagus is comprised of circular and longitudinal muscle layers. Based on the studies conducted in the colon and the small intestine, for more than a century, it has been debated whether the two muscle layers contract synchronously or reciprocally during the ascending contraction and descending relaxation of the peristaltic reflex. Recent studies in the esophagus and colon prove that the two muscle layers indeed contract and relax together in almost perfect synchrony during ascending contraction and descending relaxation of the peristaltic reflex, respectively. Studies in patients with various types of esophageal motor disorders reveal temporal disassociation between the circular and longitudinal muscle layers. We suggest that the discoordination between the two muscle layers plays a role in the genesis of esophageal symptoms, i.e., dysphagia and esophageal pain. Certain pathologies may selectively target one and not the other muscle layer, e.g., in eosinophilic esophagitis there is a selective dysfunction of the longitudinal muscle layer. In achalasia esophagus, swallows are accompanied by the strong contraction of the longitudinal muscle without circular muscle contraction. The possibility that the discoordination between two muscle layers plays a role in the genesis of esophageal symptoms, i.e., dysphagia and esophageal pain are discussed. The purpose of this review is to summarize the regulation and dysregulation of peristalsis by the coordinated and discoordinated function of circular and longitudinal muscle layers in health and diseased states.

Gastro-Esophageal Reflux in Children

Directory of Open Access Journals (Sweden)

Anna Rybak

2017-08-01

Full Text Available Gastro-esophageal reflux (GER is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD. Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines.

Gastro-Esophageal Reflux in Children.

Science.gov (United States)

Rybak, Anna; Pesce, Marcella; Thapar, Nikhil; Borrelli, Osvaldo

2017-08-01

Gastro-esophageal reflux (GER) is common in infants and children and has a varied clinical presentation: from infants with innocent regurgitation to infants and children with severe esophageal and extra-esophageal complications that define pathological gastro-esophageal reflux disease (GERD). Although the pathophysiology is similar to that of adults, symptoms of GERD in infants and children are often distinct from classic ones such as heartburn. The passage of gastric contents into the esophagus is a normal phenomenon occurring many times a day both in adults and children, but, in infants, several factors contribute to exacerbate this phenomenon, including a liquid milk-based diet, recumbent position and both structural and functional immaturity of the gastro-esophageal junction. This article focuses on the presentation, diagnosis and treatment of GERD that occurs in infants and children, based on available and current guidelines.

Serum angiotensin-converting enzyme (SACE) activity as an indicator of total body granuloma load and prognosis in sarcoidosis.

Science.gov (United States)

Muthuswamy, P P; Lopez-Majano, V; Ranginwala, M; Trainor, W D

1987-09-01

The relationship between the level of serum angiotensin converting enzyme (SACE) and the total body granuloma load in patients with sarcoidosis was studied in two groups using SACE levels and total body gallium67 scans. The study group consisted of 22 patients with SACE levels greater than or equal to 100 U/ml (EH-SACE group) and the control group consisted of 24 patients consecutively diagnosed to have sarcoidosis in a one year period with SACE level of less than 80 U/ml. The average number of organs involved in the EH-SACE group was 3.9 +/- 1 compared to 2.3 +/- 1 in the control group (p less than 0.0001). The incidence of extra pulmonary organ involvement in the EH-SACE group was 2.2 +/- 1 organs compared to 1.0 + 0.8 in the control group (p less than 0.0002). The SACE level was correlated with the number of organs involved for all patients with sarcoidosis (r = .55; p less than .0001). Following corticosteroid therapy for 39 +/- 41 weeks the SACE dropped to 64 +/- 45 units in the EH-SACE group. But it took only 13 +/- 10 weeks to normalize the SACE level to 27 +/- 9 units in the control group. The EH-SACE group patients were followed for 114 +/- 64 weeks and 73% of them still have active sarcoidosis requiring repeated cycles of corticosteroid therapy, while after 42 +/- 23 weeks of follow up only 10% of patients from the control group were still on therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Recent developments in esophageal motor disorders.

Science.gov (United States)

Beaumont, Hanneke; Boeckxstaens, Guy

2007-07-01

Every year more insight into the pathogenesis and treatment of esophageal motor disorders is obtained. This review highlights some interesting literature published in this area during the last year. Longitudinal and circular muscle contractions act in a well coordinated fashion to allow normal peristalsis. Techniques such as intraluminal impedance, high-resolution manometry and intraluminal ultrasound provide useful additional information on esophageal function both in the normal and abnormal situation. The dynamics of the gastroesophageal junction can be studied with a newly developed probe, and the mechanism behind transient lower esophageal sphincter relaxations is still being unravelled. New manometric criteria for nutcracker esophagus have been proposed, whereas further evidence is reported supporting an association between diabetes mellitus and cardiovascular disease and esophageal dysmotility and spasm, respectively. Finally, several long-term follow-up results of surgical myotomy and pneumodilatation have been reported. Due to the perfection of esophageal measuring techniques, our knowledge of esophageal function continues to increase. The studies reviewed here provide interesting information on the pathogenesis and treatment of several esophageal motor disorders.

Conservative management of esophageal perforations during pneumatic dilation for idiopathic esophageal achalasia.

Science.gov (United States)

Vanuytsel, Tim; Lerut, Toni; Coosemans, Willy; Vanbeckevoort, Dirk; Blondeau, Kathleen; Boeckxstaens, Guy; Tack, Jan

2012-02-01

Esophageal perforation is the most serious adverse event of pneumatic dilation (PD) for achalasia; it is usually managed by surgical repair. We investigated risk factors for esophageal perforation after PD and evaluated safety and long-term outcome of nonsurgical management strategies. We analyzed medical records of patients with achalasia who were treated with PD from 1992-2010 at the University Hospital Gasthuisberg in Leuven, Belgium; all patients with esophageal perforation were contacted to determine long-term outcomes. Achalasia outcomes were assessed by using the Vantrappen criteria. Of 830 PD procedures performed on 372 patients with manometry-confirmed achalasia (57 ± 1 years, 51% male), 16 were complicated by transmural esophageal perforation (4.3% of patients, 1.9% of dilations). Age >65 years was the only significant risk factor for complications (odds ratio, 3.5; 95% confidence interval, 1.2-10.2). All patients were treated conservatively with broad-spectrum antibiotics and nothing by mouth. In 6 patients (38%) the clinical course was further complicated by a pleural effusion, which required a drain in 4 patients. One patient (6%) died of mediastinal hemorrhage within 12 hours after PD. Patients with complications were discharged after 19 ± 2.3 days, compared with 4 ± 0.2 days for those without complications (P 65 years is a significant risk factor for esophageal perforation after PD. Nonsurgical management of transmural esophageal tears is feasible, with favorable short-term and long-term outcomes, but is not devoid of complications. Copyright © 2012 AGA Institute. Published by Elsevier Inc. All rights reserved.

Eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia.

Science.gov (United States)

Kassabian, Sirvart; Baez-Socorro, Virginia; Sferra, Thomas; Garcia, Reinaldo

2014-12-21

Esophageal atresia (EA) is defined as a discontinuity of the lumen of the esophagus repaired soon after birth. Dysphagia is a common symptom in these patients, usually related to stricture, dysmotility or peptic esophagitis. We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of Eosinophilic esophagitis (EoE) was made, ages ranging from 9 to 16 years. Although our patients were on acid suppression years after their EA repair, they presented with acute worsening of dysphagia. Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with EoE. Two of 4 patients improved symptomatically with the topical steroids. It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies. One of our patients developed recurrent anastomotic strictures that improved with the treatment of the EoE. A previous case report linked the recurrence of esophageal strictures in patients with EA repair with EoE. Once the EoE was treated the strictures resolved. On the other hand, based on our observation, EoE could be present in patients without recurrent anastomotic strictures. There appears to be a spectrum in the disease process. We are suggesting that EoE is a frequent concomitant problem in patients with history of congenital esophageal deformities, and for this reason any of these patients with refractory reflux symptoms or dysphagia (with or without anastomotic stricture) may benefit from an endoscopic evaluation with biopsies to rule out EoE.

[Esophageal bronchogenic cyst: an uncommon cause of dysphagia in adults. Case report and literature review].

Science.gov (United States)

Ceniceros-Cabrales, Ana P; Sánchez-Fernández, Patricio

2018-01-01

Bronchogenic cysts result from abnormal budding of the primitive tracheobronchial tube and are rare congenital cystic lesions. The location of the cyst depends on the embryological stage of abnormal budding. Although periesophageal bronchogenic cysts have been frequently reported, a completely intramural cyst is very rare. A 42-year-old female patient, a three-month course with retrosternal pain associated with food intake, accompanied by intermittent dysphagia to solids. Esophagogram, high resolution thoracic tomography and endoscopic ultrasound are performed, concluding a probable esophageal bronchogenic cyst. Resection is performed by video-assisted thoracic surgery, without complications. Patient presents with adequate evolution and complete remission of the symptomatology. Bronchogenic cysts of the esophageal wall are extremely uncommon lesions. Its surgical treatment is indicated to be symptomatic; video-assisted thoracoscopic surgery resection is of choice, with excellent long-term results and minimal morbidity. Copyright: © 2018 Permanyer.

Subtle lower esophageal sphincter relaxation abnormalities in patients with unexplained esophageal dysphagia

NARCIS (Netherlands)

Herregods, T. V. K.; van Hoeij, F. B.; Bredenoord, A. J.; Smout, A. J. P. M.

2018-01-01

Esophageal dysphagia is a relatively common symptom. We aimed to evaluate whether subtle, presently not acknowledged forms of dysfunction of the lower esophageal sphincter (LES) could explain dysphagia in a subset of patients with normal findings at high-resolution manometry (HRM) according to the

Predictive factors of esophageal stenosis associated with tumor regression in radiation therapy for locally advanced esophageal cancer

International Nuclear Information System (INIS)

Atsumi, Kazushige; Shioyama, Yoshiyuki; Nakamura, Katsumasa

2010-01-01

The purpose of this retrospective study was to clarify the predictive factors correlated with esophageal stenosis within three months after radiation therapy for locally advanced esophageal cancer. We enrolled 47 patients with advanced esophageal cancer with T2-4 and stage II-III who were treated with definitive radiation therapy and achieving complete response of primary lesion at Kyushu University Hospital between January 1998 and December 2005. Esophagography was performed for all patients before treatment and within three months after completion of the radiation therapy, the esophageal stenotic ratio was evaluated. The stenotic ratio was used to define four levels of stenosis: stenosis level 1, stenotic ratio of 0-25%; 2, 25-50%; 3, 50-75%; 4, 75-100%. We then estimated the correlation between the esophageal stenosis level after radiation therapy and each of numerous factors. The numbers and total percentages of patients at each stenosis level were as follows: level 1: n=14 (30%); level 2: 8 (17%); level 3: 14 (30%); and level 4: 11 (23%). Esophageal stenosis in the case of full circumference involvement tended to be more severe and more frequent. Increases in wall thickness tended to be associated with increases in esophageal stenosis severity and frequency. The extent of involved circumference and wall thickness of tumor region were significantly correlated with esophageal stenosis associated with tumor regression in radiation therapy (p=0.0006, p=0.005). For predicting the possibility of esophageal stenosis with tumor regression within three months in radiation therapy, the extent of involved circumference and esophageal wall thickness of the tumor region may be useful. (author)

Proton MRI in the evaluation of pulmonary sarcoidosis: Comparison to chest CT

International Nuclear Information System (INIS)

Chung, Jonathan H.; Little, Brent P.; Forssen, Anna V.; Yong, Jin; Nambu, Atsushi; Kazlouski, Demitry; Puderbach, Michael; Biederer, Juergen; Lynch, David A.

2013-01-01

Purpose: The purpose of this study was to determine the feasibility of proton MRI of the lung in sarcoidosis patients and the agreement between the imaging appearance of pulmonary sarcoidosis on MRI and CT. Materials and methods: Chest CT scans and dedicated pulmonary MRI scans (including HASTE, VIBE, and TrueFISP sequences) were performed within 90 days of each other in 29 patients. The scans were scored for gross parenchymal opacification, reticulation, nodules, and masses using a 3-point lobar scale. Total and subset scores for corresponding MRI and CT scans were compared using the Spearman correlation test, Bland–Altman plots, and Cohen's quadratic-weighted kappa analysis. MRI scores were compared to CT by lobe and disease category, using percentage agreement, Spearman rank correlation, and Cohen's quadratic-weighted kappa. Results: The mean (±s.d.) time between MRI and CT scans was 33 ± 32 days. There was substantial correlation and agreement between total disease scoring on MRI and CT with a Spearman correlation coefficient of 0.774 (p < 0.0001) and a Cohen's weighted kappa score of 0.646. Correlation and agreement were highest for gross parenchymal opacification (0.695, 0.528) and reticulation (0.609, 0.445), and lowest in the setting of nodules (0.501, 0.305). Agreement testing was not performed for mass scores due to low prevalence. Upper lobe scoring on MRI and CT demonstrated greater agreement compared to the lower lobes (average difference in Cohen's weighted kappa score of 0.112). Conclusion: There is substantial correlation and agreement between MRI and CT in the scoring of pulmonary sarcoidosis, though MRI evaluation in the upper lobes may be more accurate than in the lower lobes

Double balloon esophageal catheter for diagnosis of tracheo-esophageal fistula

International Nuclear Information System (INIS)

Kiyan, Guersu; Dagli, Tolga E.; Tugtepe, Halil; Kodalli, Nihat

2003-01-01

Congenital H-type and recurrent tracheo-esophageal fistulas (TEF) are always difficult to diagnose. For a more accurate diagnosis we designed a new double balloon catheter, which is a modification of esophageal dilatation balloon. The catheter has two balloons to occlude the esophagus proximal and distal to the fistula. The fistula can be identified by passing of the contrast material to the tracheal tree, which was injected into the esophageal segment between the inflated balloons. To prove the efficiency of this catheter, a TEF was created surgically in a New Zealand rabbit. On the postoperative fourteenth day the catheter was tried and the fistula could be visualized easily by injecting the contrast material. We think this technique may be of use in the diagnosis of TEF in children. (orig.)

Should patients with esophageal atresia be submitted to esophageal substitution before they start walking?

Science.gov (United States)

Tannuri, U; Tannuri, A C A

2011-01-01

Esophagocoloplasty and gastric transposition are two major methods for esophageal substitution in children with esophageal atresia, and there is broad agreement that these operations should not be performed before the children start walking. However, there are some reported advantages of performing such operations in the first months of life or in the neonatal period. In this study, we compared our experience with esophageal substitution procedures performed in walking children with esophageal atresia, with the outcomes of children who had the operation before the third month of life reported in the literature. The purpose of this study was to establish if we have to wait until the children start walking before indicating the esophageal replacement procedure. From February 1978 to October 2009, 129 children with esophageal atresia underwent esophageal replacement in our hospital (99 colonic interpositions and 30 gastric transpositions). The records of these patients were reviewed for data regarding demographics, complications (leaks, graft failures, strictures, and graft torsion), and mortality and compared with those reported in the two main articles on esophageal replacement in the neonatal period or in patients less than 3 months of age. The main complication of our casuistic was cervical anastomosis leakage, which sealed spontaneously in all except in four patients. One patient of the esophagocoloplasty group developed graft necrosis and three patients in the gastric transposition group had gastric outlet obstruction, secondary to axial torsion of the stomach placed in the retrosternal space. The long-term outcome of the patients in both groups was considered good to excellent in terms of normal weight gain, absence of dysphagia, and other gastrointestinal symptoms. The comparisons of the main complications and mortality rates in walking children with esophageal substitutions performed in the first months of life showed that the incidences of cervical

Understanding the sensory irregularities of esophageal disease.

Science.gov (United States)

Farmer, Adam D; Brock, Christina; Frøkjaer, Jens Brøndum; Gregersen, Hans; Khan, Sheeba; Lelic, Dina; Lottrup, Christian; Drewes, Asbjørn Mohr

2016-08-01

Symptoms relating to esophageal sensory abnormalities can be encountered in the clinical environment. Such sensory abnormalities may be present in demonstrable disease, such as erosive esophagitis, and in the ostensibly normal esophagus, such as non-erosive reflux disease or functional chest pain. In this review, the authors discuss esophageal sensation and the esophageal pain system. In addition, the authors provide a primer concerning the techniques that are available for investigating the autonomic nervous system, neuroimaging and neurophysiology of esophageal sensory function. Such technological advances, whilst not readily available in the clinic may facilitate the stratification and individualization of therapy in disorders of esophageal sensation in the future.

INTERSTITIAL LUNG-DISEASE AND MYOSITIS IN A PATIENT WITH SIMULTANEOUSLY OCCURRING SARCOIDOSIS AND SCLERODERMA

NARCIS (Netherlands)

GROEN, H; POSTMA, DS; KALLENBERG, CGM

1993-01-01

A patient initially presented with sarcoidosis in combination with myositis of sarcoid origin and Raynaud's phenomenon. During the course of his disease, he additionally developed scleroderma. Bronchoalveolar lavage, performed because of increase of interstitial markings in the presence of enlarged

Brain Abscess after Esophageal Dilatation

DEFF Research Database (Denmark)

Gaïni, S; Grand, M; Michelsen, J

2007-01-01

Brain abscess formation is a serious disease often seen as a complication to other diseases and to procedures. A rare predisposing condition is dilatation therapy of esophageal strictures. A case of brain abscess formation after esophageal dilatations is presented. A 59-year-old woman was admitted...... with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case...... illustrates the possible association between therapeutic esophageal dilatation and the risk of brain abscess formation....

Case of sarcoidosis with generalized increased uptake of /sup 67/Ga-citrate

Energy Technology Data Exchange (ETDEWEB)

Okada, Yoshitaka; Ohtake, Tohru; Nishikawa, Junichi; Iio, Masahiro; Machida, Kikuo

1985-10-01

A case of sarcoidosis was reported in which gallium-67 scintigraphy showed increased uptake in generalized sarcoid lesions. Gallium-67 uptake in skin lesions was also seen, which is rare in literature. A 22-year-old male patient was admitted to our hospital. The patient had a history of general fatigue, polydipsia and polyuria. On physical examination, swelling of the bilateral parotid glands and lacrimal glands was noted. There were many subcutaneous nodules, especially in both arms. Superficial lymphademopathy was also noted in cervical and inguinal regions. He complained of bilateral amblyopia, and gonioscopy revelaed some nodules of the uvea. Coexistent diabetes insipidus was diagnosed with dehydration test. Chest roentgenogram showed bilateral hilar lymphadenopathy. Gallium-67 scintigram showed increased uptake in bilateral parotid glands and lacrimal glands. There were multiple abnormal uptakes in the neck, mediastinum and the inguinal region. Abnormal uptake was also noted in the subcutaneous nodules. Biopsy was performed from the lesions in the parotid glands, cervical lymph nodes, subcutaneous nodules and triceps muscles. Diagnosis of sarcoidosis was confirmed histopathologically. (J.P.N.).

A case of sarcoidosis with generalized increased uptake of 67Ga-citrate

International Nuclear Information System (INIS)

Okada, Yoshitaka; Ohtake, Tohru; Nishikawa, Junichi; Iio, Masahiro; Machida, Kikuo.

1985-01-01

A case of sarcoidosis was reported in which gallium-67 scintigraphy showed increased uptake in generalized sarcoid lesions. Gallium-67 uptake in skin lesions was also seen, which is rare in literature. A 22-year-old male patient was admitted to our hospital. The patient had a history of general fatigue, polydipsia and polyuria. On physical examination, swelling of the bilateral parotid glands and lacrimal glands was noted. There were many subcutaneous nodules, especially in both arms. Superficial lymphademopathy was also noted in cervical and inguinal regions. He complained of bilateral amblyopia, and gonioscopy revelaed some nodules of the uvea. Coexistent diabetes insipidus was diagnosed with dehydration test. Chest roentgenogram showed bilateral hilar lymphadenopathy. Gallium-67 scintigram showed increased uptake in bilateral parotid glands and lacrimal glands. There were multiple abnormal uptakes in the neck, mediastinum and the inguinal region. Abnormal uptake was also noted in the subcutaneous nodules. Biopsy was performed from the lesions in the parotid glands, cervical lymph nodes, subcutaneous nodules and triceps muscles. Diagnosis of sarcoidosis was confirmed histopathologically. (J.P.N.)

Gallium-67 imaging in candidal esophagitis

International Nuclear Information System (INIS)

Rundback, J.H.; Goldfarb, C.R.; Ongseng, F.

1990-01-01

Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis

Gallium-67 imaging in candidal esophagitis

Energy Technology Data Exchange (ETDEWEB)

Rundback, J.H.; Goldfarb, C.R.; Ongseng, F. (Beth Israel Medical Center, New York, NY (USA))

1990-01-01

Ga-67 scanning has been used to evaluate esophageal carcinoma. It has demonstrated candidal infection in other body sites and, in one previous case, in the esophagus. The authors present a case of diffuse esophageal uptake of Ga-67 in esophageal candidiasis.

The Kagoshima consensus on esophageal achalasia

NARCIS (Netherlands)

Triadafilopoulos, G.; Boeckxstaens, G. E.; Gullo, R.; Patti, M. G.; Pandolfino, J. E.; Kahrilas, P. J.; Duranceau, A.; Jamieson, G.; Zaninotto, G.

2012-01-01

Esophageal achalasia is a primary esophageal motility disorder characterized by lack of peristalsis and a lower esophageal sphincter that fails to relax appropriately in response to swallowing. This article summarizes the most salient issues in the diagnosis and management of achalasia as discussed

Hyperinsulinemia Promotes Esophageal Cancer Development in a Surgically-Induced Duodeno-Esophageal Reflux Murine Model

Directory of Open Access Journals (Sweden)

Diletta Arcidiacono

2018-04-01

Full Text Available Hyperinsulinemia could have a role in the growing incidence of esophageal adenocarcinoma (EAC and its pre-cancerous lesion, Barrett’s Esophagus, a possible consequence of Gastro-Esophageal Reflux Disease. Obesity is known to mediate esophageal carcinogenesis through different mechanisms including insulin-resistance leading to hyperinsulinemia, which may mediate cancer progression via the insulin/insulin-like growth factor axis. We used the hyperinsulinemic non-obese FVB/N (Friend leukemia virus B strain MKR (muscle (M-IGF1R-lysine (K-arginine (R mouse model to evaluate the exclusive role of hyperinsulinemia in the pathogenesis of EAC related to duodeno-esophageal reflux. FVB/N wild-type (WT and MKR mice underwent jejunum-esophageal anastomosis side—to end with the exclusion of the stomach. Thirty weeks after surgery, the esophagus was processed for histological, immunological and insulin/Insulin-like growth factor 1 (IGF1 signal transduction analyses. Most of the WT mice (63.1% developed dysplasia, whereas most of the MKR mice (74.3% developed squamous cell and adenosquamous carcinomas, both expressing Human Epidermal growth factor receptor 2 (HER2. Hyperinsulinemia significantly increased esophageal cancer incidence in the presence of duodenal-reflux. Insulin receptor (IR and IGF1 receptor (IGF1R were overexpressed in the hyperinsulinemic condition. IGF1R, through ERK1/2 mitogenic pattern activation, seems to be involved in cancer onset. Hyperinsulinemia-induced IGF1R and HER2 up-regulation could also increase the possibility of forming of IGF1R/HER2 heterodimers to support cell growth/proliferation/progression in esophageal carcinogenesis.

Hyperinsulinemia Promotes Esophageal Cancer Development in a Surgically-Induced Duodeno-Esophageal Reflux Murine Model.

Science.gov (United States)

Arcidiacono, Diletta; Dedja, Arben; Giacometti, Cinzia; Fassan, Matteo; Nucci, Daniele; Francia, Simona; Fabris, Federico; Zaramella, Alice; Gallagher, Emily J; Cassaro, Mauro; Rugge, Massimo; LeRoith, Derek; Alberti, Alfredo; Realdon, Stefano

2018-04-14

Hyperinsulinemia could have a role in the growing incidence of esophageal adenocarcinoma (EAC) and its pre-cancerous lesion, Barrett's Esophagus, a possible consequence of Gastro-Esophageal Reflux Disease. Obesity is known to mediate esophageal carcinogenesis through different mechanisms including insulin-resistance leading to hyperinsulinemia, which may mediate cancer progression via the insulin/insulin-like growth factor axis. We used the hyperinsulinemic non-obese FVB/N (Friend leukemia virus B strain) MKR (muscle (M)-IGF1R-lysine (K)-arginine (R) mouse model to evaluate the exclusive role of hyperinsulinemia in the pathogenesis of EAC related to duodeno-esophageal reflux. FVB/N wild-type (WT) and MKR mice underwent jejunum-esophageal anastomosis side-to end with the exclusion of the stomach. Thirty weeks after surgery, the esophagus was processed for histological, immunological and insulin/Insulin-like growth factor 1 (IGF1) signal transduction analyses. Most of the WT mice (63.1%) developed dysplasia, whereas most of the MKR mice (74.3%) developed squamous cell and adenosquamous carcinomas, both expressing Human Epidermal growth factor receptor 2 (HER2). Hyperinsulinemia significantly increased esophageal cancer incidence in the presence of duodenal-reflux. Insulin receptor (IR) and IGF1 receptor (IGF1R) were overexpressed in the hyperinsulinemic condition. IGF1R, through ERK1/2 mitogenic pattern activation, seems to be involved in cancer onset. Hyperinsulinemia-induced IGF1R and HER2 up-regulation could also increase the possibility of forming of IGF1R/HER2 heterodimers to support cell growth/proliferation/progression in esophageal carcinogenesis.

Tl scintiscanning hemodynamics and left ventricular kinetics in patients to be suspected of myocardial sarcoidosis

International Nuclear Information System (INIS)

Schaedel, H.; Kirsten, D.; Strauss, H.J.; Haenselt, V.; Schmidt, H.; Gottschild, D.; Zinner, G.

1985-01-01

The cardiological examination of 22 patients to be suspected of heart sarcoidosis (histologically established sarcoidosis, heart rhythm disturbances, cardiomegaly) has revealed thallium scan defects in 20 patients at rest and during exercise. In 19 patients pathologic left heart wall motions established by levocardiography applying the half axis method were found. The number of pathologic half axis shortenings correlated with ejection fraction, but not with left ventricular enddiastolic pressure and volume index, resp. Coronary heart disease could not be found by coronarography in any case. Myocardial biopsy did not show myocarditis. Cardiomyopathies, other specific heart muscle diseases or rheumatic myocarditis could not be excluded as causes of the results mentioned above. The follow-up examinations of the patients will give more detailed information on the etiology of the pathologic cardiac findings. (author)

Diagnosis of Esophageal Motility Disorders: Esophageal Pressure Topography vs. Conventional Line Tracing.

Science.gov (United States)

Carlson, Dustin A; Ravi, Karthik; Kahrilas, Peter J; Gyawali, C Prakash; Bredenoord, Arjan J; Castell, Donald O; Spechler, Stuart J; Halland, Magnus; Kanuri, Navya; Katzka, David A; Leggett, Cadman L; Roman, Sabine; Saenz, Jose B; Sayuk, Gregory S; Wong, Alan C; Yadlapati, Rena; Ciolino, Jody D; Fox, Mark R; Pandolfino, John E

2015-07-01

Enhanced characterization of esophageal peristaltic and sphincter function provided by esophageal pressure topography (EPT) offers a potential diagnostic advantage over conventional line tracings (CLT). However, high-resolution manometry (HRM) and EPT require increased equipment costs over conventional systems and evidence demonstrating a significant diagnostic advantage of EPT over CLT is limited. Our aim was to investigate whether the inter-rater agreement and/or accuracy of esophageal motility diagnosis differed between EPT and CLT. Forty previously completed patient HRM studies were selected for analysis using a customized software program developed to perform blinded independent interpretation in either EPT or CLT (six pressure sensors) format. Six experienced gastroenterologists with a clinical focus in esophageal disease (attendings) and six gastroenterology trainees with minimal manometry experience (fellows) from three academic centers interpreted each of the 40 studies using both EPT and CLT formats. Rater diagnoses were assessed for inter-rater agreement and diagnostic accuracy, both for exact diagnosis and for correct identification of a major esophageal motility disorder. The total group agreement was moderate (κ=0.57; 95% CI: 0.56-0.59) for EPT and fair (κ=0.32; 0.30-0.33) for CLT. Inter-rater agreement between attendings was good (κ=0.68; 0.65-0.71) for EPT and moderate (κ=0.46; 0.43-0.50) for CLT. Inter-rater agreement between fellows was moderate (κ=0.48; 0.45-0.50) for EPT and poor to fair (κ=0.20; 0.17-0.24) for CLT. Among all raters, the odds of an incorrect exact esophageal motility diagnosis were 3.3 times higher with CLT assessment than with EPT (OR: 3.3; 95% CI: 2.4-4.5; PCLT than with EPT (OR: 3.4; 2.4-5.0; PCLT among our selected raters. On the basis of these findings, EPT may be the preferred assessment modality of esophageal motility.

Family history of esophageal cancer increases the risk of esophageal squamous cell carcinoma

Science.gov (United States)

Chen, Tiantian; Cheng, Hongwei; Chen, Xingdong; Yuan, Ziyu; Yang, Xiaorong; Zhuang, Maoqiang; Lu, Ming; Jin, Li; Ye, Weimin

2015-01-01

A population-based case-control was performed to explore familial aggregation of esophageal squamous cell carcinoma (ESCC). Family history of cancer was assessed by a structured questionnaire, and from which 2 cohorts of relatives of cases and controls were reconstructed. Unconditional logistic regression and Cox proportional hazards regression were applied for case-control design and reconstructed cohort design, respectively. We observed a close to doubled risk of ESCC associated with a positive family history of esophageal cancer among first degree relatives (odds ratio [OR] = 1.85, 95% confidence interval [CI]: 1.42–2.41), after adjusting age, sex, family size and other confounders. The excess risks of ESCC increased with the increasing of first-degree relatives affected by esophageal cancer (p < 0.001). In particular, those individuals whose both parents with esophageal cancer had an 8-fold excess risk of ESCC (95% CI: 1.74–36.32). The reconstructed cohort analysis showed that the cumulative risk of esophageal cancer to age 75 was 12.2% in the first-degree relatives of cases and 7.0% in those of controls (hazard ratio = 1.91, 95% CI: 1.54–2.37). Our results suggest family history of esophageal cancer significantly increases the risk for ESCC. Future studies are needed to understand how the shared genetic susceptibility and/or environmental exposures contribute to the observed excess risk. PMID:26526791

Deglutitive inhibition, latency between swallow and esophageal contractions and primary esophageal motor disorders.

Science.gov (United States)

Sifrim, Daniel; Jafari, Jafar

2012-01-01

Swallowing induces an inhibitory wave that is followed by a contractile wave along the esophageal body. Deglutitive inhibition in the skeletal muscle of the esophagus is controlled in the brain stem whilst in the smooth muscle, an intrinsic peripheral control mechanism is critical. The latency between swallow and contractions is determined by the pattern of activation of the inhibitory and excitatory vagal pathways, the regional gradients of inhibitory and excitatory myenteric nerves, and the intrinsic properties of the smooth muscle. A wave of inhibition precedes a swallow-induced peristaltic contraction in the smooth muscle part of the human oesophagus involving both circular and longitudinal muscles in a peristaltic fashion. Deglutitive inhibition is necessary for drinking liquids which requires multiple rapid swallows (MRS). During MRS the esophageal body remains inhibited until the last of the series of swallows and then a peristaltic contraction wave follows. A normal response to MRS requires indemnity of both inhibitory and excitatory mechanisms and esophageal muscle. MRS has recently been used to assess deglutitive inhibition in patients with esophageal motor disorders. Examples with impairment of deglutitive inhibition are achalasia of the LES and diffuse esophageal spasm.

Occurrence of chronic esophageal ulcer after high dose rate intraluminal radiation therapy for esophageal cancer

International Nuclear Information System (INIS)

Soejima, Toshinori; Hirota, Saeko; Okamoto, Yoshiaki; Obayashi, Kayoko; Takada, Yoshiki

1995-01-01

Ninety-eight patients with esophageal cancer were treated by high dose rate intraluminal radiation therapy at the Department of Radiology of the Hyogo Medical Center for Adults between January 1982 and December 1993. Twenty patients with complete response after intraluminal radiation therapy, who were followed up with esophageal fiberscopy in our institute, were reviewed. The one-year cumulative rate of occurrence of esophageal ulcers was 81%, and in 69% of the cases the ulcers occurred from 4 to 8 months after completion of intraluminal radiation therapy. We graded esophageal ulcer by fiberscopic findings. Grade 0 was defined as no ulcer, grade 1 as superficial ulcer, grade 2 as deep ulcer, grade 3 as circumferencial ulcer, and severe stenosis. Factors related to grade were studied, and shorter distances from the source to the surface of the mucosa and lower surface doses of intraluminal radiation therapy appear to reduce the severity as graded on the above scale, of the esophageal ulcer. Four of the five 2-year recurrence-free patients suffered esophageal ulcers, which were cured from 15 to 22 months after intraluminal radiation therapy. However ulcers recurred in two patients, ong term care was thought to be necessary. (author)

Failure to respond to physiologic challenge characterizes esophageal motility in erosive gastro-esophageal reflux disease.

Science.gov (United States)

Daum, C; Sweis, R; Kaufman, E; Fuellemann, A; Anggiansah, A; Fried, M; Fox, M

2011-06-01

Non-specific esophageal dysmotility with impaired clearance is often present in patients with gastro-esophageal reflux disease (GERD), especially those with erosive disease; however the physio-mechanic basis of esophageal dysfunction is not well defined. Retrospective assessment of patients with erosive reflux disease (ERD; n=20) and endoscopy negative reflux disease (ENRD; n=20) with pathologic acid exposure on pH studies (>4.2% time/24 h) and also healthy controls (n=20) studied by high resolution manometry. Esophageal motility in response to liquid and solid bolus swallows and multiple water swallows (MWS) was analyzed. Peristaltic dysfunction was defined as failed peristalsis, spasm, weak or poorly coordinated esophageal contraction (>3cm break in 30 mmHg isocontour). Peristaltic dysfunction was present in 33% of water swallows in controls, 56% ENRD and 76% ERD respectively (Preflux events and increase exposure to gastric refluxate. © 2011 Blackwell Publishing Ltd.

Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

Directory of Open Access Journals (Sweden)

Ana Grilo

2012-09-01

Full Text Available CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory

Impact of gastro-esophageal reflux on mucin mRNA expression in the esophageal mucosa.

Science.gov (United States)

van Roon, Aafke H C; Mayne, George C; Wijnhoven, Bas P L; Watson, David I; Leong, Mary P; Neijman, Gabriëlle E; Michael, Michael Z; McKay, Andrew R; Astill, David; Hussey, Damian J

2008-08-01

Changes in the expression of mucin genes in the esophageal mucosa associated with uncomplicated gastro-esophageal reflux disease have not been evaluated even though such changes could be associated with reflux-induced mucosal damage. We therefore sought to identify reflux-induced changes in mucin gene expression using a cell line and biopsies from the esophageal mucosa in patients with and without reflux. MUC-1, MUC-3, MUC-4, and MUC-5AC gene expressions were investigated in the HET-1A cell line following exposure to acid (pH 4) and/or bile (120 muM of a bile salt milieu), and in esophageal mucosal biopsies from controls, subjects with non-erosive gastro-esophageal reflux, and subjects with reflux associated with ulcerative esophagitis (erosive). The mucosal biopsies were also evaluated for IL-6 mRNA expression (inflammatory marker) and CK-14 mRNA expression (mucosal basal cell layer marker). Gene expression was determined using real-time reverse transcriptase-polymerase chain reaction analysis. In the cell line studies, there were differences in mRNA levels for all of the evaluated mucins following treatment with either acid or the acid and bile combination. In the studies which evaluated tissue specimens, IL-6 and CK-14 mRNA levels increased according to degree of reflux pathology. The expression of MUC-1 and MUC-4 in mucosa from patients with erosive reflux was lower than in subjects without reflux and in patients with non-erosive reflux, whereas the expression of MUC-3 and MUC-5AC was increased (although these differences did not reach significance at p reflux groups. The correlation between IL-6 and MUC-3 was significant within the control and erosive reflux groups, and the correlation between MUC-1 and MUC-5AC was significant within the erosive reflux group. The results of this study suggest that the profile of mucin expression in the esophageal mucosa is influenced by the pH and composition of the gastro-esophageal reflux. Further work should explore the

Thoracoscopic Surgery in a Patient with Multiple Esophageal Carcinomas after Surgery for Esophageal Achalasia

OpenAIRE

Yamasaki, Yuki; Tsukada, Tomoya; Aoki, Tatsuya; Haba, Yusuke; Hirano, Katsuhisa; Watanabe, Toshifumi; Kaji, Masahide; Shimizu, Koichi

2017-01-01

We present a case in which we used a thoracoscopic approach for resection of multiple esophageal carcinomas diagnosed 33 years after surgery for esophageal achalasia. A 68-year-old Japanese man had been diagnosed with esophageal achalasia and underwent surgical treatment 33 years earlier. He was examined at our hospital for annual routine checkup in which upper gastrointestinal endoscopy showed a “0-IIb+IIa” lesion in the middle esophagus. Iodine staining revealed multiple irregularly shaped ...

21 CFR 868.1910 - Esophageal stethoscope.

Science.gov (United States)

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Esophageal stethoscope. 868.1910 Section 868.1910...) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Diagnostic Devices § 868.1910 Esophageal stethoscope. (a) Identification. An esophageal stethoscope is a nonpowered device that is inserted into a patient's esophagus to...

Predictive value of routine esophageal high-resolution manometry for gastro-esophageal reflux disease

NARCIS (Netherlands)

van Hoeij, F. B.; Smout, A. J.; Bredenoord, A. J.

2015-01-01

Using conventional manometry, gastro-esophageal reflux disease (GERD) was associated with a reduced lower esophageal sphincter (LES) pressure and impaired peristalsis. However, with a large overlap between GERD patients and controls, these findings are of limited clinical relevance. It is uncertain

CT findings of esophageal schwannoma: A case report

Energy Technology Data Exchange (ETDEWEB)

Lee, Man Ho; Ryu, Dae Shick; Eom, Dae Woon; Shin, Dong Rock; Choi, Soo Jung; Ahn, Jae Hong; Park, Man Soo; Yoo, Dong Kon [Gangneung Asan Hospital, College of Medicine, University of Ulsan, Gangneung (Korea, Republic of)

2015-03-15

Esophageal schwannomas are a relative rare benign neoplasm that usually occurs in the upper esophagus, in the middle aged women. We report a case of a 67-year-old man with a lower esophageal schwannoma. This lesion was composed of homogenous density, iso-attenuating with the chest wall muscle on pre- and post-contrast chest computed tomography (CT). The CT findings of the esophageal schwannoma are similar to those of esophageal leiomyoma. Hense, esophageal schwannoma may be a differential diagnosis with esophageal leiomyoma.

Esophageal strictures during treatment for acute lymphoblastic leukemia.

LENUS (Irish Health Repository)

Kelly, Kevin

2012-02-01

Esophageal stricture is a rare complication of paediatric cancer treatment that usually occurs after esophageal exposure to radiotherapy. We describe 4 cases of esophageal stricture during chemotherapy for acute lymphoblastic leukemia. All patients presented with refractory vomiting and were diagnosed with radiologic contrast studies. None of the patients had received radiotherapy. Esophageal candidiasis was seen in 2 patients but the remaining 2 patients had earlier systemic candidiasis. High-dose dexamethasone may predispose these children to both esophageal candidiasis and peptic esophagitis. The etiology of esophageal strictures during treatment for acute leukemia is likely to be multifactorial but systemic candidiasis may play a significant role.

Radionuclide esophageal transit test to detect esophageal disorders in patients with mitral valve prolapse

International Nuclear Information System (INIS)

Kao Chiahung; Tsai Shihchuan; Hsieh Jihfang; Ho Yungjen; Ding Hueischjy

2000-01-01

Aim: The origin of chest discomfort in patients with mitral valve prolapse (MVP) is controversial. Our aim was to prospectively determine the incidence of esophageal disorders in MVP patients with or without chest pain. Methods: Twenty-five MVP patients with chest pain (group A) and 25 MVP patients without chest pain (group B) underwent evaluation of esophageal motility. None of the total of 50 MVP patients had significant coronary artery disease on cardiac catheterization. Esophageal motility including esophageal mean transit time (MTT), residual fraction (RF), and retrograde index (RI) was analyzed by the radionuclide esophageal transit test (RETT). Results: In comparison with 25 age and sex-matched healthy volunteers, the results showed that: (1) 19 patients in group A (76%) had abnormal RETT findings (48% of cases with prolonged MTT, 44% of cases with higher RF, and 60% of cases with higher RI); (2) 3 patients in group B (12%) had abnormal RETT findings (8% of cases with prolonged MTT, 4% of cases with higher RF, and 8% of cases with higher RI). In addition, mean values of MTT, RF, and RI in group A patients were significantly higher than in group B patients and healthy volunteers. Conclusion: We found that the chest pain in some MVP patients may be related to abnormal esophageal motility, based on the evidence from a simple and noninvasive RETT. (orig.) [de

Esophageal cancer

International Nuclear Information System (INIS)

Dupuis, O.; Ganem, G.; Denis, F.; Bera, G.; Pointreau, Y.; Pradier, O.; Martin, P.; Mirabel, X.

2010-01-01

Esophageal cancers are highly malignant tumours with often a poor prognosis, except for minimal lesions treated with surgery. Radiation therapy, or combined radiation and chemotherapy is the most used therapeutic modality, alone or before oesophagectomy. The delineation of target volumes is now more accurate owing the possibility to use routinely the new imaging techniques (mainly PET). The aim of this work is to precise the radio-anatomical particularities, the pattern of spread of esophageal cancer and the principles of 3D conformal radiotherapy illustrated with a clinical case. (authors)

Esophageal Granular Cell Tumor and Eosinophilic Esophagitis: Two Interesting Entities Identified in the Same Patient

Directory of Open Access Journals (Sweden)

Alfredo J. Lucendo

2008-02-01

Full Text Available We illustrate the case of a 41-year-old male with allergic manifestations since childhood. He sought medical attention for intermittent, progressive dysphagia from which he had been suffering for a number of years, having felt the sensation of a retrosternal lump and a self-limited obstruction to the passage of food. Endoscopy detected a submucosal tumor in the upper third of the esophagus, which was typified, via biopsy, as a granular cell tumor with benign characteristics and probably responsible for the symptoms. Two years later, the patient sought medical attention once again as these symptoms had not abated, hence digestive endoscopy was repeated. This revealed stenosis of the junction between the middle and lower thirds of the organ which had not been detected previously but was passable under gentle pressure. Eosinophilic esophagitis was detected after biopsies were taken. Esophageal manometry identified a motor disorder affecting the esophageal body. Following three months of treatment using fluticasone propionate applied topically, the symptoms went into remission, esophageal stenosis disappeared and the esophageal biopsies returned to normal. This is the first documented case of the link between granular cell tumors and Eosinophilic esophagitis, two different disorders which could cause dysphagia in young patients.

Impact of esophageal flexion level on the surgical outcome in patients with sigmoid esophageal achalasia.

Science.gov (United States)

Tsuboi, Kazuto; Omura, Nobuo; Yano, Fumiaki; Hoshino, Masato; Yamamoto, Se-Ryung; Akimoto, Shunsuke; Masuda, Takahiro; Kashiwagi, Hideyuki; Yanaga, Katsuhiko

2017-11-01

Esophageal achalasia can be roughly divided into non-sigmoid and sigmoid types. Laparoscopic surgery has been reported to be less than optimally effective for sigmoid type. The aim of this study was to examine the impact of the esophageal flexion level on the clinical condition and surgical outcomes of patients with sigmoid esophageal achalasia. The subjects were 36 patients with sigmoid esophageal achalasia who had been observed for >1 year after surgery. The subjects were divided into sigmoid type (Sg) and advanced sigmoid type (aSg) groups based on the flexion level of the lower esophagus to compare their clinical parameters and surgical outcomes. The Sg and aSg groups included 26 (72%) and 10 subjects, respectively. There were no marked differences in the clinical parameters or surgical outcomes between the two groups. However, the clearance rate calculated using the timed barium esophagogram was lower in the aSg group than in the Sg group. No differences were found in the postoperative symptom scores between the two groups, and both reported a high level of satisfaction. Although laparoscopic surgery for symptoms of sigmoid esophageal achalasia was highly successful regardless of the flexion level, the improvement in esophageal clearance was lower when the flexion level was higher.

The association between reflux esophagitis and airway hyper-reactivity in patients with gastro-esophageal reflux

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Ashraf Karbasi

2013-01-01

Full Text Available Background: The association of gastro-esophageal reflux (GER with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR in patients and the response to treatment. Materials and Methods: In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. Results: There was a significant difference in the rate of positive methacholine test between the cases (40% and the controls (6.7% prior to anti-acid therapy (P < 0.0001. After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05 but did not change in the controls (P = 0.15. Conclusion: The presence of esophagitis due to GER would increase the AHR and treatment with pantoperazole would decrease AHR in patients with proved esophagitis and no previous history of asthma after six months.

Feeding Difficulties in Children with Esophageal Atresia.

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Mahoney, Lisa; Rosen, Rachel

2016-06-01

The current available literature evaluating feeding difficulties in children with esophageal atresia was reviewed. The published literature was searched through PubMed using a pre-defined search strategy. Feeding difficulties are commonly encountered in children and adults with repaired esophageal atresia [EA]. The mechanism for abnormal feeding includes both esophageal and oropharyngeal dysphagia. Esophageal dysphagia is commonly reported in patients with EA and causes include dysmotility, anatomic lesions, esophageal outlet obstruction and esophageal inflammation. Endoscopic evaluation, esophageal manometry and esophograms can be useful studies to evaluate for causes of esophageal dysphagia. Oropharyngeal dysfunction and aspiration are also important mechanisms for feeding difficulties in patients with EA. These patients often present with respiratory symptoms. Videofluoroscopic swallow study, salivagram, fiberoptic endoscopic evaluation of swallowing and high-resolution manometry can all be helpful tools to identify aspiration. Once diagnosed, management goals include reduction of aspiration during swallowing, reducing full column reflux into the oropharynx and continuation of oral feeding to maintain skills. We review specific strategies which can be used to reduce aspiration of gastric contents, including thickening feeds, changing feeding schedule, switching formula, trialing transpyloric feeds and fundoplication. Copyright © 2015 Elsevier Ltd. All rights reserved.

Eosinophilic esophagitis: manometric and pHmetric findings

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Monica Maria Cardoso Monnerat

2012-06-01

Full Text Available CONTEXT: Eosinophilic esophagitis is an entity characterized by an esophageal inflammatory infiltrate of eosinophils, manifested by dysphagia, intermittent food impactions and symptoms similar to gastroesophageal reflux disease (GERD, that predominantly affects young adults. There may be association of eosinophilic esophagitis with GERD, and motor abnormalities have been described. OBJECTIVE: The main objectives of this study are to describe the findings at esophageal manometry and pH monitoring in patients with eosinophilic esophagitis. METHODS: Cross-sectional study of 20 patients with a diagnosis of eosinophilic esophagitis, submitted to esophageal manometry and 24h pH monitoring. Were analysed the manometric changes and the presence of abnormal reflux on pH monitoring. RESULTS: Twenty patients (15 men, 5 women had a mean age of 29 years. Motility disorders were found in 25% (5/20 patients with ineffective esophageal motility being the most common finding. pH monitoring revealed abnormal reflux on 25%, without any relationship with manometric findings. CONCLUSIONS: Manometric abnormalities were observed in 25% of patients and abnormal reflux on pH monitoring also in 25%. This study showed no relationship between abnormal reflux and the presence of manometric changes.

Evaluation of esophageal motor function in clinical practice

NARCIS (Netherlands)

Gyawali, C. P.; Bredenoord, A. J.; Conklin, J. L.; Fox, M.; Pandolfino, J. E.; Peters, J. H.; Roman, S.; Staiano, A.; Vaezi, M. F.

2013-01-01

Esophageal motor function is highly coordinated between central and enteric nervous systems and the esophageal musculature, which consists of proximal skeletal and distal smooth muscle in three functional regions, the upper and lower esophageal sphincters, and the esophageal body. While upper

Usefulness of Ga-67 citrate whole body imaging, chest spot imaging, and chest SPECT in sarcoidosis

International Nuclear Information System (INIS)

Ueno, Kyoichi; Nishi, Koichi; Namura, Masanobu; Kawashima, Yoshio; Kurumaya, Hiroshi

1999-01-01

To assess the sensitivity, and the relative role of Ga-67 whole body, chest spot imaging, and chest SPECT, we retrospectively studied 34 cases of sarcoidosis (24 biopsy proven, 10 clinically diagnosed) with Ga-67 (111 MBq), and compared the results of lung (25 cases), muscle (25 cases), skin (3 cases), and myocardial (2 cases) biopsies. Ga-67 chest SPECT (single photon emission CT) were done in 17 cases with Siemens MultiSPECT3. Ga-67 planar imaging visualized only 2 of 12 (16.7%) lung biopsy-positive cases, 5 of 12 (41.6%) muscle biopsy-positive cases, 2 of 3 (66.7%) skin biopsy-positive cases. However, Ga-67 imaging revealed the lesions in 1 of 9 (11.1%) of muscle biopsy-negative cases, in 2 of 3 (66.7%) of skin biopsy-negative cases, and in 1 of 2 myocardial biopsy-negative cases. Ga-67 chest SPECT visualized 14 hilar lymphadenopathy (LN), 3 supraclavicular LN, and 1 myocardial sarcoidosis. Although both SPECT, and planar spot imaging detected the lesions equally, the former showed them more clearly. Compared with various biopsies, the sensitivity of Ga-67 imaging was not so high. However, Ga-67 imaging is non-invasive, easy to perform the whole body imaging, and can detect the activity of the lesions. Ga-67 SPECT showed clear imaging of the hilar, mediastinal LN, and potentially fatal myocardial sarcoidosis. (author)

Gastroesophageal reflux after esophageal surgery. Evaluation by means of esophageal transit scintigram

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Nishimura, Osamu; Yokoi, Hideki; Maebeya, Shinji and others

1989-04-01

By means of esophageal transit scintigram using /sup 99m/Tc-DTPA, 15 patients (13 esophageal carcinomas and 2 cardia carcinomas) were studied, in whom esophagogastric anastomosis was done according to the posterior invagination anastomosis technique we had devised. In all 8 patients with anastomosis at cervical region, gastroesophageal reflux was not seen on both scintigrams before and after meals, and the average pressure gradient of high pressure zone at anastomosis was 39.8 cmH/sub 2/O. In 2 of 7 patients with intrathoracic anastomosis, the scintigram before meals showed severe reflux. and the endoscopic findings showed diffuse and moderate erosion in the esophageal mucosa. The average pressure gradient across the anastomosis was 6.5 cmH/sub 2/O. In these 2 patients, the new fornix with a sharp angle of His was not formed. In the remaining 5 patients with intrathoracic anastomosis, reflux was not seen on the scintigram before meals. However, in 2 of them, the scintigram after meal and endoscopic examination revealed mild reflux and mild esophagitis respectively. Furthermore in one patient very mild reflux was observed only on the scintigram after meals but the endoscopic findings showed the normal esophageal mucosa. In these 5 patients, the average pressure gradient across the anastomosis was 17.0 cmH/sub 2/O, which was significantly higher (p<0.01) than that in 2 patients with severe reflux and was significantly lower (p<0.01) than the mean value of high pressure zone in 8 patients with cervical anastomosis. In conclusion, it is presumed that the formation of a large fornix enough to store food and a sharp angle of His are important factors in maintaining an anti-reflux mechanism. The esophageal transit scintigram was proved to be an excellent technique in detecting and evaluating quantitatively gastroesophageal reflux. (author).

A rare case report of bilateral testicular masses as an initial manifestation of systemic sarcoidosis

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Hiren Patel

2015-01-01

Full Text Available Sarcoidosis is an idiopathic, systemic disease that rarely involves the genitourinary tract. Here, we present a case of a 40-year-old male presented with bilateral scrotal swelling. The scrotal ultrasound showed multiple echogenic masses bilaterally ranging between 3 mm and 15 mm involving both testicles. Enlarged retroperitoneal lymph nodes were detected on the abdominal computed tomography (CT. Surgical exploration of the testes with a frozen section analysis of the left testicular mass was carried out, and it revealed noncaseating granulomas. CT scan of the chest revealed the classic bilateral hilar and mediastinal lymphadenopathy with reticulonodular infiltrates. The final pathological diagnosis was systemic sarcoidosis with bilateral testicular involvement. Treatment with high-dose corticosteroids resulted in complete resolution of the testicular mass and a significant decrease in the size of the hilar, mediastinal, and retroperitoneal lymphadenopathy.

Follow-up of a cohort of children and adolescents with gastro-esophageal reflux disease who were free of reflux esophagitis at initial diagnosis.

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Ruigómez, Ana; Lundborg, Per; Johansson, Saga; Wallander, Mari-Ann; García Rodríguez, Luis A

2010-08-01

Few studies have examined the incidence of complications from gastro-esophageal reflux disease (GERD) in children and adolescents in primary care. Here we aimed to describe the natural history of GERD in a pediatric population with no reflux esophagitis at initial diagnosis, assessing diagnoses of new esophageal complications and extra-esophageal conditions. We used The Health Improvement Network UK primary care database (which includes data on more than 2 million patients) to identify individuals aged 1-17 years with a first diagnosis of gastro-esophageal reflux or heartburn in the period 2000-2005, via a computerized search followed by a manual review of the patient records. This search identified 1242 individuals with an incident diagnosis of GERD but no record of esophagitis. This cohort was followed-up to detect new diagnoses of esophageal complications and extra-esophageal conditions. During a mean follow-up period of almost 4 years, 40 children and adolescents had a confirmed new diagnosis of reflux esophagitis (incidence: 10.9 per 1000 person-years). No cases of Barrett's esophagus, esophageal stricture or esophageal ulcer were reported. Individuals with GERD had double the risk of an extra-esophageal condition such as asthma, pneumonia, cough or chest pain compared with children and adolescents with no diagnosis of GERD. Children and adolescents with GERD may be at risk of developing reflux esophagitis and a range of other extra-esophageal conditions, but more severe esophageal complications are rare.

Esophageal intramural pseudoverticulosis

International Nuclear Information System (INIS)

Cho, S.R.; Sanders, M.M.; Turner, M.A.; Liu, C.I.

1981-01-01

Esophageal intramural pseudodiverticulosis (EIP) is a rare condition of unknown etiology. It is characterized by multiple, small, flaskshaped outpouchings in the esophageal wall. Involvement may be segmental or diffuse. Since this entity was first reported in 1960, there have been 43 cases described in the English literature. These cases are reviewed and six additional cases are reported with emphasis on clinical and radiographic parameters of this entity. (orig.) [de

Functional esophageal disorders

OpenAIRE

Clouse, R; Richter, J; Heading, R; Janssens, J; Wilson, J

1999-01-01

The functional esophageal disorders include globus, rumination syndrome, and symptoms that typify esophageal diseases (chest pain, heartburn, and dysphagia). Factors responsible for symptom production are poorly understood. The criteria for diagnosis rest not only on compatible symptoms but also on exclusion of structural and metabolic disorders that might mimic the functional disorders. Additionally, a functional diagnosis is precluded by the presence of a pathology-based motor disorder or p...

Heller myotomy with esophageal diverticulectomy: an operation in need of improvement.

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Bowman, Ty A; Sadowitz, Benjamin D; Ross, Sharona B; Boland, Andrew; Luberice, Kenneth; Rosemurgy, Alexander S

2016-08-01

This study was undertaken to evaluate the outcomes after laparoscopic Heller myotomy with anterior fundoplication and diverticulectomy for patients with achalasia and esophageal diverticula. 634 patients undergoing laparoscopic Heller myotomy and anterior fundoplication from 1992 to 2015 are prospectively followed up; patients were stratified for those undergoing concomitant diverticulectomy. Patients graded symptom frequency and severity before and after myotomy, using a Likert scale (0 = never/not bothersome to 10 = always/very bothersome). Median data are presented (mean ± SD). Forty-four patients, age 70 years (65 ± 14.2), underwent laparoscopic Heller myotomy, anterior fundoplication, and diverticulectomy. Operative time was 182 min (183 ± 54.6). Fifty percentage of patients had a postoperative complication: Most notable were leaks at the diverticulectomy site (n = 8) and pulmonary complications (n = 11; 10 effusion, 1 empyema). Length of stay (LOS) was 3 days (5 ± 8.3). All leaks occurred after discharge and resolved without sequelae using transthoracic catheter drainage and parenteral nutrition; two patients received endoscopic esophageal stents. Median follow-up is 39 months. Symptoms amelioration was significant postoperatively, including severity of dysphagia [6 (6 ± 3.9) to 2(4 ± 3.6)]. Seventy-six percentage of patients rated their symptoms at last follow-up as satisfying/very satisfying. Seventy-seven percentage of patients had symptoms once per week or less. Eighty-one percentage would have the operation again knowing what they know now. Laparoscopic Heller myotomy, anterior fundoplication, and diverticulectomy well palliate the symptoms of achalasia with accompanying esophageal diverticulum. The operations are generally longer than those without diverticulectomy and are accompanied by a relatively longer LOS. Complications are relatively frequent and severe (e.g., leaks and pneumonia). In particular, leaks at the

Comparative study of three methods of esophageal anastomosis in dogs

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Z. T. Abd Al-Maseeh

2009-01-01

Full Text Available This study was performed to compare three methods of esophageal anastomosis. Twenty four healthy adult dogs were used in this study. The animals were divided into three groups; each one consisted of 8 animals. In group 1; two layers were used to perform the esophageal anastomosis. The first layer represented simple interrupted suture to close the mucosa with knot inside the lumen, and the second layer represented horizontal mattress interrupted suture to close the other layers of esophagus. While in group 2; one layer of cross interrupted mattress suture was used to close all layers of esophageal wall, and in group 3; one layer of Schmieden's suture was used to close all layers of esophageal wall. The results of clinical, radiological and histopathological studies after 15 and 30 days of surgical operation revealed that most of the animals showed different degrees of difficulty concerning the moderate dysphagia and regurgitation. The radiological study showed significant difference of stenosis. The best results were recorded in the second group where the mean degree of stenosis was 7.69%, however the mean degree of stenosis was 42.80% in the first group, while the mean degree of stenosis in the third groups was 37.81%, through 30 days. The histopathological study of group 2 showed rapid healing of the site of anastomosis, lack of granulation tissue and consequently the less degree of stricture and other complications as compared with groups 1 and 3. The Schmieden's suture was characterized by its standard short time as compared with group 1 and 2, although accompanied by some complications. In conclusion this study revealed that the cross mattress suture used in the second group characterized by faster healing and minimal amount of fibrous tissue formation manifested by decrease in moderate degree of stenosis as compared with the two other suture patterns used in the first and third groups.

The effects of sleeve gastectomy on gastro-esophageal reflux and gastro-esophageal motility.

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Hayat, Jamal O; Wan, Andrew

2014-05-01

Sleeve gastrectomy is an increasingly performed bariatric procedure associated with low morbidity and good short to medium term effects on weight loss and comorbid conditions. Studies assessing the prevalence of post-operative gastro-esophageal reflux disease (GERD), show sleeve gastrectomy may provoke de novo GERD symptoms or worsening of pre-existing GERD. Pathophysiological mechanisms of GERD after sleeve gastrectomy include a hypotensive lower esophageal sphincter, increased gastro-esophageal pressure gradient and intra-thoracic migration of the remnant stomach. A reduction in the compliance of the gastric remnant may provoke an increase in transient lower esophageal sphincter relaxations. Time-resolved MRI suggests relative gastric stasis in the proximal remnant and increased emptying from the antrum. A lack of standardisation of technique, along with heterogeneity of studies assessing GERD may explain the wide variability in reported results. Simultaneous and careful repair of an associated hiatus hernia may result in a reduction in the prevalence of post-operative GERD.

Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography

NARCIS (Netherlands)

Bredenoord, A. J.; Fox, M.; Kahrilas, P. J.; Pandolfino, J. E.; Schwizer, W.; Smout, A. J. P. M.; Conklin, Jeffrey L.; Cook, Ian J.; Gyawali, C. Prakash; Hebbard, Geoffrey; Holloway, Richard H.; Ke, Meiyun; Keller, Jutta; Mittal, Ravinder K.; Peters, Jeff; Richter, Joel; Roman, Sabine; Rommel, Nathalie; Sifrim, Daniel; Tutuian, Radu; Valdovinos, Miguel; Vela, Marcelo F.; Zerbib, Frank

2012-01-01

Background The Chicago Classification of esophageal motility was developed to facilitate the interpretation of clinical high resolution esophageal pressure topography (EPT) studies, concurrent with the widespread adoption of this technology into clinical practice. The Chicago Classification has been

The Comparison Between the Complications after Two Surgical Techniques of Esophageal Cancer

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Mohamad Taghi Rajabi Mashhadi

2014-08-01

Full Text Available Introduction: Esophageal cancer is a common gastro intestinal malignancy. One of the most common techniques of surgery in esophageal cancer is transhiatal esophagectomy with esophagogastric anastomosis in the neck. This technique is accompanied by complications like chronic gastero-esophegeal reflux and late stenosis. This study was designed to compare the risk of complications after two surgical techniques for esophageal cancer: esophagogastric anastomosis with partial fundoplication and esophagogastric anastomosis without it. Materials and Methods: In this retrospective cohort study, 100 patients with distal two thirds of esophageal cancer who underwent transhiatal esophagectomy in Ghaem and Omid hospitals Mashhad University of Medical Sciences from 2005 to 2010 were included. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fundoplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group. Results: In a retrospective cohort study 100 patients entered the study with 59 male & 41 female and with a mean age 54.6±6.4 years. Squamous cell carcinoma was observed in 77% of the patients and adenocarcinoma was reported in 23% of them. Seventy-two percent of tumours were located in distal third and 28% were in middle third of esophagus. Esophagogastric anastomotic leakage was observed in 3 cases of fundoplication group and 7 cases of simple anastomosis technique (P=0.182 so there was no significant difference between the two groups. Benign anastomosis stricture was reported in one of the patients who underwent esophagogastric anastomosis with fundoplication, but it was observed in 8 cases with simple anastomosis technique (P=0.03 so there was a significant difference between the two groups. Conclusion: Esophagogastric anastomosis with partial fundal fundoplication is a safe technique with low incidence of anatomic leakage and late stenosis.

Clinical application of esophageal stent in the treatment of benign and malignant esophageal strictures

International Nuclear Information System (INIS)

Guo Weiping; Wang Zhimin; Yang Renjie; Wang Yiqing; Zhang Hongxin; Wu Zhiqun; Li Wenxian; Ni Daihui; Guan Yan

2001-01-01

Objective: To investigate the indications and complications in the treatment of benign and malignant strictures using esophageal stents in order to avoid abusing effects in clinical practice. Methods: A series of 20 patients, 12 men, 8 women, aged from 45-72, with esophageal stricture. There were 3 cases had stricture at the anastomosis site. 4 cases with esophagobronchial fistula. 1 case with esophago-mediastinal fistula after surgical operation ten cases used imported stents and another 10 with domestic Nickel-Titanium stents. Results: Successful stent placement was achieved in all cases. Dysphagia were relieved in most of 20 cases. The fistula vanished in 5 cases of complications with esophagobronchial and esophago-mediastinal fistulas. Conclusions: The esophageal stent placement is an effective treatment for benign and malignant esophageal strictures. The domestic Nickel-Titanium stents is well effective as the imported ones

PET-CT manifestation of Candida esophagitis

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Bahk, Yong Whee [Sung-Ae Hospital, Seoul (Korea, Republic of); O, Joo Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical School, Seoul (Korea, Republic of)

2007-04-15

Candida esophagitis (moniliasis) is the most common infection of the gullet and has generally been attributed to as a complication of immune suppressed state. However, as the current case. Holt found the disease to occur in 3 of his 13 patients without predisposing condition. Predisposing factors other than immune deficient conditions include aplastic anemia, alcoholism and Parkinson's disease and age, diabetes mellitus, and disruption of mucosal integrity. Growing prevalence of Candida esophagitis in recent years is accounted for by an increase in the number of patients with organ transplantation, malignancy and AIDS as well as populrization of endoscopy. Microorganisms that reached the esophagus in oral secretions are rarely cultured from the esophageal surface. Of many species C. albicans is the most common offender although C. tropicalis has also been isolated with high prevalence, particularly in the patients with cancer and disseminated candidiasis. Clinically, the patients with Candida esophagitis seek medical care for esophageal or retrosternal pain, dysphagia or distress. Candida esophagitis may be the extension from oropharyngeal infection but in the majority the esophagus is the sole site of infection. The middle and lower thirds of the esophagus are more typically affected than the upper third. Diagnosis can be indicated by double contrast esophagography or endoscopy and confirmed by potassium hydroxide (KOH) stain or biopsy. It is to be noted that the more presence of Candida in smear or cultured specimen cannot indict Candida as definitive offender. Differential diagnosis includes herpes simplex infection, cytomegalovirus infection, reflux esophagitis or radiation esophagitis.

PET-CT manifestation of Candida esophagitis

International Nuclear Information System (INIS)

Bahk, Yong Whee; O, Joo Hyun

2007-01-01

Candida esophagitis (moniliasis) is the most common infection of the gullet and has generally been attributed to as a complication of immune suppressed state. However, as the current case. Holt found the disease to occur in 3 of his 13 patients without predisposing condition. Predisposing factors other than immune deficient conditions include aplastic anemia, alcoholism and Parkinson's disease and age, diabetes mellitus, and disruption of mucosal integrity. Growing prevalence of Candida esophagitis in recent years is accounted for by an increase in the number of patients with organ transplantation, malignancy and AIDS as well as populrization of endoscopy. Microorganisms that reached the esophagus in oral secretions are rarely cultured from the esophageal surface. Of many species C. albicans is the most common offender although C. tropicalis has also been isolated with high prevalence, particularly in the patients with cancer and disseminated candidiasis. Clinically, the patients with Candida esophagitis seek medical care for esophageal or retrosternal pain, dysphagia or distress. Candida esophagitis may be the extension from oropharyngeal infection but in the majority the esophagus is the sole site of infection. The middle and lower thirds of the esophagus are more typically affected than the upper third. Diagnosis can be indicated by double contrast esophagography or endoscopy and confirmed by potassium hydroxide (KOH) stain or biopsy. It is to be noted that the more presence of Candida in smear or cultured specimen cannot indict Candida as definitive offender. Differential diagnosis includes herpes simplex infection, cytomegalovirus infection, reflux esophagitis or radiation esophagitis

Esophageal Foreign Bodies

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Ufuk Cobanoglu

2014-04-01

Full Text Available Esophageal foreign body aspiration is a common event which can cause serious morbidity and mortality in the children and adult population. For that reason, early diagnosis and treatment are crucial for preventing these life threateining complications. Children most often ingest coins and toys whereas adults commonly tend to have problems with meat and bones. Esophageal foreign bodies are located at the cricopharyngeus muscle level in 70%, the thoracic esophagus in 15% and the gastroesophageal junction in the remaining 15%. Symptoms can vary according to the shape and structure of the ingested object, type of location, patient%u2019s age and complications caused by the foreign body. Delay in treatment, esophageal perforation and an underlying esophageal disease are poor prognostic factors. In treatment, observation, foley catheter, rigid or flexible esophagoscopy and removing the foreign body with a Magill forceps, pushing the foreign body into the stomach, giving intravenous glucagon and surgical treatment methods can be used. Rigid esophagoscopy is an effective and safe procedure for foreign body diagnosis and removal. Improved endoscopic experience and clinical management of thoracic surgeons led to reduced morbidity and mortality in recent years. Most of those emergencies of childhood are preventable. Family education is very important.

Laboratory animal models for esophageal cancer

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Dhanya Venugopalan Nair

2016-11-01

Full Text Available The incidence of esophageal cancer is rapidly increasing especially in developing countries. The major risk factors include unhealthy lifestyle practices such as alcohol consumption, smoking, and chewing tobacco to name a few. Diagnosis at an advanced stage and poor prognosis make esophageal cancer one of the most lethal diseases. These factors have urged further research in understanding the pathophysiology of the disease. Animal models not only aid in understanding the molecular pathogenesis of esophageal cancer but also help in developing therapeutic interventions for the disease. This review throws light on the various recent laboratory animal models for esophageal cancer.

Congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula: clinical and radiologic features

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Yoo, Hye Jin; Kim, Woo Sun; Cheon, Jung-Eun; Shin, Su-Mi; Kim, In-One; Yeon, Kyung Mo [Seoul National University College of Medicine and the Institute of Radiation Medicine, Department of Radiology, Seoul (Korea); Yoo, So-Young [Seoul National University College of Medicine and the Institute of Radiation Medicine, Department of Radiology, Seoul (Korea); Sungkyunkwan University School of Medicine, Department of Radiology and Center for Imaging Science, Samsung Medical Center, Seoul (Korea); Park, Kwi-Won; Jung, Sung-Eun [Seoul National University Children' s Hospital, Department of Pediatric Surgery, Seoul (Korea)

2010-08-15

Congenital esophageal stenosis (CES) can be associated with esophageal atresia/tracheoesophageal fistula (EA/TEF). Because there are a variety of degrees of obstruction and symptoms of CES, it is frequently difficult to make a pre- and post-operative diagnosis of the distal CES associated with EA/TEF. To evaluate the clinical and radiologic features of congenital esophageal stenosis associated with esophageal atresia/tracheoesophageal fistula. We retrospectively reviewed postoperative esophagograms and medical records of 187 children (107 boys, 80 girls) who had primary repair of EA/TEF from 1992 to 2009 at our institution. We evaluated the incidence of CES, clinical findings, radiologic features and management of CES in these children. CES was diagnosed in 22 of 187 EA/TEF children (12%); one child had double CES lesions, for a total of 23 lesions. Ten of those 22 children (45%) had presented with significant symptoms of esophageal obstruction. The diagnosis of CES was delayed in 10 children (45%) until 1-10 years of age. On esophagogram, CES (n = 23) was located in the distal esophagus (n = 20, 87%) or mid-esophagus (n = 3, 13%). The degree of stenosis was severe (n = 6, 26%), moderate (n = 10, 43%), or mild (n = 7, 30%). Eight children, including two with unsuccessful esophageal balloon dilatation of CES, were treated surgically. Histologic examination revealed tracheobronchial remnant (n = 7) or fibromuscular hyperplasia (n = 1). One child with surgically treated CES developed achalasia at the age of 3 years 9 months. Esophagography after EA/TEF repair should be performed with a high index of suspicion for the presence of distal CES, because the diagnosis and adequate management of CES can often be delayed. (orig.)

Nuclear medicine and esophageal surgery

Energy Technology Data Exchange (ETDEWEB)

Taillefer, R.; Beauchamp, G.; Duranceau, A.C.; Lafontaine, E.

1986-06-01

The principal radionuclide procedures involved in the evaluation of esophageal disorders that are amenable to surgery are illustrated and briefly described. The role of the radionuclide esophagogram (RE) in the diagnosis and management of achalasia, oculopharyngeal muscular dystrophy and its complications, tracheoesophageal fistulae, pharyngeal and esophageal diverticulae, gastric transposition, and fundoplication is discussed. Detection of columnar-lined esophagus by Tc-99m pertechnetate imaging and of esophageal carcinoma by Ga-67 citrate and Tc-99m glucoheptonate studies also is presented. 37 references.

Treatment of advanced esophageal cancer

International Nuclear Information System (INIS)

Kelsen, D.

1982-01-01

When radiation therapy is used for palliation of obstruction in patients with advanced esophageal carcinoma, an improvement in dysphagia can be expected in approximately 50% of patients. Major objective responses have rarely been quantitied but, in one study, were seen in 33% patients. Recurrence of dysphagia is usually seen within 2-6 months of treatment. Radiation toxicities and complications, even when used with palliative intent, can be substantial and include esophagitis, tracheoesophageal or esophageal-aortic fistula, mediastinitis, hemorrhage, pneumonitis, and myelosuppression

[Esophageal motor function of gastroesophageal reflux disease].

Science.gov (United States)

Wang, Hong; Tian, Yuan; Ding, Yan

2010-08-01

To study the relationship between esophageal motor functional disorder [decreased lower esophageal sphincter pressure (LESP)and ineffective motility (IEM)] and gastroesophageal reflux disease (GERD). Totally 89 patients with GERD were enrolled in this study. All of them underwent 24-hour pH monitoring with dual-channel probe and stationary esophageal manometry. In addition, 77 of these patients underwent upper endoscopy. IEM and LES, 10 mmHg were common disturbances in patients with GERD (54% and 48%, respectively). The number of the acid reflux events of distal esophagus and prevalence of moderate or severe erosive esophagitis (EE) were significantly higher in patients with low LESP and IEM than patients without low LESP ( Pesophagus was significantly correlated with the severity of esophagitis, distal esophagus amplitude, and LESP, while no such correlation was found between IEM and degree of esophageal acid exposure or esophagitis. The pathophysiology of GERD is probably multifactorial. Lower LESP or IEM is not a independent pathophysiological factor for GERD. However,one single factor is insufficient to explain all the pathogenic mechanism of GERD.

Risks of Esophageal Cancer Screening

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... alcohol use, and Barrett esophagus can affect the risk of developing esophageal cancer. Anything that increases the ... tissue gives off less light than normal tissue. Risks of Esophageal Cancer Screening Key Points Screening tests ...

High resolution vs conventional esophageal manometry in the assessment of esophageal motor disorders in patients with non-cardiac chest pain.

Science.gov (United States)

Akinsiku, O; Yamasaki, T; Brunner, S; Ganocy, S; Fass, R

2018-06-01

High-resolution esophageal manometry (HREM) has become a leading tool in the assessment of esophageal motor disorders, replacing conventional manometry. However, there is limited data about the contribution of HREM as compared with conventional manometry to the assessment of esophageal motor disorders in patients with non-cardiac chest pain (NCCP). The aim of the study was to compare the distribution of esophageal motor disorders in patients with NCCP using HREM as compared with conventional manometry and to determine if HREM improved diagnosis of these disorders. In this study, we included 300 consecutive patients with NCCP who underwent either HREM or conventional manometry over a period of 10 years. A total of 150 patients had conventional manometry and the other 150 patients HREM. The Chicago 3.0 classification and the Castell and Spechler classification were used to determine the esophageal motor disorder of NCCP patients undergoing HREM and conventional manometry, respectively. In both HREM and the conventional manometry groups, normal esophageal motility was the most frequent finding (47% and 36%; respectively, P = .054). Hypotensive lower esophageal sphincter was the most common motility disorder identified by conventional manometry (27.3%), while ineffective esophageal motility was the most common esophageal motor disorder identified by HREM (25.3%). There is a discrepancy in the type of esophageal motor disorders identified by HREM as compared with conventional manometry in NCCP patients. Hypotensive motility disorders are the most commonly diagnosed by both manometric techniques. © 2017 John Wiley & Sons Ltd.

Clinical application of endoscopic ultrasonography for esophageal achalasia.

Science.gov (United States)

Minami, Hitomi; Inoue, Haruhiro; Isomoto, Hajime; Urabe, Shigetoshi; Nakao, Kazuhiko

2015-04-01

Endoscopic ultrasonography (EUS) has been widely used for evaluating the nature of diseases of various organs. The possibility of applying EUS for esophageal motility diseases has not been well discussed despite its versatility. At present, peroral endoscopic myotomy (POEM) for esophageal achalasia and related diseases has brought new attention to esophageal diseases because POEM provides a more direct approach to the inner structures of the esophageal wall. In the present study, we discuss the clinical utility of EUS in evaluating and treating esophageal motility diseases such as esophageal achalasia and related diseases. © 2015 The Authors. Digestive Endoscopy © 2015 Japan Gastroenterological Endoscopy Society.

Randomized controlled trial comparing esophageal dilation to no dilation among adults with esophageal eosinophilia and dysphagia.

Science.gov (United States)

Kavitt, R T; Ates, F; Slaughter, J C; Higginbotham, T; Shepherd, B D; Sumner, E L; Vaezi, M F

2016-11-01

The role of esophageal dilation in patients with esophageal eosinophilia with dysphagia remains unknown. The practice of dilation is currently based on center preferences and expert opinion. The aim of this study is to determine if, and to what extent, dysphagia improves in response to initial esophageal dilation followed by standard medical therapies. We conducted a randomized, blinded, controlled trial evaluating adult patients with dysphagia and newly diagnosed esophageal eosinophilia from 2008 to 2013. Patients were randomized to dilation or no dilation at time of endoscopy and blinded to dilation status. Endoscopic features were graded as major and minor. Subsequent to randomization and endoscopy, all patients received fluticasone and dexlansoprazole for 2 months. The primary study outcome was reduction in overall dysphagia score, assessed at 30 and 60 days post-intervention. Patients with severe strictures (less than 7-mm esophageal diameter) were excluded from the study. Thirty-one patients were randomized and completed the protocol: 17 randomized to dilation and 14 to no dilation. Both groups were similar with regard to gender, age, eosinophil density, endoscopic score, and baseline dysphagia score. The population exhibited moderate to severe dysphagia and moderate esophageal stricturing at baseline. Overall, there was a significant (P dysphagia score at 30 and 60 days post-randomization compared with baseline in both groups. No significant difference in dysphagia scores between treatment groups after 30 (P = 0.93) or 60 (P = 0.21) days post-intervention was observed. Esophageal dilation did not result in additional improvement in dysphagia score compared with treatment with proton pump inhibitor and fluticasone alone. In patients with symptomatic esophageal eosinophilia without severe stricture, dilation does not appear to be a necessary initial treatment strategy. © 2015 International Society for Diseases of the Esophagus.

Association of TNF polymorphisms with sarcoidosis, its prognosis and tumour necrosis factor (TNF)-α levels in Asian Indians

Science.gov (United States)

Sharma, S; Ghosh, B; Sharma, S K

2008-01-01

Tumour necrosis factor (TNF)-α, an important proinflammatory cytokine, has been implicated in the pathogenesis of sarcoidosis, a multi-systemic granulomatous disorder of unknown aetiology. Here, we report for the first time the association of TNF haplotypes and genotypes with sarcoidosis and its prognosis in the Indian population. Five potentially functional promoter polymorphisms in the TNFA gene and a LTA_NcoI polymorphism (+252 position) of the LTA gene were genotyped in a clinically well-defined cohort of North-Indian patients with sarcoidosis (n = 96) and their regional controls (n = 155). Serum TNF-α (sTNF-α) and serum angiotensin converting enzyme (SACE) levels were measured and correlated with genotypes and haplotypes. The TNFA_-1031 and TNFA_-863 polymorphisms were identified as markers for disease onset (FET P = 0·006 and 0·042 for TNFA_-1031 and TNFA_-863, respectively). Additionally, the allele A of LTA_NcoI polymorphism was shown to be prevalent in the ‘no treatment’ group (FET P = 0·005), while the G allele was associated with frequent relapses on drug withdrawal (P = 0·057). Furthermore, the TNFA-308G>A and the TNFA-238G>A polymorphisms were found to influence sTNF-α (P = 0·054 and 0·0005, respectively) and SACE levels (P = 0·0017 and 0·056, respectively). The haplotype frequencies were significantly different in the patients and the controls (P = 0·0067). The haplotype GTCCGG was identified as the major risk/susceptibility haplotype (P = 0·003) and was associated with increased SACE levels in the patient population. In conclusion, our study suggests an association of TNF polymorphisms with sarcoidosis. PMID:18062795

Esophageal Cancer—Health Professional Version

Science.gov (United States)

The incidence of esophageal cancer has risen in recent decades, coinciding with a shift in histologic type and primary tumor location. Find evidence-based information on esophageal cancer treatment, causes and prevention, screening, research, and statistics.

Evaluation of Esophageal Motor Function With High-resolution Manometry

Science.gov (United States)

2013-01-01

For several decades esophageal manometry has been the test of choice to evaluate disorders of esophageal motor function. The recent introduction of high-resolution manometry for the study of esophageal motor function simplified performance of esophageal manometry, and revealed previously unidentified patterns of normal and abnormal esophageal motor function. Presentation of pressure data as color contour plots or esophageal pressure topography led to the development of new tools for analyzing and classifying esophageal motor patterns. The current standard and still developing approach to do this is the Chicago classification. While this methodical approach is improving our diagnosis of esophageal motor disorders, it currently does not address all motor abnormalities. We will explore the Chicago classification and disorders that it does not address. PMID:23875094

Value of dynamic esophageal scintigraphy (radionuclide transit) in the diagnosis of esophageal motor disorders

Energy Technology Data Exchange (ETDEWEB)

Simon, L.; Pasztarak, E.; Tornoczky, J.

1985-04-07

Dynamic esophageal scintigraphy is a novel technique for the diagnosis of esophageal motor disorders. Determination of radionuclide transit time was performed in 180 cases using 'single-swallow' method of a semi-solid meal labelled with 20 MBq sup(99)Tc-DTPA. The investigations were evaluated by a home-made all-purpose gamma camera, on-line linked to a microprocessor. The transit time and the characteristics of esophageal peristaltic activity were investigated in healthy individuals, in esophageal motor disorders and in patients with diabetes mellitus. Based on the experiences, the introduction of the new technique into the routine gastroenterological practice might be proposed because it proved to be reproducible, repeatable, and harmless for the patients. Its sensitivity may achieve 100 per cent, and it is suitable for the evaluation of the effect of surgical and internal therapeutic interventions. (author). 39 refs.; 6 figs.

Endoscopic Management of Benign Esophageal Strictures.

Science.gov (United States)

Ravich, William J

2017-08-24

This paper presents the author's approach to esophageal dilation. It offers a tailored approach to the application of dilation to specific types of esophageal stenotic lesions. In patients with inflammatory stricture, recent studies confirm the importance of treating the underlying inflammatory condition in order to decrease the rate of recurrence. The paper reviews some of the novel techniques that have been suggested for the treatment of refractory benign esophageal strictures, including incisional therapy, stenting, or the injection steroids or antifibrotic agents. The endoscopist who treats esophageal strictures must be familiar with the tools of the dilation and how they are best applied to specific types of stenotic lesions. If inflammation is present, effective management requires treatment of the inflammatory process in addition to mechanical dilation of the stenotic lesion. Controlled trials of novel approaches to treatment of refractory benign esophageal strictures are limited and will be necessary to determine efficacy.

Esophageal motility abnormalities in gastroesophageal reflux disease

Science.gov (United States)

Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo

2014-01-01

Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted. PMID:24868489

Clinical features of refractory radiation esophageal ulcer after proton beam therapy and its management in a patient with esophageal cancer

International Nuclear Information System (INIS)

Hisakura, Katsuji; Terashima, Hideo; Nagai, Kentaro

2012-01-01

It has been reported that proton beam therapy is an effective treatment method for patients with locally confined esophageal cancer. However, there seems to be serious problems related to post-radiotherapy (RT) esophageal ulcers. We treated 7 patients who developed post-RT esophageal ulcers with the earliest symptom of esophageal stenosis, which was observed 7-17 months (median, 10.0) after completion of RT. Five of the patients had unhealed ulcers leading to lethal events such as perforation or penetration. The mean time between the appearance of the earliest symptom and lethal episode was no more than 2 months (mean, 2.1). The first 3 patients who underwent conservative therapies died from severe complications caused by perforation or penetration of post-RT esophageal ulcers. In the case of 2 consecutive patients, we performed surgical treatment as soon as possible since there were indications of penetration in post-RT developed esophageal ulcers. Therefore, they could be cured by a salvage operation which was subtotal esophagectomy using the stomach for esophageal replacement. Through the above-mentioned experience, we discussed surgical management for esophageal ulcers after proton beam therapy. (author)

The Pathophysiology of Eosinophilic Esophagitis

Directory of Open Access Journals (Sweden)

Daniel Avi Lemberg

2014-05-01

Full Text Available Eosinophilic Esophagitis (EoE is an emerging disease characterised by esophageal eosinophilia (>15eos/hpf, lack of responsiveness to acid-suppressive medication and is managed by allergen elimination and anti-allergy therapy. Although the pathophysiology of EoE is currently unsubstantiated, evidence implicates food and aeroallergen hypersensitivity in genetically predisposed individuals as contributory factors. Genome-wide expression analyses have isolated a remarkably conserved gene-expression profile irrespective of age and gender, suggesting a genetic contribution. EoE has characteristics of mainly TH2 type immune responses but also some TH1 cytokines, which appear to strongly contribute to tissue fibrosis, with esophageal epithelial cells providing a hospitable environment for this inflammatory process. Eosinophil-degranulation products appear to play a central role in tissue remodeling in EoE. This remodeling and dysregulation predisposes to fibrosis. Mast cell-derived molecules such as histamine may have an effect on enteric nerves and may also act in concert with TGF-β to interfere with esophageal musculature. Additionally, the esophageal epithelium may facilitate the inflammatory process under pathogenic contexts such as in EoE. This article aims to discuss the contributory factors in the pathophysiology of EoE.

Dysmotility in Esophageal Atresia: Pathophysiology, Characterization, and Treatment

Science.gov (United States)

Faure, Christophe; Righini Grunder, Franziska

2017-01-01

Esophageal dysmotility is almost universal after esophageal atresia (EA) repair and is mainly related to the developmental anomaly of the esophagus. Esophageal dysmotility is involved in the pathophysiology of numerous symptoms and comorbidities associated with EA such as gastroesophageal reflux disease, aspiration and respiratory complications, and symptoms of dysphagia and feeding disorders. High-resolution esophageal manometry (HREM) has facilitated the characterization of the dysmotility, but there is an incomplete correlation between symptoms and manometrical patterns. Impedance coupled to HREM should help to predict the clinical outcome and therefore personalize patient management. Nowadays, the management of esophageal dysmotility in patients with EA is essentially based on treatment of associated inflammation related to peptic or eosinophilic esophagitis. PMID:28620599

Caustic ingestion and esophageal function

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Cadranel, S.; Di Lorenzo, C.; Rodesch, P.; Piepsz, A.; Ham, H.R. (Children University Hospital, Brussels (Belgium))

1990-02-01

The aim of the present study was to investigate esophageal motor function by means of krypton-81m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment. In chronic stages, the severity of the dysphagia was not correlated to the importance of the residual stenosis. Conversely, 81mKr esophageal transit and manometric's findings were in good agreement with the clinical symptoms, during the entire follow-up period ranging between 3 months to 7 years. The 81mKr test is undoubtedly the easiest and probably the most physiological technique currently available for long-term functional evaluation of caustic esophagitis.

Antigen presentation and MHC class II expression by human esophageal epithelial cells: role in eosinophilic esophagitis.

Science.gov (United States)

Mulder, Daniel J; Pooni, Aman; Mak, Nanette; Hurlbut, David J; Basta, Sameh; Justinich, Christopher J

2011-02-01

Professional antigen-presenting cells (APCs) play a crucial role in initiating immune responses. Under pathological conditions, epithelial cells at mucosal surfaces act as nonprofessional APCs, thereby regulating immune responses at the site of exposure. Epithelial cells in the esophagus may contribute to the pathogenesis of eosinophilic esophagitis (EoE) by presenting antigens on the major histocompatibility complex (MHC) class II. Our goal was to demonstrate the ability of esophageal epithelial cells to process and present antigens on the MHC class II system and to investigate the contribution of epithelial cell antigen presentation to EoE. Immunohistochemistry detected HLA-DR, CD80, and CD86 expression and enzyme-linked immunosorbent assay detected interferon-γ (IFNγ) in esophageal biopsies. Antigen presentation was studied using the human esophageal epithelial cell line HET-1A by reverse transcriptase-PCR, flow cytometry, and confocal microscopy. T helper cell lymphocyte proliferation was assessed by flow cytometry and IL-2 secretion. IFNγ and MHC class II were increased in mucosa of patients with EoE. IFNγ increased mRNA of HLA-DP, HLA-DQ, HLA-DR, and CIITA in HET-1A cells. HET-1A engulfed cell debris and processed ovalbumin. HET-1A cells expressed HLA-DR after IFNγ treatment. HET-1A stimulated T helper cell activation. In this study, we demonstrated the ability of esophageal epithelial cells to act as nonprofessional APCs in the presence of IFNγ. Esophageal epithelial cell antigen presentation may contribute to the pathophysiology of eosinophilic esophagitis. Copyright © 2011 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.

Objectively Quantifying Radiation Esophagitis With Novel Computed Tomography–Based Metrics

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Niedzielski, Joshua S., E-mail: jsniedzielski@mdanderson.org [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Yang, Jinzhong [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Stingo, Francesco [Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Martel, Mary K.; Mohan, Radhe [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Gomez, Daniel R. [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Briere, Tina M. [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States); Liao, Zhongxing [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Court, Laurence E. [Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); University of Texas Houston Graduate School of Biomedical Science, Houston, Texas (United States)

2016-02-01

Purpose: To study radiation-induced esophageal expansion as an objective measure of radiation esophagitis in patients with non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy. Methods and Materials: Eighty-five patients had weekly intra-treatment CT imaging and esophagitis scoring according to Common Terminlogy Criteria for Adverse Events 4.0, (24 Grade 0, 45 Grade 2, and 16 Grade 3). Nineteen esophageal expansion metrics based on mean, maximum, spatial length, and volume of expansion were calculated as voxel-based relative volume change, using the Jacobian determinant from deformable image registration between the planning and weekly CTs. An anatomic variability correction method was validated and applied to these metrics to reduce uncertainty. An analysis of expansion metrics and radiation esophagitis grade was conducted using normal tissue complication probability from univariate logistic regression and Spearman rank for grade 2 and grade 3 esophagitis endpoints, as well as the timing of expansion and esophagitis grade. Metrics' performance in classifying esophagitis was tested with receiver operating characteristic analysis. Results: Expansion increased with esophagitis grade. Thirteen of 19 expansion metrics had receiver operating characteristic area under the curve values >0.80 for both grade 2 and grade 3 esophagitis endpoints, with the highest performance from maximum axial expansion (MaxExp1) and esophageal length with axial expansion ≥30% (LenExp30%) with area under the curve values of 0.93 and 0.91 for grade 2, 0.90 and 0.90 for grade 3 esophagitis, respectively. Conclusions: Esophageal expansion may be a suitable objective measure of esophagitis, particularly maximum axial esophageal expansion and esophageal length with axial expansion ≥30%, with 2.1 Jacobian value and 98.6 mm as the metric value for 50% probability of grade 3 esophagitis. The uncertainty in esophageal Jacobian calculations can be reduced

Objectively Quantifying Radiation Esophagitis With Novel Computed Tomography–Based Metrics

International Nuclear Information System (INIS)

Niedzielski, Joshua S.; Yang, Jinzhong; Stingo, Francesco; Martel, Mary K.; Mohan, Radhe; Gomez, Daniel R.; Briere, Tina M.; Liao, Zhongxing; Court, Laurence E.

2016-01-01

Purpose: To study radiation-induced esophageal expansion as an objective measure of radiation esophagitis in patients with non-small cell lung cancer (NSCLC) treated with intensity modulated radiation therapy. Methods and Materials: Eighty-five patients had weekly intra-treatment CT imaging and esophagitis scoring according to Common Terminlogy Criteria for Adverse Events 4.0, (24 Grade 0, 45 Grade 2, and 16 Grade 3). Nineteen esophageal expansion metrics based on mean, maximum, spatial length, and volume of expansion were calculated as voxel-based relative volume change, using the Jacobian determinant from deformable image registration between the planning and weekly CTs. An anatomic variability correction method was validated and applied to these metrics to reduce uncertainty. An analysis of expansion metrics and radiation esophagitis grade was conducted using normal tissue complication probability from univariate logistic regression and Spearman rank for grade 2 and grade 3 esophagitis endpoints, as well as the timing of expansion and esophagitis grade. Metrics' performance in classifying esophagitis was tested with receiver operating characteristic analysis. Results: Expansion increased with esophagitis grade. Thirteen of 19 expansion metrics had receiver operating characteristic area under the curve values >0.80 for both grade 2 and grade 3 esophagitis endpoints, with the highest performance from maximum axial expansion (MaxExp1) and esophageal length with axial expansion ≥30% (LenExp30%) with area under the curve values of 0.93 and 0.91 for grade 2, 0.90 and 0.90 for grade 3 esophagitis, respectively. Conclusions: Esophageal expansion may be a suitable objective measure of esophagitis, particularly maximum axial esophageal expansion and esophageal length with axial expansion ≥30%, with 2.1 Jacobian value and 98.6 mm as the metric value for 50% probability of grade 3 esophagitis. The uncertainty in esophageal Jacobian calculations can be reduced

Management of congenital esophageal stenosis associated with ...

African Journals Online (AJOL)

Aim The aim of this work was to study the incidence, management of congenital esophageal stenosis (CES) associated with esophageal atresia (EA) and tracheoesophageal fistula (TEF), and its impact on esophageal stricture (ES) after primary repair. Patients and methods From January 2006 to December 2014, ...

Reproducibility of esophageal scintigraphy using semi-solid yoghurt

Energy Technology Data Exchange (ETDEWEB)

Imai, Yukinori; Kinoshita, Manabu; Asakura, Yasushi; Kakinuma, Tohru; Shimoji, Katsunori; Fujiwara, Kenji; Suzuki, Kenji; Miyamae, Tatsuya [Saitama Medical School, Moroyama (Japan)

1999-10-01

Esophageal scintigraphy is a non-invasive method which evaluate esophageal function quantitatively. We applied new technique using semi-solid yoghurt, which can evaluate esophageal function in a sitting position. To evaluate the reproducibility of this method, scintigraphy were performed in 16 healthy volunteers. From the result of four swallows except the first one, the mean coefficients of variation in esophageal transit time and esophageal emptying time were 12.8% and 13.4% respectively (interday variation). As regards the interday variation, this method had also good reproducibility from the result on the 2 separate days. (author)

The value of dynamic esophageal scintigraphy (radionuclide transit) in the diagnosis of esophageal motor disorders

International Nuclear Information System (INIS)

Simon, Laszlo; Pasztarak, Erzsebet; Tornoczky, Janos

1985-01-01

Dynamic esophageal scintigraphy is a novel technique for the diagnosis of esophageal motor disorders. Determination of radionuclide transit time was performed in 180 cases using 'single-swallow' method of a semi-solid meal labelled with 20 MBq sup(99)Tc-DTPA. The investigations were evaluated by a home-made all-purpose gamma camera, on-line linked to a microprocessor. The transit time and the characteristics of esophageal peristaltic activity were investigated in healthy individuals, in esophageal motor disorders and in patients with diabetes mellitus. Based on the experiences, the introduction of the new technique into the routine gastroenterological practice might be proposed because it proved to be reproducible, repeatable, and harmless for the patients. Its sensitivity may achieve 100 per cent, and it is suitable for the evaluation of the effect of surgical and internal therapeutic interventions. (author)

Esophageal Cancer: Insights from Mouse Models

Directory of Open Access Journals (Sweden)

Marie-Pier Tétreault

2015-01-01

Full Text Available Esophageal cancer is the eighth leading cause of cancer and the sixth most common cause of cancer-related death worldwide. Despite recent advances in the development of surgical techniques in combination with the use of radiotherapy and chemotherapy, the prognosis for esophageal cancer remains poor. The cellular and molecular mechanisms that drive the pathogenesis of esophageal cancer are still poorly understood. Hence, understanding these mechanisms is crucial to improving outcomes for patients with esophageal cancer. Mouse models constitute valuable tools for modeling human cancers and for the preclinical testing of therapeutic strategies in a manner not possible in human subjects. Mice are excellent models for studying human cancers because they are similar to humans at the physiological and molecular levels and because they have a shorter gestation time and life cycle. Moreover, a wide range of well-developed technologies for introducing genetic modifications into mice are currently available. In this review, we describe how different mouse models are used to study esophageal cancer.

Balloon Dilatation of Esophageal Strictures/Achalasia

OpenAIRE

Sabharwal, Tarun; Adam, Andreas

2004-01-01

Achalasia is an esophageal motor disorder characterized by increased lower esophageal sphincter (LES) pressure, diminished-to-absent peristalsis in the distal portion of the esophagus composed of smooth muscle, and lack of a coordinated LES relaxation in response to swallowing. These abnormalities are recognized radiographically by aperistalsis, esophageal dilatation, and decreased opening of the LES, with a characteristic “bird-beak” appearance. The principal symptom of this disorder is dysp...

[Effect of nasogastric tube on esophageal mucosa].

Science.gov (United States)

Barinagarrementeria, R; Blancas Valencia, J M; Teramoto Matsubara, O; de la Garza González, S

1991-01-01

We studied 30 patients. 20 were males and 10 females. Mean age was 48 year old. Esophageal disease was not present neither gastro-esophageal reflux. Biopsy was taken between 24 hours and 25 days after nasogastric tube (NG) was put into place. Endoscopic findings were: hyperemic mucosa, submucosal hemorrhage, clots, erosions and ulcers near Esophago-gastric junction. Intraepithelial edema, vessel congestion, polymorphonuclear infiltration, fibrin thrombosis of submucosal vessels, ischemia, epithelial regeneration and ulcer were common histologic findings. All endoscopic and histologic alterations were related to the length of time of NG tube contact with the esophageal mucosa. We concluded that NG tube damages the esophageal mucosa by two mechanisms: a) Local irritation that favors b) gastric reflux by decreasing lower esophageal sphincter pressure.

Correlative analysis of longitudinal changes in bronchoalveolar lavage, 67Gallium scanning, serum angiotensin-converting enzyme activity, chest x-ray, and pulmonary function tests in pulmonary sarcoidosis

International Nuclear Information System (INIS)

Okada, Mitsuko; Takahashi, Hideki; Nukiwa, Toshihiro; Matsuoka, Rokuro; Furuse, Makoto; Kitamura, Satoshi; Kira, Shiro.

1987-01-01

Despite the relatively high cost and complicated procedures, Gallium-67 ( 67 Ga) scanning and bronchoalveolar lavage (BAL) are increasingly advocated as more sensitive indicators of disease activity in sarcoidosis than chest X-ray and serum angiotensin-converting enzyme activity (SACE). To evaluate the clinical usefulness of 67 Ga scanning and BAL, we followed 31 patients with pulmonary sarcoidosis, using these four parameters, at 9- to 24-month intervals over periods of 9 to 48 months. We obtained 68 complete evaluations. Close correlations were observed among chest X-ray, 67 Ga scanning, SACE, and the percent-age of lymphocytes in BAL fluid (p 67 Ga scanning and BAL are not necessarily indicated in the long-term management of pulmonary sarcoidosis. (author)

Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists.

Science.gov (United States)

Mearin, Fermín; Ponce, Julio; Ponce, Marta; Balboa, Agustín; González, Miguel A; Zapardiel, Javier

2012-09-21

To investigate usefulness of adherence to gastro-esophageal reflux disease (GERD) guideline established by the Spanish Association of Gastroenterology. Prospective, observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice. Patients (aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD (heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms, such as dyspeptic symptoms and/or supraesophageal symptoms. Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists. Endoscopy was indicated in 123 (41%) patients: 50 with alarm symptoms, 32 with age > 50 years without alarm symptom. Seventy-two patients (58.5%) had esophagitis (grade A, 23, grade B, 28, grade C, 18, grade D, 3). In the presence of alarm symptoms, endoscopy was indicated consistently with recommendations in 98% of cases. However, in the absence of alarm symptoms, endoscopy was indicated in 33% of patients > 50 years (not recommended by the guideline). Adherence for proton pump inhibitors (PPIs) therapy was 80%, but doses prescribed were lower (half) in 5% of cases and higher (double) in 15%. Adherence regarding duration of PPI therapy was 69%; duration was shorter than recommended in 1% (4 wk in esophagitis grades C-D) or longer in 30% (8 wk in esophagitis grades A-B or in patients without endoscopy). Treatment response was higher when PPI doses were consistent with guidelines, although differences were not significant (95% vs 85%). GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms; PPIs were prescribed at higher doses and longer

Achalasia and Esophageal Motility Disorders

Science.gov (United States)

... Tumors Mediastinal Tumors Achalasia and Esophageal Motility Disorders Pleural Diseases Mesothelioma Achalasia and Esophageal Motility Disorders Overview The esophagus (ĕ-sof´ah-gus) is the hollow, muscular tube that moves food and liquid from your mouth to your stomach. If the ...

Advances in esophageal motor disorders

NARCIS (Netherlands)

Smout, André Jpm

2008-01-01

PURPOSE OF REVIEW: Esophageal motor disorders, often leading to dysphagia and chest pain, continue to pose diagnostic and therapeutic problems. In the past 12 months important new information regarding esophageal motor disorders was published. This information will be reviewed in this paper. RECENT

Advances in esophageal motor disorders

NARCIS (Netherlands)

Smout, Andre J. P. M.

Purpose of review Esophageal motor disorders, often leading to dysphagia and chest pain, continue to pose diagnostic and therapeutic problems. In the past 12 months important new information regarding esophageal motor disorders was published. This information will be reviewed in this paper. Recent

Genetics of Eosinophilic Esophagitis

Science.gov (United States)

2012-03-01

disease of the esophagus that affects at least 4 in 10,000 persons.1 Although symptomatically resembling gastroe - sophageal reflux disease, EE is...clinically defined as esophageal eosinophilia (>_15 intraepithelial eosinophils per high-powered field) in the absence of abnormal acid reflux disease...that distinguish eosin- ophilic esophagitis (EoE) from other inflammatory disorders, including gastroesophageal reflux disease (GERD). As the prev

Prevention of Esophageal Variceal Rebleeding

Directory of Open Access Journals (Sweden)

Gin-Ho Lo

2006-12-01

Full Text Available The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. When considering their effectiveness in reduction of rebleeding, the associated complications cannot be neglected. Due to unavoidable high incidence of complications, shunt surgery and endoscopic injection sclerotherapy are now rarely used. Transjugular intrahepatic portosystemic stent shunt was developed to replace shunt operation but is now reserved for rescue therapy. Nonselective beta-blockers alone or in combination with isosorbide mononitrate and endoscopic variceal ligation are currently the first choices in the prevention of variceal rebleeding. The combination of nonselective beta-blockers and endoscopic variceal ligation appear to enhance the efficacy. With the advent of newly developed measures, esophageal variceal rebleeding could be greatly reduced and the survival of cirrhotics with bleeding esophageal varices could thereby be prolonged.

Balloon dilatations of esophageal strictures

International Nuclear Information System (INIS)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De

1990-01-01

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used

Balloon dilatations of esophageal strictures

Energy Technology Data Exchange (ETDEWEB)

Seo, Jeong Jin; Juhng, Seon Kwan; Kim, Jae Kyu; Chung, Hyon De [Chonnam National University College of Medicine, Seoul (Korea, Republic of)

1990-04-15

Most benign esophageal strictures can be successfully dilated with conventional bougienage technique. But occasionally strictures are so tight, lengthy, or sometimes irregular that this technique fail, and surgical intervention is required. Since 1974 Gruentzig balloon catheter has succeed when used for strictures in the cardiac and peripheral vasculatures, the biliary and urinary tracts, the colon of neonates after inflammatory disease and also in the esophagus. Fluoroscopically guided balloon catheters were used to dilate 30 esophageal strictures in 30 patients over 3 years at Department of Diagnostic Radiology, Chonnam University, College of Medicine. The distribution of age was from 7 years to 71 days and the ratio of male to female was 15:15. The causes of benign stricture (23 cases) were post-operative strictures (13), chemical (4), achalasia (3), chronic inflammation (2), esophageal rupture (1) and those of malignant stricture (7 cases) were post-radiation stricture of primary esophageal cancer (6) and metastatic esophageal cancer (1). The success rate of procedure was 93% (28/30). The causes of failure were the failure of passage of stricture due to markedly dilated proximal segment of esophagus (1 case) and too long segment of stricture (1 case). Complication of procedure was the diverticular-formation of esophagus in 3 cases, but has no clinical significance in follow-up esophagography. In conclusion, fluoroscopically guided balloon dilation of esophageal stricture appears to be safe, effective treatment and may be have theoretical advantages over conventional bougienage and also should be considered before other methods of treatment are used.

Pediatric esophageal scintigraphy. Results of 200 studies

International Nuclear Information System (INIS)

Guillet, J.; Wynchank, S.; Basse-Cathalinat, B.; Christophe, E.; Ducassou, D.; Blanquet, P.

1983-01-01

Esophageal transit of a small volume of watery liquid has been observed scintigraphically in 200 studies performed on patients aged between 6 days and 16 years. Qualitative information concerning esophageal morphology and function in the various phases of deglutition, and scintigraphic features of achalasia, stenosis, and other pathologies are described. Measured esophageal transit time and its normal variation, its relevance to the diagnosis of esophagitis, and the monitoring of treatment are discussed. This technique observing distinct deglutitions has proven a useful diagnostic tool. Its advantages and limitations are discussed in comparison with other methods

Pediatric esophageal scintigraphy. Results of 200 studies

Energy Technology Data Exchange (ETDEWEB)

Guillet, J.; Wynchank, S.; Basse-Cathalinat, B.; Christophe, E.; Ducassou, D.; Blanquet, P.

1983-09-01

Esophageal transit of a small volume of watery liquid has been observed scintigraphically in 200 studies performed on patients aged between 6 days and 16 years. Qualitative information concerning esophageal morphology and function in the various phases of deglutition, and scintigraphic features of achalasia, stenosis, and other pathologies are described. Measured esophageal transit time and its normal variation, its relevance to the diagnosis of esophagitis, and the monitoring of treatment are discussed. This technique observing distinct deglutitions has proven a useful diagnostic tool. Its advantages and limitations are discussed in comparison with other methods.

Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy.

Science.gov (United States)

Jensen, Elizabeth T; Eluri, Swathi; Lebwohl, Benjamin; Genta, Robert M; Dellon, Evan S

2015-08-01

The possible association between eosinophilic esophagitis (EoE) and celiac disease is controversial because prior results have been contradictory. We aimed to determine the relationship between EoE and celiac disease among patients with concomitant esophageal and duodenal biopsies. We conducted a cross-sectional study in a U.S. national pathology database by using data from January 2009 through June 2012. Our primary case definition was defined by the presence of esophageal eosinophilia with ≥15 eosinophils per high-power field. The crude and adjusted (for age and sex) odds of esophageal eosinophilia for patients with active celiac disease were compared with those without celiac disease. Sensitivity analyses were performed by using more stringent case definitions and by estimating the associations between celiac disease and reflux esophagitis and celiac disease and Barrett's esophagus. Of 292,621 patients in the source population, 88,517 with both esophageal and duodenal biopsies were studied. Four thousand one hundred one (4.6%) met criteria for EoE, and 1203 (1.4%) met criteria for celiac disease. Odds of EoE were 26% higher in patients with celiac disease than in patients without celiac disease (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 0.98-1.60). The magnitude of association varied according to EoE case definition, but all definitions showed a weak positive association between the 2 conditions. There was no association between celiac disease and reflux esophagitis (aOR, 0.95; 95% CI, 0.85-1.07) or Barrett's esophagus (aOR, 0.89; 95% CI, 0.69-1.14) and celiac disease. There is a weak increase in EoE in patients with celiac disease. This association strengthened with increasingly stringent definitions of EoE and was not observed for other esophageal conditions. In patients with celiac disease, concomitant EoE should be considered in the correct clinical setting. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights

Chemoprevention of esophageal squamous cell carcinoma

International Nuclear Information System (INIS)

Stoner, Gary D.; Wang Lishu; Chen Tong

2007-01-01

Esophageal squamous cell carcinoma (SCC) is responsible for approximately one-sixth of all cancer-related mortality worldwide. This malignancy has a multifactorial etiology involving several environmental, dietary and genetic factors. Since esophageal cancer has often metastasized at the time of diagnosis, current treatment modalities offer poor survival and cure rates. Chemoprevention offers a viable alternative that could well be effective against the disease. Clinical investigations have shown that primary chemoprevention of this disease is feasible if potent inhibitory agents are identified. The Fischer 344 (F-344) rat model of esophageal SCC has been used extensively to investigate the biology of the disease, and to identify chemopreventive agents that could be useful in human trials. Multiple compounds that inhibit tumor initiation by esophageal carcinogens have been identified using this model. These include several isothiocyanates, diallyl sulfide and polyphenolic compounds. These compounds influence the metabolic activation of esophageal carcinogens resulting in reduced genetic (DNA) damage. Recently, a few agents have been shown to inhibit the progression of preneoplastic lesions in the rat esophagus into tumors. These agents include inhibitors of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), vascular endothelial growth factor (VEGF) and c-Jun [a component of activator protein-1 (AP-1)]. Using a food-based approach to cancer prevention, we have shown that freeze-dried berry preparations inhibit both the initiation and promotion/progression stages of esophageal SCC in F-344 rats. These observations have led to a clinical trial in China to evaluate the ability of freeze-dried strawberries to influence the progression of esophageal dysplasia to SCC

Esophageal varices in cirrhotics on dynamic computed tomography

Energy Technology Data Exchange (ETDEWEB)

Miyazaki, Masaru; Takahashi, Osamu; Shimura, Tadanori

1985-07-01

Dynamic CT was performed on fifteen cirrhotics. The cirrhotics with esophageal varices were compared with those without esophageal varices in regard to the enhanced capacity of the liver and the spleen and the declining ratio of the spleen following the enhancement. Both the liver and the spleen in cirrhotics were enhanced less than non-cirrhotics, especially in those with esophageal varices (p<0.01). Splenic declining ratio following splenic enhancement clearly distinguish cirrhotics with esophageal varices from those without esophageal varices (p<0.01). These parameters on dynamic CT could be useful for the diagnosis of portal hypertension in cirrhotics.

Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism

International Nuclear Information System (INIS)

Eastwood, G.L.; Braverman, L.E.; White, E.M.; Vander Salm, T.J.

1982-01-01

A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with 131 I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism

Reversal of lower esophageal sphincter hypotension and esophageal aperistalsis after treatment for hypothyroidism

Energy Technology Data Exchange (ETDEWEB)

Eastwood, G.L.; Braverman, L.E.; White, E.M.; Vander Salm, T.J.

1982-08-01

A 65-year-old woman suffered from both chronic gastroesophageal reflux, which was complicated by columnar metaplasia (Barrett's epithelium), and profound hypothyroidism. An esophageal motility tracing showed absence of peristalsis in the lower esophagus and the lower esophageal sphincter (LES) could not be identified. Thyroid replacement therapy, in conjunction with antacid and cimetidine treatment, was associated not only with improvement in the gastroesophageal reflux symptoms, but also with a return of esophageal peristalsis and LES pressure to normal. To support our clinical observations, we rendered four cats hypothyroid with /sup 131/I and documented a fall in LES pressure. We propose that abnormal smooth-muscle function of the esophagus may be another manifestation of the gastrointestinal motility disturbances which are associated with hypothyroidism.

Radiological evaluation of esophageal motility and gastroesophageal reflux disease

International Nuclear Information System (INIS)

Schima, W.; Pokieser, P.; Schober, E.

1995-01-01

Radiological evaluation of esophageal motility and the lower esophageal sphincter has gained increased attention in recent years. Videofluoroscopic investigation of esophageal motor function is superior to static film radiography, as repeated analysis of the videotaped recordings is possible. With emphasis on radiological techniques, normal esophagel physiology and motility and a variety of esophageal motor disorders are discussed in this review paper. Radiological evaluation of gastroesophageal reflux and reflux esophagitis is described. Clinical and radiological findings in esophageal motility disorders and gastroesophageal reflux disease and the radiological efficacy compared to that of manometry and pH-metry are discussed. (orig.) [de

Significant CD4, CD8, and CD19 lymphopenia in peripheral blood of sarcoidosis patients correlates with severe disease manifestations.

Science.gov (United States)

Sweiss, Nadera J; Salloum, Rafah; Gandhi, Seema; Ghandi, Seema; Alegre, Maria-Luisa; Sawaqed, Ray; Badaracco, Maria; Pursell, Kenneth; Pitrak, David; Baughman, Robert P; Moller, David R; Garcia, Joe G N; Niewold, Timothy B

2010-02-05

Sarcoidosis is a poorly understood chronic inflammatory condition. Infiltration of affected organs by lymphocytes is characteristic of sarcoidosis, however previous reports suggest that circulating lymphocyte counts are low in some patients with the disease. The goal of this study was to evaluate lymphocyte subsets in peripheral blood in a cohort of sarcoidosis patients to determine the prevalence, severity, and clinical features associated with lymphopenia in major lymphocyte subsets. Lymphocyte subsets in 28 sarcoid patients were analyzed using flow cytometry to determine the percentage of CD4, CD8, and CD19 positive cells. Greater than 50% of patients had abnormally low CD4, CD8, or CD19 counts (p<4x10(-10)). Lymphopenia was profound in some cases, and five of the patients had absolute CD4 counts below 200. CD4, CD8, and CD19 lymphocyte subset counts were significantly correlated (Spearman's rho 0.57, p = 0.0017), and 10 patients had low counts in all three subsets. Patients with severe organ system involvement including neurologic, cardiac, ocular, and advanced pulmonary disease had lower lymphocyte subset counts as a group than those patients with less severe manifestations (CD4 p = 0.0043, CD8 p = 0.026, CD19 p = 0.033). No significant relationships were observed between various medical therapies and lymphocyte counts, and lymphopenia was present in patients who were not receiving any medical therapy. Significant lymphopenia involving CD4, CD8, and CD19 positive cells was common in sarcoidosis patients and correlated with disease severity. Our findings suggest that lymphopenia relates more to disease pathology than medical treatment.

[Transient lower esophageal sphincter relaxation and the related esophageal motor activities].