CT引导经皮肺穿刺的临床应用--附80例临床分析

目的探讨CT引导下经皮细针肺穿刺吸取标本的方法及对肺部结节病变的诊断价值.方法总结分析80例肺部结节病变患者,全部CT检查高度怀疑肺部恶性肿瘤,42例纤维支气管镜检查,无阳性发现.术前CT定位,确定穿刺深度、方向和角度,选择0.7～0.9 mm 穿刺针吸取标本,细胞学检查.结果细胞学标本获取76例,获取率为95%.其中肺癌68例,结核6例,炎症2例.并发局限性气胸6例.结论CT引导下经皮细针肺穿刺对肺部结节性病灶,细胞学标本获取率高,操作简单、安全、可靠.     

The lymphocytic alveolitis in sarcoidosis is associated with increased amounts of soluble and cell-bound adhesion molecules in bronchoalveolar lavage fluid and serum

Berlin M, Lundahl J, Sköld CM, Grunewald J, Eklund A (Karolinska Hospital and Karolinska Institute, Stockholm, Sweden). The lymphocytic alveolitis in sarcoidosis is associated with increased amounts of soluble and cell-bound adhesion molecules in bronchoalveolar lavage fluid and serum. J Intern Med 1998; 244 : 333–340.

Objectives

Pulmonary sarcoidosis is a chronic inflammatory disorder of unknown aetiology accompanied by a lymphocytic alveolitis. It is likely that a selective and temporal expression of adhesion molecules plays a crucial role in the recruitment of cells to the inflammatory site. We investigated the expression of adhesion molecules on alveolar T-lymphocytes and in bronchoalveolar lavage (BAL) fluid and serum to elucidate mechanisms behind the accumulation of cells in the lung in sarcoidosis.

Design

In a cross-sectional study in patients with active and inactive sarcoidosis and in healthy volunteers, we examined, in serum and in BAL fluid, the soluble adhesion molecules, VCAM-1, ICAM-1, and P-, E- and L-selectin. In addition, the expressions of α₄-β₁ (VLA-4) and α₅-β₁ (VLA-5) integrins on alveolar T-lymphocytes were analysed.

Setting

The subjects attended the outpatient clinic at the Division of Respiratory Medicine, Karolinska Hospital, Stockholm, Sweden.

Subjects

Nineteen sarcoidosis patients, nine with clinically active disease, and 13 healthy volunteers were included in the study. The sarcoidosis diagnosis was based on a typical histological and/or clinical (symptoms, radiograph, lung function) picture.

Results

In sarcoidosis patients, particularly in those with active disease, an increase of the expressions of β₁-integrins was accompanied by elevated concentrations in BAL fluid of soluble VCAM-1. In serum, the levels of E-selectin and ICAM-1 were significantly higher in patients with active disease than in those with inactive disease and controls.

Conclusions

The findings offer some mechanistic explanations as to how the cell-rich alveolitis in sarcoidosis occurs, and furthermore suggest additional markers, such as s-ICAM-1, for assessment of disease activity.

     

Automated method for the determination of angiotensin-converting enzyme in serum

A method for the determination of angiotensin-converting enzyme in serum (S-ACE; EC 3.4.15.1.) with use of 3-(2-furylacryloyl)-L-phenylalanyl-glycyl-glycine (FAPGG) as substrate has been adapted for the Cobas Bio microcentri-fugal analyser. The method allows 24 determinations per hour in a sample volume of 28 μl with a within run precision of less than 3% and a between run precision of less than 5%. The reaction is linear up to at least 470 U/l. The reference interval in 92 blood donors has been determined to 14–110 U/l. The method correlates well with the manual method of Hurst & Lovell-Smith [4] (r=0.982). We have found the method excellently suited for routine assay.     

神经系统结节病

为提高对结节病神经系统损害的认识，复习９２例结节病病例，并对其中有神经系统损害的５例病例进行重点分析。５例中有１例尸解证实有脑结节病，４例有脑膜、颅神经、脊神经、周围神经损害。临床表现为癫痫、颅压高、肌肉无力、面肌瘫痪、视力减退。提示结节病的神经系统损害有多种临床表现；当临床出现原因不明的脑膜、脊髓、颅神经及周围神经病变时，应考虑结节病的可能。     

44例肺内结节病诊断方法分析并文献复习

目的回顾性分析肺内结节病的诊治过程,提高诊治水平。方法回顾分析2002年1月至2009年4月在我院住院,经各种检查确诊的肺内结节病患者44例,并复习关于肺内结节病诊断方法进展的文献。结果 44例患者中34例行支气管镜检查,其中20例次行EBB,阳性率35%。14例经纵隔镜、VATS或开胸肺活检,16例行外周淋巴结活检,阳性率均为100%,6例行前斜角肌淋巴结活检,阳性率67%,8例行皮肤病变活检,阳性率75%。结论随着支气管镜技术的发展及EBUS的应用,肺内结节病的诊断准确性增加,从而减少纵隔镜、VATS、开胸肺活检的应用。     

胸部结节病的CT表现

目的:探讨CT诊断胸部结节病的影像学表现。方法:回顾性分析经临床和病理证实并在治疗前后均进行CT检查的20例胸部结节病的CT征象。结果:20例均可见胸部淋巴结增大,其中14例有广泛的纵隔和对称性肺门淋巴结肿大;4例纵隔和单侧淋巴结肿大;2例可见纵隔淋巴结肿大。13例出现肺部病(包括9例肺内多发结节,3例斑片状融合块影,1例肺纤维化);1例胸膜病变。结论:结节病的胸部平片及临床表现缺乏特异性,CT对胸部结节病的诊断及鉴别诊断有一定的价值。     

Three cases of urolithiasis associated with sarcoidosis: A review of Japanese cases

We report three cases of urolithiasis associated with sarcoidosis and reviewed the Japanese published reports. All cases had hypercalcemia, hyperuricemia, hypercalciuria and renal dysfunction. A serum level of 1,25-(OH)2D3 was elevated and intact parathyroid hormone (PTH) was decreased. Stone components were predominantly calcium oxalate. Abnormal calcium metabolism is a well-known feature of sarcoidosis and the reported prevalence of urolithiasis in patients with sarcoidosis was 1.3-14.0% in the English published reports. However, urolithiasis associated with sarcoidosis is uncommon in Japan and we could find only 16 documented cases including ours. Abnormal calcium metabolism is caused by an increase in serum concentration of 1,25-(OH)2D3, which is derived from endogenous overproduction in the pulmonary macrophages. If patients with urolithiasis have abnormal calcium metabolism, renal impairment and suppression of PTH, the possibility of sarcoidosis should be considered for a differential diagnosis. Also, it should be emphasized that the presence or developing of urolithiasis is to be monitored during follow up of patients with sarcoidosis.     

Diagnostic value of peripheral lymph node biopsy in sarcoidosis: A report of 67 cases

A peripheral lymph node (PLN) 1 cm or greater was found in 79 of 546 sarcoidosis patients (14.5%) between 1972 and 2005. Seventy-two of the 79 sarcoidosis patients had a lymph node biopsy performed. Sixty-seven of these biopsy specimens were histologically diagnosed as sarcoidosis, whereas five patients had a reactive adenopathy. For patients with histological diagnosis of sarcoidosis, localizations of the biopsies were as follows: cervical (n=21), supra-clavicular (n=20), inguinal (n=11), axillary (n=8), epitrochlear (n=5) and submandibular (n=2). At the time of biopsy, 12 patients had stage 0 disease, 37 patients had stage I disease, 14 patients had stage II disease and four patients had stage III disease. Skin involvement (16.4%) was the most frequently observed type of organ involvement in patients who had enlarged PLNs due to sarcoidosis. In the presence of an enlarged PLN in sarcoidosis, biopsy had a greater diagnostic value compared with other methods, as well as having a relatively low cost (approximately US$120) in Turkey. No procedure-related complications were observed. In conclusion, it is recommended that PLNs be thoroughly examined when sarcoidosis is suspected. If an enlarged PLN is found, biopsy should be routinely performed because it is an easy, convenient and practical method, with a low complication risk and a high sensitivity.     

Tetracyclines: what a rheumatologist needs to know?

Tetracyclines are broad‐spectrum antibiotics that act at the ribosomal level. They were first introduced in 1948 and were widely prescribed by dermatologists in the early 1950s for treatment of acne. More recently, biologic actions of tetracyclines affecting inflammation, angiogenesis, and bone metabolism have been researched. The therapeutic effects of tetracycline and its analogues in rheumatic diseases have also been investigated. This article will review the rheumatological use of tetracycline and its analogues.     

Evidence of gastrointestinal immune reactivity in patients with sarcoidosis

Objectives. The aim of the present study was to explore the frequency of clinical and serological manifestations of gastrointestinal immune reactivity in a large group of Swedish patients with sarcoidosis. Design. In patients with documented sarcoidosis, the presence of pernicious anaemia and coeliac disease was examined. Antibodies to H⁺/K⁺ ATPase, gliadin (AGA-IgA/IgG) and endomysium (IgA-EMA) were analysed. In H⁺/K⁺ ATPase antibody-positive patients, serum gastrin levels were measured and, when elevated, gastrointestinal biopsy was offered (biopsy performed in 6/9 patients); biopsy was also offered to those with positive EMA or AGA of either class (biopsy performed in 8/12 patients). Subjects from national and local studies were used as controls. Setting. The patients were recruited at the Department of Pulmonary Medicine, and the study was conducted at the Department of Endocrinology, University of Lund, Malmö University Hospital, Malmö, Sweden. Subjects. Of all patients (n = 89) with documented sarcoidosis attending the Department of Pulmonary Medicine between January 1980 and December 1991, 78 [34 females and 44 males; median age at the time of the study, 48 (range 22–81) years; median observation time since the diagnosis of sarcoidosis, 120 (range 1–468) months] were examined. Results. Twenty-nine patients (37.2%) had signs of gastrointestinal immune reactivity. H⁺/K⁺ ATPase antibodies were detected in 19 patients (24.4 vs. 4% in controls, P = 0.00015). Serum gastrin levels (median 45, range 22–720 pmol L^–1) in those patients correlated with antibody titre (r² = 0.882). Gliadin antibodies were detected in 12 patients (15.4 vs. 8.1% in controls, P = 0.042), of whom 11 (14.1 vs. 4.5% in controls, P = 0.00114) had AGA-IgA alone. One patient had pernicious anaemia and another coeliac disease (EMA-positive). Conclusion. We have demonstrated a high frequency of gastric autoimmunity and gluten-associated immune reactivity in patients with sarcoidosis, occurring in almost 40% of the cases, the former being the most frequent gastrointestinal immune manifestation. Despite a high frequency of humoral autoimmunity, the frequencies of clinical disease, pernicious anaemia and coeliac disease were not increased as compared with the control population.