ABSTRACT
A 37-year-old man was referred to our institution for assessment of possible sarcoidosis with involvement of the central nervous system. Before referral, he experienced a systemic illness that persisted for several months, during which time ocular and pulmonary noncaseating granulomas were identified. Sarcoidosis with involvement of the central nervous system was tentatively diagnosed. Because of several inconsistencies in the preliminary diagnosis of sarcoidosis, further assessment was pursued, and syphilis was diagnosed. Herein we emphasize the useful clinical features for distinguishing syphilis from sarcoidosis and review the clinical manifestations of pulmonary syphilis.
Subject(s)
Nervous System Diseases/diagnosis , Sarcoidosis/diagnosis , Syphilis/diagnosis , Adult , Diagnosis, Differential , Humans , MaleABSTRACT
A mail survey of this type has several inherent drawbacks. First, answers to some of the questions, particularly those pertaining to complication rates, rely on the memory of participants. Second, the wording of certain questions may have imparted different meanings. Third, the format of the questionnaire may have confused some. Fourth, one cannot expect that all questionnaires will be answered fully. Fifth, as indicated by several respondents, several important topics (eg, topical anesthetic agents and mode of their delivery, prophylaxis against infective endocarditis, tracheobronchial stent placement, endobronchial intraluminal radiotherapy) were not included. Many respondents suggested inclusion of these and other questions in future surveys. Nevertheless, in the absence of any survey looking into a large number of bronchoscopy-related practices, mail surveys have the advantage of reflecting nationwide practice rather than results from selected centers, and this report provides some insight into bronchoscopy practices in North America. While the results indicate the present trends in bronchoscopy practices in North America, they do not establish or recommend any standards in bronchoscopy.
Subject(s)
Bronchoscopy , Bronchoscopy/adverse effects , Bronchoscopy/methods , Bronchoscopy/statistics & numerical data , Data Collection , Humans , United StatesABSTRACT
Stage I sarcoidosis usually presents with roentgenographic evidence of hilar adenopathy and the patients are totally asymptomatic. However, five patients were studied at the Mayo Clinic who had stage I sarcoidosis associated with obstructive disease of the airways. Four of the five presented with dyspnea, wheezing, and cough, and they were found to have expiratory slowing on physical examination. One patient was asymptomatic and her physical examination was normal. On pulmonary function testing, she had a decrease in maximal midexpiratory flow, and at fiberoptic bronchoscopy, mucosal changes consistent with noncaseating granuloma of sarcoidosis were seen. All five patients had the classic roentgenographic appearance of sarcoidosis, with hilar and right paratracheal adenopathy. Endobronchial involvement is well known in sarcoidosis, but its significance in stage I disease has not been emphasized in the literature. An awareness of this possibility is important because it may be an indication for bronchoscopy and mucosal biopsy in the patient with stage I sarcoidosis, particularly when the patient presents with dyspnea, wheezing, and cough. Also, corticosteroid, therapy may be indicated in selected patients with stage I sarcoidosis.
Subject(s)
Lung Diseases, Obstructive/etiology , Lung Diseases/complications , Sarcoidosis/complications , Adult , Aged , Female , Humans , Lung Diseases/drug therapy , Lung Diseases, Obstructive/drug therapy , Male , Middle Aged , Prednisone/therapeutic use , Sarcoidosis/drug therapyABSTRACT
Two patients, a mother and her son, had idiopathic pulmonary hemosiderosis. In the son, the onset was acute and he died of massive hemoptysis. The mother's disorder developed less acutely and the condition improved after temporary respiratory support and massive corticosteroid therapy. This is the first reported instance of idiopathic pulmonary hemosiderosis occurring in more than one member of the same family. The diagnosis of idiopathic pulmonary hemosiderosis depends on compatible clinical and pathologic data and on exclusion of secondary causes of intrapulmonary hemorrhage.
Subject(s)
Hemosiderosis/genetics , Lung Diseases/genetics , Adult , Female , Hemosiderosis/diagnosis , Hemosiderosis/pathology , Humans , Lung/pathology , Lung Diseases/pathology , Male , Middle Aged , PrognosisABSTRACT
The versatility of the flexible bronchoscope (FB) has resulted in the use of several methods for its introduction. A method is described for the oral introduction of the FB after oral intubation using the FB as a guide for insertion of a flexible oral endotracheal tube, a procedure that has been performed in more than 2,500 patients without known complications.
