A case of hepatic and bone marrow sarcoidosis with progressive renal failure: diagnostic and therapeutic challenges.

Sarcoidosis is a systemic granulomatous disease, sometimes characterized by an extrapulmonary localization in 30 - 50% of cases. We describe a 60-year-old Italian man with an unexplained history of fatigue, ascitis and progressive renal function impairment. Diagnosis of hepatic and bone marrow sarcoidosis was established by histology, and fast improvement of renal function was obtained after starting  corticosteroid therapy. Atypical presentation and simultaneous involvement of liver, bone marrow and kidneys make diagnosis of extrapulmonary sarcoidosis still a diagnostic challenge. Delayed diagnosis could lead to serious organ damage like a progressive severe kidney failure.

[Environmental pollution from dioxins and soft tissue sarcomas in the population of Venice and Mestre: an example of the use of current electronic information sources]. / Indagine su inquinamento ambientale da diossine e sarcomi dei tessuti molli nella popolazione di Venezia e Mestre: un esempio di utilizzo di fonti informative elettroniche correnti.

OBJECTIVE: Estimating the potential carcinogenic risk associated with exposure to dioxins generated by industrial emissions and urban incinerators. DESIGN: We conducted a geographical investigation on the relationship between Soft Tissue Sarcomas (STS) and other tumours, and estimated levels of exposures to dioxins. Estimates ofthe population's exposure were derived from a historical analysis of emissions of dioxins and other pollutants, conducted by the Province of Venice in all the Venetian area in 1980-1990. Cancer cases were selected from two electronic pathology databases of Venice and Mestre, computerized since 1987. All STS diagnoses were revised in order to improve the quality of the cases in the study and cases of Kaposi sarcoma were excluded from the analysis. The 198 remaining STS--Hodgkin's lymphoma, non-Hodgkin' lymphoma and subjects with at least one cancer--were linked to the registry of residents and mapped according to the pollutant level estimates using GIS techniques. The same procedure was applied to cases of non-Hodgkin's lymphoma (n=822), Hodgkin's lymphoma (n=142) and to 25.568 cases of all cancer at other sites, with microscopic confirmation for comparison. SETTING: Venetian AULSS 12. RESULTS: Risks for STS (measured as Standardized Incidence Ratios SIR) did not show any trend related to categories of dioxin pollution. Among women, a statistically significant increased SIR of 1.69 was estimated for the highest category of exposure. The corresponding SIR for Hodgkins lymphoma was 1.94 (I.C. 1.08-1.19). No major excesses were estimated for other cancer sites. CONCLUSION: Overall, no consistent association between cancer risk and estimated exposure to dioxins was detected in the population under study However, a statistically significant excess of STS among women in the highest exposure category allows for the possibility of a role of environmental exposure.