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In a retrospective review of six patients with malignancy preceding sarcoidosis, we found four cases of malignant lymphoproliferative disease (LD) and one case each of ovarian cancer and breast cancer. The median interval from onset or relapse of malignancy to sarcoidosis was nine months. Of the four patients with LD, sarcoidosis appeared within six months of termination of chemotherapy for three of the patients and 15 months after allogeneic bone marrow transplantation for the fourth patient. At the time of diagnosis of sarcoidosis, there was no clinical or pathologic evidence of malignancy in the chest. We conclude that in contradistinction to the previously described syndrome of sarcoidosis preceding LD, there exists a syndrome of sarcoidosis following malignancy with or without chemotherapy.

Pulmonary complications are a common cause of morbidity and mortality after bone marrow transplantation. Some of these complications are infectious and related to the degree of ongoing immunosuppression, and thus vary with the posttransplant marrow reconstitution and the need for continued immunomodulating drugs. Noninfectious complications are related to previous chemotherapy, the transplantation protocol and conditioning regimen, and, in allogeneic transplants, the presence of graft-versus-host disease. The various complications are classified based on their timing after the transplant procedure. A diagnostic and therapeutic approach is outlined and the prognosis is discussed.

In a retrospective study of thirty-one immunosuppressed patients with new pulmonary infiltrates transbronchial biopsy provided a specific diagnosis in 11 of the 31 (36%) patients. In a further five patients, whose biopsy showed non-specific interstitial pneumonitis, a specific diagnosis was established by other means. Overall a specific diagnosis was obtained in 52% of patients. Twelve patients were left with a diagnosis of non-specific interstitial pneumonitis. In three out of 31 (10%) patients insufficient tissue was obtained. The seven patients who had metastatic carcinoma of the lung did poorly. The nine with other specific diagnoses did better in that five of them were alive after more than 11 months of follow-up. Patients with non-specific pneumonitis did well; eight out of 12 (67%) were alive after an average follow-up of 13.4 months. In 27 of the 31 (87%) patients the procedure was felt to have influenced therapeutic decisions. This was true whether the biopsy yielded a specific or a non-specific diagnosis. In our series making a specific diagnosis did not improve the patients' survival. Those with non-specific pneumonitis who were treated empirically did well, as did patients with specific diagnoses other than metastatic carcinoma of the lung.

We have conducted a prospective comparison of 155 rheumatoid patients and 95 control subjects. Both groups were selected without regard to respiratory status, but were comparable in age, sex and smoking experience. The prevalence of respiratory symptoms, of past respiratory illnesses and of pulmonary function findings of airway obstruction was similar in both groups. However, the rheumatoids showed an increased frequency of chest crackles and abnormal chest radiographs, and had pulmonary function changes suggestive of a restrictive ventilatory defect. These pulmonary abnormalities were associated with smoking, the presence of nonpulmonary extraarticular features, the level of rheumatoid disease activity and treatment with oral corticosteroid or gold.

Infectious and noninfectious forms of pulmonary disease are the most common complications of acquired immune deficiency syndrome (AIDS), and many are amenable to treatment. We describe the clinical and radiologic features of the most common causes of lung disease in AIDS patients and review the drugs available for treatment. In addition, we provide a strategy for the clinical assessment and management of patients with human immunodeficiency virus infection who have lung infiltrates.

Study Objectives: To determine if transcatheter embolotherapy is safe and effective for the treatment of pulmonary arteriovenous malformations during pregnancy.Design: Prospective study.Setting: Specialized hereditary hemorrhagic telangiectasia centers at Yale University School of Medicine and St. Michael's Hospital, University of Toronto.Patients: Seven pregnant women (age range, 24 to 34 years; gestational age range, 16 to 36 weeks) undergoing transcatheter embolotherapy.Interventions: Transcatheter embolotherapy in all patients.Measurements and Results: Thirteen pulmonary arteriovenous malformations in seven patients were embolized with detachable silicone balloons and/or stainless steel coils without incident. The estimated fetal radiation dose ranged from < 50 to 220 mrad. No complications of pulmonary arteriovenous malformations occurred in any of the patients after transcatheter embolotherapy. The mothers went on to deliver healthy babies in all cases.Conclusions: Transcatheter embolotherapy of maternal pulmonary arteriovenous malformations performed by an experienced radiologist appears to be safe and effective after 16 weeks of gestational age. [ABSTRACT FROM AUTHOR]