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In this paper on hepatosplenic sarcoidosis the authors confirmed currently accepted concepts and further refined the examination of liver and spleen by selective arteriography of the celiac artery. In addition, they emphasized the frequency of hepatosplenomegaly in sarcoidosis as well as the speckled aspect of the parenchyma of both organs, which appeared dotted with innumerable small lacunae. This appearance was not strictly pathognomonic of sarcoidosis. Cortisone treatment caused reversion to a normal pattern in the patients.

Resume Il n'y a pas de formule des globulines et des immunoglobulines seriques capables de caracteriser la sarcoidose. L'hyperprotidemie est presente dans 31 p. cent des cas et les gammaglobulines sont augmentees dans 23 p. cent des cas. Les immunoglobulines sont accrues de maniere globale dans 79 p. cent des cas. Leur inflation porte preferentiellement sur les IgM et les IgA notamment au stade I de la maladie. Cette particularite est surtout flagrante chez les sarcoidiens anergiques a la tuberculine de meme que chez ceux qui ont un test de Kveim positif. Chez les sarcoidiens « metisoriginaires des Antilles francaises (Iles Caraibes), les anomalies de l'immunoelectrophorese des protides seriques sont observees avec une frequence plus grande que chez les sarcoidiens d'origine geographique differente. L'augmentation du taux des IgG est egalement plus frequente dans ce groupe ethnique.

L'epithelium bronchiolaire humain a ete etudie sur 3 biopsies pulmonaires. Quatre types cellulaires principaux peuvent etre identifies.

The subject of our research was the use of multiple indicators to study the lungs of rats during a pathological process induced by complete Freund's adjuvant (CFA). The parameters studied were extravascular water (idQwl), the capillary permeability of [14C]sucrose, and the unrecovered fraction of [3H5glucose. We ascertained that idQwl gives a valuable estimate of total pulmonary water (r=0.91, n=30) and allows a satisfactory quantification of granulomatosis, as is shown by the comparison between the values of idQwl measured at different stages of the lesional process with average number of nodules per slice of right middle pulmonary lobe. The capillary permeability of sucrose is normal both at early and late stages of the CFA granulomatosis process. The fraction of [3H]glucose not recovered increases significantly (p less than 0.001) during the initial stage of the CFA process. This apparent loss of indicator can be explained by the existence of a slow cellular compartment.

On the basis of eight cases, the authors consider the relationship between sarcoidosis and malignant tumours. The development of a malignant tumour simultaneously or during the years following the onset of sarcoidosis is a rarely seen phenomenon. Only seven cases out of 580 of sarcoidosis were noted in this series. The absence of comparison with control groups of similar age and sex as well as of prolonged observation in a certain number of sarcoidosis patients cured or lost from sight prevents any valid statistical assessment, but the average age (51 years) of the patients at the time of discovery of the tumour is that of the risk of spontaneous development of carcinoma. Thus the association "sarcoidosis-malignant tumour" would appear to be purely a question of chance. The finding of sarcoid-type histopathological reactions in lymph nodes involved in the spread of a malignant tumour often represents the residual expression or reactivated by the tumour of old sarcoidosis which had gone unnoticed. The development of a malignant tumour is capable of provoking in old sarcoidosis patients a late recurrence of the disease.

Fibrosis of the intestinal lymphatic vessels, produced in one case by tuberculosis and, in the other, by appendicitis and peritonitis, caused blockage of the main lymphatic vessels causing, clinically, a protein-losing enteropathy similar to that noted in congenital lymphatic diseases of childhood. In the laboratory, there was noted a fall in serum protein, lipid and cholesterol. A fat absorption test was very abnormal showing a flat curve. During laparotomy, there was discovered on the small intestine, the same layout of lymph vessels, resembling a lace network, as that observed in congenital malformations. Intestinal lymphography showed considerable stasis of the opaque substance and absence of injection of the lymph vessels in the mesentery.

Erythema nodosum was seen in 37 out of 564 cases of sarcoidosis, i.e. 6.4. per cent. The female preponderance of the association was 56.8 per cent. It was accompanied by fever in 84 per cent of cases and with an increased sedimentation rate, greater than 50 mm in the first hour, in 44 per cent of cases. Articular manifestations (arthralgia or arthritis) were seen in 73 per cent of cases, with a predilection for the ankles. Progression by acute excerbations of the erythema nodosum and/or articular manifestations was rare. Mediastino-pulmonary involvement accompanying the erythema nodosum included mediastinal lymphadenopathy in all cases. Infiltration of the pulmonary parenchyma was seen in 27 per cent. Spontaneous resolution of the mediastino-pulmonary lesions occurred in 82 per cent of cases, regardless of the initial radiological appearance.

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.

The analysis of 12 families with 2 or more members suffering from sarcoidosis led a number of findings:--the increased prevalence of sarcoidosis in persons of mixed race from the French Caribbean), which would suggest the intervention of a racial component in the pathogenesis of sarcoidosis;--the rarity of cases where sarcoidosis affects more than 2 members of the same family;--the preponderance within the same family of subjects of identical sex, whether direct collaterals or a parent-child relationship (20 cases out of 26).--the importance of mother-child transmisstion (5 cases) as opposed to father-child transmission (1 case).

Three patients with eye and salivary dryness presenting the scintigraphic and histological features of Sjogren's syndrome and also suffering from sarcoïdosis, are reported. The authors stress the rarity of clinically indentifiable dry oculo-salivary syndromes whilst routine scintigraphy of the principle salivary glands using technetium 99 m often reveals altered salivary function. They consider that the primary feature in the development of this dry salivary syndrome consists of fibro-inflammatory lesions of the glandular interstitium, seen in specimens of the glands of the labial mucosae, which are sequelae of the initial sarcoid infiltration. They point out that Sjogren's syndrome occurring in relation with sarcoïdosis has certain special features. These include its appearance in relatively young subjects, the minimal symptoms, the non-essential presence of inflammatory signs and the absence of associated connective tissue disorder.