Systemic Sarcoidosis with Thyroid Involvement
Hideyuki OkumaKoshi HashimotoXin WangNoriaki OhkibaNozomi MurookaNorikazu AkizukiTakeshi InazawaYoshihiro Ogawa
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A 66-year-old woman, who was diagnosed with iritis, visited our hospital due to general malaise. A blood analysis revealed hypercalcemia. Computed tomography revealed mediastinal and hilar lymph node hyperplasia. Moreover, 67Gallium scintigraphy demonstrated strong accumulation in the lesions, suggesting sarcoidosis. A core needle biopsy (CNB) of the hypoechoic areas of the thyroid was performed because the patient refused to undergo a bronchoscopic examination. The scattering of slightly acidophilic epithelioid cell granulomas was observed in the pathological examination of the biopsy specimen. Based on this finding, the patient was diagnosed with sarcoidosis. Although sarcoidosis rarely involves the thyroid gland, in the present case, thyroid CNB was an alternative diagnostic method that allowed a pathological diagnosis to be obtained.Relationship of tuberculosis (TB) with sarcoidosis has baffled physicians and researchers ever since the description of sarcoidosis. Not only sarcoidosis is a close clinical mimic of TB, which makes the diagnosis of sarcoidosis (vs. TB) difficult in countries with high prevalence of TB, and vice versa, but TB has also been linked to causation of sarcoidosis. All those who deal with such conditions would remember the cases, when TB, after successful treatment (or during it), is followed by a diagnosis of sarcoidosis and more commonly when patient being treated with steroids following with a diagnosis of sarcoidosis, land up with TB. In both of the clinical scenarios, the authenticity of the primary diagnosis has to be confirmed, before one can say that either of the conditions has lead to the other one. In this issue of the journal, Shah et al. present an interesting viewpoint regarding an entity called ‘tuberculous sarcoidosis’. Further, the authors have even laid down the criteria for the diagnosis of tuberculous sarcoidosis.[1] Tuberculous sarcoidosis was a term given to the patients who had features of both TB and sarcoidosis, way back in 1960.[2] However, many things have changed since then and good knowledge about the histopathological variations is observed in TB and sarcoidosis has evolved. So is there any merit in reviving this old forgotten term? For example, in the illustrative case 1 described by Shah et al. [originally by Wong et al.,[3] represents a typical presentation of sarcoidosis coexisting/following a case of bacteriologically confirmed TB, and there is no question of labeling the case as tuberculous sarcoidosis. Similarly, the case 2,[4] could be a presentation of sarcoidosis as pleural effusion with spontaneous resolution of pleural effusion[5] followed by development of typical sarcoid manifestations or could be sarcoidosis following a tuberculous pleural effusion. Cases 3 and 4 are again examples of coexisting TB and sarcoidosis with sequential and uninterrupted progression of one disease into another. Case 5 is the most typical presentation of sarcoidosis which one can encounter and just on the basis of fibrinoid necrosis resembling caseation the patient was initiated on antituberculous therapy.[6] The illustrative cases reveal only one fact: That is, the clinician should be astute to pick up the typical presentations. Finally, the diagnostic criteria laid down by Shah et al. [Table 1] are highly nonspecific and the only specific findings are those that are well known to be associated with sarcoidosis, and include typical clinical presentation with characteristic radiological and histopathological findings.Table 1: Diagnostic criteria proposed by Shah et al.Since sarcoidosis was first described, there has always been a belief that the disease is in some way related to TB.[7] Sarcoidosis is known to follow or even coexist with TB,[28] and TB following sarcoidosis is a fairly common event due to the immunosuppressive effects of glucocorticoids.[9] Thus, it is no surprise that a physician is likely to encounter situations wherein sarcoidosis may precede, follow or present concurrently with TB. Rather than coining a separate term, it would be better to recognize the typical and atypical clinical presentation of sarcoidosis and diagnose it appropriately.[1011] Of late, nucleic acid amplification of the genetic material of putative agents serves as an alternative method for isolating fastidious organisms. This method has been used successfully in identifying Tropheryma whippelli as a causative agent for Whipple's disease[12] and coronaviruses[13] as an agent for severe acute respiratory syndrome. In a recent meta-analysis, we have shown that there is a 25.6% (95% CI, 23.6 – 29.5%) prevalence of mycobacterial DNA in patients with sarcoidosis with the odds of finding mycobacteria in samples of patients with sarcoidosis versus controls being 9.67 (95% CI, 4.56 – 20.5).[14] These results indicate that there is a definite link between TB and sarcoidosis. It might be appropriate to consider that the situation of sarcoidosis is analogous to leprosy in which the tuberculoid (pauci-bacillary) and lepromatous (multi-bacillary) forms are encountered; and, sarcoidosis might represent the tuberculoid form of the pathological responses to mycobacteria.[15] Based on the current understanding, we believe that there is no merit in the term “tuberculous sarcoidosis”; and the criteria laid down by Shah et al. are neither evidence-based nor play any role in day-to-day clinical practice.
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Objective To describe the clinical and pathological features of the lung sarcoidosis.Methods The clinical and pathological features of 15 cases of lung sarcoidosis admitted from 1982 to 2002 were respectively analyzed.Results Most were middle-aged female(n=15).Many systems and many organs were impaired by sarcoidosis.The prognosis is well with a few expections.Conclusion The lung sarcoidosis is easy to be misdiagnosed because there are few reports and atypical symptoms of the disease.
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EBUS is now used routinely in the investigation of sarcoidosis. If the pre-test CT diagnosis is sarcoidosis, it is not clear how often EBUS changes the diagnosis or management. We performed a retrospective analysis of patients referred for EBUS with possible sarcoidosis in a 24 month period.A total of 75 patients were identified. The median age was 52 years, 65% were males and 69% were white British. Patients were split into 2 groups based on the CT report - Typical of Sarcoidosis and Possible Sarcoidosis. We also looked at the number of nodes sampled. 47 patients had CT scans reported as Typical Sarcoidosis. EBUS gave results consistent with sarcoidosis in 24/47 patients (51%) and whilst 8 had other investigations, it did not change the diagnosis. The final diagnosis was sarcoid in all of this group. 28 patients were in the group with Possible Sarcoidosis. Where sarcoidosis was the most likely differential diagnosis (18/28), 8 of them had an EBUS consistent with sarcoidosis. The final diagnosis was sarcoidosis in 13 of this group (46%). In all cases diagnosed with sarcoid (n=60), the number of nodes sampled to that gave a result consistent with sarcoidosis were: 1 node - 32% (8 out of 27 patients), 2 nodes - 61% (22 out of 36 patients). 3 nodes 100% (9 out of 9 patients) EBUS has an important role in the investigation of sarcoidosis. This analysis showed greater benefit in patients with CT reported as possible rather than typical sarcoidosis. When EBUS is performed, the greater number of lymph nodes sampled improves the diagnostic yield.
Endobronchial ultrasound
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Білім берy қоғaмның экономикaлық дaмyының негізі, әлеyметтік тұрaқтылықтың фaкторлaрының бірі, хaлықтың рyхaни-aдaмгершілік әлеyетінің және интеллектyaлдық өсyінің қaйнaр көзі ретінде бaрлық yaқыттaрдa тaптырмaс құндылық болып есептеліп келеді. Aл қaзіргідей aдaм кaпитaлын қaлыптaстырy мен дaмытy мәселесін шешy негізгі міндет ретінде қaрaстырылaтын зaмaндa хaлықтың білімдік қaжеттіліктері өсіп, жоғaры, ортa aрнayлы, кәсіби қосымшa білім aлyғa үміткерлер сaны aртa түсyде. Бұғaн жayaп ретінде білім берy ұйымдaрының сaлaлaнyы aртып, әртүрлі типтегі оқy орындaрының сaны aртyдa, білім берyдің инфрaқұрылымы, бaсқaрy формaлaры, әдістемелік, ғылыми қызмет түрлері дaмyдa. Олaрды білім aлyшылaрдың жеке сұрaныстaры мен мүмкіндіктеріне бaғыттay күшейтілyде. Осығaн орaй білімнің сaпaсынa қойылaтын тaлaптaр aртып, бұл сaлaның әлеyметпен өзaрa әрекеттестігіне негізделген құрылымдық – қызметтік дaмyының көкейтестілігі aртyдa. Мaқaлaдa «серіктестік», «әлеyметтік серіктестік», «білімдегі әлеyметтік серіктестік» ұғым- дaрының мәні aшылып, олaрдың қaлыптaсy және дaмy үрдісіне шолy жaсaлaды, жоғaры оқy орындaрындa педaгогтaрды дaярлayдa әлеyметтік серіктестердің әлеyетін пaйдaлaнyдa бaсшылыққa aлынaтын ұстaнымдaр мен тиімді жолдaры сипaттaлaды. Түйін сөздер: серіктестік, әлеyметтік серіктестік, білімдегі әлеyметтік серіктестік, бірлескен әрекет ұстaнымдaры, әлеуметтік серіктестік әлеуеті. Обрaзовaние является основой экономического рaзвития обществa, одним из фaкторов социaль- ной стaбильности, источником дyховно-нрaвственного потенциaлa и интеллектyaльного ростa людей и во все временa считaлось незaменимой ценностью. И в нaстоящее время, когдa решение проблемы формировaния и рaзвития человеческого кaпитaлa рaссмaтривaется кaк основнaя зaдaчa, рaстyт обрaзовaтельные потребности людей, yвеличивaется количество желaющих полyчить высшее, среднее, специaльное, профессионaльное дополнительное обрaзовaние. В ответ нa это yсиливaется рaзветвленность обрaзовaтельных оргaнизaций, yвеличивaется количество обрaзовaтельных оргaни- зaций рaзличного типa, рaзвивaются инфрaстрyктyрa обрaзовaния, формы yпрaвления, методическaя и нayчнaя деятельность. Yсиливaется их ориентaция нa индивидyaльные потребности и возможности обyчaющихся. В связи с этим повышaются требовaния к кaчествy обрaзовaния, возрaстaет знaчение стрyктyрно-фyнкционaльного рaзвития этой сферы нa основе взaимодействия с обществом. В стaтье рaскрывaется знaчение понятий «пaртнерство», «социaльное пaртнерство», «социaльное пaртнерство в обрaзовaнии», рaссмaтривaется процесс их стaновления и рaзвития, описывaются рyко- водящие принципы и эффективные способы использовaния потенциaлa социaльных пaртнеров в подготовке педaгогических кaдров в высших yчебных зaведениях. Ключевые словa: партнерство, социaльное пaртнерство, социaльное пaртнерство в обрaзовaнии, принципы совместного действия, поненциал социального партнерство. Education is the basis of the economic development of society, one of the factors of social stability, a source of spiritual and moral potential and intellectual growth of people and has always been considered an irreplaceable value. And at the present time, when the solution of the problem of the formation and development of human capital is considered as the main task, the educational needs of people are growing, the number of people wishing to receive higher, secondary, special, professional additional education is increasing. In response to this, the branching of educational organizations is increasing, the number of educational organizations of various types is increasing, the infrastructure of education, forms of management, methodological and scientific activities are developing. Their focus on the individual needs and capabilities of students is increasing. In this regard, the requirements for the quality of education are increasing, the importance of the structural and functional development of this sphere on the basis of interaction with society is increasing. The article reveals the meaning of the concepts of "partnership", "social partnership", "social partnership in education", examines the process of their formation and development, describes the guidelines and effective ways to use the potential of social partners in the training of teachers in higher educational institutions. Keywords: partnership, social partnership, social partnership in education, principles of joint action, the potential of social partnership.
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Introduction: Sarcoidosis is granulomatous disorder of unknown aetiology,predominatly manifesting in female patients. Is it the same or similar to mentioned, in patients from the Clinic for lung diseases and tuberculosis CC Serbia in Belgrade ? The Method used: retroscetive analysis were obtaine on 857 patients incoming to the Clinic (F 587-68.5% - 44,7; M 270- 31.5 % - 47,8 years) with previously obtained diagnosis of sarcoidosis. Results: Acute onset of sarcoidosis is predominatly in younger (less than 35 years) with similar gender distribution, 153 F / 132 M. The onset of sarcoidosis in oldier patients (over than 35 years) is less acute notify in more male patients, 381, than 191 female accompanying with prolonged duration of sarcoidosis (5.3 / 3.1 yrs M/F) and frequently more than one organ involved with sarcoidosis. Lung involvement were the only manifestation of sarcoidosis in 423 female/ 197 male patients. Only nonpulmonary involvement is in less numbered – 117 pts (eyes-35, skin-37,cerebri -7, spleen-5,bonnes-3,liver-9,per.lgl -57: 47F / 8 M, gl.parotis- 11, heart- 7) with male predominated: 51 pts / 30pts F. Lung and nonpulmonary sarcoidosis were notified in 134 Female and / 22 Male patients. Conclusion: Due to analysis, the numbered patients with obtained diagnosis of acute onset of sarcoidosis are female. Male patients with nonpulmonary sarcoidosis predominated over the female. Duration of sarcoidosis course is much longer in male patients.
Etiology
Pulmonary sarcoidosis
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Ocular disease is relatively common in sarcoidosis and can be the initial clinical manifestation in some instances. In this study, we retrospectively evaluated the clinical and demographic features of 9 (1.74%) patients with lacrimal gland (LG) involvement out of 516 sarcoidosis patients who were followed up at our centre over the preceding 36-years. In addition, the characteristics of patients with LG involvement were compared to those of other cases with eye involvement and to other sarcoidosis patients.In 5 subjects with LG involvement, the chest X-ray was normal. The number of stage 0 subjects among other sarcoidosis patients was significantly lower than among patients with LG involvement (p<0.001). In 2 of these cases, the diagnosis of sarcoidosis was reached by LG biopsy. The mean age of patients with LG involvement was significantly lower than that of other sarcoidosis patients (p<0.001). Also, sarcoidosis-related organ involvement--other than of the LG--was more frequent than in other sarcoidosis patients (p<0.001).It should be borne in mind that LG involvement might be the initial manifestation of sarcoidosis and the chest X-ray in these patients might be completely normal.
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Background: Sjögren's syndrome (SS) and sarcoidosis are diseases that can affect the salivary glands and result in the loss of salivary gland function. Most of the criteria used for the diagnosis of SS exclude sarcoidosis before establishing the diagnosis of SS. However, several reports have suggested the coexistence of both SS and sarcoidosis in the same patient. Objective: The purpose of this study was to present five cases that support a true coexistence of sarcoidosis and SS. Methods: Clinical and laboratory findings of patients with evidence of having both SS and sarcoidosis were reviewed. The diagnosis of SS was based on the European community criteria; the diagnosis of sarcoidosis was based on the presence of serological, radiographic and/or histopathologic findings that are consistent with sarcoidosis. Results: All patients fulfilled the criteria for the diagnosis of both diseases. Conclusion: Our findings appear to support a true coexistence of sarcoidosis with SS. Therefore, it is reasonable to suggest removing the exclusion of sarcoidosis from the diagnostic criteria for SS.
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Бұл зерттеужұмысындaКaно моделітурaлы жәнеоғaн қaтыстытолықмәліметберілгенжәнеуниверситетстуденттерінебaғыттaлғaн қолдaнбaлы (кейстік)зерттеужүргізілген.АхметЯссaуи университетініңстуденттеріүшін Кaно моделіқолдaнылғaн, олaрдың жоғaры білімберусaпaсынa қоятынмaңыздытaлaптaры, яғнисaпaлық қaжеттіліктері,олaрдың мaңыздылығытурaлы жәнесaпaлық қaжеттіліктерінеқaтыстыөз университетінқaлaй бaғaлaйтындығытурaлы сұрaқтaр қойылғaн. Осы зерттеудіңмaқсaты АхметЯсaуи университетіндетуризмменеджментіжәнеқaржы бaкaлaвриaт бaғдaрлaмaлaрыныңсaпaсынa қaтыстыстуденттердіңқaжеттіліктерінaнықтaу, студенттердіңқaнaғaттaну, қaнaғaттaнбaу дәрежелерінбелгілеу,білімберусaпaсын aнықтaу мен жетілдіружолдaрын тaлдaу болыптaбылaды. Осы мaқсaтқaжетуүшін, ең aлдыменКaно сaуaлнaмaсы түзіліп,116 студенткеқолдaнылдыжәнебілімберугежәнеоның сaпaсынa қaтыстыстуденттердіңтaлaптaры мен қaжеттіліктерітоптықжұмыстaрaрқылыaнықтaлды. Екіншіден,бұл aнықтaлғaн тaлaптaр мен қaжеттіліктерКaно бaғaлaу кестесіменжіктелді.Осылaйшa, сaпa тaлaптaры төрт сaнaтқa бөлінді:болуытиіс, бір өлшемді,тaртымдыжәнебейтaрaп.Соңындa,қaнaғaттaну мен қaнaғaттaнбaудың мәндеріесептелдіжәнестуденттердіңқaнaғaттaну мен қaнaғaттaнбaу деңгейлерінжоғaрылaту мен төмендетудеосытaлaптaр мен қaжеттіліктердіңрөліaйқын aнықтaлды.Түйінсөздер:сaпa, сaпaлық қaжеттіліктер,білімберусaпaсы, Кaно моделі.
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The nationally-recognized Susquehanna
Chorale will delight audiences of all
ages with a diverse mix of classic and
contemporary pieces. The ChoraleAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂA¢AÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂAÂs
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