Sarcoidosis Vasc Dif
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Although the lung is the primary target of involvement, sarcoidosis can involve any organ in the body, including the eye. Ocular involvement may also be the initial manifestation of sarcoidosis in many patients. ⋯ This review discusses ocular manifestations and changes based upon the anatomic site of the eye, ocular tissue biopsy, and treatment. Early recognition and intervention are essential for the reduction of ocular morbidity and the improvement of the patient's quality of life.
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Sarcoidosis Vasc Dif · Mar 2002
ReviewHistopathological approach to patterns of interstitial pneumonia in patient with connective tissue disorders.
It is well established that some patients with connective tissue disorders will suffer from pulmonary disease at some stage in their disease progression. This article concentrates on the interstitial pneumonias, seen in association with most types of connective tissue disorder, particularly in the ligh of non-specific interstitial pneumonia (NSIP) being recognised as a distinct histological pattern. Most published articles on this subject precede recognition of NSIP and, as such, the relative incidence of patterns of interstitial pneumonia, as defined by the International Consensus Classification Committee for Interstitial Lung Disease (ICCILD), as well as the clinical and prognostic significance of these patterns is undergoing further scrutiny. ⋯ The histological pattern of usual interstitial pneumonia, the most frequently seen pattern in biopsies from patients with idiopathic pulmonary fibrosis/cryptogenic fibrosing alveolitis, appears to be comparatively rare. Furthermore, any biopsy showing a combination of histological patterns, a pattern of non-specific interstitial pneumonia or a pattern of lymphoid interstitial pneumonia/follicular bronchiolitis should be thoroughly investigated for a background connective tissue disorder, if previously unsuspected. Finally, the recently published prognostic data relating to these histological patterns in idiopathic disease should not be extrapolated to patients with connective tissue disorders.
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Sarcoidosis is a multi-organ granulomatous disorder that is characterised by the accumulation of CD4+ T-lymphocytes resulting in a Th-1 type immune response. Although our understanding of the immune response in sarcoidosis has improved in recent years through studies of bronchoalveolar lavage cells and fluid, the genetic predisposition and trigger factors (and their interrelationship) remain unclear. ⋯ This review focuses specifically on two pivotal areas that have been the subjects of intensive investigation recently: a) triggering by infective agents and b) host genetic susceptibility and relates these to broader issues of pathogenesis. It is concluded that one or more microbes behaving in a non-infectious fashion in a genetically predisposed individual trigger the sarcoidosis granulomatous response.
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Sarcoidosis Vasc Dif · Oct 2000
ReviewStructural basis for airflow limitation in chronic obstructive pulmonary disease.
The airflow limitation that characterises chronic obstructive pulmonary disease (COPD) has two main components: an increased resistance, which is due to airway obstruction, and a loss of the elastic recoil pressure of the lung, which is due to parenchymal destruction. Although it has long been known that the major site of increased resistance in COPD is the peripheral airways, recent studies have shown that central airways are involved in the disease as well. The purpose of this review is to describe the major structural and cellular changes present in peripheral airways, central airways and lung parenchyma of patients with COPD, and to underline the possible mechanisms contributing to airflow limitation in these subjects.
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Sarcoidosis Vasc Dif · Mar 2000
ReviewNew perspectives in pulmonary angiitis. From pulmonary angiitis and granulomatosis to ANCA associated vasculitis.
Traditionally clinical and histopathological features were mainly relied on for classification of vasculitis and granulomatosis of the lung. These can be complemented by immunodiagnostic features which contribute to the classification as well as to the understanding of the pathogenesis of these disorders. Previously five conditions were classified together under the heading "pulmonary angiitis and granulomatosis" (PA & G), mainly on the basis of histological similarities. ⋯ The granulomatous and vasculitic disorders WG and CSS together with the non-granulomatous small-vessel vasculitis MPA now form a new group of diseases ('ANCA-associated vasculitides') which have many clinical, serological and immunohistochemical features in common. Collagen vascular diseases (CVD) are serologically characterized by distinct subspecificities of antinuclear antibodies (ANA), sometimes pronounced hypergammaglobulinaemia, complement consumption and immune deposits (antigen-antibody-complement complexes) which are common in situ in immune-complex vasculitis. In this article newer aspects of the clinical course, the immunodiagnostic procedure, and the immunopathogenesis of the relatively large group of pulmonary angiitis will be described.