Nihon rinsho. Japanese journal of clinical medicine
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The frequency of skin involvement of sarcoidosis is 10-30% of all cases, but the prevalence of a particular type of cutaneous lesion varies among races as well as individual cases. Cutaneous involvement is divided into specific and nonspecific categories. ⋯ Despite the clinical importance of scar infiltrates in the diagnosis of sarcoidosis, it is often overlooked because the lesions are usually small and asymptomatic. There is some clinical importance of cutaneous sarcoidosis; the ease in obtaining lesional samples which enables a histological diagnosis of sarcoidosis, and the association of a particular type of cutaneous lesion with other organ involvement.
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In Japan, elderly patients with sarcoidosis, cardiac sarcoidosis and severe pulmonary sarcoidosis patients have been increased. The patients with ocular manifestations without intrathoracic involvement have been also increased and it is, however, difficult to establish the diagnosis and to confirm such patients as sarcoidosis. To detect the histological findings such as epithelioid cell granuloma is gold standard in diagnosis. ⋯ We performed TBLB in 655 patients with clinical features of sarcoidosis. In 125 out of 293 patients with stage 0, 229 out of 272 with stage I, 66 out of 70 with stage II and 19 out of 20 with stage III patients, epithelioid cell granuloma was found. The effort to getting proper tissue samples of suspected sarcoidosis is important.
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Survival of patients with heart failure has improved over the past decade due to advances in medical therapy. However, sudden cardiac death continues to cause 35 to 65% of death. Ventricular arrhythmias are important causes of sudden cardiac death in patients with heart failure. ⋯ Therefore, in the absence of a clear indication, antiarrhythmic drug therapy should be avoided. A number of recent randomized trials have provided evidence that beta-adrenergic blockers, angiotensin-converting enzyme(ACE) inhibitors and angiotensin II receptor blockers(ARB) significantly reduces the risk of sudden death in patients with chronic congestive heart failure. For patients who have a history of sustained ventricular tachycardia(VT) or ventricular fibrillation(VF) amiodarone or an implantable cardioverter defibrillator(ICD) should be considered, and these therapy may benefit some high risk patients who have nonsustained VT.