Sarcoidosis Remission and Aden Protocol

Sarcoidosis Freedom Cookbook

This e-book is a 143 pages long downloadable ebook with hundreds of delicious recipes. But these recipes are not only delicious but have another crucial feature they use only the ingredients that are carefully chosen to meet all the criteria that are critically important in our pursuit of health and sarcoidosis remission. This is how The Sarcoidosis Freedom Cookbook will change your life: You will never eat a meal that triggers your sarcoidosis again. And you very likely did it today. You will gently soothe your endocrine system and shift the ravaging chemical imbalance that is eating away your organs. Kick start the boost of self-healing chemicals that will repair your organs before it's too late. Enjoy delicious meals while knowing every second that you are doing good to your body and getting closer to remission. You won't have to think about where to start in your healing, you will have all the work done for you. When you wake up in the morning you'll feel light and positive, knowing that healing chemicals in your body are doing their work every second. You won't have to spend endless hours in front of your computer or buy nutrition books to know what is completely safe for you. Never again buy another book about diet and health, because you have it all right here and written just for your condition, not general and vague. Start your healing today, without any procrastination. Once again, feel that health and energy you so desperately pursue. Continue reading...

Sarcoidosis Freedom Cookbook Summary


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Contents: 143 Page Ebook
Author: Danielle May
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My Sarcoidosis Freedom Cookbook Review

Highly Recommended

I've really worked on the chapters in this book and can only say that if you put in the time you will never revert back to your old methods.

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Chinese Secrets To Sarcoidosis Healing

The most important aspects of the program describes in the ebook are: It is research based and scientifically proven. The explanations are simple , adjusted to the Western view, specific and precise. It will allow you to discover and put a stop to the. habits, diet and lifestyle choices that are keeping. you sick and making your healing a mission impossible. It reveals all the culprits that I identified to be the. reason why people in China don't get sarcoidosis. My practices proved that once these aggravating agents are removed from your life, self-healing aided with herbs and remedies becomes simply inevitable. It reveals the remedies made from the herbal healing. agents and supplements that boost the self-healing and speed up the recovery. It will save you thousands of dollars. in drugs, doctor appointments and expensive surgeries. Continue reading...

Chinese Secrets To Sarcoidosis Healing Summary

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Author: Abe Hsieh
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Sarcoidosis is a multisystem, granulomatous disorder of uncertain etiology. Sarcoid has a predilection for the lungs (e.g., hilar adenopathy) and may produce anterior or posterior uveitis (e.g., choroiditis, retinal vascular disease, optic neuritis, optic nerve granuloma). Although lacrimal gland and extraocular muscle involvement may occur in sarcoid, orbital involvement

Wegeners Granulomatosis

2.8.4 Sarcoidosis Sarcoidosis is a chronic multisystem granulomatous disorder that has a predilection for pulmonary and upper respiratory tract mucosa. The sinonasal mucosa is rarely involved, and most patients have generalised disease 143 . Discrete non-caseating granulomata composed predominantly of epithelioid histiocytes with multinucleated giant cells and a peripheral rim of lymphocytes are present in the mucosa. Stains for acid-fast bacilli are negative. The differential diagnosis includes other granulomatous disorders, like tuberculosis, leprosy, Wegener's granulomatosis and cholesterol granuloma 57 .

Culturenegative endocarditis

Initial empirical treatment of endocarditis is penicillin plus gentamicin or, if there is an acute aggressive onset, flucloxacillin (or similar) plus gentamicin. Patients with prosthetic valves should be treated with a glycopeptide plus an aminoglycoside with or without rifampin. If blood cultures remain negative, it is probable that the patient has received previous antibiotics. The nutritionally deficient streptococci, HACEK organisms, anaerobes, Brucella species, and Listeria species may take a week or more to be recognized in culture. Rarely, failure to respond to penicillin and gentamicin may be the result of infection with Coxiella, Bartonella, or Chlamydia species, and serological tests are required. Fungal endocarditis may appear culture negative. Surgical management will be necessary if there is no response in the presence of clear vegetations on echocardiography. Collagen vascular diseases, sarcoidosis, malignancy, tuberculosis, and viral infections (including HIV) should be...

Variants And Related Syndromes

Heterogeneity is common, with some patients following a relaps-ing-remitting course and some experiencing a monophasic illness. Some patients with the syndrome undoubtedly have a form of MS, whereas others may have one of a variety of autoimmune or granulomatous disorders, such as systemic lupus erythematosus (SLE) and sarcoidosis. The term Devic disease is probably best reserved for patients with no evidence of disease outside the optic nerves and spinal cord, and who have had other potentially responsible disorders excluded.

Granulomatous Osteomyelitis

Granulomatous inflammation of the bone can be seen with either tuberculosis (TB) or fungus. Sarcoid has been reported less commonly. After a decline in the 1940s, a recent increase in TB cases has been reported. The reasons for this increase may be the result of an overall increase in the number of immunocompromised patients, as well as travel to or immigration from a region in which TB is endemic, or the emergence of resistant strains of TB. Fungal involvement of the bone is usually seen against the background of an immunocompromised patient or after prolonged use of corticosteroids.

Slit Lamp Examination

The anterior segment exam may show conjunctival chemosis or injection in thyroid disease or orbital inflammatory disease. Arterialization of the conjuncti-val vessels might suggest an underlying carotid cavernous fistula. Orbital AVMs may present with findings similar to cavernous sinus AVMs and may require superselective angiography for diagnosis. Anterior uveitis can be seen in patients with systemic inflammatory disorders including sarcoid.14-18

Hongming Zhuang MD PhD Jian Q Yu MD Abass Alavi MD

Numerous reports have demonstrated increased FDG uptake at the sites of infection and inflammation. FDG is applicable to almost any type of infection or inflammation or any anatomic location, including the following abscesses 11-17 , pneumonia 18-20 , tuberculosis 21-25 , Mycobacterium avium-intracellulare infection 26-28 , cryptococcosis 29 , mastitis 30 , enterocolitis 31-33 , infectious mononucleosis 34 , parasitic disease 35 , Clostridium perfringens infection 36 , osteomyelitis 37-42 , infection or loosening following arthrop-lasty 43-45 , fever of unknown origin (FUO) 46-48 , thrombosis 49-51 , amyloidosis 52 , sarcoidosis 53,54 , asthma 55 , bronchitis 56 , encephalitis 57 , costochondritis 58 , radiation pneumonitis 59 , esophagitis 60,61 , pancreatitis 62 , thyroiditis 63-65 , sinusitis 66 , myositis 67 , mediastinitis 68 , gastritis 69 , lobular panniculitis 70 , dental cavity 71 , and inflammation caused by foreign body 72-74 . Despite all of these findings, however,...

Computed Tomography Fluoroscopy Guidance Of Transbronchial Needle Aspiration

Fiber-optic bronchoscopy with transbronchial needle aspiration (TBNA) is useful to sample mediastinal nodes and to diagnose central parenchymal lesions. Enlarged lymph nodes occur in lung cancer and other neoplasms, tuberculosis, and sarcoidosis. Knowledge of nodal status is particularly important to stage lung cancer. Mediastinoscopy, mediastinotomy, and thoracoscopy are valuable surgical techniques for mediastinal staging, but are invasive and require general anesthesia. TBNA with bronchoscopic guidance necessitates only conscious sedation and can be used to sample abnormal lymph nodes that are in proximity to an airway 28,29,30 . Subcarinal and paratracheal lymph nodes are most accessible. One important disadvantage of TBNA compared to surgical techniques is that the target node is not visible through the bronchoscope unless erosion of mucosa has occurred. Typically, the bronchoscope needle is directed through the airway based on findings identified on the preprocedure CT scan in...

Sudden Cardiac Death And Ventricular Arrhythmias

Management of patients with ventricular arrhythmias due to lymphocytic or granulo-matous myocarditis remains problematic. Electrophysiologic testing fails to provoke inducible monomorphic ventricular tachycardia or ventricular fibrillation in more than two-thirds of patients who undergo testing.21,67,68 Many investigators use short-term immunosuppressive therapy to decrease myocardial inflammation and injury and to control ventricular tachyarrhythmias. Friedman et al.70 reported persistent complex ventricular arrhythmias after apparent resolution of myocarditis in children and young adults. Patients with life-threatening arrhythmias generally require long-term antiarrhythmic therapy. For those with out-of-hospital cardiac arrest, an implantable defibrillator is often preferable to pharmacologic treatment. Patients with histologically documented granulomatous myocarditis and those with cardiac sarcoidosis are at particularly high risk for life-threatening

Cerebrovascular Disease Unusual Forms

Bilateral occlusion of the carotid artery at the siphon is followed by the development of a fine network of collateral arteries and arterioles at the base of the brain. This may be a congenital or acquired disorder associated with previous meningitis, oral contraception or granulomatous disease (e.g. sarcoidosis). Children present with alternating hemiplegia, adults with subarachnoid haemorrhage. There is no specific treatment though some use surgical revascularisation procedures.

Role Of The Surgical Pathologist

Before the routine use of the endomyocardial biopsy in clinical cardiology practice, the diagnosis of myocarditis was often suspected but seldom proven before postmortem examination. Now, the surgical pathologist plays a pivotal role in the multidisciplinary team approach to the diagnosis and management of these patients.11 Critical functions that the surgical pathologist performs in this endeavor can be summarized as 1) to establish a histopathologic diagnosis of myocarditis using the Dallas criteria 2) to exclude other morphologic and clinical mimics of inflammatory myocardial disease 3) to classify the specific type of myocarditis for treatment and prognostic purposes (eg, lymphocytic, giant cell, hypersensitivity, toxic, infectious, sarcoidosis) 4) to monitor the effects of therapy (eg, antivirals, antibiotics, corticosteroids, and other immunosuppressive agents) 5) to evaluate for histopathologic evidence of progression to cardiomyopathy and 6) to preserve tissue for research...

Specific Types Of Human Myocarditis

The definition and diagnostic criteria described in the preceding section illustrate a crucial point for the reporting of myocarditis by the surgical pathologist. The term is primarily a descriptive one and therefore requires a qualifier to provide the clinician with important etiologic, therapeutic, and prognostic information. The remainder of the discussion focuses on specific patterns and types of myocarditis. The composition and distribution of the inflammatory cell infiltrate and the pattern and type of injury observed in the endomyocardial biopsy specimen generally offer etiologic clues. For example, infiltrates composed predominantly of polymorphonuclear cells suggest a bacterial infection eosinophils may be found in parasitic infestations or allergic drug reactions giant cells can be seen in mycobacterial or fungal infections, sarcoidosis, or idiopathic giant cell myocarditis and predominantly lymphocytic infiltrates are the typical response in myocarditis associated with...

Systemic Disease Affecting Waldeyers Ring

Involvement of the naso- and oropharynx by systemic s arcoidosis is well documented 127 . Unsuspected isolated sarcoidosis of the palatine and pharyn-geal tonsils in the absence of systemic disease is very rare 46, 126 . Histologically, the sarcoidosis granulomas are composed of densely packed epithelioid histiocytes and macrophages without central necrosis. Differential diagnoses include recurrent tonsillitis, which may feature giant cells and even foreign body giant cell granulomas. Another differential diagnosis consists of infections with mycobacterium tuberculosis and formation of caseating tuberculoid granulomas. The majority of patients with pulmonary tuberculosis have nasopharyngeal involvement, but isolated nasopharyngeal tuberculosis is rare 2, 161, 193 .

Differential Diagnosis in IGCM

Cardiac sarcoidosis and idiopathic giant cell myocarditis can be problematic. Previously, some have claimed IGCM as a type of cardiac sarcoidosis. In our experience, some degree of overlap can exist, particularly on small endomyocardial biopsy samples. In general, however, close attention to the presence or absence of granulomas is the key discriminating feature. In addition, sarcoidosis has significantly more fibrosis and few or no eosinophils within the inflammatory infiltrate. Myocyte necrosis, particularly the broad zonal distribution, is a feature of IGCM, whereas the mass-like effect is seen in sarcoidosis (Okura Y, Dec GW, Hare JM, Kodama M, Berry GJ, Tazelaar HD, Bailey KR, Cooper LT, unpublished data). Hematolymphoid malignancies can be associated with architectural distortion and myocyte necrosis (Fig. 14-5 C and 5 D). In some cases, polymorphous cell infiltrates may be present, including eosinophils. Cytologic atypia of the neoplastic cells is the cardinal feature of these...

Making Decisions About Endomyocardial Biopsy In Myocarditis

Most patients with dilated cardiomyopathy who have endomyocardial biopsy do not have any change in their clinical therapy as a result of the biopsy. About 80 to 90 of patients who have endomyocardial biopsy either because of new-onset heart failure or because of clinically suspected myocarditis have the nonspecific histologic finding of myocyte hypertrophy and fibrosis. About 10 to 20 of endomyocardial biopsies give definitive information for a specific diagnosis such as myocarditis, amyloidosis, sarcoidosis, or hemochromatosis. In less than half of the patients in whom a specific diagnosis is made, there is a change in clinical treatment based solely on the endomyocardial biopsy result. The decision to proceed with an endomyocardial biopsy in a patient with suspected myocarditis should balance the expected gain from an accurate diagnosis with its attendant therapeutic implications against the small risk of a major procedural complication. Most patients with clinically suspected...

Granulomatous Inflammation

The specific granulomatous inflammations of the in-tra-ocular tissues can be divided into infectious and autoimmune causes. The autoimmune diseases are sarcoidosis, sympathetic ophthalmitis and lens-induced uveitis. While many of these diseases may be appropriately treated with immunosuppressive medication, the management of infectious uveitis is antimicrobial therapy. Inappropriate immunosuppressive therapy may be disastrous for patients with an infection. Chorioretinal biopsy may provide useful information for determining the diagnosis and guiding the subsequent management of patients with progressive chorioretinal lesions of unknown aetiology 69 .

Sympathetic Ophthalmitis

Sympathetic ophthalmitis is an uncommon, but feared complication because of its potential to blind both eyes. It can result not only from penetrating trauma or ocular surgery, but also from non-penetrating ocular procedures. Early enucleation of the traumatised eye reduces the risk of occurrence of sympathetic oph-thalmitis in the non-traumatised ( sympathetic ) eye. The condition seems to be caused by a T-cell-mediated autoimmune response and can be treated with immu-nosuppressive therapy. Infectious causes must be ruled out before starting this therapy. Histology of the enucleated traumatised eye shows a granulomatous uve-itis with a thickened choroid featuring non-caseating granulomas with a few plasma cells and eosinophils, very similar to sarcoidosis 16 . Fine melanin granules can be seen in the cytoplasm of the histiocytes. The granulomatous inflammatory reaction can spread around small nerves.

Other demyelinating diseases

This is a demyelinative disease occurring in association with systemic illness in which cell-mediated and occasionally humoral immunity is depressed, e.g. AIDS (4 of cases), lymphoma, sarcoidosis, systemic lupus erythematosus. The disorder is due to reactivation of previous papavirus (SV40 or JC virus) infection. Clinical picture Features of diffuse process personality change, hcmiparcsis, cortical visual loss, seizures, etc. Duration of illness 3-6 months. Non-remitting and fatal.

And Lacrimal Passages

Optic neuritis presents as acute, unilateral and painful vision loss. It can result from inflammatory disorders, can occur as isolated inflammation, or may be part of the spectrum of multiple sclerosis. Magnetic resonance imaging is indicated to rule out compressive optic neuropathy. Spontaneous outcome of optic neuropathies is favourable. Secondary inflammatory optic neuritis (infection, vasculitis, sarcoidosis) is rare and usually presents with atypical evolution or other symptoms. Histologically, the optic nerve in multiple sclerosis will show a perivascular lymphocytic infiltrate with focal areas of demyelination and axonal atrophy at the end stage.

Inflammatory Processes

Enlargement of the lacrimal gland is often caused by chronic inflammatory processes that can have many different causes. When chronic dacryoadenitis is associated with enlargement of the salivary glands, it is called Mikulicz syndrome. Mikulicz syndrome can be caused by many different diseases like sarcoidosis, tu

Hypercalcemia of Malignancy

Hypercalcemia is a common clinical condition that can accompany a variety of other medical conditions, such as sarcoidosis, vitamin D toxicity, hyperparathyroidism, and malignancy. When calcium levels are exceptionally high, adjunctive measures for the control of plasma calcium levels are necessary, as this is a medical emergency. Various modalities in combination are used to treat this condition intravenous hydration with normal saline and the use of loop diuretics (e.g., furosemide) to induce calcium diuresis are the most important supportive measures.

Other Plant And Animal Allergens

In hair-setting preparations, gums have been largely replaced by polyvinylpyrrolidine, which is not allergenic. Parenthetically, most cases of chronic pulmonary disease attributed to hair spray allergy or hair spray thesaurosis have turned out to be sarcoidosis, with no basis for attributing the cause to hair spray.

Cheilitis Granulomatosa Mieschers Cheilitis

Granulomas may be few in number and multiple sections may be required to find them. In some instances, edema and a subtle lymphocytic infiltrate are the sole finding. It has been claimed that Miescher's cheilitis is an oligosympto-matic form of sarcoidosis and there are published accounts linking it to Crohn's disease. Though infrequently found, these conditions should be considered in the differential diagnosis. Intralesional injection of steroid suspension is standard treatment, and more than one round may be required. The literature contains reports of success with clofazimine and ciproheptadine. The role of cheiloplasty is controversial and probably should be reserved for debulking of advanced disease.

Cited Publications

Kreiss, Non-occupational chronic beryllium disease masquerading as sarcoidosis Identification by blood lymphocyte proliferative response to beryllium. Am. Rev. Respir. Dis. 145, 1212-1214 (1992). 64 J. J. Votto et al., A model of pulmonary granulomatous induced by beryllium sulfate in the rat. Sarcoidosis 4, 71-76 (1987). 65 L. S. Newman, Antigen-specific T cells in a mouse model of beryllium disease. In C. Grassi, G. Rizzato, and E. Polli, eds., Proceedings of XI World Conference on Sarcoidosis and Other Granulomatous Disorders, Excerpta Medica, Amsterdam, 1988, pp. 715-716. 76 W. J. Williams et al., Beryllium Skin Disease, Proc. 11th World Conf. Sarcoidosis, Elsevier Press, Milan, 1987.

Leslie T Cooper Jr md

Myocarditis was last critically surveyed nearly a decade ago. During that time, our knowledge of viral-induced myocardial injury, autoimmune pathways in the heart, and the clinical treatment of myocarditis has advanced significantly. In Myocarditis From Bench to Bedside, Leslie T. Cooper, Jr., MD, has assembled a panel of leading clinical and scientific experts to comprehensively review this new knowledge, highlighting advances in both our basic scientific understanding and our current clinical knowledge of inflammatory heart disease. Topics covered span many disciplines, from the genetics of cardiotropic viral virulence to clinical epidemiology and treatment. On the clinical side the diagnosis, prognosis, and management of both nonspecific and specific myocarditis are extensively discussed in separate chapters devoted to such major idiopathic clinical entities as cardiac sarcoidosis, giant cell myocarditis, eosinophilic myocarditis, Chagas disease, rheumatic fever, and human...

Macroscopic and Histopathologic Features

Various histopathologic patterns can be observed on endomyocardial biopsy specimens from patients with cardiac sarcoidosis. These include the classic noncaseating granuloma-tous inflammation, lymphocytic myocarditis, dilated cardiomyopathy, and in some cases normal myocardium (Fig. 14-13 see color plate 33). Diffuse myocardial involvement progresses to myocyte hypertrophy and interstitial fibrosis resembling dilated cardiomy-opathy in a minority of cases a restrictive profile is observed. The classic granulomatous pattern is characterized by firm white nodules forming discrete masses within the inter-ventricular septum, left ventricular free wall, or papillary muscle (Fig. 14-14 A see color plate 34). These may be confused with metastatic deposits or fibrous tumors. The histopathologic features are similar to extracardiac lesions and consist of noncaseating, well-formed (so-called hard) granulomas composed of epithelioid histiocytes and multinucleated giant cells arranged in round or...

Past Medical History

The past medical history should include any prior ocular or sinus disease (e.g., mucocele, malignancy, infection) systemic medical problems (e.g., thyroid disease, diabetes, tuberculosis, sarcoid), prior radiation therapy (e.g., radiation necrosis or secondary neoplasms), immunosuppressive history (e.g., risk for secondary infections or neoplasms), or previous malignancy. Social history (e.g., smoking, alcohol, occupational exposure), family history (e.g., neurofibro-matosis), past surgical history (e.g., orbital or sinus surgery), medications (e.g., steroids, antibiotics), and allergies may provide important information in the evaluation of the orbital process.

External Examination

The external examination of the ocular adenexa and eyelids can provide important information about underlying neuro-ophthalmic or systemic disorders. Lacrimal gland enlargement may be seen in sarcoidosis or underlying malignancy. Lid erythema or edema should be noted. Significant lid swelling, infiltration, or superior orbital mass can produce mechanical ptosis. Any deformity in the eyelid configuration (e.g., S-shaped eyelid in plexiform neuro-fibroma) should be documented. The lid position should be recorded and any lid retraction (e.g., thyroid ophthalmopathy) or lid lag (lid retraction in downgaze) should be noted specifically. Sarcoidosis


Ophthalmologic examination for evidence of uveitis can be useful. Definitive diagnosis, however, requires histo-logic confirmation of noncaseating epithe-lioid cell granulomas from neural tissue (usually a meningeal biopsy), with a probable diagnosis being made in cases of a clinical syndrome consistent with neurosarcoidosis and histologic evidence of systemic sarcoid disease (via pulmonary, lymph node, or con-junctival biopsy). Response to treatment can be disappointing. First-line therapy involves corticosteroids and methotrexate. More recently, radiotherapy and infliximab (anti-TNFa) also have been used in refractory cases.

Renal losses

Results from inadequate production of antidiuretic hormone (ADH). If child's access to water is hampered or thirst mechanism is affected, hypernatremia occurs. May be idiopathic, hereditary (eg, Wolfram syndrome), or caused by tumors, trauma, infections (eg, meningitis), granulomas (eg, sarcoidosis), or vascular conditions (eg, cerebral aneurysm).


Differential diagnosis includes a large spectrum of granulomatous diseases, such as sarcoidosis, cat-scratch disease, fungal infections, Wegener's granulomatosis and tumourous lesions. Differentiation between sar-coidosis and tuberculosis is difficult. Generally, granulomas in sarcoidosis lack caseation and stainings for mycobacteria are negative. Cat-scratch disease can be ruled out by the presence of rounded or stellate gran-

Clinical Information

Not infrequently, patients will experience prolonged or recurrent febrile episodes that defy diagnosis despite careful clinical assessment and conventional imaging. In choosing a nuclear medicine technique, it is important to distinguish two broad groups those with a suspected acute pyogenic process (typically developing in hospitalized patients or when there has been recent surgery) and a chronic process (usually developing in a nonhospitalized patient). In the former, a pyogenic bacterial cause is likely whereas in the latter the differential is much broader and includes non-infectious etiologies such as lymphoma, solid tumors and sarcoidosis.

Pulmonary Nodules

Abscesses and granulomas including those due to sarcoidosis, tuberculosis, anthracite inhalation, and fungus can all mimic malignant lesions in the lung. False negative results with 18FDG PET are very unusual for lesions larger than 1 cm in size although bronchoalveolar carcinoma, highly differentiated neuroendocrine carcinoma, and adenocarcinoma especially within a scar have all been reported to cause confusion (11). Improvements in CT techniques are likely to increase the number of sub-centimeter indeterminate pulmonary nodules detected. These lesions pose a diagnostic dilemma because only a small minority of them are malignant and they cannot be readily biopsied by percutaneous techniques. In the literature the smallest malignant lesion identified with 18FDG PET was a 6 mm NSCLC. The majority of lesions studied were relatively large, and as such the reliability of 18FDG PET for characterizing sub-centimeter lesions remains unclear (10). With financial restraints,18FDG PET in most...


SARCOIDOSIS Sarcoidosis is a systemic disease of unknown aetiology characterised by noncaseating epithelioid cell tubercles. Nervous system involvement occurs in 8 and may dominate the presentation. When sarcoid infiltrates the central nervous system it usually involves the meninges. In some patients mass lesions may arise from the dura, but more commonly signs and symptoms relate to an adhesive arachnoiditis involving the skull base, cranial nerves and pituitary stalk. Mass lesions may occasionally arise within the brain and spinal cord without obvious meningeal involvement.


There is substantial evidence to show that in the staging of non-Hodgkin's lymphoma (NHL) and Hodgkin's lymphoma (HL) there is a good concordance between 18FDG PET and whole-body CT (20). Moreover,18FDG PET can detect more sites of disease compared with conventional assessment (52-54). However, in the majority of patients, conventional assessment including whole-body CT is all that is necessary for planning treatment.18FDG PET is relevant in the subgroup of patients where there is a clinical need for clarification between localized disease and disseminated disease. Included in this group are those patients where there is a clinical suspicion of disseminated disease that cannot be confirmed by conventional techniques or when imaging suggests widespread disease that is not apparent clinically (48).18FDG PET however cannot consistently detect foci of low-grade NHL and foci of mucosal associated lymphoid tissue (MALT) lymphoma (55,56). Other issues which occasionally occur when 18FDG PET...

Diagnostic Strategy

Chest radiograph, an echocardiogram is usually done to exclude valvular and pericardial disease and cardiac masses. There are no specific echocardiography findings to distinguish giant cell myocarditis from other forms of myocarditis, although the rapid decline in ejection fraction that may occur over several days in giant cell myocarditis patients is uncommon in lymphocytic myocarditis or cardiac sarcoidosis. Coronary angiography is superior to noninvasive stress imaging to exclude significant coronary stenosis or dissection. Magnetic resonance imaging or computed tomography may be done if clinically indicated to help exclude such disorders as arrhythmogenic right ventricular dysplasia or constrictive pericarditis. Other diagnostic techniques that have been suggested for viral myocarditis or cardiac sarcoidosis have not been applied to giant cell myocarditis. For example, antibodies to cardiac myosin have been described for patients with acute and chronic myocarditis.75 Adenoviral...


The incidence of sarcoidosis in the United States has been estimated at 5.9 per 100,000 person-years for men and 6.3 per 100,000 person-years for women.6 In the United States, the lifetime risk of sarcoidosis is estimated at 0.85 in whites and 2.4 in blacks.7 Thus, the lifetime risk of CS with clinical symptoms developing is low. Certain ethnic groups appear to have a high prevalence of sarcoidosis, and the presentation may vary with ethnicity. For example, Sweden, Denmark, Japan, and US blacks have particularly high prevalence rates, whereas Portugal, Saudi Arabia, Spain, and India have relatively low rates.8'9 In a case series from Saudi Arabia, 16 of 21 cases of systemic sarcoidosis occurred in women, but there was no cardiac involvement.10 In a large series from Baltimore, the rate of extrathoracic sarcoid was higher in African-American than in white patients (2.15 vs. 1.20 manifestations per patient, respectively).11 From comparative autopsy data, the rate of cardiac involvement...


Because the etiology of sarcoidosis is unknown, the diagnosis remains one of exclusion. As such, there is no one test to confirm the diagnosis. Indeed, sarcoidosis' clinical hetero geneity probably reflects multiple disease etiologies. CS may represent a final common clinical and histopathologic presentation for several pathologic sequences. Acknowledging the limitations of our understanding, it is worthwhile summarizing the major studies in epidemiology and immunogenetics in systemic sarcoidosis. Few data exist for isolated cardiac disease, and these are noted when available. Boeck used the term sarkoid in 1899 to describe cutaneous lesions because he thought the lesions resembled sarcoma (reviewed in reference 17). Associations with malignant neoplasms have been described since, suggesting that sarcoidosis might be a form of or a marker for malignancy. Epithelioid granulomas were observed in the regional lymph nodes of a small percentage of patients with carcinomas or in association...


Case reports and small case series suggest heart transplantation is effective for refractory arrhythmias or end-stage cardiomyopathy due to CS.53 A limitation to transplantation is functional impairment of other organs from sarcoidosis. Sarcoidosis can occur after transplantation in the lung,54 but this is not considered a contraindication to cardiac transplantation. recurrence after tapering or discontinuing steroid therapy. Small, retrospective case series suggest that corticosteroids may prolong survival in sarcoidosis patients who received a pacemaker.55 However, treatment efficacy early in the disease is difficult to assess because there is sometimes a substantial rate of spontaneous remissions. Furthermore, late in the disease, extensive fibrosis develops that will not reverse with corticosteroids. People who are intolerant of steroids may be considered for methotrexate. Chloroquine and tetracycline benefit patients with cutaneous sarcoidosis,57 but their role in cardiac disease...

Orbital Examination

Hertel Orbit

During the clinical evaluation, one should keep in mind that the orbit is a small chamber, occupied by tissues of many types, located in a very compact fashion. Because of the close relationship of different tissue types, certain disease entities of different etiology and different tissue origin may clinically present with remarkably similar signs and symptoms. For example, a vascular tumor, a cholesteatoma, and a sarcoidosis granuloma may develop very similar clinical and radiological features. Another example of this dilemma may be experienced in the early stages of a subperiosteal abscess, secondary to ethmoiditis, which may mimic a secondary squamous cell carcinoma originating from the same sinus. Furthermore, there is surprising variability in the clinical manifestations of individual disorders good examples of this are metastatic tumor to the orbit, idiopathic orbital inflammation, and Graves disease. Similar confusion may occur in the evaluation of ultrasonography, computed...

Crohns Disease

As many as 80-90 of patients with orofacial lesions that resemble those of Crohn's disease, both clinically and microscopically, have no gastro-intestinal signs or symptoms and do not develop gut disease 159 . The term orofacial granulomatosis (OFG) has been introduced to describe this group of patients 184 . OFG, therefore, is a diagnosis based on the exclusion of other causes of granulomatous inflammation, particularly sarcoidosis, tuberculosis and other mycobacterial infections, and Crohn's disease itself. Up to 60 of patients

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