In a prospective study, Type III procollagen N-terminal peptide was measured in the sera of 38 subjects with biopsy-proven pulmonary sarcoidosis at 6-month intervals over a period of 5 yr. The subjects were divided into four groups according to their radiologic presentation and clinical course: Group A (n = 10) subjects with sarcoidosis Type I without radiologic progression over 5 yr; Group B (n = 5) subjects with sarcoidosis Type I with radiologic progression to Stage II or III; Group C (n = 9) subjects with sarcoidosis Types II and III without progression over 5 yr; and Group D (n = 14) subjects with sarcoidosis Types II and III with radiologic progression. Lung function tests (FVC, FEV1, and DLCO), chest roentgenograms, and measurements of serum angiotensin converting enzyme (S-ACE) were performed concurrently with the S-PCP-III levels. Significantly higher levels of S-PCP-III were found in group B (Type I, progressive) (18.2 +/- 1.09 ng/ml) and in group D (Type II/III, progressive) (13.9 +/- 1.2 ng/ml) compared with those of Group A (Type I, stable) (9.1 +/- 1.09 ng/ml) and Group C (Type II/III, stable) (7.6 +/- 1.1 ng/ml) or normal volunteers (9.4 +/- 4 ng/ml) (p less than 0.001 for all comparisons). Changes in S-PCP-III levels tended to parallel the clinical course, and steroid treatment resulted in a significant decrease in S-PCP-III concentrations (p less than 0.001). In contrast, serum angiotensin converting enzyme (S-ACE) levels did not correlate with either the clinical course or radiologic changes.(ABSTRACT TRUNCATED AT 250 WORDS)
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In 60 patients with histologically proven sarcoidosis, 67Ga scanning was evaluated in terms of sensitivity and specificity for assessing disease activity and compared with chest radiography, serum ACE and blood T-lymphocytes. While 67Ga scans had the highest sensitivity (94%), the specificity was only 68%. The sensitivity of chest radiography was 80%, of serum ACE and blood T-lymphocytes 77% and 48%, respectively. While in patients with radiographical type I, 67Ga scanning, chest radiography and serum ACE had a sensitivity of 92%-100%, in patients with radiographical type II-III, only 67Ga scans had a sensitivity exceeding 90%. A 67Ga score correlated significantly with serum ACE levels (r = 0.59, P less than 0.001). After effective steroid treatment, 67Ga uptake and serum ACE activities decreased markedly. While in 25% of cases, chest radiography failed to provide reliable information, 67Ga scanning and serum ACE activities always proved useful in evaluating the course of the disease and the patient's response to steroid therapy. A negative 67Ga scan together with normal serum ACE levels seem to have a high predictive value for excluding active sarcoidosis.
4 4t th h I In nt te er rn na at ti io on na al l C Co on nf fe er re en nc ce e o on n B Br ro on nc ch ho oa al lv ve eo ol la ar r L La av va ag ge e, , o or rg ga an ni iz ze ed d b by y t th he e E Eu ur ro op pe ea an n B BA AL L T Ta as sk k G Gr ro ou up p Umeå, June 17-19, 1993 H. Klech* Chairman European BAL Task GroupCorrespondence: *H. Klech, Ludwig Boltzmann Institute for BAL, 2nd Med Dept Wilhelminenspital, A-1171 Vienna, Austria. Bronchoalveolar lavage (BAL) is today a widely accepted tool both for pulmonary research and for selected clinical purposes [1][2][3]. BAL is now used in experimental medicine, in occupational medicine, by infectious disease specialists, by intensive care specialists, and by pulmonary physicians.The 4th International Conference on Bronchoalveolar Lavage was an excellent forum to review topics for which BAL is used or will be used in the future. The local organizers were L. Bjermer and T. Sandström from Umeå University. BAL in children (organized by G. Rossi and R. Ronchetti)For the first time, a comprehensive review was given concerning the use of BAL in children. European experiences were presented by Ronchetti and Midulla, complemented by American experiences presented by Wood. Midulla revealed technical aspects of BAL. His data demonstrated that in children fractional processing of BAL can differentiate between bronchial and alveolar lavage, and that these two samples differ in the concentration of lymphocytes, neutrophils, total protein, albumin, fibronectin and hyaluronic acid. He also presented data on reference values in "normal" children, showing that the differential cell count of BAL in the paediatric age group is quite similar to the count in normal adults.Ronchetti presented data concerning cellular and noncellular BAL components in children with interstitial lung disease (ILD). These children had a high concentration of lymphocytes, fibronectin and hyaluronic acid. These data demonstrated that in children with ILD, BAL is a good tool for use both in diagnosis and follow-up.Clements presented data obtained from children with sarcoidosis, and demonstrated that in children BAL can also be used as a research tool. The application of BAL in the diagnosis of opportunistic infections in immunocompromised children was presented by de Blic. Finally, Dab and Grigg presented their experiences with BAL in neonates. Their presentations supported the concept that BAL is also a safe and well-standardized technique for use in neonates. BAL in oncology (organized by St. Rennard and R. Hendriksson)In their lectures, Rennard, Hendrikson and Pirozynski concluded that BAL can be helpful in diagnosis of lung cancer, and is adequately complementary to other diagnostic techniques. The important factor is that just a couple of malignant cells obtained by BAL can provide the diagnosis. There was a comprehensive review concerning the role of BAL for assessment of immunological and cellular changes due to cancer in the pulmonary environment by Semenzato, emphasizing that BAL can add ...
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