Sažetak Uvod. Dijagnoza sarkoidoze se može postaviti kada je u korelaciji kliničko-radiološki nalaz, sa patolohistološki dokazanim nekazeoznim epiteloidnim ćelijskim granulomom. Novine u dijagnostici sarkoidoze. Uzorak za patohistološko ispitivanje može se uzeti endobronhijalno, konvencionalnom bronhoskopijom sa transbronhijalnom biopsijom pluća, bronhoalveolarnom lavažom, hirurškim procedurama kao što su i cervikalna medijastinoskopija dijagnostička torakotomija, VATS torakoskopija i, u novije vreme endoskopskim ultrazvučnim tehnikama (endobronhijalna ultrazvučno vođena transbronhijalna biopsija aspiracionom iglom, endobronhijalna ultrazvučno vođena trans bronhijalna biopsija aspiracionom iglom i endoskopski ultrazvučno vođena biopsija tankom aspiracionom iglom, endoskopski ultrazvučno vođena biopsija tan kom aspiracionom iglom). Endobronhijalna ultrazvučno vođena trans bronhijalna biopsija aspiracionom iglom i endoskopski ultrazvučno vođena biopsija tan kom aspiracionom iglom imaju značajan doprinos u dijagnostici sarkoidoze i predstavljaju sledeći dijagnostički postupak nakon negativnog patohistološkog nalaza bronhoskopije. Zaključak. Očekuje se značajno smanjenje broja hirurških procedura (prvenstveno medijastinoskopije) u dijagnostici sarkoidoze uvođenjem endobronhijalne ultrazvučno vođene trans bronhijalne biopsije aspiracionom iglom i endoskopski ultrazvučno vođene biopsije tan kom aspiracionom iglom. Ključne reči: Sarkoidoza; Dijagnoza; Endosonografija; EUS FNA; Biopsija aspiracionom iglom; Bronhoskopija Summary Introduction. The diagnosis of sarcoidosis can be established when there is a compatible clinical-radiological picture together with pathohistological evidence of noncaseating epitheloid cell granulomas. Novelties in Diagnosis of Sarcoidosis. Pathohistological specimens can be obtained by conventional bronchoscopy with endobronchial and transbronchial lung biopsy, bronchoalveolar lavage, surgical procedures like cervical mediastinoscopy, diagnostic thoracotomy, video-assisted thoracoscopic surgery, and recently introduced endoscopic ultrasound techniques (endoscopic ultrasound-guided fine-needle aspiration and endobronchial ultrasound-guided transbronchial needle aspiration). Endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration have given a great contribution to diagnosis of sarcoidosis and present next diagnostic step after negative bronchoscopy. Conclusion. Reduction of surgical procedures in diagnosis of sarcoidosis, can be expected (first of all mediastinoscopy) by introducing endobronchial ultrasound-guided transbronchial needle aspiration and endoscopic ultrasound-guided fine-needle aspiration.
Introduction. Sarcoidosis affects the central nervous system more frequently than it was previously believed. Since the diagnosis of neurosarcoidosis is often delayed, it may result in serious complications. Being non-specific when present, the symptoms may be subtle and resemble those of other neurological diseases. While the cranial nerves are most frequently affected, neurosarcoidosis can involve other nervous system tissues including the meninges, brain parenchyma (especially the hypothalamic region), spinal cord, peripheral nerve and muscle. Discussion and Review of Literature. During the past decade, a significant progress was made in understanding the epidemiology and pathophysiology of neurosarcoidosis, as well as the possibility to diagnose and treat this disease. Studies have shown that the optimal diagnostic imaging modality for neurosarcoidosis is magnetic resonance imaging with gadolinium because it enhances visualization of granulomatous infiltration in neural tissue. Subclinical neurosarcoidosis may not be uncommon in patients with sarcoidosis. It is now evident that neurosarcoidosis does not invariably present as a catastrophic event. Adverse effects associated with high-dose systemic corticosteroids, the standard therapy, have discouraged practitioners from initiating treatment in the absence of significant symptomatic neurological disease. However, other immunosuppressive agents as well newer biologic agents have emerged as an effective, well-tolerated therapeutic alternative to corticosteroids, which are often effective in corticosteroid- recalcitrant cases. Conclusion. Neurosarcoidosis, as a localized granulomatous disease, is possible and not so rare. Early recognition of neurological involvement in patients with undiagnosed or diagnosed sarcoidosis is crucial to prevent complications, which can sometimes be life-threatening. [Projekat Ministarstva nauke Republike Srbije, br. 175046 i br. 175081]
Sžetak Uvod. U prošlosti terapija kortikosteroidima smatrala se uobičajenim terapijskim tretmanom za sarkoidozu. Diskusija i pregled literature. Vremenom je razvoj naučnog saznanja o neželjenim efektima kortikosteroidne terapije jednostavno doveo do potrebe da se u terapiju ovog oboljenja uvedu druge, alternativne metode, nesteroidnim agensima koji su omogućavali čak i dugotrajno lečenje bolesnika sa hroničnom formom bolesti a da se pritom izbegne neželjeni efekat steroida na metabolizam, glikoregulaciju, povećenje telesne težine, osteoporozu, kušingoidni izgled i slično. U terapiji hronične sarkoidoze pojavila se čitava paleta lekova u pokušaju da se nađe alternativa za primenu kortikosteroida u ovoj terapiji. Nijedan lek nije savršen. Zaključak. Ovo nas navodi na zaključak da je i dalje na samom kliničaru (koji najbolje poznaje bolesnika sa sarkoidozom koga kontroliše i prati) da odabere najadekvatniji način lečenja.
Introduction. Sarcoidosis is a multisystem granulomatous disease, whose unpredictable course has prompted research into biomarkers useful to predict outcome. Discussion and Review of Literature. Chitotriosidase, a chitinase produced by activated macrophages, has recently been proposed as an indicator among the potential markers of sarcoidosis. Chitotriosidase is involved in the defense against pathogens containing chitin. Increased concentrations of chitotriosidase have been observed in a number of lysosomal storage diseases, such as Gaucher?s disease, fucosidosis, galactosialidosis, atherosclerosis, ?-thalassemia, Plasmodium falciparum-induced acute malaria, visceral leishmaniasis and more recently in the cerebrospinal fluid in patients suffering from multiple sclerosis. Serum chitotriosidase activity in patients with sarcoidosis was first evaluated by Grosso et al in 2004. The idea to detect the enzyme in sarcoidosis sprang from evidence of direct involvement of activated macrophages in the pathogenesis of sarcoidosis and granuloma formation. Serum chitotriosidase was tested as a biomarker at our department in 2011, when 217 sarcoidosis patients were examined. Serum chitotriosidase has proved to differentiate active from inactive form of the disease much better than angiotensin-converting enzyme, thus adding to its role in the diagnosis and prognosis of this disease. Conclusion. Chitotriosidase is a good biomarker of sarcoidosis with good sensitivity and specificity. [Projekat Ministarstva nauke Republike Srbije, br. 175046 i br. 175081]
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