Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Liver is frequently involved in the pathological process. Wide range of clinical manifestations can be seen: from asymptomatic lesion with normal liver function tests to cirrhosis with portal hypertension. Biopsy plays the key role in diagnosis of the hepatic sarcoidosis. It is essential for morphological diagnosis to exclude other causes of granulomatous liver disease, most often - primary biliary cholangitis. Nowadays there are no standard treatment protocols for patients with hepatic sarcoidosis.
Among the entire spectrum of respiratory pathologies in workers who come into contact with harmful industrial dust factors, those with pulmonary lesions deserve special attention. It should be remembered that in addition to pneumoconiosis, it is possible to develop other combined pulmonary pathology, including tuberculosis and sarcoidosis, which significantly complicates the differential diagnosis. In practical terms, doctors, especially occupational pathologists and pulmonologists, need to conduct a comprehensive full-fledged examination of patients with suspected occupational respiratory disease, paying special attention to various extrapulmonary lesions and the severity of inflammatory laboratory changes. Identification of the systemic nature of the pathology requires the exclusion of sarcoidosis — a disease of unknown etiology that occurs with granulomatous inflammation. In particularly difficult cases, it is necessary to perform morphological verification of the diagnosis with a thorough histological examination in a specialized expert institution. However, special difficulties may arise when a lung biopsy combines manifestations of pneumoconiosis and sarcoidosis, including the possibility of developing a so-called sarcoid reaction.A clinical observation of rare comorbidity — sarcoidosis and silicosis — in a 38-year-old woman working at a mining and processing plant who was exposed to long-term exposure to silicon-containing dust in a concentration up to 14 times higher than the MPC is presented. The performed examination did not allow to clarify the cause of pulmonary dissemination, and therefore a lung biopsy was performed, which revealed a combination of sarcoidosis and pneumoconiosis in the patient. The importance of correct diagnosis is determined by the different choice of treatment tactics for these two diseases.Funding. The study had no funding.Conflict of interests. The authors declare no conflict of interests.
Interstitial lung disease (ILD) has been recognized as an extrahepatic manifestation ofprimary biliary cholangitis (PBC), althoughlimited data are available on its prevalence and clinical significance. Therefore, we evaluated the occurrence and clinical features of ILD in a cohort of PBC patients. Ninety-three individuals without concomitant rheumatic diseases were enrolled in our prospective cohort study. All patients underwent chest high-resolution computed tomography (HRCT). Liver-related and lung-related survival wereassessed. A lung-related outcome was defined as death from ILD complications; a liver-related outcome was defined as liver transplantation or death from liver cirrhosis complications. HRCT findings suggestive ofILD were detected in 38 patients (40.9%). A sarcoid-like pattern of PBC-associated ILD was the most frequent, followed by subclinical ILD and organizing pneumonia. Patients with ILD were less likely to have liver cirrhosis and liver-related symptoms and presented with higher serum immunoglobulin M(IgM) and M2 subtype antimitochondrial antibodies (AMA-M2) positivity rates. In a multivariate analysis, the absence of liver disease symptoms at the disease presentation (OR 11.509; 95% CI 1.210–109.421; p = 0.033), the presence of hepatic non-necrotizing epithelioid cell granulomas (OR 17.754; 95% CI 1.805–174.631; p = 0.014), higher serum IgM (OR 1.535; 95% CI 1.067–2.208; p = 0.020) and higher blood leukocyte count (OR 2.356; 95% CI 1.170–4.747; p = 0.016) were independent risk factors associated with ILD in PBC. More than a third of patients with ILD showed no respiratory symptoms, and only one ILD-related death occurred during a follow-up of 29.0 months (IQR 11.5; 38.0). Patients with ILD had better liver transplant-free survival.ILD in PBC had a benign course and was associated with a lower liver disease severity. PBC-associated ILD should be included in a list of differential diagnoses of ILD.
at 10:50 am [1]. Because of a spontaneous chain reaction, the researcher saw a flash of light and physically felt heat, and then 5-10 sec later he vacated the room containing the critical assembly stand. In this paper, we present the results of determination of the neutron and 3' radiation dose received by the victim.The RFYaTs-VNIII~F deployed a personal emergency dosimetry system developed in the 1970's at the Institute of Biophysics and adopted in all sections of Minatom facilities which involved nuclear risk. This system is based on the GNEIS personal emergency dosimeter for/3, % and neutron radiation [2], including a rhodium neutron activation detector [3], a DINA track etch neutron dosimeter with targets made from 237Np-A1 alloy, developed jointly with VNIINM, on a boron filter [4], two IKS-A thermoluminescent 3' radiation dosimeters [5] on lead and aluminum filters, compensating for the energy dependence of its sensitivity. The system also includes instructions and recommendations for radiation safety departments in emergency situations [6].Following the instructions and recommendations in [6], from the results of measurement of the induced 3' radiation activity from the body of the victim (A. N. Zakharov), the head of the dosimetric monitoring group estimated the average whole-body neutron dose: -10 Gy. The nurse who answered the emergency call at the medical center administered an antiradiation drug to the victim, then he was sent to the central medical unit in Sarov. At 6:30 pm, the victim was sent via airplane to Moscow, to the clinic at the State Science Center of the Russian Federation/Institute of Biophysics.The GNEIS dosimeter was located in the area of the left collarbone of the victim, on the collar of his coverall. From the results of spectrometric measurements of the activation of the rhodium detector and also the aluminum filter of the thermoluminescent dosimeter, a preliminary estimate was made of the fast neutron dose at the position where the dosimeter was worn: about 50 Gy. In going from the neutron flux determined from the activation of the l~ detectors and the 27A1 filters to the dose, we used the known neutron leakage spectrum from a metallic core. Then the fast neutron dose was refined using the DINA track etch dosimeter, considering the dose scale division of the track typical for these neutron leakage spectra. The neutron dose at the location of the dosimeter was 45 + 5 Gy; the neutron fluence on the surface of the upper third of the breast bone, determined using DINA track etch detectors, was equal to (1.8 + 0.2)-10 lz cm -2, which matched subsequent calculations. The thermoluminescent 3' radiation dosimeters showed (using two glasses) 3.5 + 0.3 Gy (average over two detectors).The victim arrived at the clinic of the Institute of Biophysics at 9:20 pm. Using a DRG-01 T1 dosimeter right against the body, we measured the whole-body 3' radiation dose rate for the victim. A repeated measurement at 10:20 am on June 18, 1997, showed that over this time period, the dose rate dropped by almo...
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