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Staging of Pulmonary Sarcoidosis

1986; Elsevier BV; Volume: 89; Issue: 3 Linguagem: Inglês

10.1378/chest.89.3_supplement.178s

1931-3543

Gary W. Hunninghake,

Pneumocystis jirovecii pneumonia detection and treatment

Pulmonary sarcoidosis is a disorder of unknown etiology characterized by the presence of granulomas in a variety of pulmonary and nonpulmonary tissues. 1 Hunninghake GW Garrett KC Richerson HB Fantone JC Ward PA Rennard Sl et al. State of art: pathogenesis of the granulomatous lung diseases. Am Rev Respir Dis. 1984; 130: 476-496 PubMed Google Scholar , 2 Hunninghake GW Gadek JE Kawanami O Ferrans VJ Crystal RG Inflammatory and immune processes in the human lung in health and in disease: evaluation by bronchoalveolar lavage. Am J Pathol. 1979; 97: 149-206 PubMed Google Scholar , 3 Hunninghake GW Gadek JE Immunological aspects of chronic non-infectious pulmonary diseases of the lower respiratory tract in man. Clin Immunol Rev. 1981-82; 1: 337-374 PubMed Google Scholar , 4 Hunninghake GW Moseley PL Immunological abnormalities of chronic noninfectious pulmonary diseases. in: Bienenstock J Immunology of the lung and upper respiratory tract. McGraw-Hill, New York1984: 345-364 Google Scholar , 5 Hunninghake GW Keogh BA Line BR et al. Pulmonary sarcoidosis; Pathogenesis and therapy. in: Boros DL Yoshida T Basic and clinical aspects of granulomatous diseases. Elsevier/North-Holland, New York1980: 275-290 Google Scholar , 6 Crystal RG Hunninghake GW Gadek JE Keogh BA Rennard SI Bitterman PB The pathogenesis of sarcoidosis. in: Chretien J Marsac J Saltiel JC Sarcoidosis and other granulomatous disorders. Pergamon Press, Paris1981: 13-35 Google Scholar , 7 Mitchell DN Scadding JG Sarcoidosis. Am Rev Respir Dis. 1974; 110: 774-802 PubMed Google Scholar , 8 Carrington CB Gaensler EA Mikus JP Structure and function in sarcoidosis. Ann NY Acad Sci. 1976; 278: 265-282 Crossref PubMed Scopus (142) Google Scholar The initial lesion in the lung appears to be an inflammatory process (alveolitis) 9 Rosen Y Athanassiades TJ Moon S Lyons HA Nongranulomatous interstitial pneumonitis in sarcoidosis: relationship to development of epithelioid granulomas. Chest. 1978; 74: 122-125 Abstract Full Text Full Text PDF PubMed Scopus (99) Google Scholar , 10 Teilum G Morphogenesis and development of sarcoid lesions: Similarities to the group of collagenoses. Acta Med Scand [Suppl]. 1964; 425: 14-18 PubMed Google Scholar , 11 Takahashi M Histopathology of sarcoidosis and its immunologic basis. Acta Pathol. 1970; 20: 171-182 PubMed Google Scholar , 12 Bernaudin JF LaCronique J Soler P Lange F Kawanami O Basset F Alveolitis and granulomas: sequential onset and evolution in pulmonary sarcoidosis. Bull Eur Physiopathol Respir. 1981; 17: 27 PubMed Google Scholar that is composed of activated helper T-cells and activated macrophages. 1 Hunninghake GW Garrett KC Richerson HB Fantone JC Ward PA Rennard Sl et al. State of art: pathogenesis of the granulomatous lung diseases. Am Rev Respir Dis. 1984; 130: 476-496 PubMed Google Scholar , 2 Hunninghake GW Gadek JE Kawanami O Ferrans VJ Crystal RG Inflammatory and immune processes in the human lung in health and in disease: evaluation by bronchoalveolar lavage. Am J Pathol. 1979; 97: 149-206 PubMed Google Scholar , 3 Hunninghake GW Gadek JE Immunological aspects of chronic non-infectious pulmonary diseases of the lower respiratory tract in man. Clin Immunol Rev. 1981-82; 1: 337-374 PubMed Google Scholar , 4 Hunninghake GW Moseley PL Immunological abnormalities of chronic noninfectious pulmonary diseases. in: Bienenstock J Immunology of the lung and upper respiratory tract. McGraw-Hill, New York1984: 345-364 Google Scholar , 5 Hunninghake GW Keogh BA Line BR et al. Pulmonary sarcoidosis; Pathogenesis and therapy. in: Boros DL Yoshida T Basic and clinical aspects of granulomatous diseases. Elsevier/North-Holland, New York1980: 275-290 Google Scholar , 6 Crystal RG Hunninghake GW Gadek JE Keogh BA Rennard SI Bitterman PB The pathogenesis of sarcoidosis. in: Chretien J Marsac J Saltiel JC Sarcoidosis and other granulomatous disorders. Pergamon Press, Paris1981: 13-35 Google Scholar This initial lesion sets the stage for granuloma formation. 13 Hunninghake GW Gadek JE Young RC Kawanami O Ferrans VJ Crystal RG Maintenance of granuloma formation in pulmonary sarcoidosis by T-lymphocytes within the lung. N Engl J Med. 1980; 302: 594-598 Crossref PubMed Scopus (150) Google Scholar , 14 Crystal RG Ferrans VJ Gadek JE Fulmer JD Line BR Hunninghake GW Interstitial lung disease: current concepts of pathogenesis, staging and therapy. Am J Med. 1981; 70: 542-568 Abstract Full Text PDF PubMed Scopus (357) Google Scholar , 15 Hunninghake GW Crystal RG Pulmonary sarcoidosis: a disorder mediated by excess helper T-lymphocyte activity at sites of disease activity. N Engl J Med. 1981; 305: 429-434 Crossref PubMed Scopus (601) Google Scholar , 16 Hunninghake GW Fulmer JD Young RC Gadek JE Crystal RG Localization of the immune response in sarcoidosis. Am Rev Respir Dis. 1979; 120: 49-57 PubMed Google Scholar , 17 Hunninghake GW Gadek JE Weinberger S Kelman J Fulmer J Crystal RG Comparison of the alveolitis of sarcoidosis and idiopathic pulmonary fibrosis. Chest. 1979; 75: 266-267 Abstract Full Text Full Text PDF PubMed Google Scholar , 18 Hunninghake GW Kawanami O Ferrans VJ Young RC Roberts WC Crystal RG Characterization of the inflammatory and immune effector cells in the lung parenchyma of patients with interstitial lung disease. Am Rev Respir Dis. 1981; 123: 407-412 PubMed Google Scholar , 19 Hunninghake GW Correlation of interleukin-1 release by alveolar macrophages with disease activity in pulmonary sarcoidosis. Am Rev Respir Dis. 1984; 129: 569-572 PubMed Google Scholar , 20 Hunninghake GW Crystal RG Mechanisms of hypergammaglobulinemia in pulmonary sarcoidosis. J Clin Invest. 1981; 67: 86-92 Crossref PubMed Scopus (150) Google Scholar , 21 Pinkston P Bitterman PB Crystal RG Spontaneous release of interleukin-2 by lung T-lymphocytes in active pulmonary sarcoidosis. N Engl J Med. 1983; 308: 793-800 Crossref PubMed Scopus (260) Google Scholar , 22 Hunninghake GW Bedell GN Zavala DC Monick M Brady M Role of interleukin-2 release by lung T-cells in active pulmonary sarcoidosis. Am Rev Respir Dis. 1983; 128: 634-638 PubMed Google Scholar It is the granulomas that cause permanent injury to the gas-exchange units of the lung. The alveolitis and granulomas may either resolve spontaneously or be suppressed by various forms of therapy. Many of the clinical and pathologic features of sarcoidosis are related to these biologic characteristics of sarcoidosis and also form the basis for much of the staging of the disease.