Transbronchoscopic lung biopsy in sarcoidosis. Optimal number and sites for diagnosis.

By obtaining five transbronchoscopic biopsies of the lung from each of the right upper and lower lobes, the diagnosis of sarcoidosis was made in 36 of 37 prospectively studied patients. The diagnosis was made in all ten patients with stage-1 disease, but seven of the ten showed diagnostic tissue from only one lobe. Only one of the ten biopsies was diagnostic in four of those patients with a stage-1 disease. In disease of stage 2 and 3, there was good correlation between diagnostic biopsies and the radiographic distribution of infiltrates. Biopsies from the predominantly rather than the lesser involved lobe proved the diagnosis in all of these patients, except for the two patients with nodular sarcoid. We conclude that ten biopsies are optimal for obtaining the diagnosis in stage-1 disease; however, five biopsies may be adequate in non-nodular disease of stage 2 and 3 if the biopsies are of the lobe predominantly involved on the roentgenogram of the chest.

Effects of influenza vaccination on the peripheral airways of healthy human volunteers.

Forty-two volunteers (15 of them cigarette smokers) were studied to determine the effects on the airways that might result from immunization with killed influenza virus vaccine. The forced vital capacity, the forced expiratory volume in one second, the maximal expiratory flows at 50 and 75 percnet of vital capacity, and the volume isoflow were determined before and at 24, 48, and 72 hours and one and two weeks after vaccination. For both smokers and nonsmokers, there were no significant changes in the results of these tests of pulmonary function following vaccination.

Use of irradiation in lymphomatoid granulomatosis.

A middle-aged white man with lymphomatoid granulomatosis was studied over the ten-year course of his disease. Both a large subcutaneous mass in his thigh and life-threatening massive involvement of the right lung occurred on separate occasions, and each responded to therapy with irradiation after immunosuppression failed. Irradiation should be considered as one of the primary forms of treatment of lymphomatoid granulomatosis in those with localized lesions.

Sarcoidosis initially occurring as apical infiltrate and pleural reaction.

A 21-year-old black man had pleuritic pain as the initial symptom of his sarcoidosis. Chest roentgenographic examination showed an infiltrate in the left upper lobe and a left pleural thickening. Sarcoidosis was diagnosed by pulmonary biopsy. Thus, sarcoidosis may closely mimic tuberculosis by initially occurring as predominantly apical infiltrates and pleural reaction.