Concurrence of sarcoidosis and aortitis: case report and review of the literature.

Takayasu arteritis (TA) is a rare manifestation of systemic large vessel vasculitis which affects predominantly the aorta and its main branches, but often remains unrecognised owing to delayed diagnosis and non-characteristic clinical features. Sarcoidosis, too, is a systemic inflammatory disease which can affect virtually any organ system. Reports about the coincidence of both diseases have appeared. The case presented here is characterised by a significant time lag between detection of TA and appearance of clinical signs of sarcoidosis. The woman, now 39 years old, had erythema nodosum, circumscript alopecia, and recurrent uveitis, which dated back to 1980 and was attributed to sarcoidosis. At least 12 years later aortic valve insufficiency with progressive cardiac failure developed. Histology performed at the time of aortic valve prosthesis in 1997 disclosed a diagnosis of TA, which was confined to the aortic root. Incidentally, sarcoidosis was diagnosed in adjacent lymph nodes. A thorough check up failed to detect further manifestations of TA; thus, possibly, the patients had aortitis similar to, but not identical with, TA. Several related cases previously reported are discussed, suggesting that both diseases may be inherently related as they are characterised by certain non-specific, immunoinflammatory abnormalities. This case report suggests that the prevalence of TA, or related forms of arteritis, may be higher than expected and should be considered, especially in younger patients with non-characteristic cardiovascular symptoms and suspected systemic inflammatory disease. Moreover, the association with sarcoidosis in this and other previously described cases suggests that the two diseases may be related and that TA or TA-like vasculitis may even be a complication of sarcoidosis.

Treatment outcome in a private-sector residential care program.

The treatment outcomes of 60 chronic mentally ill patients who received services at Community Care, a private-sector residential care program, were analyzed. In addition to psychiatric services, the program offers instruction in living skills and vocational preparation, helps patients find jobs and housing, and operates an outpatient support network. Forty-two percent of the patients discharged during the study period achieved independence or near independence in the program and functioned at that level during a three-year follow-up period. Patients' level of education, degree of participation in the program, levels of residential and vocational achievement at discharge, and discharge status were significantly related to outcome. Patients with good participation in the program who stayed with the outpatient support network at discharge had at least a 95 percent probability of good outcome.