Nihon rinsho. Japanese journal of clinical medicine
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Although hypercalcemia has long been recognized as a complication of sarcoidosis, the incidence of hypercalcemia (> or = 11 mg/dl) in Japan is probably less than 5%. 1 alpha, 25(OH)2D3 is the main cause for hypercalcemia in sarcoidosis and overproduced by sarcoid granulomata. Gamma-interferon produced by activated lymphocytes and macrophages plays a major role in the synthesis of 1 alpha, 25(OH)2D3. ⋯ Treatment of hypercalcemia and hypercalciuria consists of a low calcium diet, adequate hydration, minimization of exposure to sunlight and reducing overproduction of 1 alpha, 25(OH)2D3. Prednisone, 15 to 25 mg/day, is the drug of choice to reduce the overproduction of 1 alpha, 25(OH)2D3.
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In Japan, elderly patients with sarcoidosis, cardiac sarcoidosis and severe pulmonary sarcoidosis patients have been increased. The patients with ocular manifestations without intrathoracic involvement have been also increased and it is, however, difficult to establish the diagnosis and to confirm such patients as sarcoidosis. To detect the histological findings such as epithelioid cell granuloma is gold standard in diagnosis. ⋯ We performed TBLB in 655 patients with clinical features of sarcoidosis. In 125 out of 293 patients with stage 0, 229 out of 272 with stage I, 66 out of 70 with stage II and 19 out of 20 with stage III patients, epithelioid cell granuloma was found. The effort to getting proper tissue samples of suspected sarcoidosis is important.
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Survival of patients with heart failure has improved over the past decade due to advances in medical therapy. However, sudden cardiac death continues to cause 35 to 65% of death. Ventricular arrhythmias are important causes of sudden cardiac death in patients with heart failure. ⋯ Therefore, in the absence of a clear indication, antiarrhythmic drug therapy should be avoided. A number of recent randomized trials have provided evidence that beta-adrenergic blockers, angiotensin-converting enzyme(ACE) inhibitors and angiotensin II receptor blockers(ARB) significantly reduces the risk of sudden death in patients with chronic congestive heart failure. For patients who have a history of sustained ventricular tachycardia(VT) or ventricular fibrillation(VF) amiodarone or an implantable cardioverter defibrillator(ICD) should be considered, and these therapy may benefit some high risk patients who have nonsustained VT.