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sarcoidosis

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poneill
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sarcoidosis

Postby poneill » Sun Jul 1 2012, 06:39

Hi i was just wondering is there any commerical helicopter pilots out there with sarcoidosis?
any info would be great.
cheer's.
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wocawoca
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Re: sarcoidosis

Postby wocawoca » Wed Jul 4 2012, 04:39

Looks like no one on the forum suffers from a severe case of sarcasm.
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2.2
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Re: sarcoidosis

Postby 2.2 » Wed Jul 4 2012, 05:21

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BenThomas
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Re: sarcoidosis

Postby BenThomas » Wed Jul 4 2012, 09:50

Sarcoidosis

Last reviewed: June 2, 2011.


Sarcoidosis is a disease in which inflammation occurs in the lymph nodes, lungs, liver, eyes, skin, or other tissues.


Causes, incidence, and risk factors

The cause of the disease is unknown. In sarcoidosis, tiny clumps of abnormal tissue (granulomas) form in certain organs of the body. Granulomas are clusters of immune cells.

The disease can affect almost any organ of the body, but it most commonly affects the lungs.

Possible causes of sarcoidosis include:

Extreme immune response to infection


High sensitivity to environmental factors


Genetic factors


The condition is more common in African Americans than Caucasians, especially in Caucasians of Scandinavian heritage. Females are usually affected more often than males.

The disease typically begins between ages 20 and 40. Sarcoidosis is very rare in young children.

A person with a close blood relative who has sarcoidosis is nearly five times as likely to develop the condition.


Symptoms

There may be no symptoms. When symptoms occur, they can involve almost any body part or organ system in your body.

Almost all patients have lung or chest symptoms:

Chest pain (most often behind your breast bone)


Dry cough


Shortness of breath


Symptoms of general discomfort or uneasiness often occur:

Fatigue (one of the most common symptoms in children)


Fever


Joint achiness or pain (arthralgia)


Overall feeling of discomfort, illness, or lack of well-being


Weight loss (one of the most common symptoms in children)


Skin symptoms:

Hair loss


Raised, red, firm skin sores (erythema nodosum), almost always on the front part of the lower legs


Rash


Scars that become raised or inflamed


Nervous system symptoms may include:

Headache


Seizures


Weakness on one side of the face


Eye symptoms include:

Burning


Discharge from the eye


Dry eyes


Itching


Pain


Vision loss


Other symptoms of this disease:

Dry mouth


Fainting spells if the heart is involved


Nosebleed


Swelling in the upper part of the abdomen



Signs and tests

A physical exam may show the following:

Abnormal breath sounds (such as rales)


Enlarged liver


Enlarged lymph glands


Enlarged spleen


Rash


Often the disease is found in patients with visible physical signs who have an abnormal chest x-ray.

Different imaging tests may help diagnose sarcoidosis:

Chest x-ray to see if the lungs are involved or lymph nodes are enlarged


CT scan of the chest


Lung gallium scan


To diagnose this condition, a biopsy is needed. Biopsy of the lung using bronchoscopy is usually done. Biopsies of other body tissues may also be done.

This disease may affect the results of the following lab tests:

Calcium levels (urine, ionized, serum)


CBC


Immunoelectrophoresis - serum


Liver function tests


Quantitative immunoglobulins (nephelometry)


Serum phosphorus



Treatment

Sarcoidosis symptoms will often get better on their own slowly without treatment.

Patients whose eyes, heart, nervous system, or lungs are involved may need to be treated with corticosteroids (prednisone or methylprednisolone). Therapy may continue for 1 or 2 years. The most severely affected patients may need lifelong therapy.

Drugs that suppress the immune system (immunosuppressive medicines) are sometimes also needed:

The drug used most often is methotrexate, but azathioprine and cyclophosphamide are also sometimes recommended.


Hydroxychloroquine is useful for skin sarcoidosis.


Rarely, some people with end-stage heart or lung damage may need an organ transplant.


Expectations (prognosis)

Many people with sarcoidosis are not seriously ill, and the disease may get better without treatment. About 30 - 50% of cases get better without treatment in 3 years. About 20% of people whose lungs are involved will develop lung damage.

The overall death rate from sarcoidosis is less than 5%. Causes of death include:

Bleeding from the lung tissue


Heart damage, leading to heart failure and abnormal heart rhythms


Lung scarring (pulmonary fibrosis)



Complications

Fungal lung infections (aspergilloma)


Glaucoma and blindness from uveitis (rare)


Kidney stones from high calcium levels in blood or urine


Osteoporosis and other complications of taking corticosteroids for long periods of time.


Pulmonary hypertension



Calling your health care provider

Call your health care provider if you have:

Difficulty breathing


Palpitations


Vision changes


Other symptoms of this disorder



References
1.Drake W, Newman LS. Sarcoidosis. In: Mason RJ, Broaddus VC, Martin Tr, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 5th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 59.
2.Iannuzzi MC, Rybicki Ba, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357:2153-2165.
3.Weinberger SE. Sarcoidosis. Goldman L, Ausiello D. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa:Saunders Elsevier; 2007:chap 95.
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StickyDingo
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Re: sarcoidosis

Postby StickyDingo » Thu Jul 5 2012, 00:05

In the absence of the CASA AVMED manual, this is taken from the ICAO Manual of Aviation Medicine. http://www.icao.int/publications/Docume ... ons_en.pdf

Sarcoidosis
1.13.16 Sarcoidosis presents special problems in certification due to its ubiquity and its occasional involvement of the
heart. It is commonly a self-limiting condition seen in young adults with the extent of systemic involvement being largely
unknown. There is often no significant systemic illness and presentation may be fortuitous with bilateral hilar
lymphadenopathy on routine chest X-ray. Or there may be erythema nodosum, malaise, arthralgia, iridocyclitis, respiratory
symptoms or other constitutional upset. In those with systemic involvement, five per cent will also have cardiac
involvement. Its aetiology is not understood, but a genetically determined sensitivity to pine pollen or an infective agent
may be involved.
1.13.17 Involvement of the heart is associated with a poor prognosis and a significant risk of sudden death; half of
those diagnosed with the condition die from the disease. Cardiac involvement may exist without concomitant involvement
of other systems. Sudden death may be due to life threatening ventricular rhythm disturbance or granulomatous
involvement of the conducting system. Dilation of the ventricles due to patchy involvement of the myocardium may lead to
the development of a dilated or restrictive cardiomyopathy.
1.13.18 There are no characteristic ECG features although Holter monitoring may be premonitory of rhythm and
conduction disturbance. Echocardiography may show patchy or generalized hypokinesia, especially if the basal
myocardium is affected, with ventricular dilation and reduction of the ejection fraction. Deposits thicker than 3 mm may be
detected non-invasively. Multiple Gated Acquisition (MUGA) and thallium MPI are inconclusive but magnetic resonance
imaging (MRI) scanning may demonstrate localized high-intensity lesions with gadolinium enhancement. Raised plasma
angiotensin-converting enzyme (ACE) activity is not diagnostic but may give an indication of active disease. A scalene
node biopsy will confirm systemic sarcoidosis if present but myocardial biopsy is often unhelpful due to the patchy nature of
the disease.
1.13.19 The diagnosis of sarcoidosis (sometimes by way of the chance discovery of bilateral hilar lymphadenopathy)
requires that the pilot should be made unfit. Satisfactory evaluation for restricted Class I certification should attempt to
establish that the disease is inactive and include:
• no increase in hilar lymphadenopathy on serial chest radiography;
• stable gas transfer factor;
• no evidence of active disease elsewhere (including scalene node biopsy);
• normal resting and exercise ECG (to at least nine minutes of the Bruce protocol);
• no significant rhythm or conduction disturbance on Holter monitoring;
• normal echocardiogram.
1.13.20 Trans-oesophageal echocardiography and/or MRI scanning will be required in the event of possible
myocardial abnormality.
III-1-40 Manual of Civil Aviation Medicine
1.13.21 Restricted certification may be permitted subject to six-monthly cardiological follow-up for at least two years.
Minimum re-investigation should include echocardiography and Holter monitoring. Full certification may be considered no
sooner than two years after the initial observation, subject to regular follow-up. Any evidence of systemic involvement
(except erythema nodosum) requires permanent restriction to multi-crew operation. Evidence of involvement of the heart
disbars for all licences.

From a military sense, this is grounds for immediate medical discharge, or denial for application to be a military pilot, due to either myocardial factors, or smoke and fume inhalation causing further damage to respiratory system damage, being a common area for sarcoidosis to invade.

Hope this helps.

SD

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