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Gallium citrate Ga67 scanning of the head and thorax of 3 patients with sarcoidosis is presented. Two patients had a progressive pulmonary sarcoidosis of recent onset and in one patient, with a chronic course of the disease, the lung changes had resolved. All 3 patients had a conjunctival sarcoid change confirmed by biopsy and a lacrimal gland affection suggested by clinical examination. A highly increased Ga67 uptake in the lacrimal and parotid glands as well as in the nasopharynx was found in all patients, and an increased lung uptake was found in the newly detected cases. It is concluded that gallium scanning is a sensitive method for detecting minute ophthalmic changes in sarcoidosis. It also reveals chronic localized ocular affection in cases in which the lung changes are no longer detectable. The mechanism and specificity of gallium uptake in sarcoidosis is also discussed.

We report a patient who developed fever and rapidly progressing lung infiltrates 4 days after the beginning of continuous quinidine sulfate therapy. The fever disappeared during the following 48 h and the pneumonitis slowly resolved over the next month once quinidine therapy was stopped. The diagnosis of quinidine-induced pneumonitis, which has not previously been reported in the literature (to our knowledge), was confirmed by means of a rechallenge with quinidine.

In a series of 281 patients with histologically confirmed sarcoidosis, 79 initially had ophthalmic sarcoid manifestations. Of 22 patients with uveitis, 21 were seen regularly as long as the inflammation was active, and 71 of the 79 patients (90%) underwent a follow-up study five to 16 years (mean, nine years) later and using the same protocol. In the 21 patients with uveitis, the disease exhibited either a monophasic course (eight patients) with favorable visual outcome or a relapsing course (13 patients) with severe visual loss in five eyes. Thirty-three patients showed chronic ophthalmic changes at the follow-up examination, including conjunctival granulomas (13 patients), lacrimal gland involvement (22 patients), uveitis (four patients), and involvement of lacrimal passages (three patients). In 15 of these 33 patients, the general physical examination and the chest x-ray showed no evidence of systemic sarcoidosis. However, the serum angiotensin converting enzyme level was increased in a significantly greater proportion of these 15 patients than in the patients assessed as totally recovered from sarcoidosis.

The incidence and clinical picture of sarcoidosis were studied on the basis of an unselected series of 354 sarcoidosis patients (168 men, 186 women) in a defined geographical area during the years 1970-81. All the patients were examined in hospital. The mean annual incidence of sarcoidosis was 15 cases per 100 000 population 15 years or older. Sixty-four per cent of the cases began or were diagnosed in the first half of the year (P less than 0.001). The disease was diagnosed in 67% of the male cases and 38% of the females before the age of 35. Sarcoidosis was found by mass chest radiographic survey or by chance in 99 men (59%) and 103 women (55%), but 85 men (51%) and 129 women (69%) had symptoms of the disease. Two hundred and eighteen patients (62%) had bilateral hilar adenopathy upon diagnosis of the disease, 120 (34%) parenchymal changes and three fibrotic radiographic changes. Lung function test results tended to decrease with the radiographic stage and were indicative more of obstruction than restriction.

The effects of inhaling 0.4 mg of fenoterol hydrobromide (Berotec), 0.2 mg of albuterol (salbutamol), or placebo were compared in a doable-blind three-way crossover study in a group of 12 asthmatic patients. After inhalation of fenoterol, the maximum increase in the forced expiratory volume in the first second (FEV 1 ) was 0.76 L (48 percent) and in the peak expiratory flow (PEF) was 100 L/min (47 percent). The corresponding figures after inhalation of albuterol were 0.68 L (46 percent) and 98 L/min (48 percent), respectively. In comparison with administration of placebo, the FEV 1 was significantly increased until six hours after inhalation of either drug. From three to six hours after inhalation, the effect of administration of fenoterol (as measured by FEV 1 or PEF) significantly exceeded that of albuterol. Administration of either drug resulted in approximately equal bronchodilation (as measured by the increase in FEV 1 or PEF), the effect of inhalation of fenoterol being of longer duration.

One hundred and ninety-nine cases of sarcoidosis were diagnosed from July 1970 to December 1976 in a defined geographical area in northern Finland. At the follow-up examination at least 5 years later (range 5–12 years) a chest rontgenogram was obtained from 179 patients (90%) and lung function tests were performed by 169 patients (85%). A normal rontgenogram was achieved by 94 of the 113 patients with stage I sarcoidosis (83%), and by 36 of the 62 patients with stage II (58%). Two patients in the former group (2%) and 14 in the latter (23%) had progressed to the fibrotic stage Ill, but the fibrosis was usually slight. FEV1 and FVC had increased during the follow-up period, Dco showing the largest number of abnormal results in the final examination. Lung function largely normalized with a normal rontgenogram, whereas the functional outcome was worst where fibrosis had developed. Only two patients had been granted a disability pension because of sarcoidosis. Six patients had died, but none of sarcoidosis. The results show a favourable prognosis for sarcoidosis in this comprehensive series of patients.

A 10-year follow-up study was carried out on 659 men aged 18 to 64 years when first surveyed by questionnaire and simple spirometry in 1967, to determine the effect of smoking habits on respiratory symptoms and ventilatory function. Symptoms tended to increase during the follow-up period, and were most marked among the men who continued to smoke. The remission rates of respiratory symptoms were high in all the smoking groups, however, and cough and phlegm actually diminished during the ten years in the men who stopped smoking after the first survey. The follow-up survey in 1977 showed a prevalence of 6 to 8 percent for severe airways obstruction in the ex-smokers and smokers, but only 2 percent in the life-long non-smokers. The average decrease in one second forced expiratory volume (FEV 1 ) was 44 ml/year in the total series, 37 ml/year in the life-long nonsmokers and 49 ml/year in the continuous smokers (P 1 .

Lung cancer was diagnosed in 446 patients during four years in a population living in a defined geographical area in northern Finland. The series comprised 420 men and 26 women, with a male/female ratio of 16.6:1. The diagnosis was confirmed histologically or cytologically in 431 cases (97%). Epidermoid carcinoma was the most common histological type of tumour in the men, followed by small cell anaplastic and adenocarcinoma, whereas in the women all these types were of equal frequency. Almost all the men, but only about half of the women, were smokers or ex-smokers. The amount smoked daily had no correlation with the histological type of cancer, whereas those patients who had started smoking early had relatively more Kreyberg group I tumours (epidermoid, small cell, and large cell carcinoma) than those who had started smoking late. Cancer was usually detected on the basis of symptoms, but 17% emerged from mass radiography or some health examination, and 12% from examinations for another disease. Fifteen per cent of the patients had no symptoms at the time of diagnosis, this being more common among the patients with epidermoid or adenocarcinoma than among those with anaplastic forms.

Serum copper (SCu), zinc (SZn) and ceruloplasmin (SCP) concentrations were measured in 199 patients with lung cancer and 81 with nonmalignant lung disease. No significant differences were detected between these groups in the mean concentrations or in the SCu:SZn ratio, nor was any correlation found between the histological type or clinical extent of the tumor and the level of SCu, SZn or SCP. SCu and SCP increased significantly in accordance with the symptomatic stages of Feinstein, and in a parallel manner. These measures were also significantly higher in the patients who died within 4 months of diagnosis than in those who lived for 4 months or longer. SZn was similar throughout and was not predictive of the prognosis. It is concluded that SCu, SZn and SCP determinations are of no help in distinguishing malignant from nonmalignant lung disease and are only of limited importance for estimating the extent of the disease or the prognosis of a patient with lung cancer.

An increased mean serum copper level was found in 149 patients with lung cancer when compared with 19 healthy people and 23 patients with non-malignant lung diseases. The level seemed to reflect the stage of disease, with asymptomatic patients showing the lowest values, and patients with metastatic symptoms the highest. In spite of significant differences between the groups of subjects the scatter in the values was large. Hence serum copper determinations can be of only limited importance for differential diagnosis or in assessing the clinical stage of cancer. No differences in copper levels were found between the groups of patients with different histological types of lung cancer.

Berotec (0.4 mg fenoterol hydrobromide, regimen B), Atrovent (0.08 mg ipratropium bromide, regimen A) and Duovent (0.2 mg fenoterol hydrobromide and 0.08 mg ipratropium bromide, regimen D) were administered by metered dose inhalers (MDI) to 12 patients with asthma (regimens D and B only) and 12 patients with chronic airflow obstruction (CAO). The increase in FEV1 was similar after all regimens, but greater in the patients with asthma than those with CAO. In the patients with asthma, the increase in FVC was greater after Berotec than Duovent but the difference may not be clinically important. In the patients with CAO, the increase in FVC was greater after Duovent than after the other regimens. Subjective side effects were commoner after Berotec than the other regimens, hence in the doses used Duovent may offer some clinical advantage as compared with Berotec and Atrovent used alone.