Assessing hypertension and diabetes knowledge, attitudes and practices among residents in Akatsi South District, Ghana using the KAP questionnaire

Objective

Low awareness of hypertension and diabetes is a public health concern in Ghana. Assessing the general population's behaviour via knowledge, attitude, and practice (KAP) will be invaluable in these diseases, where prevention and control need a lifelong commitment to a healthy lifestyle. Hence, our goal was to assess the behaviour of Akatsi South residents towards the diseases to assist health providers in implementing tailored intervention programs.

Methods

This was a population-based cross-sectional study with 150 adults (18-70 years) from November to December 2021. A semi-structured questionnaire with face-to-face interviews was used to obtain data. All variables in the model had descriptive statistics. The Chi-square (χ²) test was used to examine correlations between variables, and a value of p < 0.05 was considered statistically significant. The factors associated with checking blood sugar levels and blood pressure were determined using binary logistic regression.

Results

The respondents' mean age and BMI were 32.40 years (± 12.07) and 24.98 kg/m² (± 2.36), respectively. Only 46.67% of the respondents frequently monitor their blood pressure and 17.33% their blood glucose (at least once a year). Less than half of those surveyed had a good knowledge of hypertension (42.7%) and diabetes (32.0%), whereas nearly 3/4 had poor attitudes regarding both conditions. A binary logistic regression analysis revealed that having a good attitude toward hypertension (exp B = 2.479, p = 0.036) and diabetes (exp B = 4.547, p = 0.009) were the participants' strongest predictor of blood pressure and sugar level checks. However, being overweight (exp B = 0.046, p = 0.002,) or obese (exp B = 0.144, p = 0.034) negatively influenced the frequency with which our respondents checked their blood glucose levels.

Conclusion

In the study, we found that the population generally has poor knowledge, which affects their behaviour (attitudes and practices) towards the diseases. To enable healthcare practitioners to reduce disease-associated mortality and morbidity in the future, frequent public health education and promotion about the conditions is critical to closing the knowledge gap.

Cellular angiofibroma of the vulva

BACKGROUND

The cellular angiofibroma is a benign mesenchymal neoplasm that clinically and histologically must be distinguished from biologically more aggressive lesions. It typically arises in women of late reproductive age and lends itself to cure by complete local excision. A report of an unusual case in a postmenopausal patient is presented.

CASE

A 77-year-old woman presented with a painless vulvar mass that slowly enlarged over 3 years. Past history included a hysterectomy and bilateral salpingo-oophorectomy followed by estrogen replacement therapy. Surgical excision of the mass was performed and there is no evidence of recurrence 1 year postoperatively. Histopathologic examination revealed an admixture of hyalinized blood vessels and loose cellular stroma characteristic of a cellular angiofibroma. Immunohistochemical studies revealed stromal cell immunoreactivity for vimentin and CD34 and nonreactivity for desmin, actin, and S100 protein. The nuclei of the stromal cells demonstrated strong reactivity for estrogen and progesterone receptors.

CONCLUSION

Mesenchymal lesions of the vulva and perineum include both benign and malignant neoplasms. The cellular angiofibroma is benign; however, other lesions including the aggressive angiomyxoma must be excluded when arriving at that diagnosis. The role of long-term estrogen therapy in the genesis of this tumor awaits further analysis.

Erythroid differentiation in vitro is blocked by cyclopamine, an inhibitor of hedgehog signaling

Adult hematopoietic differentiation is a developmental process that employs many of the same molecular mechanisms as embryogenesis. To explore the possibility that hedgehog signaling is involved in the control of hematopoietic differentiation, we screened a panel of human leukemia cell lines for the expression of Patched1 and Smoothened, the receptor and coreceptor for hedgehog ligands. Expression was found in multiple cell lines, and Patched1 expression was detected in normal marrow. Induction of myeloid differentiation in cell lines downregulated expression of both genes. When normal marrow mononuclear cells were grown in semisolid medium in the presence of 10 microM cyclopamine, development of colonies of granulocytic/monocytic lineage was unaffected in terms of both number and morphology. The number of erythroid colonies, however, was significantly reduced (P < 0.01). Furthermore, hemoglobinization was substantially delayed relative to controls in those erythroid colonies that did form. Incubation of hematopoietic progenitors with Shh-N and GM-CSF resulted in increased granulocyte/monocyte colonies (P < 0.01); the increase was blocked by cyclopamine. Incubation of hematopoietic progenitors with Shh-N and stem cell factor resulted in larger erythroid colonies. These results suggest that elements of the hedgehog signaling pathway are involved in the control of hematopoietic differentiation.

Nail-patella syndrome: an incidental finding from abdominal discomfort

An otherwise healthy 18-year-old woman had abdominal discomfort. Physical examination and laboratory studies were unremarkable, with the exception of nail dystrophy of the ulnar digits. An abdominal plain film revealed bilateral posterior iliac horns, pathognomonic of nail-patella syndrome. Additional radiographs showed hypoplastic patellas bilaterally. While glomerulonephritis occurs in 30% of patients with nail-patella syndrome, there was no evidence of renal involvement.

Serous and mesothelial proliferations of the extraovarian peritoneum and pelvic lymph nodes

With rare exceptions, serous proliferations of the peritoneum are limited to women, whereas proliferations of mesothelial differentiation arise predominantly in men. The authors focus on the various types of serous and mesothelial proliferations of the peritoneum and pelvic lymph nodes. Discussion of each type focuses on clinical and morphologic features, histogenesis, differential diagnosis, and clinical outcome.

Murine Pneumocystis carinii adherence to vertical monolayers of cultured mink lung cells (MiCl1)

We describe a method for adherence and culture of murine Pneumocystis carinii in mink lung cells (MiCl1) grown on vertical supports. The vertical cultures were infected with P. carinii; the surrounding medium and inoculum were stirred to ensure circulation and contact with MiCl1 cells. When compared with conventional horizontal culture, the vertical method offers a more suitable system for assessing P. carinii adherence. This approach has proved suitable for quantitative evaluation of P. carinii adherence to MiCl1 cells in the presence of inhibitors.

Morphologic and biochemical studies of chitin expression in Pneumocystis carinii

Tomato lectin, which binds oligosaccharides of N-acetyl-D-glucosamine, and an antiserum against macromolecular chitin were used to probe sections of human and murine lungs infected with Pneumocystis carinii. By light, fluorescence and electron microscopy, lectin and antiserum binding patterns indicated that both human and murine strains of P. carinii express chitin at all identifiable stages of their life cycles. Light microscopic autoradiographs of murine P. carinii cultured in vitro with 3H-glucosamine revealed dense incorporation of the radiolabel into the cell walls in a pattern analogous to those of the antiserum and lectin binding studies. These investigations offer further evidence that chitin is an integral part of the cell wall of P. carinii trophozoites and cysts.

Immunocytochemical labeling of chitin in the cell walls of zoopathogenic fungi

Chitin is a complex polysaccharide composed of repeating units of beta-1,4-N-acetyl-D-glucosamine. It is found in many invertebrates, in some algae, in the cyst form of several protozoans and in the cell walls of most fungi. Chitin, however, is not expressed in vertebrate tissues. We used a polyclonal rabbit antiserum against macromolecular chitin to label and stain by immunoperoxidase technique in formalin-fixed, paraffin-embedded tissues a variety of zoopathogenic fungi. The antiserum bound to the cell walls of the microorganisms, but not to (mammalian) host tissue elements.

Small-cell neuroendocrine carcinoma of the cervix. A human papillomavirus type 18-associated cancer

Small-cell undifferentiated carcinomas comprise a rare but aggressive subset of uterine cervical neoplasms. Analogous to small-cell anaplastic carcinoma of the lung, these tumors frequently exhibit neuroendocrine differentiation. Although human papillomaviruses (HPV) types 16 and 18 are strongly associated with the development of cervical squamous carcinoma, there is as yet little information describing the relationship of these viruses to small-cell carcinomas. To address this question, we analyzed 20 cases of small-cell carcinoma of the cervix using in situ hybridization to detect HPV gene expression. In addition, immunohistochemistry was used to evaluate three markers of neuroendocrine differentiation. Eighteen of 20 tumors (90%) demonstrated some evidence of neuroendocrine differentiation; 17 of 20 (85%) expressed HPV type 16 or 18 messenger RNA. Of the neuroendocrine-positive cases, 14 of 18 expressed HPV 18 messenger RNA. In contrast, both of the cases with squamous differentiation were HPV 16 positive. These findings broaden the spectrum of HPV-associated cervical neoplasia and strongly suggest that HPV 18 is a viral type specifically associated with cervical small-cell neuroendocrine carcinomas.

Thymomas and thymic carcinomas

This review discusses epithelial proliferations of the thymus, excluding carcinoid tumor and small cell carcinoma. The clinical features of thymoma, possible etiologic mechanisms, and associated autoimmune and paraneoplastic conditions are summarized briefly. Histologic subtypes of thymoma, including lymphocyte predominant, mixed, and spindle cell tumors are described and illustrated. The concept of "medullary" and "cortical" differentiation in thymoma is reviewed. Immunohistochemical and electron microscopic features of this neoplasm are presented. Flow cytometric studies relating to its prognosis also are summarized. Distinctions between encapsulated thymoma, invasive thymoma, and metastatic or "malignant" thymoma are described in detail. Thymic carcinomas are reviewed, as distinguished from cytologically bland thymomas. Variants of thymic carcinoma include squamous cell, spindle cell, lymphoepithelioma-like, mucoepidermoid, adenosquamous, clear cell, basaloid, and adenoid cystic neoplasms.

Immunocytochemical detection of chitin in Pneumocystis carinii

Polyclonal antisera against chitin and chitin oligomers were used to stain Pneumocystis carinii by the immunoperoxidase technique in Formalin-fixed, paraffin-embedded sections of four human lung biopsies and in alcohol-fixed, paraffin-embedded cell blocks of two bronchioloalveolar lavage specimens from infected human patients. In all cases, the antisera bound P. carinii but did not bind the host tissue elements. Moreover, the antisera bound not only to the cyst forms of P. carinii but also to the intracystic bodies and to the trophic forms. Preadsorption of the anti-chitin antiserum with purified chitin abolished all staining of P. carinii. Our results indicate that P. carinii produces chitin at more than one stage of its life cycle in the infected human host.

Scar-associated malignant melanoma and squamous carcinoma in situ

The development of cutaneous neoplasms is a known sequela of chronic scars, squamous carcinoma being most common. We have described an elderly patient with both squamous carcinoma in situ and malignant melanoma in different scars. The coexistence of the lesions suggests a common pathogenesis.

Immunohistochemistry: a useful adjunct in the evaluation of malignant cutaneous spindle cell tumors

We used immunohistochemistry to evaluate four cytologically malignant cutaneous neoplasms on the face or neck of elderly individuals. All four lesions were composed of a dermal proliferation of spindle and pleomorphic giant cells. Differential diagnosis included spindle cell carcinoma, atypical fibroxanthoma, malignant melanoma, leiomyosarcoma, and angiosarcoma. All four neoplasms were strongly immunoreactive for vimentin and negative for cytokeratin, S100 protein, desmin, and factor-VIII-related antigen. Focal immunoreactivity for lysozyme and/or a1-antichymotrypsin was seen in the giant cells of each lesion. These results supported the diagnosis of atypical fibroxanthoma in each instance. Immunohistochemical staining can provide useful information for distinguishing among malignant cutaneous spindle cell tumors.

Primary carcinoid tumor of the testis

We have presented a case of primary testicular carcinoid in an otherwise asymptomatic 50-year-old white man treated by right orchiectomy; a postoperative abdominal CT scan was normal. Histologically and cytologically the tumor resembled carcinoids of midgut origin. Most primary testicular carcinoid tumors are not clinically functional, and thus the diagnosis is not suspected preoperatively.

Preservation of pathology specimens by silicone plastination. An innovative adjunct to pathology education

The authors have used the process of plastination to preserve gross anatomic specimens for teaching purposes. A specimen is fixed in 10% buffered formalin and dehydrated in increasing grades of ethanol. Thereafter it is saturated with methylene chloride and then impregnated in vacuo at -20 degrees C with silicone rubber. Final steps involve drainage and exposure to a curing agent. The total time required is approximately 16 weeks. The finished plastinated specimen is dry to the touch, odorless, and nontoxic, yet it maintains its original shape and, in many cases, is reasonably close in color and consistency. It resists deterioration and can be stored at room temperature indefinitely. The authors have found plastinated specimens to be superior to those preserved in formalin for teaching anatomic pathology to undergraduate medical students.

Acral mucinous syringometaplasia. A benign cutaneous lesion associated with verrucous hyperplasia

We describe herein a case of acral mucinous syringometaplasia that presented clinically as a verruca plantaris. Microscopically, verrucous hyperplasia of the epidermis and central, dilated eccrine ducts lined by a mixture of squamous and goblet cells were present. Mucinous syringometaplasia is a benign entity that should be distinguished from other mucin-containing cutaneous lesions.

Discrepant fibrinogen values during thrombolytic therapy. Comparison of aca and Data-Fi results using immunofixation. Electrophoresis as a reference

The authors compared aca and Data-Fi fibrinogen values and used a combination of plasma protein electrophoresis and immunofixation with anti-fibrinogen anti-serum to observe changes in fibrinogen from four patients receiving streptokinase (STK) therapy. For three patients, aca and Data-Fi values pre-STK and greater than or equal to 24 hours post-STK correlated well (r = 0.96, slope = 0.92, y-intercept = 2.3; n = 13 pairs); aca and Data-Fi values during STK therapy correlated poorly (r = 0.67, slope = 0.36, y-intercept = 4.1; n = 20 pairs), with aca values up to sixfold higher than Data-Fi. Protein electrophoresis and immunofixation showed loss of the discrete fibrinogen band during STK therapy; instead there was a diffuse electrophoretic zone of anti-fibrinogen reactive material having a slightly different mobility than intact fibrinogen; aca fibrinogen values were inconsistent with fibrinogen band absence. The remaining patient showed no change in the fibrinogen band. Clinically he showed no response to STK therapy. In nonresistant patients, STK results in the degradation of fibrinogen into a mixture of products (FDP), all sharing antigenic determinants with fibrinogen and at least one being still clottable. Our results exemplify loss of intact fibrinogen with persisting anti-fibrinogen reactive FDP during STK therapy. Discrepancies in aca versus Data-Fi results may be due to ways in which FDP interact with different methods--fibrometer versus turbidimetric.

Retrorectal cystic hamartoma. Report of three cases, including one with a perirenal component

Retrorectal cystic hamartomas (RCHs) are uncommon lesions of controversial pathogenesis that arise in the presacrococcygeal space. We describe the clinicopathologic features of RCHs from three adult patients. Two were asymptomatic women; the third was a man who had a pelvic abscess. All three specimens were multiloculated cysts lined by squamous, transitional, and glandular epithelium. Poorly organized collections of smooth muscle were present in the surrounding connective tissue, but no well-formed smooth-muscle coat was seen. Although RCHs possess elements of three germ-cell layers, their histologic features are similar to those of the embryonic tailgut. The male patient also had a perirenal mass that was grossly and histologically identical to the RCH. The associated kidney was malrotated. A portion of the embryonic tailgut may have been pulled cephalad by the developing kidney, inhibiting its rotation. Clinicopathologic features distinguish RCH from other retrorectal cystic lesions, including teratoma, dermoid, epidermal cyst, rectal duplication, anal duplication, and anal gland cyst.

Glandular inclusions in inguinal hernial sacs and spermatic cords. Müllerian-like remnants confused with functional reproductive structures

Small, glandular inclusions are present in approximately 6% of hernial sacs from prepubertal males. Identical structures may be present in the spermatic cord. Histologically, these are composed of ciliated, low columnar epithelium with eosinophilic cytoplasm and basal nuclei. A mantle of fibrous tissue surrounds each gland-like structure. These epithelial inclusions may be confused with reproductive ducts of functional importance; however, specific histologic features allow ready distinction. The origin of these structures is uncertain, but it is most probable that they are remnants of Müllerian ducts.

Ascending myeloencephalopathy due to intrathecal vincristine sulfate. A fatal chemotherapeutic error

A case of fatal myeloencephalopathy secondary to accidental intrathecal administration of vincristine is reported in a 16-year-old boy. He underwent a progressive ascending chemical meningoencephalitis leading to coma, and died 36 days after the injection. Multiple samples of cerebrospinal fluid (CSF) and serum were assayed for vincristine sulfate. CSF levels of vincristine were consistently much higher than serum levels. At autopsy, all regions of the brain that had been in direct contact with the CSF were necrotic. The spinal cord was likewise necrotic throughout its length. Microscopically there was total neuronal loss with tissue destruction in the affected regions. The presence of numerous gemistocytic astrocytes, some in arrested mitosis, was a conspicuous feature in these areas. Three previous reports of intrathecal vincristine instillation are reviewed. No treatment for this devastating iatrogenic error exists, underscoring the importance of preventive measures in chemotherapy administration.

Epithelial polyps of the prostatic urethra. A light-microscopic and immunohistochemical study

Epithelial polyps of the prostatic urethra are an uncommon and histologically heterogeneous group of lesions. We review the clinical and histologic features of a series of seven such polyps. Six were composed of prostatic-type epithelium. In five instances the epithelium was entirely histologically identical to that of normal prostate. One case contained foci of stratified, mitotically active cells, suggesting adenomatous transformation. All six stained intensely for both prostatic acid phosphatase and prostatic specific antigen. The seventh polyp was cytologically different. It was composed of flattened to cuboidal cells that did not stain for either antigen. All patients were treated by transurethral excision, and none of the six with follow-up developed a recurrence.

Diagnosis of Legionella micdadei pneumonia from cytologic specimens

Legionella micdadei is a recently described opportunistic pulmonary pathogen that produces an acute, suppurative pneumonia in patients receiving steroid therapy. Most prospective diagnoses have been made by open lung biopsy. We present a case in which the diagnosis was made from cytologic material. The clinicopathologic features of L. micdadei pneumonia are discussed, and criteria for diagnosis from cytologic specimens are presented.

Fine needle aspiration of thoracic extramedullary hematopoiesis

Thoracic manifestations of extramedullary hematopoiesis (EMH) are well known clinically, radiologically and pathologically; it is generally confirmed histologically by open biopsy or postmortem examination. We report a case of EMH diagnosed by percutaneous fine needle aspiration (FNA) in a patient with long-standing, acquired, sideroblastic anemia. The aspirate was very cellular and composed of normal bone marrow elements with an erythroid to myeloid cell ratio of 3 to 1. Megakaryocytes were abundant but constituted less than 1% of the total cell population. This case illustrates that the diagnosis of EMH is possible by FNA and that thoracotomy for diagnostic purposes can be circumvented.

Prognostic factors predicting the outcome of sarcoidosis: an analysis of 818 patients

A computerised, retrospective study of 818 patients with sarcoidosis was analysed to study the prognosis of each individual manifestation of the disease. The good prognosis of erythema nodosum, acute arthritis and bilateral hilar lymphadenopathy was confirmed, though 16 per cent of patients presenting with erythema nodosum pursued a chronic course. Cor pulmonale and nephrocalcinosis reflected the poorest prognosis while lupus pernio and sarcoidosis of the mucosa of the upper respiratory tract rarely resolved. Bone sarcoidosis also implied chronicity but in four of 31 patients there was no clinical evidence of disease activity two years after the initial diagnosis, although naturally the bone radiograph was still abnormal. Hepatomegaly carried a worse prognosis than splenomegaly, or indeed, than the finding of pulmonary mottling without hilar glands--a stage three chest radiograph.

Fine needle aspiration under percutaneous transhepatic cholangiographic guidance

Fine needle aspiration (FNA) is a rapid diagnostic technique accompanied by minimal patient morbidity and providing access to deep visceral lesions. We report three cases of obstructive jaundice secondary to malignancy in which FNA was performed at the time of percutaneous transhepatic cholangiogram. After the cholangiogram was performed and the obstructive lesion identified, a drainage catheter was inserted for decompression of the biliary tree. Using the drainage tube as a guide, multiple FNAs of the area of obstruction were done. In case 1 an area adjacent to the common bile duct was aspirated and diagnosed as adenocarcinoma of undetermined origin. FNA of a liver mass in case 2 revealed poorly differentiated squamous carcinoma consistent with a previous uterine cervix biopsy. Both of these patients were discharged for outpatient treatment following the procedure. In case 3 FNA diagnostic of adenocarcinoma was obtained from an intra- and extrahepatic mass. This patient underwent exploratory laparotomy for possible resection; adenocarcinoma of the head of the pancreas was found. For patients with advanced malignancies, minimizing inpatient hospital time is an important goal. In cases of obstructive jaundice secondary to malignancy, the combined techniques of percutaneous cholangiogram, biliary tree compression and FNA provide both diagnosis and palliation, with minimal morbidity and inpatient care.

A reappraisal of limited-stage undifferentiated carcinoma of the lung. Does stage I small cell undifferentiated carcinoma exist?

Patients with small cell undifferentiated carcinoma of the lung (SCUC) have a poor prognosis. Surgical excision is avoided if the diagnosis can be made with small biopsy specimens or cytologic preparations. We reviewed 323 consecutive patients with pulmonary neoplasms diagnosed as SCUC, oat cel carcinoma, and undifferentiated or poorly differentiated carcinoma. At the time of diagnosis, only 18 patients had neoplasms classified as clinical Stage I, and only one of these had SCUC after histologic review. Fifteen patients had atypical carcinoid, a tumor with features intermediate between ordinary bronchial carcinoid and SCUC. In two instances, there was insufficient tissue for definitive diagnosis. Cumulative survival of the 15 patients with Stage I atypical carcinoid tumor was 80% at 1 year and 60% at most recent follow-up (mean follow-up 20 months). Mean survival for the 305 remaining patients was 7.9 months. Atypical carcinoid may be misdiagnosed as SCUC or poorly differentiated carcinoma, particularly with limited tissue samples or cytologic preparations. Stage I SCUC exists but is exceedingly rare. Many examples of purported Stage I SCUC probably represent atypical carcinoid. Because atypical carcinoid has a far better prognosis than SCUC, precise diagnosis is important and surgical resection should be considered.

'Endometrial' adenocarcinoma of the prostatic urethra arising in a villous polyp. A light microscopic and immunoperoxidase study

A 77-year-old man had a papillary neoplasm of the prostatic urethra removed by transurethral resection. Light microscopically, much of the tissue consisted of a benign villous polyp lined by prostatic epithelium. An adenocarcinoma with cells that resembled those of uterine endometrial carcinoma was also present within the villous polyp. Using immunoperoxidase techniques, prostatic acid phosphatase and prostatic-specific antigen were localized in the epithelial cells of both the villous polyp and the adenocarcinoma. To our knowledge, this is the first reported case of adenocarcinoma arising in a urethral polyp. The immunohistochemical findings and the close association of the adenocarcinoma with the prostatic epithelium of the villous polyp provided evidence that so-called endometrial carcinoma of the prostatic utricle is of prostatic epithelial origin rather than müllerian derivation.

Atypical carcinoid tumor of the lung. A clinicopathologic study of 17 cases

We describe 17 atypical carcinoid tumors of the lung that are histologically intermediate between small-cell undifferentiated carcinoma and typical carcinoid tumor. Atypical carcinoid tumors have a distinctive microscopic pattern of nests, trabeculae, and ribbons of intermediate-sized, moderately pleomorphic cells that lack the nuclear molding and dense hyperchromasia of small-cell undifferentiated carcinoma. Mucin was present in 15 cases and nine contained argyrophilic granules. The three primary tumors and one metastasis studied ultrastructurally contained dense-core granules and variable degrees of squamous and glandular differentiation. Eleven patients were men; six were women. Their mean age was 58 years. Sixteen patients were known smokers. Twelve tumors involved the upper lobes and three were located in the right middle lobe. Mean tumor size was 4.9 cm (median 4; range 2.5--20). Four of 13 patients having potentially curative resection died of tumor. The other nine patients were disease free with a mean follow-up of 20 months. Four additional patients treated palliatively died.

Ureteral stenosis secondary to retroperitoneal rheumatoid nodules

A 57-year-old man with Felty's syndrome had flank pain as a result of ureteral obstruction and right hydronephrosis. The obstruction was due to retroperitoneal necrobiotic granulomas typical of rheumatoid nodules.

Possible genetic influences in familial sarcoidosis

Five families (three English, one Irish, one West Indian) contained eleven members with sarcoidosis, nine of whom have been investigated and followed. Their multisystem involvement and course was similar to that of other patients attending the Sarcoidosis Clinic at the Royal Northern Hospital. There were three brother-sister and two mother-offspring relations; it was not observed in a father-offspring relationship. It is noted that the course of one sister was considerably worse than that of her brother. The evidence suggests a recessive mode of inheritance for sarcoidosis susceptibility. Four other families are reported on in an Addendum.

A tale of two cities: a comparison of sarcoidosis in London and Paris

Two large series of patients with sarcoidosis in London and Paris have been analysed and compared for differences in ethnic background, clinical features, mode of onset and duration, chest radiographic resolution, laboratory investigation and treatment.

It is found that in both capitals, sarcoidosis is a multisystem disorder. Most organ-systems of the body are invaded, emphasizing the fact that sarcoidosis transcends boundaries of various specialties, making it a disorder of general medical interest.

The diagnosis was confirmed by various histological techniques and the Kveim-Siltzbach test was found to be positive in three-quarters of patients in both series.

Depression of delayed type hypersensitivity, abnormal serum globulins and hypercalcaemia were observed in a significant proportion of both series.

Corticosteroids were administered to one-third of the London and to two-thirds of the Paris patients. The patient has the same chance of survival whether he lives in London or Paris, for the overall mortality is about 5% in both countries.