This thesis has dealt with the role of endosonography in the diagnosis of sarcoidosis. The main conclusion is that endosonography with aspiration of mediastinal lymph nodes has superior... Show moreThis thesis has dealt with the role of endosonography in the diagnosis of sarcoidosis. The main conclusion is that endosonography with aspiration of mediastinal lymph nodes has superior diagnostic yield in comparison to conventional bronchoscopy with taking of peripheral (TBLB) and endobronchial (EBB) tissue (80% vs 53%). Guidelines advising to perform bronchoscopy (including TBLB and EBB) as a first choice procedure to detect granulomas should be revised. In case EUS or EBUS are not available, bronchoscopy may reach comparable sensitivity but only if cTBNA, TBLB and EBB are all performed. This will increase procedure time and likely also complications because of the number of needle and forceps samples. Secondly, we assessed morbidity and mortality rates of EBUS and EUS for pulmonary indications and found that both techniques are very safe. Fatalities have been described but are very rare with a mortality rate of 0.04% and mostly occurred in patients of fragile health. Serious adverse events happen occasionally (0.15%) and are mostly of infectious origin in patients undergoing needle aspiration of cysts, sarcoid of necrotic lymph nodes. Show less
This thesis describes the evaluation of pain perception in acute and chronic pain patients and the strength of the endogenous pain modulation system in chronic pain patients. Additionally, pain... Show moreThis thesis describes the evaluation of pain perception in acute and chronic pain patients and the strength of the endogenous pain modulation system in chronic pain patients. Additionally, pain phenotypes are determined in patients with chronic pain. The ability of patients with acute pain after surgery and patients with fibromyalgia to consistently score random painful stimuli on a numerical rating scale is assessed, and the influence of opioids on this ability is evaluated. In patients with fibromyalgia, the offset analgesia paradigm is also evaluated. Offset analgesia is defined as the reduction in pain perception after a small decrease in a nociceptive heat stimulus, that is larger than would be expected from the magnitude of the stimulus decrease. This paradigm can be used to assess the endogenous ability to modulate incoming pain signals. Another manifestation of endogenous pain modulation is conditioned pain modulation (CPM). This is the reduction of pain perception of a nociceptive stimulus by the application of a second nociceptive stimulus on a remote area on the body. In this thesis the ability of a new device specifically developed to induce CPM is evaluated. In the last 2 chapters, the signs and symptoms of chronic pain patients with fibromyalgia, diabetes and sarcoidosis are used to construct 4 pain phenotypes. These phenotypes represent groups with more homogeneous patterns of signs and symptoms, which may be important to identify and evaluate targeted drug therapy. Show less
