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TJX Fires Employee For Disclosing Vulnerability
I Don't Believe in Imaginary Property writes "A TJX employee was fired for an online post mentioning that TJX hasn't beefed up security after the recent, massive data breach that saw 94 million credit card numbers copied by criminals and money from their accounts stolen. The employee mentioned that, at first, their usernames were the same as their passwords. After they required stronger passwords, some managers complained, so they 'compromised' by allowing blank passwords. The whistleblower said he discussed his concerns with management, but that it was like talking to a brick wall. In spite of the weak internal security, TJX now has a firm that scours the internet to find bad things posted about them, which is how they found the message and fired him for it. Too bad they don't appear to have hired anyone to beef up operational security or to convince people to use strong passwords."
Sarcoid: Muscle, bone, and vascular disease manifestations
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Author
Winston Sequeira, MD
Section Editor
Peter H Schur, MD
Deputy Editor
Jerry M Greene, MD
Last literature review version 16.1: January 2008 | This topic last updated: April 17, 2006 (More)
INTRODUCTION -- Sarcoidosis, a multisystem disorder of unknown etiology, is characterized pathologically by the presence of noncaseating granulomas in affected organs. (See "Pathogenesis of sarcoidosis"). It typically affects young adults and, although any organ may be affected, the disorder commonly presents with one or more of the following three abnormalities:
Bilateral hilar adenopathy
Pulmonary infiltrates
Skin and/or eye lesions
Musculoskeletal disease is a less common problem. However, joint manifestations may be clinically significant in patients with acute disease [1] . Overall, from 4 to 38 percent of patients with sarcoidosis have one or more musculoskeletal manifestations [2]
The bone, muscle, and vascular manifestations of sarcoidosis other than arthritis will be reviewed here. General issues related to sarcoidosis and its pathogenesis are discussed separately. (See "Clinical manifestations and diagnosis of sarcoidosis" and see "Pathogenesis of sarcoidosis")
The American Thoracic Society (ATS) statement on sarcoidosis, as well as other ATS guidelines, can be accessed through the ATS web site at www.thoracic.org/sections/publications/statements/index.html.
SARCOID ARTHROPATHY -- The articular manifestations of sarcoidosis and the diagnosis and treatment of sarcoid arthropathy are presented separately. (See "Sarcoid arthropathy").
MYOPATHY -- It is estimated that skeletal muscle is involved in 50 to 80 percent of individuals with sarcoidosis, but is rarely (0.5 to 2.5 percent) symptomatic [3-5] . Symptoms may result from muscle disease involving the diaphragm, extraocular muscles, and other muscle groups [3,6-9] . Sarcoidosis should therefore be considered in patients presenting with unexplained muscle weakness, pain, or nodular swelling. (See "Approach to the patient with muscle weakness").
Three clinical patterns of myopathy have been described [10]
The most common form is the insidious onset of proximal muscle weakness with normal or elevated serum levels of muscle enzymes. This myopathy responds poorly to corticosteroids. It should be appreciated, however, that steroid therapy can induce a similar proximal myopathy. (See "Glucocorticoid-induced myopathy").
An acute myopathy, observed most commonly in women, is associated with elevated muscle enzymes.
The least frequent pattern is a nodular myopathy, which can present as single or multiple painful nodules. In one case, the large lesion resembled a tumor [4]
Electromyography -- Electromyographic studies in patients with sarcoidosis and muscle weakness may reveal a myopathic pattern. In some cases, widespread myotonia can mimic the pattern observed in acid maltase disease [6] . (See "Lysosomal acid maltase deficiency (glycogen storage disease II, Pompe disease)").
Imaging studies -- Imaging studies may help distinguish among and help diagnose the different types of myopathy. One study, for example, evaluated the relative utility of magnetic resonance imaging, CT scanning, and gallium scanning in four patients with biopsy proven lower extremity myositis [11] . Only MRI was positive in all four individuals and could distinguish between atrophic and nodular myopathy; by comparison, gallium scanning (with increased uptake) only identified nodular lesions and computed tomography failed to provide any additional information. Nodular myopathy produces a characteristic pattern on MRI: a star-shaped area of low-signal intensity centered within the nodule surrounded by areas of high intensity [12] . This finding may help direct the location of a muscle biopsy, thereby increasing the yield. It is important to be aware that the central hypointense area persists after steroid therapy [13] .
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