News HIV/AIDS News & Information - Part 4

14 Mar

Pathogenesis of Cerebral Air Embolism during Neodymium-YAG Laser Photoresection

Pathogenesis of Cerebral Air Embolism during Neodymium-YAG Laser PhotoresectionThe phenomenon of arterial air embolism has been described as a sequela to major thoracic trauma, diving accidents, selective arterial angiography, and central venous catheter malfunctions. Recently, arterial air embolism has been reported as a consequence of transthoracic needle lung aspiration. In addition, the occurrence of cerebral air embolism has been reported with transbronchial lung biopsy in a patient with miliary tuberculosis and, recently, in a patient with pulmonary amyloidosis.- In this report we present a case of acute air embolism complicating YAG laser photoresection of an endobronchial carcinoid. Continue Reading »

13 Mar

Massive Hemothorax Due to Intrathoracic Extramedullary Hematopoiesis in a Patient With Thalassemia Intermedia: Conclusion

Bone erosion and sclerosis occur in about 50 percent of patients with neurogenic tumors and lobulation is not seen. In addition, enhanced visualization of the masses on postcontrast computerized tomography supports the diagnosis of intrathoracic extra-medullary hematopoiesis as demonstrated in our case. Although invasive diagnostic procedures, including thoracotomy and aspiration needle biopsy, have been used, they are usually not necessary and are potentially hazardous because of the highly vascular nature of the thoracic masses. At thorocotomy Andras et al found the blood supply to derive from intercostal arteries and the esophageal plexus. Venous drainage was into the azygous system. In several reports surgical resection has been complicated by extensive hemorrhage requiring multiple transfusions. Our case provides a dramatic example of the hemorrhagic potential of this condition. Continue Reading »

12 Mar

Massive Hemothorax Due to Intrathoracic Extramedullary Hematopoiesis in a Patient With Thalassemia Intermedia: Discussion

Massive Hemothorax Due to Intrathoracic Extramedullary Hematopoiesis in a Patient With Thalassemia Intermedia: DiscussionIntrathoracic extramedullary hematopoiesis is a rare condition and is usually asymptomatic. Verani et al reviewed the literature in 1983 and collected 55 cases. With the exception of one patient who had dyspnea relieved with resection of an intrathoracic mass of erythropoietic tissue, the only previously reported complications have been due to spinal cord compression. Luyendijk et al in 1975 collected five cases of spinal cord compression from the literature and added one of their own. To our knowledge, our patient is the first reported case of hemothorax in this condition. Extramedullary hematopoiesis is seen in a variety of hematologic disorders. These include severe hemolytic anemias such as thalassemia and conditions such as myelofibrosis and myelophthistic anemia, where there is extensive replacement of normal marrow. Continue Reading »

01 Mar

Massive Hemothorax Due to Intrathoracic Extramedullary Hematopoiesis in a Patient With Thalassemia Intermedia: Case Report

On the morning of admission she awoke with the sudden onset of left pleuritic chest pain radiating to her left shoulder, weakness, and rapidly increasing dyspnea. She later recalled that her husbands arm had struck her chest when he turned over in his sleep the night before. On admission the blood pressure was 90/60 mm Hg; pulse rate, 120 and regular; respirations, 28/min; and temperature 38.7°C rectally. Physical examination results showed signs of a massive left pleural effusion, which a chest roentgenogram showed to extend almost to the lung apex. The WBC count was 8,400/ cu mm, and platelets were 412,000/cu mm. The bleeding time, prothrombin time, and partial thromboplastin time were normal. Thoracocentesis yielded gross blood with a hematocrit reading of 20 percent which was equal to the venous hematocrit. Pleural fluid analysis was negative for malignant cells and for microorganisms on smears and cultures. Continue Reading »

25 Feb

Massive Hemothorax Due to Intrathoracic Extramedullary Hematopoiesis in a Patient With Thalassemia Intermedia

Massive Hemothorax Due to Intrathoracic Extramedullary Hematopoiesis in a Patient With Thalassemia IntermediaMassive extramedullary erythropoeisis is an unusual phenomenon, most frequently observed as a response to the intense intramedullary hemolysis associated with the homozygous β-thalassemias and related conditions, such as hemoglobin E-thalassemia. The subset of such patients who do not require transfusion (thalassemia intermedia, or mild thalassemia) is most likely to display this phenomenon, since their erythropoeisis is not suppressed. The erythropoietic masses are usually asymptomatic, although spinal cord compression has been reported. We describe a patient with thalassemia intermedia in whom hemorrhage from a large erythroid mass resulted in massive hemothorax, to our knowledge a heretofore unreported occurrence. Continue Reading »

24 Feb

Talcosis Presenting as Pulmonary Infiltrates in an HIV-Positive Heroin Addict: Discussion

Patients with AIDS-related complex are prone to develop opportunistic lung infections. Intravenous drug abusers account for nearly one half of the female AIDS patients and 17 percent of the male AIDS patients. Inadvertent intravenous injection of talc, as happens following injection of crushed tablets, results in the development of talcosis. Pulmonary talcosis is a morbid condition, resulting from the inhalation or injection of talc into the body The talc, a native, soft mineral, chemically is hydrous magnesium silicate (Mg3 Si4 O10 [OH]2) and may sometimes contain a small portion of aluminum silicate. The pulmonary vascular bed acts as a filter retaining the crystalline particles; therefore, in the majority of cases, the pathologic lesions caused by talc are limited to the lungs. comments Continue Reading »

22 Feb

Talcosis Presenting as Pulmonary Infiltrates in an HIV-Positive Heroin Addict

Talcosis Presenting as Pulmonary Infiltrates in an HIV-Positive Heroin AddictThe lung is commonly involved in both infectious and noninfectious processes in patients with the acquired immunodeficiency syndrome (AIDS). The majority of these immunosuppressed patients usually suffer from Pneumocystis carinii pneumonia, cytomegalovirus (CMV) pneumonia, Mycobacterium avium intracellulare or Kaposi s sarcoma of the lung. Most of those opportunistic infections or neoplasms share a relatively close clinical presentation: dyspnea, cough, fever with bilateral involvement of the lungs, and a patchy reticular appearance on the chest roentgenograms. Acquired immunodeficiency syndrome-related complex occurs with increased incidence in homosexuals, intravenous drug abusers, hemophilic patients, and in multiple blood transfusion recipients. Talc, which is often present as a diluent in heroin or as a filler in tablets prepared for oral use, was associated with the development of talcosis in intravenous drug abusers.
This article reports a case of a HIV-positive young drug addict who was admitted with respiratory distress, fever, and a disseminated bilateral pulmonary process. Continue Reading »

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