News HIV/AIDS News & Information - Part 5

21 Feb

Primary Granulocytic Sarcoma Presenting with Pleural and Pulmonary Involvement: Discussion

A simultaneous serum LDH was 203 IU/L, and the total protein was 6.1 g/dl. The pleural effusion cytology study showed atypical leukocytes, but it was not diagnostic for leukemic involvement. Bronchoscopy showed a 50 percent narrowing of the left mainstem bronchus and severe narrowing of the lobar bronchi. The mucosa was red-purple, friable, and hemorrhagic. The segmental bronchi could not be seen due to the bleeding and narrowing. The bronchial biopsy showed a dense mononuclear cell infiltrate with rare atypical cells. The bronchial cytology specimen was negative. A pleural biopsy showed fibrosis and a bland mononuclear cell infiltrate. Bilateral iliac crest bone marrow aspirates and biopsies showed increased storage iron and decreased sideroblast iron without evidence of a neoplastic infiltrate. An endomyocardial biopsy showed no abnormalities. Doxycycline Continue Reading »

20 Feb

Primary Granulocytic Sarcoma Presenting with Pleural and Pulmonary Involvement

Primary Granulocytic Sarcoma Presenting with Pleural and Pulmonary InvolvementGranulocytic sarcoma (chloroma) is an unusual extramed-ullary manifestation of acute myelogenous leukemia, chronic myelogenous leukemia, and the myeloproliferative syndrome. The tumor rarely occurs in the absence of concurrent or remote peripheral blood or bone marrow involvement by leukemia. This patient developed pleural and pulmonary involvement by primary granulocytic sarcoma. Our review of the literature suggests that this is the first example of granulocytic sarcoma involving the pleura and lung but not the bone marrow. read only Continue Reading »

04 Feb

Gated Radionuclide Ventriculography in the Evaluation of Cardiac Function in Duchenne’s Muscular Dystrophy: Discussion

Gated Radionuclide Ventriculography in the Evaluation of Cardiac Function in Duchenne’s Muscular Dystrophy: DiscussionRespiratory failure is a major cause of death in those with DMD. Mechanical ventilation has opened new options for treatment of these patients. Once a treatment for the most common cause of death was available, other medical problems took on an added significance. Death from heart failure is now also a major concern. The initiation of assisted ventilation is not a minor procedure. It is a major transition for the patient, both physically and emotionally. Whether or not a patient desires such aggressive medical intervention is a question that requires a great deal of informed consideration on the part of the patient, his family, and his physician. To properly address this issue, it is critically important that the patient be given information regarding expected mortality and morbidity from both pulmonary and cardiac failure. If death or significant morbidity due to cardiac failure appears inevitable within a short time, major questions of the advisability of initiating long-term assisted ventilation arise. Continue Reading »

03 Feb

Gated Radionuclide Ventriculography in the Evaluation of Cardiac Function in Duchenne’s Muscular Dystrophy: Materials and Methods

Thirty-eight patients followed in the DMD Pulmonary Clinic at Rancho Los Amigos Medical Center were studied. All had a history, clinical course, and laboratory findings characteristic of DMD. All patients were dependent on a wheelchair, corresponding to Swin-yard class 7 or 8.“ Nine of the patients were fully dependent on a ventilator. The average age of all patients was 23.1 years (range, 12.9 to 41.6 years). All had ECGs, gated radionuclide ventriculography, and pulmonary function tests including FVC. The values for FVC were measured according to the recommendations of the American Thoracic Society using a 9-L spirometer, with the largest of three acceptable values being selected. Radionuclide ventriculography was performed by a standard gated blood pool technique using erythrocytes labeled in vivo with 20 mCi of technetium-99m. The LVEF was determined using the semiautomatic program of the Medical Data Systems A2 computer system. Linear correlation coefficients between the LVEF and age and the LVEF and FVC were determined. Continue Reading »

02 Feb

Gated Radionuclide Ventriculography in the Evaluation of Cardiac Function in Duchenne’s Muscular Dystrophy

Gated Radionuclide Ventriculography in the Evaluation of Cardiac Function in Duchenne’s Muscular DystrophyDuchenne’s muscular dystrophy is a progressive muscular dystrophy with significant respiratory and cardiac manifestations. The median age at death previously has been reported as 18 to 19 years, with rare survival to the age of 25 years. Death is related to respiratory insufficiency in 90 percent of these patients, but cardiomyopathy may be an important cause as well. Previously, with no methods of treatment available, prediction of cardiac vs respiratory failure has had only academic significance and has not been vigorously pursued; however, advances in assisted mechanical ventilation have recently begun to offer therapeutic options and some hope of prolonging longevity and meaningful survival for the patient dying of respiratory failure. Continue Reading »

01 Feb

Endobronchial Tuberculosis in the Acquired Immunodeficiency Syndrome: Conclusion

In addition, tuberculosis appears to be significantly easier to diagnose by endobronchial biopsy than Kaposi’s sarcoma.* Another endobronchial process to consider in a patient with AIDS is P carinii pneumonia. There is a recent report of a patient with a cavitary lingular infiltrate who, at the time of bronchoscopy, had a mass very similar to those described herein obstructing the lingular orifice. Biopsy revealed only P carinii pneumonia; however, two months prior to that, sputum and percutaneous needle aspiration of the left lung had grown M tuberculosis, and the patient was receiving chemotherapy. This information is difficult to interpret, and the lesion may very well have represented endobronchial tuberculosis in addition to P carinii pneumonia. Continue Reading »

31 Jan

Endobronchial Tuberculosis in the Acquired Immunodeficiency Syndrome: Outcome

Endobronchial Tuberculosis in the Acquired Immunodeficiency Syndrome: OutcomeOur findings at bronchoscopy were similar in all three cases. A white or pink exophytic mass was seen occluding the orifice to the left upper lobe, anterior segment of the right upper lobe, and the left lower lobe, respectively. Adjacent carinae were erythematous and markedly thickened, and there was an impression of submucosal infiltration in these areas. This extensive submucosal involvement and the absence of cavitary disease support the idea of lymphatic spread from a parenchymal source as the etiology of the endobronchial abnormalities. The endobronchial characteristics of tuberculosis in these patients were very similar to those reported by Ip et al in patients without AIDS. Continue Reading »

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