News HIV/AIDS News & Information - Part 6

30 Jan

Endobronchial Tuberculosis in the Acquired Immunodeficiency Syndrome: AIDS and ARC

In 1986, the incidence of tuberculosis in the United States had risen 2.6 percent compared with 1985 (unpublished data from the Centers for Disease Control). Previously, the incidence was noted to have increased predominantly in urban areas, due mainly to tuberculosis occurring in patients with AIDS and ARC. This trend was confirmed at our institution, where the rate of tuberculosis was shown to have doubled between 1978 and 1985, the majority of cases occurring in intravenous drug abusers with AIDS or ARC. Each of the three cases presented herein posed a diagnostic dilemma at the time of admission, resulting in a significant delay in the institution of antituberculosis chemotherapy. All of the patients received empiric antimicrobial agents, with a minimum of one week of hospitalization prior to undergoing fiberoptic bronchoscopy. Given the increased frequency of tuberculosis in the population with AIDS, it seems prudent to review the clinical, roentgenographic, and broncho-scopic features in these patients, as tracheobronchial involvement will surely be seen more frequently. alta white teeth whitening Continue Reading »

29 Jan

Endobronchial Tuberculosis in the Acquired Immunodeficiency Syndrome: Discussion

Endobronchial Tuberculosis in the Acquired Immunodeficiency Syndrome: DiscussionIn 1949, a post-mortem study of 1,000 patients with pulmonary tuberculosis revealed that 42 percent had involvement of the tracheobronchial tree. With the development of antituberculosis chemotherapy, endobronchial tuberculosis has become a rare occurrence. In a number of recent studies examining the use of fiberoptic bronchoscopy in the diagnosis of pulmonary tuberculosis in the population without AIDS, there were no reports of endobronchial disease. In the last 20 years, descriptions of endobronchial tuberculosis have been limited to small numbers of patients with unusual presentations often involving areas of primary tuberculosis, such as the anterior segment of the upper lobes. This was the case until So et al noted an 18 percent incidence of tracheobronchial involvement in 65 patients from Hong Kong with sputum-negative pulmonary tuberculosis. Subsequently, Ip et al reported the findings in 20 patients with endobronchial tuberculosis collected over a seven-year period. Continue Reading »

14 Jan

Endobronchial Tuberculosis in the Acquired Immunodeficiency Syndrome: Case Reports

Case 2
A 30-year-old homosexual man with a previous history of Pneumocystis carinii pneumonia and AIDS presented with fevers, nonproductive cough, and pleuritic chest pain of two weeks’ duration. The chest x-ray film taken on admission revealed anterior mediastinal adenopathy, a left upper lobe infiltrate, and a small left pleural effusion (Fig 2). The patient received intravenous antibiotic therapy but continued to have daily temperature elevations, and serial chest x-ray films showed an increase in the size of the mediastinal lymph nodes. On the sixth day of hospitalization, fiberoptic bronchoscopy revealed thickening of the secondary carina and a pink endobronchial mass obstructing the left upper lobe orifice. Biopsy of the lesion revealed an ulcerated mucosa with chronic inflammatory changes. No granulomata were seen. Continue Reading »

13 Jan

Endobronchial Tuberculosis in the Acquired Immunodeficiency Syndrome

Endobronchial Tuberculosis in the Acquired Immunodeficiency SyndromeSince the advent of antituberculosis chemotherapy in the United States, endobronchial tuberculosis has been considered a relatively unusual occurrence. Within the last two decades, the literature on this subject has consisted of a few small series of patients; however, recently, So et al from Hong Kong reported an 18 percent incidence of endobronchial involvement in patients undergoing fiberoptic bronchoscopy for diagnosis of sputum-negative pulmonary tuberculosis. Coincident with the epidemic rise in the number of patients with the acquired immunodeficiency syndrome (AIDS), the incidence of tuberculosis in the United States has increased. The pulmonary parenchymal manifestations of tuberculosis in patients with AIDS and AIDS-related complex (ARC) have been well delineated; however, endobronchial involvement has not been previously described. In this article, we will examine the clinical features of the first reported cases of endobronchial tuberculosis occurring in three patients with AIDS. Continue Reading »

12 Jan

Respiratory Acoustic Impedance in Left Ventricular Failure: Conclusion

Respiratory Acoustic Impedance in Left Ventricular Failure: ConclusionThere is evidence that the vagal reflexes induced by lung vascular congestion are activated, at least in part, by the accumulation of extravascular lung water rather than by high vascular pressures per se. Moreover, it is well known that interstitial edema responds slowly to changes in vascular pressures. In experimental hydrostatic lung edema, vagally mediated bronchoconstriction has been shown to persist after lung vascular pressures were reduced to normal. It therefore appears that large airways diameter, an important determinant of Zrs, may vary independently of vascular pressures. A delay between changes in vascular pressures and small airways resistance would also be expected if the latter is increased by intraluminal edema rather than by compression from enlarged vessels. No simple relationship should therefore be expected between lung vascular pressures and airway mechanics, especially during the unstable phase of acute left ventricular failure. Continue Reading »

11 Jan

Respiratory Acoustic Impedance in Left Ventricular Failure: Specificity of Zrs to Acute Pulmonary Vascular Congestion

Specificity of Zrs to Acute Pulmonary Vascular Congestion
The Zrs modifications observed in cardiac patients during the acute study appear to be qualitatively similar to those in asthmatic patients with severe airway obstruction (Fig 1). The latter were examined in the sitting position. However, we can infer from the effects of body position on Zrs (see above, reference values) that Zrs abnormalities would have been qualitatively similar, and even more marked quantitatively, if these subjects had been examined semirecumbent. All Zrs indices in group C were between those of groups N and A (Fig 2). These results demonstrate that no specific Zrs features can distinguish acute lung vascular congestion from primary airway obstruction. Continue Reading »

10 Jan

Respiratory Acoustic Impedance in Left Ventricular Failure: Discussion

Respiratory Acoustic Impedance in Left Ventricular Failure: DiscussionReference Values
In order to evaluate semirecumbent cardiac patients for possible Zrs abnormalities, appropriate reference Zrs values are needed. The normal values of Zrs published in the literature were recorded in ambulatory subjects in the sitting position and therefore may not be relevant to measurements obtained in hospitalized, semirecumbent patients. This is partly due to the fact that functional residual capacity, a determinant of Zrs, is position dependent. In the present study, Zrs obtained in normal subjects after 20 min of semirecumbency showed an increased resistance at all frequencies, as well as a zero or slightly negative slope of resistance from 10 to 20 Hz (Fig 1), compared with data obtained in the same subjects in the sitting position, which showed a positive slope of resistance at low frequencies (unpublished data). Continue Reading »

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