1/4. Differentiating hiv-1 parotid cysts from papillary cystadenoma lymphomatosum.BACKGROUND: patients with parotid cystic lesions may first be seen in the dental office. These conditions most often represent either papillary cystadenoma lymphomatosum, or PCL, or lymphoepithelial cysts associated with human immunodeficiency virus, or HIV, disease. The authors present a case report to illustrate the differential diagnosis. CASE DESCRIPTION: PCL represents a benign, usually unilateral, circumscribed parotid tumor with cystic elements. HIV-associated lymphoepithelial cysts of the parotid gland usually are seen bilaterally, create cosmetic concerns and are hallmarked by an associated cervical lymphadenopathy. Therapy for PCL demands surgical excision, while patients with HIV-associated lymphoepithelial cysts may be treated with antiviral therapy and undergo periodic monitoring by a physician. CLINICAL IMPLICATIONS: As a member of the health care team, the dentist must be familiar with head and neck swellings. Early clinical recognition of parotid swellings leads to successful treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Storage artifact increases helper T lymphocytes and helper-to-suppressor T lymphocyte ratio to normal levels in a patient with acquired immune deficiency related complex.An increase in both the helper/suppressor T lymphocyte ratio and the absolute number of helper T lymphocytes from subnormal to normal values was observed on overnight storage of a lymphocyte preparation from a patient with acquired immune deficiency related complex. Storage of lymphocyte preparations did not significantly alter the helper/suppressor ratio for four additional patients with acquired immune deficiency related complex but produced increases for one patient with Crohn's disease and two patients with sickle cell disease. Overnight storage of heparinized blood at room temperature did not alter the helper/suppressor ratio for one healthy volunteer and one patient with acquired immune deficiency related complex but produced increases for one patient with Crohn's disease and one patient with acute infectious mononucleosis, resulting in a change from a subnormal to a normal value in the latter patient. We suggest that physicians and laboratory directors consider storage artifacts when evaluating results of tests for absolute numbers of helper T lymphocytes or helper/suppressor T lymphocyte ratios performed on patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. Thrombotic thrombocytopenic purpura in patients with the acquired immunodeficiency syndrome (AIDS)-related complex. A report of two cases.Immune thrombocytopenia has been reported with increased incidence in high-risk persons such as intravenous drug addicts and homosexual men who have serologic evidence of infection with human immunodeficiency virus (HIV). Thrombotic thrombocytopenic purpura, generally regarded as a rare disorder, has also been seen in association with exposure to HIV. Two patients had classical symptoms and laboratory findings of thrombotic thrombocytopenic purpura and the acquired immunodeficiency syndrome (AIDS)-related complex. Both patients belong to high-risk groups. They were treated with conventional therapy for thrombotic thrombocytopenic purpura and followed for 3 months. Their response to treatment was no different from that of other groups of patients with this syndrome. This article alerts physicians to the possible association of thrombotic thrombocytopenic purpura, AIDS, and aids-related complex.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. pneumocystis carinii pneumonia presenting as asthma: increased bronchial hyperresponsiveness in pneumocystis carinii pneumonia.Two male patients presented with clinical and laboratory findings consistent with typical bronchial asthma and subsequently developed pneumocystis carinii pneumonia (PCP). Only on subsequent questioning did both admit to homosexuality and behavior associated with a high risk of HIV-infection. In order to determine how frequently reversible airway obstruction is seen in patients with PCP, we measured peak expiratory flow rates (PEFR) before and after bronchodilator administration in 37 of these patients. Initial PEFR measurements revealed a significant decrease in PEFR (< 80% predicted) in 84%, with 54% of these exhibiting a significant bronchodilator response (> or = 15% increase). For comparison, peak flow measurements were made in a control group of 31 HIV-infected patients without acute PCP, divided between those with asymptomatic HIV-infection, aids-related complex (ARC), and AIDS, (including patients with previous PCP). Only 23% of these individuals had low PEFR, and only 3% exhibited bronchodilator responses. In order to confirm the existence of bronchial hyperreactivity in patients with PCP, another 16 patients with PCP were tested by methacholine bronchial challenge and 50% were found to have positive responses. These findings suggest that both reversible airway obstruction and airway hyperreactivity are found in association with acute PCP and that as a result some patients with PCP may present with symptoms of asthma. It is important for physicians to have a high degree of suspicion to avoid missing a diagnosis of PCP in a patient presenting with apparent asthma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |