1/18. Suggestions for improving AIDS treatment in hospitals.On July 26, 1994, John William George Swaffer died of AIDS in an Ottawa hospital. His partner shares his experience while caring for John at the hospital. While the hospital did many things well, it seemed that requests for palliative care were poorly communicated among the various physicians involved with John's care. Coordination between hospital doctors and those from a local hiv clinic also seemed poor. The author recommends eight changes to better serve patients with AIDS and other terminal illnesses.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/18. Cutaneous acanthamoeba in a patient with AIDS: a case study with a review of new therapy; quiz 386.GOAL: To describe the presenting signs of an acanthamoeba infection. OBJECTIVES: Upon completion of this activity, dermatologists and general practitioners should be able to: 1. Discuss the clinical presentation of acanthamoeba infection. 2. Describe the conditions that make a patient susceptible to acanthamoeba. 3. Outline treatment options for acanthamoeba infection. CME: This article has been peer reviewed and approved by Michael Fisher, MD, Professor of medicine, Albert Einstein College of medicine. review date: April 2001. This activity has been planned and implemented in accordance with the Essentials and Standards of the accreditation Council for Continuing Medical education through the joint sponsorship of Albert Einstein College of medicine and Quadrant HealthCom, Inc. The Albert Einstein College of medicine is accredited by the ACCME to provide continuing medical education for physicians. Albert Einstein College of medicine designates this educational activity for a maximum of 1.0 hour in category 1 credit toward the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. This activity has been planned and produced in accordance with ACCME Essentials.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/18. Verrucous herpes virus infection in human immunodeficiency virus patients.OBJECTIVE: Two cases of varicella-zoster virus infection that were clinically and pathologically verrucous are reported. Although this phenomenon has previously been described in the dermatology literature, it has not, to our knowledge, been described in the pathology literature. It is important that pathologists are aware of these uncommon but histologically distinctive lesions. DATA SOURCES: The patients were seen and treated at the Departments of dermatology of the University of texas health science Center at San Antonio and Brackenridge Hospital in Austin, Tex. All information was derived from the medical records and from the attending physicians. CONCLUSIONS: Verrucous lesions of herpes (varicella) zoster virus infection are rare, but they do occur in patients with the acquired immunodeficiency syndrome. Clinically, the lesions studied resembled ordinary papillomavirus-induced verrucae. Histologically, there was verrucoid epidermal hyperplasia and, unlike ordinary lesions of herpes (varicella) zoster, very little inflammation of the dermis. Diagnostic multinucleated keratinocytes with herpesvirus cytopathic changes were present within the stratum corneum.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/18. Oral Kaposi sarcoma associated with severe alveolar bone loss: case report and review of the literature.BACKGROUND: In AIDS patients who present with an oral neoplasm, Kaposi sarcoma is the tumor most frequently encountered, comprising 50% to 80% of all tumor occurrences. However, oral Kaposi sarcoma associated with erosion of underlying bone is a relatively rare finding. This report and review of the literature documents a case of AIDS-related oral Kaposi sarcoma exhibiting severe bilateral erosion of the maxillary alveolar ridges. methods: An hiv-seropositive male with extensive maxillary Kaposi sarcoma and associated bilateral alveolar bone erosion presented for dental evaluation subsequent to radiation therapy. Clinical and radiographic examinations were performed. Medical and dental histories were procured and supplemented with consultations from the patient's primary physician and radiation oncologist. Maxillary edentulation with surgical revision for primary closure was the treatment of choice for management of the dentoalveolar pathology. A maxillary immediate treatment denture was designed to obturate anticipated antral communications with the maxillary sinus. RESULTS: Surgical and prosthetic treatments were completed, but complicated by an oral-antral perforation that subsequently healed without complication. Soft tissue biopsies obtained during surgery revealed no evidence of residual Kaposi sarcoma. CONCLUSIONS: Although AIDS-related oral Kaposi sarcoma is a relatively common finding, erosion of subjacent alveolar bone is uncommon. Treatment of the tumor with subsequent dental reconstruction can be complicated by the severe lack of bone, surgical perforation of the maxillary sinus, and lack of stable teeth to serve as abutments. Significant advances in understanding the pathogenesis of AIDS-related Kaposi sarcoma have occurred in the last decade. HHV-8 and various inflammatory cytokines have been implicated in the pathogenesis and are likely to become the primary targets for therapeutic intervention.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/18. pyelonephritis and acute renal failure.Bacterial invasion of the renal parenchyma, pyelonephritis, is rarely considered as a primary cause of acute renal failure, particularly in adults. We report two cases of acute renal failure occurring in absence of hypotension, urinary tract obstruction, or nephrotoxic medications that are likely the direct consequence of pyelonephritis. The first case involved a 48-year-old hiv-positive woman who presented with 3 days of nonspecific symptoms and was noted to have acute renal failure. Due to unremitting renal dysfunction, a renal biopsy was performed confirming the diagnosis of bacterial pyelonephritis. The second case, a 33-year-old man with hiv disease, presented with fever and was found to have pyelonephritis by urine culture and ultrasonography. These cases represented initial diagnostic dilemmas for the admitting physicians and demonstrate the varied clinical presentations of acute renal failure as a direct consequence of bacterial infiltration of the renal parenchyma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/18. meningitis due to histoplasma capsulatum and mycobacterium tuberculosis in a returned traveler with acquired immunodeficiency syndrome.histoplasmosis has rarely been reported in taiwan, and its clinical manifestations may be similar to those of tuberculosis. With increasing international travel, physicians need to be aware of the possibility of this disease when caring for patients with advanced human immunodeficiency virus (hiv) infection who have traveled to endemic areas. A 55-year-old Chinese male from Burma presented with concurrent histoplasmosis and tuberculous meningitis as the initial opportunistic infection of acquired immunodeficiency syndrome. fever, altered mentation, pancytopenia, splenomegaly and marked elevations of serum lactate dehydrogenase (3601 U/L) and ferritin (>10(6) ng/mL) were noted. Despite treatment with amphotericin b and antituberculous therapy, the patient died on the 25th day of hospitalization. This case illustrates the complexity and challenges of management of opportunistic infections in travelers returning from Southeast Asia who are in the advanced stage of hiv infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/18. Multifocal choroiditis in disseminated cryptococcus neoformans infection.PURPOSE: To report an uncommon case of multifocal choroiditis as the result of disseminated cryptococcus neoformans infection in a patient who is hiv-positive. DESIGN: Interventional case report. methods: A 27-year-old hiv-positive woman with fever, headache, and vomiting was examined. Lumbar puncture was performed and revealed C neoformans infection. Her condition evolved with sudden bilateral blindness and deafness. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. RESULTS: Postmortem examination showed disseminated C neoformans infection. Histologic examination of the eyes confirmed the presence of C neoformans in the choroiditis. CONCLUSION: Multifocal choroiditis in C neoformans infection is a rare ophthalmic manifestation. The recognition of this condition by ophthalmologists can help physicians to diagnose a disseminated and fatal disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/18. AIDS and palliative medicine: medical treatment issues.Caring for patients with AIDS in hospice programs presents numerous challenges. These go beyond the strictly medical decisions discussed in this article to include unique problems with social support, emotional support, and bereavement. This discussion centers on medical issues as they are commonly encountered. They can be stumbling blocks, or even surrogates, for addressing the other important issues at the end of life. communication between all people involved in the multidisciplinary treatment of these patients is essential. Common goals should be identified and general approaches agreed upon among the physicians, nurses (clinic, hospice, home care), therapists, clergy, and volunteers. In this way we feel that the principles of hospice and palliative care can be effectively applied to most patients with endstage AIDS.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/18. Disseminated mycobacterium scrofulaceum infection: a potentially treatable complication of AIDS.Disseminated mycobacterium scrofulaceum infection has rarely been reported (only 8 cases to date), and no case of infection associated with AIDS has been reported in detail. We report a case of disseminated M. scrofulaceum infection in an AIDS patient that presented as chronic ulcerative and nodular skin lesions with probable cavitary lung involvement. We discuss reported cases of dissminated M. scrofulaceum infection and features of human immunodeficiency virus (hiv)-associated disease due to mycobacteria other than tuberculosis. Although our patient died before susceptibility testing could be completed, the M. scrofulaceum isolate was found to be susceptible to clarithromycin, ethambutol, and clofazimine. physicians who evaluate skin lesions in hiv-infected persons should perform appropriate mycobacterial studies and search for disseminated disease. Drug susceptibility testing for mycobacteria other than tuberculosis is not yet standardized, but the broth dilution method, currently being studied in clinical trials of treatment for mycobacterium avium complex, may be superior to older methods. After the possibility of mycobacterium tuberculosis infection has been excluded, physicians should consider administering initial empirical therapy with two or more drugs, including a newer macrolide, to AIDS patients with disseminated mycobacterial disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/18. Severe co-trimoxazole reaction in a man with AIDS.Although other drugs can be used in the prophylaxis and treatment of hiv-infected persons, family physicians will prescribe co-trimoxazole frequently. These providers need to recognize the overall increased frequency of adverse reactions to this drug in this population and the potential for severe hypersensitivity effects requiring intensive hospital care. While the exact importance re-exposure has in causing this reaction remains unclear, certainly providers must pay particular attention to patients who have had any earlier sensitivity to the drug before treatment is resumed. Desensitization therapy has been used successfully in some hiv-positive individuals, even after severe reactions; however, this case again teaches the need for prudence in the use of all pharmacological agents.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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