1/8. Sarcoid-like pulmonary disorder in human immunodeficiency virus-infected patients receiving antiretroviral therapy.We report two cases of hiv-infected patients who presented with diffuse interstitial micronodular lesions on chest X-ray after institution of protease inhibitor-containing highly active antiretroviral therapy (HAART). Granulomatous pulmonary disorder mimicking sarcoidosis was diagnosed on histopathological studies revealing noncaseating granuloma and bronchoalveolar lavage analysis showing an intense CD4( ) lymphocyte alveolitis. Causative agents such as infectious organisms and environmental compounds were excluded. The relationship between sarcoid-like reaction and immune reconstitution under HAART is discussed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/8. An effective strategy for intervention with children and adolescents affected by hiv and AIDS.With John's deep sorrow and grief and inability to express it adaptively, the authors thought again about the children's therapeutic needs in group. What is planned and expected from group often turns itself over to what children expect and need. The program's wish for the children to verbally work out their conflicts was idealistic and unrealistic. Instead, the authors needed to use clinical skills creatively to re-establish safety for all the children and to help John cope with his sorrow and anger. It was obvious to the leaders that his anger regarding his mother's illness and death were escalated by the leader's pregnancy. Support needed to be provided to John and the group as a whole by understanding this psychologic struggle, and by providing a safe environment for him to establish a language to express his rage and develop more adaptive coping mechanisms. The example of John exemplifies many of the points made in this article. Although John's experiences only speak of one member's experience within a group, the power of the group is certain to be healing, not only for the individual but also for all of its members. While John's healing is made clear in the example, the other children also gained from these group experiences. They all had their anger and resentment of loss of a leader (and metaphorically of their mothers) expressed for them with a growing sense of safety in the demonstration of pain and anger. They witnessed concretely that their rage and sadness could be articulated and could not cause harm to others. Most interestingly, they all began to talk about their mothers and their early childhoods calmly, with a profound sense of connection with each other, even with silliness and age-appropriate fun. They began to use each other as sources of comfort in their sharing of their stories. The letters to and from John after his departure from group allowed the group members to continue their powerful bond. The current members remember John fondly. His angry outbursts and provocative behavior have been integrated into the story of the group. As children need to express rage they at times speak of John, using his ability to express this feeling as an example to the safety of the group. Again this type of work is not only powerful and intense, but needs to be unhurried. Children such as John and his comembers need time to experience their grief and heal their pain. Thus, groups are an effective strategy for work with hiv-affected children in helping them deal with the losses within their families and continue to grow into healthy adults.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
3/8. Laparoscopic-assisted primary repair of a complicated ventral incisional hernia.Postoperative wound dehiscence is a difficult problem for the general surgeon. Often, patients are too sick, or the wound environment is too hostile, to undergo primary repair. When an eventual repair is performed, a variety of methods are available, but most are associated with unacceptably high morbidity rates, specifically high incidences of recurrences and poor cosmetic outcome. We present here a case of postoperative wound dehiscence following a colostomy takedown repaired in a previously undescribed way--a laparoscopically assisted ventral incisional hernia repair. The method of repair is described, and the current literature regarding alternatives is reviewed.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
4/8. methamphetamine abuse: a perfect storm of complications.Previously restricted primarily to hawaii and california, methamphetamine abuse has reached epidemic proportions throughout the united states during the past decade, specifically in rural and semirural areas. Particular characteristics of methamphetamine production and use create conditions for a "perfect storm" of medical and social complications. Unlike imported recreational drugs such as heroin and cocaine, methamphetamine can be manufactured locally from commonly available household ingredients according to simple recipes readily available on the internet. methamphetamine users and producers are frequently one and the same, resulting in both physical and environmental consequences. Users experience emergent, acute, subacute, and chronic injuries to neurologic, cardiac, pulmonary, dental, and other systems. Producers can sustain life-threatening injuries in the frequent fires and explosions that result when volatile chemicals are combined. Partners and children of producers, as well as unsuspecting first responders to a crisis, are exposed to toxic by-products of methamphetamine manufacture that contaminate the places that serve simultaneously as "lab" and home. From the vantage point of a local emergency department, this article reviews the range of medical and social consequences that radiate from a single hypothetical methamphetamine-associated incident.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
5/8. mycobacterium haemophilum infection in immunocompromised patients: case report and review of the literature.mycobacterium haemophilum, previously characterized as an unusual pathogen, is found primarily in immunocompromised hosts. This organism has stringent growth characteristics and may not be isolated using routine techniques. M. haemophilum infects the skin and underlying tissues, a circumstance which reflects the organism's propensity for growth in a cooler environment. Infections have been reported in renal transplant recipients, patients with Hodgkin's disease, and, more recently, patients with AIDS. The organism has also been isolated from children with cervical lymphadenitis in the absence of apparent immunodeficiency. Response to therapy has not been uniform, and in some instances improvement in immune status has been associated with regression of lesions. With proliferation of transplantation surgery, chemotherapy, and AIDS, the number of infections due to M. haemophilum is likely to increase.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
6/8. The model of human occupation and adults with hiv infection and AIDS.hiv infection affects all aspects of a person's occupational functioning. This article examines the application of the Model of Human Occupation (Kielhofner & Burke, 1980) to adults with hiv. An occupational therapy assessment battery based on the model is introduced. Given the physical, psychosocial, and environmental needs of persons with hiv, the assessment must be comprehensive to fully evaluate the effect of hiv on occupational behaviors. Goal planning and treatment follow the assessment process. A case example illustrates the integration of the Model of Human Occupation with clinical practice.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
7/8. Hodgkin's disease and non-Hodgkin's lymphoma in an hiv positive patient.The occurrence of hiv associated non-Hodgkin's lymphoma (NHL) is a well recognized event. hiv associated Hodgkin's disease (HD) has also been observed. A unique patient with both entities is described. The patient was a 29 year old homosexual male who developed clinical IIA nodular sclerosis HD in 1985. He was hiv with CD4/CD8 = 0.2 and his sister had HD 20 years earlier. He received MOPP and had a complete response. In October 1988 he developed weight loss with an abdominal mass and biopsy revealed diffuse small non-cleaved NHL, with bone marrow involvement. This was his first AIDS associated illness. Probes identified clonally rearranged dna fragments in the J region of IgH chains and clonal rearrangements in the c-myc gene were also observed but EBV sequences could not be demonstrated. He was treated with m-BACOD but died in March 1989. His course was not complicated by opportunistic infection. Possible etiologies for the HD include his hiv status or shared sibling environment. The development of the NHL may have resulted from hiv infection and/or secondary to his treatment for HD. The relationship between the two lymphomas is uncertain and factors other than hiv exposure and its immune dysfunction may have been causal.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
8/8. Monoblastic leukemia in an hiv-infected patient: absence of viral expression in rna blasts.A small number of patients seropositive for the human immunodeficiency virus (hiv) have been reported as developing acute non-lymphoblastic leukemia (ANLL). In the cases previously published, the authors never reported a study of the link joining hiv infection and leukemia. We describe here the case of a 41-year-old hiv positive patient who developed ANLL (FAB classification M5). Using molecular techniques, we looked for a direct link between these two co-existing diseases. We showed the absence of hiv expression in the malignant clone, suggesting that the association of ANLL and Acquired Immune Deficiency syndrome is not a direct consequence of the myeloid precursors infection. Nevertheless a relationship may exist through a disorganization of the bone marrow micro-environment.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |