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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Several lines of evidence implicate tumor necrosis factor (TNF), a cytokine produced by monocytes-macrophages, in the systemic manifestations of shock induced by Gram-negative bacteria. Whether the increase of circulating TNF levels is specific to septic shock as compared to sepsis without shock or to non-septic shock is still unclear. Since TNF values recorded at the time of admission to the hospital vary widely, statistical analysis has not been possible. Therefore, we postulated that the evolution of a patient's TNF serum level as compared to his initial value may better distinguish the survivor from the non-survivor than a single initial determination. Using a radioimmunoassay, we measured the TNF concentrations in the sera of 7 patients with severe infections without shock, 16 patients with septic shock and 8 patients with non-septic shock. Blood samples were drawn within the first 12 hours after the onset of shock. Patients with cancer, HIV infection, or under steroid therapy were excluded. Repeated measurements were made during the first 3 days of septic shock in 10 patients. The circulating TNF level, determined upon admission, appears to be neither specific nor predictive of the outcome of septic shock. In contrast, persistently high levels of circulating TNF seem to be well correlated with a poor prognosis, since 5 out of 6 patients with elevated TNF values died of septic shock.
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PMID:[Specificity and serum concentrations of tumor necrosis factor in septic shock]. 228 4

Bacterial esophagitis is uncommon and has not been well characterized. We present a patient who fulfills the strict definition of bacterial esophagitis set forth by Walsh: "histopathologically demonstrable bacterial invasion of esophageal mucosa or deeper layers with no concomitant fungal, viral, or neoplastic involvement or previous surgery of the esophagus." Bacterial esophagitis should be considered in all immunocompromised patients presenting with odynophagia; however, its occurrence in association with human immunodeficiency virus infection has not yet been reported. Bacterial esophagitis can be a source of occult sepsis and requires different therapy than the other forms of infectious esophagitis.
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PMID:Bacterial esophagitis: an often forgotten cause of odynophagia. 230 80

We analysed 13 pregnancies from HIV-positive women, 12 intravenous drug abusers, and found the following complications: (1) 4 small-for-date babies and 1 premature baby; (2) 12 spontaneous births, 1 cesarean section; (3) 6 children with acute withdrawal syndrome and/or sepsis; (4) 2 children have AIDS, 3 mothers too; 1 child got ARC; (5) 4 children became HIV-negative. We propose some guidelines through pregnancy and birth for this group at risk.
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PMID:[Obstetrics for HIV positive pregnant patients]. 234 10

We have studied the outcome of 140 general surgical procedures in 112 patients known or suspected to be infected with human immunodeficiency virus (HIV) or hepatitis B virus. Forty patients had antibodies to HIV. A wide range of surgical procedures was performed, with an overall complication rate of 5.7%. Wound infection, wound haematoma and one unexplained pyrexia were the only complications seen. Some anorectal wounds in patients with HIV antibodies were noted to heal extremely slowly, but the aggressive anorectal sepsis reported by others was not seen. The postoperative course after general surgical procedures was unremarkable in patients with HIV antibodies, and in those suspected of HIV infection, but because anorectal wounds were found to heal slowly, we recommend that anorectal surgery be conservative in patients with HIV antibodies.
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PMID:Surgical procedures in patients at risk of human immunodeficiency virus infection. 185 69

One thousand and ninety human immunodeficiency virus (HIV)-positive homosexual or bisexual males were seen in one hospital for management of HIV disease over a 9-year period. One hundred and fifty-five patients were referred by acquired immunodeficiency syndrome (AIDS) physicians for general surgical management. The most frequent reason for surgical referral (64 patients) was anorectal disease which occurred in 5.9 per cent of all HIV-positive patients. One or more diagnoses were reached in 61 of the 64 patients referred with anorectal disease: warts (38 per cent of diagnoses), anorectal ulceration (26 per cent), perianal sepsis (15 per cent), neoplasia (14 per cent) and haemorrhoidal disease (8 per cent). Anorectal symptoms were relieved in 68 per cent of patients and the median survival of those treated was 17.5 months from the time of surgical referral. Both warts and perianal sepsis were associated with in situ neoplasia, but no case of progression from in situ to invasive anal squamous carcinoma was detected. The aetiology of anorectal ulcers was not clear, but surgical excision of anal ulcers and skin tags can produce healing. Palliation of anorectal symptoms in HIV-positive homosexual patients is possible but some conditions are unusual and surgeons should be familiar with their presentation and management.
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PMID:Surgical management of anorectal disease in HIV-positive homosexuals. 239 7

High levels of an acid-labile IFN-alpha have been demonstrated in the sera of patients with symptomatic HIV infection. IFNs have been shown to enhance the cytotoxic and antiproliferative actions of tumor necrosis factor (TNF), which is a potent mediator of inflammation and sepsis. We show that the acid-labile IFN-alpha present in AIDS sera can induce TNF synthesis and sensitize blood monocytes (BM) to endotoxin stimulation resulting in further synthesis of TNF in vitro. TNF production by BM from patients with HIV infections and normal controls was measured by a cytotoxicity assay on L929 cells using human TNF alpha as a standard. BM from AIDS patients spontaneously produce high levels of TNF and are hypersensitive to endotoxin stimulation, resulting in enhanced synthesis of TNF. In determining the mechanism involved, we demonstrated that treatment of normal BM with AIDS sera results in induction of TNF. Neutralization of the acid-labile IFN-alpha in AIDS sera with polyclonal anti-IFN-alpha antibodies results in diminution of TNF induction. In addition, pretreatment of normal BM with AIDS sera, IFN-alpha, or IFN-gamma renders the cells hypersensitive to endotoxin. Consequently, activation of the TNF system by the acid-labile IFN-alpha contributes to some of the physiological disturbances, such as the wasting syndrome, and to the pathophysiology of sepsis in AIDS patients.
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PMID:Endotoxin induction of tumor necrosis factor is enhanced by acid-labile interferon-alpha in acquired immunodeficiency syndrome. 250 43

This retrospective study details the findings and outcome in 34 homosexual men, out of a total of 177 patients, who underwent surgery for non-condylomatous perianal disease over a 2-year period. Of 34 homosexuals 20 presented with anorectal sepsis compared with 11 of 79 heterosexual male patients (X2 = 24.07, P less than 0.001). Lesions included chronic intersphincteric abscess (eight patients), anal fistula (seven patients) and chronic intersphincteric abscess and fistula (five patients). Anal fissure occurred in 15 patients, anal ulcer in three, skin tags in six, haemorrhoids in two and Kaposi's sarcoma in one. Eight patients were human immunodeficiency virus (HIV) antibody negative, four were asymptomatic HIV antibody positive, 12 had symptomatic HIV infection using the Centers for Disease Control classification and in ten patients HIV status was unknown. Irrespective of the type of surgery performed, healing occurred within 6 weeks of operation in all HIV antibody negative patients, all asymptomatic HIV antibody positive and in only one of nine patients with symptomatic HIV infection. Eight of nine patients with symptomatic HIV infection failed to heal by this time (X2 = 8.98, P less than 0.05). These findings suggest that the prevalence of anorectal sepsis in homosexual men is high and that symptomatic HIV infection is an important determinant of progress after surgery.
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PMID:Non-condylomatous, perianal disease in homosexual men. 259 52

Patients treated with chronic dialysis have a high risk of acquiring viral infections and blood transfusions are commonly considered to be the vehicle of transmission. In Brazil this source is implicated in infection of 15 percent of patients developing acquired immunodeficiency syndrome (AIDS). So, we evaluated the relative risk of our patients in dialysis becoming infected with human immunodeficiency virus (HIV), the virus associated with the AIDS. An enzyme immunoassay showed 6 of 104 patients on dialysis to have antibodies to HIV. In five infection with HIV was confirmed by Western blot tests. Investigation of other risk factors for AIDS showed that blood transfusion was the most likely cause of contamination. There was no correlation between HIV and HBV infections. Only one patient had leucopenia and low OKT4/T8 ratio and she died 90 days after sorologic diagnosis of HIV infection; the cause of death was encephalopathy and sepsis. Two patients died after 4 and 16 months victims of cardiocirculatory problems (non-AIDS related causes). Three patients remain asymptomatic on chronic hemodialysis 20, 36 and 37 months after diagnosis of HIV infection.
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PMID:[Prevalence of anti-HIV antibodies in dialysis patients]. 261 90

Hepatic transplantation is the only therapeutic choice for end-stage pediatric liver diseases. The survival improvement, registered in the last few years is mainly due to the employment of cyclosporine in therapy, but also to new and sophisticated surgical techniques and immunosuppressive drugs. The indications in children are: biliary atresia after unsuccessful Kasai procedure, paucity of intrahepatic bile ducts (of syndromic and not syndromic type), some metabolic diseases (alfa1 antitrypsine deficiency, hereditary tyrosinemia), post infective cirrhosis, acute fulminant hepatic failure, hepatic malignancies. Absolute contraindications include severe systemic illness, severe cardiac or kidney failure, thrombosis or abnormalities of caval and portal veins, systemic sepsis, HIV infection. Other drawbacks are mental deficiency and the inability of family to care for the child and follow therapy after discharge. Relative contraindications are: HBsAg positivity, HIV positivity without infection, malnutrition. Finally the scarcity of donors of liver of adequate size is an important limitation for transplant especially in childhood.
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PMID:[Liver transplant in children. I]. 269 3

From March 1982 to December 1986, 32 patients with standard risk leukaemia were conditioned for allogeneic bone marrow transplantation (BMT) with low dose fractionated total body irradiation (TBI) after infusion of alkylating agents. This series includes six children and 26 adults. Minimal follow-up was 24 months. The total dose of 11 Gy, given in 5 daily fractions of 2.20 Gy, was given in the lateral position, following chemotherapy with either melphalan or cyclophosphamide. Lungs were shielded for 2 out of the 5 fractions. All patients had in vivo dosimetry. The death rate is 25% without relapse or rejection. Disease-free survival is 73% at 5 years. Toxic deaths are detailed: 2 from sepsis and veino-occlusive disease of the liver, 3 from severe graft versus host disease (GVHD), 2 from GVHD associated with virus pneumonitis and one from HIV infection. Fractionated low dose rate TBI is discussed regarding its decreased toxicity and its efficiency for disease control.
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PMID:Fractionated total body irradiation and allogeneic bone marrow transplantation for standard risk leukemia. 269 33


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