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

Study objectives were to characterize the clinical syndrome of chronic idiopathic esophageal ulceration in patients with acquired immunodeficiency syndrome (AIDS), to determine the extent of local human immunodeficiency virus (HIV) infection, and to evaluate the effect of corticosteroid therapy upon symptoms and healing. Twelve AIDS patients with chronic esophageal ulcers whose etiology remained unknown after clinical evaluation were the subjects. All patients complained of severe odynophagia, chest pain, and weight loss. Barium radiography and endoscopy demonstrated large, undermined ulcers with severe acute inflammation. No evidence of herpes simplex viruses I or II, cytomegalovirus, fungi, or tumors were found histologically. Evidence of HIV was found in all ulcers using a combination of RNA in situ hybridization, immunohistochemistry, and quantitative antigen capture enzyme-linked immunosorbent assay of tissue homogenates. Steroid therapy by the oral or intravenous routes or by direct intralesional injection resulted in pain relief, weight gain in 10 patients, and ulcer healing in five patients. A characteristic clinical syndrome of chronic idiopathic esophageal ulceration may occur in patients with AIDS, related to local HIV infection in the esophagus. Corticosteroids relieve symptoms and may promote healing of the ulcer.
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PMID:Chronic idiopathic esophageal ulceration in the acquired immunodeficiency syndrome. Characterization and treatment with corticosteroids. 129 32

Pain causes considerable disability and discomfort in HIV (Human Immunodeficiency Virus) infected individuals. A large number of patients infected with HIV suffer from one or more pain-related syndromes. Pain is under-reported and suboptimally managed in these patients. An outline of the different pain syndromes, including headache, oral cavity pain, chest pain, abdominal pain, anorectal pain, musculoskeletal pain and peripheral neuropathic pain, and their aetiologies are discussed. Current pain management modalities, including non-narcotic and narcotic analgesics, tricyclic antidepressants, anticonvulsants, physical therapy and psychological techniques, are outlined. Treatment should be based on the same principles applied to the management of cancer-related pain. A multi-disciplinary, comprehensive approach to pain management will assist these individuals to achieve improved levels of comfort, function and quality of life in this ultimately terminal illness.
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PMID:Pain syndromes in HIV infection. 139 63

Many American hospitals are embracing the philosophies of continuous quality improvement (CQI) or total quality management (TQM). To date, case studies in the literature have largely dealt with administrative processes. However, CQI can also improve direct patient care (clinical) processes using direct patient care teams. The establishment of such teams has been an elusive task at many organizations, largely because of the traditional paradigm of the appropriate relationship between provider and patient. However, similarities between direct patient care teams and other cross-functional teams far exceed differences. Using case studies from two teams (HIV and chest pain) at HCA West Paces Ferry Hospital and Southeastern Health Services, this article suggests ways facilitators can help providers examine, redesign, and improve direct patient care processes.
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PMID:How to start a direct patient care team. 149 1

Surgeons managed the care of 39 patients with empyema thoracis at the University Teaching Hospital in Lusaka, Zambia between April 1989-March 1990. 33 patients were males. 26 (23 males and 3 females) tested seropositive for HIV and had AIDS. 19 patients (17 male and 2 females) had tuberculosis (TB) of the lungs. Only 2 did not test positive for HIV. The leading complaints of the 39 patients were cough (30), chest pain (29), and generalized lymphadenopathy (28). HIV positive patients stayed in the hospital longer than HIV negative patients (60 days vs. 5 days). Most patients with empyema thoracis (30) were between 16-40 years old, as were AIDS patients (22) and TB patients (19). 2 of the 4 0-5 year old patients with empyema thoracis suffered from AIDS. The leading surgical procedure for the patients with empyema thoracis was intercostal drainage (12). All 12 patients who underwent rib resection were those who suffered from AIDS. Rib resection was required because these patients presented to the hospital late at which time the aspirate had already become thick. The surgeons were able to aspirate the accumulated pus quite easily in 8 of the 9 patients with AIDS who underwent only intercostal drainage. 8 AIDS patients experienced dried up sinuses at 8 weeks. A home care team managed the rib resection patients at home which resulted in a shorter mean duration at the hospital than for intercostal drainage (8 days vs. 0 days). None of the AIDS patients died from the procedure. Yet 3 AIDS patients died within 2 weeks of entry into the hospital. 5 other AIDS patients died within 6 months of their 1st admission. All HIV negative patients recovered satisfactorily. Home care minimized the burden on hospital resources.
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PMID:Management of empyema thoracis at Lusaka, Zambia. 161 46

A 25-year-old homosexual man with a childhood history of rheumatic heart disease presented with painful joints, fever and chest pain. He was diagnosed as having acute rheumatic fever and was found to be HIV antibody-positive. His illness responded to conventional treatment but he had a persistently low CD4 lymphocyte count and was started on zidovudine. Interpretation of the significance of a low CD4 lymphocyte count is problematic in a patient with coincident rheumatic fever and HIV infection as both conditions can cause CD4 lymphopenia.
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PMID:Acute rheumatic fever in human immunodeficiency virus infection. 167 90

A 24-year-old heterosexual male, HIV-infected intravenous drug addict, with necrotizing pneumonitis and empyema due to Streptococcus cremoris is presented. The patient had fever, severe dyspnea and chest pain. Chest roentgenogram demonstrated pleural effusion on the left side. A thoracocentesis revealed purulent exudate and S. cremoris was isolated. Fever and pleural effusion disappeared with penicillin and clindamycin therapy. The most likely source of the infection was ingestion of unpasteurized milk and cheese.
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PMID:Necrotizing pneumonitis and empyema caused by Streptococcus cremoris from milk. 235 44

Whereas extralymphatic involvement is common in lymphomas associated with HIV infection, there have been few reports of pulmonary lymphoma. In 648 cases of AIDS reported in Colorado, 40 have had non-Hodgkin's lymphoma. Of these, four have had documented pulmonary involvement and are reported in detail. Clinical manifestations were nonspecific and included fever, weight loss, generalized lymphadenopathy, dyspnea, chest pain and cough. Chest roentgenograms revealed multiple nodules or interstitial infiltrates. Transbronchial biopsy failed to establish the diagnosis in all cases. Three of four patients died four to five months after appearance of pulmonary nodules; one patient with stage IE disease showed slow radiographic progression over 16 months following radiation and chemotherapy and died 18 months after appearance of pulmonary nodules. Pulmonary involvement with lymphoma should be considered in patients with HIV infection, especially if multiple nodules are seen on chest roentgenograms.
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PMID:Pulmonary non-Hodgkin's lymphoma in AIDS. 258 39

Primary pulmonary hypertension (PPH) is at present little understood. It is characterized by extensive remodeling of the pulmonary vasculature, with consequent deleterious hypertrophic changes in the right ventricle. Median survival is 2.6 years, although this varies with the severity of right heart failure. Although PPH can occur at any age and in either sex, it primarily affects young to middle-aged women. A genetic predisposition appears to be a component of this disease, triggered by presentation of a stimulus (e.g., drugs or HIV infection). Symptomatic presentation includes exertional dyspnea, chest pain, and syncope. At present, therapy consists principally of anticoagulation, calcium antagonists, nitric oxide inhalation, or continuous intravenous prostacyclin.
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PMID:Pathology and pathophysiology of primary pulmonary hypertension. 784 55

A clinical syndrome of large ulcerations of the oesophagus had been well described in the literature in HIV-infected patients. These patients are markedly symptomatic with odynophagia and substernal chest pain as their most common presenting symptoms. Weight loss often accompanies this disorder. Despite biopsy evaluation for patients with idiopathic oesophageal ulcerations, no identifiable cause of this lesion is found. Although some authors suggest that these ulcerations represent a primary HIV infection of the oesophagus, other question the role of HIV itself in the development of these lesions. Patients with this disorder appear to respond to corticosteroid therapy in the oral, intravenous or intralesional form. This therapy could possibly predispose to infectious complications. Acute HIV infection has also been described presenting with lesions of the oesophagus which may be single or multiple. It has again been suggested that HIV is the primary aetiology of the oesophageal ulcerations. Endoscopic evaluation is mandatory for the diagnosis of idiopathic oesophageal ulcerations of the oesophagus in HIV-infected patients. It is important to rule out the many other causes of oesophageal ulcerations in these patients, as treatment modalities are determined by proper diagnosis of the underlying disorder.
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PMID:Idiopathic ulcerations of the oesophagus in HIV-infected patients: a review. 873 28

A 22 year-old Thai male was admitted to our hospital because of chest pain and dyspnea. In 1989, he met with a traffic accident and was injured his head and the arm, and was given a blood transfusion in Thai. Laboratory examinations on admission revealed that serolopositivity for HIV, and CD4+T lymphocyte count was 17/microliter. Chest X-ray on admission showed bilateral diffuse nodular shadow, and he was diagnosed as miliary tuberculosis with AIDS. On the chest X-ray, in the right upper middle lung fields, the shadow was rough and partly influent. In the left lung, the nodular shadow were smaller and distributed evenly. As there was a difference in the distribution of nodular shadows between the left and right lung, the chest X-ray findings of this case was atypical of miliary tuberculosis.
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PMID:[A case of AIDS with miliary tuberculosis]. 883 Nov 93


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