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

The value of taking microbiological and cytological specimens by flexible bronchoscopy and bronchoalveolar lavage under local anaesthesia was assessed on 43 occasions in 35 HIV infected children, aged 3 months to 16 years, with interstitial pneumonitis. In acute interstitial pneumonitis (n = 22, 26 specimens from bronchoalveolar lavages) the microbiological yield was 73%, Pneumocystis carinii being the commonest infective agent (n = 14). P carinii pneumonia was found only in children with deficient antigen induced lymphocyte proliferative responses who had not been treated with long term prophylactic co-trimoxazole. In contrast, in 13 children with chronic interstitial pneumonitis that was consistent with a diagnosis of pulmonary lymphoid hyperplasia who underwent bronchoalveolar lavage on 17 occasions, there were two isolates of cytomegalovirus and one of adenovirus, but P carinii was not found. Ten of the 13 children had normal antigen induced lymphocyte proliferative responses. Useful cytological data were also gleaned from bronchoalveolar lavage specimens. Lymphocytosis was significantly higher in pulmonary lymphoid hyperplasia (36(SD 11)%) than in P carinii pneumonia (24(19)%) whereas the percentage of polymorphonuclear neutrophils was significantly lower (3(2)% compared with 12(13)%). Flexible bronchoscopy with bronchoalveolar lavage is safe even in young infants and should reduce the necessity for open lung biopsy in the management of HIV infected children with interstitial pneumonitis.
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PMID:Bronchoalveolar lavage in HIV infected patients with interstitial pneumonitis. 281 43

Doses of 150 and 450 mg RU-486 (mifepristone) were compared in a randomized double-blind trial for 2nd or 3rd trimester termination of pregnancy. The 35 women averaged 22.5 weeks gestation (range 15-34); indications were maternal (HIV infection or psychiatric), and fetal, including major genetic, chromosomal or fetal abnormalities not compatible with life. RU-486 was given orally in 9 50 mg tablets or placebos 48 hours before hospitalization. The evening upon entering the hospital they received 1.5 mg PGE2 in a vaginal suppository. Labor had ensued in 3 women before receiving PG. 150 mg of RU-486 improved cervical softening score from 0.73 to 3.3, and a cervical dilatation, judging by Hegar dilators, from 7.1 to 12.75. The 450 mg dose improved cervical score from 0.72 to 3.12, and cervical dilatation from 6.3 to 11.9 (mean n.s.). The mean interval to abortion in women 20 weeks gestation or more was 19.54 hours in the 150 mg group and 8.6 hours in the 450 mg group (n.s.). Those less than 20 weeks gestation were terminated by dilation and evacuation under general anesthesia. There were no clinical or hematological side effects. 5 patients have subsequently had normal full-term deliveries. This drug may be useful to help dilate the cervix, shorten the abortion time, and reduce the dose of prostaglandin needed. No side effects have been reported with these doses of RU-486 combined with prostaglandin for midtrimester abortion.
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PMID:Mifepristone (RU486) and therapeutic late pregnancy termination: a double-blind study of two different doses. 306 55

Infectious hazards to anaesthesia personnel are real but the appropriate use of immunization, universal blood and body fluid precautions, and respiratory precautions where appropriate, should minimize the risk of infection at work. In particular, the resistance of physicians to immunization, especially to hepatitis B, needs to be changed. Protection against other blood-borne pathogens for which immunization is not available, such as HIV, may also depend on the willingness of anaesthesia personnel to accept and carry out recommendations for universal blood and body fluid precautions. Regulatory agencies and compensation boards are likely to look closely at adherence to established guidelines when determining benefits for work-related infections. Complaints that the routine use of gloves interferes with anaesthetic practice are frequent but unacceptable in the current climate and it behooves the profession to ensure that compliance with currently accepted infection control guidelines is complete.
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PMID:The risk of infection in anaesthetic practice. 313 25

We conducted a survey to learn surgeons' attitudes and practices concerning HIV-infected patients in Japan. We mailed questionnaires to 174 general hospitals and received responses from 126 (72.6%). Concerning preoperative HIV testing, 41% of the hospitals had never performed it. Twenty-nine percent had operated on at least one HIV-infected patient and 144 HIV-infected patients have received surgery under spinal, epidural or general anesthesia. During surgery, 6 accidental needlesticks occurred, but fortunately no seroconversion has been reported since the accidents. Therefore widerspread use of barrier precautions should be undertaken during surgical intervention. This survey revealed that 40-60% of the hospitals coped inadequately with such surgery. Therefore it is important to arrange a system in Japan so that HIV-infected patients will be able to receive necessary surgical treatment. For that purpose, a medical educational program for health care professionals is needed, because not only surgeons but all health care professionals in hospitals should be able to take part in the treatment of HIV-infected patients.
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PMID:A survey on surgeons' attitudes and practices in the care of HIV-infected patients in Japan. 766 40

The prevalence of acquired immunodeficiency syndrome (AIDS) is steadily increasing among American children. The dental needs of these patients are significant. This study evaluated the oral health of forty children being treated for HIV-infection at the National Institutes of Health (NIH). Eight of twenty-two patients in primary dentition (36 percent) had baby bottle tooth decay (BBTD). These cases required extensive dental restoration usually under general anesthesia. Tooth development was delayed in 31 percent of patients. Candidiasis was the most common soft tissue abnormality, found in 35 percent of children. Preventive and therapeutic dental programs should be instituted to meet the special needs of pediatric AIDS patients.
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PMID:Oral health of pediatric AIDS patients: a hospital-based study. 804 89

As the incidence of AIDS continues to increase in the female population, there will be more cases of HIV-positive women in the obstetric suite requiring anesthesia services. Many may be asymptomatic, but there will be patients with active opportunistic infections and malignancies who may or may not have been treated. The impact of both the disease AIDS and the drugs used to treat it on anesthetic technique can be significant. Hematological, neurological, respiratory, and immune dysfunction can be expected in a significant proportion of these women. Universal precautions should be utilized for all deliveries regardless of known HIV status. The ubiquitous presence of blood and amniotic fluid during labor and delivery mandate the use of gloves, gowns, and eye protection in the obstetric suite to avoid transmission of HIV to health care workers. Transmission to the newborn during delivery can be minimized by avoidance of skin and mucous membrane trauma and careful removal of secretions and blood. Infected parturients should be carefully assessed for neurological and hematological dysfunction prior to the use of regional anesthesia, and anesthesiologists must be aware of the potential toxicities of therapeutic drug treatment and their impact on anesthesia.
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PMID:HIV infection in the parturient. 806 44

In a retrospective study, the perioperative findings and complications of AIDS patients and asymptomatic HIV-positive patients were compared to those of HIV-negative patients. Characteristic operations in HIV-positive patients were those of extremities in general surgery, and dilatation and curettage in gynecology. There were significant differences among three groups concerning preoperative hemoglobin, GOT, electrolyte concentrations and heart rate. As the preoperative findings, hepatitis and dyspnea on exertion were remarkable in the HIV-positive patients. During anesthesia tachycardia was more frequent in the HIV-positive patients. Postoperatively high fever, anemia and tachycardia were significantly more frequent in the HIV-positive patients. The postoperative leucocyte count was less in the AIDS-patients than in other two groups. As a whole there are some peculiarities about the estimation of the risk and the planning of anesthesia in the HIV-positive patients.
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PMID:[Perioperative complications in HIV-positive patients]. 818 23

This review focuses on several aspects of breast-feeding, including mothers' skills and attitudes, risk of HIV transmission in breast milk, lactational amenorrhea and its contraceptive effects, and the effects of anesthesia and analgesia on lactation. Also discussed is postpartum contraception and sources of referral for low-income women desiring assistance in nutrition.
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PMID:Puerperium and breast-feeding. 824 47

The author is a General Practitioner who worked at the Chogoria Hospital on the eastern slopes of Mount Kenya over the period 1984-86. The rural hospital of 350 beds has an outpatient facility and a large community health department which runs 30 outlying dispensaries. 6 doctors complement a total staff of about 300 Kenyans. The author served as the Director of the community health department in 1985 and 1986. He has since returned to work at the hospital and describes changes which seem to have taken place during his 5-year absence. Over the duration, the population of Nairobi seems to have grown and become more active. Schools are burgeoning with children and the growing population is exercising even greater pressure upon available public services. The community health department's outreach efforts to distribute contraceptives has, however, helped reduce the rate of population growth. Sections briefly describe conditions with malaria, HIV, mycobacteria, women's health, anaesthesia, surgery, and pediatrics. In general, severe infections diseases remain problematic; degenerative diseases are a relative rarity; and oesophageal, stomach, and liver cancers are common, while colonic cancer is unknown.
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PMID:Other people's practices. Kenya. 833 85

Ulcerative processes are the most disabling of anal diseases in HIV+ patients. The spectrum ranges from "benign" fissures to invasive ulcerative processes. It is important to recognize their salient features in order to effectuate proper management. Since 1989, 74 HIV+ patients with ulcerative anal disease were evaluated. Of 33 patients with benign fissures, 13 had sphincterotomy, with symptomatic relief in 12 and healing in 11. Ten had improvement with standard conservative treatment, and 10 did not return for re-evaluation. Of 41 patients with "idiopathic" anal ulcers, 34 underwent operative evaluation, biopsy, viral culture, and debridement. Thirty had significant pain relief, and 17 showed variable evidence of healing. Four patients with intractable pain had injection of Depo-Medrol (The Upjohn Co., Kalamazoo, MI) into the bed of the ulcer with significant pain relief. One patient was diverted. We propose that anal ulcerative disease be classified as benign lesions and therefore treated as if the patient were HIV negative. In those patients with HIV-associated anal ulcers, evaluation under anesthesia, biopsy, culture, and debridement should be performed and therapy directed against any neoplastic or viral agents found. Those patients with no identifiable agents may be helped with aggressive debridement or intralesional steroid therapy. This approach allows safe and effective treatment in most patients.
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PMID:Ulcerative disease of the anorectum in the HIV+ patient. 837 19


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