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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Despite the increasing number of patients with the human immunodeficiency virus (HIV) infection, surgical experience with these patients remains limited. A retrospective review over a 9 year period (January 1985 to December 1993) was undertaken to determine the indications, operative management, pathologic findings and outcome of major abdominal surgery in these patients. A total of 51 procedures were performed in 45 patients; 30 patients had acquired immunodeficiency syndrome (AIDS) and 15 patients had asymptomatic HIV infection. Indications included gastrointestinal bleeding, complicated pancreatic pseudocysts, cholelithiasis, bowel obstruction, immune disorders, acute abdomens, elective laparotomy, colostomy formation, menorrhagia and Caesarean section. Pathologic findings directly related to the HIV infection were found in 81% of the AIDS patients and 35% of the asymptomatic HIV infected patients (P < 0.05). These included opportunistic infections, non-Hodgkin's lymphoma, Kaposi's sarcoma, immune disorders, lymphadenopathy and pancreatic pseudocysts. It was noted that AIDS patients had more complications than asymptomatic HIV infected patients with most complications related to chest problems and sepsis (61 vs 7%; P < 0.01). Emergency operations carried a higher complication rate than elective operations though this was not significant. The hospital mortality was 12%. On follow up, 13 of the 25 AIDS patients had died with the median survival of 7 months, while three of the 14 asymptomatic HIV infected patients had died with the median survival of 40 months. Of the remaining patients, the 12 AIDS patients had a median postoperative follow up of 7 months and the 11 asymptomatic HIV infected patients had a median postoperative follow up of 29.5 months.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Abdominal surgery in HIV/AIDS patients: indications, operative management, pathology and outcome. 774 74

We report the case history of a 28-year-old homosexual man of Caucasian origin whose diagnosis of acquired immunodeficiency syndrome was established one year before admission on the basis of a positive human immunodeficiency virus serology and cutaneous Kaposi's sarcoma. Severe postprandial vomiting pointed to bowel obstruction in an emaciated, poor risk patient. Endoscopy revealed multifocal, violaceous tumours throughout the upper gastrointestinal tract which, eventually, obstructed the duodenum. Histology confirmed the putative diagnosis of gastrointestinal Kaposi's sarcoma, which responded well to monochemotherapy with vincristine. Significant clinical improvement and repeat endoscopy indicated tumour regression and resolution of bowel obstruction.
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PMID:Successful monochemotherapy of extensive gastrointestinal Kaposi's sarcoma with bowel obstruction in acquired immunodeficiency syndrome. 787 60

We report an unusual case of fibrosing peritoneal cryptococcal granulomas in a 36-year-old human immunodeficiency virus-negative man with small-bowel obstruction who previously had been treated for cryptococcal meningitis. At laparotomy, multiple pinhead-sized granulomas studded the visceral peritoneum. Microscopic examination showed cryptococcal granulomas characterized by peripheral fibrosis and central caseous necrosis. On mucicarmine staining, the rare teardrop budding and prominent capsular staining were characteristic of Cryptococcus species. We surmise that this inflammatory reaction observed in the peritoneum represents a chronic tissue reaction that occurred during the previous cryptococcal infection.
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PMID:Granulomatous peritoneal cryptococcomas. An unusual sequela of disseminated cryptococcosis. 831 65

From September 1986 to September 1994, 34 emergency laparotomies were performed in human immunodeficiency virus (HIV) seropositive patients. Patients were divided into 2 groups. Group A included 11 HIV seropositive patients without acquired immunodeficiency syndrome (AIDS). In these patients, indications for exploration included right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 3 patients, small bowel obstruction in 1 patient, and blunt abdominal trauma in 1 patient. No postoperative deaths were observed. Group B included 23 AIDS patients. Indications for exploration were diffuse peritonitis in 8 patients, right lower quadrant pain consistent with appendicitis in 6 patients, right upper quadrant pain consistent with cholecystitis in 5 patients, bowel obstruction in 2 patients, diffuse abdominal pain in 1 patient, and massive rectal hemorrhage in 1 patient. The mortality rate in this group was 35% (8 out of 23 patients). Five of the 8 patients with diffuse peritonitis died postoperatively (62%). The importance of early diagnosis and prompt surgery is emphasized to improve the prognosis in AIDS patients, because of their poor general condition and the severity of abdominal complications.
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PMID:[Abdominal surgical emergencies in human immunodeficiency virus (HIV) infected patients. Apropos of 34 cases]. 878 19

Nodular lymphoid hyperplasia (NLH) represents an uncommon lesion usually related to humoral immunodeficiency conditions. A case of NLH of the small bowel discovered by chance during an emergency laparotomy for an intestinal obstruction is herein reported. Discussion is focused on the main features of NLH which as in the reported case, is likely to be the initial manifestation of an intestinal disease not yet clinically defined.
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PMID:[A case of nodular lymphoid hyperplasia of the small bowel in a patient with intestinal obstruction]. 929 98

Testing for syphilis during pregnancy reveals a positive serologic status in 0.02% of cases. However, a 66% rate of stillbirths is noted in women who are infected and who have not benefited from any treatment. Routine screening is at present performed during the early stages of pregnancy but a second serologic test during the third trimester is useful in the diagnosis of a late infection especially in drug users or HIV (human immunodeficiency virus) positive patients. Congenital syphilis is diagnosed in utero when a positive maternal serologic status is associated with ultrasound images showing fetal abnormalities; these include hepatosplenomegaly, hyperechogenic bowel, signs of bowel obstruction or fetal hydrops. Maternal syphilis is treated by delayed action penicillin and is indicated even for patients allergic to the antibiotic which in this particular case is delivered after desensitization. First line therapy by intravenous penicillin is indicated when confronted with the following high risk factors of congenital syphilis: an elevated titre of VDRL (venereal disease research laboratory) at the time of diagnosis or delivery, unknown date of the precise onset of the infection, the appearance of a rash or of a chancre during pregnancy, ultrasound fetal abnormalities or late therapy during the third trimester. Treatment of the new-born child will depend on the results of clinical, serologic and X-ray evaluation. Long term follow-up for at least a year is mandatory.
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PMID:[Maternal and congenital syphilis]. 959 61

We report the association of neurological and intestinal disorders with the reactivation of Epstein-Barr virus (EBV) in a child. This previously healthy 13-yr-old boy presented with pharyngitis and acute abdominal ileus. Laparotomy excluded a mechanical obstruction. Postoperatively, he suffered from prolonged intestinal obstruction, pandysautonomia, and encephalomyelitis. Histological examination of the appendix and a rectal biopsy taken 3 months after the onset showed an absence of ganglion cells (appendix) and hypoganglionosis (rectum), with a mononucleate inflammatory infiltrate in close contact with the myenteric neural plexuses. EBV-PCR was positive in the blood and cerebrospinal fluid, and in situ hybridization with the Epstein-Barr virus encoded RNA probe showed positive cells throughout the appendix wall including the myenteric area, in a mesenteric lymph node, and in the gastric biopsies. EBV spontaneous lymphocytic proliferation was noted in the blood. The serology for EBV showed previous infection but anti-early antigen antibodies were present. No immunodeficiency was found. Neurological and GI recovery occurred after 6 months of parenteral nutrition and bethanechol. The omnipresence of EBV associated with the neurointestinal symptoms suggest that the virus was the causal agent. This is the first documented case of acquired hypoganglionnosis due to EBV reactivation.
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PMID:Intestinal pseudo-obstruction and acute pandysautonomia associated with Epstein-Barr virus infection. 1063 98

The authors review 45 pediatric patients with intra-abdominal tuberculosis (ATB) treated between May 1990 and April 1998. The diagnosis was confirmed histologically or by positive culture for Mycobacterium tuberculosis. Clinical presentation was with an abdominal mass (12), subacute obstruction (11), ascites (5), mass and ascites (4), peritonitis (4), and 9 unusual presentations. Mantoux tests were positive in 68% of patients tested. There were radiologic features suggestive of pulmonary TB in 29 patients (64%); abnormal abdominal radiographs were recorded in 21 (47%). Lymphadenopathy was noted on abdominal ultrasound in 23 of 30 patients (77%) and on computed tomography scan in a further 3 of 8 patients investigated. Ascitic fluid adenosine deaminase (ADA) levels were greater than 30 IU/l in 3 of 4 patients (75%), suggesting ATB. All 28 patients screened for human immunodeficiency virus were negative. A surgical procedure was performed in 39 patients. 29 (74%) had an elective diagnostic laparotomy for tissue diagnosis. One (3.4%) developed a postoperative intra-abdominal abscess. Ten (26%) presented with complications requiring surgical intervention including perforated viscus, segmental bowel resection, strictureplasty, adhesiolysis, or ileostomy. One of the latter died due to sepsis after having complications of persistent intestinal obstruction and cecal perforation. The authors recommend an aggressive approach to patients with suspected ATB in order to obtain an early definitive diagnosis, prevent complications, and reduce morbidity and mortality. They emphasize the importance of tissue diagnosis and confirmation by culture.
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PMID:Diagnostic dilemmas in abdominal tuberculosis in children. 1131 66

Patients with human immunodeficiency virus (HIV) infection or acquired immune deficiency syndrome (AIDS) can present with acute abdominal surgical problems, either with intra-abdominal opportunistic infection as a result of their immunosuppression, or with associated malignancies. We report a 39-year-old man who developed intermittent nausea and vomiting, which was originally thought to be a side-effect of the chemotherapy he was receiving for facial Kaposi's sarcoma. However, he was found to have intraperitoneal Kaposi's sarcoma causing small bowel obstruction, which was successfully excised at laparotomy. There were no perioperative complications despite AIDS-related respiratory disease. The patient remained free of abdominal symptoms until his death. HIV infections or AIDS alone should not be contraindications to surgery for such problems, as careful patient selection can yield good results and significantly improve quality of life.
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PMID:Palliative surgery for acute bowel obstruction caused by Kaposi's sarcoma in a patient with AIDS. 1280 Apr 71

Immunosuppression for therapeutic reasons (e.g. post transplantation, post chemotherapy), as well as pathologic immunodeficiency due to certain pathologic conditions (e.g. AIDS, leukemia), is increasingly encountered in daily medical practice. As a result, the concomitant risk for opportunistic infections is higher and immunocompromised patients may present with uncommon clinical and radiologic conditions. We report on a case of a 33-year-old immunocompromised woman with a history of recurrent T-cell lymphoblastic lymphoma, which presented with abdominal pain. Computed tomography (CT) images demonstrated significant small bowel dilatation, wall thickening, and high-density intestinal content, with a focal point of transition in the pelvis. Extensive fungal enteritis due to Candida Albicans with partial small bowel obstruction was found on autopsy.
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PMID:Small bowel obstruction secondary to disseminated candidiasis in an immunocompromised patient: radiologic-pathologic correlation. 1579 64


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