Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0021051 (immunodeficiency)
 71,517 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 44-year-old man diagnosed of common variable immunodeficiency associated with thrombopenia due to autoimmunity required anesthesia for anal fissure repair and hemorrhoidectomy. Hemostatic complications developed after surgery, with extreme thrombopenia (1,000 platelets/pl) and analytical changes that necessitated administration of six units of platelets from apheresis, as well as immunoglobulins, antifibrinolytic agents (e-aminocaproic acid) and granulocytic colony stimulating factors. Anesthesia for such patients is reviewed, with emphasis on careful management of the airways, preparation of sufficient material for surgery (rapid transfusion equipment, large caliber intravenous catheters, sterile material) and orientation of anesthetic technique toward general anesthesia through a laryngeal mask.
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PMID:[Common variable immunodeficiency associated with autoimmune thrombocytopenia: anesthetic management]. 992 36

Severe fungal infections have become increasingly common in the immunocompromised patient, including those infected with human immunodeficiency virus. Histoplasma capsulatum occurs in about five per cent of acquired immunodeficiency syndrome patients in the endemic areas of the Mississippi and Ohio River Valley. Immunocompromised patients who present with severe ulceration and suppuration of the anus require exam under anesthesia and thorough laboratory evaluation for opportunistic infections. Thus, surgeons play a critical role in diagnosis and initiation of treatment. A case of infiltrating H. capsulatum of the anus is presented, including the natural history, presentation, diagnosis, and treatment.
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PMID:Severe anal ulceration secondary to Histoplasma capsulatum in a patient with HIV disease. 1019 Mar 54

We conducted a retrospective study to assess the reasons for admission to the intensive care unit, and subsequent outcome, in patients infected with the human immunodeficiency virus (HIV). Four hospitals in the south of England participated, all with specialist HIV units. Data were collected on 127 patients admitted to ICU on 133 separate occasions between June 1993 and October 1997. The mean age on admission was 38 years (range 23-60 years). Ninety-four patients (70.7%) were documented HIV-positive before admission and 36 (27%) were diagnosed HIV-positive for the first time during admission; 36.1% were admitted with Pneumocystis carinii pneumonia. Overall ICU mortality was 33%, in-hospital mortality was 56% and the eventual mortality at the end of follow-up (March 1998) was 72%. Survival was highest in those admitted with respiratory HIV-related disease or HIV-unrelated illness. Associations with poor outcome included a prior AIDS-defining illness, a CD4 cell count of less than 100 cells.ml-1 and admission secondary to sepsis.
Anaesthesia 1999 Aug
PMID:ICU admission in patients infected with the human immunodeficiency virus - a multicentre survey. 1046 May 23

The acquired immune deficiency syndrome has reached pandemic proportions. Anaesthetists should be aware of the implications of dealing with increasing numbers of both diagnosed and undiagnosed, symptomatic and asymptomatic, human immunodeficiency virus-infected patients in the fields of intensive therapy, operating theatre anaesthesia, obstetrics and pain management. With recent advances, important insights have been gained into the pathogenesis of human immunodeficiency virus. Molecular techniques allow quantification of viral burden, and together with CD4 T-lymphocyte count, prognosis and response to therapy can be evaluated. New drugs and therapeutic regimens have improved prognosis for those who are infected with the virus and vertical transmission of infection from mother to infant can be minimised. Should accidental occupational exposure to the virus occur, a prophylactic regimen of antiretroviral drugs can be administered in an attempt to prevent subsequent human immunodeficiency virus infection.
Anaesthesia 2000 Apr
PMID:The implications of HIV for the anaesthetist and the intensivist. 1128 30

This article discusses the most commonly recognized bloodborne infectious diseases with which the nurse anesthetist comes into contact during the provision of clinical care: hepatitis B virus, hepatitis C virus, and the human immunodeficiency virus, along with the potential percutaneous and mucocutaneous routes of exposure. The prevention of occupational exposure to these pathogens is discussed by applying standard or universal precaution measures to anesthesia clinical practice. Treatment measures for accidental exposure to bloodborne pathogens is also discussed.
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PMID:Prevention of occupational transmission of bloodborne diseases in clinical nurse anesthesia practice. 1127 Oct 34

Female sandflies, Phlebotomus papatasi (Scopoli) (Diptera: Psychodidae), were fed via chicken membrane on heparinized blood from eight species of mammal (human, horse, cow, pig, dog, rabbit, guinea-pig, hamster) and their reproductive success rates were compared. No appreciable differences between those fed on human and animal blood were detected with respect to the proportion of flies that fed successfully, mortality-rate within 24h, number of eggs laid per blood-fed female or egg viability. When mass-rearing sandflies for research purposes, membrane-feeding avoids practical difficulties encountered if sandflies are allowed to feed on live hosts (i.e. anaesthesia, distress from handling and postfeeding inflammation) and reduction of sandfly fecundity due to host antibody interference. Use of animal blood also eliminates risks of accidental transmission of human blood-borne pathogens, e.g. hepatitis B and human immunodeficiency virus (HIV), and is less expensive than maintenance of animals and their preparation for sandfly feeding.
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PMID:Comparative fecundity and survival rates of phlebotomus papatasi sandflies membrane fed on blood from eight mammal species. 1143 53

Gram-positive organisms causing sepsis have gained more significance in the past years. Especially patients with acquired immunodeficiency have been shown to be at risk for gram-positive infections. The mortality in Streptococcus pneumoniae bacteremia has been shown to be as high as 20%. Tumor necrosis factor-alpha (TNF-alpha) plays a crucial role in the "sepsis cascade." The previously described positive effect of monoclonal TNF antibody (anti-TNF-mAb) in gram-negative sepsis should be controlled in gram-positive pneumococcal sepsis. In a porcine model, pneumococcal sepsis was induced, and the course and outcome of a group treated with anti-TNF-mAb were compared to those of an untreated control. Streptococcus pneumoniae serotype 6 B was isolated from patients with systemic infection. The isolates were prepared, cryopreserved at -80 degrees C, and recultivated in a standardized fashion as needed. Then 10(9) bacteria were injected intravenously. Pigs of the German Landrace type with a weight of 20-30 kg were anesthetized using standardized midazolam and ketamine intravenous anesthesia. After introduction of central venous, arterial, and urinary catheters, bacteria were injected intravenously via the ear vein. In the therapy group, animals were treated with anti-TNF-mAb (5 mg/kg body weight) intravenously immediately prior to pneumococci injection. Survival and survival times were primary endpoints. Biochemical and vital parameters were also compared. In the anti-TNF-mAb group, 4/11 animals died (35%), compared to 6/11 (55%) in the control group. The mean survival times were 11 and 10 h, respectively (n.s.). TNF levels were significantly different. The TNF peak at 90-240 min was not present in the anti-TNF group (340 pg/ml vs. 19 pg/ml, p = .034). Leukocyte counts differed also significantly. After an initial drop in both groups, we observed a leukocytosis of up to 32.8 +/- 5.0 g/L in the anti-TNF-group, while in the control group leukocyte counts remained below 15.0 g/L (13.3 +/- 3.0 g/L, p = .007). All other parameters did not differ significantly. Thus, anti-TNF-mAb effectively suppresses the TNF peak following gram-positive septicemia. In the presented setting, these effects did not influence overall survival or survival times.
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PMID:Anti-TNF antibody treatment has no positive effect on survival in a model of pneumococcal sepsis in pigs. 1170 Sep 23

The following guidelines for pre-sterilization counseling have been adopted by the Association for Voluntary Surgical Contraception: 1) emphasize that sterilization is permanent; 2) involve both partners in the decision making and present male sterilization as a viable option; 3) even if sterilization is requested, also present the range of long-term reversible methods available; 4) inform the client of failure rates associated with female sterilization and the associated risk of ectopic pregnancy; 5) emphasize that sterilization provides no protection against sexually transmitted diseases, including human immunodeficiency virus; 6) screen candidates for risk factors of post-sterilization regret, including young age and sterilization at the time of abortion or delivery; 7) fully explain the surgical procedure, preoperative instructions, surgical site, timing of the procedure, type of anesthesia, surgical risks, and length of recovery; 8) describe the possibility of unrelated changes in menstruation; 9) answer all questions; 10) discuss the positive effects on sexuality once concerns about unwanted pregnancy are removed; and 11) provide printed educational materials that the couple can review privately.
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PMID:Guidelines for pre-sterilization counseling. 1234 59

Hyper-IgE syndrome is a rare immunodeficiency disorder characterized by recurrent skin and pulmonary infections and extremely elevated serum levels of IgE. A 6-year-old girl with hyper-IgE syndrome underwent appendectomy. Anesthesia was induced with sevoflurane. After insertion of a laryngeal mask, anesthesia was maintained with nitrous oxide, sevoflurane, and oxygen. There were no perioperative complications related to anesthesia and surgery.
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PMID:[Anesthetic management for a patient with hyper-IgE syndrome]. 1264 74

Studies describing posttraumatic stress disorder (PTSD) as a result of physical illness and its treatment were reviewed. PTSD was described in studies investigating myocardial infarction (MI), cardiac surgery, haemorrhage and stroke, childbirth, miscarriage, abortion and gynaecological procedures, intensive care treatment, human immunodeficiency virus (HIV) infection, awareness under anaesthesia, and in a group of miscellaneous conditions. Cancer medicine was not included as it had been the subject of a recent review in this journal. Studies were reviewed in terms of the prevalence rates for PTSD, intrusive and avoidance symptoms, predictive and associated factors and the consequences of PTSD on healthcare utilization and outcome. There was considerable variability both in the study methodology and design and in the results. The highest prevalence rates were identified in patients treated in intensive care units (ICUs) and those with HIV infection. Irrespective of the physical illness, posttraumatic symptomatology is more common than PTSD caseness. Existing characteristics of the patient may well predispose individuals to the development of PTSD as do other factors such as poor social support and negative interactions with healthcare staff. Generally, the severity of the illness itself is not predictive of PTSD. Issues relating to sampling, attrition, diagnosis, the course of symptoms, aetiological pathways, and the consequences of the disorder are discussed. The presence of PTSD most probably influences the patient's use of healthcare resources and may affect their clinical outcome.
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PMID:Posttraumatic stress disorder following medical illness and treatment. 1272 79


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