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Query: UMLS:C0026916 (MAC)
 5,226 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Patients with the acquired immune deficiency syndrome (AIDS) frequently develop hepatic dysfunction. Although hepatic injury may indirectly result from malnutrition, hypotension, administered medications, sepsis, or other conditions, the hepatic injury is frequently due to opportunistic hepatic infection, directly related to AIDS. Infection with Mycobacterium avium intracellulare typically occurs in patients with advanced immunocompromise and with systemic symptoms due to widely disseminated infection. In contrast, hepatic tuberculosis often occurs with less advanced immunocompromise. Cytomegaloviral infection may produce a hepatitis. Cytomegaloviral and cryptosporidial infections have been implicated as causes of acalculous cholecystitis and of a secondary sclerosing cholangitis. About 10-20% of patients with AIDS have chronic hepatitis B infection. These patients tend to develop minimal hepatic inflammation and necrosis. The clinical findings in patients with hepatic cryptococcal infection are usually due to concomitant extrahepatic infection. Hepatic histoplasmosis usually develops as part of a widely disseminated infection with systemic symptoms. Hepatic involvement by Kaposi's sarcoma is rarely documented ante mortem because an unguided liver biopsy is an insensitive diagnostic procedure. Patients with non-Hodgkin's lymphoma of the liver typically have lymphadenopathy, hepatomegaly, and systemic symptoms. As a pragmatic approach, patients with liver dysfunction and HIV-related disease should have a sonographic or computerized tomographic examination of the liver. Patients with dilated bile ducts should undergo endoscopic retrograde cholangiopancreatography because opportunistic infection may produce biliary obstruction. Patients with a focal hepatic lesion should be considered for a guided liver biopsy. Patients with a significantly elevated serum alkaline phosphatase level should be considered for a percutaneous liver biopsy. When performed for these indications, liver biopsy will demonstrate a significant disease involving the liver in about 50% of patients with AIDS and in about 25% of patients who are HIV seropositive but who are not known to have AIDS. The clinical impact of a diagnostic biopsy is blunted by a lack of efficacious therapy for many opportunistic infections.
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PMID:Hepatobiliary manifestations of the acquired immune deficiency syndrome. 198 33

Bacterial infections of the gastrointestinal tract (GI tract) in patients with AIDS are characterized by bacteremia and persistence of the pathogen. Infections with Salmonella typhi murium are common. Infections with atypical mycobacteria (Mycobacterium avium intracellulare complex) mimic Whipple's disease both clinically and histologically; at present no established therapy is available. Among the parasitic diseases of the GI tract, cryptosporidial infection in AIDS patients, predominantly in tropical countries, plays an important role for epidemiological reasons. It leads to profuse watery diarrhea that does not respond to drug treatment. The AIDS-specific Kaposi's sarcoma and non-Hodgkin's lymphoma may have manifestations in the GI tract. Rare complications of these tumors are bleeding, diarrhea and ileus.
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PMID:[Gastrointestinal manifestations of AIDS. 2: Bacterial and vh parasitic infections, malignant tumors]. 205 81

Gastrointestinal disease in AIDS is common and is due to opportunistic infections, aggressive malignancy and possible direct HIV enteropathy. Disabling gastrointestinal symptoms are prominent both in patients with established AIDS and in patients with earlier stages of HIV infection. We report the cases of 160 patients with AIDS who underwent gastroenterological investigations at St Vincent's Hospital, Sydney, between November 1983 to October 1987. Of these, 127 had the diagnosis of AIDS established prior to referral and 33 patients had the diagnosis of AIDS established as a result of gastroenterological investigations. Diarrhoea and weight loss (88%) were the most frequent reasons for undertaking gastroenterological investigations. Swallowing disorders (47%), abdominal pain (20%), oral and perianal disease (74%) and evidence of hepatobiliary disease were the other major indications for investigation. In 90% of cases there was evidence of concurrent and active gastrointestinal disease at two or more sites within the alimentary tract. Results from this series reveal a wide range of infectious pathogens: viral (Cytomegalovirus, Herpes simplex), bacterial (Mycobacterium avium intracellulare) and parasitic (Cryptosporidium, Isospora belli). Kaposi's sarcoma and non-Hodgkin's lymphoma were the only malignancies detected in this series. Gastrointestinal disease associated with HIV infection is common, and contributes significantly to its overall morbidity and mortality. Moreover, chronic diarrhoea, weight loss and malnutrition may also contribute to the overall immunodeficiency.
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PMID:The gastrointestinal manifestations of AIDS. 234 18

Reagents that recognize antigens on lymphoid cells in fixed and wax-embedded sections have been applied to a series of cases of non-Hodgkin's lymphomas. The panel consisted of MB1, 4KB5 (CD45r), LN1, L26 and MB2 which recognize antigens expressed predominantly on B-lymphocytes; UCHL1 and MT1 which recognize antigens expressed on T-lymphocytes and myeloid cells; antibodies recognizing the non-lineage antigens LeuM1 (CD15), BerH2 (CD30), anti-EMA; anti-lysozyme and MAC 387 which detect antigens present on some macrophages; and finally TAL1B5 (class II MHC), CAM 5.2 (low molecular weight cytokeratin) and PD7/26 + 2B11(CD45). Two hundred and four cases of non-Hodgkin's lymphoma have been studied, of which 158 had been fully characterized on frozen sections. The series was biased towards high-grade (n = 108) and T-cell (n = 44) tumours and these were largely prospectively accrued. It was found that discrimination between B-cell and T-cell lymphomas can be reliably achieved using these reagents and that a small panel (CD45, L26, MB2, MT1, UCHL1) is adequate for this purpose. Using the full range of reagents it is not possible to subdivide cases into groups that correspond with morphological subtypes of lymphoma. Although paraffin section immunohistochemistry is of value, the diagnosis of lymphoproliferative disorders must still be based upon the assessment of well fixed, carefully prepared tissue sections using conventional tinctorial methods.
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PMID:Paraffin section immunohistochemistry. I. Non-Hodgkin's lymphoma. 326 64

We conducted a new chemotherapy, NEO-MAC OP-B (addition of etoposide and mitoxantrone to MACOP-B with half dose of methotrexate and half administration of doxorubicin), to reduce severe mucositis, which is a major toxic effect of MACOP-B, and to increase its effect with etoposide and mitoxantrone as new non-cross resistant drugs. Between Jan. 1989 and Mar. 1993, 12 patients with previously untreated advanced aggressive non-Hodgkin's lymphoma (NHL), 2 patients with adult T cell lymphoma, and 3 patients with relapsed NHL, were treated with NEO-MACOP-B. After termination of NEO-MACOP-B therapy, 83.3% of 12 patients with previously untreated NHL were in complete remission (CR). After median follow-up of 22 months, Kaplan-Meier estimates showed that overall survival of 12 previously untreated patients was 71.4%, and relapse-free survival of complete responder was 83.3%. Toxic effects on all 17 patients were moderate with a lower incidence of severe mucositis (only one patient with relatively severe stomatitis, WHO Grade 3). No treatment related deaths were observed. Thus, NEO-MACOP-B is an effective and safe treatment for advanced stage aggressive NHL.
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PMID:[NEO-MACOP-B chemotherapy for the treatment of advanced-stage aggressive non-Hodgkin's lymphoma]. 769 48

A 33-yr-old homosexual man with acquired immune deficiency syndrome (AIDS) and Mycobacterium avium intracellulare (MAI) infection presented with fever, sweats, lethargy and dyspnea. A chest radiograph showed cardiomegaly and an echocardiograph revealed a large pericardial effusion. After pericardial aspiration, which confirmed T cell non-Hodgkin's lymphoma, he remained dyspneic. Gallium-67 imaging was performed to determine whether the patient's residual dyspnea was related to pulmonary MAI infection or lymphomatous infiltration of the heart. Planar 67Ga scintigraphy revealed intense tracer uptake in two areas within the mediastinum and surrounding the entire heart shadow but no evidence of pulmonary MAI infection. SPECT 67Ga scintigraphy precisely localized the two mediastinal abnormalities and demonstrated the tracer uptake around the heart to be pericardial rather than myocardial. Gallium-67 scintigraphy suggested that pericardial lymphoma was the likely basis of the patient's dyspnea.
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PMID:Gallium-67 imaging of pericardial lymphoma in AIDS. 868 31

The differential diagnosis of cavitary pulmonary lesions in individuals infected with human immunodeficiency virus (HIV) is broad, especially in patients with advanced disease. In patients with Pneumocystis carinii pneumonia, cavitation is an uncommon manifestation of a common disease. It is unusual in patients with pulmonary cryptococcosis, coccidioidomycosis, and histoplasmosis but occurs frequently in patients with invasive pulmonary aspergillosis. In patients with pulmonary tuberculosis, cavities are more common during earlier stages of HIV disease, when cellular immunity is relatively preserved. Mycobacterium avium complex is an uncommon cause of lung disease and infrequently produces cavities. However, Mycobacterium kansasii, is often associated with cavitation. Cavities can complicate any bacterial pneumonia and are especially common with pneumonia due to Pseudomonas aeruginosa, Nocardia asteroides, and Rhodococcus equi. Noninfectious causes of cavitary lesions are rare, but cavitary lesions caused by pulmonary Kaposi's sarcoma and non-Hodgkin's lymphoma have been reported. Because of the broad differential diagnosis and because most cavities are caused by treatable opportunistic infections, a definitive diagnosis is essential.
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PMID:Cavitary pulmonary lesions in patients infected with human immunodeficiency virus. 872 7

A retrospective analysis of the files and Ga-67 scan findings of 32 AIDS patients with established diagnosis of disseminated Mycobacterium avium complex (MAC) was conducted in order to determine the sensitivity of Ga-67 scans for the diagnosis of this disease and the sites of MAC organ involvement. Fourteen of the 32 patients had early and delayed TI-201 scans that were also reviewed. Autopsy findings of AIDS patients in the 5 years (January 1990 to December 1994) were reviewed to determine the incidence and sites of involvement of disseminated MAC in AIDS autopsies. Chest x-ray was positive in only 41% of patients. Ga-67 scans were positive in 84% with multi-lymph node sites of involvement in 78% (hilar lymph nodes in 37.5%, supraclavicular 28.1% [all were on the left side], para-aortic 31.2%, paratracheal 18.2%, mediastinal nodes 6.2%, and axillary 3.1%), lung parenchymal in 18.7% and pleural in 9.3%). Increased uptake in the spleen in 16%, colitis 53.1% and enteritis 18.7%. Kaposi sarcoma in 9.3% and malignant lymphoma in 3.1%. TI-201 scans were only positive in 6 of 14 patients (42.8%). The autopsy data found the incidence of disseminated MAC in 23.7% (54 patients) out of a total of 228 autopsies. Approximately half of these cases (52%) were diagnosed antemortem. Other opportunistic infections were identified in 74%. The most common sites of MAC involvement were lymph nodes (74%), spleen (74%), liver (52%), lungs (22%), colon (13%), small bowel (11%), and bone marrow (9%). Associated Kaposi sarcoma was detected in 22% and non-Hodgkin's lymphoma in 13%. Problems in antemortem diagnosis were due to nonspecific presentations, involvement of intrathoracic and extrathoracic lymph nodes, liver, spleen and colon; and the higher incidence of opportunistic infections and negative chest x-ray in the majority of the patients.
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PMID:Disseminated mycobacterium avium complex. Review of Ga-67 and TI-201 scans and autopsy findings. 881 69

The medical records of patients with AIDS admitted to a general hospital in Brazil from 1989 to 1997 were reviewed retrospectively with the aim at defining the frequency and etiology of fever of undetermined origin (FUO) in HIV-infected patients of a tropical country and to evaluate the usefulness of the main diagnostic procedures. 188 (58.4%) out of 322 patients reported fever at admission to hospital and 55 (17.1%) had FUO. Those with FUO had a mean CD4+ cell count of 98/ml. A cause of fever was identified for 45 patients (81.8%). Tuberculosis (32.7%), Pneumocystis carinii pneumonia (10.9%), and Mycobacterium avium complex (9.1%) were the most frequent diagnoses. Other infectious diseases are also of note, such as cryptococcal meningitis (5.5%), sinusitis (3.6%), Salmonella-S. mansoni association (3.6%), disseminated histoplasmosis (3.6%), neurosyphilis (1.8%), and isosporiasis (1.8%). Four patients had non-Hodgkin's lymphoma (7.3%). We conclude that an initial aggressive diagnostic approach should be always considered because biopsies (lymph node, liver and bone marrow) produced the highest yield in the diagnosis of FUO and the majority of the diagnosed diseases are treatable. The association of diseases is common and have contributed to delay the final diagnosis of FUO in most cases. In our study area the routine request of hemocultures for Salmonella infection and the investigation of cryptococcal antigen in the serum should be considered.
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PMID:Fever of undetermined origin in patients with the acquired immunodeficiency syndrome in Brazil: report on 55 cases. 1043 67

Sphenoid opacifications may be discovered during the radiological work up of patients presenting with fever, headache, or neurological changes. While most of these patients do not require surgical intervention, prompt assessment and management is nevertheless required. Ten patients who underwent sphenoidotomy for drainage or biopsy at Montefiore Hospital during a 4-year period from September 1995 through January 2000 are presented. Nine out of 10 patients had predisposing factors such as AIDS, diabetes, leukemia, and end-stage renal disease. The most common presentation was altered mental status. One patient rapidly developed cavernous sinus thrombosis. Microbiology of sphenoid cultures included various fungi, Mycobacterium avium intracellulare, coagulase negative Staphylococci, and Corynebacterium. Neoplastic processes included non-Hodgkin's lymphoma and sinonasal undifferentiated carcinoma. When evaluating hospitalized patients with sphenoid sinus disease, a thorough history and a bedside nasal endoscopy should be performed. Conservative management in the form of intravenous antibiotics and topical decongestion should always be the first line of treatment. Those patients with clinical or radiological evidence of disease extending beyond the confines of the sphenoid sinus require immediate surgical intervention.
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PMID:Infectious and neoplastic diseases of the sphenoid sinus--a report of 10 cases. 1201 52


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