Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Because pancreatitis has been reported frequently in adults with human immunodeficiency virus infection, we sought to determine the incidence of pancreatitis in children with acquired immunodeficiency syndrome by reviewing all records of children with AIDS, their serum amylase and lipase levels, and the factors associated with pancreatitis through a case-control analysis. During a 6-year period pancreatitis developed in 9 (17%) of 53 pediatric patients with AIDS. Six children had vertical transmission of infection and three patients had acquired HIV infection through contaminated blood products. Pancreatitis developed at a median age of 5.2 years (range 1.2 to 20 years). All patients had vomiting and abdominal pain. When the patients were first seen, lipase values were elevated more than amylase values (p = 0.028). Amylase and lipase levels declined at comparable rates. In the case-control analysis, pentamidine isethionate was significantly associated with pancreatitis (p = 0.02); the risk was greater in patients who received pentamidine isethionate and had absolute CD4 T-lymphocyte counts less than 100 cells/mm3 (p = 0.001). Infections associated with the onset of pancreatitis included cytomegalovirus (4), Cryptosporidium (1), Pneumocystis carinii pneumonia (3), and Mycobacterium avium intracellulare (1). Coinfection with cytomegalovirus was associated with a protracted course in four children. Ultrasonographic examination demonstrated biliary ductal dilatation 6 months after the onset of pancreatitis in one child. Seven children have died at a mean of 8 months after the initial onset of pancreatitis; the one living child has survived 5 months from the onset of pancreatitis. We conclude that pancreatitis is common in pediatric patients with AIDS and may be related to pentamidine isethionate exposure, especially when absolute CD4 T-lymphocyte counts are less than 100 cells/mm3. Serum amylase levels do not always accurately predict the onset of pancreatitis; serum lipase levels should be measured in children with symptoms. The onset of pancreatitis in an HIV-infected child is a poor prognostic indicator.
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PMID:Pancreatitis in pediatric human immunodeficiency virus infection. 137 Sep 62

This is the first report from Ethiopia of a case of cryptococcal meningitis in a patient with AIDS. A 20-year-old woman was admitted to Tikur Anbessa Hospital in January 1990 with complaints of generalized pruritic skin lesions of six months, and headache, fever, and poor appetite of three months duration. The headache and low-grade intermittent fever were accompanied by nausea, vomiting, anorexia, and progressive weight loss, without diarrhea. She had had multiple sex partners. Upon admission, after being bedridden for two weeks, she appeared acutely ill and restless. Her temperature was 39.5 degrees Celsius, and she had oral thrush. There was no lymphadenopathy. Widespread, irregular erythematous and whitish macular patches (3 x 5 to 8 x 10 sq. cm in size) with peripheral scaling and tiny vesicles were found on the skin, pubic and perineal regions. She had neck stiffness, but was conscious and well-oriented. Hemoglobin (Hb) was 10.5 g%; the white cell count (WBC) was 3400/cu. mm; the erythrocyte sedimentation rate (ESR) was 92 mm/hr; the platelet count was 175,000/mm; and blood films were negative for hemoparasites. Urinalysis showed 3+ albumin and many pus cells and red cells/HPF. Urine culture was negative, and the VDRL test was nonreactive. Lumbar puncture, which was performed upon arrival, showed clear cerebrospinal fluid (CSF), with normal protein and glucose levels and no cells. CSF culture showed yeast cells, and an India ink preparation was positive for Cryptococcus neoformans. Blood taken for bacterial culture grew yeast cells. Renal and liver function tests, and chest x-rays were normal. A potassium hydroxide (KOH) preparation from a skin snip showed rounded yeast cells. ELISA and Western blot tests were both positive. The patient was given supportive treatment and amphotericin B (0.6 mg/kg daily). Although the fever decreased, the patient's general condition did not improve. She complained of headache, photophobia, nausea, and vomiting. Lumbar puncture was repeated eight days after the start of treatment; CSF culture and India ink preparations were negative. Urea nitrogen (BUN) repeated two weeks later was normal. Four weeks after admission, the patient suddenly vomited massive amounts of fresh blood and died before transfusion could be given. A discussion follows regarding the clinical manifestations, diagnosis, and treatment of this disease, particularly in AIDS patients, with a review of the literature.
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PMID:Cryptococcal meningitis in a young Ethiopian woman with AIDS. 139 20

The physiopathology of malnutrition among AIDS, ARC and HIV infected children was reviewed. One-hundred eight-three newborns were studied, 152 of which were born at "La Fe" Maternity Hospital. Of these patients, 29% were LBW and 28% preterm. Transfused and hemophiliac patients were excluded from the study. Anorexia, vomiting, fever, infections of the respiratory and GI tracts and drug therapy were the most frequent factors affecting the nutritional status. Fifty-three newborns were infected with the HIV (29%). The children were classified into three groups (G). Group-I was formed by HIV+children > 18 months of age, G-II, P-2 class by children < 18 months of age and G-III was formed by those children that died of AIDS. The most common symptoms were chronic diarrhea and infections of the respiratory tract. Of the HIV+children > 18 months of age, 65% had a weight < the 10th percentile and 61% were < the 10th percentile for height. Of the children that died of AIDS, 80% were in the lower 10th percentile for both weight and height. Hemoglobin, T4/T8, total proteins, seroalbumin and calcium were also negatively affected. Those most severely affected were the dead patients, followed by P-2 < 18 months and finally the HIV+ > 18 months of age. The differences between G-I and G-II-G-III were statistically significant, p < 0.01. The biochemical quantification of the nutritional status was difficult due to the limited amount of blood available. HIV infected children require nutrition supplementation to maintain an adequate nutritional status. Among these patients, malnutrition is a multifactorial phenomenon.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Nutritional status in HIV infection in infancy]. 145 14

To understand whether disease caused by the human immunodeficiency virus (HIV) affects zidovudine disposition, we compared the drug's pharmacokinetics in six healthy volunteers; six persons with the acquired immunodeficiency syndrome (AIDS) and no evidence of gastrointestinal (nausea, vomiting, diarrhea), renal (elevated blood urea nitrogen, serum creatinine), or hepatic (elevated liver function tests) disease; and three patients with AIDS and hepatic disease. After a single oral dose of zidovudine, serial blood samples were analyzed for drug concentration by radioimmunoassay. A one-compartment oral absorption model was fit to the concentration-time data. The absorption rate constant (4.05 vs 2.11 hr-1) and time to maximum concentration (0.61 vs 1.03 hr) were significantly different in healthy volunteers versus patients with AIDS without hepatic disease. Differences in half-life, oral clearance, and area under the curve were not statistically significant. In the three patients with AIDS plus hepatic disease, clearance was reduced an average of 63%, and area under the curve was increased by a factor of 2.3. These comparative pharmacokinetic data do not support profound differences between zidovudine's disposition in healthy volunteers and individuals with AIDS; however, the differences and trends that were observed may represent an effect of HIV disease. Although the presence of hepatic disease clearly indicates a need to modify individual dosages, these pharmacokinetic data may have more generalized implications for zidovudine dosing as the relationships between drug concentration and therapeutic or toxic effects are clarified.
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PMID:Comparative pharmacokinetics of zidovudine in healthy volunteers and in patients with AIDS with and without hepatic disease. 149 5

2 AIDS patients are described who had cryptococcal meningitis accompanied by increased intracranial pressure (ICP) and visual complications, a finding thought to be relatively rare in AIDS. Of the 2-6% of AIDS patients who develop cryptococcal meningitis, many have disseminated and recurrent infections. The 1st case was a 45-year old Ugandan woman who presented with stiff neck, and right VIth cranial nerve palsy. She was treated with amphotericin B and flucytosine with some improvement, but on the 9th day she awoke with headache, drowsiness, and total blindness, although no papilledema. Her CSF pressure was 40 cm H20. She recovered after a month of intravenous chemotherapy and acetazolamide, but remained blind. Her sudden blindness was thought to be due to bilateral optic nerve infarction. The 2nd case was a 32-year old male homosexual, admitted with headache, vomiting, confusion, and drowsiness. He had stiff neck, and a CSF of 40 cm containing Cryptococcus neoformans. He was given amphotericin B, flucytosine, and has CSF drained every other day. On day 21 papilledema was seen in the right eye, and acetazolamide was started to lower CSF pressure. This patient recovered without loss of vision. 3 published series of cryptococcus meningitis in AIDS patients remarked about the low incidence of raised ICP, while 1 reported 9 of 27 with neurological and ophthalmic complications. The visual complications and increased ICP in these patients was thought to be due to inflammatory arachnoiditis or direct cryptococcal infiltration.
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PMID:Raised intracranial pressure and visual complications in AIDS patients with cryptococcal meningitis. 156 10

The author relates her experience in Benin during a 3 and 1/2 year tenure as a nurse under the aegis of the German Development Agency. In Malanville, she was responsible for starting the operating room, caring for hygiene, sterility, and the related training of domestic staff. A septic and aseptic operating room was set up along with a storage room for instruments, a sterilization room, and a changing room. For the operating and surgical station, the following personnel were available: 2 nurses with 3 years of training, 1 nurse with 2 years of training, and 3 orderlies without training. A nurse with 3 years of training was assigned to the author to carry on the project after her departure. The standard of operating care was very low. It took a month to teach the staff what was not sterile. There was a even problem with putting on sterile gloves which required an exercise in patience. There were an average of 5 relatives per patient taking care of the patient and cooking. The undernutrition center for infants had 6 beds with 2 German nurses who administered Bacillus Calmette-Guerin (BCG), diphtheria, polio, and tetanus vaccinations. Their activity was strengthened by nutrition counselling and plans for underweight and malnourished children. Abrupt weaning that resulted in harmful diarrhea and vomiting was prevalent. Clinical signs of marasmus and kwashiorkor were frequent. In the middle of 1990, AIDS educators informed students of the public school as well as registered prostitutes about condom use. In the hospital, there were about 900 births per year, and women were asked to follow recommendations for prenatal care, especially to achieve anemia prevention by getting iron tablets. They were urged to deliver in the clinic, not at home assisted by untrained midwives. Oxytocin and syntometrin were available as was a hand-driven, vacuum evacuation pump. This experience made a lasting impression on the author who has resolved to go to another developing country to train traditional birth attendants in midwifery.
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PMID:[In Africa as a nurse]. 161 98

A 49-year-old man with the acquired immune deficiency syndrome (AIDS) developed epigastric pain, nausea, vomiting, and gastrointestinal bleeding secondary to a cytomegalovirus (CMV)-induced ulceration in the distal esophagus and proximal stomach. All symptoms improved on treatment with ganciclovir. However, 1 month later severe dysphagia led to discovery of a fibrous stricture in the area of the healed ulcer. The dysphagia was controlled by esophageal dilation. Ulcerative lesions caused by CMV can heal with ganciclovir treatment but, as with other esophageal ulcers, healing may be associated with fibrosis and stricture.
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PMID:Esophageal stricture after cytomegalovirus ulcer treated with ganciclovir. 166 46

We used an endoscopic method of quantification to evaluate the response of symptomatic gastrointestinal Kaposi's sarcoma (KS) prospectively in seven patients with acquired immune deficiency syndrome (AIDS) who were participating in chemotherapy trials for extensive cutaneous KS. The sums of the diameters of KS lesions in the esophagus, stomach, duodenum, and distal colon were used as a measure of extent of disease. Intravenous therapy [adriamycin/bleomycin/vincristine (N = 5), adriamycin (N = 1), or bleomycin/vincristine (N = 1)] was given every 2 wk for a mean of six cycles. Five of seven patients (71%) had a cutaneous response, whereas 9/15 (60%) gastrointestinal sites showed a remission. Sites of complete response all had an initial sum of lesion diameters less than or equal to 30 mm. Five of five patients with duodenal KS responded (3/5 complete), whereas just two partial responses were seen in five patients with gastric KS (4/5 with duodenal KS had sums of diameters less than or equal to 20 mm, whereas 4/5 with gastric KS had sums greater than or equal to 150 mm). Symptoms (abdominal pain, nausea/vomiting, hematemesis, diarrhea) resolved in all patients within two cycles of therapy. In summary: 1) the response rate of gastrointestinal KS to chemotherapy is similar to that of cutaneous KS; 2) the best response is seen in patients with less extensive disease and duodenal involvement; and 3) symptoms of gastrointestinal KS respond to chemotherapy even if the KS lesions do not resolve.
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PMID:The response of symptomatic gastrointestinal Kaposi's sarcoma to chemotherapy: a prospective evaluation using an endoscopic method of disease quantification. 169 12

Acalculous cholangitis and cholecystitis may occur in the course of AIDS. The symptoms are always the same: pain in the right upper quadrant, fever, nausea, vomiting, anorexia and diarrhoea, associated with biochemical signs of cholestasis, often without jaundice. Morphological explorations show thickening of the gallbladder wall and dilatation of the extrahepatic bile ducts, sometimes associated with stenosis of the major duodenal papilla and dilatation of the intrahepatic bile ducts.
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PMID:[Acalculous cholangitis and cholecystitis in two AIDS patients]. 182 15

Since intestinal microsporidiosis might be of importance in the pathogenesis of gastrointestinal symptoms in patients infected with HIV, we examined duodenal biopsies of HIV-infected patients by electron microscopy. Enterocytozoon bieneusi infection of the small intestine was found in one of 23 patients studied, which gives a 95% confidence interval for the prevalence rate between 0.1% and 22%. The infected patient was a 24-year-old homosexual male with AIDS who underwent upper endoscopy because of acute epigastric pain, nausea, and vomiting. These symptoms were obviously due to mesenterial Kaposi's sarcoma obstructing the duodenal passage, as was later revealed at autopsy. However, microsporidiosis might have caused the patient's eight-month history of diarrhea and weight loss, since infected cells showed signs of degeneration, and no other pathogens were ever detected in stool or biopsy. Our finding of Enterocytozoon bieneusi infection in a German AIDS patient supports the concept of a worldwide distribution of this parasite; further studies are needed to define its exact prevalence in HIV-infected patients and its pathogenic relevance.
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PMID:Intestinal microsporidiosis in a German patient with AIDS. 194 57


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