Appendicitis in acquired immunodeficiency syndrome.

Reports in the surgical literature are few regarding common intra-abdominal disease processes, such as gallstone disease or appendicitis, in patients with AIDS and instead have focused on AIDS-related intra-abdominal diseases that infrequently require surgical intervention unless complicated by bleeding, obstruction, or perforation. A literature review for appendicitis in AIDS patients revealed only 30 well-documented cases drawn from 13 studies, with a 40% perforation rate and frequent delays and errors in diagnosis. A 7-year experience with 28 patients with appendicitis and AIDS from 4 urban San Francisco hospitals is reviewed. There were no perioperative deaths and an 18% postoperative complication rate. Five patients (18%) were found to have normal appendices with other intra-abdominal pathology, and an AIDS-related etiology for appendicitis was discovered in 7 of 23 patients with appendicitis (30%). With the exception of diffuse versus localized abdominal pain, no preoperative symptom or sign was useful in differentiating AIDS-related and non-AIDS-related disease. Aggressive use of ultrasound and abdominal computed tomographic scanning, along with early surgical intervention, is recommended.     

ABDOMINAL SURGERY IN HIV/AIDS PATIENTS: INDICATIONS,OPERATIVE MANAGEMENT,PATHOLOGY AND OUTCOME

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 IS 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. Despite impaired immune function, surgical treatment of HIV infected patients with abdominal pathology can be practised with acceptable mortality and morbidity and be of major benefit to these patients.     

Emergency laparotomy in patients with AIDS.

The presentation, operative management and final diagnosis were reviewed in 28 patients with AIDS (27 men and one woman) who underwent emergency laparotomy. On clinical and radiological examination, six patients showed features of toxic megacolon, five patients had small bowel obstruction, six patients had localized peritonitis and three had perforated viscus with generalized peritonitis. The most common disease processes were acute colitis in seven patients (associated with cytomegalovirus (CMV) infection in six), intra-abdominal lymphoma in five patients, acute appendicitis in five patients (associated with CMV infection in two), and atypical mycobacterial (MAI) infection in four patients. Two perioperative deaths occurred; one in a patient with acute pancreatitis and a second with generalized peritonitis. Later deaths were due to progression of AIDS, and patient survival at 1 month, 3 months and 6 months was 89 per cent, 64 per cent and 48 per cent, respectively. Lower operative mortality than in previously reported series may be due to earlier intervention in CMV toxic megacolon. Surgery, however, conferred less benefit in patients with acute abdominal pain from MAI infection or lymphoma. With careful patient selection, emergency laparotomy may achieve worthwhile palliation in patients with AIDS.     

Significance of the human immunodeficiency virus infection in patients submitted to cardiac surgery.

BACKGROUND: To realize if cardiac surgery could interfere with the evolution of HIV infected patients to the acquired immunodeficiency syndrome (AIDS). METHODS: The study group consisted of 30 HIV positive patients (0.21%) among 14,785 who underwent cardiac surgery at the Heart Institute of University of Sao Paulo Medical School (Incor-FMUSP) from November 1988 to December 1994. Patients were followed up until they were discharged from hospital and a new contact was kept at the end of the first semester of 1995. RESULTS: All patients were asymptomatic at the time they were operated. Two patients progressed to death during hospitalization due to non-infectious complications and other three patients could not be traced. After all 25 patients had their progression evaluated. Six patients (24%) died within a period ranging from 1 to 46 months (average=17 months): 2 due to bacterial pneumonia and 04 due to AIDS-related complications. The average follow-up period for the 19 surviving patients was 33.6 months (ranging from 13 to 74 months), and only one of them (5.3%) saw the infection progress to AIDS. In summary, 5/25 (20%) saw HIV infection progress to AIDS within a maximum period of 74 months. CONCLUSIONS: Data available up to now show no conclusive evidence of acceleration of HIV into AIDS associated with cardiac surgery.     

Complications of laparoscopic cholecystectomy in HIV and AIDS patients

We retrospectively evaluated the results of laparoscopic cholecystectomy in patients infected with the human immunodeficiency virus (HIV) with and without acquired immunodeficiency syndrome (AIDS).One thousand one hundred twenty-seven consecutive patients underwent laparoscopic cholecystectomy by our surgical group. Eighteen of these patients were known to be infected with the HIV virus; 6 were asymptomatic and 12 had AIDS. We reviewed the medical records of all HIV-positive individuals with regard to morbidity, mortality, and postoperative outcome following laparoscopic cholecystectomy.In the six HIV-patients without AIDS, five (83%) had improvement of symptoms postoperatively. There was one minor complication (17%). In contrast, only one of the 12 patients with AIDS had postoperative improvement of symptoms and eight (66%) had complications after surgery. There were four deaths (33%) within 30 days of surgery in this group.Only a small percentage of AIDS patients benefit from laparoscopic cholecystectomy. There is a significantly morbidity and mortality following this procedure in this group. Strategies to improve outcome are presented.     

Testicular tumors in men with human immunodeficiency virus.

During a 2-year period 5 men positive for the human immunodeficiency virus (HIV) presented with 6 testis tumors among a total of 3,015 men seen at our hospital acquired immunodeficiency syndrome (AIDS) clinic. This testis tumor incidence of 0.2% is 57 times that of the United States average of 3.5 cases per 100,000 men. Two patients were only HIV positive and 3 others already had AIDS-related complex for 2 to 15 months at the time of tumor diagnosis. Tumor histology was mixed germ cell tumor in 4 patients, pure seminoma in 1 and Burkitt's lymphoma in 1. Patients underwent routine staging evaluations. Three patients had low stage mixed germ cell tumor (clinical stage 1 or 2A) and underwent retroperitoneal lymphadenectomy, which revealed pathological stage 1 or 2A disease in 1 and 2, respectively. These patients did not receive adjuvant chemotherapy. Two patients had advanced mixed germ cell tumor (clinical stage 2C) or Burkitt's lymphoma (clinical stage 4) and received combination chemotherapy from the onset. Outcome was evaluated with regard to progression of HIV disease and tumor status. The 2 patients who were only HIV positive remained so for 9 and 48 months. The 3 patients with AIDS-related complex had progression to AIDS within 1 to 9 months and 2 of these patients died 1 1/2 and 7 months after tumor diagnosis. All 3 patients with resected low stage disease had tumor recurrence within 1 to 9 months and were begun on platinum-based combination chemotherapy. The risk of false low clinical staging and early tumor progression may be higher in HIV positive men than in other testis tumor patients. Patient ability to tolerate chemotherapy and to obtain a satisfactory tumor response appeared to be primarily related to lack of progression of HIV disease to frank AIDS.     

Vascular disease in HIV/AIDS patients.

OBJECTIVES: An ongoing prospective clinical survey to determine the spectrum of vascular disease in HIV/AIDS patients and the risk factors affecting clinical outcome in order to formulate a management protocol for future use. METHODS: Comprehensive screening for risk factors for vascular disease as well as HIV/AIDS-related conditions. Disease pattern and presentation are noted and patients treated accordingly. Vascular emergencies are managed regardless of HIV status because this information is usually not available at the time of presentation. Elective management is based on immune status and risk stratification. RESULTS: 42 patients tested positive for HIV. The majority of patients presented with occlusive disease (57%), followed by aneurysms (21%) and vascular trauma (19%). A variety of vascular surgical procedures were performed on 36 patients. There was no surgical mortality and 10 patients developed complications, including 2 amputations and 7 cases of minor wound sepsis. The 3 patients who received preoperative antiretroviral therapy showed a marked reduction in viral count and a significant improvement in CD4 T-cell count. CONCLUSION: Surgery can be safe and effective in HIV-positive patients provided the necessary precautions are taken to reduce surgical morbidity.     

Otologic surgery in patients with HIV-1 and AIDS.

Otologic disease in patients infected with HIV occurs frequently and usually represents rhinologic disease and associated eustachian tube dysfunction rather than manifestations of HIV infection. As in all patients, the decision to operate on an HIV-infected individual who would benefit from major otologic surgery is a balance between the risks of the procedure and the possible benefits to the patient. Many concerns regarding wound infection and healing have been raised. The objective of this study is to evaluate the outcome of otologic procedures in this population. The charts of 9 men and 4 women were reviewed. Seven patients (54%) met the Centers for Disease Control and Prevention criteria for AIDS. Patients with chronic otitis media (46%) underwent tympanomastoidectomies, and the cases of acute mastoiditis (31%) were managed with simple mastoidectomies. Other procedures included repair of cerebrospinal fluid leak (15%) and stapedectomy (8%). Two patients had early complications and died during their hospitalizations. Three patients had prolonged hospital courses requiring long-term antibiotics. These 5 patients underwent urgent procedures and were severely immunocompromised. Of the remaining 8 patients only 2 had AIDS, and all had an uncomplicated postoperative course. Six of these patients were followed up for more than 1 year, and only 2 developed subsequent otologic disease.     

HIV/AIDS合并泌尿外科疾病腔镜手术的安全性探讨

目的探讨人类免疫缺陷病毒感染者/艾滋病患者（HIV/AIDS）合并泌尿外科疾病进行腔镜手术的安全性。 方法自2015年5月至2018年4月我院对HIV/AIDS合并泌尿外科疾病患者92例施行各类腔镜手术,对其临床资料进行回顾性分析。 结果共施行92例泌尿外科腔镜手术,其中输尿管镜下碎石取石术21例、经皮肾镜碎石取石术34例、经尿道手术31例、腹腔镜手术6例。术前及术后患者白细胞、血小板、C-反应蛋白、CD4淋巴细胞计数差异无统计学意义,5例患者术后出现发热,其中1例出现脓毒血性休克,所有患者经治疗后病情好转,围手术期无死亡病例。术中发生1例职业暴露,未发现HIV感染。 结论HIV/AIDS合并泌尿系外科疾病患者进行腔镜手术,充分做好围手术期准备,对于医患而言,总体是安全的。     

Laparotomy in HIV-infected patients. Indications, results apropos of 104 operated patients]

From May 1st 1983 to March 1st 1991, 126 laparotomies were performed on 104 patients infected by human immunodeficiency virus (HIV). We report the operative indications, macroscopic findings, anatomopathologic and microbiological results, and hospital mortality in this population. In 12.5% of cases, infection by HIV was established after operation. Sixty-eight percent of patients presented criteria for AIDS. The population was divided into 4 groups of indications: Group I: 30 patients had an emergency exploratory laparotomy. Laparotomy provided a diagnosis in 80% of cases, with a hospital mortality in 66%. Group II: 45 patients had an emergency laparotomy with a preoperative diagnosis. Hospital mortality was 24.4%. Group III: 29 patients had a non-urgent laparotomy with no mortality. Group IV: 14 patients were reoperated (22 laparotomies). For the entire population, hospital mortality was 9.3% for seropositive patients and 38.8% for AIDS patients.     

Sexual behaviour and knowledge of AIDS among urban black mothers. Implications for AIDS intervention programmes

Questionnaires were administered to 122 urban black mothers of teenagers in order to: (i) understand aspects of their sexual behaviour and knowledge of the acquired immunodeficiency syndrome (AIDS); and (ii) assess their communication with their teenage children with regard to AIDS and sexual behaviour. The subjects comprised a 12.5% random sample of all houses in Lamontville, a black township south of Durban. The level of AIDS knowledge among mothers was high, while their sexual behaviour, characterised by a high pregnancy rate and a high proportion who have had children by more than one consort, placed them at high risk of acquiring human immunodeficiency virus (HIV) infection. No mother had experienced sexual intercourse during which her partner used a condom. Communication with their teenage children was poor; none of the mothers had spoken with them about AIDS and 89.3% had not discussed contraceptive methods with their teenage children. We found that urban black mothers were at high risk of acquiring HIV and, despite their knowledge of the modes of transmission and prevention of HIV infection, they had not begun using condoms as a risk-reducing measure, nor had they communicated the risk of unprotected sex to their teenage children. We recommend that AIDS intervention strategies should not concentrate only on passing on knowledge but also on providing women with the communication skills to negotiate the use of condoms with their partners and to convey the risk of HIV infection to their teenage children.     

1989至2020年北京市东城区1 076例人类免疫缺陷病毒感染者/获得性免疫缺陷综合征患者生存时间及影响因素

目的探讨北京市东城区人类免疫缺陷病毒感染者/获得性免疫缺陷综合征（HIV/AIDS）患者生存时间及影响因素。 方法采用回顾性队列研究方法,在中国艾滋病综合防治信息系统中收集1989年1月1日~2020年12月31日北京市东城区HIV/AIDS患者共1 076例的临床资料,应用寿命表法分析累积生存率;利用Kaplan-Meier法（K-M法）绘制生存曲线;利用COX比例风险模型分析影响患者生存时间的因素。 结果所有研究对象中,完成随访1 072例（99.63%）,失访4例（0.37%）;随访过程中发生AIDS相关死亡26例（2.42%）;第1、2、5年累计生存率分别为98.03%、97.92%和97.47%。研究对象生存时间中位数为264.00个月。COX比例风险模型分析显示：首次检测CD4⁺ T细胞计数< 350个/μl（HR = 4.053、95%CI：1.412~11.628）、确诊时为AIDS患者（HR = 20.651、95%CI：4.741~89.940）、未接受抗病毒治疗（HR = 30.722、95%CI：12.389~76.18）均为患者生存时间缩短的危险因素。与初中及以下文化程度的HIV/AIDS患者相比,较高文化程度为延长患者生存时间的保护因素（高中或中专：HR = 0.317、95%CI：0.122~0.826,大专及以上：HR = 0.155、95%CI：0.055~0.439）。K-M法绘制生存曲线显示,大专及以上、高中或中专文化程度HIV/AIDS患者累计生存率显著高于初中及以下文化程度HIV/AIDS患者（χ² = 26.978、P < 0.001）。首次检测CD4⁺ T细胞计数≥ 350个/μl、确诊时疾病状态为HIV感染、行抗病毒治疗的HIV/AIDS患者累计生存率高于首次检测CD4⁺ T细胞计数< 350个/μl、确诊时疾病状态为AIDS、未行抗病毒治疗的HIV/AIDS患者（χ² = 14.329、44.559、126.836,P均< 0.001）。 结论北京市东城区HIV/AIDS患者中接受抗病毒治疗、首次CD4⁺ T细胞计数≥ 350个/μl、确诊时疾病状态为HIV感染、大专及以上文化程度者生存时间较长。故提高筛查力度,尽可能早期发现HIV感染者,尽快开展治疗,可提高其确诊后生存质量和生存时间。     

Surgery in HIV-positive and AIDS patients: indications and outcome

We have reviewed the indications for and outcome of surgery in 147 patients who were seropositive for human immunodeficiency virus (HIV), 100 of whom have developed acquired immunodeficiency syndrome (AIDS). There were 256 operations; the commonest indications were anorectal conditions (34%), central venous access (21%), lymph node and soft tissue biopsy (15%) and an important minority underwent laparotomy (4%). Complications occurred in 20% of operations and repeat procedures were required in 35 patients. Both were of equal frequency in the HIV and AIDS populations. Most operations were therefore minor, and achieved satisfactory results with an acceptable morbidity. The possibility of HIV-related infection or malignancy affected the diagnostic and therapeutic approach, particularly in those considered for anorectal surgery or laparotomy. With increasing numbers of HIV-infected patients, knowledge of the types of surgery required and the likely outcome is important to enable provision of a safe and effective surgical service.     

Is parotid lymphadenopathy a new disease or part of AIDS?

This report describes a series of 15 patients who presented with masses in the tail of the parotid gland which proved at biopsy to be benign hyperplastic lymphadenopathy similar to lymphoepithelial hyperplasia. There were 11 male and 4 female patients. All had a history of intravenous drug use. Ten patients complained of pain. Six patients had smaller masses on the contralateral side of the gland, whereas seven patients had minor axillary adenopathy. Needle aspiration was performed in 12 patients; although not conclusively diagnostic, it ruled out primary salivary tumors. Thick purulent material was aspirated in five patients. All 15 patients underwent parotid exploration. It was apparent after raising the flap that the disease was related to intraparotid and periparotid lymph nodes. Lymphadenopathy in the jugular region, which was not appreciated preoperatively, was also noted in all patients. Each patient underwent exposure of the main trunk of the facial nerve and limited superficial parotidectomy. The postoperative course in each patient was uneventful and no patient had a facial nerve deficit. Cerebral toxoplasmosis developed in one patient who died 3 months after surgery; AIDS developed in one other patient. Human immunodeficiency virus (HIV) titers were not performed routinely because none of the patients came for regular follow-up. None of these patients demonstrated lymphoma at the time of this procedure. Parotid lymphadenopathy, which occurs primarily in intravenous drug users, appears to be an early manifestation of pre-AIDS or AIDS-related complex. If patients have no other sizable lymphadenopathy for biopsy, we advocate exploration of the parotid region and excision of periparotid and intraparotid lymph nodes.     

Severe gastrointestinal haemorrhage due to primary intestinal kaposi’s sarcoma — a case report

Kaposi’s Sarcoma (KS) was previously a relatively rare disease. With the advent of HIV/AIDS pandemic however, AIDS-related KS has been on the increase and so has interest in the disease. Ninety percent of patients with KS present with skin lesions. While the gastrointestinal tract is a fairly common site of metastatic KS, primary gastrointestinal KS is uncommon. The presentation of gastrointestinal KS with severe gastrointestinal bleeding is rarer still. In this report, we present a 56-year-old HIV-negative patient who presented with severe gastrointestinal bleeding without any skin lesions. Multiple hemorrhagic polypoidal lesions were found on the walls of the jejunum and ileum as well as the liver at exploratory laparotomy and these were found to be KS on histopathologic examination. We also discuss the diagnostic and therapeutic challenges we had with this rare cause of severe GI bleeding.     

AIDS and the lung. Introduction.

Damage to the immune system induced by the human immunodeficiency virus (HIV) leads to a spectrum of opportunistic infections of which the lung is the most common site. In Europe and North America, pneumocystis carinii pneumonia is the presenting symptom in 64% of cases of acquired immunodeficiency syndrome (AIDS) and occurs at some point in 80% of AIDS victims. This infection is less common in Africa, where tuberculosis is the predominant opportunistic infection. Other AIDS-related lung infections that are gaining in prevalence include pneumonia due to pyogenic bacteria, pulmonary infection with Mycobacterium tuberculosis, and lymphoid interstitial pneumonitis. In addition, there is evidence that the lung may be extensively involved in Kaposi's sarcoma. Given the importance of the lung as a site for AIDS-related opportunistic infections, respiratory physicians will be required to become more involved in the diagnosis and management of AIDS cases.     

Acute appendicitis in patients with AIDS/HIV infection.

Nine patients known to have acquired immunodeficiency syndrome (AIDS) and/or human immunodeficiency virus (HIV) infection and operated on for acute appendicitis are presented. Six of the nine patients did not have an elevation in the white blood cell count preoperatively. Two patients underwent diagnostic laparoscopy prior to exploration. In four cases, a perforated appendix was removed. Seven patients had persistent postoperative fever, while all nine had a significant lack of leukocytosis after surgery. Other than the absence of a preoperative increase in white blood cell count, the presenting characteristics of this group were similar to those expected in immunocompetent patients. However, concern for a possible opportunistic infection etiology and a desire to avoid operating on these patients resulted in an undue delay prior to exploration. The use of diagnostic laparoscopy aided in earlier and more accurate diagnosis. Despite persistent postoperative fever, appendectomy was performed in patients with AIDS/HIV infection without significant increase in morbidity and mortality.     

Acute severe pancreatitis caused by anti-HIV drugs

Acute pancreatitis in patients with HIV infection is infrequent and often not recognized. Autopsies performed on patients died for different pathologies show pancreatic lesions approximately in 50% of cases. The etiological factors associated with acute pancreatitis are related to HIV infection and particularly to drugs used to treat the syndrome or to prevent opportunistic infections. We report a case in a 38 years old male patient with AIDS without risk factors for acute pancreatitis in which the disease developed while taking Stavudine, Lamivudine and Indinavir. His conditions improved with intensive medical therapy. The subsequent medical course became complicated. The patient died after 75 days for severe abdominal haemorrhage. A review of the literature reports several cases of A.P. in HIV patients mainly related to opportunistic infections. Many authors regard the medical treatment of HIV syndrome as etiological factor but a casual relationship was never demonstrated. The aim of the present paper is to underline that besides Lamivudine also Stavudine and Indinavir might be related to acute pancreatitis. Clinical and laboratory investigations in HIV patients are therefore indicated for an earlier diagnosis and treatment.     

Impact of AIDS on a local health department

Owing to the unique nature of the human immunodeficiency virus (HIV), AIDS infection presents a unique set of problems. This paper focuses on one local health department's response to AIDS. Ottawa County, Michigan, is largely rural and has a low seroprevalence of HIV infection. The Ottawa County Health Department has been charged with the responsibility for monitoring and controlling HIV infection and AIDS. The response of this health department is described as are some of the related problems particular to this community. The low seroprevalence rate is viewed not as a basis for complacency but rather as an opportunity to minimize the spread of this disease within the area.