Urinary symptoms in child sexual abuse

Many common genitourinary complaints may be related to sexual abuse. We report five patients referred to a Pediatric Nephrology Clinic who demonstrate some of the symptoms and signs caused by abuse, such as dysuria, genital and urinary tract infections, voiding dysfunction, and genital trauma. Difficulties in eliciting histories are described. Although these genitourinary complaints may be due to a variety of etiologies, sexual abuse should not be overlooked. Suggestions for a management approach are made.     

Human immunodeficiency virus infection in children--prevalence and psychosocial impact

As at 20 September 1989, 15 children with the acquired immunodeficiency syndrome (AIDS) had been diagnosed in South Africa and indications are that this number is going to increase at a rapid rate in the near future as the disease establishes itself in the heterosexual population. A brief overview of the clinical aspects of human immunodeficiency virus infections in children is given before the psychosocial implications are considered in more detail.     

Human immunodeficiency virus infection in end-stage renal disease patients

Human immunodeficiency virus (HIV) infection in patients with end-stage renal disease (ESRD) offers many diagnostic and therapeutic challenges to nephrologists. Renal failure may be a direct consequence of viral infection (HIV-associated nephropathy), or intrinsic renal diseases may occur in previously infected individuals. Patients receiving renal replacement therapy (RRT) may acquire HIV infection from blood transfusions, renal allografts, sexual contacts, or needle sharing by drug addicts. In the early 1980s, the overall prognosis of patients with the acquired immunodeficiency syndrome (AIDS) was very poor, and survival of those with ESRD was dismal. Consequently many even questioned the value of providing maintenance dialysis to patients with AIDS. With advances in diagnostic techniques in serologic and viral markers of disease, and deployment of highly effective antiretroviral agents, the prognosis of HIV-infected patients has dramatically improved. Over the past two decades, experiences in the management of HIV patients with ESRD is accumulating. Both peritoneal dialysis and hemodialysis are effective modes of therapy and many centers are now beginning to perform renal transplantation in HIV-infected patients. This article deals with various aspects of HIV infection in patients with ESRD.     

Cumulative trauma: The impact of child sexual abuse,adult sexual assault,and spouse abuse

The present study investigated the relationship between trauma symptoms and a history of child sexual abuse, adult sexual assault, and physical abuse by a partner as an adult. While there has been some research examining the correlation between individual victimization experiences and traumatic stress, the cumulative impact of multiple victimization experiences has not been addressed. Subjects were recruited from psychological clinics and community advocacy agencies. Additionally, a nonclinical undergraduate student sample was evaluated. The results of this study indicate not only that victimization and revictimization experiences are frequent, but also that the level of trauma specific symptoms are significantly related to the number of different types of reported victimization experiences. The research and clinical implications of these findings are discussed.     

IgA nephropathy in a child with human immunodeficiency virus type 1 infection

Infection with the human immunodeficiency virus type 1 (HIV-1) can cause a spectrum of renal disease, termed acquired immunodeficiency syndrome (AIDS) nephropathy. The most common clinical manifestations of kidney involvement in HIV-1-infected patients are proteinuria and/or nephrotic syndrome, and the histopathological pattern usually reveals focal segmental glomerulosclerosis. We describe an 8-year-old child with AIDS who presented with recurrent gross hematuria. A kidney biopsy demonstrated IgA nephropathy. This unique case indicates that the range of kidney disease in HIV-infected children may be broader than originally thought, and that these patients warrant a complete evaluation of any renal abnormality.     

Human immunodeficiency virus testing: update.

Human immunodeficiency virus (HIV) types 1 and 2 have been associated with the acquired immunodeficiency syndrome (AIDS). The detection of HIV infections is based on the screening of serum samples for the presence of antibodies to HIV proteins. Serum samples that test positive on screening must be assayed by a confirmatory test to provide a definitive report on the presence of HIV infection. This article reviews the currently available screening and confirmatory testing procedures and their limitations.     

Human immunodeficiency virus nephropathy

Varying components of the syndrome of human immunodeficiency virus nephropathy (HIVN) have been described, the most pertinent including proteinuria/nephrotic syndrome, progressive azotemia, normal blood pressure, enlarged and hyperechoic kidneys, rapid progression to end-stage renal disease (ESRD), and no response to treatment regimens. The diagnosis of HIVN requires identification of excessive proteinuria or albuminuria, determined by a total protein excretion on a timed urine collection or a high protein/creatinine ratio in a random specimen. Various pathological lesions have been found in HIVN. The lesion of focal and segmental sclerosis (FS/FSS) is most characteristic in adults and usually is associated with a rapid demise. FS/FSS also has been described in approximately one-half of the pediatric patients reported in the literature (31/64). Despite progression to ESRD, the clinical course in children with HIVN is less fulminant than in adults. Other reported histological findings include primarily mesangial hyperplasia as well as minimal change, focal necrotizing glomerulonephritis or lupus nephritis, and hemolytic uremic syndrome. In addition to glomerular pathology, interstitial findings of dilated tubules filled with a unique proteinaceous material, atrophied tubular epithelium, and interstitial cell infiltration are very common. On electron microscopy, most investigators have found tubuloreticular inclusion bodies in endothelial cells of glomerular capillaries. Treatment of patients who develop ESRD remains highly controversial. Most adult patients treated with hemodialysis have succumbed rapidly; peritoneal dialysis has been better tolerated. Transplantation in patients with HIV infection must be considered to be tentative, with reports of acceleration towards full blown acquired immunodeficiency syndrome in some and uneventful 5-year survival in others. The situation of the pediatric patient with HIVN remains unclear and awaits the benefit of experience.     

The influence of human immunodeficiency virus infection and intravenous drug abuse on complications of hemodialysis access surgery.

To examine the influence of human immunodeficiency virus (HIV) infection on complications in dialysis access surgery, a review was performed on patients undergoing hemodialysis at two major metropolitan medical centers over a 30-month period. One hundred eight patients underwent a total of 169 graft procedures; mean follow-up was 14 1/2 months. There were 18 (17%) patients who were HIV-positive who had no symptoms, 11 (10%) patients with acquired immunodeficiency syndrome (AIDS), and 79 (73%) patients who were HIV-negative. Twenty-three percent (25/108) of patients had a history of intravenous drug abuse (IVDA), most of whom also had either AIDS or asymptomatic HIV infection. Dialysis procedures included 44 autogenous reconstructions (26%), 117 polytetrafluoroethylene (PTFE) grafts (69%), and 8 (5%) procedures of unknown type. Arteriovenous fistula or graft thrombosis was a frequent complication. The overall 12-month graft patency rate was 41%, and patients with HIV infection or a history of IVDA did not have a significantly increased risk of thrombosis. Multivariate analysis showed that the use of PTFE as opposed to autogenous reconstruction was the only significant risk factor found for occlusion within the first 12 months after operation (p < 0.01). Twenty-five graft infections occurred, all in PTFE grafts. The PTFE graft infection rate was 43% in patients with AIDS, 36% in patients who were HIV-positive and who had no symptoms, and 15% in patients who were HIV-negative (p < 0.05). Patients with a history of IVDA had a 41% PTFE graft infection rate versus a 13% infection rate in patients who did not have a history of IVDA (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)     

Systemic complications of human immunodeficiency virus infection.

HIV infection causes a wide spectrum of complications affecting all organ systems. These complications may be primary to the direct infection of a specific organ system by HIV or secondary to the immunodeficiency associated with HIV infection. These complications may be specific to certain stages of HIV infection. Selected common complications of HIV infection include pulmonary, neurologic, GI, dermatologic, oral, ocular, endocrine, and hematologic complications.     

Neurosurgical aspects of human immunodeficiency virus infection.

The spectrum of neurologic disease that complicates human immunodeficiency virus (HIV) is extremely broad. This article deals with those HIV-related diseases that may occur with a frequency of more than 1% and are of potential neurosurgical importance: those that result from a direct involvement of the nervous system by HIV and those that result either directly or indirectly from the concomitant immunosuppression. Infectious complications are the most common but not the sole cause of neurologic disability in the latter category. Other causes of neurologic disease seen in association with HIV infection include neoplasms, metabolic-nutritional disorders, and vascular complications.     

Human immunodeficiency virus and osteoarticular tuberculosis

The human immunodeficiency virus pandemic has contributed to a marked increase in patients infected with tuberculosis. In parts of SubSaharan Africa, osteoarticular tuberculosis has increased fourfold in the past decade and approximately 60% of the patients are infected with the human immunodeficiency virus. The human immunodeficiency virus has complicated the diagnostic process and treatment. Tuberculosis will respond to chemotherapy in patients who are positive for the human immunodeficiency virus but adverse drug reactions are common. Careful assessment is necessary if surgery is contemplated because of the high risk of infection and poor wound healing in patients with advanced human immunodeficiency virus disease. In patients with osteoarticular tuberculosis who are positive for human immunodeficiency virus, the prognosis will depend on the stage that the human immunodeficiency virus infection has reached by the time of presentation.     

Human immunodeficiency virus and IgA nephropathy

Summary: IgA nephropathy (IgAN) in human immunodeficiency virus (HIV)-infected patients has been described with increasing frequency. In contrast to HIV-associated nephropathy, with collapsing variant of focal and segmental glomerulosclerosis and prominent tubular cell changes, a disorder which is more common in black persons, IgAN is a disease mainly of white patients. Most are asymptomatic carriers of HIV although few have acquired immunodeficiency syndrome (AIDS) or ARC at the time the renal disorder is discovered. The clinical manifestations are generally of haematuria, sometimes with proteinuria. In some patients, the finding of IgA reactive with anti-HIV IgG or IgM in circulating immune complexes and in glomerular eluates strongly suggests this glomerulopathy to be an HIV-associated immune complex disorder. Because of the demographic factors, IgAN may evolve to be an important renal lesion in HIV infection.     

Human immunodeficiency virus (HIV) infection screening in a dialysis unit

BACKGROUND: Human immunodeficiency virus (HIV) screening is a routine for long-term hemodialysis patients because of a high risk for infection. Enzyme-immunoassay (EIA) is a simple tool for screening HIV, but clinically false-positive EIA is a frequent result. Other tests such as Western blot analysis (WB) and HIV DNA and RNA by polymerase chain reaction have better specificity and sensitivity, but they cannot be accessible in many dialysis units. METHODS: Four hundred and four patients with end stage renal disease on long-term hemodialysis were screened with EIA for HIV antibodies. Repeated EIA was performed if the first test was positive result. WB was used as the confirmatory test. RESULTS: Two persons initially showed a positive EIA pattern among the 404 patients, but nobody had positive WB test result later. CONCLUSION: The ratio of false-positive EIA results for screening HIV is relatively high in long-term hemodialysis patients. Further tests should be employed to confirm the diagnosis.     

Parotid disease and human immunodeficiency virus infection in Zambia.

Among the salivary glands the parotid is unusual in that it contains lymphoid tissue within its capsule. The focus of infection with human immunodeficiency virus (HIV) is the lymphatic system and this results in a specific HIV-related pathology in the parotid. This 2-year surgical audit of parotid disease in HIV-infected patients in Lusaka shows patients presenting with parotid lymphadenopathy, bilateral diffuse parotid enlargement and parotid lymphoepithelial cysts. Clinical presentation and management are discussed.     

Glomerular disease and human immunodeficiency virus infection in Brazil.

Clinically overt glomerular disease was detected in 6 (1.1%) of 543 patients with HIV infection followed at a Brazilian National Referral Center for AIDS. In 4 cases, glomerulosclerosis was present (focal and segmental in 3, diffuse and global in 1) and rapid progression to terminal renal failure was observed 1-10 months after clinical presentation. The other 2 patients died with normal renal function, and autopsy studies suggested the diagnosis of minimal change disease. Clinically overt glomerular disease was significantly more common among Black patients, whether all the cases with glomerulopathy (p < 0.001) or just the cases with glomerular sclerosis were considered (p = 0.011). Autopsy study of renal fragments from patients without clinical evidence of glomerular disease was additionally performed and revealed the presence of focal and segmental glomerulosclerosis in 3 cases (7.5%). We concluded that a glomerulopathy with clinicopathological features which match the definition of HIV nephropathy can be found among Brazilian patients with HIV infection. Accordingly to what has been described in American series, Brazilian Black patients seem to be at increased risk of the development of that nephropathy.     

Multifocal osteonecrosis and human immunodeficiency virus infection

Over the past decade, a causal relationship between infection with human immunodeficiency virus (HIV) and osteonecrosis has been proposed. This case report (the first example presented in the English orthopaedic literature) of multifocal (> 3 sites) osteonecrosis in a patient with HIV infection highlights the current scientific knowledge regarding incidence, predisposing risk factors, proposed biologic mechanisms, and clinical orthopaedic management. This information may become increasingly relevant for the orthopaedic clinician as more patients with HIV infection live longer.