Human immunodeficiency virus infection in children.

The incidence of Acquired Immune Deficiency Syndrome (AIDS) in the pediatric population is increasing. Estimates are that in 1993 AIDS will be among the five leading causes of death in children. AIDS progresses more rapidly in children than in adults. It also has features that are unique to children, such as recurrent bacterial infections, bronchus-associated lymphoid tissue (BALT), and basal ganglia calcification. This review is written with emphasis on aspects of AIDS unique to children. Features of AIDS that are similar in adults are not discussed.     

Usual and unusual radiologic manifestations of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) infection in children

AIDS is being recognized with ever-increasing frequency in children. This article includes a discussion of the common radiographic manifestations of AIDS as well as some rarely encountered problems. It is hoped that with heightened awareness of this spectrum of radiographic findings, radiologists may contribute to a prompt diagnosis of AIDS so that appropriate short-term therapy and counseling may be instituted.     

Human immunodeficiency virus and the emergency setting: Legal considerations

The emergence of human immunodeficiency virus (HIV) has changed the atmosphere surrounding the provision of emergency medical treatment. HIV-positive patients fear denial of needed health services based on their seropositivity, whereas medical providers worry about occupational exposure. Both patients and providers have concerns regarding HIV testing and the confidentiality of test results. This article summarizes some of the many legal implications created by HIV in the emergency setting.     

骨肌系统淀粉样变性的MRI表现

淀粉样变性（AM）是由多种疾病引起的一组临床症候群,多见于肾衰而行透析治疗的病人或浆细胞骨髓瘤病人。该病是由于淀粉样物质沉积于器官或组织的细胞外间隙所引起。AM累及骨肌系统较为少见,病变的MRI表现不典型,容易误诊。就AM的概念、分类及其在骨关节及肌肉的MRI特点及鉴别诊断予以综述。     

Human immunodeficiency virus arteriopathy of the adult cerebral circulation

Arteriopathy associated with human immunodeficiency virus infection and clinical acquired immunodeficiency syndrome is well-documented. The pathophysiology of this arteriopathy may vary in different vascular beds. Although arteriopathy of central nervous system (CNS) circulation has been recognized in pediatric patients since the late 1980s, there are no reported cases of CNS arteriopathy in adults. We present the first reported case of adult CNS arteriopathy in a human immunodeficiency virus-positive patient who succumbed to complications secondary to diffuse aneurysmal disease of the Circle of Willis.     

Acquired immunodeficiency syndrome: cerebral computed tomographic manifestations

CT examination of the central nervous system was performed in 19 patients with acquired immunodeficiency syndrome (AIDS). Eighteen patients were homosexuals, and five drug abusers. Parenchymal and meningeal inflammations were seen in patients with intracranial manifestations of the disease. The most common demonstrable lesion in the parenchyma was toxoplasmosis, which produced ring enhancement, solid enhancement, and nonenhancing focal edema. The most common meningeal inflammation was cryptococcosis, which was diagnosed by examination of the cerebrospinal fluid and did not show specific CT changes. It is concluded that toxoplasmosis and cryptococcosis should be the first diagnostic consideration in patients with neurologic findings who have a history of homosexuality and/or intravenous drug abuse and previous unusual infections or anergy. A delayed contrast scan, single or double dose, appears to be the most accurate method of outlining the total extent of disease thereby helping to locate the best biopsy site for pretreatment diagnosis. Empirical institution of toxoplasmosis therapy is recommended in those cases in which CT findings are consistent with toxoplasmosis and the biopsy shows only nonspecific encephalitis. A biopsy of every parenchymal lesion is not considered necessary.     

Encephalitis caused by human immunodeficiency virus: CT and MR imaging manifestations with clinical and pathologic correlation

To determine the computed tomographic (CT) and magnetic resonance (MR) imaging manifestations of central nervous system (CNS) infection by the human immunodeficiency virus (HIV), the authors analyzed the results of imaging of the CNS in 24 patients with HIV encephalitis confirmed at autopsy. Careful pathologic correlation demonstrated that neither CT nor MR imaging enabled detection of microglial nodules with multinucleated giant cells, the hallmark of HIV encephalitis seen in all 24 affected patients. The most common abnormality observed on images of the CNS was atrophy, demonstrated in 18 patients. Demyelination and vacuolation of white matter tracts accompanying severe HIV infection caused hypoattenuation on CT scans and hyperintensity on T2-weighted MR images. These lesions had no mass effect. MR imaging was more sensitive than CT in the detection of lesions caused by HIV or other superimposed infectious agents. Although it is often difficult to attribute any radiologic appearance to a single etiologic agent in patients with acquired immunodeficiency syndrome, the combination of atrophy and symmetric, periventricular or diffuse white matter disease suggests HIV encephalitis.     

CT manifestations of respiratory syncytial virus infection in lung transplant recipients

PURPOSE: The purpose of our study was to evaluate CT findings during respiratory syncytial virus (RSV) infection in lung transplant recipients and to identify sequelae. METHOD: Thirty-nine CT scans prior to, during, and following acute infection in 10 lung transplant recipients were reviewed. Abnormalities that were new from baseline observations and occurred within 4 weeks of diagnosis were defined as acute. Chronic findings were defined as those present >4 weeks after diagnosis. RESULTS: Findings in nine patients were ground-glass (seven), air-space (five), and tree-in-bud (four) opacities and acute bronchial dilatation (four) and wall thickening (four). Patients lacked pleural effusions or lymph node enlargement. Five of seven patients with follow-up exams had new air trapping (three), persistent bronchial dilatation (three), and thickening (two). Three and 2 of the 10 patients developed bronchiolitis obliterans syndrome and obliterative bronchiolitis, respectively. CONCLUSION: During acute infection, patients commonly had ground-glass opacities but lacked pleural effusions and lymph node enlargement. There can be chronic sequelae after infection.     

艾滋病合并鸟-胞内分枝杆菌感染的胸部影像表现

目的 探讨艾滋病(AIDS)合并鸟-胞内分枝杆菌(MAC)感染的胸部影像表现及特征.方法 回顾性分析非结核分枝杆菌培养阳性,经菌种鉴定为MAC的AIDS患者31例,其影像表现及临床资料.31例患者中30例行胸部CT及X线检查,1例仅行胸部X线检查.结果 31例AIDS合并MAC感染患者中,3例肺部未见病变,28例为MAC肺部感染.AIDS合并MAC肺部感染的影像表现类似肺结核改变,常见的CT征象有斑片影21例,其中大片实变3例;支气管扩张18例,结节18例,双肺弥漫粟粒10例,空洞10例,胸腔积液10例,纵隔淋巴结肿大15例,以中度肿大为主,7例肺门淋巴结大,双肺门多见.结论 AIDS合并MAC感染的胸部影像表现多样、不典型,以斑片影、小结节及支气管扩张多见.     

Noninvasive coronary imaging for atherosclerosis in human immunodeficiency virus infection

Coronary artery disease is increasingly recognized as an important contributor to morbidity and mortality among persons living with human immunodeficiency virus (HIV) infection. Traditional cardiovascular disease risk factors as well as aspects of HIV infection and its therapy contribute to the increased coronary artery disease observed in HIV. Advances in noninvasive imaging methodologies in both computed tomography and magnetic resonance imaging provide opportunities to evaluate coronary artery atherosclerosis in ways not possible by conventional invasive x-ray angiography. Application of these techniques may prove very useful in the study of atherosclerosis in many diseases, such as HIV.     

Radionuclide imaging of musculoskeletal infection: conventional agents

The diagnosis of musculoskeletal infection can be clinically challenging, and radionuclide imaging is often performed as part of the diagnostic workup. Conventional studies include bone scan, gallium imaging, and labeled leukocyte imaging. No single test is equally efficacious in all situations, and thus the procedure(s) performed should be optimized for the individual patient. Three-phase bone imaging, readily available and relatively inexpensive, is very accurate in unviolated bone. In the setting of underlying osseous abnormalities, however, the specificity of the test decreases. Four-phase bone, sequential bone/gallium, and labeled leukocyte imaging all have been used in an effort to enhance specificity. Labeled leukocyte imaging is the radionuclide procedure of choice for diagnosing so-called complicating osteomyelitis such as infected joint prostheses, diabetic pedal osteomyelitis, and infection of the neuropathic joint. To maximize the accuracy of the study, complementary bone marrow imaging often must be performed. Labeled leukocyte imaging is of limited value in spinal osteomyelitis, however, because this entity often presents as a nonspecific photopenic defect on white cell studies. The conventional radionuclide study for evaluating spinal osteomyelitis is gallium imaging, which should be performed regardless of the findings on a contemporaneous bone scan. The reasons for this are as follows: Gallium improves the specificity of the bone scan; gallium detects accompanying soft tissue infection, whereas the bone scan does not, and gallium may be more sensitive than the bone scan in elderly patients.     

Human immunodeficiency virus/acquired immunodeficiency syndrome knowledge and risk factors in Ethiopian military personnel

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS)-related knowledge and behaviors were assessed in face-to-face structured interviews with 314 Ethiopian military personnel. A significant finding of this research was the association between HIV/AIDS knowledge and risky sexual behavior. That is, military personnel who had inaccurate knowledge about HIV/AIDS transmission and prevention were 3.4 times as likely to engage in combined sexual risk behaviors compared with personnel with accurate knowledge, after controlling for age, military rank, and marital status (odds ratio, 3.4; 95% confidence interval, 1.86-6.22). This finding highlights the potential value of educational programs in slowing the spread of HIV/AIDS in sub-Saharan Africa.     

Medical confidentiality and human immunodeficiency virus (HIV) infection: a hypothetical case

This paper describes a hypothetical case of a HIV positive pilot. It explores legal and ethical aspects of medical confidentiality and discusses who, inside and outside military and medical circles, can be told of his condition in the light of the particular circumstances. Disclosure without the patient's consent is a serious step that should not be undertaken without advice from Service medico-legal departments and medical protection organisations.