The urological manifestations of the acquired immunodeficiency syndrome

Between 1984 and March 1987, 120 patients with either the acquired immunodeficiency syndrome or its related complex seen at our hospital were studied retrospectively for urological signs and/or symptoms. Autopsy findings also were reviewed. Of the patients 84 per cent had no complaints referable to the urinary system, 2 per cent had gross hematuria (all with a negative diagnostic evaluation) and 14 per cent had urinary infections. We conclude that only a small percentage of patients with the acquired immunodeficiency syndrome suffer from significant urological manifestations and that a full urological evaluation of such patients generally is not warranted. If the patient presents with gross hematuria excretory urography should be performed if there is no infectious etiology, and cytoscopy should be performed only if the hematuria is life-threatening or prolonged and possibly to confirm significant urographic findings.     

Nutrition for the patient with acquired immunodeficiency syndrome.

Patients with ARC and AIDS develop a variety of symptoms that significantly affect their nutritional status. Podiatrists, although not directly involved with the intricacies of the nutritional management of people with AIDS, should be aware of the effect of the virus on the human body. Investigators are predicting that almost 100% of the estimated 12 million HIV-positive persons in the world will develop AIDS. By giving people with AIDS nutritional education, not only may there be a beneficial response in respect to treatment but it may enhance an individual's quality of life and positive self-image.     

Pharmacologic treatment of the patient with acquired immunodeficiency syndrome.

A pharmacologic revolution has occurred over the past 10 years with regards to antiviral therapy, specifically medications directed against HIV. This plethora of new information must be disseminated effectively throughout the medical community. HIV infection and its numerous manifestations, both pedal and systemic, are challenging and often difficult to treat. The well-informed physician will have a distinct advantage with regard to the treatment of the patient with AIDS. The information presented here, although transient, represents a solid knowledge base, a starting point on which the clinician can build effectively.     

Hospital protocol for the patient with acquired immunodeficiency syndrome.

This article discusses HIV transmission, prevention, and treatment in a hospital milieu. In a review of all the literature, minimal research has been done on correlating the potency of the virus in terms of transmission with the stage of the disease in an HIV-infected patient. It seems logical that the risk of transmission will increase when the HIV patient has the full blown disease. This might reflect the statistic that 5.3% of all the health care workers infected do not have a determinable cause. Yet it has been proven that seroconversion can occur after nonparenteral exposure. This is confirmed by a recent CDC update that reported seven cases of seroconversion from mucous membrane exposure. More extensive study is needed in developing more accurate statistics on the cumulative risk of health care workers in specific fields of medicine and specific patient communities. Because all the questions on AIDS apparently are not even close to being answered, the importance of using universal precautions cannot be overstressed. Unfortunately, research and experience have shown that compliance in adopting universal precautions is remarkably poor. Training and education must begin at the medical school level with reinforcement through yearly workshops. Prevention seems to be the only hope at this time. The physician's inability to test patients for this virus has only been a deterrent in learning about this dreadful epidemic.     

Physical therapy for the patient with acquired immunodeficiency syndrome.

Treatment of HIV-infected patients has come a long way since the not-so-long-ago beginning of the AIDS epidemic. Implementation of new drug therapies has increased longevity of a patient's life after being diagnosed with the virus. Because HIV-related illnesses are consequently becoming more chronic in nature, patients commonly experience potentially debilitating CNS, PNS, or musculoskeletal problems during the course of the disease. As a result, these patients require delicate care from a number of different health care providers. A multidisciplinary team approach must be used within the podiatrist's treatment regimen. This team must include the physiatrist overseeing the physical therapist, to provide complete and optimal care to improve the patient's functional independence and quality of life. The conditions associated with HIV infection are insidious, slow, and crushing in nature. The medical community can help the patient with HIV infection and AIDS remain on his or her feet. By doing this, costs, both social and economic, can be lowered. The podiatrist must have a strong knowledge of the pathology of AIDS. He or she must use PT along with other disciplines: podiatric medicine, orthotic therapy, and general podiatric care. PT is effective in treating conditions of the lower extremities that affect the CNS, PNS, musculoskeletal system, and, lastly, rheumatologic effects of HIV infection.     

Emergency abdominal operations in the patient with acquired immunodeficiency syndrome

We have reviewed the medical records of ten patients with acquired immunodeficiency syndrome who required emergency celiotomy in a three-year period. These operations are characterized by a high morbidity and mortality. Careful attention to the support of these immunosuppressed, malnourished patients if emergency operation is necessary may improve the poor results reported herein.     

Esophageal perforation in a patient with acquired immunodeficiency syndrome

Infection with Mycobacterium tuberculosis is frequently found in patients with acquired immunodeficiency syndrome and can result in diffuse lymphadenopathy from disseminated disease. A case is presented of esophageal erosion and perforation secondary to mediastinal lymph node enlargement from Mycobacterium tuberculosis in a patient positive for human immunodeficiency virus. Emergent surgical intervention required resection of the perforated esophagus, end-cervical esophagostomy, gastrostomy, and feeding jejunostomy. Long-term prognosis is poor owing to acquired immunodeficiency syndrome, therefore, reconstruction at a later date is uncertain.     

Cerebral toxoplasmosis in a patient with acquired immunodeficiency syndrome

Patients suffering from acquired immunodeficiency syndrome (AIDS) are being encountered more and more frequently. Because of their immunosuppressed state, they often present with opportunistic infections of the cerebrum. Herein, the case of a patient with AIDS who had cerebral toxoplasmosis is reported. Although the computed tomographic features are nonspecific for cerebral toxoplasmosis, they are interesting because of the considerable variation in type of enhancement and extent of lesions revealed by injection of contrast medium.     

Surgical management of pneumothorax in patients with acquired immunodeficiency syndrome

Pneumocystis carinii pneumonia in a patient with acquired immunodeficiency syndrome may cause severe alveolar damage, resulting in pneumothoraces that are often bilateral, recurrent, and refractory to accepted methods of treatment. The clinical features, management, and follow-up results were assessed in 22 consecutive patients who presented with a pneumothorax and acquired immunodeficiency syndrome. Seventeen patients died within the time frame of this study. Their average survival time was 147 days. Five surviving patients have lived an average of 366 days. We proposed an algorithm to assist in the management of pneumothoraces in these patients. We concluded that pneumothorax in patients with acquired immunodeficiency syndrome is prognostic of short-term survival. The results in the treatment of pneumothorax in the patient with acquired immunodeficiency syndrome are related to the pathologic lesions of the lung that are associated with Pneumocystis pneumonia and not to the surgical treatment that is employed.     

Sulfadiazine-associated obstructive nephropathy occurring in a patient with the acquired immunodeficiency syndrome

A 45-year-old man with the Acquired Immunodeficiency Syndrome (AIDS) and CNS toxoplasmosis presented with acute renal failure, hematuria, and renal colic shortly after starting treatment with sulfadiazine. Ultrasound examination of his kidneys was suggestive of intraparenchymal crystallization of sulfadiazine. His renal failure and ultrasound findings rapidly resolved with alkaline hydration. On rechallenge with sulfadiazine, he again developed renal insufficiency and ultrasonic findings consistent with stones. The use of sulfadiazine in the treatment of CNS toxoplasmosis in AIDS patients should be monitored carefully with the recognition that this form of crystalline-induced acute renal failure can occur in a dehydrated patient.     

Death, dying, and the patient with acquired immunodeficiency syndrome.

This article has attempted to provide some insight into the subject of death, dying, and the patient with AIDS. Even though the thought of death and dying is common, it is a topic that at most times is left unspoken. This is especially true in relationship to an illness that, among many, is considered taboo. This article has presented the known psychological stages travelled by a terminally ill patient, with special emphasis on the unique problems suffered by the patient with AIDS, who is often alone and afraid. Only with the support and kindness of others will this lone individual be able to live out his life to its fullest, up to his dying day.     

Miliary pulmonary cryptococcosis in a patient with the acquired immunodeficiency syndrome.

A 33 year old man with AIDS presented with fever, dyspnoea, cough and a miliary pattern on the chest radiograph. Cryptococcus neoformans infection was diagnosed from bronchoalveolar lavage bronchoscopy. This case supports the principle that, in patients with AIDS, pulmonary infections can exhibit variable radiographic features and that definitive diagnosis should always be considered.     

The lymphoid lesions associated with the acquired immunodeficiency syndrome

In the present epidemic of opportunistic infections affecting homosexual men, systemic, persistent, unexplained lymphadenopathies have frequently accompanied and often preceded other manifestations of the acquired immunodeficiency syndrome (AIDS). Studies of the lymphadenopathies associated with AIDS have not yet been published, and the lymph node lesions have been generally considered to represent reactive lymphoid hyperplasia. The present study concerns the lymph node biopsies of 36 homosexual males with systemic, persistent lymphadenopathy. The lesions were essentially uniform and consisted of focal hemorrhages, extreme hyperplasia of germinal centers, extensive cellular destruction, accumulation of neutrophils, phagocytosis of nuclear debris, proliferation of blood vessels, immunoblasts, and peculiar aggregates of clear cells. These lesions diagnosed as acute lymphadenitis accompanied diseases indicative of AIDS in six cases and preceded them by months in three cases. In two cases, the lymphadenitis was associated with Kaposi's sarcoma of lymph node and in two cases with non-Hodgkin's lymphomas. It is suggested that the systemic, persistent lymphadenitis of homosexual males is induced by a microorganism, probably a virus. The lymphotropic activity of such an agent may include the destruction of a certain class of lymphocytes leading to the induction of the acquired immunodeficiency syndrome. Under special, unknown circumstances, the uncontrolled lymph node hyperplasia may progress to the development of lymphoma.     

Surgical management of spontaneous pneumothorax in patients with acquired immunodeficiency syndrome

Spontaneous pneumothorax has been reported with increasing frequency in patients with acquired immunodeficiency syndrome and Pneumocystis carinii pneumonia. In the past year, we treated 4 patients with spontaneous pneumothorax. All of them were treated with closed tube thoracostomy, and 1 patient with bilateral apical cysts eventually required bilateral thoracotomies and pleurectomies. Only 1 patient had an uncomplicated hospital course. The remaining patients had prolonged air leaks, and 2 had synchronous pneumothoraces. Pneumothorax appears to be associated with P. carinii pneumonia. We recommend closed tube thoracostomy as the initial treatment in symptomatic patients. Pleurectomy for air leaks persisting longer than seven days can be safely performed in patients fit for thoractomy.     

Granulomatous Pneumocystis carinii pneumonia in a patient with the acquired immunodeficiency syndrome.

A patient with an unusual granulomatous response to infection with Pneumocystis carinii is described. The diagnosis was made by open lung biopsy after two negative bronchoalveolar lavages.