Primary pulmonary lymphoma in a patient with the acquired immune deficiency syndrome.

A case of primary pulmonary lymphoma presenting as a nodular lesion on the chest radiograph in a patient with the acquired immune deficiency syndrome is described.     

Abdominal pain in patients with acquired immune deficiency syndrome.

The patient with acquired immune deficiency syndrome (AIDS) and abdominal pain presents the surgeon with a difficult challenge. The pain may be due to an opportunistic infection, ileus, organomegaly, or a true surgical emergency. The hospital records of 235 patients with AIDS were reviewed. Of the 29 patients with abdominal pain, 12 had infectious diarrhea, eight were diagnosed as having ileus or organomegaly, and nine had miscellaneous causes for their pain. Only five patients underwent laparotomy. Two patients were operated on for pain associated with bleeding (Meckel's diverticulum and intestinal Kaposi's sarcoma); one had a perforated duodenal ulcer and one had severe ileitis. One patient was electively operated on for Burkitt's lymphoma. Laparotomy for abdominal pain is not usually necessary in patients with AIDS. Specific recommendations for evaluation and management of these patients are offered.     

Intracerebral toxoplasmosis in patients with acquired immune deficiency syndrome

The acquired immune deficiency syndrome (AIDS) is a recently described T-cell deficiency predisposing patients to a spectrum of opportunistic infections. Kaposi's sarcoma, and other neoplasms. It appears primarily among homosexual males and intravenous drug abusers, but is now being observed in other groups as well. The authors describe six adult patients with AIDS who developed intracranial toxoplasmosis. In four patients, diagnosis was made by brain biopsy, and in one by serology. These patients received a 90-day course of therapy with sulfadiazine, pyrimethamine, or both when tolerated, and improved neurologically. In one patient, the brain biopsy was nondiagnostic and the organism was identified at autopsy. On computerized tomographic and pathological follow-up studies the organism appeared to be eradicated by therapy. Early aggressive diagnostic study and prompt institution of therapy are imperative for reversal of neurological deficits. Despite cure of toxoplasmosis, the prognosis in patients with AIDS is poor; the mortality in this series was 67%. Isolation precautions should be taken by those caring for such patients.     

Kaposi's sarcoma of the head and neck in the acquired immune deficiency syndrome

Since 1981 a new syndrome of acquired immune deficiency (AIDS) has been recognized. Male homosexuals, male and female intravenous drug abusers, and recipients of blood products (i.e., hemophiliacs) appear to be the populations at risk. The syndrome has been manifested by community-acquired opportunistic infections and/or Kaposi's sarcoma (KS). Otolaryngologic manifestations of AIDS are not infrequent. Thirteen AIDS patients at the National Institutes of Health with KS of the head and neck region are presented. All 13 patients were homosexual or bisexual males. Nine initially presented with KS, five with KS of the head or neck. As a group the patients demonstrated lesions involving the oropharyngeal, tracheobronchial, and gastrointestinal regions. Their clinical course and complications are presented in detail. The mortality rate in this subgroup of AIDS patients is extraordinarily high (62%), with an average longevity of 11 months following initial diagnosis.     

Primary cerebral lymphoma in two consortial partners afflicted with acquired immune deficiency syndrome

Two consortial partners presented within 3 weeks of one another with signs and symptoms of neurological dysfunction. Both were found to have acquired immune deficiency syndrome (AIDS) and primary cerebral lymphoma. We found 17 case reports of primary central nervous system (CNS) lymphoma in AIDS patients. Ten of these cases were described sufficiently to enable analysis. Our 2 cases are unique in that this is the first time primary CNS lymphoma has been reported in sexual partners with AIDS. One case includes the use of magnetic resonance imaging. Both patients underwent craniotomy and received radiation therapy.     

获得性免疫缺陷综合征患者骨质疏松脆性骨折研究进展

获得性免疫缺陷综合征（AIDS）在普通人群中的发病率逐渐增加,随着高效抗逆转录病毒治疗（HAART）的应用,AIDS患者的病死率逐渐降低,但骨质疏松脆性骨折的发生率显著高于健康人群。本综述主要介绍AIDS患者骨质疏松脆性骨折的发生率和危险因素等,人类免疫缺陷病毒（HIV）和HAART对成骨细胞、破骨细胞OPG/RANK/RANKL系统的作用机制和不良反应;简述AIDS患者骨质疏松脆性骨折药物预防和治疗方法。     

获得性免疫缺陷综合征患者咽喉部病变分析

目的探讨获得性免疫缺陷综合征（AIDS）患者咽喉部病变的临床特点。 方法以2009年1月至2018年10月因咽喉部疾病且局部有阳性体征就诊于首都医科大学附属北京地坛医院耳鼻喉科的82例AIDS患者为研究对象,分析其咽喉部病变的临床特点。 结果入组患者溃疡表现者33例,溃疡发生部位以散在多发为主（10例）,其次位于扁桃体（5例）,咽后壁（4例）,腭咽弓及腭舌弓（各3例）,咽侧壁及会厌（各2例）,软腭、舌根、声带及劈裂（各1例）。咽喉部表现为急慢性充血、肿胀者21例,有白色菌苔附着者13例。伴新生物表现患者共7例,其中4例患者为卡波氏肉瘤（KS）,3例患者为乳头状瘤。声带麻痹者7例,其中6例患者声音嘶哑,1例患者吞咽困难。因免疫重建致扁桃体Ⅲ度肿大者1例。入组82例患者中有79例接受了全身高效逆转录病毒治疗（HAART）或咽喉部疾病局部针对性治疗,其中69例患者行全身HAART治疗,68例行局部的针对性治疗;而3例患者全身HAART及局部针对治疗均未施治。行治疗的79例患者转归：61例治疗有效,14例治疗无效,4例死亡;3例全身及局部均未施治者均无好转。 结论AIDS患者咽喉部疾患以溃疡表现为主,溃疡病程久、症状重、易复发、不易治愈,与基础疾病相关;除溃疡性疾病外,还会出现机会性感染及肿瘤。此类疾病的治疗以改善全身免疫状态为主,局部对症治疗为辅。     

获得性免疫缺陷综合征患者脊柱亚临床骨折研究进展

随着获得性免疫缺陷综合征（AIDS）抗病毒药物治疗的广泛应用,AIDS患者寿命已接近常人,越来越多的研究表明,AIDS患者应用高效联合抗反转录病毒治疗（HAART）后不仅出现骨质疏松脆性骨折,且椎体亚临床骨折发生率亦较健康人群显著增高,HAART此项并发症的危害逐渐受到临床医生的重视。本文就AIDS患者椎体亚临床骨折的定义、临床诊断、流行病学、发生机制以及防治措施等方面的研究进展做一综述。     

Unusual urological presentations of acquired immune deficiency syndrome: large cell lymphoma

We describe 2 patients with unrecognized acquired immunodeficiency syndrome who presented with acute urological conditions. One patient had inapparent obstructive anuric renal failure and the other had a testicular mass. The etiology in each case was large cell lymphoma. Recognition of the acquired immunodeficiency syndrome by urologists requires an awareness of its many unusual presentations.     

Head and neck presentations of acquired immunodeficiency syndrome

Since December 1980, over 3000 cases of acquired immunodeficiency syndrome (AIDS) have been reported. The charts of 102 patients admitted to the New York University Medical Center with a diagnosis of AIDS were reviewed with particular emphasis on presenting signs, symptoms, and laboratory values. Symptoms tended to be nonspecific and most often resembled those of an upper respiratory infection. Over 71% of the patients presented with at least two of the following four signs: diffuse adenopathy, oral and facial lesions consistent with Kaposi's sarcoma, white oral lesions, and anergy. Laboratory findings included leukopenia, increased erythrocyte sedimentation rate, thrombocytopenia, and anemia. The in-hospital mortality rate was 26%. The current status of our knowledge concerning AIDS is reviewed and discussed. The frequency and types of presenting signs and symptoms in the head and neck are reported to alert the otolaryngologic community to this entity.     

Pulmonary Kaposi''s sarcoma in patients with acquired immune deficiency syndrome: a clinicopathological study.

Pulmonary Kaposi's sarcoma may contribute to respiratory dysfunction in patients with acquired immune deficiency syndrome (AIDS) and features of pneumonitis. Opportunistic infections are readily recognised in endoscopic material, but pulmonary Kaposi's sarcoma is easily missed, so that patients are deprived of specific treatment. The clinical and pathological findings from nine cases of pulmonary Kaposi's sarcoma have been reviewed; these were found among 84 patients with AIDS and pneumonitis undergoing fibreoptic bronchoscopy and bronchoalveolar lavage. Diagnosis was established before death in eight patients (in five by bronchial biopsy and in three by open lung biopsy). Examination of lavage fluid showed alveolar haemorrhage in six patients. It is concluded that: (1) fibreoptic bronchoscopy may be useful in the diagnosis of endobronchial lesions of Kaposi's sarcoma; (2) alveolar haemorrhage in patients with AIDS is suggestive of pulmonary Kaposi's sarcoma. Factors that may cause difficulties in diagnosis include the focal nature of some lesions and the pleural or parenchymatous location of others. In addition, in the lung as in the skin, the early stages of Kaposi's sarcoma resemble granulation tissue. Such lesions are far more difficult to recognise than is the late nodular stage.     

Otic pneumocystosis in acquired immune deficiency syndrome

AIDS-associated otic pneumocystosis is rare. Of 14 cases documented mainly as case reports up to now, only 1 has been reported in the surgical pathology literature. We report 6 males, mean age of 32.3 years, with external auditory canal masses and otorrhea. Two biopsies contained a predominance of granulation tissue with a mixed inflammatory cell infiltrate and elusive foci of foamy exudate. In contrast, 4 biopsies demonstrated conspicuous angiocentric mantles of stippled, foamy exudate. Fibrin was noted in intravascular, perivascular, and intervascular locations. One biopsy demonstrated bordering of the foamy exudate by a palisaded granulomatous reaction, with adjacent discrete giant cell-containing granulomas. Special stains confirmed trophozoites and cysts within the foamy exudate. Review of 2 initial "nondiagnostic" biopsies confirmed granulation tissue and necrotic debris in which Pneumocystis jiroveci was identified in focal foamy exudate. After the diagnosis of otic pneumocystosis, all patients were initiated on trimethoprim-sulfamethoxazole. One patient also had dapsone. Two patients succumbed to pulmonary tuberculosis and 2 were lost to follow-up. One patient with pneumocystis pneumonia did not return for follow-up after 6 weeks. One patient experienced complete resolution of the mass on medical therapy, and is disease free for 4 years. Heightened recognition of the characteristic foamy exudate in an unconventional location remains the gold standard in the timely diagnosis of this eminently treatable disease. In all patients, otic pneumocystosis served as the sentinel of underlying HIV infection and AIDS.     

Prostatic cryptococcosis in acquired immune deficiency syndrome

A rare care is presented of recurrent dysuria and urinary obstruction due to cryptococcal prostatitis in a thirty-six-year-old male with acquired immune deficiency syndrome. Although there are a handful of reports in the world literature of patients with cryptococcal prostatitis, this appears to be the first case reported related to acquired immune deficiency syndrome.     

Cytomegaloviral epididymitis in a patient with the acquired immune deficiency syndrome

We report on a patient with cytomegaloviral epididymitis and the acquired immune deficiency syndrome. The diagnosis was suggested by epididymitis that was refractory to antibiotics, and by isolation of cytomegalovirus from the urine and semen. The definitive diagnosis was made with immunohistochemical staining for cytomegaloviral antigens in the epididymal ductal cells. Because of the ineffectiveness of antimicrobial agents in this disorder, epididymectomy is the current treatment of choice.     

获得性免疫缺陷综合征合并隐球菌性脑膜炎患者的眼部护理

目的总结获得性免疫缺陷综合征（AIDS）合并隐球菌性脑膜炎患者的眼部并发症及眼部护理方法。 方法回顾性分析42例AIDS合并隐球菌性脑膜炎患者的眼部并发症,总结其护理方案。 结果19例患者（37只眼）出现视乳头水肿,6例患者（12只眼）出现视神经萎缩,2例患者（4只眼）出现脉络膜病灶,3例患者（6只眼）出现复视,1例患者单眼合并巨细胞病毒性视网膜炎（CMVR）。11例患者眼底正常。42例患者（84只眼）中17只眼视力为光感～0.1,12只眼视力为0.12～0.3,视力≤ 0.3的患眼占总数的34.5%,55只眼视力为0.4～1.0。 结论临床护理工作中应密切观察患者的颅内压、视力及眼底变化,对低视力患者加强生活技能及视力的训练,有利于控制病情,提高患者的生活质量。     

Histopathology of testis in acquired immune deficiency syndrome

Histologic sections from the testes of 32 autopsied patients with acquired immune deficiency syndrome (AIDS) were examined. Almost invariably the testes displayed decreased spermatogenesis, and 20 of the 32 cases showed marked hypospermatogenesis with Sertoli cells predominantly lining the tubules. Although the seminiferous tubules were generally of normal size, the tunica propria at the periphery of the tubules was mildly to moderately thickened in 19 cases and markedly thickened in 10. The interstitial cells of Leydig were unaltered in most patients, with only 4 testes showing Leydig cell hyperplasia. The testicular blood vessels were slightly thickened in many patients, but 5 exhibited moderate to marked intimal proliferation with narrowing of the lumen. Mononuclear inflammatory infiltration of the testicular interstitium was slight in 11 cases, moderate in 6. Only 7 of the 28 AIDS patients with opportunistic infections had evidence of direct involvement of the testes by the infectious organisms. We concluded that the extragonadal endocrine balance of AIDS patients may be deranged due to the infectious process and so deserves clinical evaluation.