Pulmonary manifestations of AIDS: review of 106 episodes

We reviewed the clinical records and chest radiographs of all patients admitted to our institution between 1982 and 1984 who had pulmonary disease and who were later proved to have acquired immunodeficiency syndrome (AIDS) (95 patients). Diffuse parenchymal lung disease was the most common finding. These infiltrates were usually interstitial and caused by Pneumocystis carinii pneumonia or P. carinii combined with cytomegalovirus infection. Focal, multilobar, interstitial infiltrates were also often seen and usually caused by P. carinii or P. carinii and cytomegalovirus infections. Rarely, well-defined, multiple, interstitial nodules less than 10 mm in diameter were the only or predominant characteristic and were seen only in association with Mycobacterium tuberculosis or Cryptococcus neoformans infections or Kaposi sarcoma. Hilar or mediastinal adenopathy occurred in 17 of the 21 patients with M. tuberculosis or C. neoformans infections. In contrast, only 4% of patients with P. carinii infections presented with these findings. We also found that hilar or mediastinal adenopathy was not significantly associated with peripheral adenopathy. Lung cavitation, pleural effusion, or a normal chest radiograph was uncommon.     

Precise intraoperative location of gastrointestinal bleeding with a hand-held counter. Work in progress

The nuclear medicine bleeding scan is frequently insufficient to locate sites of bleeding precisely, in spite of its great sensitivity. A small, hand-held Geiger-Müller counter, placed directly on exposed intestine in the operating room, enables precise location of the probable bleeding site. In three patients, the technique allowed a minimal amount of intestine to be resected, distinguished between large- and small-intestinal hemorrhage, and eliminated other foci as sites of bleeding.     

Intraoperative localisation and management of coronary artery fistula using transesophageal echocardiography.

Coronary artery fistula is a rare congenital malformation that can be complicated by intracardiac shunts, endocarditis, myocardial infarction, coronary aneurysm and sudden death. Clinical symptomatology depends upon the underlying anatomy and the size of the fistulous connection between the left or right side of the heart. We report the successful management of a giant right coronary artery with fistulization into the right atrium. Intraoperative transesophageal echocardiography with colour flow Doppler was used for precise location of the fistulous communication, selective demonstration of vessels feeding the fistula and documentation of abolition of fistulous flow all without the need for cardiopulmonary bypass. Furthermore the effect of shunt occlusion on regional wall motion was documented which facilitated the successful ligation of the fistula.     

Chest trauma in children.

OBJECTIVES: Chest trauma in childhood is uncommon in clinical practice. The management and treatment principles of children with thoracic trauma were discussed with the data reported in the literature. METHODS: Of the chest injury diagnosed in 1653 patients, 225 were children in the last 17-year period. There were 199 boys (88.44%) and 26 girls (11.55%). The most common causes were blunt injuries in 135 cases (60%), stab wounds in 67 cases (29.77%) and gunshot wounds in 22 cases (9.77%). RESULTS: Out of 225, 217 patients were treated conservatively and eight patients were treated surgically. There was no mortality and morbidity. CONCLUSIONS: The prevalence of chest trauma in children due to blunt injuries is high in Turkey. Extremity injury is thought to be the most commonly associated extra-thoracic injury. However, thoracic trauma in children can be managed conservatively in most of the cases.     

Anti-Sc1 in pregnancy

Anti-Sc1 was detected in a gravida-2 patient at 12 weeks' gestation. At 29 weeks, the antibody was found to be of the IgG3 subclass with a titer of 16, score 36, by the indirect antiglobulin test, and it produced 7 percent lysis by antibody-dependent cellular cytotoxicity (ADCC) assay, a finding that suggested an unaffected fetus. The titer remained constant throughout the pregnancy, as did the IgG subclass and activity in the ADCC assay. At delivery of the full-term infant, the cord hemoglobin was 13.5 g per dL and the direct antiglobulin test was positive (3+) with anti-IgG. The infant did not require transfusion. A sample taken 9 weeks after delivery showed 44 percent lysis in the ADCC assay. The anti-Sc1 titer was 32, score 65.     

Comparison between pulmonary and hepatopulmonary hydatidosis.

OBJECTIVES: To compare the clinical features and the surgical approaches between single pulmonary (SPH) and hepatopulmonary hydatidosis (HPH). METHODS: The hospital and follow-up records of 141 patients who had undergone surgery for pulmonary hydatidosis in our clinic between January 1991 and January 2001 were reviewed. Forty-nine patients (34.8%) had concomitant liver cysts in addition to the pulmonary cysts and they were regarded as HPH (Group I). The remaining 92 (65.2%) patients had SPH (Group II). Both groups were compared according to their clinical, radiological and surgical features. RESULTS: Seventeen (34.7%) male and 32 (65.3%) female patients had HPH. The mean age of the patients with HPH was significantly higher than the age of those with SPH (P<0.05) and the frequency of hepatopulmonary localization, which is contrary to single pulmonary cyst, was significantly higher in females (P<0.05). The majority (67.3%) of the cysts located in the liver were solitary. Multiple pulmonary cysts were in higher ratio in Group II, compared to Group I (45.7 vs. 22.8%) and bilateral pulmonary cyst ratio was higher in Group II, as well (26.5 vs. 13%) (P<0.05). In 14 patients (28.6%), the concomitant cysts localized in the dome of liver were extirpated via right thoracophrenotomy, and in one of them sternophrenotomy was performed. There was no statistically significant difference associated with the postoperative complications and hospital stay between groups. No recurrence and mortality were recorded in Group II. CONCLUSIONS: Multi-organ localizations (especially liver) should be examined in all patients with pulmonary hydatid cysts. HPH is more frequent in female patients over 40 years of age. The pulmonary cysts in HPH show a tendency to be bilateral and multiple. HPH should be regarded as a different entity since it can cause either economic or labour loss due to the multi-operations and prolonged postoperative care. The operative strategy and approach should be different in hepatopulmonary cysts especially if they locate in the right or bilateral lung. One-session operation with the improvements of its techniques and methods should be considered in selected cases.     

Anti-desmoglein 1 antibodies in healthy related and unrelated subjects and patients with pemphigus foliaceus in endemic and non-endemic areas from Tunisia

Background  Pemphigus foliaceus is an autoimmune blistering skin disease characterized by the production of pathogenic IgG autoantibodies directed against desmoglein 1.
Aim  To determine the prevalence of anti-desmoglein 1 antibodies in healthy subjects and their distribution in the different regions of Tunisia and to better identify endemic areas of pemphigus foliaceus.
Methods  We tested, by enzyme-linked immunoserbent assay, sera of 270 normal subjects recruited from different Tunisian areas and 203 related healthy relatives to 90 Tunisian pemphigus foliaceus patients.
Results  Seventy-six patients (84.4%), 20 healthy controls (7.4%), and 32 relatives (15.76%) had anti-desmoglein 1 antibodies. In southern regions where pemphigus foliaceus is associated with a significant sex ratio imbalance (9 female : 1 male in the south vs. 2.3 : 1 in the north) and a lower mean age of disease onset (33.5 in the south vs. 45 years in the north), a higher prevalence of anti-desmoglein 1 antibodies in healthy controls was observed (9.23% vs. 5.71% in the north). Interestingly, the highest prevalence of anti-desmoglein 1 antibodies in healthy relatives (up to 22%) was observed in the most rural southern localities. More than half anti-desmoglein 1–positive healthy controls were living in rural conditions with farming as occupation, which suggests that this activity may expose the subjects to particular environmental conditions.
Conclusion  These results show that the endemic features of Tunisian pemphigus foliaceus are focused in these southern areas more than in other areas and that both environmental and genetic factors contribute to the disease.

Conflicts of interest

None declared.     

Mesoatrial shunts for Budd-Chiari syndrome and inferior vena cava thrombosis: angiographic and hemodynamic evaluations

When inferior vena caval obstruction complicates the Budd-Chiari syndrome, conventional portosystemic shunts are not possible. The mesoatrial shunt has been devised to enable portal and sinusoidal decompression in these patients. Findings in 12 patients with Budd-Chiari syndrome and inferior vena caval obstruction in whom a mesoatrial shunt was performed are reported. Preoperative inferior vena cavography with pressure measurements is essential to determine the appropriate shunt procedure. Postoperatively, shunt patency is assessed with superior mesenteric arterial portography. Where possible, transvenous catheterization of the shunt is performed to confirm patency and assess hemodynamic function.     

Influence of Gypsum Waste Utilization on Properties and Leachability of Fired Clay Brick

Wastewater treatment activities in the chemical industry have generated abundant gypsum waste, classified as scheduled waste (SW205) under the Environmental Quality Regulations 2005. The waste needs to be disposed into a secure landfill due to the high heavy metals content which is becoming a threat to the environment. Hence, an alternative disposal method was evaluated by recycling the waste into fired clay brick. The brick samples were incorporated with different percentages of gypsum waste (0% as control, 10, 20, 30, 40 and 50%) and were fired at 1050 °C using 1 °C per minute heating rate. Shrinkage, dry density, initial rate of suction (IRS) and compressive strength tests were conducted to determine the physical and mechanical properties of the brick, while the synthetic precipitation leaching procedure (SPLP) was performed to scrutinize the leachability of heavy metals from the crushed brick samples. The results showed that the properties would decrease through the incorporation of gypsum waste and indicated the best result at 10% of waste utilization with 47.5% of shrinkage, 1.37% of dry density, 22.87% of IRS and 28.3% of compressive strength. In addition, the leachability test highlighted that the concentrations of Fe and Al was significantly reduced up to 100% from 4884 to 3.13 ppm (Fe) and from 16,134 to 0.81 ppm (Al), respectively. The heavy metals content in the bricks were oxidized during the firing process, which signified the successful remediation of heavy metals in the samples. Based on the permissible incorporation of gypsum waste into fired clay brick, this study promised a more green disposing method for gypsum waste, and insight as a potential towards achieving a sustainable end product.