Acute myelopathy associated with primary infection with human immunodeficiency virus

A 29 year old white homosexual man presented with a two and a half week history of severe sore throat, fever, and extreme fatigue. His symptoms did not respond to antibiotics. He had mild bilateral conjunctivitis, a rash over his chest and back, and enlarged lymph nodes, but examination of the nervous system yielded normal results. He had low total white cell and platelet counts. The results of enzyme linked immunosorbent assay for human immunodeficiency virus (HIV) were equivocal when HIV IgM was detected in serum. Despite treatment with ampicillin his temperature remained high and he developed abnormal neurological signs, including a paraparesis and hyperreflexia of the arms. HIV was isolated from lymphocytes from blood and cerebrospinal fluid. Over the next six weeks the patient improved and was discharged. Two months later abnormal neurological signs persisted in his legs. Although various neurological syndromes associated with seroconversion to HIV have been described, this is probably the first report of a patient with myelopathy at the time of seroconversion.     

US-guided percutaneous biopsy: use of a screw biopsy stylet to aid needle detection

Insertion of a screw biopsy stylet into a thin-walled biopsy needle greatly enhances detection of the needle during ultrasound-guided percutaneous biopsy. This technique is helpful when precise needle-tip localization is needed for biopsies of small lesions.     

Decompression sickness affecting the temporomandibular joint

Two cases of pain-only decompression sickness of the temporomandibular joint following altitude chamber exposure are presented. A detailed interview of both individuals revealed no other joint involvement or other complaints. A careful neurologic examination failed to disclose abnormalities. In both cases, the pain resolved completely with compression therapy, supporting the diagnosis of decompression sickness. Decompression sickness limited to this small joint is extremely rare, and may be easily confused with other causes of joint pain.     

Pulmonary cystic disease: comparison of Pneumocystis carinii pneumatoceles and bullous emphysema due to intravenous drug abuse

A rare pulmonary manifestation of the acquired immunodeficiency syndrome or intravenous (IV) drug abuse is upper lobe cystic disease--pneumatoceles in Pneumocystis carinii pneumonia (PCP) and bullous emphysema in IV drug abuse. Because these disorders overlap, the radiographic findings in 56 patients were compared. During a 12-month period, 16 patients less than 40 years of age were found to have bullous emphysema; the 10 who were IV drug abusers constituted group 1. In the same time period, 40 patients with PCP were encountered; the eight (20%) who had or developed pneumatoceles constituted group 2. In both groups, the conventional radiographic manifestations of upper lobe cystic disease were similar. Eight patients underwent computed tomography of the chest. In five patients with bullous disease, the distribution of the bullous lesions was peripheral, with sparing of the central portions of the lungs. In contrast, PCP pneumatoceles in three patients were dispersed throughout the lung parenchyma.     

The effect of delay on treatment outcome in altitude-induced decompression sickness

Records at the USAF School of Aerospace Medicine, Hyperbaric Medicine Division, were reviewed to determine whether a relationship exists between the length of time from development of symptoms of altitude chamber decompression sickness (DCS) to start of compression therapy and the outcome of treatment. During the 5-year period from 1 January 1984 to 31 December 1988, 233 cases of altitude chamber DCS were treated in USAF hyperbaric chambers. Information obtained from each record included age, sex, time from exposure to symptom onset, time from symptom onset to start of compression therapy, time required for resolution of symptoms, and number of treatment failures (failure to resolve during the first treatment dive or recurrence of symptoms after the first dive). Analysis of the data obtained from treatment records reveals a direct relationship between length of delay to treatment with compression therapy and outcome of treatment. Patients successfully treated with a single treatment dive had an average delay to treatment of 10.6 h. Patients that failed treatment after one dive (failed to resolve or recurred) had an average delay to treatment of 18.2 h. The difference between these groups is significant (p less than 0.05). Outcome of treatment was not significantly related to patient age, sex, or type of symptoms. A discussion of factors causing delays in treatment of decompression sickness is included.