RESUMO
AIM: To evaluate the role of kidney echogenicity and morphology in the diagnosis of human immunodeficiency virus-associated nephropathy (HIVAN). SUBJECTS AND METHODS: In the cross-sectional study, a sample of 340 anti-retroviral therapy (ART)-naïve AIDS patients underwent laboratory CD4+ count, serum creatinine determination and sonographic renal echogenicity grading and size measurement. Rounded kidneys were described as bulbous while bean-shaped kidneys were described as reniform; echogenicity was categorized into grades 0, 1, 2 and 3. Kidney length, width, thickness and volume were measured in HIVAN and control groups. RESULTS: Mean age of the population was 42.7 ± 9.4 years; 87.4% had HIVAN. Mean CD4+ count, serum creatinine and GFR for HIVAN patients were 153.1 ± 103.2 cells/mm3, 218.4 ± 147.4 mmol/L and 50.1 ± 23.6 mL/min/1.73 m2 for males and 121.9 ± 91.0 cells/mm3, and 222.0 ± 150.4 mmol/L and 39.3 ± 20.6 mL/min/1.73 m2 for females, respectively; control subjects and non-HIVAN patients had grade 0 renal echogenicity; 56.9% of HIVAN patients had echogenicity grade 3; 5.3% had kidney length < 10 cm; 73.9% had bulbous kidneys; the kidney was significantly wider and thicker in HIVAN (p < 0.05). CONCLUSION: Sonographic evaluation of renal echogenicity and morphology can reliably predict HIVAN diagnosis. Apathy to screening and late presentation were high while HIV/AIDS remains an important public health problem in the city of Lagos. Unilateral reduction in kidney size could be a major sequela of AIDS while sonographic measurement of absolute kidney length appears inadequate in the evaluation of AIDS patients with nephropathy.
Assuntos
Soropositividade para HIV/diagnóstico por imagem , Rim/diagnóstico por imagem , Ultrassonografia , Nefropatia Associada a AIDS/sangue , Nefropatia Associada a AIDS/complicações , Nefropatia Associada a AIDS/diagnóstico por imagem , Adulto , Idoso , Contagem de Linfócito CD4 , Creatinina/sangue , Estudos Transversais , Feminino , Soropositividade para HIV/sangue , Soropositividade para HIV/complicações , Hospitais de Ensino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Tamanho do Órgão , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto JovemRESUMO
OBJECTIVES: Low testosterone (T) is associated with cardiovascular disease (CVD) and increased mortality in the general population; however, the impact of T on subclinical CVD in HIV disease is unknown. This study examined the relationships among free testosterone (FT), subclinical CVD, and HIV disease. METHODS: This was a cross-sectional analysis in 322 HIV-uninfected and 534 HIV-infected men in the Multicenter AIDS Cohort Study. Main outcomes were coronary artery calcification presence, defined as a coronary artery calcium (CAC) score >10 (CAC score was the geometric mean of the Agatston scores of two computed tomography replicates), and far wall common carotid intima-media thickness (IMT)/carotid lesion presence by B-mode ultrasound. RESULTS: Compared with the HIV-uninfected men in our sample, HIV-infected men were younger, with lower body mass index (BMI) and more often Black. HIV-infected men had lower FT (age-adjusted FT 88.7 ng/dL vs. 101.7 ng/dL in HIV-uninfected men; P=0.0004); however, FT was not associated with CAC, log carotid IMT, or the presence of carotid lesions. HIV status was not associated with CAC presence or log carotid IMT, but was associated with carotid lesion presence (adjusted odds ratio 1.69; 95% confidence interval 1.06, 2.71) in HIV-infected men compared with HIV-uninfected men. CONCLUSIONS: Compared with HIV-uninfected men, HIV-infected men had lower FT, as well as more prevalent carotid lesions. In both groups, FT was not associated with CAC presence, log carotid IMT, or carotid lesion presence, suggesting that FT does not influence subclinical CVD in this population of men with and at risk for HIV infection.
Assuntos
Calcinose/sangue , Doença da Artéria Coronariana/sangue , Soropositividade para HIV/sangue , Testosterona/sangue , Adulto , Índice de Massa Corporal , Espessura Intima-Media Carotídea , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etiologia , Estudos Transversais , Soropositividade para HIV/complicações , Soropositividade para HIV/diagnóstico por imagem , Homossexualidade Masculina , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Fatores de Risco , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND/OBJECTIVE: Patients with neurogenic bladder secondary to spinal cord injury who are managed long term with an indwelling catheter are known to be at increased risk for transitional cell carcinoma of the bladder. Immunosuppression is a known risk factor for malignancies that often are more aggresSive than those seen in normal populations. METHOD: Case report and discussion of management recommendations. RESULTS: We summarize the case of a 44-year-old HIV-positive C5-C6 incomplete tetraplegic male (date of injury 1980), who was diagnosed with transitional cell carcinoma of the bladder and succumbed to disease within 6 months of diagnosis. The patient was a non-smoker who was never managed with an indwelling catheter. There has been no such case reported in the literature. CONCLUSIONS: HIV infection in the presence of a neurogenic bladder may carry an increased risk of aggressive bladder malignancy. More studies are warranted to determine whether routine annual screening with cystoscopy in all patients with HIV and neurogenic bladder is indicated.
Assuntos
Carcinoma/complicações , Soropositividade para HIV/complicações , Quadriplegia/etiologia , Neoplasias da Bexiga Urinária/complicações , Bexiga Urinaria Neurogênica/etiologia , Adulto , Carcinoma/diagnóstico por imagem , Soropositividade para HIV/diagnóstico por imagem , Humanos , Masculino , Quadriplegia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Bexiga Urinaria Neurogênica/diagnóstico por imagemRESUMO
BACKGROUND: Factors of cell-mediated immunity and allergy together play their roles in the pathogenesis of pulmonary tuberculosis (PTB) and its prognosis. The purpose of this study was to investigate the computed tomographic demonstrations of HIV seropositive PTB and the relationship between its pathogenesis and CD4(+) T-lymphocyte count. METHODS: The documented CT images of a total of 44 patients with HIV seropositive PTB, definitely diagnosed by etiological or pathological examinations, their clinical data and their CD4(+) T-lymphocyte count were retrospectively reviewed. RESULTS: There were 15 cases of miliary tuberculosis, accounting for 34.1% of the total cases; 15 cases of nodular tuberculosis, 34.1%; 6 cases of ground-glass opacity, 13.6%; 5 cases of cord-liked fiber shadows, 11.4%; 16 cases of flaky and flocculating shadows, 36.4%; 5 cases of cavitation, 11.4%; 5 cases of tumor shadows, 11.4%; 2 cases of pleural thickening, 4.5% and 11 cases of pleural effusion, 25.0%; 1 case of calcification, 2.3%; 16 cases of lymphadenectasis, 36.4%. The foci were located around the pulmonary hilum, anterior segment of superior lobe, basal segment of inferior lobe, medial lobe and lingual lobe. CD4(+) T-lymphocyte count was closely related to the imaging demonstrations of HIV seropositive PTB. CONCLUSIONS: CT scanning can demonstrate various signs of PTB. CD4(+) T-lymphocyte level determines the variety of imaging demonstrations of HIV seropositive PTB and its prognosis.
Assuntos
Contagem de Linfócito CD4 , Soropositividade para HIV/diagnóstico por imagem , Soropositividade para HIV/imunologia , Tuberculose Pulmonar/diagnóstico por imagem , Tuberculose Pulmonar/imunologia , Adolescente , Adulto , Idoso , Linfócitos T CD4-Positivos/imunologia , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Derrame Pleural , Radiografia , Adulto JovemRESUMO
Diagnosis of a high-grade sarcoma on fine needle aspiration cytology (FNAC) may not pose any difficulty; however, further sub-typing is sometimes difficult. The clinical data, investigations, and finer points on cytomorphology may help for proper categorization of the tumor, however, we encountered a case of orbital sarcoma in an Human Immunodeficiency Virus (HIV) positive patient, in which further sub-typing was difficult even on histopathology and immunohistochemistry was helpful. The diagnostic difficulties on FNA cytology smears as well as histopathology are highlighted.
Assuntos
Soropositividade para HIV/complicações , Neoplasias Orbitárias/complicações , Neoplasias Orbitárias/diagnóstico , Sarcoma/complicações , Sarcoma/diagnóstico , Adulto , Soropositividade para HIV/diagnóstico por imagem , Humanos , Masculino , Neoplasias Orbitárias/diagnóstico por imagem , Neoplasias Orbitárias/patologia , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Tomografia Computadorizada por Raios XRESUMO
A 30-year-old, HIV-positive man with a previous history of an atypical nasopharyngeal Burkitt lymphoma developed fluorodeoxyglucose (FDG) avidity on a routine FDG-positron emission tomography (PET)/computed tomography scan performed 10 months after the completion of all treatment. This new FDG-avid disease was in the area of his initial disease. Flow cytometric assessment of a fine needle aspiration showed a CD10-expressing B-cell population with kappa predominance. The corresponding cytology smears had large atypical lymphoid cells along with smaller lymphocytes and macrophages. Because of the patient's previous history of a CD10(+), high-grade B-cell lymphoma, the cytologic and flow cytometric findings were considered highly suspicious for a B-cell lymphoma. Because the differential diagnosis included a relapsed Burkitt lymphoma versus a second, unrelated lymphoma (the former with a dismal prognosis) it was deemed prudent to obtain more tissue via an open biopsy for confirmation of diagnosis and exact subclassification. An open biopsy, however, revealed a reactive lymph node with enlarged geographic follicles; no lymphoma was demonstrable and c-Myc studies were negative. The patient remains without evidence of disease. Retrospectively, the original flow cytometric assessment was believed to likely represent sampling of hyperplastic germinal centers with significantly expanded CD10(+) B cells. The FDG uptake and the kappa predominance further confounded the interpretation. This case illustrates the pitfalls of standard diagnostic techniques, including PET scanning, cytology, and flow cytometry, particularly in the setting of HIV. It further underscores the importance of adequate clinical correlation and a low threshold for performing open biopsies in such patients.
Assuntos
Citometria de Fluxo , Fluordesoxiglucose F18 , Soropositividade para HIV/complicações , Soropositividade para HIV/diagnóstico por imagem , Neoplasias Nasofaríngeas/diagnóstico por imagem , Adulto , Humanos , Masculino , Neoplasias Nasofaríngeas/patologia , Tomografia por Emissão de PósitronsRESUMO
Isolated mycotic common iliac artery aneurysms are rare, and as such, there is no consensus opinion on management. Traditional surgical options include resection with extra-anatomic bypass, placement of allograft or antibiotic treated synthetic graft, or autogenous vein reconstruction. We report the case of a 46-year-old, human immunodeficiency virus-positive male who presented with a recurrent pneumonia and new onset of right lower quadrant abdominal pain associated with right lower extremity swelling. computed tomographic scan revealed an isolated 9.5 cm right common iliac artery aneurysm with no evidence of rupture. Preoperative blood cultures grew out Streptococcus pneumoniae. Operative repair included aneurysm resection and reconstruction using an autogenous femoropopliteal vein interposition graft from the ipsilateral thigh. The patient had an uneventful recovery with resolution of his lower extremity swelling and a normal duplex exam at follow-up. Large mycotic common iliac artery aneurysms can be successfully treated with aneurysm resection and reconstruction using an autogenous femoropopliteal vein conduit. This technique obviates the need for extra-anatomic bypass or other forms of reconstruction using prosthetic material.
Assuntos
Aneurisma Infectado/cirurgia , Soropositividade para HIV/complicações , Artéria Ilíaca/cirurgia , Aneurisma Infectado/complicações , Aneurisma Infectado/diagnóstico por imagem , Soropositividade para HIV/diagnóstico por imagem , Soropositividade para HIV/microbiologia , Humanos , Artéria Ilíaca/diagnóstico por imagem , Veia Ilíaca/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pneumonia Pneumocócica/complicações , Pneumonia Pneumocócica/diagnóstico por imagem , Pneumonia Pneumocócica/cirurgia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
BACKGROUND: We have previously described two cases of HIV-1-positive patients undergoing surgery for stenosis of the internal carotid arteries. Histology revealed an extensive inflammatory infiltration of the vascular wall and no evidence of atheromasic plaque. This unexpected pattern of carotid damage prompted us to perform a more accurate investigation of the characteristics of carotid plaques in a group of HIV-positive patients. The results were compared with those obtained from young patients affected by atherosclerosis of the epi-aortic vessels and patients with arteritis. METHODS: The patients underwent ultrasonography of the epi-aortic vessels using one of the latest generation power color-Doppler with 7.5 MHz probes. RESULTS: The study population included 61 HIV-positive patients and 47 HIV-negative patients (37 atherosclerotic and 10 with arteritis). Compared with HIV-negative atherosclerotic patients, there were significantly higher proportions of HIV-positive patients with iso-hypoechogenic lesions (81.8 vs. 29%) that were homogeneous both in their parietal and endoluminal portions (96.7 vs. 21.6% and 88.5 vs. 54.0%, respectively), with a smooth or slightly irregular surface (99.0 vs. 56.7%) (P=0.001 for all differences). No statistically significant differences were seen between HIV-positive and arteritis patients. CONCLUSION: Our study evidenced that the ultrasonographic structure of the epi-aortic lesions in HIV-positive patients substantially differ from those of the plaques in atherosclerotic patients, although they share similar characteristics with patients affected by arteritis. Further investigations are warranted to better define the structure and the mechanism of onset of these lesions.
Assuntos
Arterite/complicações , Aterosclerose/complicações , Artérias Carótidas/patologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico por imagem , Soropositividade para HIV/complicações , HIV-1/imunologia , Adulto , Aorta/diagnóstico por imagem , Arterite/diagnóstico por imagem , Aterosclerose/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Feminino , Infecções por HIV/tratamento farmacológico , Inibidores da Protease de HIV/farmacologia , Inibidores da Protease de HIV/uso terapêutico , Soronegatividade para HIV , Soropositividade para HIV/diagnóstico por imagem , Soropositividade para HIV/epidemiologia , HIV-1/efeitos dos fármacos , Humanos , Inflamação/diagnóstico por imagem , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , UltrassonografiaAssuntos
Linfoma de Burkitt/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico por imagem , Linfoma Relacionado a AIDS/diagnóstico por imagem , Adulto , Angiografia/métodos , Linfoma de Burkitt/patologia , Evolução Fatal , Feminino , Soropositividade para HIV/diagnóstico por imagem , Soropositividade para HIV/patologia , Humanos , Rim/diagnóstico por imagem , Rim/patologia , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Fígado/patologia , Linfoma Relacionado a AIDS/patologia , Veia Porta/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodosRESUMO
PURPOSE: Surgical staging and treatment of anal carcinoma has been replaced by noninvasive staging studies and combined modality therapy. In this study, we compare computed tomography (CT) and physical examination to [(18)F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the staging of carcinoma of the anal canal, with special emphasis on determination of spread to inguinal lymph nodes. METHODS AND MATERIALS: Between July 2003 and July 2005, 41 consecutive patients with biopsy-proved anal carcinoma underwent a complete staging evaluation including physical examination, CT, and 2-FDG-PET/CT. Patients ranged in age from 30 to 89 years. Nine men were HIV-positive. Treatment was with standard Nigro regimen. RESULTS: [(18)F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) detected 91% of nonexcised primary tumors, whereas CT visualized 59%. FDG-PET/CT detected abnormal uptake in pelvic nodes of 5 patients with normal pelvic CT scans. FDG-PET/CT detected abnormal nodes in 20% of groins that were normal by CT, and in 23% without abnormality on physical examination. Furthermore, 17% of groins negative by both CT and physical examination showed abnormal uptake on FDG-PET/CT. HIV-positive patients had an increased frequency of PET-positive lymph nodes. CONCLUSION: [(18)F]-fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography detects the primary tumor more often than CT. FDG-PET/CT detects substantially more abnormal inguinal lymph nodes than are identified by standard clinical staging with CT and physical examination.
Assuntos
Neoplasias do Ânus/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Soropositividade para HIV/diagnóstico por imagem , Humanos , Canal Inguinal , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pelve , Estudos Retrospectivos , Análise de SobrevidaRESUMO
Cocaine use is a major problem worldwide and there are numerous reports about cocaine-associated myocardial infarction. Nevertheless minimal data are available from randomised clinical trials to suggest evidence-based approaches to the management of cocaine-associated myocardial ischemia. Moreover, most reports have been limited to conservative management of cocaine-associated myocardial infarction. We report a case of a young male cocaine user with acute myocardial infarction, undergoing diagnostic coronary angiography and intravascular ultrasound revealing severe atherosclerosis, followed by successful stent implantation.
Assuntos
Angioplastia Coronária com Balão/métodos , Transtornos Relacionados ao Uso de Cocaína/terapia , Anticorpos Anti-HIV/imunologia , Soropositividade para HIV/terapia , HIV/imunologia , Infarto do Miocárdio/terapia , Ultrassonografia de Intervenção , Adulto , Implante de Prótese Vascular/instrumentação , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/diagnóstico por imagem , Seguimentos , Soropositividade para HIV/complicações , Soropositividade para HIV/diagnóstico por imagem , Humanos , Masculino , Infarto do Miocárdio/diagnóstico por imagem , Infarto do Miocárdio/etiologia , StentsAssuntos
Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Cerebelares/diagnóstico por imagem , Linfoma Relacionado a AIDS/diagnóstico por imagem , Crânio/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Cistos Aracnóideos/diagnóstico por imagem , Biópsia , Neoplasias Ósseas/patologia , Neoplasias Cerebelares/patologia , Ventriculografia Cerebral , Fossa Craniana Posterior/diagnóstico por imagem , Fossa Craniana Posterior/patologia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Soropositividade para HIV/diagnóstico por imagem , Soropositividade para HIV/patologia , Humanos , Achados Incidentais , Linfoma Relacionado a AIDS/patologia , Invasividade Neoplásica/patologia , Osso Occipital/patologia , Osso Parietal/patologia , Crânio/patologia , Abuso de Substâncias por Via Intravenosa/complicaçõesAssuntos
Gânglios da Base/fisiopatologia , Coreia/etiologia , Coreia/virologia , Soropositividade para HIV/complicações , HIV/patogenicidade , Adulto , Gânglios da Base/diagnóstico por imagem , Gânglios da Base/patologia , Gânglios da Base/virologia , Coreia/diagnóstico por imagem , Soropositividade para HIV/diagnóstico por imagem , Soropositividade para HIV/patologia , Humanos , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
OBJECTIVE: To determine the clinical features in HIV-positive patients with and without infective endocarditis (IE). PATIENTS AND METHODS: All bacteremic, HIV-positive patients with suspected IE admitted over a four-year period who underwent either transesophageal echocardiography (TEE) or transthoracic echocardiography (TTE) were retrospectively reviewed with regard to clinical, laboratory, and demographic characteristics. RESULTS: Ten (11.5%) of 87 HIV-positive patients had a clinical diagnosis of IE based on the Duke Criteria. The mean age of patients with IE was 37.8 years and without IE 39.9 years (P = NS). Both patient groups were similar with respect to gender, race, IVDA, renal failure requiring hemodialysis, history of predisposing heart disease, origin of infection, and causative organism of infection. The mean CD4 count (cells/microL) was 200.7 in patients with IE and 95.9 in patients without IE (P = NS). Of 10 HIV-positive patients with IE, seven had left-sided heart involvement, two had complications related to IE, three required cardiothoracic surgery, and three died. CONCLUSIONS: There were no differences found with regard to the clinical characteristics of HIV-positive patients with and without IE. No correlation could be drawn between mortality and the degree of immunosuppression in patients from this study. The high incidence of IE (11.5%) and mortality rate (30%) in this study suggests that IE in HIV-positive patients, including non-intravenous drug abusers, represents a real concern for clinicians and their management of these patients.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico por imagem , Soropositividade para HIV/diagnóstico por imagem , Adulto , Contagem de Linfócito CD4 , Infecções Comunitárias Adquiridas/epidemiologia , Infecção Hospitalar/epidemiologia , Feminino , Soropositividade para HIV/complicações , Cardiopatias/diagnóstico por imagem , Cardiopatias/epidemiologia , Humanos , Falência Renal Crônica/terapia , Masculino , Diálise Renal/estatística & dados numéricos , Fatores de Risco , UltrassonografiaRESUMO
PURPOSE: To evaluate the role of sonography (US) in the evaluation of parotid gland alterations in HIV+ children, in order to show their presence, severity, specificity, relationship with clinical and laboratory data and sensitivity to new drugs. MATERIAL AND METHODS: From June 2000 to December 2000 twenty-two consecutive HIV+ children (12 males and 10 females, mean age 9.7) undergoing HAART were prospectively examined with US. A multi-frequency linear probe (7.5-10 MHz) was used for the examination. The glands were assessed for alterations in gland volume and vasculature, hypoechoic foci, hyperechoic striae, lympho-epithelial cysts and solid nodules and the enlargement of intraparotid and adjacent lympho nodes. The US findings on HIV+ patients were compared with the patients'clinical and laboratory data and with US exams performed on HIV- children. Finally, we made a comparison with US exams performed on the same patients before HAART: RESULTS: In HIV+ children the most frequent US findings were hypoechoic foci (68.2% of patients), hyperechoic striae (68.2%) and the enlargement of intraparotid and adjacent lympho nodes (86.3% and 95.4%, respectively). No relationship between US outline and clinical and laboratory data was found. In the control group (HIV-negative children) hypoechoic foci and hyperechoic striae were rare (4.7% and 14.3%, respectively), while the enlargement of intraparotid and adjacent lympho nodes was very common (76.2% and 100%, respectively). The comparison with US exams performed on the same patients before HAART showed an improvement in 59.1% of patients, no improvement in 13.6% and a worsening in 13.6% (3 patients were lost to follow-up). DISCUSSION AND CONCLUSIONS: US is useful in the study of parotid gland alterations in HIV+ children. The most frequent specific US findings were hypoechoic foci and hyperechoic striae, whereas the enlargement of intraparotid and adjacent lympho nodes was frequent but completely aspecific. The analysis of results did not show any relationship between the US findings and clinical and laboratory data. HAART can be correlated to an improvement and/or a stabilization of the US pattern in most patients.
Assuntos
Terapia Antirretroviral de Alta Atividade , Soropositividade para HIV/tratamento farmacológico , Glândula Parótida/diagnóstico por imagem , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Seguimentos , Soropositividade para HIV/diagnóstico , Soropositividade para HIV/diagnóstico por imagem , Soropositividade para HIV/imunologia , Humanos , Masculino , Sensibilidade e Especificidade , Fatores Sexuais , UltrassonografiaRESUMO
PURPOSE: This study aimed to determine the role that ultrasound might play in evaluating parotid swellings in patients with human immunodeficiency virus (HIV)-1 disease. PATIENTS AND METHODS: The parotid glands of 13 HIV-positive patients, who were previously diagnosed as seropositive and who were referred because they had unilateral or bilateral parotid gland swellings, were examined sonographically. RESULTS: All patients showed multiple and varied parotid sonolucent areas bilaterally. These patterns reflected the presence of lymphoepithelial cysts, intraparotid lymphadenopathies, and parenchymal lymphoproliferation. CONCLUSION: Because parotid swellings can represent early clinical evidence of HIV disease, comprehensive gland evaluation is mandatory. Ultrasound offers a simple, rapid imaging technique to ascertain the nature of the glandular pathology.
Assuntos
Soropositividade para HIV/diagnóstico por imagem , Doenças Parotídeas/diagnóstico por imagem , Glândula Parótida/diagnóstico por imagem , Complexo Relacionado com a AIDS/diagnóstico por imagem , Adulto , Criança , Cistos/diagnóstico por imagem , Feminino , HIV-1 , Humanos , Doenças Linfáticas/diagnóstico por imagem , Linfocele/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , UltrassonografiaRESUMO
BACKGROUND: Previous uncontrolled reports have suggested that HIV-seropositive persons develop an accelerated form of emphysema. OBJECTIVE: To characterize the risk for emphysema in a stable HIV-seropositive outpatient population. DESIGN: Controlled, cross-sectional analysis. SETTING: Midwestern urban community. PARTICIPANTS: HIV-seropositive persons (n = 114) without AIDS-related pulmonary complications and HIV-seronegative controls (n = 44), matched for age and smoking history. MEASUREMENTS: Measurement of pulmonary function, bronchoalveolar lavage, and high-resolution computed tomography of the chest. RESULTS: The incidence of emphysema was 15% (17 of 114) in the HIV-seropositive group compared with 2% (1 of 44) in the HIV-seronegative group (P = 0.025). The incidence of emphysema in participants with a smoking history of 12 pack-years or greater was 37% (14 of 38 persons) in the HIV-seropositive group compared with 0% (0 of 14 persons) in the HIV-seronegative group (P = 0.011). The percentage of cytotoxic lymphocytes in lavage fluid was much higher in HIV-seropositive smokers with emphysema. CONCLUSIONS: Infection with HIV accelerates the onset of smoking-induced emphysema. The results of this study support the emerging concept that cytotoxic lymphocytes may have an important role in emphysema pathogenesis.
Assuntos
Soropositividade para HIV/complicações , Enfisema Pulmonar/etiologia , Fumar/efeitos adversos , Adulto , Idoso , Análise de Variância , Contagem de Linfócito CD4 , Estudos de Casos e Controles , Estudos Transversais , Suscetibilidade a Doenças , Feminino , Soronegatividade para HIV , Soropositividade para HIV/diagnóstico por imagem , Soropositividade para HIV/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/imunologia , Testes de Função Respiratória , Tomografia Computadorizada por Raios XAssuntos
Gastroenteropatias/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Biópsia , Análise Custo-Benefício , Diagnóstico Diferencial , Endoscopia Gastrointestinal , Feminino , Seguimentos , Gastroenteropatias/complicações , Soropositividade para HIV/complicações , Soropositividade para HIV/diagnóstico por imagem , Humanos , Intestino Delgado/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X/economia , Tomografia Computadorizada por Raios X/métodosRESUMO
The abdomen in patients with acquired immunodeficiency syndrome (AIDS) is subject to various damage. In AIDS patients, manifestations in the retroperitoneal region, including apparent changes in the pancreas, kidney and lymph nodes, have been well described in the radiological literature. However, abnormalities of the vessels and perivascular spaces have not been well investigated in this syndrome. We performed abdominal sonography in 10 patients who were seropositive for HIV. They had no history of known risk factors such as drug abuse or homosexuality. Also, 4 healthy male controls were examined for comparison. Our aim was to demonstrate and to characterize the pathological changes of the retroperitoneal vessels and perivascular spaces from sonographic observations. The sonographic evaluation included determination of the morphologic and dynamic aspects of the aorta, vena cava and superior mesenteric vessels. The echostructure of the perivascular spaces was analyzed. In this prospective and preliminary study, we have not considered the presence of an AIDS condition. We have precisely analyzed the upper umbilical areas. In all cases, there were supposed to be the same landmarks. The sonographic scans were obtained through the left renal and mesenteric vessel areas, essentially through axial scans. In all 10 patients, sonography showed at least two abnormalities. Three patients had abnormal echostructural changes in all the sites. The images showed echostructural disorganization with poor definition and "fuzzy" and "dirty" aspects of the retroperitoneal vessels and perivascular spaces. The aorta was normal in 2 patients and abnormal in 8 patients with diminished hyperechography and regularity of the aortal wall. The aortic diameter was smaller than 1.5 cm in 7 cases, with a significant attenuation of the beating of the aorta. Despite these abnormalities, the aorta had a normal left paramedian position ahead of the rachis. The inferior vena cava was normal in 1 case and abnormal in 9 cases with diminished hyperechography and regularity of the wall. The vena cava position was normal in 4 cases, displaced in 6, and laminated in 3. The superior mesenteric vessels were abnormal in 8 cases, with poorly defined aims in 6, an indefinite position in 2, and spreading in 2. Adenopathy was present in 6 patients, multiple in 5 and singular in 1 case. A retrocaval location was always observed. A perivascular infiltration and thickening was noted which was diffuse in 6 cases and micronodular in 1 case. From our observations, we conclude that these echostructural changes could be related to AIDS. However, further studies are necessary to confirm these observations and to determine if this sonographic pattern may be seen during the course of the disease. This is the first study to our knowledge which stressed the echostructural changes of the retroperitoneal vessels and perivascular spaces in patients with AIDS.