PubMed Health⌕ Search

Biomedical subjects

D Rey

Publications and source records attributed to D Rey.

At least 55 records · Page 3Linked to original sources
PubMed1999

Isolated renal Aspergillus abscess in an AIDS patient with a normal CD4+ cell count on highly active antiretroviral therapy.

Isolated renal Aspergillus abscess is a very rare complication of HIV infection. It usually occurs in patients with severe immune deficiency. The case of a 29-year-old HIV-infected homosexual male, a nonintravenous drug abuser, who developed a right renal Aspergillus abscess despite normalization of the CD4+ cell count after highly active antiretroviral treatment is described. When antimicrobial treatment failed (amphotericin B followed by itraconazole), he was cured by right nephrectomy and remains in good health 3 months later with no recurrence. In cases of Aspergillus renal abscess in HIV-infected patients, surgery is the treatment of choice, especially in the current era of highly active antiretroviral therapy.

AIDS-Related Opportunistic Infections↗
PubMed1999

Semen cryopreservation after orchidectomy in men with testicular cancer.

OBJECTIVE: To assess the feasibility of semen cryopreservation after orchidectomy in patients with testicular tumour. PATIENTS AND METHODS: The quality of semen samples was investigated in 36 men with testicular tumour (mean age 31.7 years, range 20-49) who were referred to our infertility centre for semen cryopreservation. For each patient, the number of straws, semen volume, number of spermatozoa, and sperm motility before and after freezing were evaluated. RESULTS: Fifteen patients (42%) banked sperm before and 21 (58%) after orchidectomy; the delay was >7 days in 19 patients (53%). The mean age, histological diagnosis and tumour stage did not differ significantly whatever the time of cryopreservation. Semen quality did not differ significantly in patients who cryopreserved sperm before or after orchidectomy and there were no significant differences in sperm values whatever the delay before preservation. Semen quality was the same in patients with seminoma or nonseminoma tumour. CONCLUSION: These findings indicate that spermatogenesis of the contralateral testis is sufficient for successful semen cryopreservation after orchidectomy. Urologists should be encouraged to increase the awareness among oncology teams and patients about the new developments in preserving fertility for patients with cancer.

Adult↗
PubMed1998

HIV-1 reverse transcriptase codon 215 mutation in plasma RNA: immunologic and virologic responses to zidovudine. The AIDS Clinical Trials Group Study 175 Virology Team.

Treatment of HIV infection with zidovudine (ZDV) may select for changes in the genetic sequence of the viral reverse transcriptase (RT) that imparts drug resistance. The presence of a 2-bp mutation at codon 215 of RT (from threonine to phenylalanine or tyrosine) was assessed in plasma viral RNA in 85 subjects treated with ZDV in the AIDS Clinical Trials Group (ACTG) 175 virology substudy. Median CD4 cell numbers, HIV plasma RNA levels, and infectious titers of virus were significantly different over 56 weeks of treatment among 58 subjects with the wild-type threonine at codon 215 virus at study entry compared with the 27 subjects with mutations to phenylalanine or tyrosine (MUT) virus. Thirty percent (13 of 44 subjects) with wild-type virus at study entry developed a new codon 215 mutation. Genotypic resistance at codon 215 in plasma HIV RNA is associated with the subsequent immunologic and virologic failure of ZDV monotherapy in subjects with 200 to 500 CD4 cells/mm3.

Anti-HIV Agents↗
PubMed1998

Nail changes in patients infected with human immunodeficiency virus. A prospective controlled study.

OBJECTIVES: To study the frequency of nail changes in a population of human immunodeficiency virus (HIV)-infected patients and to evaluate the specificity of these findings by comparison with HIV-negative control subjects. DESIGN: Prospective controlled study. Nail changes were recorded by a standardized clinical examination (curvature, nail plate, color, onychomycosis). In case of clinical diagnosis of onychomycosis, mycological culture was performed. SETTING: Primary care university hospital. PATIENTS: A total of 155 HIV-1-positive patients and 103 healthy HIV-negative control subjects of comparable age and sex ratio. INTERVENTION: None. MAIN OUTCOME MEASURE: Clinical examination findings. RESULTS: Nail symptoms were present in 67.7% of HIV-positive patients vs 34.0% of controls (P << .001). The following symptoms were significantly more frequent in the HIV group: clubbing (5.8%) (P < .05), transverse lines (7.1%) (P < .01), onychoschizia (7.1%) (P < .05), leukonychia (14.3%) (P < .001), and longitudinal melanonychia (14.8%) (P < .01). The main finding was onychomycosis in 30.3% of patients vs 12.6% of controls (P < .001). Trichophyton rubrum was present in 48% of onychomycoses and unusual Candida species were also recorded. Multiple fungi were frequently cultured in a single patient. The mean CD4+ cell count was lower in patients with onychomycosis and the frequency of onychomycosis increased in advanced stages of HIV disease. Acquired total leukonychia of the 20 nails was present in 4% of patients. CONCLUSION: Nail symptoms are much more frequent in patients with HIV than in healthy controls, and some of them could be linked to the level of immunosuppression.

Adult↗
PubMed1998

Production of cytokines in patients infected by hepatitis C virus.

T helper type 1 (Th1) cytokines play an important role in antiviral defence. The purpose of this study was to quantify by ELISA IL2, soluble receptor of IL2 (IL2Rs), IFNgamma TNFbeta, IL4, IL6 and IL10 levels in the sera of 134 HCV-positive patients, 69 of whom were coinfected with HIV, and in 54 HIV-HCV-negative patients. The mean IL2Rs and IFN serum levels were much higher in patients with anti-HCV than in the control group, whereas the mean IL4 and IL6 levels were lower in patients infected with HCV. There were no significant differences in cytokine levels between patients with and without HIV. There were significantly less patients with HCV than controls with IFNgamma levels under cut-off, and significantly more patients with HCV with IL4 levels under cut-off. Although serum level of cytokines must be interpreted with caution, the results suggest that Th1 response is enhanced in HCV infection.

AIDS-Related Opportunistic Infections↗
PubMed1998

HIV screening for pregnant women in south eastern France: evolution 1992-1994-1996.

OBJECTIVES: To assess the evolution of the HIV screening practices towards pregnant women between 1992 and 1996, in relation with the 1993 French mandatory obligation to offer prenatal HIV testing and recent therapeutic possibilities to reduce HIV vertical transmission. STUDY DESIGN: Three successive surveys (January 1992, May 1994 and May 1996) about HIV screening policies among medical chiefs of all prenatal care and abortion departments of South Eastern France. Sixty-seven of the 74 departments concerned agreed to participate in the three surveys. RESULTS: The proportion of departments practising routine prenatal HIV screening had not increased since 1992 (89%) but systematic women's consent is more often requested (65.5 vs. 38.2%, P < 0.01). In the context of abortion, HIV testing is more often routinely offered (38.1 vs. 16.4%, P < 0.05) but selective screening remains a frequent practice (29.1%). CONCLUSION: Mandatory proposal of HIV testing to women who terminate could improve access to test but is not sufficient to guarantee adequate preventive counselling.

Abortion, Induced↗
PubMed1998

Gender differences in risk behaviors among HIV+ persons with an IDU history. The link between partner characteristics and women's higher drug-sex risks. The Manif 2000 Study Group.

BACKGROUND AND OBJECTIVES: Risk-taking behaviors differ among women and men injection drug users (IDU). GOAL: To specify the nature of sexual and drug risk-taking among women IDU and ex-IDU and how it relates to partner characteristics. DESIGN: A cross-sectional analysis of 324 HIV+ subjects enrolled into a prospective cohort study in Marseille, France. RESULTS: Women, as compared with men, were considerably more likely to report nonuse of condoms with a main partner (31% versus 12%). They were more likely to shoot with a partner at last injection (39% versus 12%), but far less likely to sterilize used needles (4% versus 16%). Two thirds of both men and women reported consistent condom use with a seronegative partner, but only 47% of men and 23% of women reported the same with a seropositive partner. Among the women only, needle and syringe sharing was associated with consistent use of a condom. CONCLUSIONS: Women reported behaviors which protect their partners from STD infection more frequently than behaviors which protect themselves. Greater attention must be paid to sexual risk-taking among HIV+ women.

Adult↗
PubMed1998

Mandatory prenatal screening for the human immunodeficiency virus: the experience in south-eastern France of a national policy, 1992-1994.

OBJECTIVE: To evaluate the impact of the 1993 French National Policy which made it mandatory to offer screening for the presence of human immunodeficiency virus (HIV) to all pregnant women who planned to give birth, although women remained free to refuse the test. DESIGN: Successive surveys in April 1992 and May 1994 in south-eastern France. Logistic regressions were performed to identify factors which affected access to HIV testing for women who gave birth and those who terminated their pregnancy, and for each year of study. MAIN OUTCOME MEASURES: Attitudes and access to HIV testing among pregnant women, irrespective of pregnancy outcome. SETTING: All obstetrics and gynaecology departments and abortion clinics in the region. POPULATION: 3497 women in 1992 (2775 who were delivered and 722 who chose termination) and 3407 in 1994 (2701 who were delivered and 766 who chose termination). The response rates were 82% and 88%, respectively. RESULTS: In 1994 of women who were delivered, 73% had an HIV test, compared with 63% in 1992 (P < 0.001); however of women who terminated their pregnancy, only 28% had an HIV test, compared with 24.5% in 1992 (P not significant), although they were more at risk for HIV infection. Socioeconomic differences affecting access to testing were reduced between 1992 and 1994, but only among women who gave birth. CONCLUSION: Introduction of a policy which makes it mandatory to offer HIV screening to all women who intended to have their baby improved access to screening but did not improve the rate of preventative counselling. A mandatory requirement to offer HIV screening should be extended to women who request termination of pregnancy.

Abortion, Induced↗
PubMed1998

HIV testing, knowledge, attitudes, beliefs, and practices among minorities: pregnant women of North-African origin in southeastern France.

Since 1991, the French public health ministry has recommended that human immunodeficiency virus (HIV) testing be offered to all pregnant women. This study was undertaken to determine whether this recommendation is followed independently of a woman's ethnicity. It is based on a 1992 survey regarding knowledge, attitudes, beliefs, and practices on HIV infection and testing among pregnant women in southeastern France. Survey results revealed that North-African women (n = 207) were more likely to have a low socioeconomic and educational level, receive their health care at public health institutions, and be less knowledgeable about HIV transmission than French women (n = 2234). They were also more likely to have been tested for HIV without their knowing it and less likely to perceive themselves as being at risk. Consent to undergo HIV testing during pregnancy was dependent on their North-African origin after controlling for significant covariates. These results indicate that routine prenatal screening appears insufficient to ensure adequate HIV testing and counseling of women of ethnic minorities. The development of HIV prevention programs that are cultural-specific and that aim at increasing physicians' compliance with the official recommendation is needed.

AIDS Serodiagnosis↗
PubMed1998

Recurrent varicella pneumonia complicating an endogenous reactivation of chickenpox in an HIV-infected adult patient.

We report the case of an adult patient with acquired immune deficiency syndrome (AIDS) presenting with acute dyspnoea and cutaneous disseminated lesions suggestive of an atypical varicella. The chest radiograph and the computed tomography (CT)-scan revealed a miliary pneumonia. On a previous serum sample varicella-zoster (VZV)-specific serum immunoglobulin (Ig)G titre was 1/200. A high dose acyclovir treatment was effective, but recurrences occurred twice when the treatment was discontinued. During the first recurrence the polymerase chain reaction (PCR) detected the presence of VZV in the bronchoalveolar lavage (BAL) sample. These findings confirmed the diagnosis of secondary varicella with pulmonary involvement. Secondary varicella pneumonia has not been reported in a human immunodeficiency virus (HIV)-infected adult until now. The use of PCR on a BAL sample was very useful in this case because viral culture remained negative. Recurrences of the varicella pneumonia suggested that a maintenance treatment was required in this deeply immunocompromised patient.

Acquired Immunodeficiency Syndrome↗
PubMed1998

[Trends in HIV prenatal screening from 1992 to 1994 in South Eastern France].

BACKGROUND: To study trends in HIV testing among pregnant women before and after the introduction of mandatory screening in January 1993. METHODS: The study was based on data from the Prevagest surveys which were carried out in the Provence-Alpes-Côte d'Azur region in samples of pregnant women who just delivered in 1992 (n = 2,775) and 1994 (n = 2,701). RESULTS: The proportion of women declaring that they had been tested during pregnancy increased from 63% in 1992 to 73% in 1994 (p < 0.001). The percentage of women who believe they were tested without consent decreased from 14% in 1992 to 6% in 1994 (p < 0.001). In 1994, 86% nevertheless declared that they received no information on AIDS and its prevention during their pregnancy. After adjustment by a logistic model, type of prenatal care and educational level longer appeared in 1994 to be associated with a lower probability of declaring having been tested. On the contrary, women originating from North Africa, those younger than 25 years and married women had a lower probability of declaring that they have been tested in 1994 as well as 1992. CONCLUSIONS: This study stresses the need for improved communication between public health professionals and practitioners and the establishment of effective training programs in HIV preventive counselling for health professionals in charge of prenatal care.

Adult↗
PubMed1997

[Acrosyndromes induced by bleomycin in HIV 1 related Kaposi's disease. 5 cases].

OBJECTIVES: Raynaud's syndromes may be observed in HIV-infected patients, particularly those with Kaposi disease treated with bleomycin. This complication occurs in 10% of patients given bleomycin although only 7 cases have been reported in the literature. The aim of this study was to determine the frequency of certain biological abnormalities observed in HIV patients with Kaposi disease given bleomycin and who develop Raynaud's syndromes. PATIENTS AND METHODS: A survey was conducted from 1989 to 1995 among 1074 patients infected with HIV-1. There were 121 patients with Kaposi disease and 73 of these were treated with bleomycin. The clinical features and laboratory results (cryoglobulinemia, free protein-S, protein-C, anticardiolipin antibodies, von Wille-brand factor (vWF.ag) endothelin-1) were obtained in 5 patients who developed biomycin-induced Raynaud's syndrome. RESULTS: Amont the 73 patients with Kaposi disease treated with bleomycin (total mean dose = 227 mg (120-380 mg)), 5 patients (12.6%) developed a severe Raynaud's synchrome including two who suffered digital necrosis Withdrawal of bleomycin led to improved symptomatology (n = 2) or an aggravation (n = 1) in the 3 patients followed. CONCLUSION: Raynaud's syndromes are frequent (12.6%) in HIV patients with Kaposi disease treated with bleomycin. The vascular toxicity of bleomycin, demonstrated in animals, would appear to be the causal factor among others. Release of endothelial factors (vWF.ag endothelin-1) and perturbed hemostasis related to the HIV infection (protein-S deficiency, anti-cardiolipin antibodies) could be an expression of and aggravate the vascular toxicity of bleomycin.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Can prolonged expiration manoeuvres improve the prediction of arterial PCO2 from end-tidal PCO2?

We have studied, in 16 patients undergoing thoracoabdominal oesophagectomy, if two prolonged expiration manoeuvres improve prediction of arterial PCO2 (PaCO2) from end-tidal PCO2 (PE' CO2). PE' CO2, PCO2 at the end of a simple prolonged expiration (PE1 CO2), and PCO2 at the end of a prolonged expiration preceded by sustained hyperinflation of the lungs (PE2 CO2), were measured during laparotomy, in the lateral thoracotomy position during two-lung ventilation, and after transition to one-lung ventilation. (PaCO2-PE' CO2) was 1.3 (SD 0.4) kPa during laparotomy and this remained stable throughout the study. Both manoeuvres decreased the mean arterial to peak expired PCO2 difference, particularly during one-lung ventilation. However, PE1 CO2 and PE2 CO2 did not agree more closely with PaCO2 than PE' CO2 at any stage of the study. We conclude that these manoeuvres did not improve estimation of PaCO2 from PE' CO2.

Aged↗
PubMed1997

[Knowledge and behavior of pregnant women towards HIV infection and its screening].

OBJECTIVES: To assess knowledge and attitudes of pregnant women towards HIV infection and testing, and to compare them according to the outcome of the pregnancy (elective abortion vs delivery). METHODS: Between March 30 and April 26, 1992, all women ending their pregnancy in a medical center located in South Eastern France, were asked to complete an anonymous questionnaire: 3,589 (89.6%) responded: 2,825 women who delivered and 764 who chose abortion. RESULTS: 61.7% of the women who delivered and 24.1% of the women who chose abortion declared having been tested for HIV during pregnancy (p < 0.001). Among women who reported not having been tested, very few did so because they refused the test (2% among women who deliver and 1.5% among women who terminated pregnancy). A total of 2.6% of women tested during prenatal care and 19.6% in the context of abortion did not know the result of their test (p < 0.001). Knowledge about HIV transmission among women who delivered dit not differ significantly from that of women who terminated pregnancy. However risky behaviors were more frequent among the latter group (38.8% vs 17.7%, p < 0.001). CONCLUSION: This research confirms that systematic HIV screening during prenatal care was already diffused in France but remained mainly motive by foetal concerns and was not always associated with adequate preventive counselling, specially for migrant women and women with a low level of education. HIV screening and counselling is not guaranteed for women coming for elective abortion although they are more at risk for HIV infection. In spite of psychological difficulties, systematic proposal of HIV screening should be extended to the context of elective abortion.

Abortion, Legal↗