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Biomedical subjects

G Grosse

Publications and source records attributed to G Grosse.

At least 37 records · Page 2Linked to original sources
PubMed1995

Disseminated toxoplasmosis in AIDS patients--report of 16 cases.

Between June 1986 and October 1992, disseminated toxoplasmosis was diagnosed in 16 AIDS patients. 13 cases were diagnosed at autopsy where multiple organ involvement was documented in all 13. Three patients were diagnosed intra vitam. All 3 survived with appropriate treatment. Clinical features indicative of disseminated toxoplasmosis were: fever of unknown origin between 39 degrees and 40 degrees C in 16 cases, clinical signs suggestive of sepsis or septic shock in 15, with progression to multiorgan failure in 10, disseminated intravascular coagulopathy in 6, confusion, disorientation or apathy in 13 and lack of a systemic pneumocystis carinii prophylaxis in all 16. Typical laboratory markers were: CD4 cell counts below 100 x 10(6)/l in 16 cases, elevation of serum lactic dehydrogenase in 16 and creatine phosphokinase (in 4/6), normal or only slightly elevated C-reactive protein (in 9/11), positive Toxoplasma gondii IgG antibodies in 15/16 and negative IgM antibodies in all 16. Lesions indicative of cerebral toxoplasmosis were visualized on cranial computerized tomography in only 3/10 evaluated patients. In patients with advanced HIV infection presenting with a systemic illness, including the clinical and laboratory features described above, systemic Toxoplasma gondii infection must be included in the differential diagnosis. In these patients, specific and if warranted, invasive diagnostic procedures followed by early vigorous therapeutic intervention should be considered.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Histoplasmosis of the skin as an initial opportunistic infection in AIDS].

A 55-year-old homosexual Indonesian (last stay in Indonesia 2 years previously), known to be HIV positive since 1986, developed desquamating, in part ulcerating, skin eruption over the face and shoulder region. On admission his temperature was 38.2 degrees C, erythrocyte sedimentation rate 72/95 mm, white cell count 3.100/microliters, and the CD4 cell count 30/microliters. Examination of lung, oesophagus, stomach, duodenum and colon for possible opportunistic infections was negative. Fundoscopy revealed an infiltrate in the right eye with destruction of the vitreous. Skin biopsy suggested histoplasmosis, confirmed by culturing H. capsulatum varietas capsulatum. It is likely that this was the reactivation of a latent, previously symptom-free infection, in this case the first opportunistic infection in the presence of AIDS. For 30 days he received infusions of amphotericin B (initially 0.1 mg/kg daily, after the 5th day 0.5 mg/kg), resulting in rapid healing of the skin lesions. Subsequently he has received (for 6 months so far) itraconazole, 400 mg daily, without further complications.

AIDS-Related Opportunistic Infections↗
PubMed1993

[Carcinosarcoma of the urinary bladder].

A female patient is presented who had a large carcinosarcoma of the urinary bladder that became clinically manifest only 2 months before treatment. The initial treatment by transurethral resection was followed by radical cystectomy; 7 months postoperatively the patient died of local tumour recurrence with widespread metastases. Carcinosarcoma of the urinary bladder is a rare tumour with a poor prognosis. The majority of such tumours are not diagnosed until tumour growth is already far advanced. Owing to the small number of cases there is no clinically proven form of management. In contrast with superficial transitional cell carcinoma of the bladder, superficial carcinosarcoma of the bladder has always invaded the lamina propria, since in addition to the carcinomatous degeneration of the mucosa, sarcomatous degeneration of the underlying submucosal stroma is also present. Any local surgical treatment, such as TUR or partial cystectomy, involves the risk of incomplete tumor removal, because the sarcomatous elements typically invade the submucosa while the overlying mucosa remains intact. Therefore, radical cystectomy appears to be the treatment of choice for both superficial and invasive carcinosarcoma of the urinary bladder.

Carcinosarcoma↗
PubMed1993

Anergic disseminated toxoplasmosis in a patient with the acquired immunodeficiency syndrome.

Cerebral toxoplasmosis is the most common cause of focal brain disease in patients with the acquired immunodeficiency syndrome. A 24-year-old human immunodeficiency virus-infected woman with two previous episodes of Pneumocystis carinii pneumonia presented with diarrhea and fever. Despite antibiotic treatment, septic shock developed, and she died 3 weeks after the symptoms began. Histologic and histochemical studies revealed an anergic toxoplasmosis with dissemination in all examined organs. There were multiple foci of toxoplasmic cysts and free tachyzoites, sometimes with minute areas of necrosis, but no inflammatory reaction at all. Since effective treatment of toxoplasmosis is available, the occurrence of this rare form of toxoplasmosis should be kept in mind.

AIDS Dementia Complex↗
PubMed1991

Hyaline globules reacting positively with zidovudine antibody in brain and spinal cord of AIDS patients.

Histology of the central nervous system in nine AIDS showed extracellular hyaline globules in the white matter of the brain and the spinal cord. In immunohistochemical studies with a battery of antibodies, the only positive reaction of these globules was with an antibody to zidovudine. High-performance liquid chromatography showed the presence of a zidovudine isomer in eluates of brain tissue from these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1991

[Extrapulmonary manifestations of Pneumocystis carinii infection in AIDS].

Between 1986 and 1990 we found in 7 out of 100 continuously performed AIDS-autopsies at Auguste-Viktoria-Hospital (AVH) an extrapulmonary manifestation of Pneumocystis carinii (Pc). 4 of these cases showed only a singular infiltration of pulmohilar lymphnodi, while the remaining 3 cases presented various other organ involvements: spleen, liver, kidney, adrenal gland, prostate gland, pancreas, myocardium, thyroidea and eyes. All these AIDS-patients had a chronic or relapsing Pc-pneumonia with focal interstitial fibrosis, emphysema, and cavernous-cystic lesions. 6 patients developed a spontaneous pneumothorax due to ruptured subpleural bullae or cystic changes. Apparently the rare dissemination of Pc develops in the context of ruptured tissue and vessels in the pneumothorax lung of AIDS-patients during the final stage of the immunodeficiency associated with chronic lung changes.

Acquired Immunodeficiency Syndrome↗
PubMed1990

[Intestinal spirochetosis in HIV infection: prevalence, isolation and morphology of spirochetes].

The prevalence of intestinal spirochaetosis was investigated in 39 HIV-positive homosexual males (mean age 39 [24-65] years) in different stages of HIV infection (3 with the lymphadenopathy syndrome, 8 with AIDS-related complex and 28 with AIDS). Biopsies for cultural and histological demonstration of spirochaetes were obtained during routine ileoscopies. At the time of examination 35 of the 39 patients had intestinal symptoms. 27 patients had had no previous antimicrobial treatment. In 12 of the 27 previously untreated patients with intestinal symptoms spirochaetes were demonstrated, to different extent, from the terminal ileum to the rectum, while the treated group of eight and the control group of four were negative. There were no significant inflammatory changes histologically. Treatment with metronidazole in most cases improved symptoms. In their ultrastructure the microorganisms showed several complete convolutions, cone-shaped cell endings, cell length of 4-18 microns, cell diameter of 0.21-0.35 microns and five subterminal flagella. Morphological considerations favour the inclusion of these microorganisms in the genus Treponema rather than Brachyspira.

AIDS-Related Complex↗
PubMed1990

Vacuolar myelopathy in AIDS. A morphological analysis.

Between 1986 and 1988 we studied the spinal cord of 40 patients dying of AIDS. Transverse and longitudinal sections from a minimum of four levels of the spinal cord were examined by means of conventional histology, immunohistochemistry and electron microscopy. Out of 22 cases there were 6 showing a mild, 11 a moderate and 5 a severe myelopathy. Among these cases with severe myelopathy, vacuolar degeneration of the posterior, lateral, and anterior columns of the white matter, which are typical findings of vacuolar myelopathy (VM), were present. Cervical and thoracic cords were affected in all cases, the lumbal cord, however, in only two. Fusiform vacuoles, 30 to 180 microns in diameter and 200 to 500 microns in length, could be seen rising between the axolemma and the myelin sheath. Most of them were still containing an axon cylinder. Foamy phagocytic cells, phagocytosing axons of apparently preserved structure were found within the vacuoles. These foamy macrophages contained rests of axons in their cytoplasm. However, only one case with severe tissue disruption exhibited myelin debris as well. Our morphological findings suggest that in VM of AIDS a process of phagocytosis directed against the axon cylinders occurs simultaneously with vacuolar degeneration of the white matter of the spinal cord. The results suggest furthermore that VM, especially its moderate form, appears to be a more frequent condition than previously assumed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Aspergillus findings in AIDS patients suffering from cryptococcosis.

Because of the known pathogenicity of Cryptococcus neoformans and of aspergilli depending on defined but different immunodeficiencies of the host, the evaluation of their simultaneous cultural detection in specimens of the respiratory tract of AIDS patients is of epidemiological, diagnostic, pathogenetic and therapeutic interest. In 10 out of 15 AIDS patients the following species of the genus Aspergillus could be isolated either once or repeatedly during the course of Cr. neoformans infections in specimens from the respiratory tract: A. fumigatus, A. flavus, A. nidulans, A. niger and A. glaucus. From the 10 different case reports the conclusion can be drawn that the cultural findings of aspergilli in specimens from the respiratory tract during the course of cryptococcosis were of no pathogenic significance. Rather, they should be interpreted as inhaled and not yet germinated conidia still capable of growth lacking primary pathogenicity for the AIDS patient. The significance of serodiagnosis for the evaluation of the simultaneous occurrence of Cr. neoformans and Aspergillus spp. is demonstrated and discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Cryptococcus neoformans in the seminal fluid of an AIDS patient. A contribution to the clinical course of cryptococcosis.

In a 33-year-old HIV-positive homosexual male suffering from unexplained headache, cryptococcosis was diagnosed in a progressive secondary stage. After treatment with the standard combination therapy of amphotericin B + flucytosine for 34 d, the patient was clinically symptom-free and discharged, upon his own request, from the hospital. He remained under ambulatory mycological control. After an interval of 65 d during which the urine had been free from Cryptococcus neoformans (Cr.n.), the fungus could not be isolated from urine but 3 X 10(5) CFUs/ml were found in the seminal fluid. Andrologically, teratospermia and hyposemia were present. There were no clinical signs in the genitourinary tract including the prostate. The significance of ecological niches for Cr.n. colonization of the genitourinary tract after antimycotic therapy is discussed. In such cases, in addition to cultural examination of urine for Cr.n. by the membrane filtration technique (MFT) and Staib agar, an additional cultural examination of seminal fluid is recommended. It is also proposed to pay more attention to Cr.n. in andrological examinations. Special regard should be given to a possible occurrence of Cr.n. in the seminal fluid of AIDS patients. In cytology of the seminal fluid, use of the Giemsa stain is unsuitable for the purpose of Cr.n. detection. For this reason, it should be supplemented by PAS staining.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Gastritis and bacterial colonization of the gastric mucosa in adolescents.

Among 256 examined gastric biopsies from 200 adolescents, inflammatory changes were found strikingly often: 44.5% showed chronic superficial gastritis without atrophic processes. However, the percentage of biopsies of normal mucosa was substantially higher than that of a compared series of biopsies not selected according to age of the patients. According to our findings in adolescents, the interstitial stroma of normal gastric mucosa in the antrum, as well as in the corpus, was absolutely free of round cells. Bacterial colonization with Campylobacter-like organisms (CLO) occurred almost as frequently as in the series not selected according to age. Consequently, the biopsy material of adolescents substantially more often featured normal mucosa with bacterial colonization, mostly of the minimal focal variety, than did the compared series. Colonization with CLO apparently takes place at an early age, and may exacerbate into a massive colonization.

Acute Disease↗
PubMed1989

[Effects of different buffers, ethanol and hydrogen peroxide on the morphology of cultured brain cells].

Effects of different buffers: N-2-Hydroxyethylpiperazine-N-2-ethanesulfonic acid (HEPES), Ethanolamine (2-Aminoethanol), sodium bicarbonate (NaHCO3) in the presence of 0.003% H2O2 or 0.5% ethanol were investigated on cell cultures from brain (chick embryo 5 1/2 or 9 day in ovo). Morphological parameters: density of cells, reaggregation, size of cell aggregates were used. H2O2 in the presence of NaHCO3 led to a decrease of isolated cells and an increase of reaggregation with degeneration in the great clusters. When H2O2 and 5 mM HEPES were present together in the absence of NaHCO3, the aggregation was less than with HEPES alone. By use of a chemical defined medium DME/F-12 supplemented with Insulin, Transferrin, sodium selenite, bovine serum albumin and 15 mM HEPES both the number and the diameter of cell aggregates increased. Addition of 0.5% ethanol in the presence of NaHCO3 stimulated in cultures of the ganglion trigeminale and telencephalon (9 day chick embryos) the regeneration of neurites and the proliferation and migration of non-neural cells. No growth of neurites was observed on the same condition in brain cultures from 6 day chick embryo. The number of large aggregates increased significantly in the presence of NaHCO3 and in the chemical defined and supplemented medium DME/F-12. Bologa et al. (1987) demonstrated that the buffers TREA (Triethanolamine) and HEPES enhance the expression of properties related to post-mitotic differentiated cellular states in both neurons and glia.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[Gastrointestinal cytomegalovirus manifestations in AIDS].

Cytomegalovirus (CMV) infection is one of the most important intestinal opportunistic infections in AIDS. In severe cases ulcerations and colitis are the commonest manifestations. 184 HIV positive patients with gastrointestinal symptoms were investigated by endoscopy of the gastrointestinal tract. While culture, immunohistochemical staining and histology from biopsies were performed, the results of all three methods were compared. In one third the cases CMV associated lesions could be found by endoscopy. Erosions or ulcerations are the most frequent tissue lesions. In 95% the culture was positive. In addition, immunohistochemical staining in 75% and histology in 61.7% were positive in patients with more serious manifestations. For early diagnosis endoscopy of the gastrointestinal tract and histological, histochemical and microbiological investigations of biopsies are essential.

Acquired Immunodeficiency Syndrome↗