Biomedical subjects
Publications and source records attributed to J A Larkin.
HIV therapy has advanced greatly in the past couple of decades. Along with advances in treatment have come new adverse effects associated with therapy. We present a case of Toxoplasma encephalitis following initiation of HAART consistent with the emerging syndrome known as immune restoration disease.
A 69-year-old woman with a history of multiple infections of a postoperative wound from a knee replacement was diagnosed with an infection with Tsukamurella sp. The infection was treated with a course of vancomycin and pipercillin/tazobactam, followed by a course of clarithromycin, ciprofloxacin, and ethambutol. The patient responded well. This represents the first report of a Tsukamurella infection of an artificial joint.
BACKGROUND: Advances in laparoscopic instruments and video technology have made laparoscopic donor nephrectomy (LDN) feasible. We report our initial experience with this technique. METHODS: A retrospective review of 30 open donor nephrectomies and our first 30 LDNs was performed to assess donor and recipient outcome and resource usage. RESULTS: LDN was successfully completed in 26 donors (87%). The increased operative time and costs were balanced by less postoperative pain, earlier discharge, earlier return to normal activity and work, fewer incision problems, and less personal financial loss. Recipient outcome was not affected. CONCLUSION: LDN is technically feasible and safe, and recipient graft outcomes are equivalent. Convalescence is shortened, and there is less personal financial loss. LDN offers significant benefit to the donor and may result in increased organ donation.
Eleven patients with rapidly progressive herpetic retinal necrosis (RPHRN) complicating AIDS were investigated retrospectively to study the disease spectrum, systemic involvement, and therapy. The mean CD4 cell count was 24/microL. There was a characteristic disease pattern with rapid progression, 82% bilaterality, relative resistance to intravenous antiviral therapy, and 70% retinal detachment. Varicella-zoster virus was the probable cause in 10 patients (detected by polymerase chain reaction in two eyes investigated), and herpes simplex virus was the probable cause in one. Cutaneous zoster occurred previously in 73% but was not concurrent. Seventy-three percent had central nervous system disease, possibly virus-related. RPHRN may be a local herpetic recrudescence in an immune-privileged site with transneural spread. Only four of 20 affected eyes retained useful vision. Poor ocular bioavailability, retinal ischemia, acquired drug resistance, and strain pathogenicity may underlie treatment failure. Acyclovir therapy appears relatively ineffective. Combined intravenous and intravitreal therapy with foscarnet and ganciclovir may be the best current management. Research advances are needed urgently.
The number of primary and secondary syphilis cases in young women rose dramatically in the late 1980s and early 1990s, due to illicit drug use and the exchange of drugs for sex. Of infants born to mothers with primary or secondary syphilis, up to 50% will be premature, stillborn, or die in the neonatal period; further, most of these children are born with congenital disease that may not be apparent for years. While appropriate treatment of the pregnant female can prevent congenital syphilis, the major deterrent has been the inability to effectively identify these women and get them to undergo treatment. In determining a penicillin regimen, the clinician must consider the stage of maternal infection, the length of fetal exposure, and physiologic changes in pregnancy that can affect the pharmacokinetics of antibiotics. Treatment decisions may be further complicated in patients who are allergic to penicillin or infected with HIV. The pathogenesis of congenital syphilis is not completely understood, but placental invasion is the presumed major route. All women should be screened for syphilis with a nontreponemal test (eg, rapid plasma reagin [RPR] or venereal disease research laboratory [VDRL] test) in the first trimester. Those at high risk should be retested at 28 weeks and near delivery. Even with appropriate treatment of syphilis during pregnancy, fetal infection may still occur in up to 14% of cases. Treating syphilis during pregnancy can be difficult due to physiologic changes that can alter drug levels and the risk that drugs will induce uterine contractions or compromise the health of the fetus. While there are added risks and potential complications, treatment regimens parallel those in nonpregnant women.
A 25-year-old white woman arrives in your outpatient clinic with a red, nonpruritic genital rash. What is the differential diagnosis and treatment?
The objective of this study was to determine the effects of castration, with its presumed pain and inflammatory effects, including increased cortisol, and elevated cortisol per se on in vitro interferon-gamma (IFN-gamma) production, ADG, ADFI, and plasma haptoglobin and fibrinogen. Thirty Friesian bull calves (174 +/- 3.8 kg) were assigned to three treatments (given on d 0): 1) control (CON); 2) i.v. cortisol administration to mimic castration-induced increases in cortisol (CORT); and 3) surgical castration (SURG). Blood samples were collected for 12 h on d 0 and at 24 and 72 h after treatment for cortisol determination. Keyhole limpet hemocyanin (KLH)- and concanavalin A (Con A)-induced in vitro IFN-gamma production in blood, and plasma haptoglobin and fibrinogen were measured in blood samples taken before treatment on d 0 and on d 1 and 3. On d 0, CORT and SURG animals had higher peak cortisol (P < .001) and area under the cortisol curve (P < .001) than CON animals. There were no differences (P > .05) between CON, CORT, and SURG animals in cortisol at 24 and 72 h. There were no differences (P > .05) between CON and CORT animals in IFN-gamma production, haptoglobin, fibrinogen, ADG, and ADFI. Compared with CON animals, SURG animals had lower (P < .05) KLH-induced IFN-gamma on d 1 and CON A-induced IFN-gamma on d 1 and 3. Haptoglobin concentrations were greater (P < .05) for SURG than for CON animals on d 1 and 3. Fibrinogen concentrations were greater (P < .001) for SURG than for CON animals on d 3. The SURG animals had lower (P < .01) ADG and ADFI during d 0 to 7 than CON animals. In conclusion, castration decreased IFN-gamma production, ADG, and ADFI and increased haptoglobin and fibrinogen, and these effects seemed to be independent of plasma cortisol concentrations.
Primary cutaneous aspergillosis is an uncommon entity that may occur in immunosuppressed hosts, usually resulting from contact with contaminated medical devices used in patient care. The infection spreads locally with subsequent skin necrosis due to angioinvasion and thrombosis. We report primary cutaneous aspergillosis following contact with contaminated gauze, and we review the relevant literature.
The devastating effects of HIV infection in women can be altered dramatically with new therapies. Certain clinical syndromes, including oral thrush, diffuse lymphadenopathy, wasting, unexplained fevers, or oral hairy leukoplakia, clearly indicate a need for HIV testing. This article reviews other clinical syndromes, both gender-specific and non-gender-specific, that may prompt the practitioner to consider HIV testing.