Biomedical subjects
Publications and source records attributed to J B Greene.
Fungal infections have only rarely been reported to occur in patients having undergone total knee arthroplasty. This case report documents the first known case of Aspergillus fumigatus as the offending organism. Its initial presentation as a popliteal cyst further reinforces the known association of popliteal cysts and intra-articular knee pathology.
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The loss of body weight is a common finding in the setting of AIDS or ARC. Weight loss usually heralds the appearance of an AIDS-associated infectious disease or neoplasm. Multiple mechanisms for catabolism exist, including decreased caloric intake, excessive caloric loss, and increased metabolic caloric consumption. Among the most serious implications of weight loss is the fact that many of the immune defects observed in persons with AIDS are exacerbated by protein-calorie malnutrition. There are myriad causes of weight loss in patients with AIDS and ARC. A systematic and thorough diagnostic approach guided by the patient's presenting symptoms often yields an etiology and therapeutic direction.
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Eighty-six [67Ga]citrate chest scans were performed in 71 adult patients with the acquired immunodeficiency syndrome. Forty-five of these patients also had Kaposi's sarcoma. Only 29 of 57 abnormal scans were correlated with abnormal chest radiographs. Chest radiographs were negative for 27 scans and unavailable for one. Several scan patterns were seen. Diffusely increased lung uptake was seen most commonly with Pneumocystis carinii pneumonia, but also other infections and noninfectious inflammatory conditions. Focal uptake corresponding to regional lymph node groups occurred most often with Mycobacterium avium-intracellulare but aslo with lymphoma. Localized intrapulmonary uptake was seen in bacterial pneumonias. Perihilar activity occurred in two cases. When chest radiographs were abnormal and 67Ga scans negative, the most common diagnosis was pulmonary Kaposi's sarcoma.
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Five men developed disseminated infection with Mycobacterium avium-intracellulare. These patients all lived in the New York City area and presented with their illnesses between January 1981 and September 1981; four were homosexual and one was an intravenous drug abuser. Four patients died. All five patients had defects in the cell-mediated immune response. The infections were characterized histopathologically by poor or absent granulomatous tissue reaction. Clinical isolates of M. avium-intracellulare from all five patients agglutinated commonly used antimycobacterial drugs. The spectrum of opportunistic infections among populations of homosexuals and drug abusers should be expanded to include disseminated disease due to M. avium-intracellulare.
Eleven cases of community-acquired Pneumocystis carinii pneumonia occurred between 1979 and 1981 and prompted clinical and immunologic evaluation of the patients. Young men who were drug abusers (seven patients), homosexuals (six), or both (two) presented with pneumonia. Immunologic testing revealed that absolute lymphocyte counts, T-cell counts, and lymphocyte proliferation were depressed, and that humoral immunity was intact. Of the 11 patients, one was found to have Kaposi's sarcoma, and another had angioimmunoblastic lymphadenopathy. Eight patients died. In the remaining three, no diagnosis of an immunosuppressive disease was established, despite persistence of immune defects. These cases of pneumocystosis suggest the importance of cell-mediated immune function in the defense against P. carinii. The occurrence of this infection among drug abusers and homosexuals indicates that these groups may be at high risk for this infection.
The clinical findings in eight young homosexual men in New York with Kaposi's sarcoma showed some unusual features. Unlike the form usually seen in North America and Europe, it affected younger men (4th decade rather than 7th decade); the skin lesions wee generalised rather than being predominantly in the lower limbs, and the disease was more aggressive (survival of less than 20 months rather 8-13 years). All eight had had a variety of sexually transmitted diseases. All those tested for cytomegalovirus antibodies and hepatitis B surface antigen of anti-hepatitis B antibody gave positive results. This unusual occurrence of Kaposi's sarcoma in a population much exposed to sexually transmissible diseases suggests that such exposure may play a role in its pathogenesis.
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A case is presented of choriocarcinoma with cerebral metastases which was unsuspected until a life-threatening life-threatening situation occurred. A viable infant was born and there was dramatic response to treatment with probable cure.
Spirochetal organisms were demonstrated histologically in skin biopsy specimens from a patient with Lyme disease and erythema chronicum migrans. The patient responded rapidly to penicillin G benzathine administration. Convalescent serum contained a high titer of antibody to an lxodes dammini spirochete antigen. The finding of spirochetes in an erythema chronicum migrans lesion in a patient with clinical Lyme disease supports further recent evidence that this illness is an infectious disease caused by a tick-borne bacterium. The skin biopsy may be a useful diagnostic tool in this disease.