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Biomedical subjects

J Gillooley

Publications and source records attributed to J Gillooley.

6 recordsLinked to original sources
PubMed1998

Acute cholecystitis in AIDS patients: correlation of Tc-99m hepatobiliary scintigraphy with histopathologic laboratory findings and CD4 counts.

BACKGROUND: AIDS patients are susceptible to opportunistic gastrointestinal infections including ascending cholangitis and cholecystitis, especially if CD4 count is < 200. Incidence of acalculous cholecystitis has not been reported previously. PURPOSE: We aim to evaluate the incidence of acalculous cholecystitis in AIDS patients and to identify causative organisms and mortality rate following cholecystectomy. MATERIALS AND METHODS: We reviewed the files of 46 patients in order to meet the objectives of this study. RESULTS: CD4 counts were < 200 in 31 patients and > 200 in 15 patients. HIDA imaging was performed in 31 patients; in 8, the CD4 count was > 200 and all had calculous cholecystitis. The gallbladder was visualized in 3 patients for a sensitivity of 63% and no organisms were found in the gallbladder specimens. In 23 patients, the CD4 count was < 200; the gallbladder was visualized in 5 patients for a HIDA sensitivity of 78%; 16 (52%) had acalculous cholecystitis; and 15 had calculous cholecystitis. In acalculous cholecystitis, Cryptosporidium was found in six cases, cytomegalovirus (CMV) in six cases, and fungus, yeast, tuberculosis, and mycobacterium avium intracellular each in one case. The thirty day mortality rate was 18%; 5 of 28 who underwent open cholecystectomy died within 30 days, 4 of them with a CD4 count < 200. There was no mortality in the 26 patients who underwent laparoscopic cholecystectomy. CONCLUSION AND RECOMMENDATIONS: (1) Because of the high incidence of 52% of acalculous cholecystitis in AIDS patients with a CD4 count < 200, we recommend using intravenous cholecystokinin if the gallbladder is visualized on hepatobiliary scintigraphy in order to determine gallbladder ejection fraction and exclude acalculous cholecystitis. (2) Laparoscopic rather than open cholecystectomy should be the surgical procedure of choice in AIDS patients especially if the CD4 count is < 200.

AIDS-Related Opportunistic Infections↗
PubMed1997

Delayed positive thallium uptake in large B-cell non-Hodgkin's malignant lymphoma.

We report an unusual finding in an AIDS patient who presented with a large mediastinal mass and multiple lymphadenopathy. A sequential thallium and gallium scan to specify the nature of the mediastinal mass was requested. The early thallium images, acquired 15 min after the intravenous injection, showed no uptake in the mass. The delayed images 2 hr later showed intense thallium uptake. A gallium scan performed 48 hr later also showed intense gallium uptake in the mediastinal mass. Biopsy from the inguinal lymph node confirmed the presence of large-cell diffuse noncleaved malignant lymphoma. This case raises questions about the optimum time of imaging for thallium in high-grade lymphoma, whether delayed imaging is essential, about previous reports of low sensitivity of thallium in undifferentiated lymphoma and about the mechanism of thallium uptake in this type of tumor.

Citrates↗
PubMed1996

Disseminated mycobacterium avium complex. Review of Ga-67 and TI-201 scans and autopsy findings.

A retrospective analysis of the files and Ga-67 scan findings of 32 AIDS patients with established diagnosis of disseminated Mycobacterium avium complex (MAC) was conducted in order to determine the sensitivity of Ga-67 scans for the diagnosis of this disease and the sites of MAC organ involvement. Fourteen of the 32 patients had early and delayed TI-201 scans that were also reviewed. Autopsy findings of AIDS patients in the 5 years (January 1990 to December 1994) were reviewed to determine the incidence and sites of involvement of disseminated MAC in AIDS autopsies. Chest x-ray was positive in only 41% of patients. Ga-67 scans were positive in 84% with multi-lymph node sites of involvement in 78% (hilar lymph nodes in 37.5%, supraclavicular 28.1% [all were on the left side], para-aortic 31.2%, paratracheal 18.2%, mediastinal nodes 6.2%, and axillary 3.1%), lung parenchymal in 18.7% and pleural in 9.3%). Increased uptake in the spleen in 16%, colitis 53.1% and enteritis 18.7%. Kaposi sarcoma in 9.3% and malignant lymphoma in 3.1%. TI-201 scans were only positive in 6 of 14 patients (42.8%). The autopsy data found the incidence of disseminated MAC in 23.7% (54 patients) out of a total of 228 autopsies. Approximately half of these cases (52%) were diagnosed antemortem. Other opportunistic infections were identified in 74%. The most common sites of MAC involvement were lymph nodes (74%), spleen (74%), liver (52%), lungs (22%), colon (13%), small bowel (11%), and bone marrow (9%). Associated Kaposi sarcoma was detected in 22% and non-Hodgkin's lymphoma in 13%. Problems in antemortem diagnosis were due to nonspecific presentations, involvement of intrathoracic and extrathoracic lymph nodes, liver, spleen and colon; and the higher incidence of opportunistic infections and negative chest x-ray in the majority of the patients.

AIDS-Related Opportunistic Infections↗
PubMed1985

Metastatic basal cell carcinoma of the head and neck.

Five new cases of metastatic basal cell carcinoma are presented to highlight the potential of this tumor to develop malignant metastases. Histologic criteria of the primary and metastatic site are presented along with a review of the pertinent world literature.

Adult↗
PubMed1979

Pathologic identification of poor prognosis stage I (T1N0M0) cancer of the breast.

Twenty to 40% of Stage I(T1N0M0) cancers of the breast recur in ten years. This is an attempt to identify those patients in whom the disease is likely to recur. On the basis of a study of the histologic changes in the tumor and treatment failures poor prognosis was associated with several histological characteristics: poor cytologic differentiation; lymphatic permeation; blood vessel invasion and invasion of the tumor into the surrounding soft tissue. This classification was then applied to 363 cancers of the breast seen over a five year period and followed three to eight years. There were 203 Stage I (T1N0M0) tumors in the group. Ninety-four of the 203 Stage I tumors had one to four of the above histologic characteristics; 109 had none. Among the 109 patients characterized as good risks there were two treatment failures (2%). In the group of 94 with any high risk histologic features there were 47 treatment failures (50%) which were statistically significant (p = 0.001). The histologic changes had a cumulative effect on the degree of malignancy of the tumor. Pathologic changes in the tumor identified those patients whose Stage I (T1N0M0) tumors were likely to recur.

Adenocarcinoma↗