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Biomedical subjects

J Yeager

Publications and source records attributed to J Yeager.

At least 37 records · Page 2Linked to original sources
PubMed1996

Clinical and histopathologic features of hair loss in patients with HIV-1 infection.

BACKGROUND: Hair loss is common in patients with HIV-1 infection, and in black patients this loss may be associated with straightening. Possible causes are frequently present in patients with HIV-1. These causes include chronic HIV-1 infection itself and recurrent secondary infections, nutritional deficiencies, immunologic and endocrine dysregulation, and exposure to multiple drugs. However, histopathologic features have rarely been reported in these patients. OBJECTIVE: The objective was to evaluate the changes in the hairs of a group of these patients and to identify the light microscopic and ultrastructural changes in the hairs and the histologic changes in the scalp. METHODS: Hair plucks and pulls with scanning electron microscopy of the hairs were done on 10 patients with late-stage HIV-1 infection. In addition, scalp biopsy specimens were examined in both vertical and transverse sections. RESULTS: All patients had telogen effluvium. Numerous apoptotic or necrotic keratinocytes were seen in the upper external root sheath follicular epithelium in addition to a mild to moderate perifollicular mononuclear cell infiltrate often containing eosinophils. Variable dystrophy of the hair shafts was also a consistent feature. CONCLUSION: Although telogen effluvium is a common response to a wide spectrum of biologic stresses, the presence of apoptotic or necrotic keratinocytes within the upper end of the external root sheath epithelium and dystrophy of hairs may be markers of hair loss in patients with HIV-1 infection.

Acquired Immunodeficiency Syndrome↗
PubMed1996

The effects of swaddling versus standard positioning on neuromuscular development in very low birth weight infants.

A randomized control design was used to compare the effect of swaddling to standard positioning on neuromuscular development in very low birth weight (VLBW) infants (< 1,250 gm). The outcome of neuromuscular development was measured at 34 weeks postconceptional age using the Morgan Neonatal Neurobehavioral Exam (MNNE). The sample included 50 infants who met criteria for birth weight, age and who were classified as appropriate for gestational age. Exclusion criteria were also used. The infants were randomly assigned to the experimental group or the comparison group. Data analysis included descriptive and inferential statistical techniques. The results demonstrated that swaddled infants had higher total scores on the MNNE as compared to infants with standard positioning. Swaddling appears to be a positioning technique that can enhance neuromuscular development of the very low birth weight infant.

Bedding and Linens↗
PubMed1995

Decreased CD7 expression in cutaneous infiltrates of HIV-1+ patients. Military Medical Consortium for the Advancement of Retroviral Research (MMCARR).

CD7 is an early T-cell marker that has been used in the diagnosis of stem cell leukemias. Loss of expression of CD7 with a battery of other mature T-cell markers has also been used as one criteria in the diagnosis cutaneous T-cell lymphomas. More recently, CD7-negative T cells have been shown to be a normal population of T cells in the peripheral blood and the skin, and may represent a mature T-cell population with a different pattern of maturation and activation. In addition, in HIV-1 disease expansion of CD7-negative T cells has been found in the peripheral blood. We evaluated the number of CD7-negative T cells in skin infiltrates to determine whether there was an increase of CD7-negative T cells. We studied T-cell markers including CD3, CD4, CD7, CD8, CD20, CD29, and HLA-DR on cutaneous biopsy material from inflammatory dermatoses in 57 patients with HIV-1 disease in Walter Reed stages (WR) 1-6, and in 14 HIV-1-negative patients WR0. The inflammatory infiltrates showed a moderate to marked decrease in CD7 expression on CD3+ T cells in benign inflammatory infiltrates of the majority of HIV-1+ patients. The majority of HIV-1-negative patients showed no decrease in CD7 expression, although 5 of 14 showed a moderate decrease and 1 of 14 showed a marked decrease. Although the nature of CD7- T cells has not been clearly defined, this population of mature T cells appears to have distinct immunologic properties as well as a trophism for skin. Better characterization of these T cells, as well as factors that promote their maturation and activation, may give clues to the high incidence as well as the pathogenesis of skin disease in HIV-1+ patients.

Antigens, CD20↗
PubMed1994

Cutaneous findings in HIV-1-positive patients: a 42-month prospective study. Military Medical Consortium for the Advancement of Retroviral Research (MMCARR).

BACKGROUND: Cutaneous disease is common in patients infected with HIV-1. OBJECTIVE: The aim of our study was to identify cutaneous markers associated with HIV-1 infection and disease progression as measured by Walter Reed (WR) stage. METHODS: For 42 months we have observed 912 HIV-1-positive patients in all WR stages. All patients had an extensive past and present medical history taken as well as a complete physical examination, periodic visits, and appropriate diagnostic procedures. RESULTS: Increasing dryness of the skin and seborrheic dermatitis are early findings in a large percentage of patients in WR stage 1; the occurrence and severity of both conditions increase with disease progression. Tinea infections, condylomata acuminata, and verrucae are seen early, but with disease progression, although there is no clear increase in occurrence, these infections become more diffuse and resistant to treatment. Flares in acne vulgaris and folliculitis show a peak occurrence in early and mid-stage disease with a decreased occurrence in late-stage disease. Herpes simplex infections, oral candidiasis, molluscum contagiosum, Staphylococcus aureus infections, and oral hairy leukoplakia show a marked increase in occurrence with advanced disease. Conditions that have a statistically significant association with disease progression as measured by a change in a stage include drug eruptions, seborrheic dermatitis, oral candidiasis, oral hairy leukoplakia, molluscum contagiosum, herpes zoster, and hyperpigmentation (nail, oral, skin). CONCLUSION: The most frequent and persistent cutaneous disorders were asteatosis (with or without asteatotic eczema) and seborrheic dermatitis. Conditions that were associated with a change in WR stage include drug eruptions, seborrheic dermatitis, oral candidiasis, oral hairy leukoplakia, molluscum contagiosum, herpes zoster, and hyperpigmentation. In addition to Kaposi's sarcoma, patients with HIV-1 disease have an increased potential for the development of both cutaneous epithelial and probably melanocytic malignancies. Epithelial tumors were seen in patients in all stages of disease.

AIDS-Related Opportunistic Infections↗
PubMed1993

Clinical features of inflammatory dermatoses in human immunodeficiency virus type 1 disease and their correlation with Walter Reed stage. Military Medical Consortium for Applied Retroviral Research.

BACKGROUND: As part of a military study of the natural history of human immunodeficiency virus type 1 (HIV-1) disease, all patients entered in the study were examined for cutaneous changes associated with HIV-1 infection. OBJECTIVE: Our purpose was to characterize and record the types of inflammatory dermatoses in a large number of HIV-1-infected patients to determine whether there was a correlation with the stage of disease. METHODS: The clinical findings in each case were compared with the results of cultures and biopsy specimens and correlated with Walter Reed stage. RESULTS: Most of the inflammatory dermatoses were maculopapular eruptions often with prominent follicular involvement, and in some there was a lichenoid component. With increasing Walter Reed stage, many eruptions become papulosquamous, some with psoriasiform scale and some with a hypertrophic lichenoid appearance. CONCLUSION: Although most of the inflammatory eruptions were nonspecific clinically, most cases showed features resembling those in graft-versus-host disease.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Histopathologic and immunohistochemical findings associated with inflammatory dermatoses in human immunodeficiency virus type 1 disease and their correlation with Walter Reed stage. Military Medical Consortium for Applied Retroviral Research.

BACKGROUND: Cutaneous lesions are common in patients with human immunodeficiency virus type 1 (HIV-1) infection. In many cases they are nonspecific inflammatory dermatoses. OBJECTIVE: Our goal was to determine whether features of these inflammatory dermatoses were characteristic of HIV-1 infection and whether the changes correlated with the stage of disease. METHODS: Biopsy specimens of inflammatory dermatoses from 176 HIV-1-infected patients in all Walter Reed stages were reviewed and the changes were compared with each WR stage. RESULTS: The changes found were nonspecific but were suggestive of features described in graft-versus-host disease and became more prominent in late-stage disease. CONCLUSION: A correlation was found between the changes and the stage of disease, and the findings add support to prior reports that at least some of the changes in HIV-1 infection may be autoimmune in origin.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Histologic features of foreign body reactions in patients infected with human immunodeficiency virus type 1. The Military Medical Consortium for Applied Retroviral Research.

BACKGROUND: Within a large population of patients seropositive for human immunodeficiency virus type 1 (HIV-1), seven had biopsy specimens that showed foreign body reactions with histologic features different from those seen in non-HIV-1-positive patients. OBJECTIVE: These cases were reviewed to determine whether there was a specific pattern of response to foreign bodies in HIV-1 infection and whether this pattern was related to the stage of disease. METHODS: Biopsy specimens were reviewed to identify ruptured epidermal cysts. These were studied in routine hematoxylin-and-eosin-stained sections and with immunohistochemical stains to characterize the inflammatory infiltrate. RESULTS: The lesions in HIV-1-infected patients contained abundant macrophages with evidence of decreased function and a lack of giant cells. CONCLUSION: These histologic features suggest an early functional deficit before there is a significant decrease in the number of T4 lymphocytes.

Acquired Immunodeficiency Syndrome↗
PubMed1993

Immunohistochemical features in inflammatory linear verrucous epidermal nevi suggest a distinctive pattern of clonal dysregulation of growth. Military Medical Consortium for the Advancement of Retroviral Research.

BACKGROUND: We studied biopsy material from four patients with inflammatory linear verrucous epidermal nevi (ILVEN) that had a psoriasiform appearance histologically and seven cases of linear epidermal nevi (LEN). Of the seven LEN, five showed hyperkeratosis, papillomatosis, and varying degrees of acanthosis; two had features of epidermolytic hyperkeratosis. Because these lesions have distinctive histologic patterns, we wanted to determine whether we could also demonstrate a distinctive pattern of immunohistochemical markers. METHODS: On all 11 cases we performed immunohistochemical stains for PCNA, factor XIIIa, MAC-387, UCHL-1, and OPD-4. In addition, on one case of ILVEN we performed ICAM-1, ELAM-1, and HLA-DR stains. RESULTS: The pattern of staining of PCNA, factor XIIIa, MAC-387, UCHL-1, and OPD-4 was distinctly different in ILVEN and LEN. Staining for ICAM-1 was present on keratinocytes, and ELAM-1 was present on endothelial cells in two cases of ILVEN. HLA-DR in these same two cases of ILVEN stained mainly dendritic cells in the epidermis. CONCLUSION: The different pattern of staining of PCNA, factor XIIIa, MAC-387, UCHL-1, and OPD-4 in LEN and ILVEN indicates a different mechanism of growth dysregulation. Stains for ICAM-1, ELAM-1, and HLA-DR in ILVEN suggest that an inability to down-regulate the inflammatory infiltrate may be important in the growth dysregulation in ILVEN. In addition, the onset of ILVEN at the time of HIV-1 infection in one patient suggests that HIV-1 infection may be one of many factors that initiates ILVEN in a susceptible person.

Adolescent↗
PubMed1993

Cutaneous neoplasms in a military population of HIV-1-positive patients. Military Medical Consortium for the Advancement of Retroviral Research.

BACKGROUND: In HIV-1-positive patients there have been no prospective studies that show an increase in cutaneous neoplasms. OBJECTIVE: We observed HIV-1-positive patients to determine whether or not there was an increased incidence of cutaneous malignancies. METHODS: A total of 724 HIV-1-positive patients were examined during a 36-month period for the development of cutaneous malignancies. RESULTS: The most common cutaneous neoplasm found was Kaposi's sarcoma, especially in patients with late-stage disease. Basal cell carcinomas were the next most frequent tumor. We have also seen three malignant melanomas and two squamous cell carcinomas. Five patients had malignant lymphoma. One patient had a primary lymphoma of subcutaneous soft tissue; in one patient multiple cutaneous lesions developed. CONCLUSION: The distribution and prevalent types of cutaneous neoplasms in HIV-1-positive patients appear to differ from those found in other immunosuppressed populations. This may be the result of the different patterns and periods of immunosuppression in these patients and/or associated cocarcinogens to which these patients frequently are exposed.

Adult↗
PubMed1993

Helistat absorbable collagen hemostatic sponges in cutaneous surgery in HIV-1+ patients. Military Medical Consortium for the Advancement of Military Medicine (MMCAR).

BACKGROUND: While biopsies are often required for adequate diagnosis of skin lesions in HIV-1 infected patients, these procedures result in the possible exposure of medical personnel to blood and contaminated instruments. To reduce exposure of medical personnel to contaminated needles we have used collagen sponges instead of sutures to control bleeding from punch biopsy sites in HIV-1 infected patients. METHODS: A collagen sponge was placed in all punch biopsy sites in HIV-1 infected patients. In cases where there was clinical evidence of local infection the sponges were removed 5-6 minutes after hemostasis was obtained. RESULTS: In over 500 biopsies in which Helistat collagen sponges were used, there have been no cases of secondary infection, and there have been no delays in healing. CONCLUSIONS: We believe that the use of these sponges provides a high degree of safety for the physician, which may assure that the commonly atypical clinical lesions seen in HIV-1 disease are biopsied. In addition, these sponges provide hemostasis, particularly significant in this patient population, and convenience, without a significant risk of secondary infection, and may provide some benefit in healing.

Absorption↗
PubMed1993

Concurrent HPV-16 infection of the nipple and perianal area in an HIV-1+ patient. Military Medical Consortium for the Advancement of Retroviral Research (MMCARR)

BACKGROUND: In patients with HIV-1 disease there has been an increasing association with human papilloma virus (HPV) infections in multiple locations as well as an increase in associated tumors. In addition, there has been increased recovery of HPV in individuals with decreasing T4 cell counts. CASE REPORT: Recently we have seen an HIV-1+ patient with a cutaneous lesion on the nipple, as well as multiple perianal lesions in which HPV-16 was demonstrated by in-situ hybridization. Although these lesions contained the same subtype of HPV virus, they had very different clinical and histopathologic morphologies, and this represents the first reported association of HPV-16 in a nipple lesion. DISCUSSION: Our patient illustrates that in HIV-1 disease, HPV infections may present in more diffuse and atypical locations. In addition, the diffuse staining with the in-situ probe for HIV-16 within the lesions, tends to support the findings of others, that viral recovery increases with the immune suppression induced by HIV-1.

AIDS-Related Opportunistic Infections↗