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Biomedical subjects

M S Cappell

Publications and source records attributed to M S Cappell.

At least 91 records · Page 5Linked to original sources
PubMed1991

Hepatobiliary manifestations of the acquired immune deficiency syndrome.

Patients with the acquired immune deficiency syndrome (AIDS) frequently develop hepatic dysfunction. Although hepatic injury may indirectly result from malnutrition, hypotension, administered medications, sepsis, or other conditions, the hepatic injury is frequently due to opportunistic hepatic infection, directly related to AIDS. Infection with Mycobacterium avium intracellulare typically occurs in patients with advanced immunocompromise and with systemic symptoms due to widely disseminated infection. In contrast, hepatic tuberculosis often occurs with less advanced immunocompromise. Cytomegaloviral infection may produce a hepatitis. Cytomegaloviral and cryptosporidial infections have been implicated as causes of acalculous cholecystitis and of a secondary sclerosing cholangitis. About 10-20% of patients with AIDS have chronic hepatitis B infection. These patients tend to develop minimal hepatic inflammation and necrosis. The clinical findings in patients with hepatic cryptococcal infection are usually due to concomitant extrahepatic infection. Hepatic histoplasmosis usually develops as part of a widely disseminated infection with systemic symptoms. Hepatic involvement by Kaposi's sarcoma is rarely documented ante mortem because an unguided liver biopsy is an insensitive diagnostic procedure. Patients with non-Hodgkin's lymphoma of the liver typically have lymphadenopathy, hepatomegaly, and systemic symptoms. As a pragmatic approach, patients with liver dysfunction and HIV-related disease should have a sonographic or computerized tomographic examination of the liver. Patients with dilated bile ducts should undergo endoscopic retrograde cholangiopancreatography because opportunistic infection may produce biliary obstruction. Patients with a focal hepatic lesion should be considered for a guided liver biopsy. Patients with a significantly elevated serum alkaline phosphatase level should be considered for a percutaneous liver biopsy. When performed for these indications, liver biopsy will demonstrate a significant disease involving the liver in about 50% of patients with AIDS and in about 25% of patients who are HIV seropositive but who are not known to have AIDS. The clinical impact of a diagnostic biopsy is blunted by a lack of efficacious therapy for many opportunistic infections.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Appendiceal infection by Entamoeba histolytica and Strongyloides stercoralis presenting like acute appendicitis.

A 58-year-old male from Puerto Rico who was taking orally administered cortisone analogs for chronic obstructive pulmonary disease presented with fever, absolute eosinophilia, right lower quadrant pain, and rebound tenderness associated with Strongyloides stercoralis infection of the appendix. A 37-year-old alcoholic male developed fever, right lower quadrant abdominal pain, and rebound tenderness because of infection of the appendix with Entamoeba histolytica. These are the seventh reported case of isolated amebic appendicitis and the ninth reported case of appendiceal involvement with Strongyloides. In all these cases the diagnosis was made only after surgery. Patients with unexplained right lower quadrant pain, particularly if immunosuppressed or with an appropriate travel history, should have stool examinations for ova and parasites. Early diagnosis and treatment may prevent life-threatening complications such as perforation and peritonitis.

Adult↗
PubMed1990

Clinical utility of liver biopsy in patients with serum antibodies to the human immunodeficiency virus.

PURPOSE: Patients with the acquired immunodeficiency syndrome (AIDS) frequently have liver dysfunction, which may be due to a number of causes. Determination of the patients who are likely to benefit from liver biopsy, an invasive procedure, is therefore important. In this study, the results of liver biopsy in patients with AIDS were compared to those in human immunodeficiency virus (HIV)-infected patients without AIDS. PATIENTS AND METHODS: Thirty-six consecutive patients with antibodies to HIV present in the serum underwent liver biopsy from 1984 through 1988 at the Bronx Municipal Hospital. Twenty (56%) of the patients had AIDS diagnosed prior to the liver biopsy. Indications for the liver biopsy were unexplained fever in 83%, and abnormal serum levels of biochemical parameters of liver function in 89%. RESULTS: Liver biopsy was diagnostic in 18 cases (50%), including findings of hepatic infection by mycobacteria in 15, cytomegalovirus in two, and schistosoma in one; these infections had been previously detected at an extrahepatic site in only two cases. Helpful clinical information in 10 others included findings of granulomas of undetermined etiology in four, cirrhosis in five, and chronic persistent hepatitis in one. Patients with a diagnostic biopsy, as compared to patients with a nondiagnostic biopsy, had a statistically significant increase in the frequency of having AIDS diagnosed before the biopsy, longer duration of AIDS (in patients with AIDS diagnosed before the biopsy), greater number of different prior opportunistic infections, and a more elevated serum alkaline phosphatase level. For example, 70% of patients with AIDS, as compared to 25% of patients with serum antibodies to HIV but without AIDS, had diagnostic liver biopsies. Patients with a diagnostic biopsy also had statistically significantly more frequent pulmonary symptoms, possibly due to more frequent occurrence of Pneumocystis carinii pneumonia. In particular, the 15 patients with hepatic mycobacterial infection, as compared to the other patients, had a statistically significant increase in the frequency of having AIDS diagnosed prior to the biopsy, longer duration of AIDS, more frequent prior opportunistic infections, more severe leukopenia, and a more elevated serum alkaline phosphatase level. Liver biopsy was more sensitive than bone marrow aspiration and biopsy at detecting mycobacterial infection. CONCLUSION: Liver biopsy, when indicated, is useful to detect opportunistic infection in HIV-infected patients who are not known to have AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Pancreatic abscess due to mycobacterial infection associated with the acquired immunodeficiency syndrome.

Two patients with a history of intravenous drug abuse developed a pancreatic abscess due to mycobacterial infection as their initial evident opportunistic infection in association with the acquired immunodeficiency syndrome (AIDS). This presentation of mycobacterial infection has been previously reported in nine patients. The two patients reported here are the second and third reported cases in association with AIDS. As this entity should be considered a cause of a pancreatic lesion in immunosuppressed patients, fluid drained from a pancreatic abscess should have histologic stains and cultures for mycobacteria.

Abscess↗
PubMed1990

Recurrent massive upper gastrointestinal hemorrhage due to Strongyloides stercoralis infection.

A 29-yr-old black male immigrant from Africa presented with recurrent life-threatening upper gastrointestinal bleeding due to massive duodenal infection by Strongyloides stercoralis. The diagnosis was missed by repeated examinations of fresh stool specimens for ova and parasites and by an initial esophagogastroduodenoscopy. The diagnosis was made by pathologic examination of a duodenal biopsy and of a duodenal aspirate obtained at a second esophagogastroduodenoscopy. This has been previously reported as a cause of massive upper gastrointestinal hemorrhage in four cases. Patients with obscure gastrointestinal bleeding who have travelled or lived in an endemic area should have a duodenal aspiration performed at esophagogastroduodenoscopy.

Adult↗
PubMed1990

Profound spatial clustering of polyps in individuals with multiple nonmalignant polyps of the stomach and duodenal bulb: a combined endoscopic and radiographic study.

An individual's simultaneous nonmalignant gastroduodenal polyps were profoundly spatially clustered in a combined endoscopic and radiographic study of 41 consecutive patients. With endoscopic polyp localization, clustering was demonstrated using a nonparametric test of clustering (Kruskal-Wallis statistic with 40 degrees of freedom = 113.35, probability of observing this extreme statistic with no clustering less than 0.0005) and a parametric test of clustering (F test statistic with 40 and 104 degrees of freedom = 17.05, probability of observing this extreme statistic with no clustering less than 0.0005). In the 26 patients with radiographic polyp localization, polyp clustering was confirmed with the same statistical techniques (e.g., Kruskal-Wallis statistic with 25 degrees of freedom = 88.2, probability of observing this extreme statistic with no clustering less than 0.0005). In patients whose largest polyp was in any given region, there was an increased likelihood that their other polyps would be in that same region. For example, at endoscopy, the nine patients whose largest polyp was in the duodenal bulb had 13 of 15, or 87% +/- 9% (SE), of their other polyps in the duodenal bulb. In contrast, the 11 patients who, at endoscopy, had their largest polyp in the proximal stomach had 2 of 30, or 7% +/- 5% (SE), of their other polyps in the duodenal bulb. Polyp clustering was not dependent on the number of gastroduodenal polyps, or patient age or sex. Patients with at least one hyperplastic polyp, one adenomatous polyp, or with both types of polyps also exhibited profound polyp clustering. These findings suggest that local factors may be important in the pathogenesis of multiple polyps of the stomach and duodenal bulb. In particular, these findings suggest a possibly closer relationship between hyperplastic and adenomatous gastroduodenal polyps than previously appreciated.

Aged↗
PubMed1990

Colonic lesions associated with Henoch-Schonlein purpura.

Two patients with Henoch-Schonlein purpura had occult heme-positive stools and numerous punctate erythematous lesions in the colon, observed on colonoscopy. The colonic lesions resembled in appearance the cutaneous lesions present on the lower extremities in both patients. It is possible that these colonic lesions are the cause of the occult gastrointestinal bleeding frequently associated with Henoch-Schonlein purpura.

Aged↗
PubMed1989

Neuronal analysis of pharyngeal peristalsis in the gastropod Navanax in terms of identified motoneurons innervating identified muscle bands. I. Muscle band identifiability.

The neuronal basis of pharyngeal ingestion and swallowing can be conveniently studied in the marine mollusc Navanax inermis because of the small number of neurons involved in the behavior, reproducible identifiability of many individual neurons and simple muscle arrangement. The Navanax pharynx contains 3 approximately orthogonal muscle groups, circumferential, longitudinal and radial, arranged in well defined layers. Pharyngeal peristalsis involves sequential circumferential constriction, apparently with coordinated local pharyngeal expansion produced by radial muscle. Circumferential and longitudinal muscles consist of discrete, well defined bands. The number, position and arrangement of circumferential and longitudinal bands show little interanimal variability; these bands are individually identified by sequential number. Regional morphologic specializations of circumferential bands presumably facilitate peristalsis. Circumferential and longitudinal bands form a two dimensional reference system defining position on the pharyngeal surface. In the accompanying paper circumferential motor fields are described in terms of identified motoneurons innervating identified bands, and radial motor fields are located with respect to the coordinate system of overlying longitudinal and circumferential bands.

Animals↗
PubMed1989

Neuronal analysis of pharyngeal peristalsis in the gastropod Navanax in terms of identified motoneurons innervating identified muscle bands. II. Radial and circumferential motor fields.

The neuronal basis of pharyngeal ingestion and peristalsis was studied in the gastropod Navanax inermis. Radially and circumferentially oriented muscles produce expansion and constriction of the pharynx. Motor fields of 11 identified radial motoneurons and 13 identified circumferential motoneurons were determined with respect to circumferential and longitudinal muscle band coordinates by muscle movements, electromyography, antidromic stimulation and axonal anatomy. Activation of these identified motoneurons can account for all the elemental pharyngeal movements observed during feeding. Four motoneurons, each innervating most of radial muscle, can mediate ingestion. Three radial motoneurons with anterior motor fields can mediate anterior expansion during sealing of the pharyngeal lips around prey and during regurgitation. Ten circumferential motoneurons have small arciform motor fields, the distributions of which correspond to the regional specializations in circumferential band organization. Arciform constriction can center eccentric ingested prey within the pharyngeal lumen during peristalsis. Arciform constrictions could combine to form an annular constriction in peristalsis. Small, non-overlapping, circumferential motor fields maximize the number of independent annular units available to produce a fine peristaltic wave. Sphincters have more circumferential motoneurons with smaller motor fields; this innervation permits finer motor control. Radial motoneurons with posterior motor fields can produce expansion caudal to a circumferential constriction during peristalsis. Motor fields of regional radial motoneurons show greater interanimal variability than circumferential motor fields, which is correlated with a less essential role of radial motoneurons in peristalsis. Two circumferential motoneurons with giant posterior pharyngeal motor fields can mediate pharyngeal emptying either in swallowing or in regurgitation.

Action Potentials↗
PubMed1989

Pentamidine-associated pancreatitis.

Two patients without risk factors or a prior history of pancreatitis developed acute pancreatitis soon after initiating pentamidine isethionate therapy for Pneumocystis carinii pneumonia associated with the acquired immunodeficiency syndrome. In both patients the pancreatitis improved following medication cessation. One patient did not redevelop pancreatitis when he subsequently received inhaled pentamidine. Review of the literature revealed five previously reported cases of this drug reaction. Pentamidine-associated pancreatitis appears to develop within three weeks of initiating therapy and after receiving more than 1 g in cumulative dosage. Glucose abnormalities, renal insufficiency, and non-specific abdominal pain may be early warning signs of pentamidine-associated pancreatitis.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Spatial clustering of multiple hyperplastic, adenomatous, and malignant colonic polyps in individual patients.

Analysis of relative polyp locations in 426 consecutive patients with multiple colonic polyps found on colonoscopy showed novel findings. First, synchronous and metachronous neoplastic polyps showed spatial clustering in individual patients. For example, patients with their largest neoplasm in the cecum or proximal ascending colon, had 34.3 percent +/- 4.6 percent (standard error) of their other colonic neoplasms in the same location. Second, hyperplastic polyps showed spatial clustering in individuals that was statistically significantly greater than expected from the increased hyperplastic polyp concentration in the rectum and sigmoid. Third, hyperplastic polyps showed spatial clustering with neoplastic polyps; this clustering was similar in magnitude to clustering for exclusively hyperplastic or neoplastic polyps. In contrast, lipomas were not spatially clustered with hyperplastic and neoplastic polyps. The magnitude of clustering between hyperplasia and neoplasia showed a closer association between these histologic types than previously appreciated. Because of clustering, regions with prior polyps appear to merit closer surveillance. These findings suggest clinical study, using a randomized controlled clinical trial, of whether a patient who had only rectal and sigmoid adenomas on initial and follow-up colonoscopy should have surveillance with flexible sigmoidoscopy alternating annually with colonoscopy. A patient with a prior cecal adenoma should have surveillance only with a complete colonoscopy or adequate cecal views on barium enema.

Adenoma↗