ABSTRACT
BACKGROUND: 'Elite controllers' are rare HIV-infected individuals who are able to spontaneously control HIV replication without medication, maintaining viral loads that are consistently below the limits of detection by currently available commercial assays. OBJECTIVE: To examine studies of elite controllers that may elucidate mechanisms of HIV immune control useful in designing a vaccine. METHODS: Recent literature on HIV controllers and studies that have evaluated aspects of viral and host immunology that correlate with viral control are examined. RESULTS/CONCLUSIONS: Although many elements of innate and adaptive immunity are associated with control of HIV infection, the specific mechanism(s) by which elite controllers achieve control remain undefined. Ongoing studies of elite controllers, including those examining host genetic polymorphisms, should facilitate the definition of an effective HIV-specific immune response and guide vaccine design.
Subject(s)
AIDS Vaccines/immunology , HIV Infections/prevention & control , APOBEC-3G Deaminase , Antiviral Restriction Factors , CD4-Positive T-Lymphocytes/immunology , Carrier Proteins/physiology , Cytidine Deaminase/physiology , Genes, MHC Class I , HIV/genetics , HIV/physiology , HIV Infections/genetics , HIV Infections/immunology , HLA-B Antigens/genetics , Humans , Immunity, Innate , Interleukin-10/physiology , Receptors, CCR5/genetics , T-Lymphocytes, Cytotoxic/immunology , T-Lymphocytes, Regulatory/physiology , Toll-Like Receptors/physiology , Tripartite Motif Proteins , Ubiquitin-Protein Ligases , Virus ReplicationABSTRACT
Tracheal obstruction and superior vena cava (SVC) syndrome are rare complications of retrosternal goiter. These two conditions present a difficult diagnostic and therapeutic challenge. Malignancy is the most common cause of SVC syndrome. Determining whether SVC syndrome is due to a benign or malignant process is imperative before instituting treatment, but this determination may be difficult. We present a case of a patient presenting with upper airway obstruction and SVC syndrome with a large mediastinal mass. The mass was determined to be a multinodular goiter. The patient was managed by surgical removal of the goiter with complete resolution of symptoms. This case illustrates the need for careful preoperative evaluation and the importance of establishing a histologic diagnosis prior to initiating treatment for SVC syndrome.
Subject(s)
Airway Obstruction/etiology , Goiter, Nodular/complications , Goiter, Substernal/complications , Superior Vena Cava Syndrome/etiology , Tracheal Diseases/etiology , Female , Follow-Up Studies , Humans , Middle AgedABSTRACT
The treatment of patients with differentiated carcinoma of the thyroid is a controversial subject. This article discusses the authors' approach in the clinical practice. A description of the various types of papillary and follicular carcinoma is presented. Diagnostic tests, biologic behavior, and management are reviewed.
Subject(s)
Adenocarcinoma/surgery , Carcinoma, Papillary/surgery , Thyroid Neoplasms/surgery , Thyroidectomy/methods , Adenocarcinoma/diagnosis , Adolescent , Adult , Age Factors , Carcinoma, Papillary/diagnosis , Diagnosis, Differential , Female , Humans , Iodine Radioisotopes/administration & dosage , Lymphatic Metastasis , Male , Middle Aged , Neck Dissection/methods , Postoperative Care , Radiotherapy Dosage , Sex Factors , Thyroid Gland/pathology , Thyroid Gland/surgery , Thyroid Neoplasms/diagnosisABSTRACT
Synchronous parotid neoplasms are rare. Unilateral, synchronous neoplasms of two separate and histologically distinct types are extremely unusual. Our review of the literature revealed 31 previously reported cases. We add two additional cases found in 291 parotid neoplasms seen in our institutions over the last 10 years; both including a pleomorphic adenoma and a Warthin's tumor. This combination was found in 15 of 33 cases, while Warthin's tumors were found in association with another tumor in 24 of 33 reported cases (82%).
Subject(s)
Adenolymphoma/pathology , Adenoma, Pleomorphic/pathology , Neoplasms, Multiple Primary/pathology , Parotid Neoplasms/pathology , Aged , Female , Humans , Middle AgedABSTRACT
We report the sixth known case of a pleomorphic adenoma of the external auditory canal. It manifested as an aural polyp, and the diagnosis was made only after microscopic pathologic examination. Complete removal was accomplished after a total parotidectomy (with preservation of the facial nerve) provided access to the parapharyngeal space surrounding the internal carotid artery, where it is postulated that the tumor originated. A thorough knowledge of the developmental anatomy of this area greatly enhances operative success.
