ABSTRACT
BACKGROUND: Little representative information exists on the frequency of human immunodeficiency virus (HIV)-related diseases among the overall AIDS population. The objective of this research is to assess the nature, frequency and characteristics of these diseases among AIDS patients during their last year of life and to analyse these frequencies according to the mode of transmission and other socio-demographic and medical characteristics. METHODS: To obtain comprehensive data, we conducted an investigation based on retrospective collection of clinical information on a representative sample (1203 deaths) of all AIDS deaths that occurred in France during 1992. RESULTS: The frequency of the diseases was markedly higher than the one described in the AIDS surveillance registers and varied between homosexuals and intravenous drug users (IVDU). After controlling for other variables (age, CD4 counts, survival times) by means of logistic regression, homosexuality remained a significant explaining factor for Kaposi's sarcoma, cytomegalovirus infections, herpes simplex and cryptosporidiosis. In contrast, HIV encephalopathy, hepatitis, mental disorders, invasive candidiasis and cachexia were more frequent in male IVDU. Few differences were observed by sex. CONCLUSIONS: Several factors may explain the differences: variation in exposure to infectious agents, general health status, use of medical care and direct influence of the mode of HIV transmission. These data are of particular value for medical services in planning the magnitude of health care needs among the AIDS population overall, for clinicians and researchers for advancing the understanding of the natural history of AIDS and in the definition of prophylactic strategies against opportunistic infections.
Subject(s)
HIV Infections/epidemiology , AIDS Dementia Complex/epidemiology , AIDS-Related Opportunistic Infections/epidemiology , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/epidemiology , Acquired Immunodeficiency Syndrome/transmission , Adult , Cause of Death , Female , France/epidemiology , HIV Infections/complications , HIV Infections/transmission , Humans , Logistic Models , Male , Multivariate Analysis , Random Allocation , Retrospective Studies , Risk FactorsSubject(s)
Gastritis/complications , Stomach Neoplasms/etiology , Aged , Aged, 80 and over , Chronic Disease , Female , Gastritis/pathology , Humans , Male , Middle Aged , Stomach Neoplasms/pathologySubject(s)
Cholangitis/diagnosis , Adult , Biliary Tract/pathology , Biliary Tract Neoplasms/diagnosis , Cholangitis/pathology , Cholangitis/surgery , Female , Humans , Liver/pathology , Male , Middle Aged , SclerosisABSTRACT
On the basis of about one hundred and fifty cases, the authors study the effect of oral contraceptives on the gall-bladder. After having showed their results, they discuss the mechanism of the action of oral contraceptives on the gall-bladder, showing their favouring effect on gallstones and pointing out the delay in gall-bladder emptying induced by them.
Subject(s)
Contraceptives, Oral/adverse effects , Gallbladder Diseases/chemically induced , Animals , Bile/drug effects , Bile/metabolism , Cholecystography , Cholelithiasis/chemically induced , Cholelithiasis/diagnosis , Contraceptives, Oral/administration & dosage , Dogs , Female , Gallbladder/drug effects , Gallbladder/pathology , Gallbladder Diseases/diagnosis , Gallbladder Diseases/therapy , Guinea Pigs , Humans , Pregnancy , Progestins/adverse effects , RabbitsABSTRACT
The authors report seven cases of carcinomas of the lower oesophagus with peptic lesions. Based on clinical, endoscopical and histological criteria, they point out these peptic lesions preceded the carcinoma in all the cases certainly or very probably. They emphasize at last two cases where the peptic lesions after a strict supervision during many years, gave place, in spite of it all, to a cancerous transformation.
Subject(s)
Adenocarcinoma/etiology , Carcinoma, Squamous Cell/etiology , Esophageal Neoplasms/etiology , Esophagitis, Peptic/complications , Adult , Aged , Female , Humans , Male , Middle AgedABSTRACT
Studying morbidity according to age and sex in persons decreased at hospital, the authors point out that many illnesses grow in frequency with age. Very often too, illnesses grow in number with age; but this is not constant. At last, this study allows to state the behaviour of old people before illness and the influence of senescence on the terminal evolution.
Subject(s)
Mortality , Adult , Age Factors , Aged , Disease , Female , Hospitals , Humans , Male , Middle Aged , Paris , Sex FactorsABSTRACT
Based on two cases, the authors recall the anatomical lesions of the liver occurring at times in women using oral contraceptives: jaundice, benign tumors, vascular lesions; and they emphasize more particularly the vascular lesions and their relation with oral contraceptives.
PIP: The authors describe 2 observations of anatomical lesions of the liver related to the use of oral contraceptives. They remind of the different forms of lesions of the liver observed in women using oral contraceptives: jaundice (although this form has become relatively rare), benign liver tumors and vascular lesions. Some hepatic alterations provoked by oral contraceptives are very similar to lesions observed during pregnancy. Experiments performed on animals have shown the influence of sex hormones in hepatic tumors: a prolonged administration of high doses of extrogens increases the carcinogenic action of acetylaminofluoren in the female while the occurence of tumors is not increased in males treated in the same fashion. In males as well as females, testosterone has a stimulating effect on the development of hepatic tumors. It is concluded that clinicians should be aware of the hepatic risks carried by oral contraception.
Subject(s)
Chemical and Drug Induced Liver Injury , Contraceptives, Oral/adverse effects , Liver Neoplasms/chemically induced , Liver/drug effects , Adult , Female , Humans , Liver/blood supplyABSTRACT
The authors report seven cases of carcinomas of the lower third of the esophagus developed on lesions of peptic esophagitis. These lesions precede the carcinoma. They can be real precancerous states and even in situ carcinomas whose evolution over several years could be proved indeed. They argue about the therapeutical indications in peptic esophagitis considering not only that such a cancerous transformation is always possible but also the fact that a surgical ablation is always serious.
Subject(s)
Adenocarcinoma/etiology , Carcinoma, Squamous Cell/etiology , Esophageal Neoplasms/etiology , Esophagitis, Peptic/complications , Precancerous Conditions , Adenocarcinoma/therapy , Aged , Carcinoma, Squamous Cell/therapy , Esophageal Neoplasms/therapy , Esophagitis, Peptic/therapy , Female , Follow-Up Studies , Humans , Male , Middle AgedABSTRACT
By opposition to acute post-operative ischaemic enterocolitis, the authors isolate, with the aid of seven cases, the intestinal lesions which spontaneously occur on the small intestines and on the colon and due to an ischaemic mechanism without thrombosis of the mesenteric vessels. After the description of clinical and anatomical features, they point out the main part of the vascular factor in the genesis of the lesions.
Subject(s)
Colitis/etiology , Colon/blood supply , Enteritis/etiology , Intestine, Small/blood supply , Ischemia/pathology , Aged , Colitis/pathology , Colitis/physiopathology , Colon/pathology , Enteritis/pathology , Enteritis/physiopathology , Female , Humans , Intestine, Small/pathology , Ischemia/physiopathology , Male , Middle AgedSubject(s)
Aging , Hospital Mortality , Adolescent , Adult , Aged , Aged, 80 and over , Alzheimer Disease/mortality , Female , France/epidemiology , Humans , Male , Middle Aged , Morbidity , Retrospective StudiesABSTRACT
Based on a series of 159 cases of headache during oral contraception, the authors confirm the part plainly favouring and aggravating of oral contraceptives on headaches. They are dominated by the frequency of migraines and happen with predilection at the time of hormonal weaning. We deduct from this, that oral contraceptives generally aggravate or reveal a latent sensitivity to hormonal variations, especially clear with older women.
Subject(s)
Contraceptives, Oral/adverse effects , Headache/chemically induced , Adult , Age Factors , Estrogens/adverse effects , Female , Follow-Up Studies , Humans , Menstruation , Migraine Disorders/chemically induced , Progestins/adverse effects , Psychophysiologic Disorders/chemically induced , Time FactorsABSTRACT
The authors report a few unusual cases of Crohn's disease of the colon and discuss the diagnostic problems which are raised in such cases. They then review the various colonic diseases liable to be considered in a differential diagnosis, and which may be linked to colonic Crohn's disease, e.g. ulcerative colitis, intestinal tuberculosis, carcinoma of the colon, colonic diverticulosis and sarcoidosis. In a chapter on treatment, they emphasize the favourable effect of acexamic acid and the necessity for very wide colonic resection, and they note a complication which they encountered during surgery for Crohn's disease: lymphatic peritonitis on the 8th day after right colectomy.
Subject(s)
Crohn Disease , Acute Disease , Adult , Aged , Colectomy , Colitis, Ulcerative/diagnosis , Colon/pathology , Colonic Neoplasms/diagnosis , Crohn Disease/diagnosis , Crohn Disease/therapy , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Sarcoidosis/diagnosis , Tuberculosis, Gastrointestinal/diagnosisABSTRACT
The authors have observed on two occasions, a diffuse peritoneal syndrome in the post-operative period after right hemi-colectomy for Crohn's disease, and interpret, in the absence of complications at the level of the anastomosis, as peritonitis due to septic lymphorrhea. According to them, it does not seem that this syndrome has the same significance as that described following appendicectomy in children.
Subject(s)
Colectomy/adverse effects , Crohn Disease/surgery , Lymphatic Diseases/etiology , Peritonitis/etiology , Adult , Appendectomy/adverse effects , Colon/pathology , Crohn Disease/pathology , Female , Humans , Lymphatic Diseases/pathology , Male , Peritonitis/pathology , Postoperative ComplicationsSubject(s)
Contraceptives, Oral/adverse effects , Infarction/chemically induced , Intestinal Diseases/chemically induced , Colitis/chemically induced , Colitis, Ulcerative/chemically induced , Contraceptives, Oral/therapeutic use , Crohn Disease/etiology , Diarrhea/chemically induced , Female , Humans , PregnancyABSTRACT
PIP: The only intestinal complications of oral contraception, besides occasional diarrhea, are ischemic colitis, intestinal infarction, and acute ulcerative colitis. Ischemic colitis, the most common of the 3, is usually localized in the left colon, is due to intravascular coagulation, and resolves on stopping the pill. Intestinal infarction is rare but sometimes fatal, and usually occurs after thrombosis of the superior mesenteric artery. Acute ulcerative colitis is often severe but clears up on stopping the pill, although the etiologic role of the pill is in dispute. 1 case of severe Crohn's disease in a pill user was observed. This disorder is known to occur in pregnancy, but has not previously been associated with oral contraception.^ieng