ABSTRACT
The purpose of this study was to determine the extent and outcome of antifungal treatment in HIV/AIDS patients. Data obtained from patients attending a hospital-based, semi-urban comprehensive care HIV clinic, were retrospectively analysed. The clinic serves patients from urban, semi-urban and rural communities. A total of 751 confirmed black heterosexual HIV/AIDS patients received routine oral examinations and surveillance swabbing for oral yeast culture. Patients received nystatin solution as prophylaxis, miconazole for clinically detectable oral candidiasis and only in severe cases or cases of chronic candidiasis were they treated with either fluconazole or itraconazole. Treatment was regarded as successful when there was an absence or resolution of clinical lesions of oral candidiasis. Nystatin prophylaxis was prescribed to 7.9% of patients, miconazole treatment to 9.7% and 3.5% received fluconazole. Of the 60 patients who received nystatin prophylaxis, 40 (66.6%) had clinically detectable candidiasis. A negative statistical correlation was found between nystatin prophylaxis and clinically detectable candidiasis. Of 72 patients who received miconazole treatment, only 3 failed to respond. Eleven of the 27 patients who received fluconazole treatment did not return for follow-up visits. In the remaining 16 patients there was no recurrence of clinical symptoms during the following 3 - 24 months after treatment with fluconazole. It is concluded that nystatin prophylaxis proved not to be effective under these particular clinical circumstances. Resistance to azole antifungal medication is not yet a problem in this black heterosexual group of South African HIV/AIDS patients.
Subject(s)
AIDS-Related Opportunistic Infections/drug therapy , Candidiasis, Oral/drug therapy , AIDS-Related Opportunistic Infections/prevention & control , Adolescent , Adult , Aged , Antifungal Agents/therapeutic use , Candidiasis, Oral/prevention & control , Chemoprevention , Chronic Disease , Cohort Studies , Comprehensive Health Care , Female , Fluconazole/therapeutic use , Follow-Up Studies , Heterosexuality , Humans , Itraconazole/therapeutic use , Male , Miconazole/therapeutic use , Middle Aged , Nystatin/therapeutic use , Population Surveillance , Retrospective Studies , South Africa , Treatment OutcomeABSTRACT
Forty-one consecutive open-chest cardiac procedures requiring sternal retractors for visualization were prospectively studied. Chest x-rays demonstrating the course of the introducer sheaths and pulmonary artery catheters (PACs) were taken before and after sternal retractor expansion. Five different introducer sheath insertion sites were monitored (right internal jugular, left internal jugular, left subclavian, right subclavian, and right supraclavicular). The incidence of permanent loss of pulmonary artery (PA) and central venous pressure (CVP) waveforms was recorded after retractor expansion. Forty-five percent of both the left and right subclavian groups suffered loss of the PA and CVP waveforms, whereas none of the other insertion site groups was affected. Therefore, it is recommended that PACs inserted for surgery requiring sternal retractors be placed via nonsubclavian routes.
Subject(s)
Catheterization, Swan-Ganz/methods , Central Venous Pressure , Sternum/surgery , Cardiac Surgical Procedures , HumansABSTRACT
The cytomorphologic features of a case of giant lymph node hyperplasia, hyaline-vascular type, obtained by fine needle aspiration is described. Cytochemical studies of the vascular structures present in the aspirate suggest their origin as capillaries.
Subject(s)
Lymph Nodes/pathology , Aged , Biopsy, Needle , Capillaries/pathology , Cell Nucleolus/pathology , Cell Nucleus/pathology , Cytoplasm/pathology , Humans , Hyperplasia , Lymphocytes/pathology , Male , Staining and LabelingABSTRACT
Pressure sores occur frequently in patients with spinal cord injuries and require radiographic evaluation for adequate management. Plain radiography, computed tomography, direct magnification radiography, sinography, and ultrasonography were used to evaluate 218 pressures sores. The role of each of these modalities in the management of patients with pressure sores is defined, and recommendations for their use are made.
Subject(s)
Pressure Ulcer/diagnostic imaging , False Positive Reactions , Humans , Osteomyelitis/diagnostic imaging , Osteomyelitis/etiology , Pressure Ulcer/complications , Pressure Ulcer/etiology , Spinal Cord Injuries/complications , Tomography, X-Ray Computed , UltrasonographyABSTRACT
An aspiration guided by ultrasound of a clear cell renal adenocarcinoma provided abundant, well-preserved material. Surgical specimens of the granular and sarcomatoid (spindle cell) varieties of renal adenocarcinoma were aspirated with the same gauge needle as that of the Chiba University. The cytomorphologic appearances of these entities are described.
Subject(s)
Adenocarcinoma/pathology , Biopsy, Needle/methods , Kidney Neoplasms/pathology , Ultrasonics , Aged , Cytodiagnosis , Female , HumansABSTRACT
A pancreatic aspirate was obtained by fine needle biopsy guided by ultrasound in a patient clinically suspected of having a pancreatic malignancy. The cytomorphologic features of well-differentiated adenocarcinoma are described and illustrated. Comparison is made between the carcinoma and normal pancreatic cells. PAS-Trichrome stain is described as a useful cytochemical technique to properly identify normal acinar and islet cells.
