Primary gastrointestinal non-Hodgkin's lymphoma: increasingly AIDS-related.

A retrospective study was conducted to determine the influence of the acquired immunodeficiency syndrome (AIDS) epidemic on the incidence, clinical presentation, and outcome of primary gastrointestinal lymphoma (stages I and II) over a 20-year period at a single institution. Between 1971 and 1981, there were seven cases. Fifty-eight patients were diagnosed between 1983 and 1993, and 81 per cent were AIDS-related. The mean age overall was 50 years; 81 per cent were male, and 35 per cent presented with acute complications. All tumors were high or intermediate grade B cell lymphomas, and 48 per cent had bulky or advanced disease at presentation. The overall actuarial 5-year survival was 9 per cent. Human immunodeficiency virus status and stage were significant independent prognostic factors. The AIDS-related subgroup had a mean age of 43 years, and 91 per cent were male. Tumor resection was performed in 38 per cent, and the 5-year survival was 2 per cent. The mean age for the non-AIDS-related subgroup was 71 years, and 55 per cent were male. Resection was performed in 39 per cent, and 5-year survival was 28 per cent. AIDS-related disease accounted for the dramatic increase in incidence of primary gastrointestinal lymphoma since 1983. The prognosis for these patients is poor and is dominated by the underlying immunocompromise.

Appendicitis in patients with acquired immunodeficiency syndrome.

BACKGROUND: Previous reports evaluating appendicitis in patients with human immunodeficiency virus/ acquired immunodeficiency syndrome have detailed unusual pathology, atypical clinical presentations, and poor outcomes. These reports have described small groups of patients and are inconsistent with larger surveys. STUDY DESIGN: A retrospective design was used to evaluate patients diagnosed with human immunodeficiency virus or acquired immunodeficiency syndrome undergoing appendectomy from 1986 to 1995. RESULTS: Fifty-five patients were evaluated (mean age 33.4 +/- 8.2 years, 98 percent male, 90 percent clinical acquired immunodeficiency syndrome, CD4 count 144.45 +/- 34 cells/mL3). Presenting symptoms included right lower quadrant pain (91 percent), nausea and vomiting (41 percent), diarrhea (22 percent), and generalized abdominal pain (24 percent). Significant findings on examination included right lower quadrant tenderness (91 percent), rebound (74 percent), fever (54 percent), abdominal distention (7 percent), and generalized abdominal tenderness (9.3 percent). Computed tomography was performed in 26 percent and findings were suggestive of appendicitis in 93 percent of cases. Operative findings included acute inflammation (83.3 percent), appendiceal rupture (24 percent), gangrene (29 percent), and normal-appearing appendices (5.5 percent). Unusual findings included Mycobacterium tuberculosis (1.8 percent), atypical mycobacterium (1.8 percent), and chronic appendicitis (3.7 percent). Thirty-day survival was 100 percent. Significant postoperative fevers were noted in 33 percent and lasted 4.63 +/- 1.2 days. The presence of prolonged postoperative fever was linked to lower CD4 counts (p = .05). Follow-up (mean time to follow-up, 1,656 +/- 970 days) was complete in 43 percent. Survival at follow-up was noted in 57.1 percent (mean length of survival after surgery, 837 +/- 155 days). CONCLUSIONS: Appendectomy in patients with human immunodeficiency virus/acquired immunodeficiency syndrome is associated with little morbidity or mortality. Atypical pathology is rarely identified. A higher than expected rate of rupture may be linked to delays before hospitalization or to impaired immune status.

The role of cholecystectomy in acquired immunodeficiency syndrome.

BACKGROUND: Hepatobiliary disease is a common manifestation of acquired immunodeficiency syndrome, although the role of surgical intervention in the spectrum of therapy is unclear. STUDY DESIGN: A retrospective review was designed to evaluate the characteristics of patients given a diagnosis of human immunodeficiency virus infection or acquired immunodeficiency syndrome and undergoing cholecystectomy between January 1, 1986, and November 1, 1995. RESULTS: The study included 40 patients (35 men, 5 women; mean age, 42 +/- 9 years), 33 (82.5 percent) with acquired immunodeficiency syndrome; their mean preoperative T-helper (CD4) cell count was 163/mL3. Gross pathologic findings included acute (n = 9, 22.5 percent) and chronic (n = 31, 77.5 percent) cholecystitis. Gallbladder specimens were positive for cholelithiasis in 28 (70 percent), Cryptococcus organisms in 5 (12.5 percent), cytomegalovirus in 3 (7.5 percent), and lymphoma in 2 (5 percent). The median follow-up time was 48 months (range, 6 to 63 months). The percentage survival was 92.5 percent (n = 37) at 30 days, and 57.5 percent (n = 23), 37.5 percent (n = 15), and 25 percent (n = 10) at 12, 24, and 36 months, respectively. The mean survival time was 25.1 months. The likelihood of survival was directly linked to the CD4 cell count. The mean survival period was 25 months for patients with CD4 cell counts less than 200/mL3 compared with 48 months for those with CD4 cell counts greater than 200/mL3. CONCLUSIONS: Although the pathologic changes identified in patients with acquired immunodeficiency syndrome may occasionally be atypical, the clinical presentation, indications for operation, and pathologic findings identified are quite common. Patients tolerate cholecystectomy well with good long-term outcome and minimal infectious complications. Even in patients with the most compromised immune status, a 2-year survival after operation is acceptable. Cholecystectomy has a clear role in the spectrum of treatment for biliary disease relative to acquired immunodeficiency syndrome.