RESUMEN
Research of HIV infection within the family has focused upon sexual partners and vertical transmission. The scope of the problem of multiple infections and clustering of HIV among family members has, thus far, been less extensively explored. The objectives of this study are to investigate HIV infection in family members of HIV-seropositive and HIV-seronegative high-risk women and to consider the impact of multiple HIV infections within the family. Baseline data were evaluated from a prospective observational cohort of 871 HIV-seropositive and 439 seronegative at-risk women who are participants in a longitudinal study of HIV in women at four sites in the USA (Montefiore, Bronx, NY; Johns Hopkins University, Baltimore, MD; Brown University, Providence, RI; Wayne State University, Detroit, MI). Women were asked if anyone close to them had HIV/AIDS or had died from HIV/AIDS. Responses which included HIV-positive family members were analyzed. In the seropositive cohort, 35% (307/871) of the women had a family member with HIV infection. Of these 307 women, 38% reported having a sibling, 24% a husband and 27% had more than one family member with HIV/AIDS. Forty-nine per cent of Latina women, 34% of black women, and 21% of white women reported having a family member with HIV/AIDS. Using logistic regression analysis, we found that Latina and black women were significantly more likely than white women to have a sibling, extended family member or more than one family member with HIV/AIDS. Compared to seropositive women, seronegative high-risk women enrolled in this study appear equally likely to have an HIV-infected family member. In this study of HIV-positive women and high-risk seronegative women, a third reported having multiple family members with HIV infection, most often in a sibling. The high prevalence of HIV within families, particularly in the families of Latina and black women, mandates attention in planning both prevention and care.
Asunto(s)
Salud de la Familia , Infecciones por VIH/transmisión , Negro o Afroamericano , Transmisión de Enfermedad Infecciosa , Femenino , Infecciones por VIH/etnología , Hispánicos o Latinos , Humanos , Masculino , RiesgoRESUMEN
The three-phase bone scan is finding increasing utility in acute and chronic pain syndromes in sports medicine settings. This useful technique may have significant clinical application in assessing the increasing numbers of patients with exercise induced lower leg or medial tibial pain. The authors present a case of exertional lower leg pain or medial tibial pain in which three-phase bone imaging exhibited a dramatic increase in early flow after a simple derived exercise stress. The three-phase bone scan should play a key role in the assessment of exercise pain, and may be enhanced by the addition of simple exercise intervention.
Asunto(s)
Ejercicio Físico , Dolor/diagnóstico por imagen , Tibia/diagnóstico por imagen , Adulto , Síndrome del Compartimento Anterior/diagnóstico por imagen , Huesos/diagnóstico por imagen , Trastornos de Traumas Acumulados/diagnóstico por imagen , Prueba de Esfuerzo , Humanos , Masculino , Cintigrafía , Flujo Sanguíneo Regional , Medronato de Tecnecio Tc 99m , Tibia/irrigación sanguíneaRESUMEN
During a 47-month period, 68 patients were studied prospectively to compare single-level lumbar fusion with and without adjunctive pedicular fixation. Fusion indications were disabling back pain for a minimum of 6 months, inability to work, and failed conservative care. Twenty-nine patients fused without hardware and 39 fused with VSP fixation in identical procedures. All patients were evaluated according to fusion success, perceived pain, and return to work. Pseudarthrosis was demonstrated in 58.6% of the noninstrumented group. No pseudarthroses were noted in instrumented patients. Pain improvement in the nonhardware group was 41.4%, and in the hardware group, 76.9%. Return to work was 31% and 72% in each group, respectively. The fusion rate for patients exhibiting single-level disc disease improves with spinal fixation.
Asunto(s)
Dolor de Espalda/cirugía , Fijadores Internos , Fusión Vertebral/métodos , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosAsunto(s)
Incisivo/anomalías , Niño , Femenino , Humanos , Incisivo/diagnóstico por imagen , Radiografía PanorámicaRESUMEN
The author reviews 65 cases of Hirschsprung's disease seen and treated in Saskatoon between 1951 and 1981. The annual incidence of this disease is 1/4000 live births. Overall mortality was 25% and related to two factors: (a) delay in diagnosis and surgical treatment with a high incidence of enterocolitis in the earlier years of the series; (b) a mortality of 83% in patients with small bowel aganglionosis. Thirty-five resections were done for colonic aganglionosis; there was one death that occurred 20 years ago, indicating that surgery is safe in this disease, but delay in treatment is not. Of six patients with small bowel aganglionosis, only three had resection and only one of these survived. The two patients who died had very high small bowel aganglionosis, probably incompatible with survival. The Rehbein type of procedure proved useful in high colonic aganglionosis where, by necessity, anastomosis was done at up to 7 cm above the white line of the pelvis, with excellent end results. There was a 35% incidence of Hirschsprung's disease in females; 37% had high aganglionosis (above the sigmoid). Low (white line) anastomosis was done in three patients available for 12-year follow-up. All have some degree of incontinence.
Asunto(s)
Megacolon/cirugía , Colon/inervación , Femenino , Estudios de Seguimiento , Humanos , Lactante , Intestino Delgado/inervación , Masculino , Megacolon/mortalidad , Métodos , Recto/inervaciónRESUMEN
The association of bone lesions, polyarthritis and cutaneous nodules with pancreatic disease is being recognized and reported more frequently. In adults all forms of pancreatitis and carcinoma of the pancreas have been involved, but in the few children described these complications have been associated with acute traumatic pancreatitis. This paper describes two cases of acute traumatic pancreatitis in which polyarthritis and limb pains were noted after 2 to 3 weeks. In one child osteolytic lesions and periostitis were seen on roentgenograms 7 weeks after the onset of pancreatitis. In the other child minor roentgenographic changes were not seen until 5 months after the onset; however, bone scans showed clear-cut abnormalities after 1 month. Almost complete resolution could be expected within a year. Serum lipase and amylase concentrations remained elevated during the acute illness. Disseminated fat necrosis is apparently related to the excess amounts of circulating lipase.
Asunto(s)
Artritis/etiología , Enfermedades Óseas/etiología , Pancreatitis/complicaciones , Enfermedad Aguda , Adolescente , Niño , Humanos , Masculino , Pancreatitis/etiología , Heridas y Lesiones/complicacionesRESUMEN
A female infant developed apneic spells due to hypoglycemia at 73 hours of life. It was impossible to maintain the blood glucose level despite continuous intravenously given dextrose, cortisone, diazoxide, and a low-leucine diet. A subtotal pancreatectomy was performed but there was no evidence of islet cell adenoma. On second laparotomy, the head of the pancreas was removed, and on microscopic examination, islet cell adenomatosis was found. A good clinical recovery followed. Follow-up at age 3 years and 4 months shows apparently normal mental and physical development.