RESUMEN
Indwelling central venous catheters are increasingly useful in the clinical management of patients with acquired immune deficiency syndrome (AIDS). To evaluate the risk of catheter infection in this group of patients, we reviewed the records of 299 patients with Hickman and Port-a-cath catheters. Patients were stratified into three groups: (a) AIDS (n = 54), (b) non-AIDS immunodeficiencies (n = 102), and (c) immunocompetent (n = 98). The rate of infection per 1,000 catheter days was 2.02, 0.41 (p less than 0.002), and 0.23 (p less than 0.002), respectively. Gram-positive cocci were the predominant isolate. Previous catheter infection and advanced AIDS (as determined by positive p24 antigen and low CD4+ number) were associated with increased risk of infection. Exit, tunnel, and fungal infections required catheter removal. The risk of infection and management were similar in Hickman and Port-a-cath catheters. The mortality was extremely low in all groups. However, the risk of infection associated with indwelling catheters was significantly higher in AIDS patients compared to patients with other immunodeficiencies.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/terapia , Infecciones Bacterianas/epidemiología , Cateterismo Venoso Central/efectos adversos , Catéteres de Permanencia/efectos adversos , Micosis/epidemiología , Adulto , Femenino , Bacterias Grampositivas/aislamiento & purificación , Humanos , Incidencia , Masculino , Persona de Mediana EdadRESUMEN
The authors reviewed all cases of acquired immunodeficiency syndrome (AIDS)-related lymphoma (ARL) seen at their institution between January 1982 and September 1988 to determine the frequency and appearance of ARL in the chest. Of 35 patients with ARL, 11 (31%) had biopsy-proved thoracic involvement. This frequency is significantly greater than that previously reported. The radiologic appearance of the thoracic involvement varied. Pleural effusion, interstitial and alveolar lung disease, nodules, and, infrequently, hilar and mediastinal adenopathy were observed. ARL of the chest was most commonly extranodal. Pleural effusion and lung disease were the two most common manifestations of ARL on chest radiographs and computed tomographic scans. The authors recommend that clinicians treating patients with suspected or known AIDS consider ARL when a pleural effusion or a noninfective interstitial or alveolar process is present.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Linfoma/diagnóstico por imagen , Neoplasias Torácicas/diagnóstico por imagen , Adulto , Biopsia/métodos , Ecocardiografía , Neoplasias Cardíacas/diagnóstico , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Ganglios Linfáticos/diagnóstico por imagen , Linfoma/etiología , Linfoma/mortalidad , Masculino , Neoplasias del Mediastino/diagnóstico por imagen , Persona de Mediana Edad , Neoplasias Primarias Múltiples , Derrame Pleural/etiología , Neoplasias Torácicas/etiología , Neoplasias Torácicas/mortalidad , Tomografía Computarizada por Rayos XRESUMEN
The prognostic significance of DNA aneuploidy was studied restrospectively in 177 Stage I cutaneous melanomas. DNA content was determined by flow cytometry of propidium iodide-stained nuclei recovered from formalin-fixed, paraffin-embedded material. Of 162 evaluable histograms, 124 were diploid, 35 aneuploid, and 3 tetraploid. Aneuploidy strongly correlated with established predictors of unfavorable prognosis, namely, thickness p less than .005, level p less than 0.005, ulceration p less than 0.005, and presence of vertical growth phase p less than 0.02. Overall, aneuploidy was strongly correlated with recurrence (p less than 0.005) and shorter disease-free survival (p less than 0.0001). Aneuploidy was an independent predictor of recurrence for tumors less than 1.5 mm thick (p less than 0.0001) and greater than or equal to 3 mm thick (p = 0.031). For melanomas 1.5-2.9 mm thick, aneuploid tumors had a 27% higher recurrence rate than diploid tumors (63% vs. 36%). This was not statistically significant (p = 0.247). In a multivariate analysis of common predictors stratified by thickness, DNA aneuploidy was the most significant independent parameter (p less than 0.002). DNA content appears to be an important stratification parameter for Stage I cutaneous melanoma.