Patients with phagocyte defects frequently develop bacterial or fungal pneumonias, but they are not considered to be at increased risk for viral infections. We describe 3 patients with known ...phagocyte immunodeficiencies who developed lower respiratory tract infections (LRTI) caused by respiratory syncytial virus (RSV). All 3 patients had dense pneumonias as indicated by computed tomography scan of the lungs and RSV was recovered. We conclude that RSV can present as a dense pneumonia in patients with phagocyte defects. Along with common pathogens causing LRTI, RSV should be considered in the differential diagnosis. Viral cultures as well as rapid antigen detection assays for respiratory viruses should be included in the evaluation of LRTI in patients with phagocyte defects. respiratory syncytial virus, phagocyte, immunodeficiency, pneumonia.
Men are believed to have more visceral adipose tissue (VAT) than women have, but studies in African Americans that measured VAT from a single computed tomography (CT) slice found no sex difference.
...We used a serial-slice CT scan to investigate whether there is a sex difference in VAT volume among African Americans.
Single-slice CT measurements of VAT area at lumbar spine L2-3 and L4-5 levels were taken in 110 African Americans (44 men, 66 women). In 59 subjects (24 men, 35 women), VAT volume was also measured with contiguous CT slices from the diaphragm to the iliac crest. Fat mass was determined by dual-energy X-ray absorptiometry.
Men and women had similar ages (x̄ ± SD: 36.1 ± 7.8 and 35.6 ± 7.8 y, respectively) and body mass indexes in kg/m2 (29.5 ± 6.9 and 32.0 ± 8.9). The percentage of body fat was lower (P < 0.0001) in men (21.8 ± 7.3%) than in women (37.4 ± 7.9%). The VAT volume was greater (P = 0.01) in men (1443 ± 931 cm3) than in women (940 ± 821 cm3). There was no sex difference in unadjusted VAT area at L2-3 (men, 88.6 ± 63.5 cm2; women, 57.2 ± 45.4 cm2) or L4-5 (men, 65.6 ± 53.3 cm2; women, 55.0 ± 38.3 cm2). After adjustment for percentage of body fat or fat mass, men had larger VAT area at both levels (P < 0.01). After adjustment for body mass index, the sex difference in VAT area was detectable at L2-3 (P < 0.001) but not at L4-5 (P = 0.22).
VAT volume is greater in men than in women. Detection of sex differences in VAT area among African Americans on single-slice CT requires adjustment for body fat content. At L2-3, adjustment for body mass index alone is adequate to detect sex differences in VAT.
Barrier contraceptive devices like the cervical cap and diaphragm and menstrual collecting devices may block menstrual flow, increase retrograde menstruation, and thus theoretically increase the ...likelihood of developing endometriosis or adenomyosis. We describe the case of a woman with a prior tubal ligation who after four years of regular use of the Keeper, a menstrual collecting device, developed endometriosis and adenomyosis.
Epithelial ovarian cancer patients with bulky residual tumor have a poor response to therapy and limited survival. We investigated the addition of dose-intense paclitaxel to cisplatin and ...cyclophosphamide for patients with FIGO III/IV epithelial ovarian cancer. Paclitaxel dose was intensified from 135 to 250 mg/m2and administered in combination with cisplatin at ≥75 mg/m2and cyclophosphamide at 750 mg/m2. Thirty-one of 36 patients (86%) and 25 (70%) had ≥2 and ≥3 cm residual disease after surgery, respectively. One-third had stage IV disease, and 80% had grade 3 tumors. The maximally tolerated doses (MTD) were paclitaxel at 250 mg/m2, cisplatin at 75 mg/m2, and cyclophosphamide at 750 mg/m2on a 21-day cycle with G-CSF, 10 μg/kg/day. Administered dose intensity at the MTD was ≥86%. Reversible grade 3 peripheral neuropathy occurred in 28% of patients and fever during neutropenia in 2/352 cycles (0.5%). The pathologic response rate is 36% with an additional 25% having minimal microscopic disease. Median progression-free and overall survivals for patients receiving paclitaxel at 250 mg/m2at a median potential follow-up of 22 months have not been reached for the cohort nor for the ≥3-cm subgroup. This regimen should be evaluated in a prospective, randomized clinical trial.
An alcoholic with no history of clinical pancreatitis was found to have pancreas divisum and marked changes of chronic pancreatitis isolated to the ventral pancreas. Pancreas divisum has been ...suggested to cause recurrent pancreatitis in some patients. Gross and histologic changes of pancreatitis in only the dorsal pancreas of surgically resected specimens from patients with pancreas divisum is thought to support the concept that obstruction at the minor papilla produces dorsal pancreatitis. Alternative explanations for the occurrence of segmental pancreatitis and the possible synergistic role of ethanol and bile are reviewed.
This study reports the clinical and radiologic findings in seven patients infected with HIV who had 10 consecutive episodes of symptomatic cholecystopathy induced by infusion of interleukin-2.
Ten ...episodes of right upper quadrant pain associated with gallbladder wall thickening were seen in seven of 29 HIV-infected patients who received IV interleukin-2. Patients received 6-18 million IU/day of continuous interleukin-2 infusion for 5 days. Patients with right upper quadrant pain underwent sonographic examinations, which were interpreted prospectively. Medical records and previous sonographic studies were reviewed retrospectively. Follow-up was obtained through outpatient visits and sonography.
Right upper quadrant pain during these 10 episodes of cholecystopathy usually developed 4-5 days after starting infusion of interleukin-2. Sonography during that time showed gallbladder wall thickening (mean thickness, 12.4 mm; range, 5-18 mm) and a wide variety of sonographic appearances. Tenderness during sonography was focal in six episodes, diffuse in one, and absent in three. Sludge was identified in one episode; calculi were not seen. Findings on radionuclide biliary scans were normal in three cases. Symptoms abated rapidly in every case after infusion of interleukin-2 was reduced or stopped. No surgery was necessary. When treatment was repeated, three patients had recurrent episodes, with clinical courses and sonographic aberrations showing little variance from the initial episodes. Follow-up sonography in three episodes showed a maximal thickness of the gallbladder wall of 4 mm. No patient had a history or laboratory evidence of intrinsic biliary disease.
Symptomatic thickening of the gallbladder wall during infusion of interleukin-2 can exactly mimic other forms of acalculous cholecystitis, except that when associated with interleukin-2 the thickening is rapidly reversible and surgery is not required. Radionuclide scans can be useful in clinical decision making. The process appears to be benign, and cessation of interleukin-2 therapy, along with close clinical observation, appears to be the appropriate treatment.
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