1/234. Adipsic hypernatremia in two patients with AIDS and cytomegalovirus encephalitis.In patients with acquired immune deficiency syndrome (AIDS), hypoosmolality is frequently observed, whereas hypernatremia is distinctly rare. We report two patients with advanced AIDS and cytomegalovirus (CMV) encephalitis, who developed severe hypernatremia without any thirst sensation, that is, adipsic hypernatremia. Both developed severe hypernatremia of up to 164 and 162 mmol/L, with serum osmolalities of 358 and 344 mOsmol/kg while remaining alert and denying thirst. serum antidiuretic hormone (ADH) levels were 0.9 and 1.5 pg/mL, inappropriately low for the concomitant serum osmolalities. vital signs were stable. During hypernatremia, urine osmolalities were 327 and 340 mOsmol/kg, and urine Na levels were 56 and 119 mmol/L, respectively. Periventricular white matter lesions were seen on cerebral nuclear magnetic resonance imaging (NMRI) in case 1, but the pituitary appeared normal in both cases. survival after onset of hypernatremia was 6 and 4 weeks, respectively. autopsy in case 1 showed typical findings of CMV encephalitis but normal pituitary, confirming that infection with hiv or CMV most likely caused the dysfunction of the central osmostat.- - - - - - - - - - ranking = 1keywords = cytomegalovirus (Clic here for more details about this article) |
2/234. iritis associated with intravenous cidofovir.OBJECTIVE: To report two patients with AIDS and cytomegalovirus retinitis who developed iritis after receiving intravenous cidofovir. Both experienced recurrent symptoms upon rechallenge. CASE SUMMARIES: Two hiv-positive patients with cytomegalovirus retinitis infections previously controlled with intravenous ganciclovir or foscarnet were treated with intravenous cidofovir. Symptoms of iritis developed after the second or third dose of cidofovir. One patient experienced symptoms unilaterally, while the other patient had bilateral symptoms. In both patients, the iritis resolved with topical ophthalmic therapy, but recurred following subsequent infusions of cidofovir. Therapy with cidofovir was discontinued, and no further recurrences of iritis were noted. One patient had post-inflammatory fixed dilated pupils. CONCLUSIONS: iritis can uncommonly occur in patients receiving intravenous cidofovir and oral probenecid. With prompt drug discontinuation and administration of topical corticosteroids and/or mydriatic agents, symptoms are usually reversible.- - - - - - - - - - ranking = 9.3444456114838keywords = cytomegalovirus retinitis, cytomegalovirus, retinitis (Clic here for more details about this article) |
3/234. Potential complication associated with removal of ganciclovir implants.PURPOSE: To describe the complication of separation of the medication pellet from the tab during the removal of a ganciclovir implant. METHOD: case reports. RESULTS: Separation of the pellet from the tab upon removal of ganciclovir implants occurred at the time of reimplantation in two human immunodeficiency virus (hiv)-positive patients with cytomegalovirus (CMV) retinitis. CONCLUSIONS: Our cases show the possibility of pellet separation from the tab during the removal of a ganciclovir implant. Although pellet separation from its tab is rare, surgeons should be aware of this potential complication. Modifying recommended techniques to remove the ganciclovir implant may reduce the incidence of pellet-tab separation.- - - - - - - - - - ranking = 0.38726910110524keywords = cytomegalovirus, retinitis (Clic here for more details about this article) |
4/234. Management of opportunistic infections in acquired immunodeficiency syndrome. I. Treatment.A case report of a patient infected with human immunodeficiency virus (hiv) is described. The patient presents with a multitude of medical complaints that are of acute or subacute onset. The medical examination of these complaints is described and includes algorithms for the diagnosis and treatment of the most common hiv-related opportunistic infections, including pneumocystis carinii pneumonia, toxoplasmosis, mycobacterium avium complex, cytomegalovirus infection, and cryptococcal meningitis.- - - - - - - - - - ranking = 0.2keywords = cytomegalovirus (Clic here for more details about this article) |
5/234. Retinal pigment epithelial dysfunction in human immunodeficiency virus-infected patients with cytomegalovirus retinitis.OBJECTIVE: Prior clinical observations led the authors to examine electrophysiologic measures of retinal (electroretinogram [ERG]) and retinal pigment epithelial (electro-oculogram [EOG]) function in patients infected with human immunodeficiency virus (hiv) who either had or did not have cytomegalovirus (CMV) retinitis in order to determine if the ERG or EOG measures were differentially affected in CMV retinitis. DESIGN: Cross-sectional study. PARTICIPANTS: Forty-one hiv-infected patients (20 with and 21 without CMV retinopathy) were evaluated. INTERVENTION: ERGs and EOGs were recorded. patients' fundi were evaluated by indirect ophthalmoscopy or fundus photography. MAIN OUTCOME MEASURES: The ERG a- and b-wave amplitudes and EOG light/dark amplitude ratio (L/D ratio) from the eyes of all patients were compared with values 2 standard deviations from the mean of a normal sample. The area of the retinal lesions was estimated from fundus photographs or from careful drawings made during indirect ophthalmoscopy. RESULTS: The majority of the eyes (64.5%) of the patients with CMV retinitis had subnormal L/D ratios, and most eyes (95%) of patients without CMV retinitis had normal L/D ratios. Only six eyes (four with and two without CMV retinopathy) had subnormal a-wave amplitudes, and there was no significant correlation between a-wave amplitude and the L/D ratio for patients with CMV retinitis. Most eyes (80.6%) of the patients with CMV retinitis had subnormal b-wave amplitudes, but there was no significant correlation between b-wave amplitude and L/D ratio in the patients with CMV retinitis. In three patients with CMV retinitis selected to exemplify the range of effects on the ERG and EOG, the b-wave amplitude loss was roughly proportional to the area of retina visibly affected in indirect ophthalmoscopy. One patient had a nonrhegmatogenous retinal detachment. CONCLUSIONS: Middle retinal function, as reflected in the b-wave amplitude, and retinal pigment epithelial function, as reflected in the L/D ratio, were both compromised in CMV retinitis, but the effect on function in the two layers of the retina appeared independent because there was no significant correlation between the L/D ratio and b-wave amplitude. The decrease in L/D ratio was not secondary to loss of photoreceptor function and probably represents a dysfunction of the retinal pigment epithelium because there was no significant correlation between a-wave amplitude, which was normal in most cases, and L/D ratio. The inner retinal pathology of CMV retinitis is visible clinically and was associated with decreases in b-wave amplitude in this and previous studies. The significant independent retinal pigment epithelial dysfunction demonstrated in this study may be an important predisposing factor to retinal detachment in CMV retinitis.- - - - - - - - - - ranking = 20.948851335125keywords = cytomegalovirus retinitis, cytomegalovirus, retinitis (Clic here for more details about this article) |
6/234. Emergency surgery for generalized peritonitis caused by cytomegalovirus colitis in a patient with AIDS.Cytomegalovirus infection of the colon is a late and severe complication in human immunodeficiency virus patients. Despite availability of medical treatment, occasional life-saving emergency surgery must be performed. The controversial surgical aspects of treatment are discussed based upon an unusual case of aseptic generalized peritonitis without perforation. The feasibility and value of limited resection are emphasized.- - - - - - - - - - ranking = 0.8keywords = cytomegalovirus (Clic here for more details about this article) |
7/234. Progression of cytomegalovirus retinitis in acquired immunodeficiency syndrome: a case report.We report an AIDS patient with cytomegalovirus (CMV) retinitis that developed from an early minor lesion and progressed to extended involvement of the retina and severe deterioration of vision due to poor compliance with ganciclovir treatment. A 33-year-old man was known to have acquired immunodeficiency syndrome (AIDS) for eight months. The patient had no complaint of visual symptoms. A routine eye examination revealed his visual acuity to be 6/6 in both eyes. The dilated eye fundus examination using indirect ophthalmoscopy disclosed a localized white yellowish granular lesion in the peripheral retina of the right eye and a completely normal left eye. CMV retinitis with initial manifestation in the right eye was diagnosed. Due to incomplete treatment with ganciclovir, the retinal lesion rapidly enlarged and extended to the posterior pole, with eventual destruction of the nerve fiber layer and optic disc. The visual acuity of right eye dropped from 6/6 to 1/60 within six months. This case report indicates the importance of early, dilated eye fundus examination and recognition of early CMV retinitis in order to salvage visual function in AIDS patients. Completion of the anti-CMV treatment course in halting the progression of CMV retinitis is also emphasized.- - - - - - - - - - ranking = 19.637967627389keywords = cytomegalovirus retinitis, cytomegalovirus, retinitis (Clic here for more details about this article) |
8/234. A case study: the use of cidofovir for the management of progressive multifocal leukoencephalopathy.Progressive Multifocal Leukoencephalopathy (PML) is an opportunistic infection of the brain in advanced stages of AIDS. PML is caused by the jc virus, which leads to a decline in mental acuity and motor functions over a period of weeks or months. Currently, there is no treatment or cure for PML. Cidofovir, an antiviral agent, at the standard dosages for the treatment of cytomegalovirus (CMV) was implemented in the treatment and management of a 35-year-old, newly diagnosed AIDS, White male with PML. The patient presented with impaired motor functions of the left upper and lower extremities, which resulted in hemiparalysis and hemiparesis. The use of cidofovir infusions at standard recommendations for treatment and management of CMV has resulted in improvement and some resolution of the patient's paralysis and paresthesia. The patient has remained on the cidofovir for more than a year, with no signs of advancement of his PML or AIDS. Further investigation and extensive clinical trials are needed in the treatment and management of PML with the use of cidofovir.- - - - - - - - - - ranking = 0.2keywords = cytomegalovirus (Clic here for more details about this article) |
9/234. bk virus as the cause of meningoencephalitis, retinitis and nephritis in a patient with AIDS.BACKGROUND: The two widely spread human polyomaviruses, bk virus (BKV) and jc virus (JCV) establish latency in the urinary tract, and can be reactivated in AIDS. JCV might cause progressive multifocal leucoencephalopathy, but although up to 60% of AIDS patients excrete BKV in the urine there have been few reports of BKV-related renal and/or neurological disease in AIDS. OBJECTIVE: To report on an AIDS patient with progressive renal and neurological symptoms involving the retina. DESIGN: Case report. SETTING: Venhalsan, Soder Hospital, Stockholm, sweden. methods: The brain, eye tissue, cerebrospinal fluid, urine and peripheral blood mononuclear cells were analysed by nested PCR for polyoma-virus dna. Macroscopical and microscopical examination were performed of the kidney and brain post mortem. Immunohistochemical stainings for the two BKV proteins, the VP1 and the agnoprotein, were performed on autopsy material and virus infected tissue culture cells. RESULTS: BKV could be demonstrated in the brain, cerebrospinal fluid, eye tissues, kidneys and peripheral blood mononuclear cells. CONCLUSION: During 6 years, approximately 400 cerebrospinal fluid samples from immunosuppressed individuals with neurological symptoms have been investigated by PCR for the presence of polyomaviruses. BKV dna has, so far, only been found in the case reported here. Although reports of BKV infections in the nervous system are rare, there is now evidence for its occurrence in immunocompromised patients and the diagnosis should be considered in such patients with neurological symptoms and signs of renal disease. The diagnosis is simple to verify and is important to establish.- - - - - - - - - - ranking = 0.74907640442098keywords = retinitis (Clic here for more details about this article) |
10/234. MR imaging of intraventricular silicone: case report.A 42-year-old man with human immunodeficiency viral infection developed cytomegaloviral retinitis that was complicated by retinal detachment and was treated with an intravitreous injection of silicone. Fifteen months later, magnetic resonance imaging revealed intraocular and intraventricular silicone. Signal intensity characteristics and chemical shifts of silicone in the two locations were identical.- - - - - - - - - - ranking = 0.18726910110524keywords = retinitis (Clic here for more details about this article) |
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