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Biomedical subjects

P C Goodman

Publications and source records attributed to P C Goodman.

At least 19 recordsLinked to original sources
PubMed1992

Pulmonary cryptococcosis.

Cryptococcus neoformans is a ubiquitous soil fungus that rarely causes pneumonia in normal hosts but is a common cause of opportunistic infection. Pulmonary disease is initiated by inhalation of the organism, and a spectrum of radiographic manifestations can be seen. The most common finding is a poorly marginated nodule or mass. Lobar or segmental parenchymal opacities and, less commonly, a diffuse scattered nodular or reticulonodular pattern have also been observed. Associated adenopathy, pleural effusions, and cavitation are uncommon; when present, these are more common in immunocompromised patients. Establishing the diagnosis can be difficult, but pulmonary cryptococcosis should be considered in the differential diagnosis of patients in the proper clinical setting and with compatible radiographic findings.

Cryptococcosis↗
PubMed1992

Pulmonary toxoplasmosis in AIDS.

The chest radiographs obtained in nine patients with acquired immunodeficiency syndrome (AIDS) and pulmonary toxoplasmosis were reviewed. In three patients, a bilateral, diffuse, fine to medium reticulonodular pattern indistinguishable from that seen in Pneumocystis carinii pneumonia (PCP) was observed. In six patients, however, a bilateral, predominantly coarse, nodular pattern was observed. This type of abnormality is unusual with PCP, and its presence may help in distinguishing between pulmonary infections caused by Toxoplasma gondii and P carinii. Other opportunistic pneumonias occurring in patients with AIDS, including tuberculosis, histoplasmosis, and coccidioidomycosis, might show similar coarse, nodular opacities on chest radiographs and thus may not be differentiated from pulmonary toxoplasmosis. No hilar or mediastinal adenopathy was observed. Two patients had pleural fluid. Radiologists familiar with the chest radiographic appearance of T gondii pneumonia could be first to suggest this unusual complication of AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Treatment of tuberculosis in patients with advanced human immunodeficiency virus infection.

BACKGROUND AND METHODS: Infection with the human immunodeficiency virus (HIV) increases the risk of tuberculosis and may interfere with the effectiveness of antituberculosis chemotherapy. To examine the outcomes in patients with both diagnoses, we conducted a retrospective study of all 132 patients listed in both the acquired immunodeficiency syndrome (AIDS) and tuberculosis case registries in San Francisco from 1981 through 1988. RESULTS: At the time of the diagnosis of tuberculosis, 78 patients (59 percent) did not yet have a diagnosis of AIDS, 18 patients (14 percent) were given a concomitant diagnosis of AIDS (as determined by the presence of an AIDS-defining disease other than tuberculosis), and the remaining 36 patients (27 percent) already had AIDS. The manifestations of tuberculosis were entirely pulmonary in 50 patients (38 percent), entirely extrapulmonary in 40 patients (30 percent), and both pulmonary and extrapulmonary in 42 patients (32 percent). The treatment regimens were as follows: isoniazid and rifampin supplemented by ethambutol for the first two months, 52 patients; isoniazid and rifampin supplemented by pyrazinamide and ethambutol for the first two months, 39 patients; isoniazid and rifampin, 13 patients; isoniazid and rifampin supplemented by pyrazinamide for the first two months, 4 patients; and other drug regimens, 17 patients. The intended duration of treatment for patients whose regimen included pyrazinamide was six months, and for patients who did not receive pyrazinamide, nine months. Seven patients received no treatment because tuberculosis was first diagnosed after death. Sputum samples became clear of acid-fast organisms after a median of 10 weeks of therapy. Abnormalities on all chest radiographs taken after three months of treatment were stable or improved except for those of patients who had new nontuberculous infections. The only treatment failure occurred in a man infected with multiple drug-resistant organisms who did not comply with therapy. Adverse drug reactions occurred in 23 patients (18 percent). For all 125 treated patients, median survival was 16 months from the diagnosis of tuberculosis. Tuberculosis was a major contributor to death in 5 of the 7 untreated patients and 8 of the 125 treated patients. Three of 58 patients who completed therapy had a relapse (5 percent); compliance was poor in all 3. CONCLUSIONS: Tuberculosis causes substantial mortality in patients with advanced HIV infection. In patients who comply with the regimen, conventional therapy results in rapid sterilization of sputum, radiographic improvement, and low rates of relapse.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Pneumocystis carinii pneumonia.

Pneumocystis carinii pneumonia (PCP) is the most common index diagnosis in patients with acquired immunodeficiency syndrome (AIDS). Eighty percent of AIDS patients will eventually develop PCP. Common presenting symptoms are shortness of breath, cough, weight loss, and fever. The chest radiograph typically reveals a diffuse, bilateral, symmetric, fine-to-medium reticulonodular pattern of opacities. Upper lobe disease has been reported recently in patients who have undergone prophylactic therapy with aerosolized pentamidine. Pneumatoceles, or thin-walled air-containing cysts, have been noted in 10% of patients with PCP. Lymphadenopathy and pleural effusion are extremely rare. Therapy with various agents is generally successful, resulting in clinical and radiographic improvement within 7 to 10 days. Recurrence of PCP is common.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Mycobacterial disease in AIDS.

An increase in tuberculosis cases in the United States has been partially linked to the large number of patients with acquired immunodeficiency syndrome. Symptoms are indistinguishable from those of other opportunistic infections and include cough, low-grade fever, and weight loss. In patients with early human immunodeficiency virus (HIV) infection, radiographic findings resemble those seen in patients with reactivation tuberculosis. In patients with advanced HIV infection, chest radiographs typically reveal bilateral, symmetric, coarse, nodular densities. An upper lobe distribution is not prevalent. Lymphadenopathy is reported in many patients. Antituberculous therapy leads to clinical and radiographic improvement. Radiographic deterioration during therapy should suggest the presence of another opportunistic infection. Mycobacterium avium complex (MAC) infection of the lung cannot be distinguished from tuberculosis clinically or radiographically. Therapy, however, is less likely to be successful in patients with MAC infection.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Kaposi's sarcoma.

An aggressive form of Kaposi's sarcoma has been reported in patients with acquired immunodeficiency syndrome. Although pulmonary symptoms may constitute the initial complaint, Kaposi's sarcoma is generally detected because of cutaneous lesions. The chest radiograph reveals a distinctive, poorly marginated, nodular pattern in the lungs. Coarse, linear densities are also observed, and pleural effusion is seen in many patients. Bilateral distribution is most common. Pulmonary hemorrhage occurs and rarely may result in dense air-space consolidation seen on the chest radiograph.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Non-Hodgkin's lymphoma in the acquired immunodeficiency syndrome.

AIDS-related lymphomas (ARLs) are almost always of a non-Hodgkin's type. Typically, intraabdominal or subcutaneous lymph node groups are affected. Unusual presentations are not uncommon, however. Intrathoracic involvement occurs in 10% to 30% of AIDS patients. ARLs are extremely aggressive and generally present at advanced stages of disease. The chest radiograph demonstrates linear densities, lymphadenopathy, and pleural effusions. An unusual feature of ARLs is the presence of rapidly growing, well-defined lung nodules. Radiographic response to therapy may be extremely rapid, but the prognosis for patients with ARLs is poor.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Pulmonary disease in children with AIDS.

Children with acquired immunodeficiency syndrome (AIDS) may present with recurrent pneumonias or chronic debilitating illness. The chest radiographs of these patients demonstrate homogeneous densities representing staphylococcal or other pyogenic infections. Pneumocystis carinii pneumonia produces a diffuse, symmetric, fine-to-medium, reticulonodular pattern. Lymphocytic interstitial pneumonitis, a disease that is now an index diagnosis of AIDS in children under 13, may appear as a chronic, diffuse, small nodular infiltrate. An increasing number of pediatric AIDS patients will be observed in the future because of the large number of human immunodeficiency virus-infected women who are of childbearing age.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The chest film in the acquired immunodeficiency syndrome.

This paper is a selective review of the past year's literature on the infections and neoplasms that develop in patients with the acquired immunodeficiency syndrome. In general, the recent literature supports information previously reported and includes further suggestions about the pathogenesis of findings seen on chest radiographs.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Pulmonary tuberculosis in patients with acquired immunodeficiency syndrome.

An association between tuberculosis and HIV infection is becoming increasingly evident. HIV seropositivity has been seen in nearly 30% of some populations with tuberculosis. In other populations nearly 25% of patients with AIDS had tuberculosis. Clinically these patients present with nonspecific findings including weight loss, night sweats, and fever. The symptoms are generally gradual in onset and last for several weeks. Early in the course of HIV infection a PPD skin test may be positive and the radiographic findings may be similar to those seen in individuals with normal immunity. Thus, upper lobe heterogeneous and cavitary opacities may be seen on the chest radiograph. In late HIV infection, however, the PPD skin test is generally negative and the radiograph demonstrates lymphadenopathy and diffuse heterogeneous parenchymal opacities. Tuberculosis should be suspected in HIV-infected patients when diffuse interstitial lung disease is demonstrated in conjunction with hilar or mediastinal lymph node enlargement. In contrast, lymphadenopathy is not expected in the most common opportunistic lung disease, Pneumocystis carinii pneumonia. Standard antituberculous drug therapy is extremely effective in treating tuberculosis in this setting.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Lymphoma in the immunocompromised patient.

The increased incidence of malignant lymphomas in patients with congenital or acquired immunodeficiency states is now well recognized. In recent years, acquired immunodeficiency syndrome (AIDS) related non-Hodgkin's lymphoma has accounted for a growing proportion of these aggressive neoplasms. This article reviews the radiographic features of lymphoma in AIDS and non-AIDS immunocompromised patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Pulmonary edema in cocaine smokers.

Cocaine smoking can cause a number of medical complications. Pneumomediastinum and pneumothorax due to barotrauma have been the most common radiographic abnormalities reported in the medical literature. The hospital records of five patients with pulmonary edema who smoked cocaine just before admission were reviewed. Except for cocaine abuse no other possible cause for the pulmonary edema was found. Although chest radiographic abnormalities in these patients are uncommon, these cases are reported to inform the radiologist of this possible complication of cocaine smoking. The presence of pulmonary edema in a young, otherwise healthy patient without predisposing risk factors should alert the radiologist to the possible diagnosis of cocaine abuse.

Adult↗
PubMed1989

Pulmonary cysts associated with Pneumocystis carinii pneumonia in patients with AIDS.

A diffuse, bilateral interstitial infiltrate is the most common radiographic finding in Pneumocystis carinii pneumonia (PCP) in patients with the acquired immunodeficiency syndrome (AIDS). However, atypical roentgenographic patterns also exist. Chest radiographs of 100 consecutive AIDS patients with PCP were retrospectively analyzed for the presence of pulmonary air-filled cysts, or pneumatoceles, which were identified in 10% of the cases. The pneumatoceles were typically thin-walled with no intracystic material and no predilection for a particular area of the lung. They appear to behave like pneumatoceles due to other infectious processes. They were present on the initial radiograph or developed during treatment of PCP. Analysis of available follow-up radiographs indicated resolution of the pulmonary cysts within 7 months in most cases. The cause of these cysts is unknown, but a "check-valve" obstruction or, perhaps less likely, parenchymal necrosis may be involved. Rupture of these pulmonary cysts may lead to spontaneous pneumothorax.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Presumptive diagnosis and treatment of pulmonary tuberculosis based on radiographic findings.

We analyzed the outcome of therapy for 139 patients who were treated for a presumptive diagnosis of pulmonary tuberculosis based on radiographic abnormalities. Patients who had acid-fast bacilli seen on sputum smears and patients who had received adequate therapy for tuberculosis in the past were excluded from the analysis. Accuracy of the diagnosis was determined by comparison of clinical and radiographic findings after 3 months of isoniazid, rifampin, and ethambutol, as well as the results of sputum cultures. Of 139 patients started on therapy presumptively, 66 (48%) were determined to have current tuberculosis (16 had positive cultures, 43 because of improvement in their chest films, and 7 because of clinical improvement). Adverse reactions requiring change of therapy occurred in six of 72 (8.3%) patients determined to have inactive tuberculosis. One patient had both tuberculosis and carcinoma found at bronchoscopy after 3 months of therapy. For purposes of comparison, chest radiographs of 59 patients documented by culture to have current tuberculosis were reviewed. Of these, 45 (70%) were improved at 3 months. Presumptive therapy is of benefit in that it stops progression of the disease at an early stage and decreases the potential for spread of tuberculous infection. In addition, such therapy coupled with systematic reevaluation of patients substantiates the diagnosis or indicates that further evaluation is needed. These benefits must be weighed against the adverse reactions and costs of overtreating patients with inactive disease. Determining the appropriateness of presumptive therapy must be based on local factors including prevalence of tuberculosis and available resources.

Antitubercular Agents↗