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Biomedical subjects

P C Goodman

Publications and source records attributed to P C Goodman.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1988

Kaposi's sarcoma involving the lung in patients with the acquired immunodeficiency syndrome.

To determine the distinguishing features of pulmonary Kaposi's sarcoma (KS) in patients with the acquired immunodeficiency syndrome (AIDS), we compared three groups of patients, 16 with endobronchial KS, 15 with endobronchial KS and an opportunistic lung infection, and 40 with Pneumocystis carinii pneumonia (PCP) without concomitant pulmonary KS. The majority of pulmonary KS patients had extensive cutaneous disease at the time of pulmonary diagnosis, and the diagnosis of pulmonary KS was easily established by the characteristic appearance of the endobronchial lesions. Dyspnea, fever, and cough were common presenting symptoms, but occurred more commonly in association with accompanying opportunistic infection. Diffuse interstitial infiltrates were observed in most patients in both groups, but the findings of nodular parenchymal densities or pleural effusion were more commonly observed in patients with pulmonary KS than in those with PCP alone. Pulmonary uptake of gallium-67 citrate or a diffusing capacity less than 80% were unusual in patients with pulmonary KS alone, but common in those with accompanying opportunistic infection or with PCP alone. Median survival in patients with pulmonary KS was only 2 months, and most patients had complicating opportunistic infections at the time of death. Pulmonary KS is generally a late and often preterminal manifestation of AIDS. Chest radiographs, gallium lung scans, and pulmonary function testing may provide diagnostic information that is helpful in distinguishing pulmonary KS from opportunistic lung infections.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Carcinoids associated with multiple endocrine neoplasia syndromes.

Carcinoids occur in association with MEN types 1 and 2. To determine the relationship between carcinoids and MEN, we reviewed nine patients with carcinoids and other endocrine tumors. Analyzing these 9 patients and 56 other patients previously described in the literature, we found several clinically important relationships. In contrast to the usual midgut and hindgut origin, most carcinoids associated with MEN (69 percent) are of foregut origin (thymus 24 percent, bronchus 27 percent, stomach 3 percent, and duodenum 14 percent). Carcinoids are more commonly associated with MEN type 1 than MEN type 2 (59 patients and 6 patients, respectively). Thymic carcinoids associated with MEN are more common in men (15 versus 2), and most (82 percent) are malignant. Bronchial carcinoids associated with MEN are more common in women (15 versus 4), and most (74 percent) are benign. There is a strong association between thymic carcinoids and parathyroid tumors and between bronchial carcinoids and pituitary tumors. Most patients with carcinoids and hyperparathyroidism (82 percent) have had parathyroid hyperplasia or multiple parathyroid adenomas. Thus, carcinoids may occur in association with both MEN type I and MEN type II. MEN should be suspected in patients with foregut carcinoids. Patients with MEN and ectopic ACTH production should be considered to have bronchial carcinoids if they are female and thymic carcinoid if they are male. The thymus should be routinely removed in patients with MEN type I because of the possible presence of an ectopic parathyroid gland in this tissue and to prevent subsequent development of a carcinoid tumor.

Adolescent↗
PubMed1986

Spontaneous pneumothorax in AIDS patients with Pneumocystis carinii pneumonia.

Although spontaneous pneumothorax has rarely been reported as a complication of Pneumocystis carinii pneumonia in AIDS patients, recent experience suggests that its frequency is increasing. Seven such cases have been encountered in the past 1 1/2 years, whereas no cases were found in an earlier review at San Francisco General Hospital of 90 AIDS patients of whom 56 had Pneumocystis carinii pneumonia. The cause of this increasing frequency is unknown.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Hydropneumothorax: detection on supine radiographs.

Hydropneumothorax may be diagnosed on a supine radiograph by recognition of a pleural line with increased density lateral to it in the pleural space. Recognition of this condition may have implications for therapeutic chest tube placement.

Adolescent↗
PubMed1984

Digital subtraction angiography in extremity trauma.

Digital subtraction angiography (DSA) may have considerable impact on the work-up of patients who have suffered blunt or penetrating trauma. The angiographic evaluation of vascular injuries (e.g., arteriovenous fistulae, pseudoaneurysms, hemorrhage) can be accomplished rapidly and with minimal catheter use and manipulation, which is particularly important for those critically ill patients who have significant immobility because of multiple fractures. We retrospectively reviewed the digital subtraction angiograms in 50 consecutive cases of extremity trauma. The quality of the images in 44 of these permitted a confident diagnosis, the accuracy of which was confirmed by surgical or clinical follow-up. One false-positive and three false-negative examinations for small muscle bleeders were discovered, but none of these was considered clinically significant. DSA reduces the time required to perform the procedure, the amount of contrast material injected, patient discomfort, and film cost. Its major disadvantage is the limited field size of the image intensifier.

Angiography↗