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Biomedical subjects

S E Barton

Publications and source records attributed to S E Barton.

At least 91 records · Page 5Linked to original sources
PubMed1991

Disseminated histoplasmosis in an AIDS patient treated with itraconazole.

A patient with AIDS presented with a fever, shortness of breath and a productive cough. A provisional diagnosis of Pneumocystis carinii pneumonia was made; however, blood cultures and bone marrow examination revealed disseminated infection with Histoplasmosis capsulatum. This was treated by itraconazole with initial success, but the patient relapsed while on maintenance therapy.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Assessment of psychiatric morbidity in patients attending a colposcopy clinic situated in a genitourinary medicine clinic.

OBJECTIVE: To determine the adverse psychological implications of referral for colposcopic screening within a genitourinary medicine clinic. DESIGN: Cross sectional survey. SETTING: A colposcopy clinic held within a genitourinary medicine clinic. SUBJECTS: 160 consecutive women referred to the clinic were assessed for psychiatric morbidity using the General Health Questionnaire (GHQ-28). Women were referred to the colposcopy clinic because of one or more of the following: abnormal cervical cytology, condylomata acuminata, HIV antibody positivity. A history of prior local ablative therapy to the cervix was also included in the analysis. RESULTS: There was no difference in psychiatric morbidity, as detected by the GHQ-28, in women referred to the clinic because of abnormal cervical cytology or condylomata acuminata. The total GHQ-28 scores indicated a significant increase in psychiatric morbidity, with increased sub-scores indicating social dysfunction, anxiety and somatic symptoms, in women who had had prior laser therapy to the cervix. Women with HIV infection attending the clinic were noted to have an increase in GHQ-28 sub-scores indicating social dysfunction and depression. CONCLUSIONS: Women who have undergone laser therapy to the cervix may benefit from psychological evaluation and supportive measures if they develop further genital lesions which require colposcopic evaluation. Women with HIV infection need further psychological evaluation prior to planning intervention and preventative strategies.

Anxiety Disorders↗
PubMed1991

Persistent ulceration of the anal margin in homosexuals with HIV infection.

A study of the outcome of surgical treatment of ulceration of the anal margin occurring in male homosexuals with HIV infection was undertaken. Ten patients with acquired immunodeficiency syndrome and three patients with symptomatic HIV infection were referred to the Department of Surgery with painful anal ulceration which had not responded to medical treatment. The medical treatments given prior to surgical referral included high dose oral acyclovir, intravenous foscarnet and broad spectrum antibiotics. Excision biopsy was performed in 12 patients and in 11 cases was followed by healing of the ulcers within 10 weeks. One patient died 2 weeks postoperatively from Pneumocystis carinii pneumonia without healing. The response to excision biopsy was unexpected but suggests that surgical excision may be beneficial for lesions which have failed to respond to aggressive medical treatment.

Acquired Immunodeficiency Syndrome↗
PubMed1991

The clinical management of patients with HIV infection and AIDS.

The clinician is faced with a number of problems when treating patients infected with the human immunodeficiency (HIV) virus. Firstly, there is a lack of accurate data on the numbers of people infected by the HIV virus and uncertainty as to the natural history of the infection. This limits the ability to plan health care strategies for the future. Secondly, it is difficult to encompass detailed knowledge of the variety of illnesses which occur in patients with HIV infection and AIDS and the even broader range of therapies and outcomes reported in the literature. Thirdly, the clinician has to keep pace with the rapidly changing nature of the models for HIV pathogenesis and possible therapeutic interventions. However, despite these gaping holes in our knowledge, the main message of this clinical review is that a general awareness of the wide spectrum of conditions associated with HIV infection, coupled with a well organised, multidisciplinary and pragmatic approach, will provide the patients with the best chance of being correctly diagnosed and treated. Furthermore, it must be remembered that, while seeking scientific knowledge and experimenting for a cure, AIDS remains a universally fatal condition. It is essential that palliative care is available alongside and within facilities which are providing potentially curative clinical drug trials. It is equally vital that the patients be given autonomy in deciding which of these aspects of care they choose at any time. Such an approach, and the experience of caring for patients with HIV infection who pass from apparent health to fatal disease, will continue to test the skills and reserves of physicians well into the next century.

Female↗
PubMed1990

The significance of the detection of cytomegalovirus in the bronchoalveolar lavage fluid in AIDS patients with pneumonia.

We performed a retrospective study on 112 patients with AIDS-related pneumonias who underwent bronchoscopy and in whom Pneumocystis carinii pneumonia (PCP) and/or cytomegalovirus (CMV) were identified in bronchoalveolar fluid (BAL). CMV was identified by detection of early antigen fluorescent foci (DEAFF) testing in cell cultures of BAL fluid. The short- and long-term survival of all patients was similar regardless of whether PCP, CMV or both were detected at bronchoscopy. Ten out of 14 patients with CMV alone and 13 out of 26 with both CMV and PCP were treated with anti-CMV therapy, but the short- and long-term mortality was similar to that in patients who had no specific antiviral therapy. Extrapulmonary recurrence of CMV (retinitis or gastrointestinal disease) occurred in 22% of patients with evidence of CMV in BAL compared with 16% of those with PCP alone, but this difference was not statistically significant and this recurrence rate was independent of anti-CMV therapy. Detection of CMV shedding from more than one site (BAL, urine, throat or blood) was associated with a worse prognosis at 3 months than in patients in whom CMV was detected in BAL alone. It does not appear that finding CMV shedding is a guide to the cause of pneumonia or an indication for treatment in AIDS patients.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Gonococcal arthritis caused by auxotype P in a man with HIV infection.

The development of gonococcal arthritis is reported in a man with HIV infection and CDC Stage IVC2 disease. The diagnosis of disseminated Neisseria gonorrhoeae was facilitated by microbiological examination of a joint aspirate. The auxotype identified by culture was moderately resistant to penicillin, a characteristic which is highly unusual for an organism causing disseminated gonococcal infection. This case serves as an example of the role of HIV infection in the modification of host response to common pathogens and the need for clinicians to modify their management of disseminated gonococcal infection especially in immunosuppressed persons.

Adult↗
PubMed1990

Self-medication by women attending a genitourinary medicine clinic.

A questionnaire was completed by 103 symptomatic women attending a busy, walk-in genitourinary medicine clinic in London before seeing a doctor. This questionnaire asked about the patients' own diagnosis of symptoms, previous remedies and their source. The answers were compared to their past history and current diagnosis. Of symptomatic women 56% had used a self-administered remedy prior to attending the clinic. This was significantly associated with a history of a previous episode of genital infection which had produced similar symptoms to the current problem. Forty-three percent of those who used self-medication reported some improvement in symptoms and more than 50% tolerated longer than 10 days of symptoms before attending the clinic.

Female↗
PubMed1989

An explanation for the problem of false-negative cervical smears.

False-negative cervical cytology due to sampling error is a well-recognized problem. Forty-seven women with histologically proven cervical intraepithelial neoplasia (CIN) were studied. All had two cervical smears performed at a mean interval of 3 months. At the time of the second smear, cervicography, colposcopy and biopsy were performed. The area of acetowhite cervical lesions and of the total visible atypical transformation zone (ATZ) were measured from the cervical photographs. The 17 women in whom one or both smears showed no dyskaryosis were found to have a significantly smaller proportion of their ATZ affected by CIN. It is suggested that this finding can account for the sampling error which causes false-negative cervical cytology. New screening techniques, such as cervicography, may offer a method of detecting and assessing these relatively smaller cervical lesions.

Biopsy↗
PubMed1989

Cytological status and lesion size: a further dimension in cervical intraepithelial neoplasia.

Quantitative histological study of 84 laser cone biopsies showed a highly significant correlation between the grade of a cervical smear and the size of the lesion for all grades of cervical intraepithelial neoplasia (CIN) (CIN I P = 0.004; CIN II P = 0.0001; CIN III P = 0.003; total CIN P less than 0.0001); 10 of 34 (29%) of women with CIN III and mild dyskaryosis or less had significantly smaller lesions than 23 of 36 (63%) of women with CIN III and moderate or severe dyskaryosis. Repeat cytology identified as severe dyskaryosis all those with large CIN III lesions. Lesion size has been neglected in studies of the natural history of CIN and in the assessment of cytological screening, but offers an explanation for the apparent discrepancies between cytological, colposcopic and histological assessment of progression of CIN.

Biopsy↗
PubMed1989

Possible cofactors in the etiology of cervical intraepithelial neoplasia. An immunopathologic study.

Previous work in our department demonstrated a reduction in the numbers of Langerhans' cells in cervical epithelium showing histologic changes of human papillomavirus (HPV) infection and cervical intraepithelial neoplasia (CIN). In conjunction with a localized reversal of the T4:T8 ratio of T-lymphocytes, that finding provides evidence of the association of epithelial immunosuppression with both HPV infection and CIN. To investigate whether that phenomenon occurs primarily because of HPV alone or might be caused by a cofactor (e.g., cigarette smoking, oral contraceptive use, chlamydial infection), we performed a study of the effect of those cofactors on the immune defenses of the cervical epithelium. In a study of Langerhans' cells we showed that infection with HPV type 16 and current cigarette smoking both exert effects that cause a reduction in those cells. That diminution of the major antigen-presenting cells in cervical epithelium may constitute a mechanism that explains the observed role of those agents in the etiology of cervical neoplasia.

Antigens, CD1↗
PubMed1988

Effect of cigarette smoking on cervical epithelial immunity: a mechanism for neoplastic change?

Langerhans' cells in cervical epithelium in colposcopic biopsy specimens were identified by immunocytochemical staining for S100 protein and T6 (CD1) antigen, and their density was quantified. Possible cofactors for the development of cervical neoplasia were examined for any effect on the cell counts per unit area. Current cigarette smoking was associated with a significant decrease in the Langerhans' cell population in both normal epithelium and lesions due to cervical intraepithelial neoplasia. Ex-smokers tended to have cell counts between those of smokers and non-smokers. There was a dose-response relation between number of cigarettes smoked daily and effect on cell counts. These findings of a local immunological effect of smoking on cervical epithelium may explain the means by which cigarette smoking contributes to the development of cervical neoplasia.

Cell Count↗