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Biomedical subjects

W Heise

Publications and source records attributed to W Heise.

47 records · Page 3Linked to original sources
PubMed1989

[Retinitis in AIDS patients: diagnosis, follow-up and treatment].

Of 147 patients with AIDS (Walter Reed 3-6), 28 showed signs of retinal infection. Toxoplasmic retinochoroiditis had developed in 5 eyes of 4 patients, whereas cytomegalovirus (CMV) retinitis occurred in 40 eyes of 24 patients. All patients with toxoplasmosis complained of visual symptoms at the first visit, but only 60% of patients with CMV retinitis had ocular symptoms at this time. The important problems involved in making a timely and correct diagnosis (early CMV retinitis vs cotton wool spots vs toxoplasmic retinitis; significance of laboratory data) are presented and discussed. The course of CMV retinitis is sometimes fast and devastating and requires immediate treatment to prevent blindness in patients who are in otherwise still fair general health. Eighteen patients (28 eyes) were treated by intravenous ganciclovir (DHPG) for 1-9 months. Initial therapy (10 mg/kg body wt., 2-4 weeks) led to regression of fundus lesions in all eyes. Under maintenance treatment (5 mg/kg BW body wt., 5 times a week), 14 eyes still demonstrated significant regression or cicatrization of the lesions, 9 eyes showed little progress and 5 eyes moderate recovery. However, 8 of 12 untreated eyes became legally blind before the patient died. None of the 23 treated eyes with useful initial visual acuity (greater than or equal to 0.2) lost visual function. Only in three cases did the drug have to be stopped because of serious side effects (severe leukopenia, pancytopenia, psychosis). Toxoplasmic retinochoroiditis healed in all affected eyes after specific treatment (pyrimethamine, sulfamethoxydiazine, clindamycin, and spiramycin in double or triple combination).(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Gastrointestinal cytomegalovirus manifestations in AIDS].

Cytomegalovirus (CMV) infection is one of the most important intestinal opportunistic infections in AIDS. In severe cases ulcerations and colitis are the commonest manifestations. 184 HIV positive patients with gastrointestinal symptoms were investigated by endoscopy of the gastrointestinal tract. While culture, immunohistochemical staining and histology from biopsies were performed, the results of all three methods were compared. In one third the cases CMV associated lesions could be found by endoscopy. Erosions or ulcerations are the most frequent tissue lesions. In 95% the culture was positive. In addition, immunohistochemical staining in 75% and histology in 61.7% were positive in patients with more serious manifestations. For early diagnosis endoscopy of the gastrointestinal tract and histological, histochemical and microbiological investigations of biopsies are essential.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Spongiform encephalopathy in AIDS dementia complex: report of five cases.

We describe the morphological findings in the brain of five AIDS patients who died with a clinical diagnosis of dementia. We have found a spongiform change (small rounded vacuoles) in different parts of the brain and a similar but morphologically different sponginess, the status spongiosus, characterized by looser and coarser microcystic cavitations of the grey matter in which the tiny cysts and vacuoles are enmeshed by glial fibrils. At the ultrastructural level, round and oval clear spaces, divided by septae into several smaller ones, appeared in the neuropil. The pathogenesis of the majority of the vacuoles and cavitations is not clear yet but a focal loss of cortical neurons was evident and furthermore some of the vacuoles were identified as remnants of dendrites. The light and electron microscopic findings can not be interpreted as artefacts or as a simple edema of the brain and also can not be explained by the different infective complications. We have found spongiform alterations in all cases of clinically diagnosed dementia and therefore it seems obvious that these findings are quite frequent in AIDS dementia.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Concentrations of magnesium, zinc and copper in serum of patients with acquired immuno-deficiency syndrome.

The concentrations of Mg, Zn, Cu and albumin, and pseudocholinesterase activity were measured in the sera of 31 AIDS patients, 27 belonging to group IVC1 and 4 to group IVC2. Mean values for all patients were within the normal ranges. Only two patients showed hypozincaemia. A correlation was found between the concentrations of serum zinc and albumin. The serum albumin concentration was correlated with the serum pseudocholinesterase activity.

Acquired Immunodeficiency Syndrome↗
PubMed1988

[Gastrointestinal findings in HIV infection. Clinical aspects, microbiological findings and endoscopic picture].

Among 200 hospitalized patients treated for HIV infections there were 98 with gastrointestinal symptoms, independent of the stage of the disease. Only 22 had abnormal stool findings. But histological examination and culture of endoscopically obtained biopsies revealed opportunistic infection in 62, of whom 28 had a cytomegalovirus infection. Mycobacterium avium-intracellulare was found in the gastrointestinal mucosa of 25 patients, but its clinical significance is unclear. In 33 of the 98 patients previously classified as positive for HIV or AIDS-related complex, endoscopic demonstration of an opportunistic infection required amendment of their HIV stage. In over 60% endoscopy revealed mucosal changes. A distinction from Crohn's disease or ulcerative colitis could only be made by histology or exclusion of the causative microorganism. Demonstration of the causative microorganism from the biopsy is thus essential in patients with gastrointestinal symptoms, because specific treatment is in principle possible and successful for some opportunistic infections.

AIDS-Related Complex↗
PubMedDate not supplied

Foscarnet 5 versus 7 days a week treatment for severe gastrointestinal CMV disease in HIV-infected patients.

In a randomized open trial foscarnet 90 mg/kg b.i.d. 5 days for 3 weeks was compared to 90 mg/kg b.i.d. daily in severe gastrointestinal cytomegalovirus disease in HIV-infected patients. Thirty-eight patients were randomized, 36 were evaluable (all male, age 24-54 years, median 40 years; CD4/microliter 0-150, median 10). Treatment efficacy was evaluated based on a score consisting of symptoms, endoscopic and histologic examination. In the 5-day treatment group 10/16 (62%) patients responded to treatment, in the 7-day treatment group 13/20 (65%), with symptoms resolving in most patients after 1 week. Side effects and adverse events were seen in 13 patients in the 5-day treatment group and in 15 patients in the 7-day treatment group. Laboratory abnormalities were common in both groups, in one patient reversible renal insufficiency developed. Efficacy and safety of treatment 5 days a week was comparable to the standard regimen.

Adult↗
PubMedDate not supplied

Foscarnet and ganciclovir combination therapy for CMV disease in HIV-infected patients.

An open prospective trial of combined ganciclovir and foscarnet therapy for 3 weeks was initiated in 14 episodes of severe CMV-disease in 13 HIV-infected patients (all CDC class IV, age 30-42, median 34 years, CD4+ cell count 0-80, median 10/microliters). In seven episodes of gastrointestinal disease (five colitis, two esophagitis) remission of symptoms and mucosal changes was achieved in five. In seven episodes of retinitis, scarring was achieved in six. Renal toxicity was seen in two patients, moderate hematologic toxicity in eight patients. Overall efficacy was comparable to monotherapy; no new toxicities were seen with the combination of these two drugs.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Fluconazole therapy of oral candidiasis in HIV-infected patients: results of a multicentre study.

In an open phase-III study 103 HIV-positive patients with oral candidiasis were treated with oral fluconazole 100 mg/day for 7-21 days (mean 12.2 +/- 6.1 days). Ninety per cent of the patients presented with the full clinical picture of AIDS, in 83% CD4-lymphocytes were < 100/mm3. Clinical and mycological (smear and mouth rinsing) examinations were performed at the start of therapy, after weeks 1, 2, and 3, and at the end of therapy. The clinical findings showed fluconazole therapy to have achieved cure in 71% of the patients and improvement in 16%. Therapy failed in 13%. Mycological tests revealed elimination in 57% and reduction in colony counts in 23% of patients. Therapy failure according to mycological criteria was observed in 20% of all subjects. Adverse events were recorded for 26% of all patients. A causal connection with study therapy was considered as "unlikely" in 20 cases, "questionable" in 17 cases, and "likely" in three cases. Premature discontinuation of fluconazole therapy was required in seven patients, in three of them because of adverse events due to fluconazole. Even in patients with advanced HIV infection and consequently severe immunodeficiency, fluconazole is an important improvement of the therapeutic spectrum.

AIDS-Related Opportunistic Infections↗
PubMedDate not supplied

Severe toxoplasmic ventriculomeningoencephalomyelitis in two AIDS patients following treatment of cerebral toxoplasmic granuloma.

Two patients with acquired immunodeficiency syndrome (AIDS) who were successfully treated for cerebral toxoplasmosis presented a few weeks later with neurologic abnormalities. Brain CT scan showed ventricular dilatation, ependymitis, and meningoencephalitis. Both patients died despite extensive treatment. Neuropathological examination showed enlargement of the cerebral ventricles, severe ventriculoencephalitis with large ependymal and subependymal necrosis, and numerous pseudomembranes within the ventricle lumen. Microscopic examination revealed severe necrotizing ventriculoencephalitis, meningoencephalitis and myelitis. Immunohistochemical studies revealed the presence of miriads of tachyzoites within and around the necrotic areas. Such form of toxoplasmosis as a diffuse meningo-encephalo-ventriculo-myelitis appear unique to AIDS and, to our knowledge, have not been previously documented.

AIDS Dementia Complex↗