Hanasoge T. Girishkumar

Histoplasmosis of the small bowel in patients with AIDS.

Two cases of jejunal strictures caused byHistoplasma capsulatum in AIDS patients are presented. Both patients were intravenous drug abusers. One patient, who was being treated for Pneumocystis carnii pneumonia, presented with jejunal perforation and the other presented with lower gastrointestinal bleeding and intestinal obstruction. On exploration, both patients were found to have jejunal strictures; one had intestinal perforation, and the other had intestinal obstruction with ulcers and strictures resulting in gastrointestinal bleeding. In areas where it is endemic, histoplasmosis is rarely disseminated. Dissemination is most commonly seen in immunosuppressed patients. Dissemination and extrapulmonary histoplasmosis is now included in the case definition of AIDS.

Cystic Hypersecretory Duct Carcinoma of the Breast

Abstract: We present two cases of a rare form of intraductal carcinoma of the breast, “cystic hypersecretory carcinoma of the breast.” The clinical and pathologic characteristics of the lesion are discussed, along with a review of the literature.

Experience with invasive Candida infections

Between January and July 1995, 227 patients at the Bronx-Lebanon Hospital Center had positive fungal cultures.Candida spp were the most common fungi isolated. Forty-three patients with invasive disease, as indicated by fungus-positive blood cultures, became the focus of our study.C albicans caused fungaemia in 21 patients (49%). Twenty-eight patients (65%) were less than 50 years of age; three were neonates. The most common presenting symptoms were fever, chills, and weakness (20 patients, 47%). Thirty patients died, giving a mortality rate of 70%. The patients who died stayed in the hospital an average of 49 days. The highest mortality occurred among patients who became bacteraemic before or at the same time they became candidaemic (24 of 26 patients) or who were receiving broad-spectrum antibiotics (20 of 26 patients). We also found high mortality rates from invasive fungal infection among patients with HIV infection, a central venous catheter, and liver, renal, or respiratory failure. We did not find any increase in the incidence of invasive fungal infection or mortality among leukopenic or diabetic patients.

Ultrasound as an aid in the diagnosis of acute appendicitis

This 1-year prospective study used high-resolution ultrasound at 5 MHz to assess 79 patients admitted with a possible diagnosis of acute appendicitis. The sonographic criterion used to diagnose acute appendicitis was visualization of a noncompressible appendiceal shadow having a diameter of 5 mm or more. Ultrasound examination proved to be a valuable tool in the differential diagnosis of acute appendicitis in all patients who had equivocal symptoms and signs. Ultrasound was particularly useful when applied to female patients of childbearing age.

Stereotactic needle breast biopsy: a review of current status and practice

Abstract The early detection of breast cancer is a concern to women and their physicians. Although screening mammography can identify early breast lesions, many are small and non-palpable. In the past, open excisional biopsy often was required to establish the diagnosis. Recently, stereotactic breast biopsy, a minimally invasive technique, has permitted tissue diagnosis of small lesions without open surgery, with results comparable to those obtainable with excisional biopsy. We reviewed this technique, its application in identifying small breast lesions, and in diagnosing breast cancer in its early stages.