       Document 0693
 DOCN  M9630693
 TI    Open lung biopsy for investigation of acute respiratory episodes in
       patients with HIV infection and AIDS.
 DT    9603
 AU    Miller RF; Pugsley WB; Griffiths MH; Department of Medicine, University
       College London Medical School,; UK.
 SO    Genitourin Med. 1995 Oct;71(5):280-5. Unique Identifier : AIDSLINE
       MED/96096204
 AB    BACKGROUND--Open lung biopsy (OLB) is rarely necessary for investigation
       of HIV positive patients with acute respiratory episodes because of the
       high yield from fibreoptic bronchoscopy with bronchoalveolar lavage
       (BAL). METHODS--A retrospective review of OLB in HIV positive patients
       admitted to a specialist inpatient unit with acute respiratory symptoms
       was carried out in order to define clinical indications, diagnostic
       yield, impact on management, complications and outcome. RESULTS--OLB was
       performed in 23 patients; 21 had undergone one or more bronchoscopies
       with BAL (5 also had negative results from transbronchial biopsy).
       Indications for OLB were: Group A, 15 patients thought clinically to
       have pneumocystis pneumonia but not responding to treatment; Group B, 4
       patients with focal chest radiographic abnormalities; Group C, 4
       patients with diffuse radiographic abnormalities and miscellaneous
       conditions. Preoperative PaO2 (on air) ranged from 4.4 to 14.5 (mean =
       9.5) kPa. The results of OLB were in Group A 5 patients had non specific
       interstitial pneumonitis (NIP), 1 also had Kaposi's sarcoma, 4 had
       pneumocystis pneumonia (1 also had bronchiolitis obliterans organising
       pneumonia [BOOP]), 3 had Kaposi's sarcoma and 1 had BOOP and emphysema,
       1 had pulmonary infarction and no infection and 1 had normal lung
       tissue. In Group B diagnoses were NIP, B cell lymphoma, occult alveolar
       haemorrhage and Pseudomonas aeruginosa pneumonia with BOOP; In Group C 2
       patients had NIP and 2 had pneumocystis pneumonia (1 also had
       cytomegalovirus pneumonitis). All patients survived surgery and none
       required mechanical ventilation. OLB results significantly affected
       management; in Group A inappropriate treatment was discontinued in 11
       patients found not to have pneumocystis pneumonia, and alternative
       therapy was begun in the 4 with pneumocystis and in Groups B and C 6
       patients began specific therapy; unnecessary therapy was avoided in one
       and antimicrobial treatment was modified in one. CONCLUSIONS--Open lung
       biopsy in HIV positive patients with focal and diffuse radiographic
       abnormalities has a high diagnostic yield and low morbidity. This
       investigation should be considered in those with acute respiratory
       episodes and negative results from bronchoscopic investigations or who
       have contra-indications to this procedure.
 DE    Acquired Immunodeficiency Syndrome/*PATHOLOGY  Adult  Bronchiolitis
       Obliterans Organizing Pneumonia/PATHOLOGY  Female  Human  HIV
       Infections/COMPLICATIONS/*PATHOLOGY  Lung/*PATHOLOGY  Lung Diseases,
       Interstitial/PATHOLOGY  Lung Neoplasms/PATHOLOGY  Male  Middle Age
       Pneumonia, Pneumocystis carinii/PATHOLOGY  Respiration
       Disorders/ETIOLOGY/*PATHOLOGY  Retrospective Studies  Sarcoma,
       Kaposi's/PATHOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

