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ObjectivesOur aim was to investigate the durability of different initial regimens in patients starting ART with CD4+ counts 5 log10 copies/mL.MethodsThis was a retrospective study of HIV-infected patients prospectively followed in the ICONA cohort. Those who started ART with boosted protease inhibitors (bPIs), NNRTIs or integrase strand transfer inhibitors (InSTIs), with CD4+ 5 log10 copies/mL, were included. The primary endpoint was treatment failure (TF), a composite endpoint defined as virological failure (VF, first of two consecutive HIV-RNA >50 copies/mL after 6 months of treatment), discontinuation of class of the anchor drug or death. Independent associations were investigated by Poisson regression analysis in a model including age, gender, mode of HIV transmission, CDC stage, HCV and HBV co-infection, pre-treatment HIV-RNA, CD4+ count and CD4+/CD8+ ratio, ongoing opportunistic disease, fibrosis FIB-4 index, estimated glomerular filtration rate, haemoglobin, platelets, neutrophils, calendar year of ART initiation, anchor drug class (treatment group) and nucleos(t)ide backbone.ResultsA total of 1195 patients fulfilled the inclusion criteria: 696 started ART with a bPI, 315 with an InSTI and 184 with an NNRTI. During 2759 person-years of follow up, 642 patients experienced TF. Starting ART with bPIs [adjusted incidence rate ratio (aIRR) (95% CI) 1.62 (1.29–2.03) versus starting with NNRTIs; P ConclusionsIn patients starting ART with 5 log10 HIV-RNA copies/mL, the durability of regimens based on InSTIs was longer than that of NNRTI- and bPI-based regimens.

OBJECTIVES The aim of the study was to analyse the prevalence of integrase resistance mutations in integrase strand transfer inhibitor (INSTI)-experienced HIV-1-infected patients and its predictors. METHODS We selected HIV-1 integrase sequences from the Antiviral Response Cohort Analysis (ARCA) database, derived from INSTI-experienced patients between 2008 and 2017. Differences in the prevalence of resistance to raltegravir (RAL), elvitegravir (EVG) and dolutegravir (DTG) were assessed by χ2 test and predictors of resistance were analysed by logistic regression. RESULTS We included 462 genotypes from INSTI-exposed individuals: 356 'INSTI-failing' patients and 106 'previously INSTI-exposed' patients (obtained a median of 42 weeks after INSTI discontinuation [interquartile range (IQR) 17-110 weeks]). Overall, at least low-level resistance (LLR) to any INSTI (Stanford 8.5 algorithm) was detected in 198 (42.9%) cases. The most frequent INSTI resistance mutation was N155H, followed by Q148H/K/R, G140A/C/S, E138A/K/T and Y143C/H/R. Y143R and E138A were more prevalent in viral subtype B versus non-B [5.2 versus 1.5%, respectively (P = 0.04), and 3.1 versus 0%, respectively (P = 0.02)]. Overall, the Q148H/K/R plus G140A/C/S and/or E138A/K/T pattern, defining an intermediate level of resistance to DTG, was detected in 70 (15%) cases. Independent predictors of at least LLR to any INSTI were current use versus past use of INSTIs, a lower genotypic sensitivity score (GSS) for contemporary antiretroviral drugs used, and having an integrase sequence obtained in calendar year 2016 as compared to 2008-2009. CONCLUSIONS The results support integrase resistance testing in INSTI-experienced patients. Emergence of INSTI resistance is facilitated by the reduced genetic barrier of the regimen as a consequence of resistance to companion drugs. However, INSTI resistance may become undetectable by standard population sequencing upon INSTI discontinuation.

To present a clinical case of an adult affected by Langerhans cell histiocytosis with bilateral, non-simultaneous, involvement of the temporal bone, associated with diabetes insipidus and to review the literature.A rare case of bilateral temporal bone involvement of Langerhans cell histiocytosis in a 42-year-old woman affected by diabetes insipidus is reported. We present patient's clinical history supported by radiologic, histopathologic and audiologic findings.The patient was submitted to a series of otologic surgical procedures due to the progression of the disease. Ossicular chain was always preserved, so that conservative surgery (canal wall-up technique) was performed, permitting the achievement of good hearing results, bilaterally.Temporal bone involvement of Langerhans cell histiocytosis may lead to a progressive chronic disease. However, the ossicular chain can remain uninvolved, making a conservative surgical treatment possible. Careful follow-up is essential for detecting new lesions and serial CT scans are mandatory.

Extracranial involvement of the recurrent laryngeal nerve and the hypoglossal nerve is known as Tapia's syndrome. Ipsilateral paralysis of the vocal cord and tongue is present. Lesion of these nerves may be a rare complication of airway management. Herein, a case of Tapia's Syndrome complicating transoral intubation during general anaesthesia in a rhinoplasty operation, together with a review of pertinent literature to evaluate the incidence and the possible pathogenic mechanism of the lesion. There are recent reports in the literature on mono or bilateral paralysis of the XII or laryngeal recurrent nerve after use of laryngeal mask with a pathogenic mechanism of compression. Furthermore, there are reports, following oro-tracheal intubation, of recurrent laryngeal paralysis, likely legacies to the compression of the anterior branch of inferior laryngeal nerve by the cuff of the oro-tracheal tube against the postero-medial part of the thyroid cartilage. Hypoglossal nerve damage could be caused by a stretching of the nerve against the greater horn of the hyoid bone by a laryngeal mask or oro-tracheal tube or compression of the posterior part of the laryngoscope or oro-tracheal tube. In our case, the lesion probably occurred as the result of a two-fold compressive mechanism: on one hand, compression by the cuff of the endo-tracheal tube due to excessive throat pack in the oro-pharynx; on the other hand a prolonged stretching mechanism of these nerves may have occurred due to excessive anterior and lateral flexion of the head. From the data reported in the literature, as in our case, complete recovery of function is generally achieved within the first six months. This progressive recovery of function suggests nerve damage of a neuro-praxic type, which is typical of compression injury. In conclusion, the response of this rare complication confirms the importance not only of the position of the head and patient on the operating table but also the meticulous and correct performance of the routine manoeuvres of airway management.

High level HIV-1 drug resistance in recently infected treatment-naive individuals correlates with sub-optimal virological responses to highly active antiretroviral therapy (HAART). To determine whether genotypic HIV-1 drug resistance in chronic naive patients, as interpreted by various systems, could predict the virological outcomes of HAART, isolates from patients enrolled in a prospective observational cohort (ICoNA) prior to treatment start were genotyped. Genotypic susceptibility scores (GSS) assigned to the initial HAART regimens using the interpretations of pre-therapy resistance mutations by 13 systems were related to virological outcomes. Of 415 patients, 42 (10%) had at least one major resistance mutation. According to the different interpretations, 1.9-20.5% of patients had some level of resistance to at least one drug in the initial regimen. In multivariable analysis, GSS from two systems significantly predicted the time to virological success: Rega 5.5, for each unit increase in GSS adjusted relative hazard (RH) 1.86 [95% confidence intervals (95% CI): 1.15-3.02] and hivresistanceWeb v3, RH 1.87 (95% CI: 1.00-3.48). With three other systems, GSS showed a trend towards a significant prediction of success: Retrogram 1.6, RH 2.33 (95% CI: 0.98-5.53), Menéndez 2002, RH 2.36 (95% CI: 0.97-5.72) and Stanford hivdb, RH 2.06 (95% CI: 0.94-4.49). Genotypic resistance testing coupled with adequate interpretation in chronic naive patients can usefully identify those at risk of sub-optimal virological response to HAART. This work was presented in part at the First European Workshop on HIV Drug Resistance. Luxembourg, 4-6 March 2003 (Abstract 44); and at the 9th European Conference on CIinical AIDS Therapy. Warsaw, 25-28 October 2003 (Abstract F6/7).

Multiple sclerosis is an autoimmune and inflammatory disease of the CNS characterised by recurrent destruction of myelin which results in heterogeneous and unpredictable clinical manifestations. Although the factors able to foster the initial changes leading to CNS demyelination in patients with multiple sclerosis are still unknown, a discrete number of genes are likely to predispose to the occurrence of multiple sclerosis and to influence its clinical variables. Due to the inflammatory nature of the pathogenic mechanisms mediating CNS damage during multiple sclerosis, association studies have been focused on candidate genes coding for immunorelevant molecules. The interleukin (IL)-1 gene cluster (including IL-1A , IL-1B , IL-1RN ), located on the long arm of chromosome 2 (2q12–22; OMIM Database of National Center for Biotechnology Information; www3.ncbi.nlm.nih.gov:80/Omim) and polymorphic in different sites, represents a good target for association studies in multiple sclerosis. IL-1, in fact, has been detected within multiple sclerosis lesions.1 Moreover, lipopolysaccharide stimulated peripheral blood monocytes of patients with multiple sclerosis produce more IL-1α and IL-1β than controls.2 Due to the potential involvement of IL-1α and IL-1β in multiple sclerosis, a genetically determined polymorphic variation in their production may contribute to the occurrence of multiple sclerosis, or modulate its clinical features. Furthermore, we have recently reported the association …

This report describes a 26 year old woman with a Coxsackie B virus infection complicated by an acute pandysautonomic and sensory neuropathy. Electrophysiological studies suggested an axonal neuropathy. A sural nerve biopsy performed early in the disease showed axonal degeneration with a virtual absence of unmyelinated fibres and moderate loss of myelinated fibres, mainly affecting the small fibres; this differs from previous reports. An immune-mediated or direct virus action might explain the pathogenesis of this unusual evolution of a viral infection.

Kikuchi's disease or histiocytic necrotizing lymphadenitis is an uncommon clinical condition that causes diagnostic difficulties because of its lack of specific signs, symptoms and serological markers. Diagnosis is based on histopathological findings, but overlapping of the histological features requires a differential diagnosis among histiocytic necrotizing lymphadenitis and a number of infectious, autoimmune and lymphoproliferative lymphadenopathies. We report a case of Kikuchi's disease in a 19-year-old woman presenting with generalized lymphadenopathy and persistent fever.

Up to the present, pancreatic complications due to cryptosporidium parvum infection have been described only in a few patients with acquired immunodeficiency syndrome (AIDS). We report our experience with 3 subjects with AIDS who presented with acute or chronic pancreatitis related to cryptosporidiosis. All 3 patients had abdominal pain resistant to analgesics, increased serum amylase and abnormalities at both sonography and computed tomography. Endoscopic retrograde cholangiopancreotography revealed papillary stenosis in all patients; one patient also had stenosis of the Wirsung duct. Cryptosporidium was found in both bile and stool samples in all patients, while viral cultures were negative, even in the 2 patients who had cytomegalovirus retinitis. Endoscopic sphincterotomy temporally relieved abdominal pain in all patients, but did not prevent either acute or recurrent pancreatic inflammation. Several antibiotic therapeutic protocols were ineffective against the parasite.

This paper concerns one of the four research projects developed during a training course in clinical epidemiology managed by the Lombardy training centers IREF.To compare the recommendations for treatment concerning 9 vignettes derived from the Australian Quality Assurance Project.Six Mental Health Services of Regione Lombardia.For each vignette, all psychiatrists working in the 6 Mental Health Services were asked to fill in a questionnaire about treatment location, psychopharmacology, psychotherapy, priority between psychotherapy and psychopharmacology and degree of difficulty in answering.44 out of 52 target psychiatrists took part to the study. Remarkable variability for treatment location and psychotherapies; moderate variation for psychodrugs prescriptions and a good agreement for diagnoses were observed. In drugs prescription an access of association was observed. The most prevalent model of psychotherapy was the psychodynamic, followed by the cognitive-behavioural and the family-systemic. There was a tendency toward a flexible approach, as suggested by recommendations of different psychotherapeutic models according to the nature of the disorder. No case were judged very difficult; only in 3 cases a judgement of "somewhat difficult" was expressed by more than 20% (but less than 30%) of the psychiatrists.Studies of this type are very easy to carry out and give useful information for continuous training programs and Continuous Quality Improvement projects.

There is very little experience reported in the literature on the treatment of patients with relapsed or resistant human immunodeficiency virus-related non-Hodgkin's lymphoma (HIV-NHL). We performed a prospective study to evaluate the feasibility and activity of a second-line chemotherapy regimen consisting of etoposide, mitoxantrone, and prednimustine (VMP) in this setting.Twenty-one patients were consecutively treated. Thirteen patients were resistant to primary chemotherapy and 8 patients had relapsed after their first complete remission (CR). Etoposide and prednimustine were both given orally at doses of 80 mg/m2 daily for 5 days, and mitoxantrone was given intravenously at a dose of 10 mg/m2 on Day 1; the cycles were repeated every 3 weeks.Nineteen of 21 patients were evaluable for response. The median number of cycles administered was 2 (range, 1-5). A CR occurred in 5 of 19 patients (26%; exact 95% confidence interval; 9-51%). Four of these CRs were observed in the 7 evaluable relapsed patients. Of 45 cycles evaluable for toxicity, severe neutropenia (500/microL) occurred in 19 (42%) cycles and severe thrombocytopenia (25,000/microL) in 6 (13%) cycles. One toxic death occurred due to sepsis during neutropenia. The overall median survival was 2 months (range,1-13 months); the median survival time for the 5 patients with CR (13 months; range, 6-13 months) was statistically significantly longer than that observed in patients without CR (2 months; range,1-7 months).Although the overall prognosis of patients with resistant or relapsed HIV-NHL is very poor, palliative therapy with VMP can be effective and relatively safe in the latter group. Prolonged survival has been observed in some patients who had relapsed after initial chemotherapy.

The importance of Rhodococcus equi infection, an uncommon human pathogen that almost exclusively affects immunocompromised hosts, has greatly increased following the advent of acquired immune deficiency syndrome (AIDS) epidemics. Until the present time, 38 cases of R. equi infection have been described in human immunodeficiency virus (HIV)-infected patients; we now report a further five personal cases. R. equi was acquired via respiratory exposure to animals in less than half of the patients, and caused invasive pulmonary infection (91%), bacteraemia and sometimes bloodstream dissemination. R. equi was easily cultured from sputum or blood, but its diagnosis was often difficult due to microbiological and clinical similarities with other pathogens. The persistence of the micro-organism inside macrophages and its high tissular load represent the major limitation to an effective treatment. Several antibiotics are active in vitro, but their efficacy in vivo depends on macrophage uptake and/or bactericidal activity. Treatment should start with at least two intravenous bactericidal antibiotics for 3-4 weeks, and then continue with oral therapy for a period of up to several months with at least two intracellularly active drugs. Surgical resection of the lesions may be beneficial in selected cases.

We studied an AIDS patient who suffered from numbness, paresthesias and pain in the territories of different non-contiguous cutaneous nerves at different times. A transitory partial loss of touch and pinprick sensibility was also present in the same cutaneous areas. Sensory conduction velocities and SAP amplitudes were normal. The clinical picture was consistent with the Migrant Sensory Neuritis of Wartenberg. This rare neuropathy has never previously been described in patients affected by AIDS.

The analysis of valvular morphology is important in selecting patients with mitral rheumatic stenosis for percutaneous mitral valvuloplasty. Transthoracic echocardiography definitely plays a major role in this characterization whereas the usefulness of transesophageal echocardiography has not been determined yet. We studied 95 patients (82 females, 13 males, mean age 51 +/- 12 years) undergoing mitral valvuloplasty (Inoue's technique). The two methods were compared for: morphologic mitral score; correlation between score and increase in mitral valve area; ability to predict post valvuloplasty mitral regurgitation; accuracy in detecting atrial thrombosis. A significant linear correlation between transthoracic and transesophageal echocardiographic scores was observed (r = 0.78, p0.001). Transesophageal echocardiographic score was significantly lower (6.8 +/- 1.62 versus 7.17 +/- 1.69, p0.05) due to a lower estimation of the extent of calcifications (0.7 +/- 0.97 versus 1 +/- 1.12, p0.05). Correlation coefficients between increase in mitral valve area and scores obtained with the two methods were similar (0.29 and 0.30). For both echocardiographic techniques 6 was the best cut-off score value. None of the clinical, hemodynamic and echocardiographic variables was able to predict the occurrence of severe mitral regurgitation. Five patients with atrial thrombosis were identified by transesophageal echocardiography but only 1 by transthoracic echocardiography. We conclude that the two echocardiographic methods have complementary roles in the evaluation of patients undergoing mitral balloon valvuloplasty. Mitral valve morphologic score can generally be assessed adequately by transthoracic echocardiography but transesophageal echocardiography is mandatory in order to exclude left atrial thrombi. The occurrence of post valvuloplasty severe mitral regurgitation cannot be reasonably predicted on echocardiographic basis.

Available information on atherosclerosis of thoracic aorta in man is scanty and mostly derived from pathological or surgical series. Transesophageal echocardiography makes a clear definition of the entire thoracic aorta possible and enables large, population based studies. In order to define prevalence, risk factors and clinical implications of aortic atherosclerosis, the echocardiographic recordings of 220 patients suitable for both evaluation of thoracic aorta and risk factors analysis were reviewed. Transesophageal echocardiography has been performed because of valvular diseases (78), suspected aortic aneurysm or trauma (43), evaluation of valve prosthesis (39), previous cerebral or peripheral embolic events (22), infective endocarditis (14), cardiac mass lesions (12) or other indications (12). Age ranged from 5 to 81 years (55 +/- 15), male to female ratio was 0.99. Simple and complex atherosclerotic plaques were identified in 33% and 10% respectively. Complex atheromas were more frequent among patients with previous embolic episodes (6/22, 27% versus 17/198, 8.5%; p = 0.019). The prevalence of any type of atherosclerosis progressively increased from the fourth (8%) to the eighth (88%) decade of age. By univariate analysis age (p0.001), history of hypertension (p0.001), systolic (p0.001) and diastolic (p0.05) pressure, type II diabetes mellitus (p0.01), HDL cholesterol (p0.01), HDL/total cholesterol (p0.01) and uricaemia (p0.05) were associated with aortic atherosclerosis. Discriminant analysis identified 5 independent variables associated with the presence and the extent of atherosclerosis (Wilk's Lambda = 0.43): number of cigarettes per day, age, history of hypertension, systolic pressure and type II diabetes mellitus. This model provided a 63% correct classification rate.(ABSTRACT TRUNCATED AT 250 WORDS)

We discuss here our experience with Mycobacterium avium complex (MAC) infection in 446 HIV-positive patients. MAC was found in 13 cases (2.9%): 10 males, 3 females, age range 21-47 years. Infection was disseminated in 10 cases and limited to the lung in 3. CD4+ cells were, on average, 48 per microliters. At clinical onset, all patients suffered from fever and weight loss, 10 from anemia, and 5 from diarrhea. MAC was found in its disseminated form in cultures of blood (10 patients), stool (5 patients) and urine (1 patient). Broncho-alveolar lavage seemed to be the most specific diagnostic method for lung infection. Twelve patients were treated with a multi-drug regimen consisting of an association of 4 or 5 antibiotics, selected on the basis of antibiogram, from the following: clofazimine, rifabutin, ciprofloxacin, ethambutol, isoniazid, amikacin and piazofolin. Mean survival of patients was 91.7%, 83.4%, 71.8% and 58.4% at 4, 5, 6 and 7 months of treatment respectively. Although the mean survival of the treated group is similar to that of untreated patients, multi-drug therapy seems to improve quality of life inasmuch as it brings temperature to normal and enables weight gain. Dissemination was never observed after treatment in patients with pulmonary infection only.

We report the case of a 37-year-old woman with oxalosis, and cardiopulmonary involvement. Two-dimensional and Doppler echocardiography disclosed intracardiac calcifications compatible with deposition of calcium oxalate, and severe chronic pulmonary hypertension. Endomyocardial biopsy showed interstitial deposition of calcium oxalate. The absence of severe cardiac disease strengthened a deposition of calcium oxalate even in the arteries of the lungs, with secondary chronic pulmonary hypertension.

Although lymphadenopathy occurs in 60% of patients with adult Still's disease, its histopathological pattern has only recently been described. We report on the immunohistological study of a lymph node biopsy and the clinical course of 2 patients with adult Still's disease. The lymph node histology was characterized by a diffuse paracortical expansion with a high content of immunoblasts and plump endothelium venules. Immunohistochemistry using the alkaline phosphatase, antialkaline phosphatase technique showed the mixed B and T cell nature both of proliferating cells and immunoblasts. When antiheavy and light chain reagents were applied, the B cell component became polytypic. Our report stresses the relevance of immunohistological investigation in the diagnostic approach to Still's disease in which histological findings, if taken alone, might be misleading.

The Italian Cooperative Group on AIDSTumors (GICAT) is collecting data on the epidemiological and clinical features of Kaposi's sarcoma (KS) in Italy, a country where intravenous drug users (IVDUs) comprise the largest group affected by AIDS. As of December 31st 1989, among 5317 cases of CDC-defined AIDS reported to the National Registry of AIDS, there were 419 (8%) cases of KS. Twenty-five percent of all of the homosexual men with CDC-defined AIDS had KS, while only 3% of the IVDU patients with CDC-defined AIDS had KS. The first case of KS was observed in 1982, 2 cases in 1983, 7 cases in 1984, 17 cases in 1985, 55 cases in 1986, 89 cases in 1987, 120 cases in 1988 and 128 cases in 1989. Of the 226 cases of KS reported to GICAT, 60% were in homosexual men, 21% in IVDUs, and 9% in heterosexuals. An increased number of KS has been observed since 1982, although the number of new cases in the past year seems to have been stable, possibly due to the usual delay in notification. There is, however, an actual decrease of the percentage of KS among AIDS patients, from 18% in 1984 to 6% in 1989. Almost half of the patients had had a diagnosis of AIDS prior to the appearance of KS, but in 25% of the patients KS was the first AIDS manifestation. Almost all patients had skin involvement either alone or in association with other sites, whereas very few patients had only lymph node involvement. Only treatment with alpha-2 interferon was able to obtain complete remission in 9% of evaluable patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Controversies exist about the functional evaluation of chronic heart failure; aim of this study has been the assessment of the feasibility of the Goldman classification, based on the metabolic cost of various daily physical activities, in a cohort of patients with mild to moderate heart failure, its relation to NYHA class and to the main clinical parameters currently used. We evaluated 114 patients (mean age 61 years) with mild to moderate heart failure due to idiopathic cardiomyopathy (78%), ischemic heart disease (14%) and others (8%). Based on the Goldman classification there were 82 patients (72%) in second and 28 (24%) in third class while 83 (73%) were in NYHA II class and 31 (27%) in NYHA III class. The concordance rate between Goldman second and NYHA II class was 84% and 64% between Goldman third and NYHA III class. The cardiothoracic ratio was statistically different in all 3 Goldman classes while this happened only in NYHA IIM and III versus IIS. Double product and duration of exercise were statistically different in all Goldman classes but only in NYHA II and III class. No relation was observed with ejection fraction on echocardiogram. In the subgroups analysis there was a linear positive relation between duration of exercise versus double product and cardiothoracic ratio versus cardiac volume. We conclude that Goldman class is a feasible method to assess quality of life in chronic heart failure and is more helpful and objective than NYHA class in determining the functional class of the patient.(ABSTRACT TRUNCATED AT 250 WORDS)

Radical nephrectomy with extensive lymphadenectomy was performed by the same surgeon on 104 consecutive patients with renal cell carcinoma. No significant differences in over-all survival owing to age, sex and preoperative embolization were noted. Only extension of the disease proved to be important as a prognostic factor. In the light of the statistical analysis of this variable the prognosis for patients with renal cell carcinoma has been classified as 1) good—patients with tumors confined to the kidney, 2) intermediate—patients with perirenal fat involvement, lymph node metastases and venous extension, and 3) poor—patients with distant metastases.

SUMMARY The nycotohemeral pattern of serum luteinizing (LH), follicle-stimulating hormone (FSH) and prolactin (PRL) in eight patients with myotonic dystrophy (MD) was studied. Gonadotropin patterns were classified as adult, pubertal or infantile. Six patients showed an adult pattern, whereas two had a pubertal or infantile pattern. A normal pattern of PRL secretion was found in seven patients and a blunted sleep-related hormonal increase was observed in one. Impaired hypothalamic control of pituitary secretion in MD is proposed as the cause for these findings.

The effects of nalorphine 5 mg i. m., a partial opiate antagonist, on circulating levels of PRL, GH, TSH, LH, FSH and cortisol were studied in six healthy men. Nalorphine produced a produced a prompt and sharp increase in serum PRL and a small, delayed rise in serum GH. Serum LH and cortisol decreased after drug administration and no change in serum FSH and TSH was observed. These findings are discussed and a possible site of action of nalorphine is suggested.

Between August 1985 and June 1987, 809 subjects at risk for AIDS have been studied. 231 (28.5%) were seropositive for human immunodeficiency virus (HIV) antibodies. The seropositivity rate was 41% among drug addicts, 20.5% among homosexual/bisexual males, 19.7% among sexual partners of seropositive individuals. None of 62 subjects belonging to the health care personnel who interacted with seropositive patients and none of the 26 relatives of HIV-infected subject, have been found to be seropositive. Moreover the HIV seropositivity in the population of Parma was only 0.01%. Among the seropositive subjects, 155 (67.1%) were asymptomatic; 2 (0.8%) showed acute infection (a mononucleosis-like syndrome in both, associated with aseptic meningitis in one); 57 (24.6%) had PLG, 7 (3.4%) ARC, 9 (3.8%) full-blown AIDS (8 of these latter are dead).

In relation to the general issue of the long-term effects of epileptic activity on the higher nervous functions, monohemispheric epileptic patients--divided into "lesional" [i.e., with computed tomography (CT) scan-visible lesions] and "nonlesional" (i.e., with CT scan-nonvisible lesions)--were submitted to dichotic verbal and tonal tasks, dichoptic verbal and spatial tasks, and a visual tachistoscopic attentional task. The aim was to investigate whether the typical patterns of hemispheric prevalence, which were observed in normal subjects by using these tests, undergo significant changes in epileptic patients. The findings versus normal subjects seem to demonstrate that (a) in lesional epileptic patients, the prevalence of the hemisphere without macroscopic lesions is a constant rule, whether or not this hemisphere is prevalent in normal subjects; (b) in nonlesional epileptic patients, the patterns are the following: when the epileptic hemisphere is the one that is prevalent in normal subjects, its prevalence is enhanced, whichever the hemisphere; when the epileptic hemisphere is not the hemisphere prevalent in normal subjects, the left one attracts and maintains prevalence, whereas the right one reduces and variously interferes with contralateral prevalence. It is concluded that, with respect to the functions tested, the nature of the epileptic foci seems to influence markedly the interhemispheric prevalence pattern.

Involuntary groping-grasping responses to visual stimuli were studied in relation to the location of the stimuli in the space surrounding the patient. The following space-related patterns of stimulus-response were observed in four patients: (a) responses were evoked only by visual stimuli in the hemispace ipsilateral to the arm involved; (b) responses were evoked only by visual stimuli within the reach of maximal arm extension; (c) responses were evoked only by visual stimuli in the space around the hand; (d) all such patterns were variously combined. These findings are discussed in relation to the general problem of specific correlations between sensorimotor subsystems and peripersonal behavioral space.

In January 1984 a hepatitis B vaccination campaign was started in health care workers of Hospital of Parma. Within 3 years, of the 953 subjects submitted to serologic screening, 446 were eligible and 409, serum negative for HBV, completed the vaccination. 202 received HB-VAX vaccine (M.S.D.) intramusculary into the buttock at 0.1 and 6 months, and 208 received HEVAC-B vaccine (Pasteur) into deltoid region at 0, 1, 2 and 12 months. After the booster injection, percent of seroconversion (anti-HBs greater than 10 UI/l) and anti-HBs antibody titres were significantly (p less than 0.01) higher in HEVAC-B recipients (95.6%, mean anti-HBs titres = 6400 UI/l), than in the subjects vaccined with HB-VAX (77.1%, mean anti-HBs titres = 2703 UI/l). There was no significative difference in immune response in both groups with respect to age, sex or occupational category. Three hepatitis B infections were identified in HB-VAX recipients, but no one in individuals vaccined with HEVAC-B. No participants had serious adverse effects, minor side effects occurred with equal frequency in both groups. In general, both plasma-derived vaccines have proved to be highly immunogenic, safe and well tolerated in health care workers, however HEVAC-B vaccine, since contains S and pre-S ag, has shown a more satisfactory immunogenic effect.

The efficacy and safety of mezlocillin, a new broad-spectrum semisynthetic penicillin, were compared with those of carbenicillin in a nonblind, controlled clinical study in 89 adult patients. The infections treated were primarily those of the urinary tract, skin, and gastrointestinal or hepatobiliary tract. Escherichia coli, Proteus mirabilis, Proteus morganii, and Pseudomonas aeruginosa were the causative organisms isolated most frequently. A complete resolution of signs and symptoms was achieved in 78% of the mezlocillin patients and in 71% of the carbenicillin patients. In the mezlocillin group, causative organisms were eliminated in 80% of the courses, and in the carbenicillin group the elimination rate was 86%. Two adverse reactions, rash and diarrhea, were reported in mezlocillin-treated patients; none were reported for the carbenicillin group.

GH, PRL, LH, FSH and TSH were measured in serum and in cerebrospinal fluid (CSF) in 16 patients with chromophobe adenomas, in 8 with acromegaly and in 18 subjects with neurological diseases without endocrine troubles. Elevated mean GH and PRL levels in serum and in CSF were found in patients with chromophobe adenomas and with acromegaly. No constant correlation was observed between serum and CSF values. The highest hormonal levels in CSF were usually observed in adenomas with suprasellar extension, but this finding was inconstant. The determination of hormonal levels in CSF does not seem to supply any reliable information about the characteristics of pituitary tumors.

A total of 743 patients affected by various gastrointestinal disorders were examined by ultrasound. The presence in the gallbladder bile of low-level echoes (LLE) was observed in 56 (7.5%). Twenty-six of these patients had surgery: 24 underwent cholecystectomy for important biliary-like painful symptomatology, and 2 had cephalopancreatectomy for pancreatic head carcinoma. Both macro- and microscopic controls of the bile were carried out in all 26 patients. In 20 cases, only microscopic cholesterol crystals and calcium bilirubinate granules were observed in the bile. The microscopic evidence of these crystals was associated in four cases with macroscopic evidence of so-called “biliary sludge” and in four cases with macroscopic evidence of highly viscous bile. In the other 6 cases these crystals were associated with the presence of cholesterol stones. The authors consider that the observation of LLE in the gallbladder bile is an important index of the presence of cholesterol crystals and/or calcium bilirubinate granules. These LLE can assume polymorphic aspects, described by the authors, which may simulate other pathologies and lead to incorrect echographic diagnosis. The high incidence of LLE in an alithiasic population (5.1%), together with the elevated frequency, according to the authors, of association of these echoes with a painful biliary-like symptomatology (52.6%), underlines the diagnostic importance of an accurate ultrasound investigation in this type of pathology.

Thirty members of the staff and fifty-one patients of Parma hemodialysis unit, serum negative for HBV markers, having completed the vaccination (HB-vax vaccine) against hepatitis B, were followed for two years after booster dose. After the third injection, the response to HB vaccine was significantly higher (p less than .0005) in staff members, than in patients. In the staff group, 83.3% were responders at mean titers of anti-HBs of 2703 mUI/ml; only 51% of patients developed anti-HBs at mean titres of 287 mUI/ml. As to either sex or age, no significant differences were observed in the two groups. Among hemodialysis patients the higher response (71.4%) was noted in the less than 40 aged individuals in comparison with those 40-60 (56.9%) or greater than 60 aged (38%). The persistence of the immunisation in both groups appeared to be statistically correlated to the anti-HBs titres after booster injection. At the end of the follow-up, 63.3% of the staff vaccinated members, but only 15.6% of the patients still had protective titre. No ill-effects induced by vaccine developed. Hepatitis B infection was only observed in one non responder member of the staff. The study demonstrates a low response to HB-vaccine and a rapid decrease of anti-HBs titre in the hemodialysis patients, thus leading to the need of frequent revaccination.

A brief survey of the relevant literature is followed by an account of the method and techniques employed in combined radiotherapy and polychemotherapy of 32 cases of cancer of the mouth. The results are described, together with the indications and limitations associated with the method. It is suggested that this form of treatment is sound, though it is pointed out that follow-up of the series has not been long.

The psychological and behavioural impairment following head injury has been investigated in order to throw light on and assess the related epidemiological aspects, methodological approaches, clinical manifestations, and the correlations between the sequelae and the variables of head trauma, i.e. degree of severity of trauma, age of patients, presence or absence of fractures and haematoma. This study was conducted on 117 head- injured patients and 43 matched "control" subjects. The findings point out the following: a) Even the medical staff is often largely misinformed about this type of sequelae. The methods used for assessment should therefore be further developed and a more systematic evaluation of the higher functions following head injury appears to be necessary. b) The syndromes observed are mostly of a composite and diffuse type. It is therefore difficult to classify them according to strict criteria; indeed, it appears that the only possible approach is to define large groups of head- injured patients based on clinical description, which are partly borne out and partly described ex novo in the present series. c) As regards the correlations between the variables of the injury and the resulting neuropsychological impairment, the age factor should be distinguished from the severity of injury. If it is true that the older patients, the greater the impairment, such a direct correlation no longer exists when severity of the injury is considered. Indeed, the latter does not appear to be a significant differential factor in determining the degree of impairment. Similarly, whether the injury is an "open" or "closed" one, or the presence of haematoma do not appear to be differential factors, either.

An experiment is reported which was aimed at investigating interhemispheric differences upon tachistoscopic presentation of Same vs Different stimuli, i.e. pairs of 16-side Vanderplas and Garvin figures selected for their complexity, unfamiliarity and lack of verbalization. The right hemisphere was found to be faster and more accurate in Same judgments and the left hemisphere in Different judgements. These findings seem to further confirm the assumption that the right hemisphere would mostly use a holistic strategy and the left hemisphere an analytic strategy.

A sharp increase in serum and CSF prolactin (PRL) values after acute metoclopramide (10 mg i.m.) administration was found in six male patients without endocrine diseases. Peak values occurred simultaneously in serum and in CSF. This finding suggests the possibility that CSF PRL content depends also on the retrograde transport from pituitary gland.

After stressing the uncertainties of classifying the syndrome exactly and the part played by psychosomatism in its aetiopathogenesis, some forms of acupuncture have been attempted as alternatives to psychodrugs and antispastic substances. 50 cases are examined in which diagnosis of irritable colon was confirmed by thorough clinical and laboratory examinations, use is also being made of appropriate computerizable tables.

Nalorphine 5 mg im caused a significant increase in serum PRL in 8 healthy volunteers. Pretreatment with bromocriptine 5 mg inhibited the nalorphine-induced release of PRL, whereas sulpiride administration enhanced it.

Administration of 50 mg trazodone, an antidepressant drug, in a single oral dose to 10 normal subjects of both sexes, aged 24--41, resulted in a significant (p less than 0.01) decrease of serum prolactin (PRL) values. The mean serum PRL levels were 8.9 +/- 2.2 ng/ml in basal conditions and 4.5 +/- 1.7 ng/ml 180 min after trazodone. Pretreatment with trazodone does not modify TRH-induced PRL release.