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Teicoplanin is a glycopeptide antibiotic whose activity is selectively oriented against Gram-positive aerobic and anaerobic bacteria, including Staphylococcus aureus, coagulase-negative staphylococci, Clostridium difficile, Peptostreptococcus spp. and Corynebacterium jeikeium; such activity is affected by neither methicillin resistance nor beta-lactamase production. Teicoplanin is not significantly absorbed from the gastrointestinal tract; consequently, it has to be administered intravenously (either by infusion or by rapid injection) or intramuscularly. Its long half-life allows regimens based upon once daily administration. The adverse effects most frequently associated with teicoplanin treatment are local and hypersensitivity reactions, such as itching and drug fever; anaphylactoid reactions (the 'red man syndrome') are seldom observed. Teicoplanin also has less potential than vancomycin to cause nephrotoxicity, especially when administered in combination with an aminoglycoside. Teicoplanin has been proven to be effective in the treatment of microbiologically documented Gram-positive infections, including 'difficult to treat infections' such as endocarditis and prosthetic infections. Furthermore, recent trials in patients with haematological malignancies or other cancers have clearly demonstrated that teicoplanin is at least as efficacious as vancomycin in the empirical initial antibiotic regimen for febrile neutropenic patients, and is associated with fewer adverse effects. Finally, owing to its good tolerability profile and the advantage of once daily administration by both intravenous and intramuscular routes, teicoplanin has proven to be very useful for the outpatient treatment of serious Gram-positive infections. In conclusion, teicoplanin is potentially an effective alternative to vancomycin both in immunocompetent and immunocompromised patients, with the advantage over vancomycin of single daily dose administration and lower toxicity. Further comparative studies with vancomycin are, however, required to better define the therapeutic role of teicoplanin for particular infections (i.e. infective endocarditis).

Five hundred and sixty-six women, consecutively admitted to nine different hospitals for elective abdominal hysterectomy, were randomized to receive a single 2 g i.v. dose of either cefotetan or piperacillin at induction of anesthesia. Five patients were excluded and 561 (287 given cefotetan and 274 given piperacillin) could be evaluated. In 10 patients (5 for each drug) the concentrations of either cefotetan or piperacillin in serum and subcutaneous tissue at the beginning and at the end of surgery and in uterus, salpinx and ovary samples, were microbiologically assessed. No significant differences could be found between cefotetan and piperacillin groups for any of the considered infectious complications (bacteremia, wound or vaginal cuff infection, pelvic cellulitis and febrile morbidity) nor for the pooled data (cefotetan group: 4.9%, piperacillin group: 5.8%, p:NS). As for the concentrations of prophylactic drugs, serum levels throughout surgery were found to be adequate.

Between December 1986 and December 1991, the Italian Cooperative Group on AIDS-related tumours documented 94 HIV related solid tumours. Of 21 germinal testicular tumours collected, ten were seminomas. Cervical carcinoma was observed observed in 28 IVDAs (intraepithelial in 8 and advanced, with rapid progression, in one). Lung cancer associated with HIV infection was reported in 14 patients. Also reported were two cases of colorectal carcinoma, one anorectal carcinoma, one pancreatic carcinoma, one carcinoid, one oral carcinoma. Of the central nervous system tumours, were diagnosed 3 cases of glioblastomas, one medulloblastoma and one meningioma. This retrospective study shows that while oral and anorectal tumours were very rarely observed, a wide spectrum of other HIV-related solid tumours were found in this series. The required therapeutic approaches may not necessarily be influenced by the HIV infection, in contrast with the observed pattern for treatment of EKS and lymphomas in HIV infected subjects.

Objective: To evaluate the costs and cost-effectiveness of home-care assistance (HCA) as an alternative to hospital-based care only for patients with AIDS (PWA)., Design: A 6-month prospective study. Use of resources by a control group of PWA receiving ordinary hospital-based care (OC group) was compared with that by a random group of PWA who, in addition to hospital care, were also receiving home care (HC group)., Setting: Home- and hospital-based care for PWA in Vicenza, Italy., Patients: HC group selection was based on eligibility criteria for severity of illness, home location and economic and family support. Ten of the PWA satisfying all eligibility criteria were randomly allocated to the HC group. The control group consisted of 32 PWA lacking one or more of the eligibility criteria., Intervention: HCA involved the provision of palliative care for PWA by a multidisciplinary team of caregivers. Hospital-based services covered inpatient and outpatient services., Main Outcome Measure: The health benefits for HC and OC groups using a quantitative quality of life measure (the Quality of Well-Being Scale)., Results: Overall health-care cost savings of 6-7%, relative to the OC group, were predicted for the HC group. Costs per well week were estimated at US$482 for the HC group and US$791 for the OC group., Conclusion: Home-care assistance appears to be a cost-effective strategy for the treatment and care of PWA if strict eligibility criteria are adhered to.

A prospective, randomized study was carried out in order to assess the efficacy and safety of the mezlocillin-netilmicin combination in the prophylaxis of first permanent transvenous cardiac pacemaker implantation. Five hundred and fifty-two consecutive patients were randomly administered either 2 g mezlocillin and 200 mg netilmicin both as an i.v. bolus before implantation or 2g mezlocillin before and then 6 and 12 hours after surgery and 200 mg netilmicin before and then 12 hours after implantation. No adverse events were seen. Neither pocket nor electrode infections were observed in the 457 subjects still alive (mean follow-up: 29.2 months) or in patients who died after 1 year of follow-up (mean follow-up: 20.1 months) or before this time (mean follow-up: 4.7 months). The serum and pocket concentrations of mezlocillin and netilmicin at the end of surgery were found to be adequate to cover microorganisms that most often cause infections, including methicillin-resistant staphylococci.

In order to compare the seroepidemiology of human immunodeficiency virus (HIV), hepatitis B virus, delta agent and Treponema pallidum infections in two rural populations living in north Uganda (Kitgum district) and in central Burundi (Butezi, Ruyigi region), 448 sera were tested for HBS-Ag, HBS-Ab, and anti-HIV antibodies and screened for syphilis using the T. pallidum haemagglutination (TPHA) test. HBS-Ag positive sera were also tested for anti-delta antibodies. Overall seropositivity rates in healthy subjects, outpatients and inpatients (non-AIDS) were 14.2% and 9.5% in Kitgum district and Butezi, respectively. The prevalence of HBS-Ag and HBS-Ab ranged from 10.0% to 15.6% and from 66.2% to 68.9%, respectively. In north Uganda the rates of anti-delta positivity were 3.1% in the overall population and 30.6% in the HBS-Ag positive subjects. No serum obtained in Butezi was anti-delta positive. In Ugandan people, 64.0% of anti-HIV positive and 25.8% of anti-HIV negative patients were also TPHA-positive (P less than 0.01). For Butezi the corresponding figures were 21.4% and 1.6% respectively (P less than 0.04). On the contrary, no correlation was found between either anti-HIV or TPHA positives and seropositivity for B and delta hepatitis serological markers. The study demonstrated an association between seropositivities for HIV and T. pallidum (TPHA), suggesting common patterns of transmission. On the contrary, no association seemed to exist between HBV and HIV infections.

Two-hundred-ninety-nine hospital workers were randomly allocated to receive MSD hepatitis B vaccine in different injection sites and by different routes (intramuscularly by gluteal or deltoid injections or subcutaneously in the arm) or Pasteur vaccine subcutaneously. Highest rates of seroconversion and highest mean anti-HB, titres were found in subjects given MSD vaccine by intramuscular injection into the deltoid muscle.

Endemic non-filarial elephantiasis has not yet been described in the central tableland of Tanzania. We report the results of a clinical study in Tosamaganga Hospital, located in the middle of Tanzania (Iringa District). 30 patients with elephantiasis of the lower limbs were studied parasitologically (by blood smears) and clinically. Inguinal lymph nodes were removed from 10 patients and histologically examined. The mineral content of soil samples collected from 4 different areas of the region was assayed by X-ray fluorescence. The clinical, histological, parasitological and epidemiological data prompted us to conclude that in these patients elephantiasis was not of the filarial type, and that endemic non-filarial elephantiasis is present in the Central District of Tanzania.

An autochthonous case of dirofilaria infection observed in Italy is described. The parasite was an unidentified species of dirofilaria removed from a subcutaneous nodule of a patient. The most recent data about epidemiology and geographical distribution of the parasite in Italy are briefly discussed.

Two hundred and seventy-one male patients suffering from uncomplicated gonococcal urethritis were treated in an open randomized study with either 250 mg (121 patients) or 500 mg (150 patients) single oral doses of ciprofloxacin. The efficacy of treatment was verified on the third day by direct examination of urethral swabs in 91 patients and by culture and direct microscopic examination in 180 subjects. Cure rates were 100% in the 500 mg group and 96.6% in the 250 mg treated patients. No side effects were seen. Ciprofloxacin appears to be a very effective and safe drug in the treatment of uncomplicated gonococcal urethritis in men.

Australia Antigen was detected by radioimmunoassay technique in 80 cases of viral hepatitis. Incidence of the antigen was 40% in patients with epidemiologic data of infectious hepatitis, 84% in patients with epidemiologic data of serum hepatitis and 61% in a group of patients not reporting a reliable epidemiologic history. The count rate was periodically determined during the course of the illness in the attempt to evaluate, within the limits of the method, the amount of the antigen in the serum samples. Results are briefly discussed, together with the problem of the correlation between the presence of Australia Antigen and the two types of hepatitis infection.

Liver biopsies from 30 HBsAg seronegative and 33 HBsAg positive subjects affected by liver diseases were stained by orcein method for the histochemical detection of HBsAg. All biopsies from HBsAg negative cases were orcein negative. Staining was positive in 55% of seropositive patients. The frequency of the different patterns of the staining is analyzed and its value as a diagnostic and prognostic tool in chronic liver disease is discussed.

Coagulation studies were performed on 8 patients with acute liver failure from viral hepatitis. Four died and four recovered. At the time of development of coma, levels of clotting factors resulted markedly reduced in all cases and were not of value as a prognostic index. Subsequent serial determinations (every 8 hours) during the evolution of coma showed that prothrombin activity and levels of factor I, II, V and X were not correlated with clinical conditions, most probably owing to the influence of the administration of blood and blood components. Of all coagulation tests, the assay of factor VII, which has the shortest half-life, appeared the most reliable index of hepatic synthetic function at a particular point in time.

Two cases of intestinal amoebiasis, one of which autochthonous and the other acquired in Africa, are described. The first of the patients, who never moved to the Tropics nor to Southern Italy, had profuse bloody diarrhea leading to hypovolemic shock; the second case was characterized by massive hemorrhage. Both responded well to appropriate treatment. Infection with E. histolytica should be borne in mind in patients with abdominal symptoms not only if they have travelled in the Tropics, but also in temperate regions, including Northern Italy.

Alpha-fetoprotein levels were measured by radioimmunoassay in 40 cases of acute viral hepatitis, 5 cases of chronic persistent hepatitis, 15 cases of chronic aggressive hepatitis and 5 cases of hepatic coma from fulminant viral hepatitis. Serum concentrations were increased in 55% of patients with acute viral hepatitis and in about 33% of patients with chronic aggressive hepatitis. Levels resulted markedly raised among the patients with coma from fulminant viral hepatitis who survived. The high aplha-fetoprotein values may reflect liver cell regeneration after necrosis of a critical mass of hepatic tissue.

During the months of October and November 1977, 560 children aged between three and five attending some kindergartens of Milan were studied to evaluate the diffusion of intestinal parasitic infections. Among a first group of 274 children, examination of the stool only with Ritchie's method was positive in 14.96% of subjects. When Scotch tape swab test for enterobiasis was also carried out, the diffusion of parasitic infections resulted higher (54.54% in a second group of 286 cases). These data were correlated to the same parameters (age and sex, place of origin and social status of the family, density of inhabitants, hygienic situation), obtaining almost corresponding values in the two groups. In particular, an increase of the incidence of parasitic infections with advancing age and a higher diffusion among members of immigrated italian families (especially if living in overcrowded houses at low hygienic conditions) were observed.