AIDS related neoplasms in Genoa, Italy.

The study defines the epidemiological characteristics of HIV-infection in the population of Genoa and estimates the entity of AIDS-cancer association. The cohort includes 317 subjects resident in the Municipality of Genoa, aged above 14 years and notified prior to 31 December 1991 and/or dead from AIDS in the period 1988-1991. From 1984 to 1991, 44 cases of tumour were recorded. The comparison between the rate ratios found in the AIDS patients' cohort and in the general population of Genoa strengthen the significant association highlighted in literature regarding overall cancer, 26.7 (p < 0.05), and in particular, Kaposi's sarcoma, 3239.4 (p < 0.05); non-Hodgkin's lymphomas, 84.8 (p < 0.05); Hodgkin's lymphomas, 20.6 (p < 0.05). Moreover, a significant increase in the risk of testicular seminoma, 61.5 (p < 0.05) and lung cancer, 18.0 (p < 0.05) is confirmed.

Testicular germ cell tumors and human immunodeficiency virus infection: a report of 26 cases. Italian Cooperative Group on AIDS and Tumors.

PURPOSE: Besides tumors that are diagnostic of AIDS, such as non-Hodgkin's lymphoma, Kaposi's sarcoma, and invasive carcinoma of the cervix, other tumors have been described in the human immunodeficiency virus (HIV) setting. Some case reports on testicular cancer in HIV-infected patients have appeared in the literature. We present a retrospective study on 26 cases of testicular germ cell tumors (TGCTs) observed within the Italian Cooperative Group on AIDS and Tumors (GICAT) between November 1986 and September 1994. PATIENTS AND METHODS: Twenty-six patients with TGCT and HIV-infection from the GICAT were retrospectively analyzed. RESULTS: Fourteen patients had seminoma and 12 had nonseminoma. Four patients underwent only orchidectomy, one patient received only chemotherapy, nine patients were treated with postsurgical chemotherapy, 10 patients (38%) received postsurgical radiotherapy, one patient received postsurgical chemotherapy plus radiotherapy, and one patient was lost for follow-up evaluation immediately after diagnosis. The complete response (CR) rate was 95%. Relapse occurred in 32% of patients. The median follow-up time was 33 months. The mortality rate was 37%. Causes of death were neoplasia in three of nine patients, AIDS in five of nine patients, and fortuitous event in one of nine patients. The overall 3-year survival rate was 65%, and the 3-year disease-free survival rate was 65%. Severe hematologic toxicity was observed in seven of 15 patients. CONCLUSION: HIV-infected patients with testicular cancer should be offered standard oncologic therapy, irrespective of their HIV status, since the majority can be cured of their tumor and have a good quality of life. Use of concomitant prophylaxis for opportunistic infections is recommended.

[Rhodococcus equi infections in AIDS: personal cases]. / Sepsi da Rhodococcus equi in corso di AIDS: osservazioni personali.

We report on the occurrence of an uncommon pathogen, Rhodococcus equi (R.e.) in HIV infection. In the period february 1990-July 1991 we performed the diagnosis of R.e. infection (lung, lung-central nervous system) in two infected patients, aged 27 and 31 years, both males, drug addicts, classified as CDC IV. In the first of them an cavitating right bronchopneumonia (bpm) was diagnosed as of tuberculous origin, on the ground of the microscopic demonstration of an acid-fast, gram-positive strain in b.a.l.. A standard antituberculous regimen was uneffective and R.e. was eventually isolated in three blood culture taken shortly before the exitus and at post-mortem examination of the lungs. In the second patient a subclavian right bpm developed without microbiological evidence of any common pathogen. A third-generation cephalosporin course was only partially successful (clinical amelioration, incomplete clearing of radiological findings). After 3 months the patient relapsed and an aseptic meningitis developed. Cultures of blood and csf yielded a R.e. strain; post-mortem examination revealed a diffuse, cavitating bpm. Our personal experience underlines the difficulty in recognizing R.e. infections in compromised host, because of similarity to other entities (i.e. tuberculosis) and the absence of pathognomonic hints.

Cotrimoxazole therapy of Toxoplasma gondii encephalitis in AIDS patients.

Twenty-four consecutive HIV-positive patients affected by Toxoplasma gondii encephalitis received trimethoprim-sulfamethoxazole (cotrimoxazole) as acute-phase treatment. Two dosage regimens of cotrimoxazole were used: 40 mg/kg/day (12 patients) or 120 mg/kg/day (12 patients) of total compound (trimethoprim plus sulfamethoxazole). Clinical and radiological responses to treatment were evaluated, and the product-limit method for survival data analysis was used. Eighteen of 24 patients showed both a clinical and radiological response (75% response rate). There were no differences in response rates between patients receiving the two dosage regimens of cotrimoxazole. Adverse reaction consisted of leukopenia (two cases) and skin rash (three cases) which led to the discontinuation of the drug in one case. These results suggest that a randomized, controlled clinical trial should be carried out comparing cotrimoxazole versus sulfadiazine-pyrimethamine in AIDS patients with Toxoplasma gondii encephalitis.

[Esophageal ulcer caused by Geotrichum candidum in a case of AIDS]. / Ulcera esofagea da Geotrichum candidum in un caso di AIDS.

Isolate esophageal ulcer caused by Geotrichum candidum in a case of AIDS. We report the case of a 29-year-old white man, AIDS affected, presented with odynophagia, dysphagia and chest pain. X-ray and endoscopic study revealed an isolated esophageal ulcer whose culture demonstrated to be caused by Geotrichum candidum. This etiologic agent was not previously described in this kind of lesion.

[Cerebrospinal fluid immunoglobulins in various types of meningitis]. / Studio delle immunoglobuline liquorali in alcune meningiti.

The Authors using new immunochemical method studied the increases of CSF fluid immunoglobulin fractions during bacterial, viral and tuberculous meningitis. IgG, IgM and IgA levels are increases in all forms of acute meningitis, therefore the rise result most marked in bacterial. It presents further increase in the later stages of viral meningitis. The Authors valued, by mathematical proceeding, IgG, IgA and IgM variations to offer further physiopathologic, diagnostic, therapeutic and prognostic aknowledgements.

[Scroto-perineal gas gangrene. Etiopathogenetic aspects and therapeutic prospects]. / Di una gangrena gassosa scroto-perineale. Aspetti etiopatogenetici e prospettive di terapia.

A case of scrotoperineal gas gangrene is presented. This condition is discussed as an expression of anaerobic infection and both old and new views as to its aetiopathogenesis are described. Treatment has been potentiated by the introduction of clindamycin and other particularly active drugs. It is felt that cultures should be directed to the detection of both anaerobic and aerobic germs, since the former have shown a recent tendency to reappear as causes of infection.

[Problems of the prenatal prophylaxis of the viral infections (author's transl)]. / Problemi di profilassi prenatale delle infezioni da virus

The present review will supply an simple notice over the characters of every one viral infection interesting the materne-faetal conditions, and also propose the most convenient intervention for each observed type. A not small lot of these problems are not resolved in the field of the antiviral immunity regarding the mother and newborn.