[Past and present of pneumonia]. / A proposito di polmoniti: raffronto tra passato e presente.

A comparison is made between the most common types of pneumonias usually observed when Vincenzo Cuomo was active and those of the present day. Socially-transmitted pneumonias are contrasted with hospital-acquired pneumonias, mostly due to Gram negative bacteria, often multiresistant to antibiotics. Additional pneumonias are due to mycoplasmas, rickettsiae and Legionella and also to viruses, such as Cytomegalovirus, for example.

Clinical experience with ofloxacin (DL-8280) in the therapy of various infections.

Thirty-four hospitalized patients with various infections: 19 with typhoid fever, 4 with gastroenteritis, 7 with lower respiratory tract infections, 2 with biliary tract infections, 1 with brucellosis and 1 with infection of necrotic ulceration of the feet, were treated with ofloxacin at a daily dosage ranging between 600 and 900 mg orally. Thirty-one of 34 patients (91.18%) completely recovered and pathogens were eradicated. In 2 patients, both with respiratory tract infections, the treatment failed and in one patient, affected by infection of necrotic ulcerations of the feet, improvement was registered. No side effects were recorded. Ofloxacin can be considered a safe and effective antimicrobial agent in the therapy of these infections.

Antibiotic treatment in patients with altered pathophysiological pathways.

The pharmacokinetics of antibiotics are reviewed under particular physiological (senescence) and pathological (renal failure, liver failure) conditions. As regards the antibiotic management in the elderly, the main problems are related to the "immunosenescence" and to kinetic modifications, occurring even in the absence of an evident renal impairment. If manifest renal failure is present, the main issue is the correct dosage, and a careful consideration of the interest of the patient when they have to undergo hemodialysis. In cases of liver failure, a number of factors impairing the kinetics of antibiotics are discussed, underlining how these are too often underestimated in therapeutical approaches. The paper is focused on the behavior of new molecules, with particular regard to Teicoplanin, Carbapenems and Fluoroquinolones.

Efficacy of human leukocyte interferon-alpha treatment in elderly patients with hepatitis-C virus-related chronic liver disease.

Sixty-seven aged patients (mean age 69, age range 67-73 years) with hepatitis C virus (HCV)-related chronic liver disease were treated with human leukocyte interferon-alpha at a dose of 9 mU/week for 9 months and then followed up for other 6 months. At the end of treatment, 39 patients (58.2%) showed normalization of alanine aminotransferase (ALT) levels; however, 24 responders (61.5%) had a relapse of the disease in the following 6 months. Fifteen out of 39 responders (38.5%) had a sustained response. Of these, 9 (60%) showed clearance of HCV-RNA from serum. Similar rates were observed in a group of younger patients (mean age 48, age range 17-58 years) treated with the same schedule. In both groups, the most important predictor of response appeared to be the degree of fibrosis at liver histology, rather than the patients' age. These data suggest that interferon-alpha treatment may be as much useful in elderly patients as it may be in younger patients, provided that liver injury is not advanced too much.

[Comparative evaluation of the therapeutic action and tolerance of diftalone and indomethacin in the long-term treatment of rheumatoid arthritis]. / Valutazione comparativa del- l'attività terapeutica e della tollerabilità del diftalone e del- l'indometacina nel trattamento a lungo termine dell'artrite reumatoide

The therapeutic effectiveness and tolerability of diphthalone and indomethacine administered for long periods were compared in 10 patients suffering from rheumatoid arthritis in the active phase. Each patient was treated with one of the two drugs on a double blind basis. Diphthalone proved to be more active than indomethacine on morning stiffness and on hand grip strength. Diphthalone also produced fewer side effects. The differences indicated proved to be significant statistically.

[Classification of acute bacterial enteropathies]. / Inquadramento e classificazione delle enteropatie batteriche acute.

The first part considers pathogenic microorganisms (Vibrio cholerae and parahaemolytic vibrio, Clostridium welchii, enteropathogenic E. coli, Shigella, Salmonella, other enterobacteria and pseudomonas. Yersinia, simply enterotoxic Staphylococcus and that producing acute enteritis) and the process of infection (formation of a surface link without endocellular penetration with elaboration of hexotoxins, formation of a surface link with subsequent intracellular penetration, submucosa penetration). The second part discusses Salmonellae on the basis of personal experience. Particular attention is paid to current aspects of Salmonella microbiological pathomorphosis, the various isolated serotypes in relation to carriers or patients, biochemical atypias of Salmonellae strains, present-day aspects of resistance to chemoantibiotic treatment and the transfer of Salmonella Wien resistances.

[Biological tumor markers]. / I biomarcatori tumorali.

The classification of tumor markers can at present be only provisional since in this field new acquisitions are reported daily. Nevertheless, during the last few years, a number of monographs and chapters in oncology texts have become available for students and physicians in which certain parameters (sensitivity, specificity, predictive value of individual markers) are illustrated, thus allowing for a more accurate evaluation of their diagnostic efficacy and offering indications as to which of these markers are most useful in relation to the site of the tumor. Although tumor markers are present throughout the organism, the above review is limited to those found in blood. Clinical results obtained to far have already lead to the conclusion that tumor markers are useful above all for the diagnostic and therapeutic follow-up of patients rather than for the diagnosis of tumors. The present tendency is for the association of several markers since a higher percentage of positive results is achieved both for diagnostic purposes and for the detection of residual foci after apparently successful treatments and for the precocious detection of recurrences, as well as for the evaluation of the efficacy of ongoing therapies.

[Mycoplasmas and mycoplasmosis: the etiopathogenetic problems and nosological, clinical and diagnostic advances]. / Micoplasmi e micoplasmosi: problematiche etiopatogenetiche ed attualità nosologiche, cliniche e diagnostiche.

Authors point out, on the basis of literature and of their own experience, the following aspects of Mycoplasma infections: 1) Genetical and biological progresses, especially related to pathogenetic aspects and diagnostic procedures. 2) Recent clinical and diagnostic findings of M. pneumoniae infections: "bacteria-like" pulmonary presentations by mycoplasmas (and, on the contrary, "virus-like" pulmonary presentations by bacteria); atypical kinds of pulmonary presentations by mycoplasmas; role of autoimmunity in extrapulmonary involvement. 3) Relationship among mycoplasmas, immune system and autoimmune diseases, with particular regard to animal models and to the Mycoplasma "superantigen". 4) Appearance of new pathogens and of a new spectrum of Mycoplasma infections: genito-urinary involvement by Ureaplasma urealyticum and by M. Hominis; relationship between Mycoplasma spp. and HIV infection.

[Infections due to hard-to-treat germs. Endocarditis and nosocomial opportunistic infections]. / Le infezioni da germi difficili. Endocarditi ed infezioni opportunistiche nosocomiali.

The authors describe some aspects of "difficult to treat" infections, pointing out, on the basis of their experience, infective endocarditis (IE) and nosocomial infections in compromised host. Among difficult-to-treat IE, the authors stress: 1) the peculiar etio-epidemiological features and the frequent causative pathogens multiresistance on early post-surgical IE; 2) the problems in detecting and management of IE by HACEK group microorganisms; 3) the problems related to other unusual agents IE, with particular regard to nutritionally deficient variants of S. viridans and to Coxiella burnetii. Among nosocomial infections in compromised host, Authors underline the relationship between either nosocomial flora or surgical/instrumental practices and possible underlying immunodeficiencies. Clinical and diagnostic remarks of sepsis, pneumonitis, meningitis, enteritis in neutropenic patients are then stressed, pointing out their atypical presentations and severe prognosis.

[Microparticulate aerosols and respiratory allergy]. / Microparticolato aerosolico e allergopatie respiratorie.

The assessment of allergenic activity in submicronic particles could explain some unknown aspects of pollinosis pathogenesis. Twenty-five 0.5 discs have been obtained using a high volume sampler (Hi Vol Andersen) equipped with 0.3 micron Whatman paper filters. These discs have been challenged with a concentrated pool of sera of Parietaria allergic patients by RIA in order to evaluate the presence of allergenic activity on filters. Discs of non sampled filters and discs of sampled filters challenged with serum pool of patients sensitized to house dust mites were used as controls. The percentage of bound radioactivity was detected by gamma-counter. The radioactivity bound to sampled discs with Parietaria sera was 2.3 +/- 0.55 (Standard Deviation); radioactivity detected on control discs was comparable to background values detected by counter. These preliminary date might suggest that submicronic particles of Parietaria can retain some allergenic activity.

[The epidemiology of adverse reactions to nonsteroidal anti-inflammatory drugs. Nimesulide is tolerated by patients with adverse reactions to NSAIDs and modulates in man the skin response to histamine and codeine]. / Epidemiologia delle reazioni avverse ai farmaci antiinfiammatori non steroidei. La nimesulide è tollerata dai pazienti con reazioni avverse ai FANS e modula nell'uomo la risposta cutanea all'istamina ed alla codeina.

We evaluated the tolerance to NIM in patients with adverse reactions to NSAIDs, expressed by urticaria-angioedema, bronchial asthma or erythema polymorphous on 92 patients among which 32 atopics affected by asthma, rhinitis or contact dermatitis. Challenge test has been performed with increasing amounts of NIM per os every 2 hrs to a maximum of 100 mg/dose. The last dosage was repeated every 12 hrs for 4 times more. No reactions were observed in 86 patients (93.4%). Moreover we evaluated the efficacy of NIM in modulating pomphoid cutaneous reaction to histamine (HIS) and codeine (COD). Three subjects were prick tested with HIS and COD solutions at different concentrations (0.1 to 10 mg/ml), before and after a 5 days therapy with NIM at different dosages/kg/die. At NIM dosages of 3.7 and 2.7 mg/kg/die we observed a strong reduction of pomphoid activity of both HIS and COD. No clear effects were detected at 2.2 mg/kg/die dosage. We assume a dose-related in vivo inhibitory effect of NIM on cutaneous mast cells releasability or a direct anti-histaminic effect. We point out the possible therapeutic role of NIM in the treatment of allergic flogosis at steroid and cromon's side.