Liver transplantation in HIV-positive patients.

AIMS: The aim of this study was to evaluate the feasibility of liver transplantation (OLT) in human immunodeficiency virus (HIV), hepatitis C virus (HCV) coinfected patients in Italy. METHODS: Between September 2002 and April 2006, 12 HIV(+) coinfected patients (11 men, mean age 42 years) underwent OLT at our Institute. Eleven (91%) patients were HCV-positive and one was hepatitis B virus-positive. Pre-OLT plasma HIV 1-RNA level was undetectable and CD4(+) T-cell count >200 cells/microL for 3 months in all patients. Six patients had to stop highly active antiretroviral therapy (HAART) before OLT because of liver disease severity (n = 2) and for hepato cellular carcinoma (n = 4). RESULTS: The actuarial 1-, 2-, and 3-year survival rates were 83.3%, 58.3%, and 58.3%, respectively, which were significantly lower than those observed among HIV-negative patients transplanted in our center. Six patients are alive with a mean follow-up of 26 months (range: 5 to 46 months). We recorded a low rate of opportunistic infections and rejection. All alive patients have low levels of HIV RNA, and the CD4(+) T-cell counts increased after OLT. Nine patients developed early recurrence of hepatitis C requiring combination therapy with peg-interferon plus ribavirin. Significant improvement in the quality of life was observed in 7/11 patients. CONCLUSIONS: OLT in HIV-positive patients was feasible with good results in the short and medium term. Early severe HCV recurrence may be observed. Key challenges for the management of HIV(+) patients after transplantation included treatment of severe HCV recurrence and attention to the pharmacological interactions of HAART with immunosuppressive drugs.

First-line liver resection and salvage liver transplantation are increasing therapeutic strategies for patients with hepatocellular carcinoma and child a cirrhosis.

AIM: The present study focused on nine patients with hepatocellular carcinoma (HCC) associated with Child A liver cirrhosis undergoing first-line liver resection and salvage liver transplantation (SLT) for liver tumor recurrence. PATIENTS AND METHODS: Forty-six patients with HCC underwent liver transplantation (OLT); 37 (80.5%) were primary liver transplantations (PLTs) and 9 (19.5%) were SLTs. All patients who underwent SLT received minor transabdominal liver resections. RESULTS: The posttransplant 1-, 3-, and 5-year overall survival rates for SLT (88.9%, 88.9%, and 88.9%) were similar to those for PLT (78%, 62.7%, and 62.7%). Four (10.8%) patients in the PLT group had HCC recurrence, while there was zero recurrence in the SLT group. The 1-, 3-, 5-year disease-free survival rates for PLT (89%, 74%, and 74%) were similar to those for SLT (100%, 100%, and 100%). The 1-, 3-, 5-year disease-free survival rates after PLT were 89%, 74%, and 74%, and after SLT were 100%, 100%, and 100%, respectively. The operative mortality, intraperioperative bleeding, operative time, intensive care unit stay, in-hospital stay, and overall incidence of postoperative complications were similar in the two groups. CONCLUSIONS: In our experience, SLT for HCC is a feasible procedure with similar results in terms of overall survival, disease-free survival, and postoperative complications to those reported for patients who underwent PLT at our institute. An important role exists for SLT as shown by the fact that such a strategy has been used in the 20% of the patients undergoing OLT for HCC.

A cheap protocol for colour measure and for diagnostic in planning a cultural heritage restoration. Case study: main façade of Palazzo Governi (Cagliari, Sardinia, Italy).

Due to the bad state of conservation, "Palazzo Governi", a seventeenth-century building located in the old town district of "Stampace" in Cagliari (Sardinia, Italy), was subjected to restoration. Thus, according to the Italian Law n. 1089, the main façade colour must be reproduced, and therefore, its identification was required. The available samples looked fairly degraded, in particular as an easy plaster to crumble; so, some other analyses able to identify the degradation cause were performed. Two different approaches were adopted to attain the first goal, the visual colour assessment by a sensory panel (subjective) and the instrumental measurement by colorimetry (objective). Ion chromatography and inductively coupled plasma-optical emission spectroscopy analyses, as well as conductivity and pH measurements, were performed to evaluate the presence of water-soluble salts inside the plaster, as possible cause of degradation; the binder/aggregate ratio was also evaluated. A full mineralogical and petrographic characterisation of the materials constituting the samples, as well as the identification of their stratigraphy and some other morphologic and structural features suitable to highlight eventual forms of degradation, were performed by optical microscopy. Scanning electron microscopy coupled to X-ray microanalysis was been also used in order to confirm and/or to integrate data obtained by optical microscopy. The samples have been compared with two samples coming from two other buildings, also located in Sardinia, that looked in good conservation state. The results evidenced that the causes of degradation come from a high salt (especially sulphate) content and a scarce presence of binder in the plaster that can be imputed to a wrong initial composition and/ or to a leaching by acidic rain.

A microclimate study on hypogea environments of ancient roman building.

Roman hypogea, vernacular settlements or crypts, are underground places characterised by specific and unique challenges (RH<90% and almost constant temperature throughout the whole year) related to their relative isolation from the outdoor environment. These sites often require adequate monitoring tools providing complete environmental information in order to carry out appropriate strategies for scheduling routine maintenance and designing suitable layouts for their preservation. In this work we present the results of a carefully planned thermo-hygrometric monitoring campaign conducted in a peculiar Roman building (130CE), the "Casa di Diana" Mithraeum, sited in Ostia Antica (archaeological site, Rome-Italy), with the aim of characterising the indoor environment as the structure suffers of several conservation problems (biocolonisation, efflorescences, evaporating and condensing cycle for wall-building materials). The campaign involving multipoint continuous measurement was carefully planned to better describe this micro-clime. In addition to underground environmental data available in literature, we have also performed, as a checkpoint control, a thermo-hygrometric monitoring campaign in the "Terme di Mitra" Hypogeum, a few meters from the "Casa di Diana". The recorded data was analysed by multivariate statistical and chemometric analyses. The results brought to light the presence of different microclimates (three areas) within a single Mithraeum: a room (pre-Mithraeum) and an area (Mithraeum: 2-4m) present a thermo-hygrometric environmental behaviour in accordance with a semi-confined environment, another area (Mithraeum: 1-2m) behaves accordingly with underground environments (although it cannot be described as such), and the last area (Mithraeum: 0-1m) where was recording RH values close to saturation (96-99%), associated with non-ventilated areas where the rising damp is "held" and not dispersed, describing an own micro-clime, comparable to a "small greenhouse". This study has allowed to identify some critical areas in view of planning future conservation solutions, without exporting the artefacts kept inside.

Hospital use by HIV patients in Italy: a retrospective longitudinal study. National Study Group on HIV-Related Hospital Use.

Hospital-based treatment for HIV patients consumes considerable health care resources, and for planning purposes it is important to know the hospital needs for each stage of infection. In this paper, we report the results of a national study in Italy on hospital stay for cohorts of patients hospitalized for the first time with HIV-related illnesses during the years 1984-86 and 1987-88. Using the Kaplan-Meier survival methods, we demonstrate a substantial decrease in the proportion of time spent in the hospital by patients newly diagnosed with AIDS (from 49% to 25%) in the latter study period. Treatment with zidovudine (ZDV), estimated only for 1988, emphasizes this trend even more. A reduction in hospital use also occurred for AIDS-related complex (ARC) and persistent general lymphadenopathy (PGL) patients. Possible reasons for this decrease in proportion of time spent in the hospital include longer life span of patients and expansion of outpatient care, as has already been reported in the United States.

Evaluation of the inhibiting effects from exposure to microwaves on the respiratory activity of yeast cells or on enzyme activity.

Microwaves are used in medical applications, so their eventual toxicity effects must be carefully evaluated. An integral toxicity test, based on the monitoring of the respiratory activity of yeast cells, is proposed to evaluate the damage from microwave exposure. Different exposure times and microwave powers were considered. On supposing that the damages occur at enzymatic levels, the inhibiting effects of microwave exposure on two enzymes (glucose oxidase (GOD) and superoxide dismutase (SOD)), assumed like models as present in the human organism, was evaluated.

Liver damage with reversible portal hypertension from vitamin A intoxication: demonstration of Ito cells.

A patient with sudden onset of ascites and hepatosplenomegaly made a complete recovery after vitamin A was withdrawn. Fluorescence microscopy on embedded tissue provided a simple method of demonstrating the accumulation of fat storage (Ito) cells in the liver.

Long-term effects of recombinant leukocyte alpha interferon in the treatment of chronic delta hepatitis.

A pilot study is described, in which 25 chronic CDH patients were treated with 3 MU recombinant alpha-interferon per week for 4 months. Improvement was transient and no long-term effects were noted. Side effects were well tolerated and reversible so that longer treatment and higher dosages should be possible.

Chemometric study and analytical enzymatic methods for diagnosis of cholesterol gallstones.

The lithogenic index (IL) provides an estimate of cholesterol saturation in gallbladder bile and is of possible value for prediction of gallstone formation. A package for pattern recognition of analytical chemical data, known as "Parvus", was used to study the different values of IL obtained experimentally using common enzymic methods for cholesterol and bile salts and other analytical techniques for phospholipids. Ten patients were investigated and some interesting conclusions were drawn, both on the equivalence of various analytical methods for the determination of phospholipids and on the contribution of pattern recognition analysis to the diagnosis of gallstones.

Chemometric investigation of some analytical methods used for the chemical test of foetal lung maturity.

The lecithin/sphingomyelin (L/S) ratio is particularly important for the prediction of foetal lung maturity. A package for pattern recognition of analytical chemical data, "Parvus", was used to handle the different values of the L/S ratio obtained experimentally by common amperometric, spectrometric and chromatographic methods for the determination of lecithin. Eight subjects were considered and some interesting conclusions drawn on the equivalence of different analytical methods of determining lecithin in amniotic fluid.

Resection and transplantation: evaluation of surgical perspectives in HIV positive patients affected by end-stage liver disease.

PURPOSE: The aim of this study was to evaluate the opportunity of surgical treatment in terms of liver resection or liver transplantation in HIV positive patients affected by an end stage liver disease that referred to our liver unit. METHODS: Among 1350 outpatients who referred to our liver unit from January 2002 to September 2003, thirty-two (2,4%) were HIV positive. The routes of transmission of the viral infection, the related co-infections and the underlying liver disease were recorded. The therapeutic pathway was analysed. The kind and the duration of the surgical procedures were assessed. RESULTS: Fourteen (44%) of these thirty-two patients were not suitable for surgical treatment. Surgery was planned in 9 of 32 HIV positive patients (28%). Four patients (12%) were submitted to liver resection and OLT was performed in five patients (15%). Hepatocellular Carcinoma was present in 4 (44%) of the HIV positive patients considered for surgery. CONCLUSIONS: In conclusion in our centre the 28% of HIV positive out patients had the opportunity to receive a surgical treatment. The candidate to this surgery is mostly young, HCV and/or HBV coinfected and affected by HCC in 44% of cases.

The efficacy and safety of imipenem/cilastatin in the treatment of severe bacterial infections.

We have assessed the efficacy and safety of imipenem/cilastatin in a non-comparative study of 27 immunocompromised patients suffering from severe bacterial infections. Moreover in two groups of 14 patients the efficacy of imipenem/cilastatin versus a standard broad spectrum antibiotic therapy has also been compared. Clinical and microbiological efficacy and side effects have been evaluated.

[Acute liver toxicity of antiretroviral therapy (HAART) after liver transplantation in a patient with HIV-HCV coinfection and associated hepatocarcinoma (HCC)]. / Tossicità epatica acuta da terapia antiretrovirale (HAART) dopo trapianto di fegato in un paziente con coinfezione da HIV-HCV ed associato epatocarcinoma (HCC).

OLT in HIV infected patients still remains a challenging option requiring a careful monitoring of patients for HCV reinfection, drug interactions and antiretroviral toxicity. Severe adverse events due to HAART have been already reported for post exposure prophylaxis in HIV infected patients. Here we report a case of liver graft toxicity related to HAART in a HIV-HCV co-infected patient (46 yrs-male) with associated a small HCC transplanted with a marginal liver graft. The patient had pre-OLT plasma HIV 1-RNA levels undetectable and CD4+ T-cell count of > 200 cells/microL for 6 months. At day 2 a severe graft dysfunction was observed (AST 1570 U/L, ALT 2180 U/L, BIL tot 8.3 mg/dL, BIL Dir 6.6 mg/dL and PT 35%--INR 2.5). Doppler scan showed hepatic artery always patient. Later the postoperative in-hospital course was complicated by tense ascites and severe cholestasis. Serum bilirubin reached 42 mg/dL in day 12. Hypertransaminasemia ended at day 15 while cholestasis ended after 46 days. Tacrolimus was reintroduced at day 7. A liver biopsy 10 after OLT showed severe intrahepatic cholestasis, centrolobular necrosis and macrovesicular steatosis (30%). The patient was discharged 48 days after OLT with good liver function. After seven months HIV-RNA is still undetectable and HAART has not been restarted. We believe that the early complications we observed may be attributed to a sudden increase in plasma concentration of antiretroviral drugs secondary to drug redistribution from peripheral tissues and hepatic clearance deficiency after OLT. Although a pre-OLT withdrawal of HAART seems unjustified a delayed re-introduction of HAART or the use of less hepatotoxic drugs may be advisable.

Gastrointestinal tubercular arteritis during HIV infection.

Although digestive tract is often involved in HIV disease, severe gastrointestinal bleeding rarely occurs. We describe a case of severe gastrointestinal bleeding associated with a mycobacterium tuberculosis arteritis of colonic tract. It is reported a morphology change of mesenteric arteries by mycobacterium tuberculosis revealed by angiography. The superselective embolization of branches mesenteric inferior artery resolved the important bleeding without surgical intervention. In AIDS patients, during intestinal tuberculosis, massive enteric-hemorrhage suggests for involvement of mesenteric arteries by mycobacterium tuberculosis. An angiography is basic to discover bleeding and if necessary for the therapeutic treatment.

Identification of different types of imperial age marble finds using instrumental chemical analysis and pattern recognition analysis.

A physical-chemical characterisation of several marbles frequently used in ancient times for artistic or decorative purposes was performed in support the work of historians and restorers. The data were obtained using several different types of instrumental chemical methods (Thermogravimetry, Differential Thermal Analysis, X-ray Diffractometry and ICP Plasma Emission Spectroscopy) and have been summarised in short tables. The data have already proved useful in the identification of a small number of finds (statues or architectonic elements) from Ancient Rome (Imperial Age, 2nd-3nd cent. A.D.) for the purpose of which also a well-known pattern recognition analysis software package was used for data processing. In practice, the research showed that an organised set of chemical data obtained using several modern instrumental methods can provide a valid basis for the reasonably rapid and reliable identification of the type of marble used to make artistic artifacts that have not yet been subjected to typological study.

[Enoxacin in the treatment of bacterial infections of the urinary tract]. / L'enoxacina nel trattamento delle infezioni batteriche delle vie urinarie.

In order to evaluate effectiveness and tolerance of treatment with 300 mg tablets of enoxacine (one every 12 hours), 30 patients between the ages of 29 and 75 were selected (51.23 +/- 2.19 yrs. was the average age), 4 males and 26 females; 18 patients had acute cystitis, 7 had pyelonephritis, 4 had cystopyelitis, and 1 had urethroprostatitis. Treatment lasted on average of 10.77 +/- 0.52 days, with a minimum of 7 and a maximum of 20 days. Initial culture analysis of urine samples ascertained the presence of microbial pathogens sensitive to enoxacine. After one week of treatment, culture analysis of urine samples did not reveal the presence of these pathogens, all having been successfully eliminated. The improvement of the objective and symptomatic parameters chosen for evaluating the effectiveness of the treatment was found to be rapid and decisive in the majority of patients. The systemic tolerance was good; the side effects were minimal (three cases of slight gastroenteric intolerance). At the end of treatment, results were considered excellent in 18 patients and good in 12, on the basis of the more or less rapid resolution of the clinical and symptomatic situation.

[Piperacillin in the therapy of severe bacterial infections: comparison of its efficacy and tolerance vs. ceftazidime]. / La piperacillina nella terapia delle infezioni batteriche gravi: confronto dell'efficacia e tollerabilità vs ceftazidime.

38 patients with severe acute bacterial systemic infections have been enrolled in this study: 19 patients were treated with piperacillin (100-200 mg/kg/day) and 19 with ceftazidime (45-90 mg/kg/day) by i.v. route. In both groups monotherapy has been found effective and well tolerated. Serious side-effects have not been observed. The high cure and eradication rates in both groups do not show statistically significant differences (chi 2 = 0.620 and chi 2 = 0.219, respectively, p greater than 0.05).

[Cefotetan vs ceftriaxone: clinical and bacteriological efficacy in complicated forms of urinary tract infection]. / Cefotetan vs ceftriaxone: efficacia clinica e batteriologica nelle forme complicate di infezione del tratto urinario.

Forty adult patients with UTI complicated by local and/or general diseases have been treated, 20 with Cefotetan and 20 with Ceftriaxone. Both treatments showed good clinical and bacteriological efficacy, with no statistically significant differences between the results. Cefotetan and Ceftriaxone were both well tolerated, without any local or systemic side effects.

[Hypertensive encephalopathy in post-infective glomerulonephritis]. / Encefalopatia ipertensiva in corso di glomerulonefrite post-infettiva.

We described the case of a thirteen years old boy who came to our observation because of ematuria, orbital oedema, headache and hypertension (with renal symptoms). In few hours this syndrome evolved in a serious hypertensive encephalopathia with convulsions and emiparesis.