Intrathecal/intraventricular colistin in external ventricular device-related infections by multi-drug resistant Gram negative bacteria: case reports and review.

We report three cases of external ventricular derivation infections caused by multidrug-resistant Gram-negative rods and treated successfully with intraventricular colistin. The intrathecal or intraventricular use of colistin have been reported in more than 100 cases without any consensus on dosage, duration and type (monotherapy or combination therapy) of treatment. Based on our comprehensive review of the relevant literature relating to both clinical and pharmacokinetic data, we conclude that the intrathecal/intraventricular administration of colistin is a safe and effective option to treat central nervous system infections caused by multidrug-resistant Gram-negative bacteria.

[Hepatosplenic cat-scratch disease in the immunocompetent adult]. / Malattia da graffio di gatto epatosplenica in adulto immunocompetente.

Atypical manifestations of cat-scratch disease have been described in children and immunosuppressed adults. We report the first case of hepatosplenic cat-scratch disease in an immunocompetent subject, demonstration of diversity of this infection. A 33-year-old man presented with prolonged fever, lymphadenopathy and multiple hypodense lesions of liver and spleen in ultrasonographic imaging. The hepatic biopsy showed non-specific inflammatory reactions including granulomata and stellate necrosis. Anti-Bartonella antibodies have been found. The therapy with clarithromycin and doxycycline for many weeks was effective for hepatic lesions. A month ago a history of a cat contact with the presence of a skin lesion has been reported.

[Hemorrhagic syndrome during high-dose ampicillin treatment]. / Sindrome emorragica in corso di terapia con ampicillina ad alte dosi.

In high doses, the beta-lactams--particularly cephalosporins--can cause bleeding from impairment of prothrombin formation. We report a case of hemorrhagic syndrome in a 63-year-old woman during therapy with high doses of ampicillin for Listeria monocytogenes meningitis.

[Immune restoration syndrome]. / La sindrome da immunoricostituzione.

A new syndrome, "immune restoration syndrome", has been described among patients with CMV retinitis, mycobacterial infections or cryptococcosis when HAART is initiated. The mechanism is most likely an enhanced immunologic reaction at the site of infection due to an improved T-lymphocyte function. The syndrome appears to be a rare event: the authors report a case of immune restoration syndrome in a patient with atypical mycobacteriosis.

[Bacteremia in tonsillectomy: Sluder's technique versus dissection. Preliminary results]. / Batteriemia in corso di tonsillectomia: tecnica di Sluder versus dissezione. Risultati preliminari.

Fifty-one patients undergoing elective tonsillectomy for recurrent acute tonsillitis, 21 by dissection tonsillectomy (41%), and 30 guillotine tonsillectomy (59%). Positive post-operative blood cultures were obtained in 22 patients (43%), but only 4 in the dissection group (19%) and in 18 of the guillotine group (60%). Streptococci (21.5%) and Staphylococci (9.8%) are the commonest organisms cultured. This data are suggestive for the necessity of an antibiotic prophylaxis before tonsillectomy.

Therapy of non-small-cell lung cancer (NSCLC) in patients with HIV infection. GICAT. Cooperative Group on AIDS and Tumors.

Incidence and mortality of AIDS patients have significantly declined in the developed countries due to the very active anti-HIV combination therapy available today. Because of the prolongation of the survival expectancy of these patients, other non-AIDS defining tumours have been recently reported in several cohort studies with increased frequency. We want to report the clinico-pathological features and the outcome of 39 patients with lung cancer and HIV infection, collected by the Italian Cooperative Group on AIDS and Tumors (GICAT) between 1986 and December 1997. As a control group, we decided to evaluate patients, less than 60 years of age, with lung cancer but without HIV infection seen at the CRO, Aviano, during 1995 and 1996. The median age of the study group patients was 38 years (range 28-58) and 90% of them were males. Sixty-nine percent of patients were intravenous drug users and HIV infection was asymtomatic in 41% of patients. NSCLC was observed in 78% of patients, SCLC in 13% and mesothelioma in 8%. Among NSCLC, adenocarcinoma was the most frequently observed histological subtype (48%). No differences were found as regards the stage of disease at diagnosis and the histologic subtype in comparison with the control group. The median overall survival was significantly shorter for patients with HIV infection when compared to that of the control group (5 months vs. 10 months, P < 0.0001). In conclusion, the outcome of patients with SNCLC and HIV infection seems worse than that of the general population, suggesting a synergistic and/or addictive adverse effect of HIV on the outcome of lung cancer.