Incidence and clinicopathological heterogeneity of HIV-related non-Hodgkin's lymphoma.

The characteristics of 14 HIV-seropositive patients with NHL consecutively observed between 1984 and 1988 at our Institution are described. Patients belonged to a known population of 1242 HIV-seropositive individuals in whom the incidence of NHL was 1.13%, significantly higher than in age-matched controls (P less than .0001). Within this population, a previous diagnosis of ARC or AIDS, but not of LAS, was the only significant risk factor for the development of NHL (P less than .0001). According to the status of HIV infection at the time of NHL diagnosis, two groups of patients could be clearly identified with different clinicopathological features and prognosis. In fact, NHL developing in 7 patients previously affected by ARC or AIDS, presented as localized, extranodal disease, predominantly in the CNS; large cell histology, peripheral blood cytopenia, severe immunodeficiency and poor prognosis further distinguished this subgroup. Conversely, NHL developing in 7 patients with either asymptomatic HIV-seropositivity or LAS, more often presented as disseminated disease both in nodal and extranodal sites, with Burkitt's-type histology. Cytopenia was uncommon and immunodeficiency was significantly less severe. In this subgroup complete remission (CR) was achieved with aggressive treatment in 6 of 7 patients. No relapses occurred but two opportunistic infection-related deaths were observed. Four patients are alive 6-34 months after CR, two of whom show newly developed opportunistic infections.

Prevalence, clinical, and laboratory features of thrombocytopenia among HIV-infected individuals.

Prevalence and clinical features of human immunodeficiency virus (HIV)-related thrombocytopenia have been investigated among a random population of 657 anti-HIV-positive individuals. A platelet count below 100 X 10(9)/liter was detected in 72 patients (10.9%). Compared with anti-HIV-positive controls with normal platelets, a significantly higher prevalence of males (p less than 0.02) and of intravenous drug abusers (p less than 0.02) as well as a higher frequency of patients with advanced HIV-related disease (p less than 0.001) were detected among thrombocytopenic patients. Those patients whose thrombocytopenia was associated with neutropenia and/or anemia (14 cases, 2.1%) clearly differed from patients with isolated thrombocytopenia (IT) (58 cases, 8.8%) since they belonged to the more advanced groups of the CDC classification of HIV-related disorders, had lower CD4-positive lymphocyte counts, a higher frequency of cutaneous anergy, and less persistent thrombocytopenia. In the cohort of patients with persistent IT (47 cases), no single epidemiological or clinical data proved to correlate with the severity of thrombocytopenia. They did not differ significantly from anti-HIV-positive controls in their distribution among CDC groups, but the total lymphocyte and the CD4-positive lymphocyte counts were significantly lower in IT patients belonging to CDC group II (p less than 0.05 and p less than 0.02, respectively) and III (p less than 0.01 and p less than 0.005, respectively) compared with CDC group-matched controls; after a median followup of one year, the two cohorts showed similar rates of progression to CDC Group IV.

[Immunological follow-up of 95 HIV seropositive drug abusers in the bresciana area]. / Follow-up immunologico di 95 tossicodipendenti HIV sieropositivi nell'area bresciana.

We evaluated 95 HIV seropositive drug-addicts during a follow-up period of one year. The patients were classified and reclassified at each visit, according to the criteria proposed by the Centers for Disease Control (CDC) in 1986. At the first visit the patients were classified as follows: 70 in IIa-IIIa, 23 in IIb-IIIb and 2 in group IV. a and b indicate the absence or the presence of immunological and/or hematological alterations. 1 out of 70 IIa-IIIa patients versus 8 out of 23 IIb-IIIb patients developed AIDS in one year (p less than 0.001). Only one patient belonging to IIa-IIIa groups at the first visit progressed to AIDS in one year. This patient was reclassified in subgroup b after six months. No differences were noted among patients classified in IIb (5 patients) and IIIb (4 patients) who progressed to AIDS. Taken together these data indicate that the belonging to b subgroup is a risk factor for developing AIDS and the passage through a b subgroup (II or III) is a necessary step before the appearance of clinical manifestations of AIDS.

Cefotaxime in the cerebrospinal fluid and serum in patients with purulent meningitis.

Cefotaxime concentrations in the cerebrospinal fluid and serum were determined in patients with purulent meningitis by means of a simple, rapid and reproducible method in agar medium. The CSF concentrations of cefotaxime fluctuated around 4 mg/l. The pharmacokinetics of the antibiotic in relation to the integrity of the blood-brain barrier was studied by means of an assay of the albumin and IgG present in the cerebrospinal fluid and in the serum.

[Clinical aspects and therapy of tetanus]. / Clinica e terapia del tetano.

The various clinical symptoms of the tetanus are included by the Authors in three different groups. In the first and the second ones are the localized forms or tetanus, which affects several skeletal muscle groups without involvement of the respiratory apparatus. In the third group, in addition to the tetanus of the new-born babies, are the most severe forms of tetanus, the dangerousness of which is due to a respiratory involvement or to the persistence of a severe hypertensive-hypotensive syndrome, associated with hyperpyrexia and an ingravescent uncontrollable circulatory failure, in the completely sedated patient. An encephalopathic coma may also occur. The highest mortality (55-70 per cent) is observed in the tetanuses of the third group. The therapy is based on the triad seroanatoxins, antibiotics and sedative drugs. Tracheotomy and assisted mechanical ventilation are essential in the patients of the third group in order to be allowed to administer curare-like drugs as choice remedy. But, in spite of all these heroic treatments, the mortality is still high.