Biomedical subjects
Publications and source records attributed to A Pesce.
The authors report a case of non-Hodgkin's malignant lymphoma which developed in a patient under low-dose methotrexate for rheumatoid arthritis. Although rheumatoid arthritis without immunosuppressive therapy may be associated with an increased incidence of malignant lymphoma, the immunosuppressive effects of methotrexate may further promote the development of malignant lymphoma.
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The purpose of this study was to compare heterotopic jejunal and ileal allografts in the dog under cyclosporine A. Fourteen allografts (8 ileal and 6 jejunal) were successfully performed. There was no case of graft-versus-host disease in this series. Six allografts (42.5 percent), 3 jejunal (50 percent) and 3 ileal (37.5 percent), were rejected during the first 3 months (NS). Eight allografts, 5 ileal and 3 jejunal, were tolerated up to 3 months and then removed; 2 ileal and 2 jejunal were normal; 2 ileal and 1 jejunal showed signs of chronic rejection, and 1 ileal signs of advanced rejection. It is concluded that there is no major difference between jejunal and ileal allografts in the dog.
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We evaluated the postantibiotic effect (PAE) of lomefloxacin, a new difluorinated quinolone, on multiply drug-resistant gram-positive and gram-negative clinical pathogens. Lomefloxacin induced a PAE of about 2 hours in gram-negative and gram-positive bacteria exposed for 1 hour to concentrations corresponding to four times their minimum inhibitory concentrations (MIC). PAE values (hours) ranged from 1.8 with Serratia marcescens to 2.5 with Staphylococcus aureus. No significant differences in PAE values were found for ciprofloxacin or ofloxacin against the same pathogens. The PAE was increased when the time of drug exposure was increased to 2 hours. These results indicate that lomefloxacin has a PAE equivalent to that of other fluoroquinolones.
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This paper deals with the management of pregnant women with HIV infection. The virus is transmitted by the mother to 20-30 percent of the infants, and therapeutic abortion should be offered to women whose pregnancy does not exceed 26 weeks of amenorrhoea. If pregnancy is pursued, the mother must be investigated for sexually transmitted diseases which are particularly frequent in this population and may have repercussions on the newborn. Pneumocystis carinii pneumonia is the most common opportunistic infection in pregnancy. In case of T4-cell depletion chemotherapy with pentamidine must be instituted. Hygienic and dietetic measures should be applied to avoid listeriosis and toxoplasmosis. Serological tests for toxoplasmosis are necessary in all HIV patients, with chemoprophylaxis in case of increased IgG levels. Thrombocytopenia usually responds to human immunoglobulins. At delivery, there is no need to modify the usual obstetrical procedures. During the post-partum period, another pregnancy must be avoided by good compliance with a reliable contraceptive method. As for the preventive treatment of mother-to-child HIV transmission, at the moment only AZT can be considered, but its effectiveness remains to be evaluated in therapeutic trials.
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We have previously derived an index, based on retrospective data, for mortality in patients with end-stage renal disease (ESRD) treated by dialysis and transplantation. We used this index to calculate probability of death and rates of hospitalization, two measures of severity of illness, for 436 patients enrolled in our ESRD program after the original index was derived. Applied when ESRD treatment was initiated, it predicted future mortality and hospitalization rates. We then analyzed clinical characteristics, including variables in the predictive model, in all 718 patients enrolled in 3-year cohorts from 1976 to 1989. Over time, there was trend toward enrolling patients with a higher likelihood of dying, ie, more severely ill. The severity index facilitated description of the patients and their changing characteristics over time, and proved useful in comparing the degree of illness in different population groups.
The wide and potent in vitro activity of cefixime, a new oral broad spectrum cephalosporin, has been confirmed on a collection of respiratory and urinary pathogens recently isolated in Italy. The new cephem emerged as the most bactericidal of all the comparators tested against several fast as well as slowly-growing gram-negative species including Enterobacteria, Haemophilus and Moraxella, irrespective of their ability to synthetize beta-lactamases. Among the gram-positive species Streptococcus pyogenes and S. pneumoniae were effectively covered. Cefixime activity was not adversely influenced by several important variables such as pH (over the range from 5 to 8), inoculum size (from 10(5) to 10(8) CFU per ml) and the presence of 50% human serum or urine. Time-kill tests confirmed a pronounced bactericidal potency of the drug especially towards common respiratory pathogens (H. influenzae, M. catarrhalis, S. pneumoniae and S. pyogenes). Killing of urinary strains was optimal at cefixime concentrations reached in urine since eradication, except for Proteus mirabilis, was enhanced with increasing levels of the drug. The absence of an untoward paradoxic effect on the rate of cefixime bactericidal action was confirmed by employing a dynamic bladder model simulating the pharmacokinetic parameters of the drug after a single 200 mg daily dosage. Interactions of cefixime with several other drugs that may be employed in combination therapy were generally prone to provide indifference and synergism while antagonism was never observed. Favorable interactions were also registered when cefixime acted with other antibiotics on partially resistant species such as Staphylococci and Pseudomonas. The new cephem seems to provide excellent opportunities for expanding oral cephalosporin therapy to a wide range of infections produced by susceptible pathogens in the adult and pediatric populations.
Alarming reports from various parts of the world of an increase in multiple-drug resistance among enterococci have prompted the Italian Association of Clinical Microbiologists to sponsor a nationwide study aimed at assessing the magnitude of this problem in Italy. During the last 3 months of 1988, technicians from a total of 162 general and teaching hospitals, in 16 of the 20 Italian regions and covering 89,061 beds, isolated 58,886 bacterial strains from inpatients and outpatients. Enterococci (4,879) represented 8.3% of all microorganisms identified, with Enterococcus faecalis accounting for 4,554 strains and Enterococcus faecium for the remaining 316 (6.5% of all enterococci analyzed). Enterococci were recovered most frequently from urine (62.5%) and genitourinary samples (13.7%). Only 58 strains (1.2%) were associated with bacteremia. The in vitro susceptibility of these organisms to 21 commonly used antibiotics is reported and compared with the susceptibility of isolates from a smaller epidemiologic study conducted in Italy in 1986 as well as with more recent findings from individual laboratories.
The in-vitro activity of flurithromycin against common respiratory tract Gram-positive (85 strains) and Gram-negative (44 strains) pathogens, and a collection of anaerobes (125 strains) was compared with that of erythromycin, cefixime, amoxycillin, co-amoxiclav, ciprofloxacin, netilmicin and clindamycin. Flurithromycin possessed the same spectrum and potency of antimicrobial activity as erythromycin. The presence of 50% human serum in the test media enhanced the activity of flurithromycin against all isolates, with the exception of Streptococcus pyogenes. Flurithromycin induced a post-antibiotic effect (PAE) that ranged from 0.25 h (Haemophilus influenzae) to 3.5 h (Streptococcus pneumoniae) for all strains tested. The presence of serum increased or diminished the duration of the PAE, depending on the strain being analysed. No interaction between flurithromycin and the other drugs tested was observed by the checkerboard technique, but when the time-kill system was used, 35 cases of synergy were noted out of 120 tests performed (29%), of which 15 (43%) were with Moraxella catarrhalis, 12 (34%) with Staphylococcus aureus, four (11%) with H. influenzae and the remainder with S. pneumoniae and S. pyogenes. Netilmicin produced most synergic interactions. Antagonism was not detected by either methods.
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