A clinico-epidemiological study is reported concerning a group of 306 parenteral drug addicts (PDAs), 71 of whom were affected with the lymphadenopathy syndrome (LAS); all were followed-up between 1981 and 1984. Although full-blown acquired immune deficiency syndrome (AIDS) was observed only in one case, none of the other patients examined have undergone complete recovery so far. The results of our study point to a wide circulation of LAV/HTLV III among our group of PDAs, starting at least as early as 1981 and preceding by a few months the development of clinical signs and symptoms of LAS. A peak incidence of the latter was observed during the winter of 1983/1984, running parallel with a marked increase in seropositives for LAV/HTLV III antibody. Drug addiction, sexual promiscuity and a low standard of living all seem to play a decisive role in the spread of the infection and, consequently, of the diseases related to it (LAS, AIDS-related complex and AIDS). In fact, PDAs appear to represent the major source of the disease in Italy.

Antibodies, Viral↗

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Cryoglobulins and infectious diseases.

The relationship between infectious diseases due to various pathogenetic factors and cryoglobulin production mechanisms has been investigated. Cryoglobulins have been evidenced in infections caused by very heterogeneous pathogens, i.e. leptospirosis, psittacosis, Mediterranean tick typhus, brucellosis, gram-negative bacterial septicemias, in which they had never been previously reported. In type A hepatitis a high cryoglobulin prevalence (91%) has been confirmed during the acute phase, with a rapid decrease both in prevalence and concentration in the subsequent stages of the disease. Cryoglobulins were all of type III and were mainly represented by IgM; anti-HAV-IgM antibodies have been evidenced in all but one cryoprecipitates. In non-A, non-B hepatitis a lower cryoglobulin prevalence (44.7%) was shown during the acute phase and the same fast decrease has been noted in the subsequent stages. Cryoglobulins were all of type III and in some cases polyclonal IgG was the only Ig class present in cryoprecipitates. The cryoglobulin prevalence in the acute phase of HBsAg-positive hepatitis amounted to 73.4%; all the cryoprecipitates were of type III. No correlation between the presence of cryoglobulins and HBeAg positivity or between cryoglobulins and delta agent infections was found. In all the cases studied the presence of cryoglobulins was related to the persistence of liver damage. Cryoglobulins were not found in HBsAg chronic carriers, while they have been evidenced, by a preliminary study, in 41.6% of HTLV-III antibody-positive subjects complaining of a persistent generalized lymphadenopathy without clinical or laboratory signs of liver impairment. No HTLV-III antibodies were found by ELISA method in the type III cryoprecipitates.

AIDS-Related Complex↗

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Leucocyte function after antenatal betamethasone given to prevent respiratory distress.

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Betamethasone↗

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Epidemiology of non-A, non-B hepatitis.

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Antibodies, Viral↗

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Sporadic non-A, non-B hepatitis.

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Adult↗

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Thiamphenicol in the prophylaxis and treatment of mixed infections of the female genital tract.

Surgical procedures involving bacteriologically contaminated sites (e.g., vaginal or abdominal hysterectomy) are frequently followed by local or systemic infections. The efficacy of thiamphenicol against such infections was investigated in two studies: an open clinical study of the treatment of severe, mixed aerobic-anaerobic infections of the female genital tract and a randomized, prospective, controlled trial of short-term perioperative prophylaxis. Thirty-five patients were enrolled in the first study and 750 patients in the second (490 undergoing abdominal hysterectomy and 260 undergoing vaginal hysterectomy). Thiamphenicol appeared to be effective in both trials. When used for prophylaxis, it significantly reduced three postoperative parameters: infectious morbidity, use of antibiotics, and period of hospitalization. When used for treatment, it cured 30 (86%) of 35 postoperative gynecologic infections, including 13 infections that had not responded to previous, empirical antibiotic therapy.

Aminoglycosides↗

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5-Fluorouracil and d,l-leucovorin calcium are active to treat unresectable hepatocellular carcinoma patients: preliminary results of a phase II study.

Twenty-five patients affected with unresectable hepatocellular carcinomas (HCCs) were treated with 370 mg/m2 5-fluorouracil (5-FU) plus 200 mg/m2 racemic leucovorin both for 5 consecutive days. The chemotherapy cycle was repeated every 4 weeks until disease progression. One complete remission (4%) and 6 partial responses (24%) were obtained, that is 7 objective responses in all (28%, ninety-five confidence interval: 10.1-45.9%). All responders had a good PS and only 1 of them presented with bulky disease. Five patients (20%) exhibited stable disease, while the remaining 13 patients (52%) progressed. Toxicity was mild: 11 patients (44%) had grade II/III mucositis, 10 patients (40%) grade II diarrhea, 7 patients (28%) grade II nausea, 2 patients grade III granulocytopenia and 1 patient only (4%) grade I skin toxicity. This regimen made it possible to obtain a high rate of objective responses even in inoperable HCCs which are commonly considered as chemoresistant lesions.

Aged↗

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Cisplatin, mitomycin-C, 5-fluorouracil and leucovorin combination chemotherapy (l-FCM) in locally advanced unresectable or metastatic gastric carcinoma: a phase-II study.

Despite relevant progress, the impact of chemotherapy on advanced gastric cancer patients' survival is still unsatisfactory. Thus, the key objective of our efforts should be palliation of the symptoms and the maintenance of an adequate quality of life. In this phase-II study, we evaluated toxicity and efficacy of the combination of cisplatin, fluorofolates and mitomycin C. Thirty-one advanced gastric cancer patients received cisplatin (15 mg/m2) and 5-fluorouracil (350 mg/m2), both for 5 consecutive days every 4 weeks; 5-fluorouracil infusion was preceded by a rapid i.v. injection of 100 mg/m2 leucovorin, while mitomycin-C (10 mg/m2) was administered on day 1 of odd cycles. Cycles were repeated every 4 weeks until disease progression. We recorded 16 objective responses (51.6%, 95% confidence interval: 42.63-60.57); furthermore, such a response rate was coupled with a moderate degree of toxicity and an extremely good tolerance. In particular, alopecia, a frequent and distressing side-effect in patients, especially women, in our series occurred only in two patients. This treatment appears to be an active and tolerable therapeutic option for patients with advanced gastric carcinoma.

Adult↗

PubMedDate not supplied

Prevalence of hepatitis G virus RNA in human immunodeficiency virus type 1-positive intravenous drug users.

OBJECTIVE: The aim of this study was to evaluate the prevalence of the new human flavivirus hepatitis G virus (HGV) in Italian intravenous drug users (IDUs) and its interaction with human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV). STUDY DESIGN/METHODS: Seventy-nine IDUs with different clinical stages of HIV-1 infection and 20 non-IDU patients with chronic HCV infection were included in the study. HGV RNA was detected by means of reverse transcription-polymerase chain reaction (RT-PCR) used for the amplification of two HGV-related sequences included in the 5'-noncoding (NCR) and NS5a regions. RESULTS: Eighteen (22.8%) of the 79 IDUs were positive for plasma HGV RNA; there was no difference in mean serum alanine aminotransferase (ALT) levels between the HGV-positive and HGV-negative patients. No significant correlation was observed between HGV and other viral markers (hepatitis B virus [HBV], HCV, human T-cell lymphotropic virus type II [HTLV-II]) or HCV genotype. The number of patients with symptomatic HIV-1 infection in whom HGV RNA was detected was significantly lower than the number of those who were asymptomatic (6 of 49 [12.2%] versus 12 of 30 [40%]; P = 0.004). The mean plasma HGV RNA titer was higher in the asymptomatic than in the symptomatic patients (4.6 versus 3.2 log PCR-amplified units in 1 mL of plasma sample [PU/mL]; P = 0.03). CONCLUSIONS: Our results show a considerable spread of HGV levels among Italian HIV-1-positive IDUs and do not indicate that HGV infection enhances liver impairment. We suggest that the greater prevalence of HGV RNA in IDUs with asymptomatic HIV-1 infection may reflect the relatively recent HGV infection in this population.

Adult↗