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Purpose: To report a case of interface infection by Candida albicans after deep anterior lamellar keratoplasty (DALK)., Methods: A 30-year-old man with keratoconus underwent DALK. Four weeks after surgery, the patient developed multiple infiltrates in the graft-host interface with absence of intraocular infection. Donor rim cultures grew C. albicans. Penetrating keratoplasty (PK) was performed because of worsening of the infection despite topical, local, and systemic antifungal therapy., Results: Cultures carried out on the excised donor cornea confirmed donor-to-host transmission of C. albicans. An aqueous tap taken before PK was negative. Six months after PK, the corneal graft was clear with no recurrence of infection., Conclusions: After DALK, in cases of donor graft microbial contamination, infection may develop at the graft-host interface. This may delay or prevent direct intraocular penetration of microorganisms, reducing the risk of development of endophthalmitis. PK may be needed to eradicate the infection in cases where conservative treatment fails.

Purpose: To compare the frequency of positive rim cultures after penetrating keratoplasty using corneas preserved by hypothermic and organ culture storage. To evaluate the influence of standard procurement techniques on the frequency of microbial donor rim contamination., Methods: Six hundred four donor corneas stored at 31 degrees C and 214 at 4 degrees C were studied. Microbiology studies were carried out during organ culture storage, and corneas with positive medium cultures were discarded. Frequency of postoperative positive rim cultures was related to the type of corneal storage and procurement technique used., Results: Thirty-nine (6.4%) corneas with positive medium cultures were discarded during organ culture. Microbiology reports of 628 donor rims cultures from 671 (94%) consecutive transplants were reviewed. Positive rim cultures resulted in 24 (3.8%) cases. None of the patients developed endophthalmitis. The frequency of postoperative positive rim cultures was greater after hypothermic than organ culture storage, being 9.8% and 1.3%, respectively (chi(2) = 24.9; P < 0.001). With organ culture storage, the frequency of positive rim cultures was 1.3% and 1.4% after enucleation and in situ corneal excision, respectively (chi(2) = 0.03; P = 0.638). After hypothermic storage, positive rim cultures were found in 8% of the corneas procured using enucleation and 12% of the corneas excised in situ (chi(2) = 0.829; P = 0.254)., Conclusions: Organ culture storage allows one to recognize and discard corneas with microbial contamination during storage. This method significantly reduces the frequency of postoperative positive rim cultures compared with hypothermic storage. Procurement methods do not influence the percentage of positive rim cultures.

In order to evaluate whether the risk of bacterial contamination increased during low-flow anaesthesia without bacterial filter compared with non-rebreathing anaesthesia with a disposable bacterial filter, two groups of patient were studied. In the first group a disposable circle absorber system was changed once daily, thus it was used for several patients. In the second group a non-rebreathing system was connected to a disposable bacterial filter before each surgical procedure. Samples for microbiological examination were taken preoperatively from the oropharynx and postoperatively from three locations in the circle system and in the non-rebreathing system. No difference in rates of circuit contamination were observed between the two groups.

The clinical features of our cases demonstrated some of the already known characteristics of the variable spectrum of HIV infection. DA are the most important risk category in Italy. 10% of the ARC cases evolved into AIDS during a 12-month follow-up, on average. The most frequent OI in our AIDS cases were PCP, C. albicans esophagitis and chronic mucocutaneous ulcers. An high percentage of neurologic involvement from HIV was observed, and malignancies were encountered in AIDS (3 KS and 1 undifferentiated B lymphoma) as well as in ARC (1 Hodgkin's lymphoma). Statistically, significant worsening of the immunologic situation is evident as the disease progresses from LAS to AIDS. Activated B lymphocytes represent most of the cells of the germinal center during the hyperplastic stage of lymphadenopathy. Reversal of the T4/T8 ratio appears early during the initial stage of lymphadenopathy and is due to a decrease of CD4 and a relative increase of CD8. Also, destruction of the follicular dendritic cells is an early feature which becomes more evident as the disease advances and the lymph node evolves toward progressive involution. Activated B-lymphocyte augmentation with polyclonal Ig secretion appears to be related to T-independent B stimulation by coinfection such as CMV, EBV and HBV. The increase of cytotoxic/suppressor lymphocytes seems to be partly related to the excessive activation of B lymphocytes and partially directed to the cells infected by HIV or coated with its proteins (6,7,8,9). The destruction of follicular dendritic cells has been interpreted not only as a killer effect of the virus but also as a result of the intervention of CTL sensitized to the cells containing the virus (10,11). Their destruction may contribute to the impaired recognition of soluble antigen which is one of the main features of the immune deficiency of HIV infection (9,13,16).

The authors estimated E, E.A.C., and E-active rosette in 13 chronic active hepatitis (C.A.H.), 5 chronic persistent hepatitis and 4 cirrhosis. The results showed a significant decrease of the concentration of peripheral blood T-lymphocytes in patients with C.A.H., C.P.H., cirrhosis. E.A.C. rosette forming cells were not significantly different from the control population in all groups studied. E-active rosette were decrease in patients with C.A.H. and C.P.H. and were increased after stimulation by P.P.D. (5 U.V.I.) in C.A.H. and C.P.H. and in control group studied.