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Resumen Las metástasis en vesícula biliar (VB) de los melanomas malignos (MM) son muy infrecuentes. Mujer de 68 años, diagnosticada en 2012 por un melanoma en coana derecha (B-RAF y C-kit negativos), tratada con cirugía y nivolumab. En abril de 2016 se realiza colecistectomía por metástasis en vesícula biliar. Presenta progresión de la enfermedad y fallece veinticuatro meses después, una de las supervivencias más largas publicadas. Las MM de VB suelen ser asintomáticas, se diagnostican por ecografía o tomografía en el contexto de enfermedad diseminada y deben ser intervenidas quirúrgicamente, pues mejora la supervivencia y la calidad de vida.

Resumen Les presentamos la imagen relativa a un paciente con Enfermedad de Crohn y episodio de perforación asociado a cuerpo extraño. Basándonos en el caso, realizamos un breve resumen acerca del abordaje y tratamiento de esta patología. Nos parecen de especial interés didáctico las imágenes en 3D que aportamos.

Meta-analytic studies are distinguished by comparing literature that reports positive effects with respect to literature that warns of spurious or negative effects. The aim of the present work was to establish the proportion of probabilities between categories and subcategories extracted from the consulted, updated and specialized literature. A documentary study was carried out with a selection of sources indexed to international repositories such as Copernicus, Dialnet, Ebsco, Latindex, Redalyc, Scielo. An indistinct scenario was found, even though the literature that reports positive effects on the quality of life and the subjective well-being of public health services prevails; suggesting the extension of the work to repositories like WoS and Scopus.

This research was conducted to examine the tools, strategies, and problems encountered in assessing student learning by pre-service teachers in science during their on-and-off campus clinical experience. An explanatory sequential mixed method design was used in the study. Three instruments were used in this study: The Assessment Checklist for Student Teachers in Science, Focus Group Discussion (FGD) Questions, and the In-depth Interview Questions. 17 pre-service teachers participated from one teacher education institution. Findings of the study using Kruskal-Wallis One-way Analysis of Variance and Thematical Analysis using Phenomenological Reduction Method revealed the assessment tools used most frequently and least frequently, assessment strategies, and the problems encountered by pre-service teachers in science in assessing student learning. The findings also revealed that there was a significant difference in the use of rubric (p value=0.045) as the least frequently used assessment tool by pre-service teachers in science when grouped according to specialization.

Acquisition, treatment, and final disposal of health-care waste is a vital public concern. Improper disposal has heightened this concern as it could lead to a widened risk of transmission of agents associated with blood-borne diseases. One of the ways to address these concerns is waste disposal and waste-to-energy plant. This facility is envisioned not only to manage hazardous wastes from hospitals with the least emissions of toxic substances and greenhouse gases but also to generate electricity. This study investigated the feasibility of developing waste disposal and waste-to-energy plant which involved: the selection of hospital type and location, waste composition, energy conversion, and power plant technology, and financial viability of the plant. The sampling design process identified the hospitals to be surveyed. The criteria include proximity of the hospitals, number of beds, and type of hospitals. A survey of waste generation across the specialty hospitals was then conducted and determined the type of waste, the quantity of the wastes produced, the percentage by weight, bulk density, and composition of the wastes. A selection was done to determine the energy conversion technology. The electric power plant technology was then selected knowing the characterization of the synthetic gas. The average waste generation was found to be 579 kg waste per day which has 29,062 kJ/kg calorific value. The study shows that electricity could be generated from this waste by utilizing a Pyrolyzer - Rankine Cycle power plant and is viable with a payback period of 5 years, and a Benefit-to-Cost ratio of 4. A business plan and enabling environment for the establishment of the Pyrolyzer – Rankine Cycle power plant is recommended to be studied.

The potential for wax formation and deposition along subsea production systems pose a severe flow assurance risk. During early stages of a field development (when information is limited), the risk needs to be quantified in order to develop preliminary mitigation strategies. This paper presents a workflow that can be used to evaluate the wax deposition risk for any field development by integrating the available wax laboratory data with simulation tools. The proposed workflow consists of tuning fluids models, benchmarking the wax deposition models (using the measured wax deposition rates), and conducting wax deposition simulations with the benchmarked models. Deposition mechanisms such as diffusion and shear stripping can be adjusted during the benchmarking step. The wax deposition predictions can be used to evaluate various design options during development stage and for devising operating strategies throughout the life of the field (such as insulation requirements, injection of paraffin inhibitor, pigging operations, etc.). In field developments where thermal management is a challenge and wax deposition cannot be avoided, a structured approach toward wax modeling is crucial to make the right engineering decisions. Wax laboratory measurements alone are not sufficient to quantify the wax deposition risk because of the uncertainties associated with the laboratory results and the difficulties to reproduce the actual field production conditions. When comparing the results obtained with the default wax model coefficients (no benchmarking) and the benchmarked models, the predictions are significantly different. Similar deviations are observed with the predictions based on wax data reported by different laboratories (for the same fluid sample). The overall design and operating strategy are highly dependent on wax deposition rates. Therefore, the discrepancies between the wax data measured by different laboratories suggest the need to standardize the test protocols. The main objective of the proposed workflow is to try to bridge the gap between the laboratory wax test measurements and transient flow assurance modeling. The ultimate goal is to reflect the wax characteristics in the large scale field operations. This workflow is intended to facilitate the communications between engineering design teams and flow assurance laboratories; because more representative data are needed to better predict the wax problem throughout the field life.

Circular Couette flow of inelastic shear-thinning materials in annuli is examined. The curved streamlines of the circular Couette flow can cause a centrifugal instability leading to toroidal vortices, well known as Taylor vortices. The presence of these vortices changes the hydrodynamic and heat transfer characteristics of the processes at which this type of flow occurs. Therefore, it is quite important to be able to predict the onset of instability. Most of the available theoretical and experimental analyses are for Newtonian and viscoelastic (dilute polymeric solutions) liquids. In this work, the effect of the shear-thinning behavior of high concentration suspensions on the onset of the Taylor vortices is determined theoretically by solving the conservation equations, constructing the solution path as the inner cylinder speed rises and searching for the critical conditions. This procedure avoids the need for a stability analysis of the flow and the solution of an eigenproblem. The differential equations were solved by the Galerkin/finite-element method and the resulting set of nonlinear algebraic equations, by Newton’s method.

Objective: To assess the role of Flavobacterium spp. infection in patients with HIV disease. Methods: Clinical charts of 2412 consecutive HIV-infected patients hospitalized in a 8-year period were retrospectively reviewed, to identify all cases of Flavobacterium spp. infections, and to evaluate their occurrence and outcome according to several epidemiological, clinical, and laboratory parameters. Results: Six patients out of 2412 (0.25%,), developed Flavobacterium spp. complications: septicaeama in five cases, and pneumonia in the remaining patient, with F. meningosepticum and F. odoratum isolated in two cases and one case, respectively, and unnamed Flavobacterium spp. organisms in the remaining three cases. Flavobacterium spp. organisms were responsible for six out of 1939 overall episodes of non-mycobacterial bacterial diseases observed in our patient group (0.31%). All patients were severely immunocompromised, showing a prior diagnosis of AIDS, a mean CD4+ lymphocyte count of 64.2 (range 12–187) cells/μl, and a mean neutrophil count of 1.143 (range 700–1600) cells (range 700–1600) cells/μl. Antibiotic, corticosteriod, or cotrimoxazole treatment was carried out during the month preceding disease onset by three, two and five patients, respectively Community-acquired and nosocomial Flavobacterium spp. disease were equally frequent, but the latter occurred with a significantly lower mean neutrophil and CD4+ cell count. Antimicrobial susceptibility assays showed complete sensitivity to ciprofloxacin, and variable resistance to ureidopenicillins, ceftazidirne, imipenem, aztreonam, and aminoglycosides. An appropriate antimicrobial regimen obtained clinical and microbiological cure in all cases, in absence of related mortality or relapses. Conclusions: Since only one episode of HIV-associated F. (Sphingobacterium) multivorum complication has been described to date, our series represents the largest one dealing with Flavobacterium spp. infection in the setting of HIV disease. Our experience suggests that Flavobacterium spp. organisms may play a pathogenic role in patients with advanced HIV disease, even when some commonly recognized risk factors are lacking (i.e. indwelling catheters, instrumentation, IV drug abuse), while a very love CD4+ lymphocyte count, leukopaenia-neutropaenia, and concurrent AIDS-related infectious complications may act as important predisposing factors. In view of the infrequent occurrence of these infections, early suspicion is essential for both clinicians and microbiologists facing immunocompromised patients at risk for invasive bacterial complications. Flavobacterium spp. organisms should be taken into consideration as nosocomial- or community-acquired opportunistic pathogens, due to their relationship with advanced immunodeficiency and their elevated resistance to many antimicrobial agents commonly used against Cram-negative bacterial pathogens.

AZT is a thymidine analogue useful in the treatment of AIDS. It has been demonstrated that this compound can possess a significant antineoplastic activity when combined with de novo thymidylate synthesis inhibitors, such as 5-fluorouracil (5FU) and methotrexate (MTX). Here we report a review of our data concerning the efficacy and tolerance of the combination AZT + MTX in HIV-related non Hodgkin's lymphomas (NHL). Twenty-nine patients were treated, at weekly intervals, with three (patient 1 to 10) or six (patient 11 to 29) consecutive courses of MTX 1g/m2 and increasing doses of oral AZT (2, 4 and 6g/m2) with leucovorin rescue. Of 26 evaluable patients, a total (complete + partial) response rate of 77% was obtained. The median complete response duration was 16.8 months. There was one therapy-related death due to septic shock. Grade III-IV neutropenia was observed after 19% of the courses, but was prevented by G-CSF administration in 82/119 courses. Grade III-IV anemia was observed after 9% of the courses. In conclusion, the combination AZT + MTX was effective and well tolerated in our series of HIV-related NHL patients.

Optimal delivery of chemotherapy in AIDS patients with Kaposi's sarcoma (KS) is frequently limited by hematological toxicity, mainly neutropenia. We have conducted an open-label study to investigate the safety and efficacy of recombinant human granulocyte colony-stimulating factor (filgrastim, r-metHuG-CSF) administration in 25 AIDS patients with pulmonary KS treated with Adriamycin, bleomycin, and vincristine (ABV) combination. The patients were assigned to receive r-metHuG-CSF (Neupogen, Dompé, Biotec, 5 mg/kg of body weight per day) injected subcutaneously for 3-5 days before chemotherapy until the absolute neutrophil count was higher than 25 x 10(9); r-metHuG-CSF was then discontinued 5 days before chemotherapy. Patients were eligible to resume r-metHuG-CSF 3 days after completing the anticancer regimen until normalization of the absolute neutrophil count occurred, for a maximum of 10 days. The cytotoxic regimen included vincristine 1.4 mg/m2, bleomycin 10 mg/m2, and doxorubicin 20 mg/m2, every 2 weeks. The overall response rate was 58% with a complete response rate of 18%. Median survival was 11 months and median response duration was 6 months. Adverse effects consisted of transient nausea and vomiting in 48% of patients, and moderate headache in 43%. Hematologic toxicities included anemia in 27%, and mild to moderate neutropenia (grade II-III) in 38%. The mean leukocyte and neutrophil nadirs were 1920 and 850 mm3. The mean duration of neutropenia was 3.2 days. The combination of r-metHuG-CSF and ABV chemotherapy was well tolerated. Administration of r-metHuG-CSF within 5 days before chemotherapy appears to be an acceptable treatment with important clinical implications. We stress that further studies are needed to determine the maximum tolerable doses of combination chemotherapy supported by G-CSF in AIDS-associated KS patients.

Life-threatening necrotizing fasciitis and relapsing Lemierre syndrome associated with Fusobacterium necrophorum septicaemia occurred in young adults with a moderate Chron's disease and a missed profound IgA deficiency. This unexpected association of a chronic bowel inflammatory syndrome with prominent IgA abnormalities and severe bacterial infection deserves careful attention by physicians faced with young patients with Chron's disease.

Recurrent transient neurological deficits have been described in human immunodeficiency virus (HIV)-infected subjects, but their frequency, pathogenesis, and outcome are still unsettled. We describe 10 HIV-infected patients with transient neurological deficits (0.8% of all patients followed in our department during the last decade). All patients were in the advanced stage of immunological disease. None of the clinical or special investigations performed outside of the attacks indicated an underlying structural lesion of the central nervous system. In 80% of these patients, anticardiolipin antibodies were present. The final outcome was unrelated to these transient neurological deficits which, per se, had a benign course. We discuss the possible etiopathogenetic mechanisms of such episodes and suggest that they may be "migrainelike" events, possibly related to transient functional circulatory abnormalities secondary to an immunological antiphospholipid antibody-dependent mechanism.

We have previously reported that 3′-azido 3′-deoxythymidine (AZT) can possess a significant antineoplastic activity when combined with drugs that disrupt de novo thymidylate synthesis, such as 5-fluorouracil and methotrexate (MTX). The aim of the present study was to evaluate the efficacy and the tolerance of the combination AZT + MTX in human immunodeficiency virus (HIV)-related non-Hodgkin's lymphoma (NHL). Twenty-nine patients (22 men and 7 women), either newly diagnosed or pretreated, have been enrolled in the trial; the median age was 34 years, 45% had acquired immunodeficiency syndrome before lymphoma and 19 patients had less than 100 CD4 lymphocytes/μL. Histologic diagnoses were mainly Burkitt (27%) and diffuse large B-cell lymphoma (45%); extranodal involvement was present in 20 patients. The treatment plan included three weekly courses of MTX at 1 g/m2 (days 1, 8, and 15) plus oral AZT at 2 g/m2 (days 1, 2, and 3), 4 g/m2 (days 8, 9, and 10), and 6 g/m2 (days 15, 16, and 17), plus leucovorin rescue. From the eleventh patient on, in case of complete or partial remission, the treatment was continued with three additional courses, using AZT at the maximum dose. In 26 evaluable patients, the total (complete + partial) response rate was 77% (95% confidence interval, 58% to 89%), with complete remission (CR) in 46% of the patients (95% confidence interval, 29% to 65%). The median CR duration was 12.8 months. Grade III-IV neutropenia and anemia were observed in 52% and 31% of the courses, respectively. There was one therapy-related death due to bacteremia followed by septic shock; the only other recorded infection was a herpes vaginalis. In conclusion, we suggest that AZT + MTX is an effective and well-tolerated regimen in HIV-related NHL.

Pericarditis is one of the most common cardiac complications in the course of HIV disease. Opportunistic infections and neoplastic processes represent the most common etiology of pericardial disease. Pericardial tuberculosis is an uncommon condition, especially in developed countries. Two cases of tuberculous pericarditis in adult patients with AIDS occurred over a 12-month period at our clinic, which prompted a literature review of the published cases of tuberculous pericarditis in AIDS. Of note is that in the first patient pericardial effusion represented the AIDS-defining illness and was an expression of a disseminated tuberculous disease. The second patient developed a fatal pericarditis due to a multiple-drug resistant Mycobacterium tuberculosis infection.

Clinical charts of 235 consecutive patients with AIDS who died in our in-patient Department between 1985-94 have been evaluated in order to assess the delivery of care during the last week of life, regarding drug administration and diagnostic procedures. The management of the 81 subjects who died between 1985 and 1990 (period A) was compared with that of the 154 patients who died between 1991 and 1994 (period B). Patients followed during period B were treated with a greater number of antimicrobial agents (p < 0.001), supportive drugs (p < 0.001), and blood and blood products units (p < 0.005), while no significant difference was found for agents used for pain management. When assessing diagnostic procedures, during period B our patients had a greater number of plain radiological and ultrasonographic exams (p < 0.001), tomographic and scintigraphic scans (p < 0.005), while the use of other invasive diagnostic techniques did not change significantly. As suggested by our evaluation of possible indicators of curative or palliative care, during recent years the availability of more advanced, diagnostic techniques and new treatments for AIDS complications seemed to have influenced the management and medication of terminal disease in a potentially curative rather than palliative way.

Coagulase-negative staphylococci recently have been implicated as a cause of serious infections in immunocompromised individuals. An unusual case of community-acquired pneumonia due to Staphylococcus cohnii in an HIV-infected drug user is described. Results of a study conducted to examine the prevalence of infection due to Staphylococcus cohnii strains and their antibiotic-sensitivity patterns show a low frequency but a high morbidity. These results and a brief review of the literature emphasize the importance of these organisms and other staphylococcal species as emerging opportunistic pathogens in patients with AIDS.

This paper presents a methodology used for design a small wind turbine of low cost for domestic use. Method engineering is used to planning the construction and assembly of the prototype in a easy way and safely. The methodology of this paper establishes the steps for the construction. First, the wind turbine mechanical system design can be done using the computer aided design (CAD), which allows developing drawings of the full system and spared parts in 3D. Then, in this manner, the entire system can be visualized before its construction to see if all part fits in a suitable way. The results of this methodology are validated building a wind turbine prototype.

Summary HIV infection is associated with a variety of rheumatic syndromes and arthritis, including reactive arthritis, psoriatic arthritis, polymyositis, Sjogren syndrome, vasculitis syndromes, AIDS-associated arthritis, and septic arthritis. Only a few cases of Candida albicans septic arthritis in HIV-positive individuals have been documented. In this report we describe a case of chondrocostal arthritis and sternal osteomyielitis due to C. albicans infection in a HIV-infected woman in which use of the triazole fluconazole resulted in a successful treatment of this complication. This case emphasizes that Candida arthritis should be considered in the differential diagnosis of infectious arthritis, especially in immunocompromised individuals with documented candidemia and unexplained bone and/or articular abnormalities. A brief review concerning arthritis caused by C. albicans and therapeutic approach to this arthropathy is also discussed.

A prospective clinical survey was carried out in order to determine the effects of Smectite in patients with AIDS-associated chronic idiopathic diarrhea.A total of 22 patients has been included in this study. All patients received smectite, 3 g orally three times daily far from meals for a period of 10-21 days. The outcome of chronic diarrhea has been evaluated during treatment.A significant reduction of duration of diarrhea, of frequency of stool number, and of the amount of liquid stools, has been recorded in all patients after the third and the fourth day of treatment. No major adverse effects and drug interactions have been documented in all treated patients.Smectite may be considered as adjuvant therapy in patients with AIDS-associated chronic idiopathic diarrhea by virtue of its efficacy and tolerability.

Summary Streptococcus intermedius is usually regarded as a normal commensal bacteria of the human mouth flora, the gastrointestinal tract, and the urogenital tract. The clinical spectrum of human diseases caused by S. intermedius mainly consist in a variety of suppurative infections, mostly reported in adult patients. This is probably the first reported case of pleural empyema caused by S. intermedius in an immunocompromised host, infected with HIV. This patient was successfully treated by antibiotherapy. Our case shows that S. intermedius should be considered as one of the potential pathogens involved in the development of pleural empyema, among HIV or AIDS. This report also underlines that regular dental care should be included in primary health care for individuals with HIV infection, because untreated oral infections can have a significant impact on the health and quality of life of these patients.

Summary The most common localization of Toxoplasma gondii infection in HIV-positive patients is the central nervous system; autoptic findings have revealed disseminated disease also. Clinical manifestations of severe gastrointestinal involvement, especially of the pancreas, have been rarely described. We report a rare case of toxoplasmic pancreatitis in a patient with AIDS. Few other cases have been described in the literature.

The authors carried out a retrospective study by reviewing all patients with HIV disease presenting esophageal symptoms who were evaluated by upper endoscopy. Three cases of bacterial esophagitis are reported and discussed according to literature data.

Objective: To assess the natural story of HIV-associated affective and cognitive disorders and the relationship with clinical, pharmacological, immunological and behavioural factors. Method: A total of 395 HIV-positive patients, naive to Highly Active Antirectroviral therapy (HAART), with no severe psychiatric disorders have been enrolled in the Neuro-ICONA Study. All participants were administered a comprehensive data collection instrument including an addiction behaviour survey, a medical problem list, a psychiatric assessment, a validated neuropsychological test battery. Results: The global prevalence of cognitive impairment and of prominent depressive symptomatology were 17.9 and 15.5%, respectively. A significant difference in the prevalence of prominent depressive symptomatology was observed between patients in HAART and those not taking HAART(14.1 vs. 23.8%; P=0.05). Conclusion: Depressive and cognitive disorders affect a substantial proportion of HIV-seropositive subjects. The prevalence of prominent depressive symptomatology appears to significantly vary in relationship to the therapeutic protocol.

Pericarditis is one of the most common cardiac complications in the course of HIV disease. Opportunistic infections and neoplastic processes represent the most common etiology of pericardial disease. Pericardial tuberculosis is an uncommon condition, especially in developed countries. Two cases of tuberculous pericarditis in adult patients with AIDS occurred over a 12-month period at our clinic, which prompted a literature review of the published cases of tuberculous pericarditis in AIDS. Of note is that in the first patient pericardial effusion represented the AIDS-defining illness and was an expression of a disseminated tuberculous disease. The second patient developed a fatal pericarditis due to a multiple-drug resistant Mycobacterium tuberculosis infection.

In order to assess the value of quantitative measurement of cytomegalovir us (CMV) antigenaemia as a marker for the guidance of antiviral chemotherapy in the AIDS setting, 33 patients with CMV complications and showing at least 20 pp65-positive polymorphonuclear leucocytes per 2 X 10 5 cells, received either ganciclovir or foscarnet as induction and maintenance therapy. Antigenaemia was assessed every 1‐4 weeks. During acute-phase antiviral therapy, a significant decrease of CMV antigenaemia (>50% of pretreatment levels) paralleled clinical improvement in 2‐7 weeks in 32 of 33 subjects. In ten of 24 evaluable patients followed up during a further 4‐12 months, disease relapses occurred concurrently with an increase of CMV antigenaemia in seven cases, while three cases of relapsing retinitis did not show a significant increase in antigenaemia. All patients with recurrent disease had a favourable response to further treatment, including halted clinical progression and significant decrease in antigenaemia. In HIV-related CMV disease, periodic monitoring of quantitative CMV antigenaemia proves useful in evaluating response to antivirals, in guiding therapeutic management and in predicting disease relapses.

In order to assess the efficacy and safety of recombinant human granulocyte-macrophage colony-stimulating factor (rHuGM-CSF) in the treatment of HIV-associated leukopenia, 35 subjects suffering from severe leukopenia/neutropenia (24 with a previous diagnosis of AIDS, 11 with AIDS-related complex), received rHuGM-CSF at 0.5-3 micrograms/Kg/day subcutaneously for a mean period of 9.7 +/- 12.5 weeks (range 2-43 weeks). Five patients have been treated continuously for more than 6 months. rHuGM-CSF administration led to a significant (at least two-fold; P < .001) increase in total leukocyte, neutrophil and monocyte count by the second week of treatment, subsequently maintained through the entire course of therapy. No considerable effects on other hematological, immunological and virological parameters have been detected. Patients treated with rHuGM-CSF did not suffer from novel opportunistic diseases, while bacterial infections occurred in only 3 cases (pneumonia in 2, otitis/mastoiditis in 1). Long-term treatment with rHuGM-CSF allowed continuation or resumption of potentially myelotoxic drugs in 22 patients out of 35. A self-limited flu-like syndrome represented the most common adverse event (observed in 15 patients), while no other significant clinical or laboratory abnormalities were found. In conclusion, long-term rHuGM-CSF therapy showed a good efficacy and safety profile in the treatment of HIV-related leukopenia, also increasing tolerability to potentially myelosuppressive drugs, and leading to a significant reduction in morbidity due to secondary infections.

Eight out of 30 consecutive patients with AIDS and cryptococcal meningoencephalitis (26,7%) presented cutaneous involvement, in the form of papulo-nodular lesions in 3 patients, molluscum contagiosum-like lesions in 3 patients, and pustular-ulcerative lesions in 2 patients. Skin localization represented an untoward prognostic sign, and in 3 out of 8 patients the lesions were diagnosed 2 to 6 weeks before the onset of systemic and neurologic signs and symptoms of the disease. A systematical examination of all suspected cutaneous lesions in subjects with advanced HIV disease may lead to an earlier diagnosis and treatment of disseminated cryptococcosis.

3' azido-3' deoxythymidine (AZT) is a thymidine analogue useful in the treatment of AIDS. We have previously demonstrated that AZT can possess significant antineoplastic activity when combined with de novo thymidylate synthesis inhibitors, such as 5-fluorouracil or methotrexate (MTX). We report here on the feasibility and tolerance of the combination AZT+MTX in the treatment of HIV-related non-Hodgkin lymphomas (NHL).IV-positive patients with high-grade NHL were treated, at weekly intervals, with three consecutive courses of MTX 1 g/m2 plus increasing doses of oral AZT (2, 4 and 6 g/m2) and folinic acid rescue.From July 1992 to June 1994, 16 patients were enrolled in the trial after giving informed consent. Grade III-IV neutropenia was observed after 22% of the courses, but was prevented by G-CSF administration in 34/59 courses. Grade III-IV anemia was observed after 15% of the courses. No non hematological toxicity was observed.The combination AZT+MTX was extremely well tolerated in this series of HIV-related NHL patients. If these results are confirmed in terms of antineoplastic efficacy, the protocol will deserve wider application.

We report lethal interstitial pneumonia in an 18-year-old young man with measles infection following recent infectious mononucleosis. We speculate that the documented T cell immune impairment caused by the concurrent Epstein-Barr and measles viral infections (as expressed by a proportionately low CD4+ lymphocyte count) was responsible for the complicated clinical course and unfavorable outcome.

Neurological complications represent one of the most important causes of morbidity and mortality in patients with HIV infection or AIDS. The peripheral nervous system is frequently involved in different stages of HIV disease, and the etiopathogenetic mechanisms are various. Idiopathic peripheral facial nerve palsy (Bell's palsy) has been considered by several Authors as one of the possible neurologic complications of HIV infection, mainly described in the early stages. As a matter of fact when facial palsy onsets in the late stages of the disease, when there is a severe immunodeficiency, usually is secondary to opportunistic infections, polyradiculopathy, or tumors involving the nervous system. To our knowledge, in the current literature there are few clinical studies reporting facial palsy associated to HIV infection. Since 1986 till 1992 three HIV infected patients with Bell's palsy have come to our observation. All three of them were asymptomatic (CDC II) and in one of them was the first clinical manifestation indicating HIV infection. The palsy in this patient and those reported by others was self-limiting with a good prognosis.

In an ongoing phase II study, 12 patients with lymphoma and HIV infection were treated with zidovudine (ZDV) and recombinant interleukin-2 (rIL-2) to evaluate if this association may produce beneficial effect on the immunologic status and the outcome of lymphoma. The protocol included daily doses of rIL-2 at 6 MIU/m2 over 5 days in c.i. per week for a total 4 courses; ZDV was associated at 600 mg/d in the period under study. An improved CD4 count, exceeding 2- to 4-fold the basal count, was obtained in patients with a basal CD4 number greater than 100/microliters accompanied by a significant increase of NK and LAK activity (p less than 0.001). From the clinical point of view the reduction of tumor manifestation was proportional to CD4 basal number; 2 patients from those with CD4 greater than 100/microliters obtained a complete remission after rIL-2 and ZVD. The p24 antigen, taken as parameter of viral replication, remained invariably negative after rIL-2 and ZDV in patients already negative and became negative in 1 patient previously positive. Our conclusion is that the association of rIL-2 and AZT is safe and useful in patients with lymphoma and HIV infection.

to treatment, with resolution of the diarrhea a mean of 7 days after A total of 985 stool samples from 312 patients were examined. antibiotic therapy was instituted. These patients were cured and During the survey period, 35 (11%) of the 312 patients with diar- remained asymptomatic during the follow-up period of 12 months. rhea were identified from the microbiology records as having cul- The drugs were well tolerated by all patients; there were no sigtures and cytotoxin assays positive for C. difficile. Twenty-six nificant adverse events. Despite initial treatment with metronidaepisodes of CDAD were identified in 19 (54%) of the 35 patients zole, five patients relapsed at a mean time of 18 days after treatment with AIDS. There were 13 men (68%) and 6 women (32%), and was discontinued. In these cases the diarrhea completely resolved the mean age was 29 years (range, 4‐43 years). AIDS was diag- after therapy with vancomycin or teicoplanin was instituted. nosed before the onset of CDAD in all cases. HIV infection was C. difficile causes a wide spectrum of disease in patients with acquired through intravenous drug abuse by eight patients (five AIDS, and CDAD may represent £12.5% of the diarrheas that males and three females), homosexual relations (five males), and occur in this patient population [1]. Although HIV infection itself heterosexual relations (three males and three females). The CD4 / is not considered an intrinsic risk factor for C. difficile infection, lymphocyte count was very low in most instances (median count, individuals infected with HIV appear to be at increased risk for 48/mm 3 ; range, 5‐115/mm 3 ). CDAD [1‐6]. The predisposing conditions for acquiring C. diffiNo cases of diarrhea were due to medications or concomitant cile disease include the use of antibiotics or antineoplastic agents, infection with protozoa, mycobacteria, viruses, or bacterial patho- gastrointestinal procedures or surgery, prolonged hospitalization, gens. Endoscopic examinations were performed for 11 patients; and severe underlying disease that may increase host susceptibility evidence of severe colitis was present in eight of these patients, to infection. Patients with AIDS frequently require recurrent and and the presence of pseudomembranous colitis could be confirmed prolonged hospitalization, leading to colonization with nosocomial by histology for three other patients. Presenting complaints in- microorganisms including C. difficile. The frequent exposure of cluded watery diarrhea (85% of patients), abdominal pain (90%), these patients to prolonged or multiple courses of antibimicrobial fever (80%), nausea (60%), weakness (65%), and bloody diarrhea or anticancer chemotherapy may result in profound changes in the composition of endogenous bacteria in the alimentary tract, leading to the overgrowth of toxigenic C. difficile. A variety of antimicrobial agents have been linked with the