Human immunodeficiency virus (HIV) seropositivity in intravenous (i.v.) drug abusers in three cities of Italy: possible natural history of HIV infection in i.v. drug addicts in Italy

The prevalence of human immunodeficiency virus (HIV) antibodies and the symptoms induced [persistent generalized lymphadenopathy (PGL), AIDS-related complex (ARC), acquired immunodeficiency syndrome (AIDS)] was evaluated in several groups of intravenous (IV) drug abusers in three large Italian cities (Milan, Bologna, and Rome). The earliest evidence of seropositivity in sera collected from patients with acute viral hepatitis dates back to 1979 in Milan and to 1981 in Bologna with peaks in 1983 in both cities. In two groups of IV drug addicts on methadone-maintenance treatment at assistance centers, the prevalence of seropositivity differed sharply between Rome (33.3%) and Milan (69.3%) in 1985. Rates of seroconversion were also found to be higher in Milan than in Bologna and Rome. When a population of IV drug abusers voluntarily attending centers for surveillance of AIDS and/or ARC were investigated, high levels (range 55.2-81.5%) of seropositivity were found in the three cities. ARC prevalence among seropositives was very high (range 48.1-64.2% in 1985) in the three cities. The evolution rate to AIDS in Milan was higher among those attending a center for AIDS surveillance (7.4%) than among those attending an assistance center for methadone treatment (0.9%). These data are compatible with the hypothesis that virus infection among IV drug abusers originated in and then spread widely in Northern Italy (Milan first and then Bologna). Both the first appearance and subsequent spread of virus infection are in keeping with the reported occurrence of AIDS cases in the corresponding three regions of Milan, Bologna, and Rome.

Treatment of hemodialysis-related porphyria cutanea tarda with small repeated phlebotomies

Phlebotomy is generally thought to be contraindicated in porphyria cutanea tarda (PTC) associated with hemodialysis for the anemia which is often present in uremic patients. We report a patient with a severe form of hemodialysis-related PTC and biochemical parameters suggestive of iron overload in whom treatment with small repeated phlebotomies was well tolerated without any significant worsening of the anemia and gave marked biochemical improvement and complete clinical remission.

Hypoglycemia associated with a leiomyosarcoma of the small bowel

A patient with recurrent hypoglycemic episodes associated with a leiomyosarcoma of the small bowel is described. Fasting plasma insulin levels were consistently low and a subnormal insulin response to provocative stimuli (oral glucose and i.v. glucagon) was shown. After removal of the tumor, hypoglycemic episodes disappeared, fasting plasma insulin concentrations rose to normal values and insulin response to both OGTT and glucagon test was markedly enhanced. The possible mechanisms responsible for the hypoglycemia and the causes of subnormal insulin response to provocative stimuli are discussed.