Phosphoinositide 3-kinase is involved in the tumor-specific activation of human breast cancer cell Na(+)/H(+) exchange, motility, and invasion induced by serum deprivation

Whereas the tumor acidic extracellular pH plays a crucial role in the invasive process, the mechanism(s) behind this acidification, especially in low nutrient conditions, are unclear. The regulation of the Na(+)/H(+) exchanger (NHE) and invasion by serum deprivation were studied in a series of breast epithelial cell lines representing progression from non-tumor to highly metastatic cells. Whereas serum deprivation reduced lactate production in all three cells lines, it inhibited NHE activity in the non-tumor cells and stimulated it in the tumor cells with a larger stimulation in the metastatic cells. The stimulation of NHE in the tumor cell lines was the result of an increased affinity of the internal H(+) regulatory site of the NHE without changes in sodium kinetics or expression. Serum deprivation conferred increased cell motility and invasive ability that were abrogated by specific inhibition of the NHE. Inhibition of phosphoinositide 3-kinase by overexpression of a dominant-negative mutant or wortmannin incubation inhibited NHE activity and invasion in serum replete conditions while potentiating the serum deprivation-dependent activation of the NHE and invasion. These results indicate that the up-regulation of the NHE by a phosphoinositide 3-kinase-dependent mechanism plays an essential role in increased tumor cell invasion induced by serum deprivation.

Four drug-HAART in primary HIV-1 infection: clinical benefits and virologic parameters

BACKGROUND

From a theoretical standpoint, primary HIV infection (PHI) represents a great chance to modify the natural history of the disease. In this study we purposed a four drugs regimen with zidovudine, lamivudine, ritonavir and saquinavir to treat aggressively the infection and achieve a complete immune reconstitution.

METHODS

This is an Italian multicentric open label study. Adult patients with PHI were eligible for the study if they met at least one clinical criterion and one laboratory criterion of the following. Clinical criteria: Signs and symptoms of acute retroviral syndrome within the past 70 days, exposure to HIV-1 within the last 3 months, a preceding negative antibody test within the past 6 months. Laboratory criteria: Detectable p24 antigen with neutralization in serum; detectable HIV-RNA in plasma; indeterminate Western blot test with negative or low positive value HIV antibody in ELISA test.

RESULTS

Since April 1997 to April 1999 40 patients with PHI have been enrolled; 80% of this cohort referred symptoms related to acute antiretroviral syndrome. Treatment has been withdrawn in 17 patients (12 for intolerance, 3 for toxicity and 2 for failure). At baseline the mean CD4+ T cells count and CD4/CD8 ratio were 537 (range 55-1287) and 0.58 (range 0.1-1.03) and the mean plasma HIV-RNA level was 5.9 log copies/ml (range 3-7.15). Plasmatic HIV-1 RNA levels of all patients dropped below 200 copies/ml in 68% of patients at week 12, 81% at week 24, 93% after 12 months and 100% after 18 months. Immunological parameters have been improved and have achieved normal range since 6th month.

CONCLUSIONS

A rapid virologic suppression and immunological reconstitution are associated with PHI therapy. However early treatment should be weighted against the potential disadvantages such as immediate adverse events (intolerance and drug toxicity) and long term manifestation (metabolic disorders).

[Multicenter study of the variability and adequacy of antimicrobial therapy for community-acquired pneumonia in adults]

We performed a study to evaluate the variability and adequacy of prescribing antibiotics in community-acquired pneumonia (CAP) in 10 Spanish hospitals. We studied 452 patients with CAP. Initial empirical administration of antibiotics was prescribed in 90.7% of the cases, 82.5% as monotherapy. Macrolides and third and second generation cephalosporins were the most widely used groups of antibiotics. Penicillin and amoxicillin were only prescribed in 1. 7% of the patients. A significant variability between hospitals was observed. Reference patterns for the use of antibiotics in CAP were devised by a panel of experts. According to the recommendations of this panel, 29% of the total prescriptions were not adequate, with this percentage reaching 65% in outpatients older than 65 years or with comorbidity. This was mainly due to the fact that monotherapy with erythromycin, which was considered inadequate, was the most widely prescribed treatment.

Ability and fitness to drive of Parkinson's disease patients

The authors review reports in the literature on the fitness and ability to drive of neurosurgical patients and subjects afflicted by neurological disorders, before focusing on their own series of 204 idiopathic Parkinson's disease (PD) patients. The study sample comprised 173 men and 31 women (average age 70.6 and 74.2 years, respectively) of whom 51, for various reasons, still drove (albeit only short distances). Different variables were examined (Hoehn & Yahr scale values (of the total group and of the subgroup of active drivers), scores for various clinical diseases, and so on) looking for an association between these variables and the number of accidents incurred by PD patients as compared with the healthy population and with a control group of healthy age-matched subjects (ISTAT data). The need for adequate legislation on driving in PD emerges clearly and recommendations are given on which such legislation might be based.

The control of epidermal stem cells (holoclones) in the treatment of massive full-thickness burns with autologous keratinocytes cultured on fibrin

BACKGROUND

Cell therapy is an emerging therapeutic strategy aimed at replacing or repairing severely damaged tissues with cultured cells. Epidermal regeneration obtained with autologous cultured keratinocytes (cultured autografts) can be life-saving for patients suffering from massive full-thickness burns. However, the widespread use of cultured autografts has been hampered by poor clinical results that have been consistently reported by different burn units, even when cells were applied on properly prepared wound beds. This might arise from the depletion of epidermal stem cells (holoclones) in culture. Depletion of holoclones can occur because of (i) incorrect culture conditions, (ii) environmental damage of the exposed basal layer of cultured grafts, or (iii) use of new substrates or culture technologies not pretested for holoclone preservation. The aim of this study was to show that, if new keratinocyte culture technologies and/or "delivery systems" are proposed, a careful evaluation of epidermal stem cell preservation is essential for the clinical performance of this life-saving technology.

METHODS

Fibrin was chosen as a potential substrate for keratinocyte cultivation. Stem cells were monitored by clonal analysis using the culture system originally described by Rheinwald and Green as a reference. Massive full-thickness burns were treated with the composite allodermis/cultured autograft technique.

RESULTS

We show that: (i) the relative percentage of holoclones, meroclones, and paraclones is maintained when keratinocytes are cultivated on fibrin, proving that fibrin does not induce clonal conversion and consequent loss of epidermal stem cells; (ii) the clonogenic ability, growth rate, and long-term proliferative potential are not affected by the new culture system; (iii) when fibrin-cultured autografts bearing stem cells are applied on massive full-thickness burns, the "take" of keratinocytes is high, reproducible, and permanent; and (iv) fibrin allows a significant reduction of the cost of cultured autografts and eliminates problems related to their handling and transportation.

CONCLUSION

Our data demonstrate that: (i) cultured autografts bearing stem cells can indeed rapidly and permanently cover a large body surface; and (ii) fibrin is a suitable substrate for keratinocyte cultivation and transplantation. These data lend strength to the concept that the success of cell therapy at a clinical level requires cultivation and transplantation of stem cells. We therefore suggest that the proposal of a culture system aimed at the replacement of any severely damaged self-renewing tissue should be preceded by a careful evaluation of its stem cell population.

[Anti-tuberculosis drug consumption as an indicator of the epidemiological situation of tuberculosis in Spain]

OBJECTIVES

To describe anti-tuberculosis drug consumption in Spain for the period, 1985-1995, compare the associated time trend and geographical pattern against case reports of tuberculosis (TB), and estimate the number of persons undergoing anti-tuberculosis therapy in 1995.

METHODS

The official Drug Database was used to ascertain consumption of anti-tuberculosis drugs (isoniazid, rifampicin, pyrazinamide and ethambutol) in Spain during the period, 1985-1995. The technical units of measurement used for comparison purposes were daily defined dose (DDD) and DDD rate per day per 100,000 population. Annual trends and geographical patterns of consumption were plotted. The respective numbers of persons treated in 1995 with each of the four drugs were first estimated and then compared against TB case reports.

RESULTS

There was an overall decline in the consumption of isoniazid, rifampicin and ethambutol over the period, 1985-1995, though the former two registered rises in 1991 and 1992. Pyrazinamide consumption showed growth throughout the study period. The highest 1995 consumption rates were registered by Galicia, Cantabria, Asturias, the Basque Country, Ceuta and Melilla, and the lowest by the Canary Islands and Navarre. Comparisons run against TB case reports revealed a greater degree of underreporting in certain provinces. In 1995, approximately 18,858 persons (48 per 100,000 population) must be assumed to have undergone pyrazinamide therapy in Spain, indicating that the reported TB rate of 22 per 100,000 population could well represent underreporting in excess of 100%.

CONCLUSIONS

The trend in anti-tuberculosis drug consumption reflects shifts in treatment guidelines and is compatible with a rise in TB incidence in recent years. Major underreporting of TB marked by wide inter-regional and -provincial differences was in evidence. Pyrazinamide consumption is probably the best indicator for estimating minimum TB incidence.

[Practice variation and appropriateness study of antimicrobial therapy for acute pharyngotonsillitis in adults]

OBJECTIVE

Infectious pharyngotonsillitis is usually managed with antibiotics by general practitioners and pediatricians both in primary care and the emergency services. In the present work we try to assess the antibiotic variability and appropriateness in the management of acute pharyngotonsillitis among several emergency services in our country related to scientific evidence based in an expert panel criteria.

METHOD

A transversal trial was carried on in ten emergency services of our country. We included patients older than fourteen years an analyzed the following variables: type of respiratory infection, antibiotic prescription, comorbidity, physician's status and hospital admission. The antibiotics were classified in three levels according to the expert panel criteria: first election, alternative use and inappropriate use. We compared the antibiotic treatments to these three levels.

RESULTS

2,869 patients were diagnosed of acute respiratory infection, 356 (12.4%) with pharyngotonsillitis. Commonly the patients were prescribed antibiotics (315; 81%) and the most used were amoxicillin-clavulanate (33%), amoxicillin (16%), penicillin (7%), cefuroxime (6%), erythromicin (4%) and cefixime (3%). Among the 315 prescriptions, 98 (32%) were first election, 147 (50%) alternative use and 50 (17%) inappropriate use.

CONCLUSIONS

Most of the patients suffering of pharyngotonsillitis were empirically prescribed antibiotics probably many of these cases were non-bacterial pharyngotonsillitis. Alternative and inappropriate use of antibiotics was high.

Alpha subunit of glycoprotein hormones in the sera of acromegalic patients and its mRNA in the tumors

Within a population of 16 pituitary adenomas we found high levels of glycoprotein alpha subunits in the sera of patients with somatotrophic tumors. This finding was correlated with the presence of mRNA alpha subunit in these tumors indicating the adenomas themselves as the origin of the circulating alpha-subunit. Synthesis of these two hormones, which are chemically very different, by the same tumor cells indicates a high degree of differentiation of these cells. We are unable at this time to conclusively correlate differentiation of these tumors aggressively.

Cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma

A case of cervicofacial and pulmonary actinomycosis associated with non-Hodgkin's lymphoma (NHL) is reported. The patient underwent antimicrobial treatment and surgical debridement of a palatine lesion. Complete clinical recovery was achieved. The presence of actinomycosis may obscure and delay the diagnosis of NHL.

Urinary elimination of erythropoietin in patients under treatment with cytostatics drugs

Reductions in the hemoglobin (Hb) mass are followed by increases in the level of plasma erythropoietin (EPO) concentrations which are directly proportional to the level of the hormone required to bring the hemoglobin values back to normalcy. Hypoplastic anemias (AHC) on the other hand, are accompanied by significantly larger increases in the erythropoietin concentration. In this study we have measured the relationship between the severity of the anemia and the levels of erythropoietin elimination in the urine patients (EpoU) under treatment with cytostatic drugs. Simultaneously other parameters used as indicators of bone marrow activity were determined. These observations suggest that the levels of erythropoietin depends not only by the tissue oxygen availability but by others factors related to the marrow cellularity.

Comparison of losartan and amlodipine in renally impaired hypertensive patients

Effects of losartan and amlodipine on blood pressure and albuminuria were compared in a randomized, double-blind, parallel trial involving 48 patients with essential hypertension (sitting diastolic blood pressure between 95 to 115 mm Hg) and impaired renal function (creatinine clearance of 30 to 60 ml/min/1.73 m2). After four weeks of placebo administration, patients were stratified according to baseline albuminuria (< or > or = 300 micrograms/min) and randomized to once-daily treatment with losartan 50 mg (N = 24) or amlodipine 5 mg (N = 24) for 12 weeks. Titration to losartan 50 mg/hydrochlorothiazide (HCTZ) 12.5 mg or amlodipine 10 mg was possible at weeks 3 or 6 for patients having an inadequate blood pressure response. After 12 weeks of treatment, the mean decreases in sitting diastolic and systolic blood pressures were significantly larger in the losartan group (-18.1 +/- 7.2 and -27.7 +/- 15.2 mm Hg) than in the amlodipine group (-12.4 +/- 7.5 and -16.3 +/- 12.1 mm Hg; P = 0.009 and P = 0.008, respectively). The greater antihypertensive response to losartan was not influenced by the initial degree of albuminuria. The losartan and amlodipine regimens were well-tolerated. Baseline levels of albuminuria were reduced after 12 weeks of losartan treatment (median change of -29.5 micrograms/min), while amlodipine therapy was associated with a median increase (48.4 micrograms/min) in this renal marker at week 12. The treatment difference was statistically significant (P = 0.021). These results indicate that losartan 50 mg, administered alone or in combination with HCTZ 12.5 mg, is more effective than amlodipine 5/10 mg in lowering blood pressure and albuminuria in patients with essential hypertension complicated by impaired renal function.

[An increase in renal dopamine production after the administration of radiographic contrast agents]

Renal vasoconstriction and anti-natriuresis conditioned by radiographic contrast agents (CA) may be antagonised by the administration of exogenous dopamine. However, the influence of CA on the activity of renal synthesis of dopamine has not been studied. This study assessed the daily urinary excretion of dopamine, its precursor. L-3, 4-dihydroxyphenylaline (L-DOPA), and its metabolites (acid 3, 4-dihydroxyphenylacetic, DOPAC; homovanillic acid, HVA) 24 hours before and 48 hours following administration of a non ionic and hyposmolar (lopromide) CA in patients (n = 10; average age 61.3 +/- 4.3 years) submitted to coronary angiography. Urinary excretion of noradrenalin, a marker of sympathetic activity, was also assessed during the same period. The deputation of creatinine (Ccr) and the urinary excretion of sodium (UNa+) lowered after the administration of the CA (Ccr, 79.2 +/- 10.2 vs 72.2 +/- 9.6 ml/min/1.73 m2, p < 0.05; UNa+, 112.8 +/- 9.6 vs 61.7 +/- 25.1 mmol/24 h, p < 0.05). On the contrary, the urinary excretion of potassium increased in the period of 24 h following the administration of the AC (31.7 +/- 5.2 vs 103.8 +/- 10.8 mmol/24 h, p < 0.05). There was an increase in the urinary excretion of dopamine as well as noradrelalin during the 24 hour period following the administration of the CA (dopamine, 1260.2 +/- 196.8 vs 1571.5 +/- 170.2 mmol/24 h p < 0.5; noradrenalin, 186 +/- 36.6 mmol/24 h, p < 0.05). On the contrary, the urinary excretion of L-DOPA lowered after the administration of the CA (115.4 +/- 25.5 vs 80.5 +/- 13.2 mmol/24 h, p < 0.05). These results conditioned an increase in the dopamine/L-DOPA ratio in the urine, after the administration of the CA (12.2 +/- 1.5 vs 22.2 +/- 4.5 mmol/24 h, p < 0.05). In conclusion, the administration of CA is accompanied by an increase in the renal production of dopamine which, in these conditions, may act as a compensatory natriuretic hormone.

Cultivation of human keratinocyte stem cells: current and future clinical applications

Cultured human keratinocytes have a wide spectrum of clinical applications. Clinical results reported by several investigators are, however, contradictory. In this review, the authors discuss the biological and surgical issues which play a key role in the clinical outcome of cultured epidermal autografts used for the treatment of massive full-thickness burns. The importance of cultivation of epidermal stem cells and of their transplantation onto a wound bed prepared with donor dermis is emphasised. The paper also reviews recent data showing that: (i) cultured epidermal autografts bearing melanocytes can be used for the treatment of stable vitiligo; (ii) keratinocytes isolated from other lining epithelia, such as oral, urethral and corneal epithelia, can be cultivated and grafted onto patients suffering from disabling epithelial defects; (iii) keratinocyte stem cells can be stably transduced with retroviral vectors and are therefore attractive targets for the gene therapy of genodermatoses.

Renal dopaminergic system in nephrotic syndrome and after remission

BACKGROUND

Although intrarenal dopamine is known to behave as an endogenous natriuretic hormone the role of the renal dopaminergic system in the sodium handling of nephrotic oedema remains unknown.

STUDY DESIGN

We monitored the daily urinary excretion of free dopamine, L-DOPA-its precursor, and its metabolites, DOPAC and HVA, during sodium retention accompanying the nephrotic state and natriuresis leading to oedema mobilization in eight patients (mean age 8.0+/-2.4 years) with drug-induced remission of minimal-change nephrotic syndrome (MCNS).

RESULTS

During natriuresis the urinary levels of dopamine did not increase in parallel with sodium excretion in any of the eight patients studied. Moreover, after remission of the nephrotic syndrome the urinary levels of dopamine were significantly lower than during the nephrotic state (1565.3+/-361.7 vs 2416.1+/-558.4, P= 0.02). In contrast, the urinary excretion of L-DOPA increased markedly during natriuresis resulting from remission of proteinuria (from 87.0+/-40.5 up to 296.9+/-86.3 nmol/24 h; P< 0.01).

CONCLUSION

We conclude that the natriuretic response resulting from drug-induced remission of proteinuria in MCNS is accompanied by a decrease in the renal uptake/decarboxylation of L-DOPA to dopamine.

Antiproliferative effects of N1,N4-dibenzylputrescine in human and rodent tumor cells

Polyamines (putrescine, spermidine and spermine) increase in proliferating tissues and are essential for cellular growth and cell division processes. We had previously shown that alkyl substituted putrescines can inhibit cell proliferation. We now tested the effects of the (N(alpha),N(omega)-dibenzyl derivatives of the simple diamines putrescine, cadaverine and 1,3-diaminopropane on the growth of three human squamous cell carcinoma (SCC) lines and a rat hepatoma (H-4-II-E) cell line. Survival assays were measured by treating exponentially-growing SCC cultures with N1,N4-dibenzylputrescine (DBP) (270 microM) or a rat hepatoma cell culture with DBP (100 microM) for 48 hrs. Inhibition of cell growth was measured either by the colony forming assay or by cell counting. DBP inhibited proliferation of the rat hepatoma (H-4-II-E) cell line and induced cytotoxicity when used at a concentration of 100 microM for >48 hrs. N1,N5-dibenzylcadaverine (DBC) also induced cytotoxicity at a similar concentration, while N1,N3-dibenzyl-1,3-diaminopropane (DBPr) was a much weaker inhibitor of cell growth. Inhibition of cell growth by DBP resulted in marked modifications of cell morphology, such as vacuole formation, decrease in size, pycnosis, change in staining behavior toward trypan blue and lack of adherence. DBP was also growth inhibitory in the three human SCC cell lines tested. The concentration of DBP required to achieve growth inhibition of SCC cells could be dramatically decreased in the presence of N1,N4-bis(buta-2,3-dienyl)butanediamine, a specific inhibitor of polyamine oxidase (PAOI). Moreover, although the presence of PAOI only prevented the oxidation (debenzylation) of approximately 20% of intracellular DBP over a 5-day period, it produced a 5-fold increase in the inhibition of cell proliferation by DBP. DBP (and DBC) inhibited putrescine uptake by rat hepatoma (H-4-II-E) cells in what appears to be a competitive reaction. A tenfold excess of putrescine over DBP did not inhibit the antiproliferative or cytotoxic effects of the latter. DBP administered for 72 hrs. depleted intracellular levels of putrescine, spermidine and spermine in the SCC lines by 50-100% of control values. It was found that DBP inhibited nucleic acid and protein synthesis at an early stage of cell proliferation, hence its growth inhibitory effect may be related to inhibition of the synthesis of macromolecules.

Polarized distribution of Na+/H+ exchanger isoforms in rabbit collecting duct cells

The present study describes two Na+/H+ exchanger (NHE) isoforms in an immortalized rabbit renal cortical collecting tubule cell line (RC.SV3). Na+/H+ exchange activity was assayed using fluorescence measurements of intracellular pH (pHi) in monolayers mounted in a cuvette containing two fluid compartments, making it possible to independently measure Na+/H+ exchange activity on either the apical or basolateral surface. RC.SV3 monolayers express Na+/H+ exchange activities in both the apical and basolateral membrane domains. The two exchangers have half-saturation constants (Km) for external sodium and sensitivities to dimethylamiloride, to HOE-694 and to cimetidine and clonidine consistant with the NHE-1 isoform on the basolateral cell surface and the NHE-2 isoform on the apical surface. Protein kinase A inhibition of basolateral exchanger activity was significantly higher than that of the apical exchanger. Protein kinase C significantly stimulated both exchangers equally. RT-PCR analysis found RNA for only NHE-1 and NHE-2, and immunofluorescence with an antibody against NHE-1 demonstrated a basolateral location for this isoform. The results suggest that RC.SV3 cells have two Na+/H+ exchange activities separated spatially to the two cellular membranes, with the NHE-1 and the NHE-2 isoforms located on the basolateral and the apical membranes, respectively.

Contact dermatitis caused by sesquiterpene lactones

BACKGROUND

Compositae dermatitis involves workers such as gardeners, florists, and farmers, and less commonly people not employed in occupations at risk.

OBJECTIVE

To report a case of contact sensitization caused by Compositae, the source of sensitization being both pesticides and plants.

METHODS

A 65-year-old man, whose hobby was gardening, was affected by a chronic eczema of the face and the hands for 6 months that reoccurred after using fertilizers and handling plants. Patch tests with the International Contact Dermatitis Research Group standard series, the plants series and pesticides series (Hermal Trolab) were performed.

RESULTS

We found the following positive reactions at day 2 and day 3: sesquiterpene lactone mix, 0.1% in petrolatum; arnica tincture, 20% in petrolatum; pyrethrum, 2% in petrolatum; captafol, 0.1% in petrolatum.

CONCLUSION

Pyrethrum and its derivatives are made from Compositae plants; the arnica tincture is obtained from Arnica montana, which is also a member of the Compositae family. In our patient, the clinical manifestations were certainly caused by the exposure to sesquiterpene lactones, confirmed by the positive patch test to sesquiterpene lactone mix.

90K (Mac-2 BP) predicts CD4 decline in human immunodeficiency virus-infected patients with CD4 counts above 200 x 10(6) cells/L

OBJECTIVE

To evaluate the ability of serum levels of 90K, previously reported as a progression marker of human immunodeficiency virus infection, to predict the future rate of CD4 lymphocyte decline.

DESIGN

Retrospective analysis of data from outpatients enrolled in a multi-institutional study.

PATIENTS

One hundred five human immunodeficiency virus-positive intravenous drug users who had at least six serial CD4 lymphocyte measurements and starting CD4 levels of 200 x 10(6) cells/L or higher.

MAIN OUTCOME MEASURE

Rate of CD4 lymphocyte decline.

RESULTS

During a median follow-up of 28 months (range, 20-36 months), the estimated loss of CD4 cells in the whole patient population was 3.4 x 106 cells/L per month (P = .0045). Subjects who were on zidovudine treatment at study entry showed an average loss of 3.8 x 10(6) cells/L per month, significantly higher than in untreated subjects (P = .02), but similar to the loss observed for those requiring initiation of treatment during the course of the study. At baseline, 56 subjects had 90K levels of 10 microg/mL or less, and 49 had more than 10 microg/mL. The rate of CD4 decline in the high-90K group was approximately 5 x 10(6) cells/L per month (P < .0015), whereas in the low-90K group it was not different from zero (P = ns). No difference emerged in the rate of CD4 decline when subjects were stratified according to baseline 90K levels and zidovudine treatment, beta2-microglobulin, or neopterin serum levels.

CONCLUSION

90K serum levels are predictive of CD4 decline.

Pulmonary and extrapulmonary tuberculosis at AIDS diagnosis in Spain: epidemiological differences and implications for control

OBJECTIVE

To ascertain the differential factors associated with pulmonary versus extrapulmonary tuberculosis (TB) at AIDS diagnosis in Spain.

DESIGN

Analysis of AIDS surveillance data.

METHODS

Data about AIDS patients, aged 12 years and over, diagnosed in 1995 were taken from the Spanish AIDS Register. The respective proportions of cases presenting with pulmonary and extrapulmonary TB at AIDS diagnosis were analysed by gender, age, HIV transmission category, prison record, province, country of origin and CD4+ lymphocyte count. A multivariate analysis was carried out using logistic regression analysis.

RESULTS

Of 6161 AIDS cases analysed, 20.1% presented with pulmonary TB and 20.4% with extrapulmonary TB. Overall, TB showed association with men, age under 30 years, injecting drug users (IDU), cases of heterosexual HIV transmission, and concurrent or past stay in prison. Frequency of TB proved no different among foreign-born patients. Pulmonary and extrapulmonary TB showed a similar distribution for most of the variables. Current prison inmates registered a high risk of pulmonary TB [adjusted odds ratio (OR), 4.2; 99% confidence interval (CI), 3.1-5.8] compared with patients without prison record, and ex-prison inmates registered an intermediate risk (OR, 2.3; 99% CI, 1.8-3.0). Among patients with TB at AIDS diagnosis, pulmonary TB was associated with subjects currently in prison (OR, 2.1; 99% CI, 1.5-3.0) and injecting drug use (OR, 1.5; 99% CI, 1.0-2.4). Pulmonary TB presented with higher CD4+ lymphocyte counts than extrapulmonary TB (P < 0.001).

CONCLUSIONS

The results suggest the importance that recent transmission of TB may be having among young adults, IDU and prison inmates in particular, and calls for a review of control strategies.

Overdenture prosthesis for oral rehabilitation of hypohidrotic ectodermal dysplasia: a case report

The dentition of a patient with ectodermal dysplasia was restored with a modified hollowed maxillary overdenture opposing a conventional mandibular overdenture. Lingualized occlusion was used because it was the ideal occlusal scheme for this patient to achieve denture stability. The lingual cusps of the maxillary posterior teeth contacted the fossae of the mandibular teeth to create freedom of movement and to prevent lateral interference.

Elective neurotraumatology and therapeutic strategies in early post-trauma

The aim of elective neurotraumatology is to outline new and valid therapeutic strategies in early post-trauma in order to obtain a more favourable long-term outcome for cranial and spinal trauma patients than usually achieved with conventional intensive therapies. After a critical review of all drugs and measures currently used for the treatment of damage due to cerebral trauma and a brief mention of new agents still being studied, the results of a retrospective study of 128 patients with severe head injury are reported. For all patients a complete clinical and pharmacological history of their traumatic event, which had occurred from 5 to 14 years before the present evaluation, was available. Eighty-nine had undergone traditional therapies and 39 had been given complementary neuroprotective drugs, variously associated with traditional therapies. There was no statistically significant difference between the groups in terms of the global clinical outcome, (assessed by a 5-point scale: death, worsening, unchanged condition, improvement, recovery), and some sequelae, such as decubitus, impairment of sphincter control, neurological focal deficits and post-traumatic epilepsy. On the contrary, cognitive impairment and depression resulted statistically less frequent in patients who underwent conventional therapies and early complementary neuroprotective treatments than in the controls. In conclusion it would be very interesting to perform controlled clinical studies to confirm these preliminary results and the effectiveness of early neuroprotection on the long-term clinical outcome of patients with severe head injury. The therapeutic approach in early post-trauma is still not completely standardised and the purpose of elective neurotraumatology is to emphasise and promote the importance of such a standardisation.