[Revascularization of the carotid and vertebral arteries in the elderly]

From January 1994 to July 2004, 323 patients underwent 348 revascularization of carotid bifurcation for atherosclerotic stenoses. Eighty eight patients (group A) were 75 year-old or older, whereas 235 (group B) were younger than 75 years. Postoperative mortality/neurologic morbidity rate was 1% in group A, and 1.4% in group B. At 5 years, patency and freedom from symptoms/stroke were, respectively, 91% and 92% in group A, and 89% and 91% in group B. None of these differences was statistically significant. In the same time period, 26 internal carotid arteries were revascularized in 24 patients, 75 or more aged, for a symptomatic kinking. Postoperative mortality/morbidity rate was absent, whereas, at 5 years, patency and freedom from symptoms/stroke were, respectively, 88% and 92%. Twelve vertebral arteries were revascularized in 12 patients, 75 or more aged, for invalidating symptoms of vertebrobasilar insufficiency. Postoperative mortality/neurologic morbidity rate was absent. In one case postoperative recurrence of symptoms occurred, despite a patent revascularization. Patency and freedom from symptoms/stroke were 84% and 75%, at 5 years. Revascularization of carotid and vertebral arteries in the elderly can be accomplished with good results, superposable to those of standard revascularization of carotid bifurcation in a younger patients' population.

Sexual behaviour of heterosexual individuals with HIV infection naive for antiretroviral therapy in Italy

BACKGROUND

Specific information about determinants of sexual behaviour of HIV infected heterosexuals, like injecting drug use (IDU), are essential to design interventions aimed at promoting safer sex practices.

METHODS

We analysed data on sexual behaviour collected, between March 1997 and March 1999, through a self administered questionnaire among 1050 IDUs and 642 non-IDU heterosexuals enrolled in a prospective multicentre cohort study on the natural history of HIV infection.

RESULTS

Among non-IDU heterosexuals, more women (48.5%) than men (25.1%) (p<0.001) reported that they were infected by HIV positive regular partners whose HIV status they were not aware of. Among the 1119 heterosexual males, one fifth reported having had more than 25 sexual partners during their lifetime. Condom use in the last sexual intercourse was more common among heterosexual IDUs (64.9%) than among non-IDU heterosexual males (58.3%) (p=0.05). Heterosexual IDU males were more likely (66.7%) than non-IDU heterosexuals (50.6%) to have an HIV negative partner (p<0.001). Of the 573 heterosexual females studied, 10.2% reported having had more than 25 lifetime sex partners. This proportion was higher among heterosexual IDUs (18.8%) than among non-IDU heterosexuals (4.3%) (p<0.001). Nearly 50% of the women in both groups reported having used a condom in the last intercourse. Almost 57% of heterosexual IDUs had a current HIV negative partner, compared with 34.9% non-IDU heterosexuals (p<0.001). In both sexes, the findings from univariate analysis were confirmed by multiple logistic regression analysis.

CONCLUSIONS

This study identified some important differences, in both males and females, in sexual lifestyles according to injecting drug use (for example, in terms of HIV negative partners). This observation indicates the need to tailor HIV prevention messages according to history of injecting drug use.

Seroprevalence, risk factors and attitude to HIV-1 in a representative sample of lesbians in Turin

OBJECTIVE

To estimate the HIV-1 seroprevalence, behavioural risks and attitude to HIV-1 infection among lesbians.

SETTING

Institute of Infectious Diseases, University of Turin, Italy.

SUBJECTS

From March 1992 to May 1993, 181 lesbians were tested for HIV-1 and included in the study.

METHODS

Sociodemographic details, nonsexual risks for HIV-1, sexual behaviour, STD history and attitude to HIV-1 were obtained from an anonymous, standardised, self-administered, 30-item questionnaire. Snow-ball techniques were used to recruit the largest possible number of participants.

RESULTS

11 lesbians (6.1%) were found to be HIV-1 antibody positive. Of them, 10 were intravenous (i.v.) drug users. STD episodes were higher among lesbians with HIV-1 than without (p = 0.04), increasing in both groups over time. Syphilis, genital herpes and viral hepatitis were highly associated with HIV-1 (p = 0.000). In univariate analysis, i.v. drug use, bisexual behaviour, history of STDs, sex during menses and vaginal/anal manipulation were significantly linked to HIV-1 (p = 0.000). In multivariate analysis only history of i.v. drug use (p = 0.04) and bisexual behaviour (p = 0.06) remained independently associated with HIV-1. Seventy-one participants (39.3%) had already undergone AIDS testing. Only 3.5% admitted to be at risk for HIV-1 and 11% changed their sex habits after first hearing of AIDS. No lesbian had ever practised safe-sex. Television was the most important source of information on HIV-1 (84%).

CONCLUSION

I.v. drug use was the most likely means of HIV-1 infecting the lesbians of Turin. The high rate of STDs and the low perceived risk to HIV-1 require programmes of STD prevention and AIDS information to be targeted at the lesbian community.

[Clinical course of HIV infection in a cohort of 100 drug addicts in prison from 1984 to 1988]

A population of 100 drug addicts, two of whom were homosexual, all of them jailed has been considered. Patients were admitted on more than one occasion to a specially equipped ward for jailed patients at the "Amedeo di Savoia" of USL 4 of Turin. The clinical course of the condition brought on by HIV infection was compared with a similar sample of non-imprisoned subjects. In conclusion, some socio-assistential operative proposals for responding to the clinico-therapeutic, psychological and socio-familial needs of such patients are reported.

Non-A, non-B hepatitis; factors involved in progression to chronicity

A cross-sectional, longitudinal study was undertaken on a group of acute non-A, non-B hepatitis patients, as well as on a control group of hepatitis B patients, in order to assess both the prevalence of the most important factors favoring infection, and the relevance of these factors in promoting evolution towards chronic liver disease. Exposures to unknown risk factors were present in 47.4% of acute non-A, non-B infections, followed by blood transfusions (17.9%), sporadic exposures (17.9%) and drug addiction (16.6%). Unknown as well as sporadic exposures showed a greater prevalence in control population if compared to non-A, non-B cases, while drug addiction was equally represented in the two groups, and blood transfusion nearly absent from control group. The risk of evolution to chronic liver disease was about 13 times greater in non-A, non-B group than in controls, with the greatest risk for drug addicts and the lowest for patients with unknown exposures. Among patients with known exposures, the lowest risk of chronic hepatitis was observed in post-transfusion and in sporadic cases, while the greatest was observed in drug addicts.

[Identification of Pneumocystis carinii in a patient dying of AIDS]

We compared two different techniques in the preparation of slides for the demonstration of Pneumocystis carinii in lung tissue of a patient died for AIDS. The impressions were prepared by imprinting the autopsy tissue surfaces on glass slides, while the concentrates were prepared by a partial homogenization and subsequent centrifugation of the pulmonary tissue. After staining, the number of protozoa microscopically observed resulted similar with both techniques; moreover using impression smears P. carinii were more easily visible.

[Clinico-epidemiologic findings in a group of patients with acute viral hepatitis]

Certain clinical and epidemiological findings among 2262 AVH patients are reported. The patients were all admitted to the A. di Savoia Hospital for Infectious Diseases in Turin over a two-year period.

IgM antibody against hepatitis B core antigen (IgM anti-HBc): diagnostic and prognostic significance in acute HBsAg positive hepatitis

IgM antibody against hepatitis B core antigen (IgM anti-HBc), a marker of recent hepatitis B virus infection, was sought by radioimmunoassay in sera diluted 1/4000 from 376 patients presenting to four centres in Italy with acute, apparently type B hepatitis (hepatitis B surface antigen (HBsAg) positive). In 320 patients (85%) a positive IgM anti-HBc test result confirmed that hepatitis was due to primary infection with hepatitis B virus. In the remaining 56 patients absence of the IgM marker indicated that they were previously unrecognised long term carriers of HBsAg. Further serum analysis often showed delta infection and occasionally hepatitis A or cytomegalovirus infection as the true cause of their illness. After six to eight months circulating HBsAg persisted in 38 of 45 patients (84%) without IgM anti-HBc but in only six of 150 patients (4%) with the IgM antibody (p less than 0.0001). A negative IgM anti-HBc test result in patients with acute HBsAg positive hepatitis points to a factor other than hepatitis B virus as the cause of the liver damage and predicts the carriage of HBsAg.

[A case of the Ramsay-Hunt syndrome (herpes zoster of the geniculate ganglion) with concomitant C2 and C3 nerve involvement]

A case of Ramsay-Hunt syndrome (herpes zoster of the genicular ganglion with paresis of the facial nerve) presenting concomitant involvement of the sensitive nerve roots C2 and C3 is reported. The main aetiopathogenetic hypotheses as reported in the literature are presented and an attempt made to formulate a standard aetiopathogenetic theory comprising lesions to the motor nerve fibres and those of the sensitive nerve fibres.

[Research on the immunity status of the Turin population with respect to 3 recent variations of influenza A virus]

Measurement of influenza A/Torino/1/75, A/MRC 11 and A/Scotland/840/74 viruses h.i. antibodies in a sample of the Turin population represented by 200 non-vaccinated adults, showed that the percentage of subjects carrying antibiodies at the minimum titre of 1/10 was respectively 83, 78,5 and 52 and respective mean titres were 1/65, 1/65 and 1/43. These results confirm the antigenic affinity between A/Torino/1/75 and A/MRC/11 strains and their diversity with respect to A/Scotland/840/74. It is emphasized that vaccines should include the Scottish variant of the influenza virus also.