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Biomedical subjects

P Crocchiolo

Publications and source records attributed to P Crocchiolo.

At least 19 recordsLinked to original sources

Single-dose fosfomycin trometamol versus multiple-dose cotrimoxazole in the treatment of lower urinary tract infections in general practice. Multicenter Group of General Practitioners.

A randomized trial, comparing a single dose treatment of fosfomycin trometamol (FT, 3 g) versus a 3-times daily regimen of cotrimoxazole (CTX, 960 mg) was carried out in women with uncomplicated urinary tract infections. Of 36 evaluable patients, 19 were treated with FT and 17 with TMP. The bacteriological results after 4 weeks of follow-up were in the FT group (n = 19): cure in 17 (89%), and failure in 2 (11%). For the CTX group (n = 17) the results were cure in 13 (76%), and failure in 4 (24%). Adverse events were reported in 3 patients on FT (2 diarrhoea, 1 epigastralgia) and in 2 on CTX (1 stain rash, 1 asthenia).

Bacteriuria↗

HIV-related severe thrombocytopenia in intravenous drug users: prevalence, response to therapy in a medium-term follow-up, and pathogenetic evaluation.

Severe thrombocytopenia (TP) accounted for 5.3% of cases in a consecutive series of 380 HIV-infected intravenous drug users (IVDUs) at presentation. Forty-one of 53 subjects with severe TP showed haemorrhages and were treated as follows: ten were splenectomized, 17 were given high-dose intravenous immunoglobulins (HDIg), and 10 received anti-Rh(D) immunoglobulins (anti-Rh Ig). Splenectomy induced a complete clinical response in all cases: four out of 10 patients maintained platelet counts greater than 100 x 10(9)/l. HDlg gave a good clinical response in all patients, but eight out of 17 suffered haemorrhages during the follow-up and recall treatments were necessary. Six out of 10 patients treated with anti-Rh lg maintained platelet counts greater than 30 x 10(9)/l, but in two cases the treatment was interrupted because of severe haemolysis. No patient progressed to overt AIDS during the follow-up. Splenectomized patients in particular did not show adjunctive risks of worsening of the HIV-related clinical picture. A platelet kinetic study performed in 20 patients with severe HIV-related TP suggests a possible role for platelet sequestration in TP of HIV-infected IVDUs, in which a liver involvement is very frequent.

Adult↗

A trial with ribavirin in patients with AIDS or AIDS-related complex.

A therapeutic trial is described which concerns 6 patients with AIDS and 6 patients with ARC who were submitted to a 6 month course of Ribavirin. Ribavirin was administered orally as the following doses: 3.000 mg daily the first week, 2.000 mg daily the second 2 weeks, and 1.000 mg daily up to completion of the 6 months period. No major side-effects were recorded; only a transient anemia was observed in almost all patients at the higher dose; none of them, however, required to be transfused. No improvement was shown by any of the 6 AIDS patients, neither clinically nor according to laboratory test, whereas all 6 patients with ARC experienced a sense of well-being, a clearing of their symptoms and an average weight gain of about 2.5 kg. No significant changes, though, were recorded as for their immune parameters. A remarkable drop of aminotransfereas was also observed in 4 of the patients, who were affected with chronic hepatitis as well. We conclude that additional, if any, Ribavirin trials should be carried out only in ARC patients.

AIDS-Related Complex↗

T-lymphocyte subsets and delayed type hypersensitivity as classification parameters for HIV infection among drug-addicts.

HIV selectively infects T helper lymphocytes, which play an essential role in cell-mediated immunity mechanisms. Impairment of these mechanisms can be evaluated, other than by clinical parameters, by testing lymphocytic subsets and cutaneous delayed type hypersensitivity. All these indices are used in the Walter Reed Foundation (WR) staging system, which includes the different stages of HIV infection. In our study we investigated the above mentioned parameters in a series of 180 HIV positive PDAs. A classification of the same patients according to WR's criteria was also designed. Of our patients, 46.1% resulted normoergic, 27.2% hypoergic and 26.7% anergic. Of all normoergic subjects, 83.7% (with more than 400 OKT4+ cells/mmc) could be assigned to the WR2 and 16.3% (with less than 400 OKT4+ cells/mmc) to the WR3 staging group. Among the hypoergic patients, only 34.7% were assignable to the WR4 group, whereas the majority (65.3%) had more than 400 OKT4+ cell/mmc. Even among the anergic group, 62.5% did not fit the WR5 stage, exhibiting an OKT4+ level higher than 400/mmc. In the latter 2 groups (referred to as D and E), T helper lymphocyte counts were performed at regular intervals; however, only the ones followed-up for at least 6 months were evaluated. OKT4+ cells were shown to decrease more frequently and more rapidly in the anergic than in the hypoergic patients, which points to cutaneous anergy as representing an early sign of impairment of cell-mediated immunity.

Acquired Immunodeficiency Syndrome↗

Milan as possible starting point of LAV/HTLV III epidemic among Italian drug addicts.

Sera collected between 1978 and 1985 from 716 parenteral drug-addicts admitted to our Clinic with viral hepatitis were tested for antibodies to HTLV III. None of the patients was showing symptoms suggestive of LAV/HTLV III infection at the time of sera collection. Positivity for HTLV III antibody was found and confirmed (by ELISA) in 212 subjects (29.6%). The earliest positivity appeared in a serum sample collected in February 1979. These and other data point to Milan as to the actual source of the Italian PDAs-linked LAV/HTLV-III epidemic.

Acquired Immunodeficiency Syndrome↗

Role of PMN's candidicidal activity in the pathogenesis of AIDS-related systemic candidiases.

Phagocytic and fungicidal activity towards C. albicans spores were tested in 9 patients with AIDS-Related Complex (ARC), but without Candida infections, and in 13 patients with AIDS and deep candidiasis. No significant differences were observed between the two mentioned groups as far as PMN's phagocytosis and killing were concerned. PMN's migration in response to a "non-mycotic" chemoattractant was defective in both groups; although, from this point of view, patients with candidiasis were more severely affected. A significant difference was noted, instead, as far as mean T helper values were concerned; in fact, their number was significantly lower in patients with systemic candidiasis than in those with ARC or even AIDS, but oesophageal candidiasis only. In conclusion, defective PMN's activity towards C. albicans spores, as observed in vitro, does not seem in itself to predispose AIDS patients to candidiasis in vivo; mycoses may be rather due to defects of cell-mediated immunity as a whole.

AIDS-Related Complex↗

Clinical and epidemiological aspects of the first 50 cases of AIDS in Milan.

Between April 1984 and December 1985, 50 patients diagnosed as AIDS were observed in our Clinic. Risk factors were homosexuality in 21 cases (42%), drug addiction in 20 (40%), homosexuality and drug addiction in 3 (6%), haemophilia in 1 (2%). In the remaining 5 cases the infection was acquired by vertical transmission in 2 (4%), by promiscuous heterosexual intercourse in 2 (4%) and by a single blood transfusion in 1 (2%). Kaposi's sarcoma (KS) was the main clinical feature in 8 patients, although associated with opportunistic infections (OI) in 7 of them. A total of 91 different OI were diagnosed with a noteworthy prevalence of mycotic infections compared with OI due to other micro-organisms: 40 deep mycoses by Candida albicans, and 5 cryptococcoses. Pneumocystis carinii pneumonia (PCP) was diagnosed in 20 patients. Our data differ from the ones collected in the USA both epidemiologically, since we observed a greater incidence of AIDS in drug-addicts than in homosexuals and clinically, since in Italy a lower rate of neoplastic disease and, conversely, a higher rate of OI other than PCP are reported.

Acquired Immunodeficiency Syndrome↗

Albendazole in the treatment of cystic hydatid disease.

Four cases of cystic hydatid disease treated with albendazole are described. The first patient had previously undergone surgical treatment with only partial removal of her hepatic cysts. The size of the remaining cyst resulted remarkably reduced after three courses of the drug. The second patient had recurrent hydatid disease involving the lumbar spine. After therapy, an evident diminution in the size of the cyst was detected. Two patients (one with a partially calcified cyst of the liver, the other one with multiple pulmonary lesions) did not show any objective evidence of improvement. Failures were probably due to the presence of calcified or thick-walled cysts. In all the patients, neither side-effects were observed, nor recurrences were noted during a 2 years' follow-up. In cystic hydatid disease, whenever radical surgical procedures are impracticable, albendazole treatment can achieve significant clinical results.

Adolescent↗

[Transitory increase of OKT4+ lymphocytes in the peripheral blood of patients with lymphadenopathy syndrome treated with beta-interferon].

A therapeutic trial with IFN-beta (Hu. Interferon beta lyophilized, Sclavo S.p.A., Siena, Italy), administered thrice weekly but once monthly in six courses was performed for immune-modulating purposes in five parenteral drug addicts affected with lymphadenopathy syndrome. Each dose consisted of 12 X 10(6) international units I.V. Preliminary observations evidenced a significant increase of OKT4+ cells after the first course of therapy. No significant differences from the basal values, though, were found after the following courses, while in a control group of untreated LAS patients, a significant decrease of OKT4+ lymphocytes was observed. Partial remission of symptoms and/or reduction in size of the lymphatic masses were also achieved in all treated patients, although so far none of them can be considered as actually cured.

Antibodies, Monoclonal↗

Attempt to treat acute type B hepatitis with an orally administered thymic extract (thymomodulin): preliminary results.

A double-blind trial with thymomodulin (TM) was performed in a consecutive series of 50 inpatients affected with acute type B hepatitis. Twenty-six randomly selected patients received TM (Leucotrofina, Ellem), 1 ampoule b.i.d. per os for 30 days, and 24 patients received the same amount of placebo for the same period. TM-treated patients showed accelerated AST and ALT decrease and an earlier HBsAg clearance. However, only the difference in ALT decrease was statistically significant in comparison with the controls (p less than 0.02). Before the treatment was started, lymphocyte subsets, as determined by monoclonal antibodies, showed a different pattern in the two groups despite strict randomization. Nevertheless, by the end of the trial, mean T4+/T8+ ratios were increased in the treated group, but remained unchanged in the control group. The trends in the two groups were significantly different (p less than 0.005). Further information is expected from a long-term follow-up.

Acute Disease↗