surgical treatment of solitary or scant pulmonary metastases from melanoma has proved its efficacy with a gain in overall and disease-free survival. Nevertheless, this treatment cannot be proposed in patients with contraindications for anaesthesia or compromised pulmonary function. In this population, radiofrequency ablation appears to offer a potentially valuable alternative to surgery. Additionally, the related morbidity and duration of hospitalisation associated with radiofrequency seemed to be improved. As seen in these two cases, the efficacy and increased survival achieved with radiofrequency appears comparable to those obtained through surgery.

Background. - Based on consensual recommendations, surgery remains the standard treatment for curable lung metastases. In this setting, radiofrequency ablation of limited metastases has been described in numerous studies in recent years. We report herein two patients presenting with low-burden lung metastases from malignant melanoma treated by radiofrequency.Patients and methods. - Two patients presented with one to two limited burden lung metastases from malignant melanoma, respectively. Both patients received neoadjuvant chemotherapy leading to disease stabilization, after which the lung metastases were treated by radiofrequency. Both patients had complete remission following radiofrequency, with 12 and 21 months follow-up respectively.Discussion. - Surgical treatment of solitary or scant pulmonary metastases from melanoma has proved its efficacy with a gain in overall and disease-free survival. Nevertheless, this treatment cannot be proposed in patients with contraindications for anaesthesia or compromised pulmonary function. In this population, radiofrequency ablation appears to offer a potentially valuable alternative to surgery. Additionally, the related morbidity and duration of hospitalisation associated with radiofrequency seemed to be improved. As seen in these two cases, the efficacy and increased survival achieved with radiofrequency appears comparable to those obtained through surgery. (C) 2010 Elsevier Masson SAS. All rights reserved.

The Infectious Diseases Unit of Lucca Hospital conducted a multicentric retrospective study to evaluate the epidemiological and clinical features of adult patients affected by bacterial meningitis attending all the Infectious Diseases Units of Tuscany (Italy) from July 1999 to June 2004. A specific questionnaire was sent to all the units to collect information about each case of bacterial meningitis occurring in patients older than sixteen. Patients with meningitis by Mycobacterium tuberculosis were excluded from the analysis. Nine out of 12 Infectious Diseases Units of Tuscany took part in the study and 197 cases were identified. Most cases of meningitis occurred during 2002 with a slight reduction in cases in subsequent years. Streptococcus pneumoniae and Neisseria meningitidis were the most frequently isolated pathogens with an increase in diagnosis from 1999 to 2004; in 23.8% of patients no pathogens were isolated, with a reduction in meningitis from unknown aetiology from 1999 to 2004. Most patients were treated with a combination of two antibiotics, and corticosteroid drugs were added to the therapy; in the group of patients treated with corticosteroid drugs invalidating complications occurred in 23% of cases and 5% of patients died. In all, 27 out of 197 subjects (13.7%) developed invalidating complications and 20 out of 197 patients (10.2%) died.

BACKGROUND:We obtained estimates of the incidence of tuberculosis (TB) among patients receiving HAART and identified determinants of the incidence. METHODS:We analyzed the incidence of TB during the first 3 years after initiation of HAART among 17,142 treatment-naive, AIDS-free persons starting HAART who were enrolled in 12 cohorts from Europe and North America. We used univariable and multivariable Poisson regression models to identify factors associated with the incidence. RESULTS:During the first 3 years (36,906 person-years), 173 patients developed TB (incidence, 4.69 cases per 1000 person-years). In multivariable analysis, the incidence rate was lower for men who have sex with men, compared with injection drug users (relative rate, 2.46; 95% confidence interval [CI], 1.51-4.01), heterosexuals (relative rate, 2.42; 95% CI, 1.64-3.59), those with other suspected modes of transmission (relative rate, 1.66; 95% CI, 0.91-3.06), and those with a higher CD4+ count at the time of HAART initiation (relative rate per log2 cells/microL, 0.87; 95% CI, 0.84-0.91). During 28,846 person-years of follow-up after the first 6 months of HAART, 88 patients developed TB (incidence, 3.1 cases per 1000 person-years of follow-up). In multivariable analyses, a low baseline CD4+ count (relative rate per log2 cells/microL, 0.89; 95% CI, 0.83-0.96), 6-month CD4+ count (relative rate per log2 cells/microL, 0.90; 95% CI, 0.81-0.99), and a 6-month HIV RNA level >400 copies/mL (relative rate, 2.21; 95% CI, 1.33-3.67) were significantly associated with the risk of acquiring TB after 6 months of HAART. CONCLUSION:The level of immunodeficiency at which HAART is initiated and the response to HAART are important determinants of the risk of TB. However, this risk remains appreciable even among those with a good response to HAART, suggesting that other interventions may be needed to control the TB epidemic in the HIV-infected population.

In the numerous reports of cases of sarcoidosis associated with interferon-a (IFN-a) treatment for chronic hepatitis due to virus infection, particularly hepatitis C virus (HCV), sarcoidosis appeared during interferon treatment, and in very few cases after withdrawal of treatment (1 /3). In the majority of cases, the disease tended to clear up in about 2 /8 months after suspension of interferon and only very few cases required steroid treatment (4 /10). This paper describes 2 cases of sarcoidosis associated with HCV infection characterized by a long period between the end of interferon therapy and the diagnosis of sarcoidosis. One of the patients showed progress of sarcoidosis after the end of treatment.

Background: The application of pharmacokinetic (PK) and pharmacodynamic (PD) data in conjunction with minimum inhibitory concentrations (MICs) of antibacterial agents has been shown to allow for improved selection and appropriate dosing of antimicrobial agents for specific infections, increasing the likelihood of bacteriologic cure and, through this, reducing the risk for the development of resistant organisms.Objectives: This study was undertaken to provide data on current levels of resistance among common community-acquired bacterial species to 7 betalactam antimicrobial agents (including the combination product amoxicillin/clavulanate), azithromycin, and clarithromycin, determined through application of the PK/PD breakpoints based on time-above-MIC for the beta-lactams and the nonazalide macrolide clarithromycin, and on 24-hour serum area under the curve divided by MIC for the azalide macrolide azithromycin.Methods: The antimicrobial products tested were amoxicillin/clavylanate, cefpodoxime, cefdinir, cefditoren, cefprozil, cefuroxime, cefixime, azithromycin, and clarithromycin. The bacterial species comprised 70 penicillin-susceptible, 68 penicillin-intermediate, and 69 penicillin-resistant strains of Streptococcus pneumoniae; 46 beta-lactamase-positive and 54 beta-lactamase-negative strains of Haemophilus influenzae; 49 strains of Moraxella catarrhalis; and 100 methicillin-sensitive strains of Staphylococcus aureus (MSSA). Strains were isolated from clinical specimens obtained from outpatient-acquired infections in 1 clinical center in the Northeast and 1 in the north-central area of the United States within the past 2 years. National Committee for Clinical Laboratory Standards microdilution MIC methodology was used. PK/PD breakpoints were obtained from previously published studies and were based on blood values.Results: Amoxicillin/clavulanate was the product to which the greatest percentage of susceptible, intermediate, and resistant strains of pneumococci were sensitive at the PK/PD breakpoint, followed by cefditoren, cefpodoxime, cefuroxime, cefdinir, and cefprozil. None of the cephalosporins were active against penicillin-resistant pneumococci. Cefditoren and cefpodozime were the agents to which the greatest percentage of beta-lactamase-positive and beta-lactamase-negative strains of H influenzae were sensitive, followed by amoxicillin/clavulanate, cefdinir, and cefuroxime. Cefprozil was inactive against H influenzae. All of the beta-lactam products were active against M catarrhalis. All but cefpodoxime, cefditoren, and cefixime were active against MSSA.Conclusions: In this study, based on PK/PD breakpoints, amoxicillin/clavulanate had the best overall activity of the 9 antimicrobial products tested. Cefpodoxime and cefditoren were active against ⩾90% of strains of penicillin-susceptible and penicillin-intermediate pneumococci, H influenzae, and M catarrhalis. The macrolides azithromycin and clarithromycin were active against penicillin-susceptible and penicillin-intermediate pneumococci and M catarrhalis; they were inactive against H influenzae and penicillin-resistant pneumococci.

Hypertriglyceridemia has frequently been found both in subjects with AIDS and in asymptomatic HIV-positive ones. In order to evaluate the importance of hyperlipemia as an index of the clinical evolution of HIV infection, the levels of triglycerides, total cholesterol and CD4 lymphocytes were determined over a period of 2 years in 8 haemophiliacs with AIDS, 13 asymptomatic HIV-positive and 45 HIV-negative haemophiliacs attending the Operative Unit of Coagulation Disorders of the University of Pisa. The mean concentration of triglycerides and incidence of hypertriglyceridemia were significantly higher in haemophiliacs with AIDS, compared with HIV-negative subjects (p<0.0001), while the triglycerides values of asymptomatic HIV-positives fell between those of the other groups. Cholesterol levels were lower in HIV-positive haemophiliacs and in those with AIDS compared with HIV-negatives. No correlation was found between triglyceride levels and those of CD4 lymphocytes.

Epstein-Barr virus (EBV) is associated with a wide range of clinical manifestations. Neurological involvement (NI) during Infectious Mononucleosis occur in 1-5% of the cases, the only NI is more rare. From January 1995 to December 1996 three patients with NI and EBV infection have been observed in our department. The diagnosis were: meningoradiculitis (1 case), meningoencephalitis (1 case), aseptic meningitis (1 case). The diagnosis was based on the results of the lumbar puncture and on the serology: IgM VCA positive at the onset of the symptoms and a significant increase of the IgG VCA after three weeks. No other etiology was apparent. All the patients have been treated with dexamethasone, glycerol and acyclovir obtaining a complete remission of the disease. In these cases the NI has been the only clinical manifestation of the EBV infection. Therefore the authors believe that it is important recognize that EBV can cause a myriad of neurological illness with or without the stigmata of infectious mononucleosis and recommend the need to suspect this infection in any acute neurologic disorder.

The effect of albendazole was studied in 12 patients with cystic hydatid disease (CHD) of the liver. Six patients received albendazole continuously for 6 months, while 6 patients received albendazole for 6 courses of 4 weeks with a 2 week drug-free interval between cycles. The continuous therapy proved successful, with stable involution at the follow-up at 24 months, while the patients treated with discontinuous therapy showed improvement or relapse. In our experience, continuous therapy was more effective and can be considered to be a suitable alternative or percutaneous therapy in uncomplicated hydatid liver disease, as an initial treatment.

Rhinosporidiosis is a mycotic infection caused by Rhinosporidium seeberi. The fungus occurs in tissues as spherules measuring 0.25-3 mm. The spherules contain endospores. Diagnosis is usually made histologically on biopsy specimens from polypoid lesions on the mucous membranes of the nasopharynx, larynx, trachea, bronchus and conjunctiva. In our experience two cases of rhinosporidiosis were diagnosed by cytology. The cytologic features are typical. On direct examination the spherules are well-circumscribed, globular structures with several endospores within. The spherules show great variability in size, up to 10-fold. The diameter ranges from 30 to 300 microns. Permanent stains for detecting R seeberi are Giemsa, Gridley and toluidine blue. Numerous mycotic infections (Coccidioides immitis, Histoplasma capsulatum, Mucor, Aspergillus, Blastoschizomya capitatus, Paracoccidioides brasilienses, Cryptococcus neoformans) can be definitively diagnosed or strongly suspected on cytology. In immunocompromised patients it is important to commence the diagnostic study on unstained material. By direct examination R seeberi organisms are identified readily by their brown color. Much more information can be gained from material stained with special stains, especially periodic acid-Schiff, in differentiating R seeberi from Coccidioides immitis.

Antibody response to antigen A60 (a mycobacterial antigen) was evaluated in ELISA in 18 HIV+ subjects with clinical and cultural evidences of mycobacterial infections, in 10 HIV+ subjects without Mycobacterial infections and in 22 healthy donors. We found higher levels of specific IgG in the HIV+ patients with Mycobacterial infections (mean 179.2 +/- 83 U) compared to the values of the donors (mean 92.5 +/- 35.5 U: p < 0.01). This test may be useful in the diagnosis of tuberculosis, but it needs clinical validation.

Four cases of percutaneous treatment of hydatid cysts are reported. Cytologic examination of the cyst fluid is important to confirm the diagnosis in patients who did not develop antibodies. Gomori stain gives the best results in identifying the three elements of a hydatid cyst: scolices, hooklets and laminated membranes. Moreover, staining for viability assessment gives information about the success of drug treatment.