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The Authors report on a case of a 69 years old woman with an acute peritonitis secondary to a perforated jejunal diverticulum, treated by laparotomy and intestinal resection with end-to-end anastomosis in one layer. The patient was dismissed after seven days, in good general conditions. Jejunal diverticula occur in around 1% of general population. They are usually asymptomatic; sometimes they give origin to dyspepsia or acute manifestations. These are due to complications at the site of the diverticulum like bleeding, occlusion and acute infection with perforation and peritonitis, as occurred in our patient. The main risk in diverticular complications is to prolong the interval between admission of the patient and surgical treatment, favouring the initiation of hypovolemic or septic shock. For these reasons, in most recent years, C.T. and, in case of bleeding, capsule endoscopy, were used in the diagnostic pre-operative work-up. The surgical technique is jejunal resection with direct anastomosis, leaving percutaneous drainage only for patients with an abscess, in poor general conditions for a narcosis.

The effects of two different concentrations of IL-2 on human pituitary adenomas (one secreting ACTH and one secreting GH) were evaluated in vitro. A specimen of the tumor was dissagregated and the cells were incubated for three days with RPMI 1640 medium. The medium was then decanted and the cells were incubated with 1 mlo of fresh medium for three hours and then with new fresh medium containing two different concentrations of IL-2, 100U/ml, for three hours too. The pituitary hormones, ACTH and GH, released into the medium were assayed by RIA. Dose of 100 U IL-2 induced a profound increase of ACTH release. The other dose decreased ACTH release. The release of GH was suppressed by IL-2 at the two concentrations tested. IL-2 may be an immunologic messenger exerting direct action at pituitary level. It appears probable that IL-2 plays an important role in determining the response of the pituitary to stress and infections.

Sixty cases of goitrous Hashimoto's thyroiditis were observed at the first diagnosis. For 18 of the cases, the diagnosis was made only on the basis of cytological examination since antithyroid antibodies were always negative. To determine if seronegative or seropositive forms constituted a particular genetically determined subgroup, we evaluated whether such peculiarities were related to specific HLA haplotype. Analysis of HLA antigens showed in the seropositive a significant increase in the frequency of HLA-B51 and HLA-A2, a significant decrease in the frequency of HLA-A1 and HLA-DR1. In seronegative cases no increase was found in the frequency of HLA-A-B-DR antigens, but they showed a strong positive association with HLA-DQ3. Our results show that association of Hashimoto's thyroiditis with HLA antigens was different in seronegative and seropositive subgroup. This finding would seem to support the hypothesis that in a few subjects the entire immune process develops exclusively within the involved organ and this process would be genetically determined.

A controlled clinical trial was made of the anti-ammoniaemic properties of gamma-ethylester glutamic acid, arginine and placebo in a series of 45 patients with hepatic insufficiency characterized by hyperammonemia (excluding cases of pre-coma and coma) randomly assigned to three groups for treatment with: gamma-ethylester of glutamic acid (25 g), l-arginine (25 g) and physiological solution in identical 500 ml bottles. Various parameters were controlled. The results obtained were assessed with different statistical techniques, depending on the parameter concerned and the aims of the trial. Blood ammoniaemia was significantly decreased by both-ethylester of glutamic acid and arginine though the former was more effective quantitatively and in terms of time. SGOT and BSF values also followed the same pattern.

A rare case of cystic lymphangioma of the spleen accompanying hypersplenism syndrome is described. After stressing the importance of certain examinations such as arteriography and splenic scintigraphy in diagnosis the condition, the many ways in which cystic lymphangioma of the spleen may present clinically are reviewed; these go from asymptomatic to straightforward splenomegaly, with or without clinical signs, up to a clear-cut hypersplenism syndrome. The present case merits consideration for three reasons: 1) The absolutely exceptional nature of cystic lymphangioma of the spleen; 2) Exceptional association with hypersplenism syndrome; 3) Remission of the syndrome following splenectomy. It is concluded that, notwithstanding the condition's rarity, cystic lymphangioma of the spleen should be considered in the differential diagnosis of splenomegalic syndromes when these are also accompanied by hypersplenism.

The ethiocholanolone test was used to evaluate the granulocyte reserve in 22 patients with Hodgkin's disease before and during polychemical antiblastic and radiation therapy. Under basal conditions, the reserve was normal and its behavior was fairly constantly related to histological type. Stress is laid on the inadequacy of the simple leukocyte count as a guide to the planning of treatment by comparison with the more accurate picture offered by the granulocyte reserve.

The AA. administered i.v. large doses of gamma-ethylester of glutamic acid to 22 patients affected with severe liver failure associated to mental and neuromuscolar abnormalities as tremors, confusion, restlesness which have been duly recorded for the purpose of this evaluation. The average daily dose was 36.3 gm and the treatment lasted as an average 9.5 days. The peripheral venous blood ammonia was checked, at the beginning and at the end of the treatment, in all the patients and in some, at random, the following parameters were determined: pH, pCO2, pO2, HCO3, TCO2, oxygen saturation on arterial blood. The treatment caused a statistically remarkable decrease of blood ammonia in 21 of 22 patients. The mental and neuromuscolar abnormalities too showed a statistically important downward trend vs. the basal values. The acid-base balance did not record any remarkable variation. The AA. judge as absolutely positive the trial carried out with gamma-ethylester of glutamic acid. The large doses used caused clear-cut and dramatic improvements and were estremely well tolerated.