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It has been demonstrated that surgery may induce immunosuppression. This finding could influence the clinical course of surgically treated cancer patients. Moreover, preliminary experimental studies have shown that a preoperative injection of IL-2, whose importance in generating the antitumor immune response is well known, may neutralize surgery-induced immunosuppression. At present, however, it is still unknown whether preoperative IL-2-induced immune improvement in the postoperative period may influence the prognosis of surgically treated cancer patients. The present study was performed to evaluate the prognostic impact of IL-2 presurgical therapy in advanced colorectal cancer patients. The study included 50 colorectal cancer patients, Dukes' stage D, who were randomized to be treated with or without IL-2 preoperatively (18.10(6) IU/day subcutaneously for 3 consecutive days). After surgery, all patients underwent chemotherapy with 5-FU and folates until disease progression. Postoperative mean numbers of lymphocytes, T lymphocytes, natural killer cells and activated lymphocytes were significantly higher in IL-2-treated patients than in controls. Moreover, the percent of lymphocytic and/or eosinophilic tumor infiltration was significantly higher in IL-2 group than in controls. Finally, both survival curve and the percent of survival at 1 year were significantly greater in patients pretreated with IL-2 than in controls. This clinical trial demonstrates that preoperative IL-2-induced neutralization of postoperative lymphocytopenia is associated with a prolonged survival time in advanced colorectal cancer patients.

Our previous studies have shown that a preoperative injection of high dose IL-2 is able to abrogate surgery-induced immunosuppression in colorectal cancer patients. Moreover, our previous clinical investigations have indicated the possibility of amplifying IL-2 activity by a concomitant administration of the pineal immunomodulating hormone melatonin (MLT). On this basis, a biological study was performed to investigate the immune effects of a preoperative biotherapy consisting of low-dose IL-2 plus MLT in patients with gastrointestinal tumors. The study included 20 consecutive patients with gastrointestinal tract tumors, who underwent radical or palliative surgery. Patients were randomized to receive no preoperative treatment or a presurgical neuroimmunotherapeutic regimen consisting of low dose of IL-2 and MLT. IL-2 was injected subcutaneously at 3 million IU twice/day for 5 days in combination with MLT at 40 mg/day in the evening. Patients underwent surgery within 36 h from the last IL-2 injection. The mean number of lymphocytes, T lymphocytes and NK cells significantly decreased during the postoperative period in control patients, whereas it increased in patients pre-treated by immunotherapy. CD25-positive mean cell number increased in both groups of patients; however, postoperative mean number of CD25 expressing cells was significantly higher in patients pretreated with IL-2 and MLT than in controls. No immunotherapy-related toxicity occurred. This preliminary study would suggest that a neuroimmunotherapeutic regimen with low-dose IL-2 and MLT given preoperatively is a well tolerated therapy, which is able to prevent surgery-induced lymphocytopenia in cancer patients. This perioperative manipulation of host anticancer defenses could have a prognostic role in the clinical course of the neoplastic disease.

Interleukin-2 (IL-2) may induce peripheral eosinophilia and this phenomenon is related with response to IL-2 immunotherapy in patients with metastatic renal cell carcinoma. In previous experiences is reported that preoperative course with IL-2 may reverse the surgery-induced immunosuppression. This study's objective is to evaluate the histological changes of inflammatory infiltration in tumour stroma, in patients pretreated with IL-2 immunotherapy. 7 patients admitted to our surgical department with resectable recurrent colorectal cancer were treated with pre-operative course of IL-2; the tissue samples were analyzed for eosinophilic and inflammatory infiltration and compared with the samples obtained in the primary operation, performed without immunotherapy. In all patients were observed an increase of eosinophilic infiltration in tumour tissue. The mean increase were 200%, with high statistical significance (p < 0.0001). IL-2 pre-operative immunotherapy is able to change the interaction between host and tumour, by modifying the histological inflammatory infiltration in colorectal cancer tissue.

Surgery-induced immunosuppression could influence tumor/host interactions in surgically treated cancer patients. Previous studies have shown that high-dose IL-2 preoperative therapy may neutralize surgery-induced lymphocytopenia. Moreover, experimental studies have demonstrated that the immunomodulating neurohormone melatonin (MLT) may amplify IL-2 activity and reduce its dose required to activate the immune system. On this basis, we have compared the immune effects of presurgical therapy with high-dose IL-2 with respect to those obtained with preoperative neuroimmunotherapy consisting of low-dose IL-2 plus MLT. The study included 30 patients with gastrointestinal tract tumors, who were randomized to undergo surgery alone, or surgery plus a preoperative biotherapy with high-dose IL-2 (18 million IU/day subcutaneously for 3 days) or low-dose IL-2 (6 million IU/day subcutaneously for 5 days) plus MLT (40 mg/day orally). Patients underwent surgery within 36 hours from IL-2 interruption. Both IL-2 plus MLT were able to prevent surgery-induced lymphocytopenia. However, mean number of lymphocytes, T lymphocytes and T helper lymphocytes observed on day 1 of postoperative period was significantly higher in patients treated with IL-2 plus MLT than in those receiving IL-2 alone. Moreover, toxicity was less in patients treated with IL-2 and MLT. This biological study shows that both immunotherapy with high-dose IL-2 or neuroimmunotherapy with low-dose IL-2 plus MLT preoperatively are tolerated biotherapies, capable of neutralizing surgery-induced lymphocytopenia in cancer patients. Moreover, the study would suggest that the neuroimmunotherapy may induce a more rapid effect on postoperative immune changes with respect to IL-2 alone.

Reference is made to the experimental preliminary remark and the first, clinical observations underlying the surgical management of severe obesity, together with the techniques employed, starting with the jejunal-colic by-pass of Payne et al. This, however, led to serious liver damage and electrolyte imbalance, whereupon Payne et al. proposed end-to-side and Scott end-to-end jejunal-ileal by-pass. The end-to-end variety has been used with excellent results in 33 cases. Mason's gastric and gastroplastic techniques is till now unfrequently used. An account is also given of experimental ileo-cholecystostomy and biliopancreatic by-pass. In agreement with most other workers, a preference is expressed for the end-to-end jejunal-ileal by-pass as the most suitable technique available at present.

An association of 5-fluoruracyl (or methotrexate) and cyclophosphamide was used in the treatment of 20 cases of hormone-resistant breast cancer. Five objective regressions were obtained. Mean survival here was 28.25 (S.D. 2.87) months, as opposed to 12.75 (S.D. 6.93) months in the remainder. Side-effects of various kinds were noted in 9 patients.

On the basis of two personal cases and a review of the most recent literature, the main features of this rare pancreatic condition are reported. Special attention is paid to the post-diagnostic importance of radical exeresis. This is the only way of preventing the patient running the risk of malignant degeneration. The observation of a bisalbuminaemic band and the association with an aberrant pancreatic adenoma were of interest in the two cases described.

The results obtained in 14 patients suffering from hormone-resistant metastatic breast cancer treated with the following association: methotrexate (5-fluorouracyl in case of methotrexate intolerance), cyclophosphamide, vinblastin administered i.v. once every 10-13 days, are reported. 4 objective regression (29%) were observed but survival did not very appreciably differing therapy. In 9 cases (65%) intolerance of various types was observed but in 8 these signs regressed in a short time and the therapy was resumed.

This reviews 839 isolated lumbar sympathectomy performed between 1950 and 1975. The patients are stratified by decades and grouped in 3 periods : 1950 to 1959, 1960 to 1969 and 1970 to 1975. In the first period most patients were between 50 and 59 years old; in the last period most were between 60 and 69 years old. At this time direct vascular reconstruction had become more frequent. The approach described by Pearls was used exclusively in the last period. Isolated lumbar sympathectomy yields a symptomatic improvement. Best results are obtined in peripheral and isolated lesions.

A short account of the aetiopathogenesis of the iliac vein compression syndrome is followed by a description of a little-known form, called Cockett's syndrome, due to compression of the left iliac vein by the right common iliac artery. This syndrome should be looked for with care. If diagnosed in the "functional" stage, it can be ameliorated by means of a special surgical treatment known as "venous stocking plasty".

Three personal cases of adenolymphoma of the parotid are described and attention is drawn to the rarity and benign nature of this form. Its anatomical and pathological features are discussed, along with the various theories concerning its histogenesis. Of these, the salivary theory is the most widely accepted. Lastly, an account is given of the symptoms (primarily consisting of cosmetic damage), differential diagnosis, and treatment (simple enucleation). The long-term prognosis is always good. Recurrences (also benign) are very rare.

A comparison was made between 73 patients with colon-rectum neoplasia operated urgently due to occlusion and 85 electively operated in the absence of mechanical ileus. Six parameters were examined: 1) Duration of preoperative symptomatology; 2) Seriousness of preoperative symptomatology; 3) Extention of neoplasia at surgery; 4) Type of operation; 5) Postoperative mortality; 6) Long-term survival. It was found that obstruction often occurs within 5 months after the onset of symptoms and in cases where the tumour is still local (55%). It is attended by higher postoperative mortality (22%) and shorter survival (18 as opposed to 23 months).

Transient hypomagnesiaemia was noted postoperatively, particularly on the 1st day in patients submitted to intestinal procedures. Slight hypocalcaemia was also observed; this was often related to a low plasma Mg value. A hormonal mechanism is presumed to be the cause of this stress-linked fall in blood magnesium.

The Authors show their method to set up and to plan a T.P.N. for surgical patients. They emphasize how the introduction of the computer in the intensive therapy practice, not only helps the work of the medical corps and the hospital attendants, but it marks and plans again every day the components' dosages on the blood-metabolical alterations, daily checked on the patients. They are here showing their experiences since 1977, appraising in a critical way the directions and the results.

The results obtained in a series of 75 patients suffering from advanced cancer of the colon-rectum are examined. Survival of these patients is looked at as a function of the extent of surgical demolition, and as a function of postoperative chemotherapy. Demolition interventions were followed by much higher survival than was observed following palliative operations. At the same time, survival was higher in patients who underwent post-operative chemotherapy. The results therefore justify a more aggressive approach in advanced cancer of the colon-rectum.

Alkylating drugs, alkylating drugs + antimetabolites, and alkylating drugs + antimetabolites + Vinblastine were used to treat 62 patients. The results were assessed in terms of Karnofsky's classes and related to the following parameters: age, free interval, menopausal status, results of prior endocrine management, site of dominant metastases, length of survival. 44 failures (71%) and 18 objective responses (29%) were noted. A mean survival of 17.3 months was noted for the entire series. Subjects who failed to respond survived an average of 14 months, as opposed to 25.5 months for the responders. This difference was just significant. No relation could be shown between the results and the other parameters, whereas that between the results and the length of survival was highly significant. It is clear that the variables considered cannot be relied upon in predicting the outcome of chemotherapeutical management. If the latter is effective, however, survival will almost certainly be prolonged.

The results obtained in 26 patients suffering from metastatic cancer of the breast no longer sensitive to hormone treatment are reported. The patients were treated with ciclophosphamide (CTX) (500 mg i.v.) once a week and triethylenethiophosphamide (20-30 mg i.m.) (TSPA) every 4 weeks associated with cyclophosphamide as follows: CTX--CTX--CTX--CTX+TSPA. 9 objective regressions (34.6%) were observed. Those with objective regression lived 28 months on average (SD 23.45) and those without lived on average 11.41 months (SD 9.89). The difference is statistically significant. Side effects of various types were observed in 7 patients (27%).