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In human one-way mixed lymphocyte reactions we have observed an increase in the percentage of sIgD bearing lymphocytes, detected by direct membrane immunofluorescent staining. This increase does not seem to be attributable either to the synthesis of sIgD receptor molecules by previously negative T or null cells or to a non specific stimulation of B cells by a factor released in the course of the MLR.

Twenty-one cases of gastro-enteric complications during aorto-iliac-femoral reconstructive surgery carried out from 1965 to 1973 in the Department of Surgery of University in Milan are studied. Causes, frequence, clinical data and medical and surgical procedures are discussed.

First, lymphocyte transplantation into total body-irradiated rats is discussed. The effect on spleen colony formation caused by the transplantation of untreated lymphocytes, as well as of lymphocytes previously incubated with PHA, or with PHA plus L-asparaginase, or with lymphokines, was studied. Then the effect of the urinary colony-stimulating factor in vitro, and the in vitro feeder-layer activity of leucocytes on colony formation of human and mice bone marrow cells in haematological diseases is dealth with. The injection of rat lymphocytes previously incubated for 24 hours with PHA resulted in a higher number and a larger size of colonies in the spleen of the recipient rats. Lymphocytes preincubated with lymphokines gave rise to the formation of spleen colonies which were larger than those developing after the injection of untreated lymphocytes. When the lymphocytes were previously incubated with PHA plus L-asparaginase, PHA failed to stimulate colony formation in the spleen. The phenomenon is explained by assuming that PHA, as an aspecific stimulator of cell division, initiated the division of CFUs, thus the CFUs content of the preincubated samples increased, resulting in an increase in the number of colonies formed after the transplantation of lymphocytes pretreated with PHA. Another possible explanation is that CFUs division, or their spleen take is enhanced by the immunocompetent lymphocytes activated by PHA, either directly or via soluble mediators produced or released by immunocompetent lymphocytes such as lymphokines. The study of colony-forming cells and colony-stimulating activity in primary myelofibrosis (PM) showed an increase in the number of circulating CFUc in this condition, and an abnormal density of these cells reaching a peak below 1.062. The lowering of CSA in the first two peripheral blood gradient fractions agrees with the observation in the same fractions of a high percentage of CFUc at the expense of the CSC population. Thus, double cell population seems to exist in PM. One is greatly abnormal with a low specific density and high plating efficiency, whereas the other population is almost normal, showing a higher specific density and a lower plating efficiency.

The detection of renal artery aneurysms has greatly increased in the last years with the use of angiographic procedures and nowadays thanks to digital subtraction angiography routinely adopted in the diagnostic evaluation of patients affected by lesions at the renal artery level. This study reports the data of 31 renal artery aneurysms observed in 30 patients admitted to our Institute from 1970 to 1986. All the aneurysms were demonstrated by means of selective renal angiographies. Twenty-two patients out of 30 presented hypertension. In order to establish the possible role of the aneurysm in the genesis of hypertension, in all these cases the PRA was determined. In 27 patients a surgical procedure was adopted. This paper reviews our series of patients, analyzing the diagnostic procedures, the symptomatology presented with particular regard to the presence and the type of the associated hypertensive condition, the adopted therapeutic procedures and the results.

832 patients with abdominal aortic aneurysm were admitted to our Hospital, at the University of Milan, from 1965 to 1983. 238 patients were operated on as an emergency for rupture of the aneurysm while 541 underwent elective surgery. The overall postoperative mortality was 7% for the patients operated on electively and 54.3% for the ruptured aneurysm operated on as an emergency.

We have studied the effects of the immunosuppressive agent Cyclosporin A (CsA) on the allogenic stimulation of human lymphocytes from 10 patients with progressive systemic sclerosis (PSS) and 10 healthy controls, when activated in vitro during 1ry and 2ry MLR. CsA markedly suppressed 1ry MLR in both PSS subjects and controls. In contrast to the marked suppression of 2ry MLR observed for most of the PSS subjects and all control subjects, lymphocytes from 3 out of 10 PSS patients had paradoxically amplified allogenic responses when primed in the presence of CsA. The possibility is discussed that in these patients the recruitment of suppressor-effector cells by CsA-resistant suppressor-inducer lymphocytes is impaired.

The Authors analyse 121 cases of patients affected by abdominal malignant tumors, who underwent a palliative operation. Although the number of the examinated cases is small, it appears clear that the longest survival requires, when possible, the removal of most of the malignant tissue. This seems to be in accordance with the results reported by the literature.

In this study we investigated whether the interindividual variability of lymphocyte sensitivity to cyclosporin A (CsA) could be controlled by the HLA region. The models used were the in vitro primary and secondary autologous (AMLR) and allogeneic mixed lymphocyte (MLR) cultures of cells from 32 healthy subjects from our HLA reference panel. Our results show that CsA inhibited primary allogeneic MLR to a much greater extent than primary AMLR (-81 +/- 2% vs -38 +/- 8%, P less than 0.001). The same pattern was observed when cells harvested from CsA-treated primary cultures were rechallenged in secondary cultures with the original sensitizing stimulator cells (-40 +/- 6% vs -17 +/- 9%, P less than 0.05). No differences were observed in primary autologous and allogeneic cultures among responders of different HLA phenotypes. In contrast, the secondary responses did vary according to the HLA types: in secondary AMLR, CsA-priming did not lower, or even enhance, the proliferative responses of DR5+ and/or DR2+ lymphocytes (+7 +/- 13%), whereas it significantly lowered the responses of DR2-5- cells (-46 +/- 8%). In secondary MLR, lymphocytes proliferation was lowered by CsA-priming in all but DRW11(5)+ subjects (-45 +/- 7% vs +2 +/- 23%, P less than 0.05). It is concluded that the individual HLA phenotype influences the pattern of lymphocyte sensitivity to CsA.

A case of arterial hypertension due to suprarenal medulla hyperplasia is reported. Having accepted the existence of this form, the problem of its recognition is stressed, in the presence of catecholamine pathology, even though the type or site of its anatomo-pathological substrate cannot be identified, explorative surgery and possible removal of the suprarenal glands can be indicated.

The authors compare the figures for a sequence of lumbar ganglionectomy operations in 2 different time spans. They point to a reduction in lumbar ganglionectomy indications as related to the spreading of arterial reconstructive surgery. The follow-up review of the results has shown that th percent worsening rate in the second time span should be ascribed to a change in the kind of cases rather than to a modification in the nature of indications. The authors conclude by describing the role of lumbar ganglionectomy as fundamental in dysfunctional, inflammatory and peripheral degenerative forms, and supporting in reconstructive surgery operations on mixed atherosclerotic forms.