Locoregional IL-2 therapy in the treatment of colon cancer. Cell-induced lesions of a murine model.

BACKGROUND: Local therapy with IL-2 may be very effective in the treatment of different forms of cancer. The aim of this study was to determine the effectiveness of IL-2 locoregional application in the treatment of colon cancer. MATERIALS AND METHODS: Twenty eight syngenic BDIX rats were utilized in this study. The rats were divided into two groups of fourteen animals: group T (treatment) and group C (control). All rats of both groups were injected, under the splenic capsule, with T 10(7) DHD/K2/ TRb neoplastic cells. Then, within and around the site of the previous inoculation, the T group was injected with 1 ml of glucosate solutions + 0.1% albumin (BSA) containing 2.5 x 10(6) IU of IL-2 ( Proleukin-Chiron), whereas the C group was injected with 1 ml of BSA alone. After three weeks, rats were sacrificed and the liver and spleen were removed. The following parameters were considered: volume and weight, neoplastic-non neoplastic tissue index of the spleen, mitotic index and vascular density of splenic and hepatic lesions. RESULTS: All the studied parameters showed statistically significant differences in treated and untreated animals. CONCLUSION: This study of a murine model demonstrated that IL-2 locoregional therapy may be effective in the treatment of colon cancer.

Clinical and biological features of an intranodal palisaded myofibroblastoma.

Intranodal palisaded myofibroblastoma (IPM) is a rare benign tumor of the lymph nodes probably arising from smooth muscle-like cells. The tumor is characterized by intranodal proliferation of spindle cells. Neoplastic spindle-cell proliferation is most often of metastatic repetition which is very important in the recognition of IPM, because it may be mistaken for metastasis or other tumors such as Kaposi's sarcoma. We report a novel case of IPM that confirms the myofibroblastic differentiation of the tumor. The onset of IPM has been associated with Epstein-Barr virus (EBV). In addition, recently reported cases of IPM have been seen with cyclin 1 overexpression and also with human herpes virus (HHV)-8 and EBV DNA sequences. In our case, there was no evidence of HHV-8 and EBV DNA sequences and we were not able to find cyclin 1 overexpression.

[The Bochdalek hernia in the adult: case report and review of the literature]. / L'ernia di Bochdalek nell'adulto: caso clinico e revisione della letteratura.

The Bochdalek hernia, the most common diaphragmatic hernia, except the hiatus hernia, is located on the posterolateral side of this muscle. This pathology is generally diagnosed in children; in fact only 105 such cases occurring in adults have been described in the literature. In these cases, surgical intervention is made necessary by the severity of potential complications. The Author's attention was drawn to a woman of 60 years of age, affected by pituitary nanism, who suffered from a left hand Bochdalek hernia. The symptomatology, characterised by abdominal pains and constipation had been presented for about one year. The computerised tomography confirmed the hernia of abdominal viscera in the thorax cavity. The intervention was conduced via the abdomen: the hernia were reduced, the hernial hole were closed with a double strata and the muscular plane reinforced with a synthetic prosthesis (dual mesh). The postoperative process was regular and the patient dismissed on 11th postoperative day.

[Benign cicatricial stenosis of colorectal anastomosis: considerations on 2 cases]. / La stenosi cicatriziale benigna dell'anastomosi colorettale: considerazioni su due casi di nostra osservazione.

During the surgical treatment of two patients with benign anastomotic colorectal stenosis, the Authors registered the presence of concomitant tenacious adherence of the anastomotic line to the sacral bone. Such event, according to the Authors, could represent one of the causes of failure and greater risk of perforation during the treatment with the different endoscopic therapies that, nevertheless, ought to be considered the gold standard in the therapy of benign structures. The Authors developed their hypothesis physiopathologic on the basis of personal experience and of the search a diagnostic procedure able to highlight the presence of a tenacious adherence with solid structures during the operative evaluation. If further studies focused on this subject will bring to satisfactory results, this would represent a further aid for the evaluation of the best therapeutic approach of the benign post anastomotic stenosis.

Has desmoplastic response extent protective action against tumor aggressiveness in gastric carcinoma?

A clinical assessment of protective action of desmoplastic response by limiting tumor aggressiveness has been carried out in 171 patients with gastric carcinoma, surgically treated at the First Surgical Clinic of the University of Rome "La Sapienza" between 1988-1999. A univariate statistical analysis was performed using Kaplan-Meier method for: desmoplastic reaction, age, sex, histologic type, tumor size, stage, lymphonodal status and metastases. To determine the influence of these factors on prognosis, the Cox regression was applied. We found a significant association between desmoplastic reaction extent and presence or absence of metastases (p= 0.026), lymphonodal involvement (p = 0.05), stage (p = 0.036). In the univariate analysis, survival was significantly related to sex (p = 0.012), tumor size (p = 0.009), lymphonodal involvement (p = 0.000), metastases (p = 0.000), stage (p = 0.000), desmoplastic reaction extent (p = 0.05); age and histologic type showed no relationship (p = n.s.). The desmoplastic response extent is not a protective factor against tumor invasiveness in gastric carcinoma, on the contrary it may be considered a negative prognostic factor.

[Prognostic criteria in ruptured aneurysm of the abdominal aorta]. / Criteri prognostici associati negli aneurismi dell'aorta addominale rotti.

A logistic regression analysis of risk factors affecting the mortality on 69 cases of ruptured abdominal aortic aneurysm (RAAA), treated between 1988-1996, has been carried out. Mortality was 33.3%. No single risk factor significantly influenced mortality except the shock (p = 0.0016). The presence of two o less risk factors in the same patient was associated with 24% mortality, whereas three o more risk factors were associated with 92.4% mortality.

[Surgery associated with intraoperative hyperthermia-chemotherapy in the treatment of malignant tumors of the digestive system with peritoneal carcinosis]. / Chirurgia associata ad ipertermochemioterapia intraoperatoria nel trattamento dei tumori maligni dell'apparato digerente con carcinosi peritoneale.

In the last two years the authors have treated 4 patients affected with malignant tumors of large bowel with very poor prognosis. In every cases they found large spreading to peritoneal cavity. These patients underwent to intraperitoneal hyperthermia-chemotherapy using a special device conceived by authors. This treatment produced promising results as related to life quality in these cases.

Postoperative combined radiohyperthermia in Astler-Coller stages B2 and C distal rectal cancer.

Pelvic perineal recurrence rate is the major therapeutic problem after curative surgery of extraperithoneal rectal cancer, after lower anterior resection as well as abdomino-perineal resection: local failure rate is high, particularly for stages B2-C. Radiotherapy alone or in combination with chemotherapy proved to be an useful adjunct to surgery. Postoperative radiotherapy, with 40 to 50 Gy doses, has shown local improvement, but causing intestinal damaging. There is now evidence that hyperthermia enthances radiation effects, by killing radioresistant acid tumor cells. In order to give high postoperative radiation doses, without intestinal damage, and to kill acid tumor cells by hyperthermia, we developed a device, able both to displace intestinal loops and to produce combined hyperthermia. From 1993 to 1995, four patients with Astler-Coller stages B2 (2 patients), C1 (1 patient) and C2 (1 patient) distal cancer, were operated by Hartmann's procedure and treated with postoperative radio-hyperthermia with our device. Overall radiation dose delivered in the pelvic area was of 65 Gy, associated with three heating sessions at 43 degrees C for 30 minutes. Pelvic infection occurred in one patient; all pelvic byopsies were negative and no bowel damage was found. Three patients underwent recanalization, one had anasthomotic leackage. The C1 and C2 stage patients died from hepatic metastasis, 18 and 11 months after recanalization; one B2 stage patient is still under treatment and the other is alive and disease free 13 months after recanalization. Our technique allows to give high postoperative radiation doses, without small intestine damage, and to give a good hyperthermia for better control of local failure.

[Surgical strategy in gastric cancer in aged patients]. / Strategia chirurgica del cancro gastrico nel paziente anziano.

The trend of the National mortality rate for gastric cancer in the general population and in the old people between 1955 and 1990 was studied. A decreased incidence of mortality in the general population whereas an increased mortality rate in elderly was found. Between 1990 and 1994, 17 patients over 70 years of age were operated on for gastric cancer. The influence of the ASA classification on postoperative complications was then evaluated registering a significant statistical difference between patients included in ASA III group and or > and major complications and mortality (P = 0.044). The surgical strategy in the management of elderly patients with gastric cancer is also discussed.

[A modified Thal cardioplasty in the management of advanced esophageal achalasia]. / Modifica dell'intervento di cardioplastica secondo Thal nel trattamento dell'acalasia esofagea avanzata.

A modified esophagocardioplasty with gastric patch in the treatment of advanced achalasia is presented. The technique was employed in 4 patients from 1977 through 1993 and satisfactory results were obtained in follow up studies up to 16 years. This procedure provides better passage through the esophagogastric junction with preservation of the antireflux mechanism.

[Use of pulsed expansion in lengthening of tubed cutaneous flaps. Experimental study]. / Sull'impiego dell'espansione pulsata per l'allungamento di lembi cutanei tubulati. Ricerca sperimentale.

The Authors describe an intermittent pulsed pressure methodic applied to bipedicle tubed flaps prepared on the back of the rabbit. Clinical, thermographic, and histological data have demonstrated the safety of the flaps and a microvascular bed increase larger than in inexpanded ones.

[Anatomo-surgical study on a new technique of nephropexy]. / Studio anatomo-chirurgico su di una nuova tecnica di nefropessi.

The Authors carried an autoptic study on ten cadavers in order to clarify and if necessary modify some aspects of the nephropexy technique which was modified and improved by them. Two main conclusions are reported. First, the approach is better obtained by a prolonged incision to the twelfth rib. Second, possible damage to the diaphragm and to the lung are avoided with this technique. Furthermore, the study provides information about the preparation and suture of the capsule.

[Diverticula of the cecum. Our experience]. / I diverticoli del cieco. La nostra esperienza.

On the basis of their experience in right colonic emergencies, the Authors report two cases of diverticular disease presenting with acute abdomen. Pointing out the difficulty of a correct pre- and intraoperative diagnosis, different surgical procedures are analysed.

[Peritoneal oxygenation-dialysis as a temporary treatment of intestinal infarction]. / L'ossigenazione-dialisi per via peritoneale come trattamento provvisorio dell'infarto dell'intestino.

The interval preceding the growth of irreversible lesions in an abdominal apoplexy is variable (3-48 hours). It may be used to improve the ischaemic viscus oxygenation, also compensating possible metabolic imbalances. 16 rabbits were used for research, in which apoplexy by the ligature of the arteria mesenterica superior was induced. Dialysis-oxygenation peritoneal treatment was carried out for 8 rabbits, the results of which were evaluated on the basis of the intestine macroscopic morphologic aspect; on the basis of the hematic phosphates values and in enteral biopsy. The oxygenation-dialysis produced a rapid improvement in enteral hue and in enteral motility, an important increase of PO2 and a reduction of hematic phosphates compared with the control group. Histologic examination did not show any significant variation. The attempt to increase general oxygenation by supplying PO2 via the peritoneum, was partly successful (10-15%). The aim of oxygenation the ischaemic enteral zone was successful. This due to elimination of CO2 and toxic products using dialysis. This simple method seems to be effective but further tests on swine would be necessary for clinical applications.

[Colostomy control using an original occluding device. A clinico-experimental study]. / Il controllo delle colostomie mediante occlosure originale. Studio clinico-sperimentale.

After having examined different methods as to continence colostomy, the authors introduce their own control system for the stoma. The study was carried out on 6 colostomized patients. Preliminary, the intraluminal pressure in closed colostomy was recorded. Pressure waves, largely varying from patient to patient, were obtained as to frequency of waves and pressure values. The same variations were observed during meals waking and sleeping. Sometimes the patients suffered from serious disorder, but in most cases they did not feel pain. A catheter, provided with an inflatable balloon for closing the stoma, formed the system tested. It was also provided with a second intraluminal low-pressure inflated balloon, connected with an external compensating chamber. As a result of the system the pressure dropped down to about 1/6 compared with the reference values observed under the same conditions. In addition, the continence was complete and the patient did not suffer from any disorder in non-stop recordings up to 24 hours. We believe that the system may be useful for colostomized patients if carefully carried out.

[Supplemental proposal in the surgical treatment of liver injury. Experimental studies]. / Proposta complementare nel trattamento chirurgico della trancia epatica. Ricerche sperimentali.

Liver resections pose a great variety of problems, not least repair of the cut. The various reconstruction modalities are reviewed and personal experience in twenty rats submitted to surgical removal of the median lobe of the liver with cover of the sectioned surface by means of omental mesh autograft is reported. The results were flattering for the absence of significant complications and for the haematological and haematochemical data obtained which confirm low easily the graft takes, its regenerative potential and the modulator action of peritoneal repair processes.