Possible role of granulocyte-macrophage colony stimulating factor (GM-CSF) on the rapid progression of AIDS-related Kaposi's sarcoma lesions in vivo

Drug-related neutropenia is a common observation in AIDS patients. Haematological growth factors are therefore increasingly used in combination with myelotoxic agents to reduce the risk of infection and to improve the haematological tolerance of these regimens. We report a case of an AIDS patient with Kaposi's sarcoma who received GM-CSF for severe neutropenia due to anti-tumour chemotherapy combining alpha-interferon 2b and zidovudine. During GM-CSF administration there was a marked increase in the size of the Kaposi's sarcoma lesions as confirmed by ultrasonographic examination. As GM-CSF in vitro has been shown to promote Kaposi's sarcoma-like cell cultures, we discuss the potential role of this growth factor in increasing Kaposi's sarcoma lesions in vivo.

Transitory expansion of a CD3+TcR gamma/delta+CD16+ lymphocytic population in two patients with advanced human immunodeficiency virus infection and high levels of natural killer activity

In the present study, we describe an expansion of CD16+ cells with a CD3+ TcR gamma/delta+ phenotype, in the presence of normal numbers of "classic" CD3-CD16+ natural killer (NK) cells, in two patients with human immunodeficiency virus (HIV) infection in late stage. The NK activity of the two subjects was substantially higher then that of HIV+ subjects in the same stage of infection. A second evaluation of one of the patients showed levels of NK activity consistent with the clinical stage of HIV infection, concomitant with a remarkable reduction in the percentage of double-positive CD3/TcR gamma/delta cells. The number of CD16+ cells also reached values comparable to those of the control group. In conclusion, we have identified a population of CD3+TcR gamma/delta+CD16+ cells that have the capability to lyse an NK-sensitive target in two patients with unusually high levels of NK activity.

[Extended and palliative surgery in the treatment of gastric cancer in advanced stage]

Five hundred and fifty patients operated between 1965 and 1983 for stomach carcinoma were included in the study. Of these, 244 (44.4%) underwent extended (54 patients) or palliative surgery (190 patients) due to the extragastric diffusion of the neoplasia. Global postoperative mortality for patients undergoing extended surgery was 16.7% and the five-year survival rate was 18.5%; in the case of those undergoing palliative surgery the postoperative mortality rate was 30.5% and the two-year survival rate was 14% for resection and 4% for derivatives. Patients who underwent a derivative operation showed an easing of symptoms and an improved quality of life. On the basis of these results the Authors consider that the possibility of extended surgery should still be carefully evaluated in patients in whom a stomach tumour has exceeded the gastric boundary, irrespective of its extent, since the limit of radical surgery is not related to the extension of surgical demolition but to the entity of the extragastric diffusion of the neoplasia. In addition, surgical abstention is not always justified even in patients in whom surgery cannot be curative since a 10% five-year survival rate was observed in patients undergoing palliative resection.

Postpartum coronary artery dissection followed by heart transplantation

A rare case of coronary artery dissection was observed in a 33-year-old woman on the fourth postpartum day. The ischemic syndrome was followed by aneurysmal dilatation of the left ventricle and progressive heart failure that necessitated cardiac transplantation. The patient is alive and well 3 years after the transplantation.

[Neurotoxicity of intra-arterial cis-platinum (CDDP) in the locoregional treatment of diffuse liver metastasis of carcinoma of the colon and rectum]

Peripheral neurotoxicity of i.v. cisplatin (CDDP) at high cumulative dosage is well documented. On the contrary neurotoxicity of CDDP following intra-arterial administration is less known. Five patients with liver metastasis from colorectal carcinoma have been treated with intraarterial CDDP and i.v. 5-fluorouracil according to a trial of the National Registry on Implantable Devices (RNSI); in these patients a severe peripheral neurotoxicity has been observed since the fourth cycle of chemotherapy. In the present paper we report the electroneurographic changes observed immediately after chemotherapy and several months later. Clinical characteristics of neuropathy following i.a. CDDP are the following: preferentially localized at the distal extremities of the limbs, exclusively sensitive, not reversible.

[Pseudoaneurysm of the right iliac artery with fistula into the cecum. A clinical case]

A case is reported of pseudoaneurysm of the right iliac artery secondary to an endarterectomy with dacron patch due to atherosclerosis performed 4 years ago. The case presented acute anemia and massive enteric hemorrhage subsequent to arterial rupture into the cecum. Because of the dramatic onset, the patient was immediately operated. The surgical procedure used was total pseudoaneurysm excision, "in situ" by-pass with dacron prosthesis and suture of the cecum. The problems of pathophysiology, diagnosis, symptoms and management are discussed and compared to previously published cases. The peculiarity of the described case is underlined.

[Red lesions of the oral mucosa as early manifestations of squamous cell carcinoma]

Red lesions of oral mucous membranes may have various aetiology, but we must never forget, that among them, there is also the so-called erythroplachia, the oral variation of the better known and mainly genital form of Queyrat, which is one of the most typical examples of cancer in situ (c.i.s.).

[Skin suture with skin stapler in general surgery]

The immediate and long term results of skin sutures using a skin stapler and silk stitches were compared. The series examined included 394 patients, on 193 of whom the stapler and APPOSE ULC metal stapler was used, the remaining 201 being given silk stitches using an atraumatic needle. The skin stapler produced less inflammation and a better aesthetic result over time than the silk stitches. In addition, given the same skin incision length the stapler was 4-7 times faster than stitching. It is concluded that such staplers offer substantial advantages over silk stitches and the hope is expressed that their wider use will help to reduce their cost.

Effects of nesosteine on Herxheimer microshock in guinea-pigs

In this paper we firstly report the inhibitory effect of nesosteine, a mucolytic drug, on Herxheimer microshock in guinea-pigs. Nesosteine (5-50 mg/kg) is able to protect sensitized animals from ovalbumin-induced bronchospasm. On the other hand, the drug is ineffective against the bronchospasm induced by histamine and acetylcholine. These results have also been confirmed in in vitro experiments where it has been demonstrated that nesosteine (10(-5) M) inhibits ovalbumin-induced histamine release in the trachea of sensitized animals. In the same preparation, the drug is ineffective against the contractions induced by histamine or acetylcholine. In conclusion, the drug presented here may be helpful in pathological conditions where reductions both of mucolysis and bronchospasm are sought.

[Double-contrast with insufflated barium-meal technic in the routine radiological study of the esophagus]

The results are reported of the esophagus double contrast examination with "Insufflated Barium Meal" technique as first part of the routine upper digestive system radiological examination. This technique gives good double contrast without those artifacts using effervescent powders and without modifying the normal radiological alimentary tract examination established way. The double contrast is administered by a special container with a built-in mouthpiece which allows the simultaneous ingestion of barium suspension and air. The esophageal mucosa can be examined as far as the distal tract where frequently the barium contrast stops using different techniques. Good results in 90% of patients have been obtained. The early detection of inflammatory and tumoral lesions has taken particular advantage in patients sometimes asymptomatic.

[Reactive lymphoreticular hyperplasia or pseudolymphoma of the stomach]

Three cases of reactive lymphoreticular hyperplasia of the stomach (pseudolymphoma) are reported. The histogenesis and the radio-endoscopic aspects are illustrated and the differential diagnosis with the malignant lymphoma and the early cancer is discussed. In each case the radiological examination has shown a granular aspect in the mucosal circonferential area (moth eaten sign) with erosions and multiple ulcers (in two cases).

[Degree of parietal penetration of gastric cancer in relation to medium- and long-term survival]

The Authors analysed their experience about gastric carcinoma, with particular reference to short, middle and long time survival in relation to the degree of parietal penetration. In the patients without remote metastases, the survival till 5 years depends mainly on this factor, whereas the lymphonodal spreading plays a secundary rôle, especially in the cases where the tumour deeply infiltrated the gastric wall. Lymphoadenectomy, therefore, seems essential in cases of neoplasm with low degree of parietal penetration, whereas in those with high degree it does not seem determinant on the remote results.