Emergency laparoscopic treatment of acute incarcerated incisional hernia.

BACKGROUND: The emergency treatment of incisional hernias can be accomplished by a laparoscopic approach in order to avoid the common complications following open techniques. METHODS: From January 2001 to September 2007, we performed 48 emergency laparoscopic treatments of incarcerated hernias. RESULTS: In our hospital, 320 patients with incisional hernia and 65 patients with primary abdominal wall hernia were treated laparoscopically. Forty-eight patients (30 females and 18 males) underwent emergency surgery. The mean operative time was 62 min (range 45­80 min). The average length of hospital stay was 4 days (range 3­6 days). We had eight post-surgical seromas, all of which were treated successfully by needle aspiration. We saw no mesh sepsis and no metabolic or surgical complications. We had no recurrence nor the need for a second operation. Mortality was nil. CONCLUSIONS: The results of this series prove the feasibility of emergency laparoscopic surgery in incarcerated incisional hernias using new-generation meshes.

Use of fibrin glue (Tissucol) as a hemostatic in laparoscopic conservative treatment of spleen trauma.

BACKGROUND: This study aimed to evaluate the effect of fibrin glue in laparoscopic spleen-preserving procedures for traumatic rupture. METHODS: From January 2002 to December 2005, six laparoscopic spleen-preserving procedures were performed for traumatic rupture using fibrin glue. Two of the cases had previous middle and lower abdominal surgery. Survey of the abdominal cavity was performed by inserting two 5- to 12-mm trocars, one 5-mm trocar, and a 30 degree scope. A complete survey of all the patients was performed. RESULTS: None of the patients required laparotomy, and no postoperative bleeding occurred. The fibrin sealant achieved immediate hemostasis, and all the patients recovered without further splenic bleeding. The mean postoperative stay was 4.3 days (range, 4-5 days). All the patients were followed up for 3 to 12 months. Postoperative immunoglobulin scanning, ultrasonography, and computed tomography (CT) results were normal. CONCLUSIONS: Laparoscopic management of spleen trauma can be used once a positive diagnosis has been made. It is useful for assessing the degree of splenic injury. A laparoscopic spleen-preserving procedure can be used safely for patients with stable vital data. It is an effective procedure for the evaluation and treatment of hemodynamically stable patients with splenic injuries for whom nonoperative treatment is controversial. The topical application of a fibrin sealant in splenic trauma achieves definitive hemostasis safely, rapidly, and reliably. It also is simple to use in either laparoscopic or open procedures.

Laparoscopic versus open incisional hernia repair: an open randomized controlled study.

BACKGROUND: Incisional hernia is a common complication of abdominal surgery, and it is often a source of morbidity and high costs for health care. This is a case-control study to compare laparoscopic versus anterior-open incisional hernia repair. METHODS: 170 patients with incisional hernia were enrolled in this study between September 2001 and December 2004. Of these, 85 underwent anterior-open repair (open group: OG), and 85 underwent laparoscopic repair (laparoscopic group: LG). The clinical outcome was determined by a median follow-up of 24.0 months for LG and OG. RESULTS: No difference was noticed between the two groups in age, American Society of Anesthesiologists (ASA) score, body mass index (BMI), and incisional hernia diameter. Mean operative time was 61.0 min for LG patients and 150.9 min for OG patients (p < .05). Mean hospitalization was 2.7 days for LG patients and 9.9 days for OG patients (p < .05). Mean return to work was 13 days (range, 6-15 days) in LG patients and 25 days (range, 16-30 days) in OG patients. Complications occurred in 16.4 % of LG patients and 29.4 % of OG patients, with a relapse rate of 2.3% in LG and 1.1% in OG patients. CONCLUSIONS: Short-term results indicate that laparoscopic incisional hernia repair is associated with a shorter operative time and hospitalization, a faster return to work, and a lower incidence of wound infections and major complications compared to the anterior-open procedure. Further studies and longer follow-up are required to confirm these findings.

Use of fibrin glue (Tissucol) in laparoscopic repair of abdominal wall defects: preliminary experience.

INTRODUCTION: The aim of this study was to establish the efficacy and tolerability of human fibrin glue (Tissucol) for the nontraumatic fixation of a composite prosthesis (Parietex) in the laparoscopic repair of small to medium-sized incisional hernias and primary defects of the abdominal wall. MATERIALS AND METHODS: From October 2003 to October 2005, 40 patients underwent laparoscopic repair at the hands of one surgeon with expertise in laparoscopic surgery; all meshes were implanted in an intraperitoneal position. Follow-up visits were scheduled for 7 days and 1, 6, and 12 months. These included assessments for pain and postoperative complications. RESULTS: Forty patients (24 females, 16 males) with a mean age of 50 years (range, 26-65 years) and a mean Body Mass Index (BMI) of 27 (range 25 to 30) were included in the study. Sixteen patients had incisional hernias, and 24 had primary defects. The size of the defects varied from 2 to 7 cm. Adhesiolysis was necessary in 92.5% of cases (25/40). There were no intraoperative complications or conversions. After a mean follow-up of 16 months (range, 3-24 months), no postoperative complications were observed. The mean surgical intervention time was 36 min (range, 12-40 min), with an average hospitalization time of 1 day. CONCLUSIONS: The use of fibrin glue in the present study provided stable and uniform fixation of the prosthesis and minimized intraoperative and postoperative complications. Consequently, laparoscopic treatment of small to medium-sized abdominal defects using this approach is our therapeutic option of choice.

Fibrin glue for mesh fixation in laparoscopic transabdominal preperitoneal (TAPP) hernia repair: indications, technique, and outcomes.

BACKGROUND: The efficacy and safety of prosthesis fixation were studied by means of fibrin glue (Tissucol, Baxter Healthcare) during laparoscopic transabdominal preperitoneal (TAPP) treatment of inguinal and femoral hernias. METHODS: Between September 2001 and December 2004, fibrin glue was used for mesh fixation during TAPP. RESULTS: In this study, 320 hernias were treated for 230 patients (225 men and 5 women) with an average age of 45 years (range, 20-75 years). No perioperative complications were observed. After an average follow-up period of 26 months (range, 1-40 months), the only postoperative complications observed were six seromas (1.8%) and one trocar-site hematoma (0.3%). The mean operating time was 30 min for unilateral hernias and 50 min for bilateral hernias, whether primary or recurrent. Patients usually were discharged the day after surgery and returned to work after 5 days. CONCLUSIONS: The authors' experience demonstrates that fibrin glue (Tissucol) is an effective method for mesh fixation during TAPP.

Prospective clinical study of laparoscopic treatment of incisional and ventral hernia using a composite mesh: indications, complications and results.

The aim of this study is to establish the indications, safety, efficacy, feasibility and reproducibility of the laparoscopic technique in treating defects in the abdominal wall, including those of large dimensions, to standardise the surgical technique and to confirm the performance of the composite prosthesis used (Parietex, Sofradim). The study encompassed the period from January 2001 to December 2004 and included 178 nonselected patients (108 women and 70 men), with an average age of 56 years (range: 26-77 years) and an average body mass index (BMI) of 30 (range: 26-40). These patients were treated for either abdominal hernia (156 patients; 89.7%) or a primary defect (22 patients; 10.3%). The dimensions of the abdominal hernias treated varied from 4 to 26 cm (average: 12.1 cm). All patients were treated using the laparoscopic technique, and all meshes were placed in the intraperitoneal position. Eleven (7%) postoperative complications arose after an average follow-up period of 29 months (range: 1-48 months): seven seromas (4.4%) lasting for 4 weeks, with one becoming infected after being punctured repeatedly; we removed the infected prosthesis by laparoscopy; three (1.9%) patients with persistent neuralgia, which were resolved after 2 months with a prescription for FANS; one patient with a haematoma at the trocar site. There were also four recurrences (2.5%), all of which occurred between 1 and 3 months postsurgery: one in the 'small' group of abdominal hernias (less than 9 cm) and three in the 'large' group of abdominal hernias. With the exclusion of any primary defects, an adhesiolysis was carried out in 99.3% of the patients. In seven cases (4.4%) we carried out a raphe for speritonealisations of loops in the small intestine; in four patients (2.5%), following tenacious adhesion (one patient) and loops fixed to the previous scar by stitches (three patients), we carried out an intestinal perforation (ileus) which was sutured by laparoscopy. The average operating time was 65.6 min (range: 28-130 min), with an average postoperative period in the hospital of 2.1 days (range: 1-5 days). No conversion was observed, and mortality was zero. The results obtained during the clinical trial demonstrate the safety and efficacy of the laparoscopic technique and of the mesh used as well as the reproducibility of the technique in the intraperitoneal treatment of congenital and postincision defects in the abdominal wall, including those of large dimensions.

[Laparoscopic transabdominal preperitoneal repair of inguinal hernia: indications, technique, complications and results in 10 years experience]. / Ernioplastica inguinale transaddominale preperitoneale laparoscopica. Indicazioni, tecnica, complicanze dopo 10 anni di esperienza.

AIM: Inguinal hernia play a major role in a general surgical division. In the last 10 years laparoscopy has gained a key role even in the treatment of this disease. This study aims to review a single institution's experience with laparoscopic transabdominal preperitoneal repair of inguinal hernia (TAPP). METHODS: A retrospective study of 715 operations in 500 patients from 1992 to September 2002. Two hundred and eight six (56.6%) of these were monolateral hernias and 214 (43.4%) were bilateral while 215 (30%) were recurrent. RESULTS: Of 214 operations recurrence rate was 0.43 with a mean operating time of 30 min (range 25-50) for monolateral hernias and of 70 min (range 45-120) for bilateral hernias. Mean length of stay was 2 days (range 1-10). Return to work occurred in 6 days while sports were resumed after 10 days. Complications occurred in 40 (8.6%) patients with only 2 (0.4%) major complications. Mean follow up time was 58.3 months. CONCLUSION: According to personal experience, and in agreement with international literature, laparoscopy showed to be effective mostly in treating bilateral and recurrent hernias, particularly for faster recovery and less postoperative pain compared to traditional techniques.

Laparoscopic liver resection with radiofrequency.

BACKGROUND/AIMS: In this report, the feasibility, efficacy and safety of laparoscopic liver resection with radiofrequency has been evaluated in a small series of patients. METHODOLOGY: From January 1993 to May 2002 we carried out 7 laparoscopic liver resections (3 men and 4 women), five of which were for benign pathology and two for metastases from colorectal cancer. In four of the above resections we used an argon coagulator; the last three were accomplished by means of a radiofrequency instrument. RESULTS: We had no perioperative or postoperative complications in this small series of patients. There were no deaths. Perioperative blood loss was of 120 mL (range 80-200) and the procedure took about 90 minutes (range 80-110). Hospitalization was of 4 days and pain was adequately controlled by 2 mL of Toradol twice a day. CONCLUSIONS: We think that the advantages of laparoscopic techniques together with the efficacy of the radiofrequency instrument in hepatic surgery will allow the diffusion of this method and its extension to safe execution of major resections.

Abnormal bone scintigraphy and acute-onset severe primary hyperparathyroidism.

Acute-onset primary hyperparathyroidism in a previously asymptomatic individual is uncommon. We herein report the case of a 61-yr old woman who underwent bone scintigraphy for severe, rapidly worsening, diffuse bone pain, associated with weight loss, anxiety and confusion. The patient was asymptomatic until a few days before presentation. A marked redistribution of the tracer was observed, with poor bone uptake and relevant accumulation in liver, kidneys, lungs and spleen. Blood chemistry unequivocally allowed the diagnosis of primary hyperparathyroidism due to multiple parathyroid adenomas, as suggested by parathyroid scan. Unfortunately, the patient critically worsened and surgery was made impossible. She died despite intensive critical care. Autopsy confirmed both massive intraparenchymal calcium deposition in the kidneys, lungs, liver and spleen, as well as multiple parathyroid adenomas. One may speculate that some adaptation of the organism to progressively increasing blood calcium levels and to slowly increasing intraparenchymal calcium salt deposition occurred, until critically high concentrations were attained.

Association of hyperfunctioning thyroid adenoma with thyroid cancer presenting as "trapping only" nodule at 99mTcO4- scintigraphy.

Rarely may a non-hyperfunctioning thyroid nodule present as "hot" at Technetium-99m pertechnetate (99mTcO4-) and "cold" at radioiodine scintigraphy at late acquisitions. We report the case of a hyperthyroid female patient whose 99mTcO4- scintigraphy showed two "hot" nodules, whereas Iodide-131 (131I-) revealed a lack of indicator uptake by the larger, and intense uptake by the smaller nodule. The patient underwent surgery: histology demonstrated that the larger nodule, mismatched at pertechnetate vs iodine scintigraphy, was a papillary carcinoma. Our suggestion is to perform thyroid scintigraphy with radioiodine in hyperthyroid patients with more than one nodule concentrating pertechnetate, especially when an ultrasonographic pattern possibly suspect for malignancy is present.

Retrospective analysis of the association of nodular goiter with primary and secondary hyperparathyroidism.

BACKGROUND: The association of hyperparathyroidism (HPT) with thyroid disease has long been known, but the mechanisms underlying such an association have not yet been clarified. OBJECTIVE: To elucidate the main factors determining this combination of endocrine diseases, in a retrospective multicenter study. METHODS: We retrospectively reviewed all patients referred for parathyroid scintigraphy in the period 1990-1999. A total of 487 patients in the age range 17-65 years were selected for the analysis (339 women and 148 men); group A included 241 patients with primary and group B 246 patients with secondary HPT. RESULTS: A total of 124/241 patients in group A (51.5%), but only 92/246 patients in group B (38.2%) had thyroid disorders (notably nodular goiter) associated with HPT (P=0.0035). Thyroid disorders were evenly distributed throughout the entire 17-65 years age range in group A, but 17-40-year-old patients in group B had significantly fewer thyroid disorders than the older patients of the same group (15.5% compared with 43.3%, P<0.002), as expected in a general population. In patients with primary HPT there was no difference in the prevalence of thyroid disease between women and men, whereas the ratio of women to men in secondary HPT patients with thyroid disease was about 3:1. CONCLUSIONS: These results demonstrate an increased prevalence of nodular goiter in patients with primary rather than secondary HPT, and are consistent with a possible role of increased endogenous calcium concentrations (a hallmark of primary, but not of secondary, HPT) as a goitrogenic factor in patients with HPT.

Immunohistochemical reactivity of anti-melanoma monoclonal antibody 225.28S in human breast cancer biopsies.

The high molecular weight melanoma-associated antigen, defined by murine monoclonal antibody (IgG1) 225.28S is largely expressed by melanoma cells and weakly expressed by other human tumors originating from neural crest. In this study, we analyzed the immunohistochemical reactivity of MoAb 225.28S in human breast cancer biopsies. A total of 92 breast cancer biopsies (66 infiltrating lobular and 26 infiltrating ductal carcinomas) were initially tested along with 26 melanomas (positive controls), 23 gastric/colonic adenocarcinomas and 13 neuroendocrine tumors. Forty-four out of 66 lobular breast carcinomas showed positive immunostaining with 225.28S MoAb as well as only 6 out of 26 infiltrating ductal histotype and 12 out of 26 melanomas. Conversely, gastric and colonic adenocarcinomas and neuroendocrine tumors were completely negative. The pattern of positivity in breast carcinomas was associated with malignant cells, rather than with the stroma or histiocytes infiltrating the lesions. Nonspecific cross-reactivity of 225.28S with breast carcinomas was excluded using a similar murine antithyreoglobulin MoAb, which gave negative staining in all biopsies. These results indicated that HMW-MAA or a similar sequence recognized by 225.28S MoAb is often expressed by lobular breast carcinomas but rarely by ductal adenocarcinomas. This seems to suggest that lobular breast carcinoma has common "ancestor" antigens with melanoma.

[TC-99m-pertechnetate scintigraphy in the diagnosis of abdominal diseases]. / La scintigrafia con TC-99m-pertecnetato nella diagnostica della patologia endoaddominale.

OBJECTIVE: To show the possible role of abdominal scintigraphy in the diagnosis of intra-abdominal pathology and its accuracy in detecting ectopic gastric mucosa in pts with intestinal bleeding and/or abdominal pain. METHOD: 99m-Tc-pertechnetate scintigraphy was performed on 54 pts with a history of intestinal bleeding and/or abdominal pain with the following results: 11 true positive pts (9 with Meckel's D; 2 with enteric duplication) all of whom were confirmed at surgery; 14 false positive pts in whom the presence and location of entero-colic (12 pts), renal (2 pts), and uterine (1 pt) pathology were determined; 28 true negative pts; an arca of persistent low activity was found in the bladder of 1 pt which later proved to be a ureterocele at ultrasound; 1 false negative pt who was found to have Meckel's D at surgery. CONCLUSION: In this case series abdominal scintigraphy was effective in diagnosing 26/54 pts and, in particular, in diagnosis, 23/28 pts in recurrent intestinal bleeding. Given that its sensitivity is not negligible and that it is an exam which is scarcely invasive, easy to perform and interpret and requires low irradiation (definitely lower than barium enemas, digestive tract radiography and CT), abdominal scintigraphy should be the first examination to be performed in all pts with intestinal bleeding and/or abdominal pain, especially children, whose diagnosis cannot be simply or rapidly determined.

[Transcutaneous radiotherapy after thyroidectomy for differentiated thyroid carcinoma]. / La radioterapia transcutanea dopo tiroidectomia per carcinoma tiroideo differenziato.

PURPOSE: To compare the results, in terms of 10-year actuarial survival, between I-131-therapy and I-131-therapy + external beam radiotherapy (RT) in patients operated on for differentiated thyroid carcinoma. PATIENTS AND METHODS: Over a period of 13 years (1982-1995) 408 patients underwent thyroidectomy with or without linphoadenectomy for pT0/T4 Nx or pN0, pN1a, pN1b thyroid carcinoma. In all cases, thyroidectomy was radical. Patients were divided into two groups, which were comparable according to several prognostic factors: group A composed of 165 patients (surgery + I-131) and group B, 243 patients (surgery + I-131 + RT). RESULTS: The percentage of deaths related to relapsed or metastatic thyroid carcinoma was 6.25%. In the group treated with adjuvant radiotherapy, 14.8% of the patients experienced acute tracheal or esophageal side effects. Late toxicity (mouth dryness, skin and/or muscle fibrosis) was recorded only in a small percentage of the patients (2.4%). CONCLUSIONS: Adjuvant RT resulted in a statistically significant improvement (p < 0.01) in survival of patients with extracapsular diffusion of the cancer, especially those with pT4 N1b tumors or tumors involving the trachea.

Cisplatin, interleukin-2, interferon-alpha and tamoxifen in metastatic melanoma. A phase II study.

PURPOSE: To evaluate the efficacy and toxicity of an immuno-hormonal-chemotherapeutic combination of cisplatin, interleukin-2, interferon-a and tamoxifen in metastatic malignant melanoma. PATIENTS AND METHODS: Fifteen consecutive patients were treated with cisplatin at a dose of 100 mg/m2 on day 1, interleukin-2 subcutaneously at a dose of 18 MU from days 3-6 and from days 17-21, interferon-a 2-b subcutaneously at a dose of 3 MU three times weekly and tamoxifen orally at a dose of 20 mg daily. The cycle was repeated on day 28. Patients were evaluated after two cycles. Patients with progressive disease stopped the treatment while responding patients and those with stable disease underwent two further cycles. No maintenance regimen was employed. RESULTS: Two partial remissions (PR, 13%), 5 stable disease (SD, 33%) and 8 progression disease (PD, 53%) were observed. Patients with PR and SD had better survival than those with PD (11 vs 6 months). Toxicity was predominantly fever and vomiting besides chills, fatigue and flu-like syndrome, normally related to cytokine administration and often influencing the quality of life. CONCLUSIONS: Our results, unlike the good results of previous trials, are very poor. Therefore we do not recommend this combination for routine treatment of advanced melanoma.

[Ectopic thyroid and late-onset functional deficit of the thyroid gland]. / Ectopia tiroidea e deficit funzionale tiroideo ad esordio tardivo.

PURPOSE: To evaluate retrospectively the incidence of ectopic thyroid gland causing hypothyroidism in patients referred to "Di Venere" Hospital, Bari. PATIENTS AND METHODS: Over a period of 14 years, ectopic thyroid gland has been detected by thyroid scan in 56 out of 122 patients with hypothyroidism due to congenital thyroid abnormalities. Of these 56 patients, 48 were < 1 year old, 2 were < 2 years old, while 8 with late onset of the disease were 7 to 35 years old. RESULTS: Among the eight patients with late onset hypothyroidism, 3 had normal serum levels of thyroid hormones at birth. Overall, an ectopic thyroid gland was observed in 6 out of 32 (18.7%) patients with hypothyroidism beginning between 2.5 and 14 years of age. CONCLUSIONS: Thyroid scan is a safe and effective procedure in the diagnosis of ectopic thyroid gland in neonatal patients. It should be recommended as neonatal screening in order to prevent irreversible damage to central nervous system.

Is pyloric function preserved in pylorus-preserving pancreaticoduodenectomy?

OBJECTIVE: To assess the function of the pylorus after pylorus-preserving pancreaticoduodenectomy (PPPD) done for periampullary or pancreatic cancer. DESIGN: Prospective, observational controlled clinical study. SETTING: Teaching hospital, Italy. SUBJECTS: 17 patients who had undergone PPPD, and 15 healthy control subjects. INVESTIGATIONS: Endoscopy to check for gastritis and marginal ulcers and 24 h-pH monitoring and 99mTc HIDA scintigraphy to detect jejunogastric reflux. Scintigraphy was also used to evaluate gastric and jejunal transit after a solid meal labelled with 99mTc colloid sulphur. MAIN OUTCOME MEASURES: Signs of delayed gastric emptying, jejunogastric reflux and gastric outlet obstruction in the short and long term. RESULTS: In the early postoperative period only 1 patient had delayed gastric emptying. In the long term, two patients had symptoms of dyspepsia and 8/11 showed alkaline reflux with persistent gastric pH more than 4 for more than 12 hours; 3 had histological signs of gastritis. There was no difference in gastric emptying compared with controls, but three patients had prolonged emptying time (T1/2 more than 85 minutes). Endoscopy findings correlated with pH monitoring results. CONCLUSIONS: After PPPD, most patients have abnormal pyloric function, but it is clinically evident in only a small proportion.

[Hernioplasty using a Lichtenstein polypropylene mesh]. / Ernioplastica con rete in polipropilene sec. Lichtenstein. Risultati a distanza.

"Tension free" technique with prosthetic mesh for inguinal hernia repair was introduced since 1988 in Authors' Institution. In a review of 98 hernioplasties performed, only one relapse was observed (around 1%), while prosthetic infection cases were never observed. The disorder most frequently complained by the patients is a pain in the pubic area, persisting even months after the operation. Therefore this technique seems to be reliable, safe, and easy. While waiting for a long-term follow up to confirm these results, the Authors however suggest to limit the indications for this technique avoiding the use of prosthetic material in young patients since Shouldice's hernioplasty assures a low percentage of relapse for them.

Influence of blood transfusions on surgery-induced immune changes in colorectal carcinoma.

Perioperative blood transfusions have been shown to enhance recurrence rates in patients with operable solid tumors, perhaps by inducing immunosuppression through unknown mechanisms. Since the surgical treatment per se has been proven to induce immune alterations, the present study was carried out to evaluate the immune effect of blood transfusions on surgery-induced immune variations. The study included 27 patients with resectable colorectal carcinoma, 18 of whom received no transfusion, while the other 9 received blood transfusions in the perioperative period. Total lymphocytes, total T lymphocytes (CD3) and soluble IL-2 receptor serum levels (SIL-2R) were measured on venous blood samples collected from each patient either before or 7 days after surgery. Both in non transfused and in transfused patients, SIL-2R mean levels were significantly higher after than before surgery. Their increase was associated with a significant decrease in both lymphocytes and CD3 cells in non-transfused patients, while in the transfused ones lymphocytes and CD3 cells did not show significant changes with surgery. This study shows that blood transfusions modify the relation between changes in SIL-2R and those in lymphocyte number induced by major surgery. It remains to be understood which relation exist between these immune effects and the promoting action of blood transfusion on relapse frequency in cancer.

Effects of a preoperative course of interleukin-2 on surgical and immunobiological variables in patients with colorectal cancer: a phase 2 study.

OBJECTIVE: A phase 2 study to evaluate the effects of a short preoperative course of interleukin-2 (IL-2) on the postoperative course of patients with cancer. DESIGN: Open study. SETTING: San Gerardo Hospital, Monza, Italy. SUBJECTS: 16 Consecutive patients with locally advanced colorectal cancer, with or without metastases. INTERVENTION: IL-2 in a dose of 9 x 10(6) IU/m2 twice daily for three days; patients were operated on within 36 hours of the cessation of IL-2 treatment. MAIN OUTCOME MEASURES: Morbidity, mortality, and changes in numbers of lymphocytes, T lymphocytes, natural killer (NK) cells, and CD25 (cluster of determination) positive cells. RESULTS: There was no morbidity or mortality--in particular, there were no infections even in the patients who were at highest risk. The mean numbers of lymphocytes, T lymphocytes, NK cells, and CD25 positive cells increased significantly during the postoperative period. All patients showed evidence of infiltration of lymphocytes or eosinophils (or both) into the tumour tissue. CONCLUSIONS: The results suggest that a three day course of IL-2 preoperatively is well tolerated, stimulates would repair, neutralizes the lymphocytopenia induced by major operation, and induces immune cells to infiltrate the tumour. Randomised studies are needed to confirm these results.