Abnormal cytokine serum levels correlate with impaired cellular immune responses after surgery.

Serum levels of the interleukins (IL)-2, -1 beta, and -6, tumor-necrosis factor alpha (TNF-alpha), and prostaglandin E2 (PGE2) were measured serially before and after operation in patients undergoing various surgical procedures. Peripheral blood mononuclear cells (PBMC) from the same patients were analyzed before and after surgery for proliferative responses in the autologous mixed lymphocyte reaction (AMLR) and for cytolytic activity against the natural killer (NK)-sensitive K562 cell line. In patients who had major surgery, a decrease in IL-2 levels and increases in IL-1 beta, TNF-alpha, IL-6, and PGE2 levels were observed up to 9 days after the operation compared to those of the preoperative values. Decreased AMLR responses and NK activity were also observed in PBMC collected 5 days after surgery. All these changes were more intense in patients who had undergone major surgical procedures of increasing severity (i.e., cancer patients). Similar, although weaker, changes in cytokine serum levels, AMLR responses, and NK activity were also observed in patients undergoing minor surgery. Our data suggest that changes in cytokine serum levels may cause cellular immune dysfunctions, particularly in patients undergoing major surgery, and provide the basis for immune intervention in order to avoid infections occurring after major surgery.

Technical considerations and results of a "new" method of reconstruction of alimentary continuity after duodenopancreatectomy.

A total of (152) patients who consecutively underwent extended pancreaticoduodenectomy between 1983 and August 1992 had reconstruction of alimentary continuity, using two independent jejunal loops. One for the fashioning of a pancreatic and biliary anastomosis and the other for creating the gastric anastomosis. From the results of this study it has been shown that the present technique is contributing to low mortality, early morbidity and a satisfactory quality of post-operative life in long-term survivors. Four patients died during the first 30 days after surgery, and only 25% of those with confirmed pancreaticojejunal anastomotic leakages required early reoperation. Moreover, no patient developed marginal ulceration, or reflux gastritis, or dumping, while the incidence of steatorrhea and diabetes mellitus remained low. Additionally, the present technique makes locoregional radical surgery possible and we thus believe that it merits consideration with respect to the choice of method of reconstruction of alimentary continuity after extended pancreaticoduodenectomy. The present technique has been proved to be safe, simple and effective in fulfilling current demands on resectional pancreatic surgery, particularly in the case of pancreatic malignancies, and can therefore be recommended.

A new look in the management of unresectable primary hepatocellular carcinoma.

From January 1992 to October 1992, nine patients with unresectable primary hepatocellular carcinoma were treated either by liver resection combined with transarterial on-target chemotherapy (n = 4) or by transarterial on-target chemotherapy alone (n = 5). All nine patients were seen with diffuse spread of their disease and were considered as refractory to surgical treatment. The patients who had liver resection combined with alcohol transtumoral injection of the residual tumor in the liver remnant and transarterial lipiodol on-target chemotherapy, responded well and were seen postoperatively with a significant decrease in size of their residual tumor, which was found histologically to have advanced necrotic changes. Similarly, the remaining patients, who had only alcohol injection and frequent administration of on-target chemotherapy, were seen with necrosis of their tumor and with decrease in its size. The fetoprotein serum levels were decreased in all patients. None of the patients showed systemic effects from the use of chemotherapy, nor did they demonstrate any hepatotoxic side effects.