Progression mechanisms in colon cancer: soluble interleukin-2 (IL-2) receptor, IL-2 plus anti-CD3 proliferative response and tumour stage correlations.

Soluble interleukin-2 receptor (sIL-2R) levels have been found to be elevated in several clinical conditions, including disseminated solid neoplasms, whereas they are generally within the normal range in patients with locally limited neoplastic disease. The aim of the present study was to examine this in our colon cancer patients, and to assess if this situation can affect the in vitro activation of peripheral blood mononuclear cells (PBMC), examining the proliferative response to IL-2 and anti-CD3 monoclonal antibody, the IL-2 serum levels and the PBMC phenotype. The results show that sIL-2R levels were significantly correlated with the stage of the disease, showing an increase from stage I to stage IV; moreover, it is worth noting that the proliferative response to IL-2 plus anti-CD3 is significantly higher than to IL-2 alone in stage IV, without significant alteration in the numerical presence of T and natural killer cells. So it seems that in the peripheral blood of patients, connected with the disease progression, are present cellular populations showing a different response to activation, and that T cells acquire a better response condition than NK. Thus, since the T cellular population includes the tumour-specific cytotoxic precursor cells, this should be helpful for its tumour regressive activity, but it is conceivable that this population cannot perform its functions, owing to a deficiency in responsiveness of the specific ThCD4+ subpopulation.

[The endoscopic diagnosis of rectorrhagias]. / Diagnostica endoscopica delle rettorragie.

The diagnosis of bleeding of gastrointestinal low tract is still a very controversial subject. At the Service of Digestive Endoscopy of Popoli (PE) Hospital, in a period of 4 years, 2074 colonoscopies have been effected. In 640 cases, that is 30.8%, the indication for the exam was suggested by rectal bleeding. In the 566 patients examined for minor rectal bleeding, the most frequent lesions were: haemorrhoids (35.3%), polyps (15.2%), malignant neoplastic disease (9.3%). In all active rectal haemorrhages (14 massive, 41 medium) an urgent colonoscopy has been carried out with a percentage of success of 90%; in the 20 cases of unexplained melena, colonoscopy has not led to a diagnosis; in the 14 patients with unexplained anemia, colonoscopy has shown 2 carcinomas, whereas in the 5 cases with occult blood in stools it has been diagnostic in the percentage of 60%. We have ascertained that, when barium enema was effected before colonoscopy, the diagnostic agreement between the two examinations was only of 21.4 (9/42); on the contrary there was an agreement of 95% when colonoscopy was effected before barium enema. In accordance with Siewert and Blum (25), Ottenjann (24) and Farrands (42), we believe that colonoscopy should be considered the main examination after either major or minor rectal bleeding, because it is a quick and safe investigation with high diagnostic specificity and sensitivity. We refuse William's position (41), because, even in presence of haemorrhoids or anal fissures, the colon must be studied as a whole, especially in a period when neoplastic disease of this tract of intestine is considerably increasing.(ABSTRACT TRUNCATED AT 250 WORDS)

[A case of annular pancreas]. / Un caso pancreas anulare.

The embryology and aetiopathogenesis of annular pancreas are described together with its clinical and radiological aspects. A case in which preoperative diagnosis of megaduodenum due to stenosis caused by an incomplete pancreatic ring is presented. Successful surgical management by means of a duodenojejunal shunt is described.

[Surgical treatment of pulmonary metastases. A personal case]. / La terapia chirurgica delle metastasi polmonari. A proposito di una nostra osservazione.

A particularly interesting case of pumonary metastasis due to renal adenocarcinoma, treated with right medio-inferior bilobectomy is reported. The topicality and complexity of the problem of the surgical treatment of lung metastases is the reason for the present contribution. The criteria for choice, indications for treatment and the limitations of the form of surgery are reviewed in brief.