NK cell activity in the presence of IL-12 is a prognostic assay to neoadjuvant chemotherapy in cervical cancer.

OBJECTIVE: Little is known about the impact of neoadjuvant chemotherapy on cell-mediated immunity in patients with advanced cervical cancers. PATIENTS AND METHODS: We have studied 24 patients with advanced cervical cancer submitted to neoadjuvant chemotherapy (CT) using cis-platinum (100 mg/m(2)/cycle) and bleomycin (30 mg/cycle). The cell-mediated immunity parameters available before and after CT were NK cells, CD4(+)/CD28 and CD8(+)/CD28 T-lymphocyte numbers, PBMC cytotoxicity, and modification of this parameter with "in vitro" addition of IL-12. RESULTS: The number of NK cells was higher before CT (P < 0.008) in 13 patients who presented a good clinical response to treatment, compared to 11 patients with a poor clinical response. In addition, PBMC cytotoxicity (P < 0.001), CD4(+) and CD8(+) T-lymphocyte values (P < 0.0047), and CD8(+)/CD28(+) cells were also higher in the group with a good response compared with the group with a poor response. Addition of IL-12 to the medium increased the lytic capacity of PBMC after CT only in the group with a good clinical response (P < 0.05). CONCLUSIONS: NK cell numbers, CD8(+) T-cell levels, and CD8(+)/CD28(+) cell levels can be used as prognostic factors before CT. Our results suggest that patients with a poor response have lower lytic activity per NK cell and are refractory to IL-12 stimulation, probably as a result of the reduced expression of IL-12 receptors or of an intracellular defect in the mechanism of transduction. These observations also provide support for human clinical trials of IL-12 and neoadjuvant CT in patients with cervical cancer.

Selection of criteria for the treatment of ovarian cysts on the bases of ultrasound and cytology.

The major objective of the present study was to determine whether leakage of ovarian cyst cells occurs when the cysts are punctured inside a container with saline. Other subjectives were to determine the sensitivity and specificity of cytology in the differentiation between malignant and benign cysts by comparing cytology data with histology data, and also to determine whether ultrasound can provide consistent evidence for predicting whether the cyst is benign or malignant, thus permitting the selection of patients with benign cysts for puncture rather than surgical exeresis. A cytologic study was carried out on the contents of 62 ovarian cysts diagnosed by ultrasound and clinical examination, and excised from 51 patients submitted to exploratory laparotomy. The cyst was excised and immersed in a container with saline outside the surgical field. The cyst was punctured and its contents aspirated through the wall of the container. Five samples were obtained for cytology: (1) presurgical abdominal wash; (2) saline before cyst puncture; (3) fluid from the punctured cyst; (4) saline after cyst puncture, and (5) postoperative abdominal wash. The materials obtained were submitted to centrifugation and slides of the precipitate were prepared for cytology. A total of 248 slides were studied. Slides of cysts with good cellularity were stained with silver to study the nucleolar organizer regions. Analysis using Kappa statistics showed excellent agreement between the cytologic and histologic diagnoses (p < 0.001). The sensitivity of the cytologic study of the cyst was 75% and the specificity 100%, with a positive predictive value of 100%, a negative predictive value of 92%, and 93% accuracy. The present results led us to conclude that cell leakage into physiological saline occurred after puncture and that cytologic study of cysts valuable in the diagnosis of benign and malignant processes.

Evaluation of long-term results of surgical correction of stress urinary incontinence.

A total of 109 patients submitted to surgery for the correction of urinary stress incontinence (USI) by two different techniques, i.e. anterior colporrhaphy (group I, n = 57) when cystocele grade II/III was present, and Burch procedure (group II, n = 52) when cystocele grade I was present, were reevaluated an average of 5 years after surgery (range: 54-66 months). The curve constructed with the reevaluation data showed a sharp superiority of the Burch technique in terms of correction of USI and associated genital prolapses. There was a progressive recurrence rate that stabilized at 5 years, with values of 78.9% in group I and 40% in group II. Anterior colporrhaphy was ineffective for the correction of any of these parameters in group I. The data clearly show the need to improve the presurgical diagnostic methods for the selection of patients that will benefit from treatment: detailed history of the current disease and auxiliary tests such as Q-tip test, transvaginal ultrasound, and urodynamic study. Other factors were associated with ineffective treatment in both groups, such as hypoestrogenism (20/109), excessive weight gain (19/109) and chronic intestinal constipation and/or coughing present in 36 patients, with recurrence in 28 of them.