[Immunological status and surgery of cancer of the lung. Prognostic aspects and therapeutic prospects].
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Biomedical subjects
Publications and source records attributed to S Colizza.
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Two hundred forty-two patients who had bronchial carcinoma and who underwent radical surgery were studied in order to determine putative host resistance to the tumor at histologic level, i.e., lymphocytic infiltration in the center and around the tumor, together with sinus histiocytosis and follicular hyperplasia in the regional lymph nodes. These features were evaluated in a semiquantitative way, giving rise to three groups of patients: D- (reaction absent or poor), D+ (reaction present), and D++ (strong reaction present). Five-year survival rates and the incidence of metastases in regional nodes were significantly related to the putative host resistance against the tumor, but no clear-cut correlation between grade of malignancy of the tumor and histologic type was evidenced. The significance of these reactive changes is fully discussed.
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Prolongation of survival time of heart transplants in inbred rats following intravenous injection of donor strain blood according to various time-dose schedules is described. The immunological status of long-term survivors shows detectable antidonor antibodies, normal graft-versus-host reactions and rejection of skin grafts in the usual time. Lymphocytotoxic activity is well related to the survival time of the heart in those rats which respond to the treatment.
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The degree of lymphocytic infiltration in and around breast tumours together with sinus histiocytosis and follicular hyperplasia in regional lymph nodes has been studied in 310 cases of breast cancer treated with standard radical mastectomy. The presence of these features was regarded as evidence of host resistance against the tumour and made possible the division of patients into three classes-no or poor reaction, good reaction, and strong reaction. The grading was shown to have a close correlation with prognosis. The relationship between host defensive factor grading and malignancy, nodal metastases, and survival was also examined. The results support the hypothesis that prognosis in breast cancer is closely related to a histological picture of cell-mediated immunity against the tumour.
The nature of the immune response to the tumor cell is complex and has yet to be clearly defined. Although past research has foscused on the cytotoxic effect of T lymphocytes versus tumor cells, it has been shown in animal studies that B lymphocytes may also be implicated. Lymphocytes from patients with respiratory and digestive tract tumors were studied. B and T lymphocytes of peripheral blood and of draining lymph node tumors were studied using the following techniques: E rosettes (marker for T cells); membrane Ig, EAC rosettes, aggregated-Ig (marker for B lymphocytes); PHA and PKW in vitro response of lymphocytes using tritiated thymidine incorporation. It was observed that both groups of patients had normal or depressed B and T populations. PHA response was depressed in the majority of the cases with lung tumor. No difference was observed between lymphocytes from peripheral blood and from lymph node suspensions. As in normal lymph nodes the EAC rosettes were constantly observed in the cortical area of lymph node draining tumors. The immune defect observed in part of these cases is discussed in relation to the local and general immunological factors probably responsible for this defect.
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The operative morbidity observed in a consecutive series of 286 patients who underwent shunt surgery for portal hypertension is reported. 149 patients out of 286 (52.1%) had a postoperative complication, which required reoperation in 11 cases (5 intestinal perforations, 2 bleeding peptic ulcers, 1 eventratio, 1 cholestasis, 1 acute pancreatitis, 1 strangulated hernia). 42 patients out of the 149 with complications died of the complication (operative mortality 14.6%). Operative morbidity and mortality appeared higher in patients operated as emergencies. Whereas elective shunts gave better results. The problem involved in preventing and treating the serious complications following shunt surgery for portal hypertension are discussed.