Chirurgia italiana
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It is by now an established fact that the status of the immune system stands in some relationship with the onset and evolution of malignancy. To clarify this relationship the authors investigated the immune system of patients with pulmonary carcinoma, with special regard to the functions of the T and B lymphocyte lines. ⋯ With B lymphocytes the EA rosette test was often depressed, whereas antibody titers were normal or even above normal, and the pokeweed blast test was invariable above normal values. These preliminary results show that at the time of diagnosing malignancy, the greater aggressiveness characteristic of the less differentiated cellular types, or of stages of diffuse malignancy, is associated with overpowering of cell defenses and (within certain limits) enhancement of the humoral response.
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In view of the results obtained in 32 cases of primary closure of the perineum after amputation of the rectum for cancer, the authors believe that this policy is best after removal of the malignancy by the abdominoperineal approach. Unquestionable advantages are shortening of the patient's hospital stay and a more rapid recovery; the possible disadvantages are relatively rare, from an uncommonly severe dysmetabolic situation to local disorders such as poor hemostasis, contamination of the operation site, inadequate preoperative antibacterial protection, or an unusually large tumor.
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The authors describe four cases of penetrating heart wounds: two from slash and puncture injuries and two from gunshot. Hearth lesions involved the left ventricle and pericardium in two cases, the right ventricle in one case, and only the diaphragmatic pericardium in one case. After a review of the literature, the authors discuss clinical and diagnostic problems relative to penetrating chest wounds and particularly those of the heart, stressing the need for very prompt diagnosis; as for actual treatment, they conclude that this can be carried out without any special problems in any Department of general emergency surgery.