TNM-classification of carcinomas of the oral cavity-efficacy of clinically available data (TN).

Using adequate number of cases, the influence of the spread of primary tumour and the degree of regional metastasis on prognosis were investigated. Assuming a practicable classification as a prerequisite for clinico-therapeutic cancer research, experience has shown that the assessment of the spread of primary tumour alone does not suffice for the establishment of comparable homogenous data. The investigation on the importance of the degree of regional metastasis has shown, above all, that the percentage of N3-metastasis within the T-groups contributes essentially to the fact that these show a marked difference in their prognosis. It would therefore appear necessary also to examine the importance of other clinically accessible data in the assessment of prognosis. Only then could we be in a position to judge whether, and to what extent a clinically practicable classification and integration into special groups is possible on the basis of clinically available data. The inclusion of more clinics in the joint investigation is encouraged.     

IL-2 antagonists: the European perspective

Acute rejection remains the main risk factor following intestinal transplantation. New immunosuppressive agents have substantially reduced the incidence of severe acute rejection. The question arises, which is the most powerful immunosuppressive combination with the lowest incidence of side effects? According to International Intestinal Transplant Registry data, anti-IL-2 antibodies are slightly advantageous compared with antilymphocyte preparations with respect to long-term patient survival. However, different antilymphocyte preparations are used in different doses and at different time points. The anti-IL-2 antibodies daclizumab and basiliximab were also used in different protocols. Therefore, final results on efficacy are awaited. The most important difference between IL-2 antibodies and antilymphocyte preparations is the suppression of CD4+ CD25+ T lymphocytes by anti-IL-2 antibodies. Antilymphocyte preparations do not affect CD4+ CD25+ T cells. Because regulatory CD4+ CD25+ T cells are essential for tolerance induction, protocols attempting tolerance may omit anti-IL-2 antibodies in the future.     

Mucin production in defining mixed carcinoma of the uterine cervix: a clinicopathologic study

Eighty-seven Stage 1 cervical carcinomas treated by radical hysterectomy between 1970 and 1979 were reviewed for histologic type, outcome, and factors predicting behavior. Initially, the cases were histologically classified by the Wentz and Reagan system and graded according to the Broders method. Stains for intracellular mucin were then examined in 69 cases and 39% were shown to contain intracellular mucin. Using intracellular mucin as an indicator of mixed carcinoma, this study showed a distribution of 35% keratinizing, 16% nonkeratinizing, 3% small cell, 16% adeno-, 3% undifferentiated, and 26% mixed carcinoma. The mixed carcinomas were derived from the traditional keratinizing, nonkeratinizing and small cell categories. Mixed carcinoma was the only histologic type that predicted lymph node metastasis (p = 0.009). The presence of lymph node metastasis predicted death due to disease or recurrence (p = 0.014) as did pure adenocarcinoma histology (p = 0.025). Overall 5 year survival was 92%. Survival at 5 years for adenocarcinoma was 85%, but one additional death occurred at 12 years and a first recurrence occurred at 7 years. An additional patient with a collision tumor (adenocarcinoma and squamous carcinoma) died at 8 years. Mixed carcinoma is relatively common and appears to be associated with a higher incidence of lymph node metastasis. Adenocarcinoma appears to have a poorer prognosis and a tendency for late recurrence in distant sites.     

Successful nonsibling bone marrow transplantation in severe combined immunodeficiency.

Severe combined immunodeficiency (SCID) was diagnosed in a girl immediately after birth; her older brother had SCID and was successfully reconstituted by bone marrow transplantation from his uncle. She was isolated in a laminar air flow bench and decontaminated. The father differed by one HLA-A antigen but was HLA-Dw2 homozygous like the patient; his lymphocytes showed a slight response to the patient's cells in mixed lymphocyte culture (MLC). At the age of 2 1/2 months and again at 5 months, she was given a bone marrow transplant from the father. During the entire course the patient had no infections, and apart from a transient eosinophilia she had no signs of graft-versus-host reaction. Immunological reconstitution was nearly complete at 9 months of age, when she was recontaminated. One year later plasma immunoglobulin concentrations are in the low normal range (IgG and IgM) or decreased (IgA); tests of cell-mediated immunity are normal. Apart from slight upper respiratory infections, the patient has been healthy. Physical and psychological development have been normal.