Perioperative immunomodulation with interleukin-2 in patients with renal cell carcinoma: results of a controlled phase II trial

We conducted a non-randomised controlled phase II trial to investigate the role of preoperative administration of interleukin-2 (IL-2) in patients with renal cell carcinoma undergoing tumour nephrectomy. A total of 120 consecutive patients were allocated alternately to the two study groups: perioperative immunomodulation with IL-2 (IL-2 group; n=60) and perioperative immunomonitoring without immunomodulation (control group; n=60). Patients from the IL-2 group received four doses of 10 × 106 IU m−2 twice daily subcutaneously a week before operation followed by a daily maintenance dose of 3 × 106 IU m−2 subcutaneously until a day before the operation. Parameters of cellular and humoral immunity (leucocytes, T-cell markers CD3, CD4, and CD8, B-cell marker CD19, monocyte marker CD14, natural killer (NK) cell markers CD16, CD56, and CD57, activation markers CD6, CD25, CD28, and CD69, progenitor cell marker CD34, as well as IL-2, IL-6, IL-10, soluble IL-2 receptor, IL-1 receptor antagonist, transforming growth factor-β1, and vascular endothelial growth factor) were measured in peripheral venous blood at various intervals. Interleukin-2-related toxicity was WHO grade 1 (24%), 2 (67%), and 3 (9%). In the postoperative period, T-cell markers, activation markers, and NK cell markers decreased, and IL-6 and IL-10 increased. However, all these alterations were significantly less accentuated in patients who had been pretreated with IL-2. Median follow-up was 40 months. Tumour-specific survival in the IL-2 group and the control group was 98 vs 81% after 1 year and 86 vs 73% after 5 years (P=0.04). A similar effect was found for progression-free survival. We conclude that IL-2 can be safely administered in the perioperative period and modulates immunological parameters. However, to validate the survival data, a larger randomised phase III trial is needed

The Testicles: Trauma, Inflammation and Testicular Torsion

6noThe majority of cases of acute scrotum are due to one of these three causes: trauma, torsion and inflammation. Acute scrotum syndrome of any origin always merits immediate evaluation to prevent testicular function and chronic irreversible complication [1]. Correct differential diagnoses between these conditions are mandatory because uncorrected diagnosis could lead to catastrophic consequence. Often physical examination is not sufficient to avoid suspicious conditions that require surgical correction and then imaging. High-resolution ultrasound is the imaging modality of choice for the examination of superficially located scrotal sac and its contents. Greyscale ultrasonography in combination with colour or power Doppler imaging is a well-accepted technique for assessing scrotal lesions and testicular perfusion. In this chapter, clinical features, greyscale and colour Doppler US appearance of testicular torsion, trauma and inflammation are described.reservedmixedBucci, Stefano; Rizzo, Michele; Liguori, Giovanni; Umari, Paolo; Chiriacò, Giovanni; Bertolotto, MicheleBucci, Stefano; Rizzo, Michele; Liguori, Giovanni; Umari, Paolo; Chiriacò, Giovanni; Bertolotto, Michel