SummaryIn a previous report we found an inverse correlation between pre-operative platelet count (PlC) levels and the risk of post-operative pulmonary embolism in patients undergoing hip surgery. In the present study, we prospectively evaluated the prognostic significance of pre-operative PlC levels on survival in 180 consecutive patients undergoing surgery for colorectal cancer. Other major clinicopathological parameters studied were age, gender, Dukes’ stage, duration of surgery, pre-operative haemoglobin levels and transfusion requirements.There were no significant differences in mean pre-operative PlC levels according to tumor stage. Thirty-three patients (18%) died during follow-up (3-23 months, median: 13 months). Univariate analysis (Kaplan-Meier estimates) showed that advanced tumor stage (p <0.001), duration of surgery (p <0.05) and a high pre-operative PlC level (p <0.001) were significantly associated to a poor survival. The multivariate Cox analysis revealed that tumor stage (RR:5.734; 95%C.I.: 2.644-12.44), a high pre-operative PlC level (RR: 2.467; 95%C.I.: 1.117-5.452), and to a lesser extent the patients’ age remained independent prognostic variables for mortality. The findings of this preliminary study may be of interest from the point of view of pathogenesis, but also clinically, since they might be used in the decision as to which patients or groups of patients should receive more aggressive therapeutic intervention.

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Clinical transplantation of human islets has a disappointingly low rate of success. We report here the identification of a possible causative factor: endotoxin present in the collagenase preparations used to disperse the pancreatic tissue before islet purification and transplantation. Supporting evidence includes (1) detection of unexpectedly high levels of endotoxin in most collagenase solutions currently used to digest human pancreases; (2) demonstration that supernatants generated during islet separation are able to induce the inflammatory cytokines interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-alpha) in macrophages; and (3) induction of IL-1, IL-6, and TNF-alpha in the islets during the separation procedure. Cytokine expression was assessed by reverse transcription-polymerase chain reaction and, for TNF-alpha, confirmed by enzyme-linked immunoabsorbent assay. It is proposed that endotoxin and locally induced cytokines carried over with the graft activate the endothelium and promote lymphomonocytic infiltration of grafted islets and surrounding liver tissue favoring primary nonfunction and early rejection. These results also have implications for the numerous experimental procedures that use collagenase, and they point to possible ways to improve islet preparation and transplantation protocols.

The radioguided technique is as effective as the standard wire technique for localization and excision of nonpalpable breast cancer lesions and is somewhat faster and simpler to perform than wire localization.