Positive radiologic findings were identified in the small and large bowels in three infants with various gastrointestinal manifestations of cow's milk protein/soy protein allergy, which was diagnosed on the basis of clinical features and histologic findings. Small bowel findings were thickened valvulae conniventes (plicae circulares), a ribbon-like ileum, and a thickened bowel wall. Narrowing, thumbprinting, and spasm were seen in the large bowel. These cases were seen at intervals far enough apart to exclude an endemic infection. The diagnosis of food protein allergy should be considered when diffuse small bowel disease or colitis is identified in an infant.

This review addresses some of the immunological issues surrounding the complex problem of perioperative sepsis. It identifies an immunological paradox between the relative immunosuppression of the immediate postoperative period and the relative immune activation of established sepsis, in addition to discussing current knowledge of the mechanisms surrounding these phenomena. Much remains unknown about perioperative immunoregulation; there are a number of potential mechanisms, however, whereby local and systemic immune defences can be modified or enhanced. Provided patients at risk can be identified, such manipulations may find application in preventing infection and sepsis after surgery.

Summary Serum-free supernatants from in vitro maintained gastrointestinal cancer and melanoma cell lines inhibit the generation of lymphokine (IL-2) activated killer (LAK) Lafreniere et al., 1985;Mule et al., 1986b;Rosenberg et al., 1986). Unfortunately this experience is not paralleled by the clinical application of such an approach where some 60% of patients with metastatic disease fail to respond to this therapy West et al., 1987;Topalian et al., 1988). Similarly, treatment with IL-2 alone appears to be ineffective (Lotze et al., 1986) despite the fact that many human tumours are infiltrated by host mononuclear cells which might become cytotoxic following exposure to IL-2 in vivo (Svennevig et al., 1984;Cozzolino et al., 1986).Prompted by the observations that both IL-2 production and LAK cell generation were impaired with patients with tumours which had extended beyond local confines (Monson et al., 1986(Monson et al., , 1987, we have previously shown that the presence of low numbers of some cell-line derived tumour cells was found to potently inhibit LAK cell generation in vitro (Guillou et al., 1989). A number of reports have demonstrated that supernatants derived from tumour cell lines can inhibit lymphocyte proliferation and cytokine production (Werkmeister et al., 1980; Meischner et al., 1986;Ebert et al., 1987;Pommier et al., 1987;Farram et al., 1982;Hersey et al., 1983). However, the effects of these supernatants on the generation of cytotoxic responses has rarely been examined (Cozzolino et al., 1987

Summary The effects of treatment with 5-FU/folinic acid on interleukin-2 related lymphocyte responses was investigated in 21 patients with advanced colorectal cancer. The treatment was not suppressive of IL-2 related lymphocyte responses. Furthermore, at certain time points in the treatment cycles the capacity to generate lymphokine-activated killer (LAK) cells from the peripheral blood mononuclear cells of these patients was significantly augmented above that observed prior to treatment. These results provide a logical basis for the design of regimens which combine two approaches, each of low individual therapeutic efficacy, to treat patients with advanced colorectal cancer in the hope of increasing clinical response rates.

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