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P.21 Modifications of immunological parameters during pre and postoperative tpn with and without fat emulsions in gastric cancer patients
P.21 MODIFICATIONS OF IMMUNOLOGICAL PARAMETERS DURING PRE AND POSTOPERATIVE TPN WITH AND WITHOUT FAT EMULSIONS IN GA STRIC CANCERPATIENTS P. Dionigi, V. Jemos, C. Tibaldeschi, S. Olezza, A. Clerici, g. Dionigi (Dipartlmento di Chirurgia, Sezione di Patologia Chlrurgica, UniversitA di Pavia, 27100 Pavia, I t a ly) IPB with lipids is frequently used in malnourished patients. However, possible negative effects of fat emul sions upon the immunological responsiveness has been reported in experimental studies. Purpose of this study is to evaluate variations of same immunological parameters during fat emulsion infusion. Eighteen malnourished p~ tients (body weight Ioss>lO~) with advanced gastric cancer received the same amount of calories and nitrogen (2800 Kcal and 13.6 g N/die) as pre and postoperative TPN (2 and I week respectively). In I0 patients (group A: g m - I f; 61jlO y) the 4gx of the total caloric amount was supplied as fat emulsions, whereas 8 patients (group B: 4 m - 4 f; 66+11 y) received glucose as the only caloric source. The two groups were similar for type of cancer, stage of disease and nutritional status. The following immunoIoglcal parameters were sequentially de termined at admission, preoperatively (-I2,-g,-5,-2 day) and postoperatively (+4,+7,+15): WBC, lymphocytes (to ta], T and B), neutrophil chemotaxls, phagocytosis and adherence, complement components (C3c, C3 activator), IgG, IgM, ceruloplasmin. Delayed hypersensitivity response (DHR) was investigated at the admission only. Nutri tional parameters were impared inltially, they decreased during the study, but no significant difference could be recorded between the two groups. At admission DHR was severely compromised in both groups (abnormal respo~ ses: A=gO~, B=67~). Total lymphocyte count was below the normal range (A=I620+6go; B=1670+820) and Further de creased during the study, T lymphocytes being more impaired (55~) than B iymphocytes (25~). Abnormal high con centratlons of C3c and ceruloplasmln were observed at diagnosis but only in group B they presented a progress !
ve reduction and reached the normal level. All the other immunological parameters remained withln the normal range and showed negligible differences between group A and B. In conclusion our results demonstrate that i.v. administration of fat emulsions in malnourlshed cancer patients does not affect per se the immunological param~ ters consldered.
P.22THE RELATION OF PRE-OPERATIVE INTRADERMALTESTING WITH RECALL ANTIGENS AND POST-OPERATIVE COMPLICATIONS IN SURGICAL PATIENTS (n=143) AND A CONTROL GROUP (n=38) P.C.M.de Jong, M.Rouflart, R.l.C.Wesdorp, P.B.Soeters and J.M.Greep (St.Annadal Hospital, University of Limburg, Dpt.of Surgery, Maastricht, The Netherlands). Many investigators have suggested, that intradermal testing with r e c a l l antigens is a simple means of testing immunity and they proved a r e l a t i o n s h i p between altered host resistance, sepsis and m o r t a l i t y in surgical patients. Others could not confirm this r e la tionship. To investigate the r e l a t i o n in Dutch surgical p a t ie n t s , 143 patients were tested p r e - o p e r a t i v e l y with 5 recall antigens (streptokinase-streptodornase, mumps, candida, trichophyton and PPD (tuberculin))and the post-operative complications ( i n f e c t i o n , sepsis and m o r t a l i t y ) were registered. These results were compared with a control group of 38 e l e c t i v e l y admitted patients (hernia repair and varicose veins). Anergic (A) = no induration a f t e r 24 and 48 hours of at least 5 mm. Relative anergic (RA) = i positive reaction of at least 5 mm. Normal reacting (NR) = 2 or more p o s i t i v e reactions. S i g n i f i c a n t d i f ferences (p<0.05) were found between the A- and NR- group in m o r t a l i t y (A = 19.5% NR = 4.8%), sepsis (A = 19.5%~--,NR =7.2%) and i n f e c t i o n (A = 14.6%~--~ NR = 6%). When the RA group was considered to be NR (strong evidence f o r this is found when this p a t ie n t group is compared with the control group), the A group and the N + RA group were also s i g n i f i c a n t l y d i f f e r e n t in complication rate : m o r t a l i t y (A = 19.5%~-~RA + N = 5.8%), sepsis (A = 19.5%<--> RA + N = 7.8%) and i n f e c t i o n (A = 14.6%<-~RA + N = 7.8%). These results were influenced by age because the anergic patients were s i g n i f i c a n t l y older than those with a normal response. Malignancy and t o t a l parenteral n u t r i t i o n (TPN) correlated well with anergy and some commonly used indicators of m a l n u t r i t i o n . In the control group, where 2 patients were anergic and 36 normal reacting, no complications developed in the post-operative period. Although in the overall results there was a s i g n i f i c a n t r e l a t i o n ship between complications and anergy, strong influences appeared to be exerted by age, underlying disease and malnourishment.
ve reduction and reached the normal level. All the other immunological parameters remained withln the normal range and showed negligible differences between group A and B. In conclusion our results demonstrate that i.v. administration of fat emulsions in malnourlshed cancer patients does not affect per se the immunological param~ ters consldered.
P.22THE RELATION OF PRE-OPERATIVE INTRADERMALTESTING WITH RECALL ANTIGENS AND POST-OPERATIVE COMPLICATIONS IN SURGICAL PATIENTS (n=143) AND A CONTROL GROUP (n=38) P.C.M.de Jong, M.Rouflart, R.l.C.Wesdorp, P.B.Soeters and J.M.Greep (St.Annadal Hospital, University of Limburg, Dpt.of Surgery, Maastricht, The Netherlands). Many investigators have suggested, that intradermal testing with r e c a l l antigens is a simple means of testing immunity and they proved a r e l a t i o n s h i p between altered host resistance, sepsis and m o r t a l i t y in surgical patients. Others could not confirm this r e la tionship. To investigate the r e l a t i o n in Dutch surgical p a t ie n t s , 143 patients were tested p r e - o p e r a t i v e l y with 5 recall antigens (streptokinase-streptodornase, mumps, candida, trichophyton and PPD (tuberculin))and the post-operative complications ( i n f e c t i o n , sepsis and m o r t a l i t y ) were registered. These results were compared with a control group of 38 e l e c t i v e l y admitted patients (hernia repair and varicose veins). Anergic (A) = no induration a f t e r 24 and 48 hours of at least 5 mm. Relative anergic (RA) = i positive reaction of at least 5 mm. Normal reacting (NR) = 2 or more p o s i t i v e reactions. S i g n i f i c a n t d i f ferences (p<0.05) were found between the A- and NR- group in m o r t a l i t y (A = 19.5% NR = 4.8%), sepsis (A = 19.5%~--,NR =7.2%) and i n f e c t i o n (A = 14.6%~--~ NR = 6%). When the RA group was considered to be NR (strong evidence f o r this is found when this p a t ie n t group is compared with the control group), the A group and the N + RA group were also s i g n i f i c a n t l y d i f f e r e n t in complication rate : m o r t a l i t y (A = 19.5%~-~RA + N = 5.8%), sepsis (A = 19.5%<--> RA + N = 7.8%) and i n f e c t i o n (A = 14.6%<-~RA + N = 7.8%). These results were influenced by age because the anergic patients were s i g n i f i c a n t l y older than those with a normal response. Malignancy and t o t a l parenteral n u t r i t i o n (TPN) correlated well with anergy and some commonly used indicators of m a l n u t r i t i o n . In the control group, where 2 patients were anergic and 36 normal reacting, no complications developed in the post-operative period. Although in the overall results there was a s i g n i f i c a n t r e l a t i o n ship between complications and anergy, strong influences appeared to be exerted by age, underlying disease and malnourishment.