Annals of surgery
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Effects of nutritional repletion with intravenous hyperalimentation (IVH) on sequential skin test reactivity were evaluated in 160 malnourished cancer patients undergoing chemotherapy (76 patients), surgery (49 patients), radiation therapy (20 patients) and supportive care (15 patients). In the chemotherapy group, 45 patients had negative reactions initially, and 25 patients (55%) had at least one skin test convert to positive in an average period of 19 days of IVH. In the surgery group, 23 patients (46%) were initially positive and remained positive, 13 patients (24%) converted from negative to positive, and 13 patients (30%) remained negative or converted to negative. ⋯ Nutritional therapy with IVH was associated with restored skin test reactivity in 51% of malnourished cancer patients undergoing oncologic therapy. Radiation therapy was generally immunosuppressive despite adequate nutritional repletion. In surgical patients, positive skin test reactivity correlated directly with a favorable response to operative therapy.
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Thirty of 33 patients (ages 18-67) with acute dissection of the ascending aorta underwent surgical intervention. There were four deaths. There were eight male and five female patients and 15 patients were known to be hypertensive. ⋯ One patient had a femorofemoral graft two months after the initial operation and another patient has mild aortic insufficiency. It is concluded that prompt surgical management is mandatory in acute ascending aortic dissection, and in most patients aortic valve competency can be re-established with resuspension of the valve preventing the added morbidity associated with a prosthetic valve. Four patients have been followed for five years and additional follow-up data will better define long-term survival.