The British journal of surgery
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Randomized Controlled Trial Clinical Trial
Effects of low dose perioperative interferon on the surgically induced suppression of antitumour immune responses.
General surgical procedures are followed by a period of generalized immunosuppression that may favour the deposition of metastases seeded at operation in patients with malignant disease. In an attempt to prevent the suppression of host-antitumour immune mechanisms following surgery we have studied the immunological effects of low-dose perioperative interferon-alpha (r-HuIFN alpha). Patients were randomly allocated pre-operatively to the control (n = 15) or treatment group (n = 15). ⋯ Treatment with r-HuIFN alpha did not prevent the postoperative impairment of interleukin 2 production or lymphokine activated killer cell cytotoxicity. However it prevented the fall in natural killer cell activity normally observed following surgery. This may have important consequences in controlling metastatic dissemination of tumour in this vulnerable period.
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A prospective trial was conducted in 20 surgical intensive care unit patients receiving mechanical ventilation to compare estimates of resting energy expenditure (REE) with the measured values. The 12 women and 8 men (mean age 61.7 +/- 2.8 (s.e.m.) years) underwent a full nutritional assessment before measurement of their REE by indirect calorimetry using the MGM II metabolic cart (Utah Medical). Their REE was estimated by the Harris-Benedict formula (mean 1324 +/- 53 (s.e.m.) kcal/day) as well as an empirical formula (where empirical formula = 22 x body weight in kg) (1370 +/- 68 (s.e.m.) kcal/day). ⋯ Thus, mean estimates were excellent for the group but less predictive for the individual. Multiple linear regressions did reveal that body composition and metabolic stress were of greater predictive value, since an equation relating weight (P less than 0.003), sex (P less than 0.003), white blood cell count (P less than 0.003) and 24-h urinary creatinine excretion (P less than 0.05) could predict 76 per cent of the variation (r = 0.87) in the MREE with an overall significance of P = 0.0002. Given the importance of matching energy intake to needs in many critically ill patients who are mechanically ventilated, accurate measurement of the REE is recommended now that instrumentation is equal to the task.
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In nine subjects undergoing oesophagectomy a transient but significant increase in pulmonary vascular permeability to transferrin was detected in both lungs 8 h after surgery. It coincided with a significant increase in plasma lactoferrin, evidence of intravascular and intra-alveolar neutrophil elastase release and with arterial hypoxaemia. The postoperative state in these patients had intravascular and pulmonary features often associated with the adult respiratory distress syndrome, and might be a useful model for the study of the early inflammatory events underlying lung injury in man.