Comparison of a immunonutrition formula enriched arginine, glutamine and omega-3 fatty acid, with a currently high-enriched enteral nutrition for trauma patients.

The severe trauma or burn patients required aggressive resuscitation, operation and metabolic support to reduce morbidity and motality. Nutrition is one of the most important treatment for these patients, improving body protein and immune function, reducing rate of infection and shortening hospitalization. METHOD: To evaluate the metabolic and immune effects of dietary arginine, glutamine and omega-3 fatty acids (fish oil) supplementation, we performed a prospective study in patients age 15-60 yrs after severe trauma (Injury Severity Scores (ISS) 15-30) or burn patients (body surface area (BSA) 30-60%) in Siriraj Hospital. They were randomized to receive either Neomune or Traumacal. The nasogastric feeding was started in post-injury day 2 (PID2) with half of concentration at the rate of 30 ml/h. From PID3 to PID10, the normal concentration was administered at the rate of 80-100 ml/h depending on optimal caloric requirement. All patients received 5 per cent dextrose in half or full strength saline solution as clinically indicated. No other oral nutrients apart from study formula were allowed during the study. Blood sample was with-drawn on PID2, PID6 and PID11 for measurements of CBC, coagulogram, albumin, transferrin, CRP, LFT, BUN, Cr, CD3, CD19, CD4, CD8, C3, IgG, IgM, and IgA. Nitrogen balance was calculated from UUN. Unpaired student t-test was applied to compare variables between the two groups. RESULTS: 36 patients were selected (16 trauma and 20 burn), male = 29, mean age = 29.86 yrs. The patients were divided equally into two groups to receive Neomune or Traumacal. The data were compared and showed significance on total protein on PID11 (Neomune = 6.52 +/- 1.29, Traumacal = 5.59 +/- 1.21, p = 0.03) and serum triglycerides on PID11 (Neomune = 128.39 +/- 53.45, Traumacal = 186.25 +/- 84.07, p = 0.02). The ICU stay was observed shorter in Neomune than in Traumacal group (3.41 and 7.83 days) with no statistical significance. The wean-off respirator day was also shorter in Neomune than in Traumacal group (2.71 and 7.39 days). One patient in each group died. CONCLUSIONS: The feeding of Neomune in critically injured patients was well tolerated as Traumacal and significant improvement was observed in serum protein. Shorten ICU stay and wean-off respirator day may benefit from using the immunonutrient formula.

Evaluation of clinical significance of a new tumour marker, cyfra21-1, in diagnosios of squamous cell cervical cancer: A preliminary study.

The purpose of this study was to evaluate the significance of Cyfra21-1 as a new tumour marker in the diagnosis of squamous cell cervical cancer. Cyfra21-1 enzyme immunoassay was used for the determination of Cyfra21-1 levels in sera of 120 cervical cancer patients and 17 normal control cases. According to the International Federation of Gynaecology and Obstetrics (FIGO) stage, these cervical cancer patients were staged at CIN or CIS, stage I, stage II and stage III (19,17,42 and 42 cases, respec-tively). The 17 normal controls comprised five healthy women and 12 patients with benign gynaecological diseases and tumours that had presented negative results from Papanicolauo smears. We found that the normal value of serum Cyfra21-1 level was 0.99 + 0.28 ng/ml (mean+ 2SE). Serum Cyfra21-1 levels of the cervical cancer patients increased depending on the severity of the disease. Moreover, the Serum Cyfra12-1 levels of only the patients with FIGO stage III were significantly higher than those of the normal controls, and the patients in CIN or CIS and stage I (p=0.0055). The serum Cyfra21-1 levels of the normal controls the patients in CIN or CIS, stage I, and stage II differed insignificantly from one another. This test showed a sensitivity of 65 per cent and specificity of 82 per cent. The ROC curve was used to determine the cut-off value (1.3 ng/ml) of the increased levels. A prospective study should be further performed to evaluate the usefulness of this marker as a non-invasive modality for diagnosis and monitoring cervical cancer in the future.

Acupuncture treatment in perennial rhinitis.

The investigation for clinical effectiveness and immunological response of perennial rhinitis after acupuncture treatment was performed at the Acupuncture Unit, Department of Anesthesiology, Faculty of Medicine Siriraj Hospital. Twenty-four patients with perennial rhinitis and 49 healthy controls were included in the study. The patients were divided into allergic (11 cases) and non-allergic (13 cases) groups. All patients had never had immuno therapy and had eye and nose symptoms for more than 1 year before the treatment. After courses of acupuncture treatment, the clinical symptoms improved in 63 percent of patients in the allergic group and 46 percent in the non-allergic group. The amount of antihistamine tablets was also decreased significantly. The levels of serum IgE in the allergic group showed no significant change when compared with levels before treatment. The preliminary results suggest that the therapeutic efficacy of acupuncture in this disease probably functions via the autonomic nervous system rather than the immune system.