A comparison of pre-operative nutritional status with post-operative morbidity and mortality in obese esophageal surgery patients.

OBJECTIVES: The nutrition state of obese patients scheduled to undergo esophageal surgery was evaluated using two nutritional score systems: the mini nutritional assessment (MNA) and the prognostic and nutritional index (PINI). A further comparison of various proteins, lymphocytes and cholesterol was performed using biochemical tests. These factors were compared with post-operative morbidity and mortality in a prospective, descriptive clinical study. MATERIAL AND METHODS: The study included 34 obese patients undergoing esophagus resection due to cancer, who were examined over four years using both scoring systems to analyze whether nutritional status influences the outcome of surgery. The patients were divided into four groups based on the severity of the outcome and their MNA and PINI scores were analyzed. RESULTS: There were no significant differences between the nutritional status of survivors and deceased patients. The European Society for Parenteral and Enteral Nutrition (ESPEN) nutritional risk score was 1.35 ± 0.47 for Group I and 1.47 ± 0.58 for Group II (p = 0.62). With respect to severe morbidity there was no significant difference between Group III and Group IV: 2.01 ± 2.28 vs. 1.02 ± 3.67 (p = 0.54). Although there were minor differences, there were no major variations seen in the MNA or PINI scores comparing the four examined groups. No significant changes were observed in the biochemical parameters. CONCLUSIONS: The study found no differences between post-operative morbidity or mortality and the pre-operative nutrition status of obese patients who underwent surgery due to esophageal cancer.

[Differential scanning calorimetry of blood plasma in breast cancer patients]. / Emlodaganatos betegek vérplazmájának differenciál pásztázó kalorimetriás vizsgálata.

Breast cancer is the commonest cause of cancer death in women worldwide. Its incidence has been increasing for many years in economically developed countries. Differential scanning calorimetry (DSC) is a thermoanalytical technique which monitors small heat changes between sample and reference materials. This examination is a validly efficient method for the demonstration of structural changes not only in the physical sciences, but in numerous human oncological diseases. The goal of this study was to measure DSC thermogram of blood plasma in breast cancer patients with different stages. Nineteen women with different tumor diameter (0.5-7.5 mm) and with or without regional lymph node metastases were involved in the study. Preoperatively peripheral blood samples were collected from the patients and from healthy controls, and plasma components were analysed by SETARAM micro DSC-II calorimeter. The diameter of the tumor tissue and the number of metastatic lymph nodes were evaluated on the basis of postoperative histological results. In the current study we found difference in changes of the thermal parameters (transition temperature, calorimetric enthalpy) of breast cancer patients' plasma components. Moreover, a tendency has been found for association of these results with tumor size and with the degree of regional lymph node involvement. Preliminary study of the clinical utility of DSC technology arises, even though there is no data in the literature. In cases of breast cancer the blood plasma may be suitable for DSC analysis for diagnosis or staging as well. In order to clarify the relationships we are planning further studies.

Survival after surgery following chemotherapy for non-small-cell lung cancer.

A retrospective study was carried out on 74 patients with advanced non-small-cell lung cancer (52 in stage IIIA, 22 in stage IIIB) who received platinum-based induction chemotherapy in doublets and triplets, followed by tumor resection. Thirty-day postoperative mortality was 5.4% (4 patients); 5 patients in stage IIIB and 17 in stage IIIA did not respond, but the other 47 (63.5%) were downstaged to < IIIA (26 were downstaged to stage I, 20 to stage II, and 1 had complete remission). There was no change in T factor in 22 (30%) patients, nor in N factor in 21 (28%). The actuarial 5-year survival rate for patients in postoperative stages IIIA and IIIB was 0.496; survival was significantly longer in patients who responded to therapy. Parallel improvement in both T and N status predicted worse survival than a multistage regression in any single factor. N status was found to be a stronger survival indicator than T status. Cell type did not influence the response rate or outcome. Induction chemotherapy significantly improved survival in patients who responded, despite a poor prognosis.

Esophagus reconstruction with free jejunal transfer.

Following pharyngolaryngectomy, reconstruction is one of the most challenging surgical procedures. Here we review our own experiences using a microvascularly transferred free jejunal graft. This method was performed in 22 patients (19 male and 3 female, aged 40-63 years). Seven patients underwent neoadjuvant chemo-radiotherapy. Eighteen patients had immediate reconstruction after pharyngolaryngectomy, and 4 patients had delayed reconstruction because of complications from previous surgeries (2 stenoses, and 2 recurrent cancers). The duration of surgery ranged from 5-9 h (mean, 6.3 h), and the ischemic time of the graft was 70-125 min (mean, 88 min). This method has several advantages: it is a one-step operation; the graft is covered by self-cleaning mucosa; the development of fistulas and stenoses is rare; and the technique provides good swallowing. Owing to its good blood supply, this reconstructive method can also be used in previously irradiated areas.

[The results of Lichtenstein operation for groin hernias--prospective multicenter study]. / Lágyéksérvek Lichtenstein mutéttel történo megoldásának eredményei. Prospektív multicentrikus tanulmány.

UNLABELLED: Authors describe the short and long term results of a prospective multicentric Lichtenstein-trial started in March 1999. For the first time in our country, the exchange of information between the participating institutes has been arranged via Internet. 1434 patients were admitted for primary hernia repair and included in the trial. However, only 714 (49.8 per cent) have attended at the last follow-up control 4 years after surgery. Premilene and Prolene meshes were used in the course of Lichtenstein's tension-free procedure. RESULTS: Wound suppuration occurred only in a very small number of the patients (0.76 per cent) and there was merely one occasion when the mesh implant had to be removed because of sepsis. The intensity of postoperative pain and demand for analgesics was very low. During the follow-up period of 4 years 16 recurrent hernias were diagnosed (2.4 per cent). A hydrocele developed in 8 patients (0.5 per cent) while necrosis of the testicle was found in 4 patients (0.27 per cent). We realised that both the attitude and practice of the institutes participating in the study has changed thoroughly and the Bassini-repair seems to be replaced by the Lichtenstein procedure in these surgical departments. CONCLUSION: The study has reached its objective in more aspects: First it helped to achieve a significant reduction in recurrence rates and it also has shown that there is no increase in wound suppuration. The great number of surgeons performing this kind of inguinal hernia repair and their good results also indicate that this operation in less depending on surgical skills and practice than the Bassini-repair. The study has largely contributed to the national spread of this operation and has doubtlessly verified the advantage of information and data processing through the Internet, ie. a prompt and correct evaluation of the data recorded

The effects of preconditioning on the oxidative stress in small-bowel autotransplantation.

BACKGROUND: One determining factor in intestinal transplantation is the extreme sensitivity of the small bowel to ischemia-reperfusion injury. This study investigated the effect of ischemic preconditioning prior to autotransplantation. METHODS: Total orthotopic intestinal autotransplantation was performed in 40 mongrel dogs. In 4 groups (GI-GIV), grafts were stored for 3 hours in cold Euro Collins (GI,GIII) and University of Wisconsin (GII,GIV) solutions. In GIII and GIV, before preservation, preconditioning was induced by 4 cycles (5-min ischemia + 10-min reperfusion). Bowel samples were collected after laparotomy (control), at the end of preservation and reperfusion periods. We determined oxidative stress markers (reduced glutathione [GSH], superoxide dismutase [SOD]), production of oxygen free radicals, activity of nuclear factor-kappaB (NF-kappaB), and DNA damage. RESULTS: In the non-preconditioned groups, GSH concentration increased slightly, while SOD activity decreased significantly during reperfusion. In the preconditioned groups, GSH increased markedly, and better preservation of SOD was observed. The number of oxygen free radicals increased during reperfusion mainly in non-preconditioned groups. Activation of NF-kappaB peaked by 1 hour, and decreased 3 hours after preconditioning. We observed DNA-damaged cells in all groups. CONCLUSIONS: Our findings confirm that preconditioning prior to preservation can moderate the severity of oxidative stress and activate the endogenous cellular adaptation in bowel tissue.