Relationship of blood transfusion, post-operative infections and immunoreactivity in patients undergoing surgery for gastrointestinal cancer.

BACKGROUND AND OBJECTIVE: The immunosuppression induced by perioperative blood transfusion (BT) and its effect on the incidence of post-surgical infectious complications remains controversial. In this study, the relationship between BT and postoperative infections was investigated in 136 gastrointestinal cancer patients submitted to curative surgery. METHODS: Clinical and laboratory variables, data on postoperative infections, infection risk factors and types of transfusion were analyzed. Immune function was evaluated in 76 patients and compared before and after surgery. RESULTS: The overall postoperative infection rate was 28% for the transfused and 4.6% for the untransfused patients. The univariate analysis of investigated variables indicated that BT, progressive cancer stage, duration of surgery, drains, all had significant association with infection. The multiple logistic regression analysis confirmed BT (p = 0.0028) and advanced cancer stage (p < 0.001) as significant risk factors for the postoperative infections. The results of immunological tests showed no significant differences between transfused and untransfused patient groups, after surgery. Comparing pre- and postoperative data from individual patients, an impairment of natural killer (NK) activity was observed in all patients regardless of their transfusional status; the synthesis of interleukin-2 (IL-2) and interferon-gamma (IFN-gamma) was also decreased respectively in the untransfused and in the transfused patients. INTERPRETATION AND CONCLUSIONS: These results indicate that other factors, beside BT, can induce immunosuppressive effects in these patients and thus increase their susceptibility to postoperative infections.

Clinical utility and prognostic value of ambulatory blood pressure monitoring.

Ambulatory blood pressure monitoring is a useful procedure in the diagnosis and management of hypertension, in the assessment of anti-hypertensive drugs and as a means of predicting outcome in hypertension. With ambulatory blood pressure monitoring is possible to detect usual variability of blood pressure, circadian rhythms and the response to environmental influences in both normotensive and hypertensive subjects. A number of clinical conditions are better evaluated with this procedure than with conventional measurements, eg white-coat hypertension (the rise of blood pressure in the physician's office), borderline hypertension, episodic hypertension and secondary hypertension. Multiple readings improve the precision of the estimate of blood pressure profile of the patient and allow a precise evaluation of blood pressure load to which a patient is exposed throughout 24 h. Ambulatory blood pressure monitoring is closely related to the incidence of cardio- and cerebrovascular events and to the prevalence and the degree of target-organ damage. Casual and ambulatory blood pressure readings are not alternative but complementary tools for clinical management of hypertension and for assessment of the prognostic risk of hypertension.

Chemoprophylaxis in the surgical ward: results of a national survey in Italy.

As part of a national program for the control of hospital acquired infections, a survey on the use of antibiotic chemoprophylaxis was conducted in 1050 public hospitals in Italy (95% of the total number of hospitals in the country). In each hospital, the chief of the general surgery ward was interviewed by means of a standard mail questionnaire. Answers were obtained from 479 surgeons (45.6%) after two mailings. More than 60% of these reported that they used chemoprophylaxis in clean surgery (mastectomy, splenectomy, hernioplasty). More than 80% used antibiotic prophylaxis in surgery in which antimicrobial prophylaxis is facultative (i.e. elective cholecystectomy, gastric resection), and 97.1% used antibiotic prophylaxis in large bowel surgery. The authors recorded starting times and duration of chemoprophylaxis. Cephalosporins were found to be the most commonly used antibiotics followed by penicillin.

[HLA and hypo-responsivity to anti-HBV vaccination (genetic study of non-responder subjects to anti-hepatitis B viral vaccine)]. / HLA e iporesponsività alla vaccinazione anti-HBV (studio genetico di soggetti non-responders al vaccino anti-epatite virale B).

The control of the immunization due to hepatitis B vaccines (HB-VAX and HEVAC B) showed that a low percentage of healthy adults vaccinated develop a non protective title of HBsAb or do not produce antibodies. The correlation between immunity and HLA has already been demonstrated: HLA is at the base of individual immunological response; this correlation directed our genetic study of low-responders or non-responders patients to anti-HBV vaccine. In our study 11 out of 97 subjects vaccinated (11.34%) with HB VAX or HEVAC B resulted hyporesponsive and underwent complete HLA typing to verify the relation between immune deficiency response and genetic system. There was an increase in phenotype HLA-DR7 incidence, with respect to a non-selective population and a decrease of HLA-DR1, as it has already been mentioned in the literature, the variations were not statistically significant taking into account the exiguity of the samples considered.

Preliminary results of immune response to hepatitis B (HB) vaccine (Pasteur) in adults.

Antibody responses were estimated in 42 healthy high risk volunteers submitted to three monthly intradeltoid inoculations of a 5 micrograms HBs vaccine containing both subtypes adw and ayw. The presence and concentration of anti-HBs varied according to individual responses and the number of injections. One month after the 1st dose those responding numbered 19%, one month after the 2nd the number rose to 83,3%, and reached 100% one month after the 3rd dose. In a few cases antibody levels were low (less than or equal to 50 mIU/ml), while in most subjects they rose after the 2nd dose, reaching high titres. Concordance and comparability of anti-HBs concentration were achieved by three different measurements (S/N, RIA Units, mIU/ml). No important side effects were observed. The timing of booster doses is discussed.