1.
Reduced infections with perioperative immunonutrition in head and neck cancer: exploratory results of a multicenter, prospective, randomized, double-blind study.
Falewee, MN, Schilf, A, Boufflers, E, Cartier, C, Bachmann, P, Pressoir, M, Banal, A, Michel, C, Ettaiche, M
Clinical nutrition (Edinburgh, Scotland). 2014;(5):776-84
Abstract
BACKGROUND & AIMS Head and neck cancer surgery is affected by complications in 20-60% of cases, with risk factors being malnutrition, alcoholism and immunosuppression due to cancer. The aim of the study was to investigate whether preoperative or perioperative immunonutrition could reduce postoperative infectious complications (IC) and surgical-site infections (SSI) in this population. METHODS This was a multicenter, prospective, randomized, double-blind study. Patients with oropharyngeal and pharyngolaryngeal tumour were randomly allocated to three groups: a) perioperative formula of Impact(®) without immune nutrients, named "reference diet" (group A, control); b) preoperative Impact(®) and "reference diet" postoperatively (group B); c) Impact(®) perioperatively (group C). Products were available in oral and enteral formula and were given 7 days before surgery and for 7-15 days postoperatively. The primary and secondary endpoints were the incidence of IC and SSI, respectively. RESULTS Of 312 randomized patients, 205 were evaluable for ITT analysis. There was no significant difference in IC and SSI. However out of this population, only 64 patients had taken at least 75% of the theoretical intake from surgery to day 10 (per-protocol population). In this condition, a significant difference in IC (OR = 0.24, p = 0.05), SSI (OR = 0.17, p = 0.04) and also in the median length of postoperative stay (18 vs. 25 days, p = 0.05) was demonstrated between groups A and C. CONCLUSIONS In the ITT population, no significant difference in IC, SSI and LOS was demonstrated. Positive exploratory results on the perioperative Impact(®) per-protocol population, encourage further study in head and neck cancer patients. Registered under ClinicalTrials.gov Identifier no. NCT00765440.
2.
Perioperative treatment with human growth hormone down-regulates apoptosis and increases superoxide production in PMN from patients undergoing infrarenal abdominal aortic aneurysm repair.
Decker, D, Springer, W, Tolba, R, Lauschke, H, Hirner, A, von Ruecker, A
Growth hormone & IGF research : official journal of the Growth Hormone Research Society and the International IGF Research Society. 2005;(3):193-9
Abstract
BACKGROUND Recombinant human growth hormone (hGH) therapy has a beneficial effect on catabolism and wound healing after major surgery. Polymorphonuclear neutrophils (PMN) play an important role in this context. In a prospective, double-blind, randomized, placebo-controlled trial we studied the effect of perioperative hGH treatment on postoperative wound healing and on changes in superoxide generation and susceptibility to apoptosis of PMN in elderly patients undergoing elective abdominal aortic aneurysm repair. METHODS Seven patients were treated with high-dose hGH (16 U/d) for nine days, seven patients with a placebo. IGF-I, neutrophil count, O2-production induced by opsonized zymosan and apoptosis of PMN were measured and correlated with clinical outcome. RESULTS Perioperative hGH treatment more than doubled the O2- production in PMN before and 24 h after surgery (p < 0.01). The long-term capacity of PMN to generate O2 in vitro was prolonged (p < 0.001) in the hGH group. Spontaneous and Fas-inducible apoptosis was strongly down-regulated in PMN after surgery in all patients (p < 0.01). hGH-treatment distinctly reduced apoptosis in PMN before and after surgery (p < 0.01). Clinical outcome was similar in both groups. CONCLUSION Perioperative hGH treatment results in an enhanced O2- production in PMN and in a prolongation of the functional life span of these cells. This may improve immune function and help to overcome the postoperative anergic state of the immune system especially in elderly individuals.
3.
[Applications of immunomodulators in complex of treatment of the soft tissue purulent wounds].
Potiĭ, VV
Klinichna khirurhiia. 2000;(10):15-6
Abstract
In 31 patients with purulent wound of soft tissues more rapid cleansing and healing of the wound, the immunity indexes normalization were noted while application of immunomodulator thymogen in combination with the siliceous sorbent sillard application and adaptogenic preparation--tincture of Echinacea Purpurea.