R. Dionigi

Infections in cancer patients.

Some of the factors that predispose cancer patients to infections are related to the malignant disease and the tumor mass itself; others include age, length and type of surgery, degree of nutritional deprivation, and alterations of host defense mechanisms secondary to the type of cancer and treatment. Cancer patients who are preoperatively anergic to skin tests are at greater risk of developing postoperative infection. Administration of opsonic proteins may benefit patients with severe infections.

Immunological factors in nutritional assessment

Multiple studies have demonstrated that malnutrition is one of the major causes of increased morbidity and mortality among hospitalized patients. A variety of anthropometric, biochemical and immunological parameters has been used as indicators of protein-energy malnutrition. However, the relative value of each of these measurements has not been clearly defined. This is especially true for the immunological parameters, where abnormalities are often observed in clinical and subclinical malnutrition. The purpose of this,paper is to review and discuss some of the most significant results relating to ( I ) the effects of malnutrition on the immune processes and (2) the effectiveness of immunological testing and assessment of nutritional status to identify high-risk patients.

Postoperative infections and variations of complement components in cancer patients.

Sequential determinations of C4 and factor B serum levels were performed pre- and postoperatively in 56 cancer patients. Patients who underwent radical mastectomy and excision of melanoma had an incidence of surgical infections of 7 % and 15 %, respectively, and showed a significant postoperative acute-phase increase of C4 and factor B serum levels. A higher incidence of postoperative infections, mostly Gram negative, was recorded in patients who underwent gastric resection (35%) and colorectal resection (73%); these failed to show an early acute-phase response of complement postoperatively. The results of this study confirm the high susceptibility of cancer patients to postoperative infections. Moreover, the lack of postoperative acute-phase increase of C4 and factor B observed in cancer patients who developed postoperative infections suggests an active role of complement in host defense mechanisms against surgical infections.

Radioimmunoguided surgery benefits in carcinoembryonic antigen-directed second-look surgery in the asymptomatic patient after curative resection of colorectal cancer.

Radioimmunoguided surgery (RIGS) with radiolabeled monoclonal antibodies (MoAbs) has been reported as useful in second-look colorectal cancer procedures to improve surgical decision-making by helping avoid needless extensive surgery and expanding curative resection to sites of recurrence that have been missed previously. Sixteen asymptomatic patients with an history of colorectal cancer surgery underwent second-look surgery using the RIGS system, solely on the basis of rising serum levels of carcinoembryonic antigen (CEA). All patients were injected preoperatively with the anti-tumor-associated glycoprotein (TAG) 125I-labeled MoAb B72.3. Both traditional and RIGS exploration were used to determine the extension of a possible recurrence and its resectability for cure. Recurrent disease was observed in 14 of the 16 patients as the result of this combined exploration. Exploration alone showed the presence of recurrent disease in 9 of 16 patients (56.2%). Thus, RIGS found overlooked tumor in five patients (31.2%). All the additional RIGS-detected tumor sites were locoregional recurrences resectable for cure; conversely, no diagnostic improvements were shown in patients with liver metastases. Resection for cure was obtained by this approach in 9 of 16 patients (56.2%). Two patients without disease at the exploratory laparotomy recurred within 2 months at sites away from the abdomen. RIGS improved the results of colorectal cancer CEA-guided second-look procedures in asymptomatic patients by recruiting one-third of patients to curative resections.

Sonographic features of liver metastases from pancreatic glucagonoma and acinar cell carcinoma

The previously unreported ultrasonographic (US) features of liver metastases of pancreatic glucagonoma and of pancreatic acinar cell carcinoma are described. They present as complex masses with hyperechoic solid component, containing echo-free cystic areas; these sonographic features markedly differ from the echo-poor US pattern of the much more common metastases of pancreatic ductal carcinoma. Survival from diagnosis of liver metastases was 45 months in the patient with pancreatic glucagonoma and 23 months in the patient with acinar cell carcinoma. These survivals were much longer than the expected survival of patients with pancreatic ductal carcinoma metastatic to the liver. The US finding of highly reflective lesions in the liver, containing echo-free cystic areas, should alert one that the primary pancreatic tumor has a histotype different from ductal carcinoma. Such US findings could affect the decision to resect the pancreatic tumor and its liver metastases, if histology confirms a malignancy less aggressive than ductal carcinoma.

Correlation between peri-operative blood transfusion and post-operative infective complication

Nosocomial infections are the most frequent complications observed in surgical patients. In recent years reductions of post-operative infections have been mostly due to a correct use of prophylactic measures such as pre-operative selective bowel decontamination, adequate antibiotic prophylaxis, and better anaesthetic and intensive care management.

Surgical Treatment of Solitary Neurofibroma of the Common Hepatic Duct: A Rare Cause of Obstructive Jaundice

A 39-year-old man developed obstructive jaundice caused by solitary plexiform neurofibroma of the common hepatic duct. Bile duct neurofibroma of the solitary type is a very rare tumor, of which only 3