One hundred and sixty-six patients undergoing elective major laparotomy were skin tested preoperatively with four common recall antigens in an attempt to correlate preoperative cell-mediated immune status with postoperative septic complications. Nineteen patients were anergic, 22 relatively anergic and the remaining 125 reacted to two or more of the antigens and were regarded as normally reactive. No significant differences in morbidity or mortality were found between patients who had depressed delayed cutaneous hypersensitivity reactions and those who reacted normally. We conclude that identification of those patients with depressed cell-mediated immunity preoperatively does not help in predicting postoperative problems.
SummaryIn tra-ocular pressure ( I O P ) The intravenous anaesthetic agent etomidate has been shown to produce a major reduction in 1OP when used as an induction agent.* The use of a total intravenous anaesthetic technique using etomidate was considered therefore, to have potential value in combining pollution-free anaesthesia with possible optimal effects on IOP.This study compared changes in 1OP which occur. under standardised conditions, between conventional inhalational anaesthesia and a technique based on an etomidate infusion. Paticwt.\ ond method\Ten patients were studied in each group. All patients were ASA I rated and prcscnted for elective ophthalmic surgery; informed consent was obtained in each case. Approval was obtaincd from the Ethical and Standards Committee of the Iiniversity of Natal.Premedicntion in both groups consisted of papaveretum I S mg intramuscularly with diazepam 10 mg orally. administered 1 hour before surgery. Upon arrival at the operating room, a central venous catheter (16 FG) was inserted under local anaesthcsia (l';,; Iignocaine), via the antecubital fossa or right internal jugular vein. Position of the catheter tip was not ascertained radiologically, but oscillation with respiration and free grav-ity reflux of blood was demonstrated in each case. A separate intravenous (i.v.) infusion of Ringer's lactate was commenced at a suitable peripheral site.Thc patient was then placed in a horizontal supine position on the operating table. A control reading of IOP was taken using the Perkins applanation tonometer following the installation of benoxinate 0.2:,,> with fluorescein. Simultaneous readings of systolic arterial ~ *Present appointment: Senior Registrar. Department or Anaesthesia. Royal Infirmary. Bristol BS2 8HW.
Fifty patients from a socioeconomically disadvantaged population who were diagnosed when younger than 40 with colorectal cancer between 1968 and 1978 were analyzed. These patients had an increased survival compared with their older counterparts aged 40 years and older who were diagnosed during the same time. The young women had significantly better survival than the young men. Advanced stages, distribution of primary sites, and precancerous conditions were not major factors. The fact that the younger patients' cancers had a higher incidence of extracellular mucin production may have been counterbalanced by their receiving more extensive treatment. At the same time, cultural and social factors related to gender may have more to do with better survival than do factors evaluated in previous studies. In fact, because of the pervasive lack of male/female analysis, it is not known whether the survival difference due to gender found in this report is a universal tendency in young populations.
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