Levamisole and postoperative complications: A controlled clinical trial

Ausobsky, J. R.; Evans, Mary; Pollock, A. V.

doi:10.1002/bjs.1800690804

Cited by 5 publications

(2 citation statements)

References 8 publications

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“…The same authors proposed serial testing of skin reactivity, at weekly intervals, as a very sensitive guide to the adequacy of management and prognosis. Similar studies performed subsequently in the United Kingdom [40,41] did not confirm the results of the Canadian group and concluded that preoperative delayed hypersensitivity testing is valueless, either for warning or for reassurance about the occurrence of postoperative complications.…”

Section: Immunological and Nutritional Predictive Modelsmentioning

confidence: 86%

Nutritional assessment and severity of illness classification systems: A critical review on their clinical relevance

et al. 1986

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Several studies have attempted to define nutritional parameters that can be used to select undernourished hospitalized patients and identify those who present higher risk of postoperative septic complications. Nevertheless, the majority of these studies do not take into consideration the severity of infectious episodes. Systems for scoring the severity of illness are of critical importance in hospital practice and clinical research. In fact, they could be used for the following purposes: (a) a more correct stratification of patients in clinical studies; (b) monitoring the evolution of the infectious complication; (c) prediction of survival; (d) optimization of the criteria for admission to and discharge from intensive care units; and (e) evaluation of quality, quantity, and costs of nutritional therapy in critically ill patients. In this article, the authors present a critical review on the clinical relevance of the methods of nutritional assessment more commonly used in clinical practice; and, moreover they discuss the more recently proposed systems for scoring the severity of illness.

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Section: Immunological and Nutritional Predictive Modelsmentioning

confidence: 86%

Nutritional assessment and severity of illness classification systems: A critical review on their clinical relevance

et al. 1986

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“…44 Layered closure was previously found to reduce incisional-SSI rate in a 1985 study; however, the incisions were predominantly vertical and the type of incision was dependent upon assignment. 45 It therefore seems that, despite progress in management of surgical patients, layered closure still decreases the incisional-SSI risk. Although a single previous nonrandomized study showed no differences in incisional-SSIs between patients undergoing layered and mass closure of transverse laparotomies, the technique was strictly dependent on surgical division, mass and layered closure differed with respect to other technical aspects (continuous/interrupted) and applied material, and the incisional-SSI rate was <2% in both groups.…”

Section: Discussionmentioning

confidence: 99%

Incisional Surgical Site Infections After Mass and Layered Closure of Upper Abdominal Transverse Incisions

Grąt¹,

Morawski²,

Krasnodębski³

et al. 2021

Annals of Surgery

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Objective: To compare the early results of mass and layered closure of upper abdominal transverse incisions. Summary of Background Data: Contrary to midline incisions, data on closure of transverse abdominal incisions are lacking. Methods: This is the first analysis of a randomized controlled trial primarily designed to compare mass with layered closure of transverse incisions with respect to incisional hernias. Patients undergoing laparotomy through upper abdominal transverse incisions were randomized to either mass or layered closure with continuous sutures. Incisional surgical site infection (incisional-SSI) was the primary end-point. Secondary end-points comprised suture-to-wound length ratio (SWLR), closure duration, and fascial dehiscence (clinicatrials.gov NCT03561727). Results: A total of 268 patients were randomized to either mass (n=134) or layered (n=134) closure. Incisional-SSIs occurred in 24 (17.9%) and 8 (6.0%) patients after mass and layered closure, respectively (P =0.004), with crude odds ratio (OR) of 0.29 [95% confidence interval (95% CI) 0.13–0.67; P =0.004]. Layered technique was independently associated with fewer incisional-SSIs (OR: 0.29; 95% CI 0.12–0.69; P =0.005). The number needed to treat, absolute, and relative risk reduction for layered technique in reducing incisional-SSIs were 8.4 patients, 11.9%, and 66.5%, respectively. Dehiscence occurred in one (0.8%) patient after layered closure and in two (1.5%) patients after mass closure (P >0.999). Median SWLR were 8.1 and 5.6 (P <0.001) with median closure times of 27.5 and 25.0 minutes (P =0.044) for layered and mass closures, respectively. Conclusions: Layered closure of upper abdominal transverse incisions should be preferred due to lower risk of incisional-SSIs and higher SWLR, despite clinically irrelevant longer duration.

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Correspondence

Bohnen

Christou

MacLean

et al. 1983

Journal of British Surgery

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Correspondence SirThe conclusion of Ausobsky et al. (Br. J . Surg. 1982; 6 9 346-8), that skin testing is not predictive of postoperative problems, raises four points that deserve comment. First, the authors' patient numbers are far too small to conclude that skin testing is of no value in studying a patient population. Their incidence of major sepsis is higher among anergic than reactive patients, and though statistical significance is not reached, this certainly does not rule out an association. The low incidence may also reflect the high percentage of clean cases defined in their text.Secondly, the authors state that 'skin hypersensitivity tests are, however, only indicators of cell-mediated immunity, and d o not reflect the defensive powers of macrophages or polymorphonuclear leucocytes'. In fact, although skin testing has traditionally been used as a clinical test of so-called cell-mediated immunity, the great majority of cells infiltrating a skin test site are immunologically non-specific cells (mainly monocytes and lymphocytes, and including neutrophils) recruited from the blood by specifically sensitized T lymphocytes (I).Therefore, the skin test requires a number of specific and non-specific functions to be carried out. Several cell types and humoral factors are involved, making the skin test far more than just an assessment of 'cellmediated immunity' or T-cell function. Furthermore, patients with cutaneous anergy have been found to have abnormal neutrophil function and serum inhibitors of neutrophil chemotaxis (2.3).As a third comment we must object to the authors' omission of relevant information about their study. In a follow-up article (4), which deals with the same 166 patients as described in their above mentioned first paper, Ausobsky et al. indicate that roughly half their patients received perioperatively the immunomodulating agent levamisole. This fact is not included in the first report. Finally, there is a major discrepancy in the descriptions of the patient population given in the two papers. Their earlier report states in Table IV that 66 of the 166 patients had a malignant tumour; the more recent paper (4) claims in Table I that 89 of the 166 patients had a malignancy.We agree that the question of which comes first, sepsis or anergy, is valid. To determine if sepsis induces anergy in patients is difficult; however, in an animal model (5), previously reactive rats became anergic after sepsis was induced. Therefore, it does appear that sepsis among many other factors may lead to anergy and further defects in host defences. J. M. BOHNEN 1. Marchal G . , Seman M.. Milon G. et al.: Local adoptive transfer of skin delayed-type hypersensitivity initiated by a single T lymphocyte. J. Immunol. 1982; 129: 954-8. Christou N. V. and Meakins J. L.: Neutrophil function in surgical patients: two inhibitors of granulocyte chemotaxis associated with sepsis. J. Surg. Res. 1979; 26: 355-64. tion of serum inhibitors of neutrophil chemotaxis associated with anergy. J. Immunol. 1974; 113 189-200. Ausobsky J. R....

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Levamisole and postoperative complications: A controlled clinical trial

Cited by 5 publications

References 8 publications

Nutritional assessment and severity of illness classification systems: A critical review on their clinical relevance

Nutritional assessment and severity of illness classification systems: A critical review on their clinical relevance

Incisional Surgical Site Infections After Mass and Layered Closure of Upper Abdominal Transverse Incisions

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