Acupuncture Therapy ; Edema ; etiology ; immunology ; therapy ; Female ; Humans ; Lower Extremity ; pathology ; Middle Aged ; Ovarian Neoplasms ; surgery ; Postoperative Complications ; etiology ; therapy

OBJECTIVETo evaluate the role of nutritional status on serum immunoglobulins, body weight and postoperative infectious-related complications in patients with Crohn's disease receiving perioperative parenteral nutrition (PN).

METHODS32 patients with Crohn's disease receiving perioperative parenteral nutrition in our department between 1984 and 1994 were enrolled in this survey. 16 patients with loss of body weight in the range of 15%-30% were assigned to the malnutrition group, the other 16 patients with normal weight or loss of body weight less than 15% to the control group. Serum IgM, IgG and IgA levels were measured before and after PN by enzyme-linked immunosorbent assays. Liver function, body weight changes and postoperative complications were also analyzed.

RESULTSIgM levels were elevated before PN in both groups [control group: (133 +/- 16) mg/dl, malnutrition group: (139 +/- 41) mg/dl; normal value: (110 +/- 35) mg/dl; P = 0.04], decreased to normal value [(105 +/- 29) mg/dl, P = 0.02] in the malnutrition group while having no obvious changes in the control group [(129 +/- 13) mg/dl, P = 0.34]. No significant changes in concentrations of IgG and IgA were found (P in the range of 0.20-0.57). The average weight gain was 1.862 kg in malnutrition group [before PN: (45.8 +/- 8.9) kg, after PN: (48.0 +/- 8.8) kg; P = 0.005] and no significant changes in the control group [before PN: (55.6 +/- 6.1) kg, after PN: (56.3 +/- 6.0) kg; P = 0.46]. There was an increase in infectious complications in the control group (control group: 4 cases, 25%, malnourished group: 2 cases, 12.5%; P = 0.13).

CONCLUSIONSPerioperative parenteral nutrition ameliorated the humoral immunity, increased the body weight in patients with obvious malnutrition, whereas it had little value for those without or with mild malnutrition.

Adult ; Aged ; Body Weight ; Crohn Disease ; immunology ; surgery ; therapy ; Female ; Humans ; Immunoglobulins ; blood ; Male ; Malnutrition ; etiology ; Middle Aged ; Nutritional Status ; Parenteral Nutrition ; Pneumonia ; etiology ; Postoperative Complications ; etiology

BACKGROUNDThe relationship between inflammation and delirium remains to be determined. The purposes of this study were to investigate the association between serum interleukin-6 levels and the occurrence of delirium in elderly patients after major noncardiac surgery.

METHODSA total of 338 elderly patients (60 years of age and over) undergoing major noncardiac surgery were enrolled. Blood samples were obtained before anesthesia and in the first postoperative morning and serum interleukin-6 concentrations were measured. Delirium was assessed twice daily by the confusion assessment method for the Intensive Care Unit during the first three postoperative days. Survival analyses were performed to assess the relationship between the serum IL-6 level and the occurrence of postoperative delirium.

RESULTSPostoperative delirium occurred in 14.8% (50 of 338) of patients. High serum interleukin-6 levelsafter surgery were significantly associated with increased risk of the occurrence of postoperative delirium (hazard ratio 1.514, 95% confidence interval 1.155-1.985, P = 0.003). Other independent predictors of delirium included increasing age, poor preoperative New York Heart Association classification, low preoperative Mini-Mental State Examination score, and high total postoperative Visual Analogue Scale pain score. Patients who developed delirium had a prolonged hospital stay after surgery.

CONCLUSIONSDelirium is a frequent complication in elderly patients after noncardiac surgery. High serum interleukin-6 level after surgery is associated with increased risk of the occurrence of postoperative delirium.

Aged ; Cohort Studies ; Delirium ; etiology ; immunology ; Female ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Postoperative Complications ; blood ; etiology ; Prospective Studies ; Risk

Alterations of absolute number or percentage of circulating white blood cell (WBC) subsets are associated with psychological and physical stress. Gender effects on the changes of circulating WBC subsets following surgical treatment have not been determined. Therefore, the current study aimed to determine whether circulating neutrophils, lymphocytes and monocytes, and neutrophil-lymphocyte ratio (N/L) are different following major surgery according to the gender. We studied 409 male patients and 212 female patients who underwent total or subtotal gastrectomy due to stomach cancer, from 1 January to 31 December in 2005. The WBC count and percentage of its subsets were obtained from database and N/L was directly calculated from the full blood count preoperatively, immediate postoperatively, and postoperative day 1, 3, 5 in a retrospective manner. Compared to preoperative values, neutrophilia, lymphopenia, monocytopenia, and increased N/L were associated with gastrectomy in all patients. In the comparison study between genders, there were significantly increased proportion of neutrophils, decreased lymphocytes and monocytes, and higher N/L in female patients than in male patients after gastrectomy. These findings indicate that female patients showed more immune-compromised response to gastrectomy than male patients.
Adult ; Aged ; Female ; Gastrectomy/adverse effects ; Humans ; Immunocompromised Host ; Leukocyte Count ; Lymphopenia/blood/etiology/immunology ; Male ; Middle Aged ; Monocytes ; Neutrophils ; Postoperative Complications/etiology/immunology ; Retrospective Studies ; Sex Characteristics ; Stomach Neoplasms/*blood/immunology/*surgery

PURPOSE: To report clinical characteristics of thyroid-associated ophthalmopathy (TAO) in patients who previously underwent total thyroidectomy for thyroid cancer or a benign mass of the thyroid. MATERIALS AND METHODS: Of the patients who were diagnosed with TAO from March 2008 to March 2012, we performed a retrospective chart review on those who had undergone total thyroidectomy for thyroid cancer or a benign mass of the thyroid before the occurrence of ophthalmopathy. RESULTS: Of the 206 patients diagnosed with TAO, seven (3.4%) met the inclusion criteria. The mean age of the subjects was 47.4 years, and all were female. Six patients were diagnosed with papillary thyroid cancer, and one was diagnosed with a benign mass. The duration between total thyroidectomy and onset of TAO ranged from 3-120 months (median 48 months). Ophthalmic manifestations varied among cases. Except for the patient who was diagnosed with a benign mass, all patients showed hyperthyroid status and were under Synthroid hormone treatment at the time of TAO development. Five of these six patients had positive levels of thyroid-stimulating hormone (TSH) receptor autoantibodies. CONCLUSION: TAO rarely develops after total thyroidectomy, and the mechanism of TAO occurrence is unclear. However, most patients showed abnormalities in thyroid function and TSH receptor autoantibodies.
Adult ; Aged ; Autoantibodies/blood ; Carcinoma ; Carcinoma, Papillary/immunology/surgery ; Female ; Graves Ophthalmopathy/*diagnosis/immunology ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology/immunology/pathology ; Receptors, Thyrotropin ; Retrospective Studies ; Thyroid Neoplasms/complications/*surgery ; Thyroidectomy/adverse effects/*methods ; Thyrotropin/blood ; Treatment Outcome

OBJECTIVETo study postoperative sepsis in HIV/AIDS patients who underwent abdominal operations.

METHODSA retrospective analysis was performed to study 34 HIV/AIDS patients treated between January 2009 and December 2010 at the Shanghai Public Health Clinical Center Affiliated to Fudan University.

RESULTSThere were 31 males and 3 females in this cohort with a mean age of 45±13 years. Nineteen patients developed postoperative sepsis. The levels of preoperative CD4, postoperative CD4, preoperative CD4/CD8, and postoperative platelet were significantly lower than those without sepsis (all P<0.05). Among 19 patients with a preoperative CD4 cell count less than or equal to 200×10(6)/L, the incidence of postoperative sepsis rate was 84.2%(16/19), and for those with a preoperative CD4 cell count greater than 200×10(6)/L, the incidence of postoperative sepsis rate was 20.0%(3/15), the difference was statistically significant(P<0.05). There were 3 postoperative deaths.

CONCLUSIONCD4 cell count can be used as a predictive marker for the development of postoperative sepsis in patients with HIV/AIDS.

Abdomen ; surgery ; Adult ; Aged ; CD4 Lymphocyte Count ; CD4-Positive T-Lymphocytes ; immunology ; Female ; HIV Infections ; complications ; immunology ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Sepsis ; etiology ; Young Adult

OBJECTIVETo investigate the long-term complications after liver transplantation.

METHODSTotally 85 living patients who received liver transplantation from December 30th 1998 to May 28th 2002 in Tianjin First Central Hospital were followed up till October 2007. Liver and kidney functions, blood drug levels, blood pressure, blood sugar, and blood fat were recorded and ultrasound imaging was performed during follow-up.

RESULTSAt the end of the study, most patients had experienced one or more complications of prolonged immunosuppressant treatment, including posttransplantation diabetes mellitus (21.18%, 18/85), hypertension (10.59%, 9/85), renal impairment (8.24%, 7/85), hyperlipemia (7.06%, 6/85), hyperuricaemia (7.06%, 6/85), denovo malignancy (2.35%, 2/85), new-onset hepatitis C (7.06%, 6/ 85), recurrent hepatitis B (5.56%, 4/72).

CONCLUSIONRecipients of liver transportation often suffers long-term complications, which should be carefully managed to improve their quality of life.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Kidney ; physiopathology ; Liver ; physiopathology ; Liver Transplantation ; adverse effects ; immunology ; Male ; Middle Aged ; Postoperative Complications ; etiology ; immunology ; physiopathology ; Young Adult

OBJECTIVESTo study clinical characteristics and outcome of pure red cell aplasia (PRCA) following major ABO-incompatible allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSVariables including sex, age, stem cell source, granulocyte engraftment time, blood transfusion and isoagglutinin type against donor RBC were analyzed to identify risk factors for the development of PRCA.

RESULTSTwelve of 100 patients received major ABO-incompatible allo-HSCT developed PRCA, with out any effect on incidence of aGVHD and CMV infection. ABO blood groups of recipient/donor pairs of these twelve PRCA patients were O/A in nine, B/A in one and O/B in two. Patients with anti-A isoagglutinins against donor RBC developed PRCA more frequently than those with anti-B (10/49 vs 2/49). Median duration to the recovery of erythropoiesis tended to be longer in patients with PRCA (PRCA vs non-PRCA, 203.5 vs. 76 days, P < 0.05 ). Median durations to the disappearance of incompatible isoagglutinins tended to be longer in patients with PRCA (PRCA vs. non-PRCA, 150.5 vs. 60 days,P <0.05) and in those with anti-A isoagglutinins (anti-A vs anti-B, 90 vs 55 days, P < 0.05).

CONCLUSIONABO blood group of O/A in recipient/donor pair was the only high risk factor for PRCA after major ABO-incompatible allo-HSCT.

ABO Blood-Group System ; immunology ; Blood Group Incompatibility ; Hematopoietic Stem Cell Transplantation ; adverse effects ; methods ; Humans ; Postoperative Complications ; etiology ; therapy ; Prognosis ; Red-Cell Aplasia, Pure ; etiology ; therapy ; Retrospective Studies ; Risk Factors

OBJECTIVETo observe the immunologic changes in patients who have complications after polyacrylamide hydrogel (HPG) injection.

METHODSTo compare the patients in the HPG injection group and the control group, the expressions of immunoglobulin IgG, IgM, IgA and complement C3, C4 of serum were measured by immunoturbidimetry.

RESULTSThe expressions of IgG and C3 in the injection group were lower than the control group with extremely significant difference (P < 0.01). The expressions of IgM were higher than the control group with significant difference (P < 0.05). The expression of IgA and C4 had no significant differences between the two groups. The immunologic changes had no relation to the injection doses.

CONCLUSIONSClinical application of HPG as a soft tissue filling material may cause foreign-body rejection reaction. The long-term immunologic effect of HPG needs further observation in more cases.

Acrylic Resins ; adverse effects ; Adult ; Breast ; surgery ; Complement C3 ; analysis ; Complement C4 ; analysis ; Humans ; Immunoglobulin A ; blood ; Immunoglobulin G ; blood ; Immunoglobulin M ; blood ; Male ; Nephelometry and Turbidimetry ; Postoperative Complications ; etiology ; immunology