Malnutrition as an unfavorable prognostic factor after surgical treatment for metastatic colorectal cancer.

<b><br>Introduction:</b> Colorectal cancer (CRC) is the second-leading cause of cancer-related deaths worldwide. Distant metastases are usually located in the liver and are present in 50% of patients.</br> <b><br>Aim:</b> The aim of this study is to evaluate changes in body composition and phase angle before and after surgical treatment of CRC liver metastases, as well as survival time and treatment costs.</br> <b><br>Material and methods:</b> The study included 134 patients who received 174 surgeries for CRC liver metastases. Bioelectrical impedance analysis (BIA) was performed using an AKERN BIA 101 analyzer.</br> <b><br>Results:</b> BIA was performed before and after surgery. The results of tests (total body water content [TBW], body cell mass [BCM], and phase angle) showed a reduction in BCM by 2.21 kg and a statistically significant decrease in phase angle values after surgery (from 5.06 to 4.25 in women and from 5.34 to 4.76 in men). These values are below the reference range for both sexes. There was a correlation between phase angle values and muscle mass, both before (R = 0.528, p<0001) and after surgery (R = 0.634, p<000.1). Preoperative levels of the tumor marker CEA were elevated in more than half of the patients. The median survival time after resection of liver metastases was 37.6 months.</br> <b><br>Discussion:</b> A significant factor that increases complications, mortality, and treatment costs of cancer patients is malnutrition, which could be the earliest symptom of malignant disease.</br> <b><br>Conclusions:</b> Successful treatment of CRC requires the patients to participate in follow-up examinations and to be aware of early signs associated with recurrence (e.g., blood in the stool or weight loss). The patients' nutritional status should be monitored and recorded in a DILO card.</br>.

Review of the monograph "Dietetics in oncological diseases".

The new monograph concerning the dietetics in oncological diseases was discussed.

[Selected lifestyle characteristic of patients with extreme obesity qualified for bariatric surgery]. / Wybrane cechy trybu zycia pacjentów z otyloscia olbrzymia zakwalifikowanych do operacji bariatrycznych.

The aim of the study was the analysis of chosen nutritional habits and physical activity among patients qualified for bariatric surgery. The research was conducted by questionnaire method. The results of the study show that number and regularity of meals was improper. Everybody snack, eg. sweets. About 50% of researched read information on the food packages, but only few participants paid attention to the nutritional and energy value of food products. TV and radio were the main source of nutritional information. Nutritional behaviors men and women were different. The level of physical activity was low.

Systematic mediastinal lymphadenectomy does not increase postoperative immune response after major lung resections.

OBJECTIVE: To assess the influence of mediastinal lymphadenectomy on postoperative concentration of interleukin 6 (IL-6) and interleukin 1 receptor antagonist (IL-1 ra) in serum, sputum, and pleural fluid, in patients operated upon due to lung cancer and benign pulmonary diseases. METHODS: Thirty-three patients undergoing uncomplicated resections, including 23 with lung cancer and 10 with benign diseases, were analyzed. In patients with right lung cancer we performed a systematic lymphadenectomy, while in patients with left lung cancer systematic sampling was performed. Serum IL-6 and IL-1 ra concentration was measured before and after surgery, and on postoperative days 1, 3, and 7, as well as in sputum at the end of surgery and in pleural fluid on postoperative day 1, by ELISA test. RESULTS: In 23 patients with cancer, 19.0+/-11.43 mediastinal lymph nodes were removed (in 11 patients with right lung cancer 27.6+/-7.6 and in 12 patients with left lung cancer 11.1+/-8.1). No differences were found in serum and sputum concentration of IL-6 and IL-1 ra between patients after right and left thoracotomy due to cancer and between patients with cancer and patients with benign diseases. Patients with cancer had a lower concentration of IL-1 ra in pleural fluid (median 16950, range 16050-45470.05 pg/ml) than patients with benign diseases (76665.6 pg/ml (range 53618-89617.9); p=0.0008). In 23 cancer patients a negative correlation between concentration of cytokines in pleural fluid and a number of mediastinal lymph nodes resected was observed (Spearman correlation coefficient for IL-6: r=-0.44, p=0.04; for IL-1 ra: r=-0.57, p=0.01). Such correlation was not observed for a number of positive N2 lymph nodes. CONCLUSIONS: Systematic lymphadenectomy added to major lung resection does not increase postoperative humoral immune response in uncomplicated cases, as measured by levels of IL-6 and IL-1 ra in serum, pleural fluid, and sputum.

Malnutrition, inflammation, atherosclerosis in hemodialysis patients.

Protein-energy malnutrition with muscle wasting occurs in a large proportion of patients with chronic renal failure and is, in addition to atherosclerosis, a strong risk factor for cardiovascular mortality in dialysis patients. There is evidence that a chronic inflammation with activation of C-reactive protein and proinfalammatory cytokines is associated with increased oxidative stress and endothelial dysfunction. Strong relations between malnutrition, inflammation and atherosclerosis in dialysis patients suggest the presence of a MIA (malnutrition, inflammation and atherosclerosis) syndrome, which is associated with high mortality rate. Thus, it could be speculated that suppression of the vicious cycle of malnutrition, inflammation and atherosclerosis would improve survival in dialysis patients.

Interleukin 6 and interleukin 1 receptor antagonist as early markers of complications after lung cancer surgery.

OBJECTIVE: To assess changes of interleukin 6 (IL-6) and interleukin 1 receptor antagonist (IL-1ra) in serum, sputum, and drained pleural fluid of patients operated on due to lung cancer. METHODS: Twenty-seven patients treated with lobectomy or pneumonectomy, including 14 with complications and 13 without complications, were analyzed. Serum IL-6 and IL-1ra concentration was measured before, at the end of surgery, and on postoperative day 1, 3, and 7, by ELISA test. Additionally, concentration of IL-6 and IL-1ra was measured in sputum at the end of surgery and in pleural fluid on postoperative day 1. RESULTS: In the entire group serum concentrations of IL-6 and IL-1ra were significantly elevated after surgery, in comparison with preoperative values. Serum IL-6 concentration was higher in patients with complications only on day 7 (median 59.0 (range: 41.25-76.65) pg/ml vs 21.5 (9.87-35.0) pg/ml; p=0.012). Patients with complications had higher concentration of IL-6 in pleural fluid (91312 (51812-94872) pg/ml vs 2006 (1926-2108) pg/ml; p=0.00008). Serum IL-1ra concentration was higher in patients with complications on day 1 (1832.4 (1144.7-2362.2) pg/ml vs 1088.4 (817.5-1312.5) pg/ml; p=0.01). Concentration of IL-1ra in drained fluid was higher in patients with complications (68128.8 (48104-108564) pg/ml vs 16470 (15930-16875) pg/ml; p=0.0003). On day 1 after surgery a significant correlation between serum and pleural fluid concentration for IL-6 as well as for IL-1ra were observed (Spearman test for IL-6: r=0.47; p=0.02; for IL-1ra: r=0.48; p=0.02). CONCLUSIONS: Elevated concentrations of IL-6 and IL-1ra in pleural fluid on postoperative day 1 are promising early markers of postoperative complications. Elevated concentrations of IL-6 and IL-1ra in serum are good early markers of severity of surgical injury and may reflect development of postoperative complications.

[Nutritional status of patients in hospitals in Poland. I. Screening of adult patients]. / Stan odzywienia pacjentów w szpitalach w Polsce. I. Ocena przesiewowa pacjentów doroslych.

The aim of the study was a screening assessment of the nutritional status of patients admitted to hospitals and discharged from hospitals. The study was carried out in 4 university hospitals, 4 woivodeship hospitals and 4 district hospitals. In randomly selected 3310 patients (every 10th patient admitted to hospital) anthropometric parameters were assessed: body height, body mass, body mass index (BMI), waist-hip ratio (WHR), arm circumference, blood morphological and biochemical parameters were determined (erythrocyte, white blood cell and lymphocyte count in blood, albumin and haemoglobin concentration in serum). The mean values of the assessed parameters in the whole studied population of patients admitted to various types of hospitals were not different from the normative values for adults, however, a gradual decrease of the values of certain parameters in the over 70 years age group was observed. Although, the mean values of the studied parameters of the nutritional status were within the accepted normal range, 10.43% of the studied patients had BMI below 20 kg/m2, and 20.7% of the patients the serum albumin level was below 3.5 g/dl on admission, which could suggest protein-energy malnutrition. In a yet higher proportion of patients (21%) lymphocyte count was below 1500/mm3. During hospital stay tendency became even more pronounced. On discharge from hospital the proportion of patients with BMI below 20 kg/m2 rose to 11.21%, and with serum albumin level below 3.5 g/dl rose to 28.6%. Only the proportion of patients with low lymphocyte count remained unchanged during hospital stay and was 21.1% on discharge. In the studied population 42.29% of the patients reported receiving of additional food beyond hospital diet.

[Nutritional status of patients in hospitals in Poland. More thorough assessment of nutritional status of adult patients]. / Stan odzywienia pacjentów w szpitalach w Polsce. II. Poglebiona ocena stanu odzywienia pacjentów doroslych.

The purpose of the study was a more thorough assessment of the nutrition state of patients admitted to hospitals in Poland. The study was carried out in four hospitals at teaching centre level, in four hospitals at province level, and in four county hospitals. The patients for the study were selected randomly from 3310 adult patients (every 10th patient admitted to these hospitals). For the study 210 patients (122 women and 88 men) were qualified. Their mean age was 54 +/- 16 years (range 15-82 years). The patients were subjected to various biochemical tests including determination of antioxidant vitamins (vitamins A, E and C), vitamin B12, folic acid, ferritin, and homocysteine and blood lipids. Vitamin deficiency accepted as vitamin malnutrition was found in the case of vitamin C in 51.8% of the patients, folic acid in 32%, vitamin E in 10%, vitamin B12 in 6.8%, vitamin A in 1.4%. Vitamin deficiency was equally frequent in patients with malnutrition, overweight or with obesity. Lipid profile disturbances were found in 51% and high homocysteine level in 63% of the studied patients.