Postoperative leukocyte changes in facial fracture patients: a randomized prospective study with short-term dexamethasone.

PURPOSE: We investigated leukocyte changes in facial fracture patients undergoing surgery. Of specific interest was the effect of perioperative dexamethasone on leukocyte changes. METHODS: Facial fracture patients were randomized to receive perioperatively a total dose of 30 mg of dexamethasone, whereas patients in the control group received no glucocorticoid. All patients received antibiotics until postoperative days 7-10. Leukocyte count was measured on postoperative days 1 and 2. Clinical infections were observed during the follow-up. RESULTS: A total of 110 adult patients were included in the study. Postoperative leukocytosis was found in 91.2% of patients receiving dexamethasone and in 67.9% of controls. Dexamethasone was associated strongly with leukocyte rise (p < 0.001) on both postoperative days. Transoral surgery and younger age (≤40 years) showed significant associations with leukocytosis on the first postoperative day (p = 0.002). In regression analyses, dexamethasone associated with leukocytosis most significantly (p < 0.001). No association was found with infections. CONCLUSIONS: Dexamethasone use was the most significant predictor of leukocyte rise. As a drug response, perioperative dexamethasone caused sixfold postoperative leukocytosis. High-dose dexamethasone-induced leukocytosis may confuse the clinical decision-making especially in assessment of early infections.

[Immunocorrection in the combined treatment of patients with osteomyelitis developing following combined injuries to the maxillofacial and craniocerebral areas]. / Immunokorrektsiia v kompleksnom lechenii bol'nykh s osteomielitom, razvivshimsia posle sochetannykh povrezhdenii cheliustno-litsevoi i cherepno-mozgovoi oblastei.

Twenty-one of the forty-two patients with osteomyelitis developing after a combined maxillofacial and craniocerebral injury were administered thymogen, an immunocorrective drug, as a component of combined therapy; immunologic indications for the prescription of such an agent were present in all these patients. Depressed T-cellular immunity was the principal disorder of the immunologic reactivity of this patient population; they also developed elevated counts of NK cells and increased interleukin synthesis by the macrophages, this reflecting a high activity of inflammation. Thymogen therapy was conducive to normalization of the immunologic and nonspecific reactivity and enhanced the treatment efficacy on the whole.

[T- and B-lymphocytes, interleukins and natural killers in patients with osteomyelitis developing after combined injuries to the maxillofacial and craniocerebral areas]. / T- i B-limfotsity, interleikiny i estestvennye killery u bol'nykh s osteomielitom, razvivshimsia posle sochetannykh povrezhdenii cheliustno-litsevoi i cherepno-mozgovoi oblastei.

Forty-three patients with traumatic osteomyelitis developing after combined maxillofacial and craniocerebral injuries and thirty normal subjects were examined. Immunologic findings permit distinguishing two groups of patients: those with marked disorders of the T cellular immunity (reduced T helper and Tx counts, interleukin-2 synthesis, and Tx/T suppressor coefficient) and without such shifts. The therapy of patients without manifest immunity shifts was generally effective whereas in those with marked immunity disorders the therapy efficacy was inadequate and the immunity disorders persisted.

[The pathogenetic aspects of the effect of hypoxia on the trigger mechanisms of suppurative-inflammatory complications in patients with combined maxillofacial and craniocerebral trauma]. / Patogeneticheskie aspekty vliianiia gipoksii na triggernye mekhanizmy gnoino-vospalitel'nykh oslozhnenii u bol'nykh s sochetannoi cheliustno-litsevoi i cherepno-mozgovoi travmoi.

Study of the relationship between the time course of secondary tissue hypoxia development and changes in the neutrophilic phagocytic activity, which was carried out in 65 patients with combined maxillofacial and craniocerebral injury, has revealed a detrimental effect of hypoxia on antibacterial defense factors of the body, this effect being conductive to development of pyoinflammatory complications; this should be borne in mind when planning treatment strategy.

[The immunologic aspects of inflammatory complications in combined maxillofacial and craniocerebral trauma]. / Immunologicheskie aspekty vospalitel'nykh oslozhnenii pri sochetannoi cheliustno-litsevoi i cherepno-mozgovoi travme.

In 56 patients with combined maxillofacial and craniocerebral trauma the indices of cellular and humoral immunity were investigated in the course of acute post-trauma period and related to trauma severity. Investigated was also the influence of ACTH and corticosteroid hormones on the mechanisms of secondary transitory immune deficiency and related complications. It was established that in combined craniocerebral and maxillofacial trauma the late complications developed against the background of a considerable catabolic activation (increased levels of ACTH and cortisol), and suppression of cellular immunity. These were indications to goal-directed immune correction as a part in combined therapeutic intervention at the early stages of traumatic disease.