Immunonutrition and cytokine response in patients with head injury.

BACKGROUND: To investigate whether short-term postoperative immunonutrients feeding can modulate the level of cytokines in patients with head injury compared to standard enteral tube feeding formula. MATERIAL AND METHOD: A randomized double-blind study was carried out on 40 moderate to severe head injury patients. They were randomized to have continuous nasogastric tube feeding within 24 hours after surgery of either the immunonutrient containing enteral formula (group A) or the standard enteral formula (group B). The level of interleukin-6 (IL-6) and 10 (IL-10) were measured on day 1 (before feeding), and subsequently on day 3 and day 5. RESULTS: Twenty patients were randomly selected in each group, who had similar severity levels of injury. Compared to the level of IL-6 on day 1, the level of IL-6 was markedly reduced on day 3 in group A (p = 0.002), whereas such reduction in group B was not statistically significant. CONCLUSION: Short term postoperative immunonutrient feeding can reduce cytokine level, indicating that systemic inflammatory response syndrome might be modulated by such feeding.

Left retroperitoneal versus midline transperitoneal approach for abdominal aortic aneurysms (AAAs) repair.

OBJECTIVE: The purpose of this prospective randomized study was to compare the left retroperitoneal approach (RPA) with the midline transperitoneal approach (TPA) for infrarenal abdominal aortic aneurysms (AAAs) repair with operative details, postoperative complications, and total cost comparision. MATERIAL AND METHOD: Between January 2000 and December 2003, 36 patients undergoing elective surgery for infrarenal AAAs were included in the prospective comparison of transperitoneal approach (TPA) with retroperitoneal approach (RPA). Thirty-six patients were analyzed, with 18 in group 2 (TPA) and 18 in group I (PRA). There was no significant differences between the groups in patient demographics. (p value > 0.05) RESULTS: There was no significant differences in the aortic cross clamp time, operative time, estimated blood loss and intraoperative blood transfusion between the two groups (p value > 0.05); however, significantly more intraoperative fluid needs and bowel function onset had a statistically longer return in group 11 (TPA) than in group I (RPA). Statistically reduction in postoperative ileus (>4 days) and total length of hospital stay was observed in group I (RPA) (p value < 0.05). Postoperative cardiopulmonary complications were statistically significantly more increased in group II (TPA) than in group I (RPA). Wound complications were more in group I (RPA) (1 hematoma, 4 abdominal wall hernia, and 4 chronic wound pain) than in group II (TPA) (2 chronic wound pain). Total cost payment was not significantly different in both groups. CONCLUSION: The left retroperitoneal approach for infrarenal AAAs repair, with fewer cardiopulmonary complications and shorter hospital stay has more unsatisfactory postoperative wound complications than the midline transperitoneal approach.