ABSTRACT
The incidence of infectious complications due to several contributory causes is particularly elevated and life-threatening in patients undergoing peritonectomy and HIPEC procedure for peritoneal carcinomatosis. Following a previous experience, we started a prospective protocol study of preoperative screening, perioperative prophylaxis and postoperative surveillance and treatment. A total of 111 patients with peritoneal carcinomatosis of various origin underwent CRS with HIPEC between April 2004 and December 2012. The group was divided into a pilot group of 30 patients (04/04 to 05/08) and a main group of 81 patients (06/08 to 12/12). Overall postoperative morbidity rate was 44%, with 35.8% of symptomatic infections. No post-operative mortality was observed. Microorganisms were isolated in 24 patients (80.0%) in the first group and 54 (66.7%) in the second. They were symptomatic in 18 cases (75.0%) and 25 (46.3%) cases respectively. In addition, 7 invasive candidosis were recorded (25.9%). Colon resection (P = 0.01) and duration of surgery (P = 0.0008) were associated with infection at logistic regression model. Concerning symptomatic infections, only Infection Risk Index (P = 0.009) showed significance at multivariate analysis. Despite a significant incidence of infectious complications, establishment of a prevention, surveillance and treatment protocol lead to a zero mortality rate in the observed patients of our experience. Owing to the obtained results, we suggest the use of a standardized protocol for the prevention, monitoring and treatment in all patients enrolled for cytoreductive surgery and HIPEC.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Bacterial Infections/etiology , Bacterial Infections/therapy , Carcinoma/therapy , Chemotherapy, Cancer, Regional Perfusion , Disinfection/methods , Hyperthermia, Induced , Peritoneal Neoplasms/therapy , Primary Prevention/methods , Adolescent , Adult , Aged , Antibiotic Prophylaxis , Bacteremia/etiology , Bacteremia/therapy , Bacterial Infections/microbiology , Bacterial Infections/prevention & control , Carcinoma/drug therapy , Carcinoma/surgery , Chemotherapy, Adjuvant , Chemotherapy, Cancer, Regional Perfusion/methods , Clinical Protocols , Drainage , Female , Humans , Male , Middle Aged , Mycoses/etiology , Mycoses/therapy , Peritoneal Cavity , Peritoneal Neoplasms/drug therapy , Peritoneal Neoplasms/surgery , Population Surveillance , Postoperative Complications/etiology , Postoperative Complications/therapy , Prospective Studies , Surgical Wound Infection/etiology , Surgical Wound Infection/therapy , Urinary Tract Infections/etiology , Urinary Tract Infections/therapyABSTRACT
This paper investigated the chemotactic capacity of blood eosinophils (EOS) in response to C5a and formyl-leucyl-phenylalanine (FMLP) in 15 Parietaria-pollen-allergic patients with mild asthma during the Parietaria pollen season. Data showed that EOS chemotaxis toward C5a was significantly reduced during the peak pollen count, compared with the values obtained in normal subjects. On the other hand, FMLP could induce EOS chemotactic activity only in Parietaria-allergic patients, the highest value being registered during the height of the Parietaria season. In vitro cimetidine modulation of chemotactic function in comparison with C5a led to a recovery of the impaired results obtained in the presence of high histamine levels. Moreover, diphenhydramine preincubation of EOS induced a reduction of the enhanced chemotactic activity obtained with low concentrations. The data suggest that different serum histamine levels give rise to an impaired immune-phlogistic response in allergic patients and that histamine-receptor antagonists may modulate this effect.