Impact of patients nutritional status on major surgery outcome.

OBJECTIVE: Surgery is a major stress factor that activates several inflammatory and catabolic pathways in man. An appropriate nutritional status allows the body to react properly to this stressor and recover in a faster and more efficient manner. On the other hand, malnutrition is related to a worse surgery outcome and to a higher prevalence of comorbidities and mortality. The aims of this study were to evaluate the nutritional status of patients undergoing major surgery and investigate the potential correlation between malnutrition and surgical outcomes. PATIENTS AND METHODS: Mini Nutritional Assessment (MNA) and global clinical examination (including biochemical parameters and comorbidities existence) were undertaken in 50 consecutive patients undergoing major surgery. Patients' clinical conditions were re-evaluated at 3 and 6 days after surgery, recording biochemical parameters and systemic and/or wound-related complications. RESULTS: A compromised nutritional status was present in more than half (54%) of patients (malnutrition in 10% and risk of malnutrition in 44% of patients, respectively). Females were slightly more at risk of malnutrition (48% vs. 41%, p=NS, females vs. males) and clearly malnourished (14% vs. 7%, p<0.05, females vs. males). Age was an independent risk factor for malnutrition and within the elders' group (> 80 years old) 16.70% of patients was diagnosed with malnutrition and 58.3% was at risk of malnutrition. Systemic complications were registered in all patients both at 3 and 6 days after surgery. However, well-nourished and at-risk of malnutrition patients had earlier complications that only partially resolved within six days after the operation. Malnourished patients showed fewer complications at the 3rd post-surgery follow-up day but had a worse outcome six days after surgery. CONCLUSIONS: Older age and but not female sex are independent risk factors for malnutrition development in patients undergoing major surgery. More interestingly, more than half of patients with an impaired nutritional status presented a less appropriated stress response to surgery. These data suggest that nutritional status assessment may be important to recognize patients at potential risk of surgical complications and that early nutritional interventions must be promptly arranged.

The nature of the disorder underlying the inability to retrieve proper names.

Two patients with the syndrome of proper name anomia were investigated. Both patients were only able to produce around 50% of the names of contemporary celebrities, but performed significantly better on a task calling for naming of historical figures. The names of relatives and friends were spared in one patient, while the other retrieved names of people known since childhood much better than those of people familiar to him since the age of 25. Geographical names, names of monuments and masterpieces were preserved. The above dissociations are taken to imply that in moderately impaired patients, a temporal gradient effect concurs to modulate the severity of the naming block. A similar impairment was found in both patients when they attempted to retrieve or relearn familiar telephone numbers. This finding suggests that the core of the disorder resides in the inability to gain access to words used to identify a single entity, regardless of whether they belong to the class of proper or common names.

Interferon alpha 2-b therapy of HCV and nonBnonC chronic hepatitis.

Twenty-four patients with HCV and NonBNonC chronic hepatitis--4 with HIV coinfection--were treated with r-IFN alpha for at least six months. In this period 62.5% of patients show a normalization of ALT but not a sustained remission. Non-responders have histologically more severe and long-lasting chronic hepatitis.