P.21 MODIFICATIONS OF IMMUNOLOGICAL PARAMETERS DURING PRE AND POSTOPERATIVE TPN WITH AND WITHOUT FAT EMULSIONS IN GA

STRIC CANCER PATIENTS P. Dionigi, V. Jemos, C. Tibaldeschi, S. Olezza, A. Clerici , g. Dionigi (Dipartlmento di

Chirurgia, Sezione di Patologia Chlrurgica, UniversitA di Pavia, 27100 Pavia, I ta ly)

IPB with l ipids is frequently used in malnourished patients. However, possible negative effects of fat emul

sions upon the immunological responsiveness has been reported in experimental studies. Purpose of this study is

to evaluate variations of same immunological parameters during fat emulsion infusion. Eighteen malnourished p~

tients (body weight Ioss>lO~) with advanced gastric cancer received the same amount of calories and nitrogen

(2800 Kcal and 13.6 g N/die) as pre and postoperative TPN (2 and I week respectively). In I0 patients (group A:

g m - I f; 61jlO y) the 4gx of the total caloric amount was supplied as fat emulsions, whereas 8 patients

(group B: 4 m - 4 f; 66+11 y) received glucose as the only caloric source. The two groups were similar for type

of cancer, stage of disease and nutritional status. The following immunoIoglcal parameters were sequentially de

termined at admission, preoperatively (-I2,-g,-5,-2 day) and postoperatively (+4,+7,+15): WBC, lymphocytes (to

ta], T and B), neutrophil chemotaxls, phagocytosis and adherence, complement components (C3c, C3 activator),

IgG, IgM, ceruloplasmin. Delayed hypersensitivity response (DHR) was investigated at the admission only. Nutri

tional parameters were impared inltially, they decreased during the study, but no significant difference could

be recorded between the two groups. At admission DHR was severely compromised in both groups (abnormal respo~

ses: A=gO~, B=67~). Total lymphocyte count was below the normal range (A=I620+6go; B=1670+820) and Further de

creased during the study, T lymphocytes being more impaired (55~) than B iymphocytes (25~). Abnormal high con

centratlons of C3c and ceruloplasmln were observed at diagnosis but only in group B they presented a progress !

ve reduction and reached the normal level. All the other immunological parameters remained withln the normal

range and showed negligible differences between group A and B. In conclusion our results demonstrate that i.v.

administration of fat emulsions in malnourlshed cancer patients does not affect per se the immunological param~

ters consldered.

P.22THE RELATION OF PRE-OPERATIVE INTRADERMAL TESTING WITH RECALL ANTIGENS AND POST-OPERA- TIVE COMPLICATIONS IN SURGICAL PATIENTS (n=143) AND A CONTROL GROUP (n=38) P.C.M.de Jong, M.Rouflart, R.l.C.Wesdorp, P.B.Soeters and J.M.Greep (St.Annadal Hospital , University of Limburg, Dpt.of Surgery, Maastricht, The Netherlands).

Many invest igators have suggested, that intradermal test ing with recal l antigens is a simple means of test ing immunity and they proved a re lat ionship between altered host re- sistance, sepsis and mor ta l i ty in surgical patients. Others could not confirm this rela- t ionship. To invest igate the re la t ion in Dutch surgical pat ients, 143 patients were tes- ted pre-operat ively with 5 recal l antigens (streptokinase-streptodornase, mumps, candida, trichophyton and PPD (tubercul in))and the post-operative complications ( in fec t ion, sepsis and mor ta l i ty ) were registered. These results were compared with a control group of 38 e lec t i ve ly admitted patients (hernia repair and varicose veins). Anergic (A) = no indura- t ion a f ter 24 and 48 hours of at least 5 mm. Relative anergic (RA) = i posi t ive reaction of at least 5 mm. Normal reacting (NR) = 2 or more posi t ive reactions. S ign i f icant d i f - ferences (p<0.05) were found between the A- and NR- group in mor ta l i t y (A = 19.5% NR = 4.8%), sepsis (A = 19.5%~--,NR =7.2%) and in fect ion (A = 14.6%~--~ NR = 6%). When the RA group was considered to be NR (strong evidence for this is found when this pat ient group is compared with the control group), the A group and the N + RA group were also s ign i f i can t l y d i f fe ren t in complication rate : mor ta l i ty (A = 19.5%~-~RA + N = 5.8%), sepsis (A = 19.5%<--> RA + N = 7.8%) and infect ion (A = 14.6%<-~RA + N = 7.8%). These re- sults were influenced by age because the anergic patients were s ign i f i can t l y older than those with a normal response. Malignancy and to ta l parenteral nu t r i t i on (TPN) correlated well with anergy and some commonly used indicators of malnutr i t ion. In the control group, where 2 patients were anergic and 36 normal reacting, no complications developed in the post-operative period. Although in the overal l results there was a s ign i f i can t re la t ion- ship between complications and anergy, strong influences appeared to be exerted by age, underlying disease and malnourishment.