ABSTRACTS 99

GENERAL CONSIDERATIONS

Hazards to Children in Traffic. R. H. Jackson. Arch Dis Child 53:807-813, (October), 1978+

The magnitude of the problem of traffic accidents in Britain involving children is highlighted by the statistics of mortality and morbidity. Improvements in the past few years in numbers of fatal traffic accidents involving children under 10 yr is partly offset by an increase in fatal accidents in the 10-14 yr group. A total of 557 road accident deaths occurred in 1976 (42% of all accidental deaths in children). Morbidity statistics are more difficult to ascertain but in 1976 over 11,000 children were seriously injured on the roads. The best place to collect these figures is probably the Accident and Emergency Department. Analyses of accidents from the viewpoints of the child himself, the "agent" causing the accident and the circumstances surrounding the accident show in particular the important influence of the child's development and behavior on the likelihood of accident. Factors such as the child's limited ability to see traffic easily because of his height, to localise sound accurately, to concen- trate on more than one thing at a time and to understand the traffic signs have a strong bearing on the chances and nature of accidents. An improved understanding by adults of chil- dren's problems in coping with traffic would lead to greater safety and the work of the proposed Joint Committee on Childhood Accident Prevention will be directed to this end.--Peter .4. M. Raine.

Total Parenteral Nutrition in Pediatric Surgery: Experience in 5 5 C a s e s . U. Tannuri, I. Alves, and .4. L. Mathias. Rev Assoc Med Bras 25:143-145, (April), 1979.

The authors present their experience in 55 cases of surgi- cal pediatric cases submitted to total parenteral nutrition (TPN) either before or before and after surgery. There was a significant decrease in the overall mortality rate, mainly in neonatal surgery.--Alberto Peha

Clinical Experience With Central Venous Catheters in Infants and Children. K. Pleskott, M. Ujvhry, and 1. Szhntb. Orvosi Hetilap 120:1515-1518, (June), 1979.

The authors describe their technique using central venous catheters. They divide the complications into five groups: malposition of the catheter, perforation, thrombosis, infec- tion, and cardiac arrest. Radiographic localization of the catheter is mandatory, however, it is sometimes not suffi- cient. Cases of displacement of the catheter caused by active or passive movements of the patient leading to serious complications have been observed.--Andrew Pintkr

Evaluation of Cellular Immunity and Adrenocortical and Activity in Surgical Patients. S. J. Shochat, C. A. Mil ler, and P. Snyder. J Surg Res 26:332-340, (March), 1979.

The depression of immune response following surgery and general anesthesia has previously been demonstrated. A main component of this depression seems to be a defect in cell-mediated immunity. This depression has been attributed in part to a release of adrenocorticoids in response to the stress of trauma or surgery, although simultaneous evaluation

of cell-mediated immunity and adrenocortical function has not previously been reported. Mitogen- and antigen-induced lymphocyte transformation, T-Cell, and B-Cell rosette formation, and serum coritsol assays were serially analyzed during the preoperative, intraoperative, and postoperative periods in 18 elective surgical patients. The lymphoprolifera- tive response to phytohemagglutinin and staphylococcal phage lysate declined following induction of anesthesia. Significant inhibition was seen immediately following surgery and on the first postoperative day with recovery by the fifth postoperative day. The T-lymphocyte rosettes declined slightly during the postoperative period and remained depressed until recovery by the fifth postoperative day. There was no decline in B-lymphocyte rosette forma- tion, and the number of rosettes actually increased slightly during the postoperative period. No change in the proportion of T- and B-Cells in the postoperative period was observed. The mean serum cortisol level, though slightly elevated in the preoperative period, declined significantly following the induction in anesthesia and approached, but did not exceed, the preoperative value during the postoperative period. Since the cortisol values in the postinduction and immediate post- operative period did not exceed preoperative values, the significant depression of lymphocyte stimulation cannot be explained on the basis of corticosteroid release. This study confirms the finding that surgery and general anesthesia induce a profound, but transient depression of lymphocyte function. The immuno suppression demonstrated in the post- operative period suggest a multifactorial situation and further studies will be required to determine its et iology.- Richard J. Andrassy

Risk Factors in Postoperative Sepsis: Significance of Preoperative Lymphocytopenia. R. T. Lewis and H. Klein. J Surg Res 26:365-371, (April), 1979.

A retrospective analysis of 6 risk factors affecting the frequency of postoperative sepsis was undertaken in 105 patients. Patient age, duration of operation, malignancy, preoperative blood lymphocyte count, wound contamination, and serum albumin were reviewed. Significant associations with infection were observed with preoperative lymphocyto- penia, hypoalbuminemia, and wound contamination. Nine of 24 patients with preoperative lymphocyte counts below 1000/ml 3 developed postoperative sepsis, while only 7 of 81 with lymphocyte counts above that level did so (p < 0.0007). The same risk factors were then examined prospectively in 125 patients undergoing major surgery. The preoperative lymphocyte count, wound contamination, and serum albu- min were again found to be significant. Lymphocytopenia below 1000/ml 3 was associated with hypoalbuminemia below 2.7g/100ml (p < 0.001). The incidence of postopera- tive sepsis was significantly increased when a low preopera- tive blood lymphocyte count and serum albumin was seen in conjunction with intraoperative wound contamination. The preoperative lymphocyte count measures host resistance simply, reliably, and rapidly, and correlates with nutritional deficiency as indicated by preoperative hypoalbuminemia. The preoperative lymphocyte count is a good measure of host resistance to developing postoperative sepsis.--Richard J. Andrassy