Short-term preoperative supplementation of an immunoenriched diet does not improve clinical outcome in well-nourished patients undergoing abdominal cancer surgery

ObjectiveA recent study suggested that the anti-inflammatory effect of immunonutrition starts after only two d. We therefore investigated the effect of an immunoenriched oral diet administered for three d preoperatively.MethodsIn this prospective, randomized, double-blind, placebo-controlled study, well-nourished patients (Nutrition Risk Screening 2002 <3) with gastrointestinal cancer who were scheduled for major elective abdominal cancer surgery were randomly assigned to either 750 mL of an immunoenriched formula (IEF group) or 750 mL of an isocaloric, isonitrogenous placebo diet (Con group) for 3 consecutive d preoperatively.ResultsA total of 108 patients (IEF group: n = 55; Con group: n = 53) were randomized. The two groups were comparable for all baseline and surgical characteristics. The overall mortality was 2.8% and not significantly different between the two groups (IEF group: 3.6% vs. Con group: 1.9%, P = 1.00). Intention-to-treat analysis showed no difference for the incidence of postoperative overall (IEF group: 29% vs. Con group: 30%; P = 1.00) and infectious (IEF group: 15% vs. Con group: 17%; P = 0.79) complications. Length of hospital stay was 12 ± 4.9 d in the IEF group and 11.6 ± 5.3 d in the Con group (P = 0.68).ConclusionsPreoperative oral supplementation with an immunoenriched diet for 3 d preoperatively did not improve postoperative outcome compared with the placebo in well-nourished patients with elective gastrointestinal cancer surgery.     

Biobanken – zwischen Forschungs- und Spenderinteressen

The establishment and operation of research biobanks are still not regulated by special laws. As a consequence, the acquisition, storage and use of biobank materials and data are only covered by quite general legal regulations. The way in which these rules are to be interpreted in relation to the specific problems of biobanks is rather controversial. The central question revolves around the tense relationship between the right to privacy of the donor and the academic freedom of the researchers. This article gives an overview of the current discussion and suggestions for practice.     

Akzidentelle Quadrizepstenodese durch arthroskopische Kreuzbandplastik

Adjustable loop button fixations are commonly applied in anterior cruciate ligament (ACL) surgery. In the following case of a young female soccer player, the combination of soft tissue interposition and tunnel malplacement led to an accidental tenodesis of the quadriceps tendon. This resulted in a massive restriction of the joint function which was resolved by arthroscopic removal of the transplant and fixation. The patient gained full range of motion 8 weeks postoperatively.     

Effects of ivacaftor on severely ill patients with cystic fibrosis carrying a G551D mutation

BackgroundRecently, ivacaftor, a CFTR-potentiator, has been shown to be effective and safe in patients with cystic fibrosis carrying a G551D mutation and moderately impaired lung function. The objective of this retrospective study was to assess efficacy and safety of ivacaftor in severely ill patients with at least one G551D mutation.MethodsData from 14 patients with a FEV1 < 40% predicted who received ivacaftor on a “named patient program” base in Germany were analyzed.ResultsOne patient took ivacaftor at a lower than recommended dose due to abundant mucus and a feeling to “suffocate.” No additional severe adverse events were reported. One further patient stopped ivacaftor due to lung transplantation, one due to perceived poor effectiveness, one due to pregnancy, and one stopped standard therapy. The remaining patients took ivacaftor regularly and did not change other therapies. FEV₁ increased by more than 5 %predicted in 5 of the 14 patients from baseline (average FEV₁ during the year prior to ivacaftor). On average, FEV₁ increased significantly by 5.2 ± 5.6%predicted (p < 0.01). The relative improvement in FEV₁ was 19.7 ± 22.1%.ConclusionIvacaftor was effective in many patients with poor lung function. The response was, however, variable. Although the drug appeared safe for most of these patients, increased bronchial secretions may warrant intensified physiotherapy and intravenous antibiotic treatment when ivacaftor is initiated.