The effect of a continuous infusion of a soybean oil emulsion on immune function was evaluated in 40 malnourished patients who were randomized to receive preoperatively either a 25% glucose-5% amino acid solution (group G) or a 15% glucose-3.3% Intralipid-5% amino acid solution (group G-F). Average length of total parenteral nutrition (TPN) was 10.3 +/- 0.9 days for group G and 9.0 +/- 0.8 days for group G-F. Initial nutritional status and response to TPN were similar for both groups. Immune function was assessed before TPN and after nutritional repletion prior to surgery for each patient. The levels of immunoglobulins, C3, C4, circulating B lymphocytes and T lymphocytes, suppressor T lymphocytes, natural killer cell activity, and monocytes were normal before TPN and after nutritional therapy. However, the total number of T cells and helper T cells were low before TPN and remained so after TPN. In addition, lymphocyte function measured by the lymphocyte blastogenic response to phytohemagglutinin and pokeweed mitogen was depressed prior to TPN and was not improved by either regimen. Neutrophil chemotaxis and bactericidal activity were not affected by either nutritional regimen while neutrophil phagocytosis was enhanced before TPN and remained elevated throughout TPN with either regimen. There were no differences in infection rates during TPN. The addition of Intralipid to the TPN regimen did not alter immune function in these patients who showed depressed cell-mediated immunity before TPN compared with the standard glucose TPN regimen.

B-Lymphocytes↗

PubMedDate not supplied

Staging of lung cancer.

The morphology of the tumor and the anatomic extent of the disease are important factors influencing treatment selection and ultimately survival for patients with lung cancer. The American Joint Committee TNM system provides a method for consistent reproducible description of the primary tumor (T), the status of the regional lymph nodes (N), and the presence or absence of distant metastasis (M). The TNM subsets thus classified can be grouped into three "stages" of disease such that the survival expectations for patients in each stage and cell type are similar. This classification of patients with respect to estimates of their prognosis is essential for valid comparisons of treatment modalities and meaningful communication of end results information.Clinical characteristics which influence survival are reflected in the staging recommendations. The size of the lesion, the proximal margination, and the presence or absence of other pulmonary complications are features which distinguish the T classification as T1, T2, or T3. The presence or absence of lymph node involvement has an important bearing on survival expectations. Advancing from no nodal involvement, N0, to involvement of the peribronchial and hilar nodes, N1, and then to the mediastinal nodes, N2, causes progressive erosion in survival expectations. The tumor morphology and specific nodes that are involved are important components of this relationship. The presence of distant metastasis, M1, is synonymous with an extremely poor prognosis. Using these prognostic elements, the TNM subsets are combined into three stages of disease so that patients in each group will have a generally similar life expectancy, the survival for patients with stage I disease being significantly greater than that for patients with stage II disease which is significantly greater than survival for patients with stage III disease.Improvements in the outcome for lung cancer patients depend upon the depth and scope of our scientific understandings and our ability to communicate our observations to one another. Measures of response to treatment can be translated into therapeutic practice only if uniform evaluators are used. Accordingly, a reproducible valid system for staging of lung cancer is recommended.

Aged↗