[Preoperative cognitive function in very old patients : Influence on the complication rate and length of hospitalization]

BACKGROUND

Gastrointestinal cancer is a frequent diagnosis in older patients. A curative resection, possibly in combination with radiotherapy and/or chemotherapy, is the standard therapy. The advanced age of the patients with an increasing number of comorbidities and often the presence of cognitive impairment represents a high risk for perioperative complications and a longer stay in hospital. The challenge in the clinical routine is to recognize a cognitive impairment in older patients and to prepare these patients for the operative intervention in the best possible way.

OBJECTIVE

This retrospective analysis was carried out to find out whether preoperative cognitive impairment is a prognostic factor for the postoperative outcome.

METHODS

In patients over the age of 75 years who were prepared for abdominal surgery of gastrointestinal cancer in the preoperative consultation, the mini mental state examination (MMSE) and the clock test were carried out. The results of the tests were retrospectively compared with the complication rate and the duration of hospital stay.

RESULTS

Low MMSE values were significantly associated with the complication rate and the development of a severe complication (Clavien-Dindo grade ≥ 3a). A cut-off value of 24 points in the MMSE was predictive for the development of complications and a longer hospital stay. The age of the patients was not associated with the MMSE.

CONCLUSION

Cognitive impairment is an important prognostic factor for the development of perioperative complications and the duration of the hospital stay in patients undergoing extensive abdominal surgery for gastrointestinal cancer. Therefore, a preoperative assessment, for example with the MMSE, is recommended in order to identify high-risk patients.

The influence of medium composition and matrix on long-term cultivation of primary porcine and human hepatocytes

The differentiated hepatocyte phenotype remains difficult to maintain in culture. The duration over which phenotypically stable hepatocytes can be cultured ranges from a couple of days to a few weeks. Shortcomings in medium formulation may be a factor in this lack of success. We have investigated effects of medium formulation on primary porcine and human hepatocyte cultures. We tested seven culture medium compositions (DMEM, ExCell 400, HepatoZYME-SFM, L-15 Leibovitz, SF-3, Waymouth, and Williams' E) and the effects of serum, fibronectin and biomatrix in a sandwich culture configuration. Albumin, urea, cholesterol, GOT, GPT, LDH and triglyceride concentrations were measured over 14 days. For both human and porcine cultures, the best results were obtained with SF-3 medium. Cells cultivated with Williams' E medium and FCS had good morphology and synthetic function during the first days of culture. However, continued addition of serum, was associated with a subsequent loss of differentiated phenotype. Addition of fibronectin was associated with improved function in cultures maintained in SF-3 medium whilst biomatrix had no effect. In contrast, addition of fibronectin did not influence cultures maintained in Williams' E medium, but cultures with biomatrix were associated with improved function at longer time points.