Mechanism of inflammation as related to surgical management and general resistance.

Abstract

• Three cases involving elderly patients are described to illustrate the effectiveness of orally administered corticoids in increasing general resistance to recurrent infections and to surgical shock. An 85-year-old man who had gone into profound shock after catheterization subsequently underwent the first and second stages of suprapubic prostatectomy without reactions with the help of maintenance doses of cortisone. A 78-year-old man went into profound shock after the third of a series of operations, but was maintained on doses of hydrocortisone not exceeding 50 mg. per day until death resulted from the rupture of an aortic aneurysm. A 50-year-old woman had been hospitalized repeatedly for recurring pyelonephritis unaffected by antibiotics and chemotherapy; recurrences stopped when cortisone was administered in doses of 2.5 mg. daily by mouth. Antibiotics and chemotherapy should always be used along with corticoid medication, and their use should be continued for a time after corticoid medication has been stopped. It is important to adjust the dosage of corticoids so as to avoid the gastrointestinal necrosis, delayed healing, and upset of electrolyte balance that have been reported after the use of large doses.