INTRODUCTION TO THE PROBLEM
The moderator for the discussion was Nicholas V. Christou, MD, from Montreal, and the panelists were John A. Mannick, MD, from Boston; Michael A. West, MD, from Minneapolis; and Dennis L. Kasper, MD, from Boston.
Dr Christou: Research into host defenses against life-threatening infections following surgery and trauma has been extensive in the last ten years. Abnormalities in all components of host defense have been detected in both elective and emergency surgical patients. A curious finding is that anergy to delayed-type hypersensitivity skin test antigens will identify preoperative patients with a higher risk for septic related mortality.1 This finding has been confirmed by many laboratories throughout the world2-10 with the exception of the group from Britain.11 This observation is curious because classic theory would have such patients develop opportunistic infections with viruses and intracellular parasites. This is not the case. Such patients develop gram-negative