The effects of ethacrynic acid upon the potassium concentration in guinea pig cochlear fluids

After i.v. injection of 50 mg/kg ethacrynic acid (EA), potassium concentration in the endolymph (K_e⁺) measured with K⁺-specific microelectrodes decreases by 10 mM at the most and endocochlear potential falls to negative values. Potassium concentration in the perilymph (K_p⁺) generally does not change, but sometimes a transient decrease in K_p⁺ level of about 0.5 mM was observed, presumably due to the electrogenic effect of the time-related decrease of the endocochlear potential.When anoxia is induced approximately 120 min after EA administration, K_e⁺ slowly decreases. The decrease in K_e⁺ 50 min after the arrest of ventilation is smaller when compared with the K_e⁺ anoxic decrease without preceding EA administration. The endocochlear potential, which falls to negative values during anoxia after EA administration, does not return to the zero level as in the case when only anoxia is applied. Similarly, during anoxia, which follows EA administration, the perilymphatic K_e⁺ concentration increases more slowly than in the case when only anoxia is introduced. It is assumed from the results that EA abolishes activity of the positive electrogenic K⁺ pump and reduces the passive permeability of the walls of the cochlear duct to the potassium ions.     

Nutrition of very low birth-weight premature infants with enriched breast milk during the adjustment phase

To enable an enteral nutrition in very low birth weight infants appropriate for gestational age, adapted to the high nutritional requirements, pooled human milk from mothers delivered preterm was enriched with human milk lyophilisate 6 g/100 ml. The concentrations of protein increase from 11.8 +/- 1.2 to 15.8 +/- 2.1 g/l and the non-protein energy substrates raise in the same proportion. Osmolality increases from 291.6 +/- 11.2 to 384.9 +/- 19.6 mosmol/l. The higher protein intake was tolerated without relevant metabolic imbalances. Only small increasing of amino acids concentrations in serum and a higher renal excretion of amino acids could be observed. The nitrogen balance was equalized during the first two days of life and positive from the 3rd day of life. Nitrogen retention was significantly higher in the group fed human milk lyophilisate enriched human milk from the 2nd day of life. Also the postnatal weight losses were significantly lower and the birth weight was reached significantly earlier. Human milk lyophilisate enriched human milk can be recommended for nutrition of very low birth weight infants appropriate for gestational age from the first day of life.     

Nutrition of newborns small for gestational age with human milk lyophilisate enriched human milk during the first week of life

In 24 very low birth weight infants appropriate or small for gestational age, the metabolic response to nutrition with human milk lyophilisate enriched human milk was estimated during the first week of life. In contrast to newborns appropriate for gestational age, in newborns small for gestational age signs of metabolic overloading could be observed: increased urinary amino acid excretion and neonatal cholestasis. Both depended on the degree of fetal growth retardation. It was concluded that nutrition with human milk lyophilisate enriched human milk cannot be recommended for very low birth weight infants during the first week of life. In newborns small for gestational age the metabolic situation has to be estimated before starting a high protein diet. If the level of total bile acids amounts to more than 30 mumol/l, protein intake should be increased carefully during the first week of life.     

Brain metastases of epithelial ovarian carcinoma responding to cisplatin and gemcitabine combination chemotherapy: a case report and review of the literature

BACKGROUND: Brain represents a rare site of metastasis in patients with epithelial ovarian carcinoma (EOC). CASE REPORT: We observed a case of multiple brain metastases in an EOC patient after complete response of a pelvic recurrence to platinum/paclitaxel chemotherapy. Complete response of brain metastases was observed after whole brain radiotherapy and subsequent chemotherapy by combination of cisplatin and gemcitabine. Three subsequent recurrences of brain metastases were controlled by re-treatment by the combination of 5-fluorouracil, cisplatin and gemcitabine. METHODS: Because of limited information on the outcome of EOC brain metastases in reported case series, a pooled analysis of the published reports in patients with EOC brain metastases was performed. Data were extracted from 46 reports that contained sufficient details on 189 individual patients. The survival was analyzed by the Kaplan-Meier method. Univariate and multivariate analyses were performed by the log-rank test and Cox method, respectively. RESULTS: The most favorable outcome was observed in patients treated by surgery combined with radiotherapy and/or chemotherapy. The survival was significantly better in reports describing only one or two cases, in patients diagnosed after 1992, in patients who received therapy in addition to symptomatic treatment, in patients treated by radiotherapy, chemotherapy and surgery, in patients without extracranial metastases and with single brain metastases. On multivariate analysis, the absence of extracranial metastases, treatment by chemotherapy, surgery and radiotherapy were independent positive predictors of survival. CONCLUSIONS: EOC brain metastases are responsive to chemotherapy. An aggressive multidisciplinary therapeutic approach including chemotherapy may lead to prolonged survival.     

Epidermal growth factor and necrotizing enterocolitis

As the number of extremely low-birth-weight infants increases,necrotizing enterocolitis remains a critical eminent problem. Supplementation of enteral feeds with biologically active substances normally present in breast milk, such as epidermal growth factor, seems to be a logical and safe way to reduce the incidence of intestinal inflammation and necrotizing enterocolitis. Continuing basic research and clinical studies are essential before epidermal growth factor can be introduced as an efficient therapeutic approach in the treatment of neonatal necrotizing enterocolitis.