Demand feeding for healthy premature newborns: a randomized crossover study.

BACKGROUND AND PURPOSE: In hospitals, preterm infants are routinely fed specified amounts of formula on a fixed schedule. This results in the baby's intake volume being regular and easily confirmed, but does not consider the individual baby's needs. The purpose of this study was to compare the effects of demand feeding and fixed schedule feeding for healthy premature newborn babies. METHODS: A 2-feeding-type, 2-period crossover study design was employed, in which each period consisted of 2 days, the first of which was a washout period, comprising a self-comparison protocol designed to identify any differences in the feeding characteristics of premature infants on demand or scheduled bottle-feeding. Eleven preterm infants were included. The sample size was monitored during the observation period by power calculation. The mean weight at study entry was 1897.27 +/- 175.94 g and the mean postconceptional age was 35.34 +/- 1.54 weeks. RESULTS: Compared with scheduled feeding, demand feeding was associated with a longer daily mean interval (4.17 vs 3.02 hours; p = 0.00), greater volume per feed for demand feeding (67.28 vs 51.11; p = 0.00), greater feeding speed (5.73 vs 4.51 mL/min; p = 0.00), but a similar daily total duration of feeding. There was no significant difference in the daily total feeding volume. CONCLUSIONS: Demand feeding provides superior volume per feed, and feeding speed and shortens the duration of feeding compared to feeding on a routine schedule. It is suitable and feasible for healthy premature newborns.     

Cervical Cancer with Paraaortic Metastases: Significance of Residual Paraaortic Disease after Surgical Staging

Cervical carcinoma frequently metastasizes to the paraaortic region, necessitating extended field radiotherapy to effect a cure. As imaging modalities are unreliable in identifying all cases of paraaortic nodal metastases (PAN), surgical staging is often utilized prior to radiotherapy. This study was aimed at identifying factors predictive of survival in women with cervical carcinoma and paraaortic metastases. In particular, survival based on extent of paraaortic disease was examined. The study group consisted of 43 women (stages IB–IVB) identified between 1982 and 1993 who were treated with extended field radiation for cervical carcinoma with histologically confirmed paraaortic metastases. The estimated 5-year survival for the study population was 24% with a median survival of 18 months. Pelvic tumor size had a significant impact on survival with the median survival being 34 months if the primary lesion was <6 cm compared to 14 months if ≥6 cm (P= 0.01). Eight of the 26 (31%) women without residual PAN disease after surgical staging remain alive and disease free (mean follow-up, 74 months). In contrast, only 1 of the 17 (6%) women with gross residual PAN is alive 71 months after treatment (P= 0.05). However, a comparison of Kaplan–Meier survival curves did not show a statistically significant advantage to the surgical excision of grossly involved PAN (P= 0.98). Although long-term survival among women with grossly involved, unresected paraaortic metastases is uncommon, further study is necessary to elucidate the role of surgical excision of bulky aortic disease in women with cervical cancer.     

Laparoscopic mobilization of the inferior epigastric artery for penile revascularization in vasculogenic impotence.

A laparoscopic approach was used for penile revascularization in a patient with vasculogenic impotence to avoid the long abdominal incision which was traditionally required to harvest the inferior epigastric artery as a neoarterial source. Despite the time-consuming nature of laparoscopy, this procedure was as efficacious but less morbid and required less convalescence than open revascularization. Whether more patients may benefit from this procedure must be evaluated in further studies.