Study of the pharmacokinetics of mitomycin C in humans during intraperitoneal chemohyperthermia with special mention of the concentration in local tissues

The aim of this work is to estimate the 24-hour distribution and elimination of mitomycin C (MMC) during and after intraperitoneal chemohyperthermia (IPCH) in 18 patients (13 gastric adenocarcinoma, 3 pancreatic adenocarcinoma, 2 malignant mesothelioma) who received 60 mg MMC during 90-120 min in 6 liters of heating solution HS; (42 degrees C) or HS flowing at 0.4 liters/min in a closed circuit. MMC assay in the serum, urine, HS and in local biopsies were performed by high performance liquid chromatography. The amount of MMC in HS decreased by 54.1 +/- 13.6% during IPCH. The maximum MMC levels in serum reached 0.4 +/- 0.18 mg/l 45 min after the start of IPCH, then rapidly decreased. Only 1.77 +/- 0.93 mg were recovered in urine in 24 h. These data are consistent with a large and rapid absorption, mostly in local tissue, demonstrated by the level in 7 post-IPCH biopsies (8.3 +/- 7.6 mg/kg).

Maturation and effect of stimulus rate on brainstem auditory evoked potentials

Brainstem auditory evoked potentials (BAEPs) at three stimulus rates (20, 41.3 and 61.3 c/s) were recorded in 104 normal preterm infants, distributed in four age groups between 32 and 39 weeks (conceptional age), and in 20 normal adults. The latency shifts between 61.3 c/s and 20 c/s, and between 41.3 c/s and 20 c/s, were calculated for each wave, and studied as a function of age. A significant effect of conceptional age was shown on the '61.3-20 c/s' and the '41.3-20 c/s' wave V latency shifts, and a significant difference between adults and newborns was noted for the wave V and wave III latency shifts. No significant difference was obtained for the wave I latency shifts. This suggests that the changes of auditory adaptation with maturation may be predominantly at a central level, i.e. on central synapses.

Functional maturation of cochlear active mechanisms and of the medial olivocochlear system in humans

The aim of this study was to investigate the functional development of cochlear active mechanisms and of the medial efferent olivocochlear system. Otoacoustic emissions (evoked and spontaneous) were recorded in 42 preterm neonates (conceptional age ranging form 33 to 39 weeks) and a control group of 20 young normal-hearing adults. Medial olivocochlear system activity was examined by coupling evoked otoacoustic emission recording to a contralateral stimulation. Otoacoustic emission recordings were carried out using the Otodynamic ILO88 software and hardware. The stimuli were unfiltered clicks and the contralateral stimulation was broad band noise of 50 and 70 dBSPL delivered by an Adam generator. The results revealed the presence of EOAEs and SOAEs from at least 33 weeks in humans, suggesting that the functional maturation of the outer hair cells is nearly complete at that age. The study further revealed that the contralateral stimulation had no effect on evoked otoacoustic emissions in preterm neonates. The lack of activity observed in medial olivocochlear system indicated functional immaturity here, at least before full-term birth.

Treatment of malignant peritoneal effusion in digestive and ovarian cancer

Intra Peritoneal Chemo Hyperthermia (IPCH) with Mitomycin C (MMC) or Cisplatinum (CP) was used to treat 32 patients with far advanced digestive or ovarian cancers and peritoneal carcinomatosis. Surgical resection of the primary tumor has been possible in 18 cases. After closure of the abdominal wall, a 90 minutes IPCH as performed under general anaesthesia and 32 degrees C general hypothermia, through 3 intraperitoneal drainages realizing a closed circuit, using 10 mg/l of MMC or 15 to 25 mg/l of CP in 6 l of peritoneal dialysate heated at the inflow temperature of 46 to 49 degrees C. The mortality rate was 3% and the morbidity rate was 3%. In 11 out of 12 patients with preoperative malignant ascites, no more ascites could be found after IPCH. For peritoneal carcinomatosis from digestive origin, median survival was 11.2 months and 1 year survival rate was 46.9%. These encouraging preliminary results show that IPCH is a safe and reliable treatment for peritoneal carcinomatosis in far advanced digestive or ovarian cancers.

Leucine kinetics in fed low-birth-weight infants: importance of splanchnic tissues

Whole body Leu kinetics were determined in fed low-birth-weight (LBW) infants. To assess the importance of first-pass splanchnic extraction of ingested amino acids, two tracers were simultaneously infused by intravenous (L-[1-13C]Leu) and intragastric (L-[5,5,5-2H3]Leu) routes in 13 LBW infants [1,742 +/- 169 (SE) g] fed with protein-enriched human milk (protein intake 3.23 +/- 0.97 g.kg-1.day-1). Splanchnic extraction estimated from plasma [2H3]Leu appearance was 48.2 +/- 15.6% of Leu intake. Total Leu flux, endogenous Leu flux (index of protein catabolism), and nonoxidative Leu disposal (NOLD, index of protein synthesis) were 3.45 +/- 0.57, 1.90 +/- 0.74, and 2.54 +/- 0.62 mumol.kg-1.min-1, respectively. Higher estimates were obtained when using alpha-ketoisocaproate as a precursor pool. There was a wide individual variation of protein intake due to the use of human milk, and, over this range, Leu intake was correlated negatively with endogenous Leu flux (r = 0.88, P less than 0.01) whereas NOLD remained fairly constant. Thus, in LBW infants, 1) splanchnic extraction is two times as high as in adults and might reflect an elevated splanchnic protein turnover and 2) increasing protein intake probably promotes protein gain mainly by inhibiting protein catabolism.

Differential maturation of brainstem auditory evoked potentials in preterm infants according to birthweight

Brainstem auditory evoked potentials (BAEPs) were recorded from 39 preterm infants, divided into 3 groups: small-for-gestational-age, with a birthweight less than or equal to 1500 g (SGA); appropriate-for-gestational-age, with a birthweight less than or equal to 1500 g (AGA1); and appropriate-for-gestational-age, with a birthweight higher than 1500 g (AGA2). A significant shortening of the I-V interval due to an increase in wave I latency was found in the SGA group. The lower-weight AGA group (AGA1) was never significantly different from the SGA group. Although there was no correlation between conceptional age and weight at the time of the examination for the studied population, negative correlations were found between wave I latency and weight at the time of the examination. These findings confirm previous research and suggest the existence of a link between weight and basal cochlear maturation.

[The hazards of forceps: the viewpoint of the pediatrician and the obstetrician]

Neonatal and maternal complications observed after 410 forceps deliveries were retrospectively compared to those occurring after spontaneous vaginal delivery. Mild scalp and facial lesions as well as facial palsy were significantly increased in the forceps group. No severe maternal complications were observed. A short literature review was done, and other instrumental extractions were discussed.

Whole body protein turnover measured with 13C-leucine and energy expenditure in preterm infants

Our study was undertaken in preterm infants to examine the relationship of whole body protein kinetics with protein intake and energy expenditure. Leucine kinetics were determined in seven low birth wt preterm infants fed human milk or human milk enriched with protein (2.5 to 4.3 g protein/kg.d). The infants received a short (4-h) constant infusion of L-[1-13C]leucine and leucine turnover and oxidation were calculated from 13C-plasma leucine and expired 13CO2 enrichments measured by mass spectrometry. Energy expenditure was measured by indirect calorimetry. Nonoxidative leucine disposal (an estimate of protein synthesis) and leucine derived from protein (an estimate of protein breakdown) were, respectively, 2.98 +/- 0.82 and 2.06 +/- 0.74 mumol/kg.min. Whole body protein turnover and deposition, derived from leucine kinetics, were 8.22 +/- 2.31 and 2.17 +/- 0.50 g/kg.d, whereas energy expenditure was 56.3 kcal/kg.day. Protein turnover was correlated with protein intake but not with protein deposition. Energy expenditure was correlated with protein turnover, synthesis, and breakdown but not with protein deposition. These data are in agreement with the fact that protein deposition depends upon protein intake, but they also suggest that an elevated protein deposition is not necessarily the result of a rapid protein turnover or associated with an elevated energy expenditure.

Respiratory and metabolic ultradian (40 min<period<6h) variations in normal premature infants periodically fed through a gastric tube

Oxygen consumption (VO2) and carbon dioxide emission (VCO2) have been continuously recorded for 24 consecutive hours in 7 premature infants with a range of gestational age of 29-31 weeks at birth, and placed in incubators within a thermal neutral limit. These infants, submitted to continuous light, were fed every 3-4h through a gastric tube which was left in their stomachs throughout the whole experiment. Variance and spectral analyses performed on VCO2 values sampled on the recordings every 10 min showed ultradian variations, in the 40 min-6 h period range, which represent 20 and even 40% of the mean level. Moreover 5 out of the 7 premature infants show ultradian VCO2, VO2 and respiratory quotient rhythms related to feeding frequency.

Are click-evoked BAEPs useful in case of neonate hyperbilirubinemia?

There is still controversy about the usefulness of click-evoked brainstem auditory evoked potentials (BAEPs) for the investigation of neonatal hyperbilirubinemia. The present work concerns the study of click-evoked BAEP responses in a population of 72 hyperbilirubinemic children (conceptional age between 33 and 42 weeks). Their bilirubinemia rates were between 219 and 600 mumol/l. The waves I, III and V were always present, and click BAEP thresholds were normal in all subjects. Latency anomalies were found only for 8 of the 72 subjects. The comparison of subjects having the higher (greater than 307 mumol/l) bilirubin levels with the group having the lower ones failed to show any significant differences for the I-III and I-V intervals. The influence of prematurity in BAEP alteration has not been demonstrated in this study. These data show, on the one hand, normal click-BAEP thresholds but, on the other hand, alterations of central conduction time in some hyperbilirubinemic newborns. It seems that other factors than hyperbilirubinemia might be operating.

Functional hypersomatotropism in small for gestational age (SGA) newborn infants

Basal plasma GH levels and the GH responses to an injection of 1 microgram/kg 1-44(NH2) GHRH were determined on day 3 postnatally in 5 small gestational age (SGA) twin newborns and their appropriate gestational age (AGA) co-twins, and in 10 SGA singleton newborns and 6 AGA singleton newborns. The mean basal plasma GH level was higher in the SGA than in the AGA infants but the difference was significant only for singleton newborns (p less than 0.01). The mean peak plasma GH level was markedly increased in SGA compared to AGA infants (p less than 0.05 for twins, p less than 0.01 for singletons). Twelve SGA infants re-tested at 1 month had lower basal and peak plasma GH levels (p less than 0.001 and p less than 0.01). In 21 SGA and 17 AGA infants, serum IGF-I, measured by RIA between 12 and 96 hours after birth, was significantly higher in SGA than in AGA (p less than 0.001). These results suggest that, whatever the mechanism, functional hypersomatotropism is present at day 3 in SGA infants. This hypersomatotropism may participate in the early catch-up growth process.

Is there a difference between extrauterine and intrauterine maturation on BAEP?

A difference between extrauterine and intrauterine maturation on BAEP has not been established, remaining a subject of controversy. The present study involved 76 children, aged between 36 and 37 weeks (conceptional age), with an extrauterine life duration of equal to or less than 2 weeks (N = 46) or more than 2 weeks (N = 30). The latencies for waves III and V, and the I-III and I-V intervals were significantly shorter for the neonates with a greater extrauterine life duration. An explanation for this finding is discussed: the head size is significantly smaller in the group with a greater extrauterine life duration. An influence of extrauterine life duration on BAEP is thus shown, but it seems to reflect the anatomical consideration and not to peripheral auditory system maturation.

Maturational changes in the intensity latency relation of the brainstem auditory evoked potentials in humans

The effects of stimulus intensity variation on brainstem auditory evoked potentials have been studied on 111 preterm, 36 fullterm neonates and 50 adults. When intensity decreases the lengthening of latencies is greater in preterm neonates. This effect is clearer with wave I than waves III and V and suggests an immaturity of the basal part of the human cochlea in preterm neonates.

[High frequency ventilation by oscillation in the treatment of the hyaline membrane disease in severe form]

Seventeen premature babies were ventilated with high frequency oscillation (HFO) for severe hyaline membrane disease. The results were compared to a group of 16 babies ventilated with classical positive pressure ventilation and presenting with hyaline membrane disease of the same severity. The results demonstrated an improvement of the mortality rate with HFO without any significant difference of pulmonary or neurologic complications. Furthermore, a controlled study in order to demonstrate an improvement of this type of ventilation is required.

Renal aspects of calcium and phosphorus metabolism in preterm infants

The aim of this study is to emphasize renal aspects of calcium and phosphorus metabolism from our data of more than 200 metabolic balance studies carried out in preterm infants. Renal production of 1,25-dihydroxyvitamin D increased rapidly after birth provided the concentration of the substrate, 25-hydroxyvitamin D, is adequate. The gut of preterm infants is able to respond to the active metabolite of vitamin D. Mean plasma phosphate threshold for tubular reabsorption of phosphate is high, about 2.1 mmol/l or 6.5 mg/dl. The low fractional excretion of phosphate cannot be explained by immature parathyroid function nor by renal unresponsiveness to parathormone, at least after the first days of life. It is probably due to regulating factors related to the high rate of growth. Because of reduced glomerular filtration rate, a too high phosphorus intake may result in hyperphosphatemia. Conversely, a too low phosphorus intake will lead to a phosphate depletion syndrome characterized by marked increase in urinary calcium excretion, no urinary phosphate, and hypophosphatemia. Preterm infants with chronic metabolic acidosis are able to acidify urine so that titratable acid is directly related to urinary excretion of phosphate. Clinical implications are that calcium:phosphorus ratio in milk must be adapted according to net bone and soft tissue retention.

Effect of stimulus intensity variation on brainstem auditory evoked potentials. Maturational changes

The effect of stimulus intensity variation on brainstem auditory evoked potentials in premature and full-term neonates has been studied in two experiments. They show that the effects are different according to age and to waves. The variation of latencies is greater the younger the child and it is clearer with wave I than waves III and V. The findings are discussed in terms of the maturation of the basal part of the cochlea.

Effect of brainstem auditory evoked potential stimulus intensity variations in neonates of small for gestational age

The latencies of brainstem auditory evoked potentials were compared first in 25 small for gestational age (SGA) neonates (conceptional age less than 43 weeks) matched with 25 appropriate for gestational age (AGA) neonates, and then in the 8 younger SGA neonates (less than 37 weeks) matched with 8 AGA neonates. In this last subgroup the results showed that the I-V interval is shorter in SGA than in AGA neonates, as previously described. This shortening effect is essentially linked to a lengthening of wave I. So the results are discussed in terms of immaturity of the basal end of the cochlea, rather than of precocious development of the auditory brainstem neural function in SGA infants.

[Involvement of the urinary tract in a syndrome of congenital epidermolysis bullosa and atresia of the pylorus]

Epidermolysis bullosa associated with pyloric atresia is a rare autosomal recessive condition, usually fatal in the first few months of life. Since 1983 urinary tract disease is known to be another manifestation of this syndrome which becomes the main problem in children surviving beyond infancy. The case of a 2 1/2 year-old boy with mild cutaneous manifestations of junctional epidermolysis bullosa, corrected pyloric atresia and renal disease is reported. Hematuria, dysuria, obstruction of the uretero-vesical junction and worsening hydronephrosis led to bilateral ureterostomy (ureteral reimplantation was not attempted because the thickness of the bladder wall and the extensive ureteral fibrosis).

Increased percentage of activated Ia+ T lymphocytes in peripheral blood of neonates following exchange blood transfusion

The expression of Ia-like antigens in peripheral blood T lymphocytes from newborns receiving postnatal total blood exchange was analyzed. A significantly increased percentage of Ia-positive T lymphocytes (Ia+ T cells) was observed 2 days after postnatal transfusion with total blood in comparison to data observed on Days 0, 5, and 15. Ia+ T cells were also significantly higher than in normal control newborns tested in the same period. When newborns received the blood exchange with irradiated total blood or with leukocyte-depleted blood, no increase in Ia+ T cells was observed and the percentage of these cells remained in the normal range (1-7%) on all the days tested (0, 2, 5, 15 days). For easy identification of the origin of Ia+ T cells, sex-incompatible blood was used for exchange, and a karyotype analysis was carried out for the detection of the Y chromosome on Ia+ T cells separated from peripheral blood on Day 2 and then cultured with interleukin 2 (IL-2) for 48 hr. It was thus established that Ia+ T cells were not of donor origin. Simultaneously with the expression of Ia-like antigens, host T cells also carried the interleukin-2 receptor (TAC). An allogeneic response, comparable to a host-versus-graft reaction, was probably responsible for the activation of T cells 2 days after total blood exchange in newborns.

Effect of stimulus intensity variation on brain-stem auditory evoked potentials: comparison between neonates and adults

Brain auditory evoked potentials (BAEPs) were recorded from 40 adult subjects and 40 neonates at 80 and 60 dB (nHL) to compare the effects of stimulus intensity variation on waves I, III and V and on intervals I-III, III-V and I-V. The results show that the changes in latency for wave, I, I-III and I-V intervals are significantly greater in neonates than in adults. So the effects of stimulus intensity variation on BAEPs are different in neonates and in adults and a major effect is in the peripheral auditory mechanism.

Supplementation of pooled human milk with casein hydrolysate: energy and nitrogen balance and weight gain composition in very low birth weight infants

Growth and nitrogen and energy balances were studied with a combined technique of nutrient balance and indirect calorimetry measurement in two groups of eight very low birth weight infants fed pooled pasteurized human milk (HM) or cow's milk casein hydrolysate supplemented HM (HM-Pr). There was no difference in the amount of energy absorbed (91 +/- 17 kcal/kg/day with HM-Pr versus 95 +/- 8 with HM-P) or in the growth rate. The infants fed HM-Pr had a higher nitrogen intake (602 +/- 80 versus 395 +/- 64 mg/kg/day; p less than 0.001), urinary nitrogen excretion (160 +/- 64 versus 78 +/- 16 mg/kg/day; p less than 0.005) and nitrogen retention (326 +/- 32 versus 252 +/- 48 mg/kg/day; p less than 0.01). They also had increased plasma concentrations of essential amino acids, urea nitrogen, and total protein without metabolic imbalance. Energy expenditure was higher (58 versus 49 kcal/kg/day; p less than 0.005) and energy storage lower (33 versus 47 kcal/kg/day; p less than 0.05) with HM-Pr. In percent of weight gain, protein and fat accretion represented 12 and 14% in HM-Pr group versus 10 and 27% in HM group. Very low birth weight infants fed casein hydrolysate supplemented pooled HM achieved a growth rate and a weight gain composition similar to the fetus.