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In this study mitoxantrone (Mtx) induced DNA strand breaks were measured with the alkaline elution technique in short term cell cultures derived from human gliomas. Glioblastomas or astrocytomasfrom 5 patients who underwent intracranial surgery were cultured and incubated 1 h with different concentrations of Mtx (0, 0.01, 0.1 and 1.0 μg/ml). The alkaline elution methodwas modified to measure DNA lesions in human gliomas. Mtx inducedDNA strand breaks in a dose dependent manner in all cell culturestested. There was a linear increase of DNA strand break frequencyinduced by Mtx between 0.01—1.0 μg/ml. Concerning these in vitro data, Mtx might be potentially useful for the treatment ofpatients with malignant brain tumors.

Summary: This contribution summarizes a discussion of several experts on the field of clinical nutrition, which was held in Evangelische Akademie Loccum, Germany, May 7 – 8, 1997. For nutritional therapy, the critically and ``stable'' in- or out-patients have to be differentiated. Nutritional status can be assessed by Subjective Global Assessment (SGA) as clinical observation of the patient is basic during clinical nutrition. Laboratory routine parameters (e. g., serum electrolytes, glucose, urea, triglycerides) also have to be analyzed from a nutritional point of view. For stable in- and out-patients, body composition analysis (B. I. A.) is frequently used for calculation of body cell and extracellular mass. For long-term parenteral and enteral nutrition, skin fold measurement is useful. However, the value of body composition analysis is still open with respect to repeated measurements during the course of parenteral and enteral nutrition. Due to extraordinary expansion of the extracellular space and body water, monofrequent B. I. A. using the present calculation formula is not a reliable tool in the critically ill. Energy requirements can be calculated for ``stable'' patients by use of the body weight by Harris-Benedict formula, while this may be inadequate in the critically ill. A very useful tool is indirect calorimetry for measurement of energy expenditure and substrate oxidation rates. Even in the critically ill, daily assessment of respiratory quotient (RQ) is obviously not required. In these patients, calorie and substrate administration should be primarily based on metabolic activity and feeding tolerance. Further discussions and consensus statements about the standard assessment during nutritional therapy will be necessary. Because nutritional therapy is supportive treatment in many patients, even avoidance of malnutrition or deterioration of nutritional status have to be considered therapeutic success. In terms of cost-benefit ratio, benefit of clinical nutrition has to be also evaluated according to ``outcome'' parameters like complication rate, mortality, and hospital stay. For long-term studies, nutritional state and quality of life should be the preferred end points. With regard to complexity of diseases this may be hardly demonstrated, unless there is need for more well-designed, controlled, randomized trials in the future.