Corneal sensitivity in keratoconus after penetrating and deep anterior lamellar keratoplasty

PURPOSE

To evaluate recovery of corneal sensitivity in the graft following penetrating keratoplasty (PK) or deep anterior lamellar keratoplasty (DALK) in patients with keratoconus.

MATERIALS AND METHODS

113 eyes of 113 patients (39 females, 74 males) were examined. All eyes had undergone corneal grafting: 39 PK, 74 DALK. Corneal sensitivity tested using the Cochet-Bonnet esthesiometer was evaluated the day before and 3 days, 3, 6, 12 and 24 months after surgery. The corneal sensitivity recovery was associated with surgical techniques (PK or DALK), age and sex of recipient and donor, cadaver time and type of preservation of the cornea.

RESULTS

The average percentage of recovery of corneal sensitivity was 91% at 2 years. Surgical techniques and other qualitative and quantitative variables did not affect the statistically significant recovery of corneal sensitivity.

CONCLUSIONS

In both surgical techniques, PK and DALK, we noticed a good recovery of corneal sensitivity in 2 years.

An analysis of two different schedules of radiochemotherapy with concomitant temozolomide in high grade gliomas

2035

Background: We compared two different schedules of temozolomide (TMZ) concomitant therapy in terms of toxicity and outcome. Methods: 70 patients (median age 61 years, range 27–80) affected by high grade gliomas were treated with concomitant chemoradiation. Conformal radiotherapy (5,940 cGy, 180 cGy/day; CTV2: tumor bed + residual tumor if present + oedema, 3,960 cGy; CTV1: tumor bed + residual tumor if present + margins, 1,980 cGy) was associated with one of the following TMZ schedules: TMZ1: (75 mg/m2 × 5 days, first and last week of radiotherapy); TMZ2 (75 mg/m2, 7 days/week, from the first to the last day of radiotherapy); Toxicities were graded according to RTOG criteria. Survival analysis based on the Kaplan-Meier model. Results: From October, 2000 to March, 2006, 54 patients high grade gliomas were evaluated. 41 patients (29 GBL, 70.7%; 12 AA, 29.3%) were treated between October 2003 and March 2006 with TMZ2, and compared to an historical series of 29 patients (25 GBL, 86.2%; 4 AA, 13.%) treated in our Institution before 2003 with TMZ1. All patients received adjuvant chemotherapy with TMZ for 6 cycles or until disease progression. Hematological toxicity was mild in both group, whereas neurological toxicity (seizures) was higher in TMZ2 group, with a grade > 2 toxicity registered in 11/41 pts (26.8%) compared to 1/29 of the TMZ1 group (3.5%), even if this difference failed to achieve statistical significance (p=0.06). The overall survival did not significantly differ among the 2 schedules (p=0.60). In fact, at a median follow-up of 21 months (range 3- 68), median survival time was 21 months and 19 months, for TMZ1 and TMZ2 groups, respectively, with a 1-year and 2-year overall survival of 73.1% in the TMZ1 group and 75.3% in the TMZ2 group, respectively. Conclusions: In our experience, the concomitant administration of TMZ at the daily dose of 75 mg/m2 given continuously or only in the first and the last week of radiotherapy obtained comparable results in terms of outcome, with a heavier neurological toxicity when given 7 days per week, from the first to the last day of radiotherapy. These data suggest that, in selected cases, the TMZ1 schedule can be considered as a safe, alternative strategy, which does not impact significantly on patient outcome, compared to the standard TMZ2.

No significant financial relationships to disclose.

Isolation and characterization of new lignans from the leaves of Cestrum parqui

Three new compounds, a sesquilignans, an oxyneolignan and a norlignan, have been isolated from the aqueous fraction of Cestrum parqui. All of the compounds have been identified on the basis of their spectroscopic properties and tested on the species Lactuca sativa and Lycopersicon esculentum to evaluate their phytotoxic activity.

Energy substrates, mitochondrial membrane potential and human preimplantation embryo division

Carbohydrate additives to modern embryo culture media are based on three basic energy sources, glucose, pyruvate and lactate. Although the use of these substrates is almost universal, debate continues as to the roles of the individual components in the human. This is mainly due to the lack of human embryos for research and the reliance on animal model systems. In the present work, the human embryo was used to study the role of the above simple substrates in the maintenance of the mitochondrial membrane potential and cell division. The mitochondrial membrane potential was measured with fluorescence techniques. Cell division was scored as the number of blastomeres on day 3. Both the mitochondrial membrane potential and cell division were dramatically lost in the absence of energy sources. The mitochondrial membrane potential and cell division were normal in media containing all three energy sources, or in pyruvate-containing media. Both glucose and lactate individually proved poor energy sources for the maintenance of the mitochondrial membrane potential. However, cell division continued in the presence of glucose, suggesting that some energy production can continue. These data suggest that pyruvate is an absolute requirement for mitochondrial respiration and cell cleavage during human preimplantation development. The role of lactate is as yet unclear.

Two new polyhydroxylated sterols from Ruppia maritima

Two new sterols have been isolated from the aquatic plant Ruppia maritima and their structures were established as (24R) ergosta-8,22-diene-3 beta,6 beta,7 alpha-triol (1) and (24R) ergosta-8(14),22-diene-3 beta,6 beta,7 alpha-triol (2) on the basis of spectroscopic analysis.

Potential allelochemicals from Sambucus nigra

Twenty-four aromatic metabolites belonging to cyanogenins, lignans, flavonoids, and phenolic glycosides were obtained from Sambucus nigra. Structures were determined on the basis of their spectroscopic features. Two compounds have been isolated and identified as (2S)-2-O-beta-D-glucopyranosyl-2-hydroxyphenylacetic acid and benzyl 2-O-beta-D-glucopyranosyl-2,6-dihydroxybenzoate. All the compounds have been assayed on dicotyledons Lactuca sativa (lettuce) and Raphanus sativus (radish) and monocotyledon Allium cepa (onion) to test their stimulatory or inhibitory effects on seed germination and radicle elongation. Cyanogenins have a mainly inhibiting effect while lignans stimulate the growth. Some compounds show different effects on dicotyledons and monocotyledons.

Conscious sedation versus general anaesthesia for minilaparoscopic gamete intra-Fallopian transfer: a prospective randomized study

BACKGROUND

Gamete intra-Fallopian transfer (GIFT) is a successful technique for infertile women, and is performed almost exclusively by laparoscopy under general anaesthesia.

METHODS

We performed a prospective randomized study of 67 infertile patients to assess the efficacy of minilaparoscopic GIFT under conscious sedation/local anaesthesia (group A) compared with general anaesthesia (group B). Operative and discharge times and pregnancy outcome were evaluated in both groups.

RESULTS

Operative time was similar in both groups. The rate of patients discharged 2 h after surgery was significantly higher in group A. The necessity for postoperative analgesics was significantly higher in group B. No significant differences were noted between the two study groups in terms of pregnancy outcome.

CONCLUSIONS

Conscious sedation and local anaesthesia will allow us to perform an outpatient minilaparoscopic GIFT without the need for general anaesthesia. The simplicity of the method, and the quicker discharge time in comparison with general anaesthesia, offer a detectable benefit for patients.

Antialgal furano-diterpenes from Potamogeton natans L

Six furano-ent-labdanes, 19-acetoxy-15,16-epoxy-8(17),13(16),14-ent-labdatrien-20-al, 15,16-epoxy-12-oxo-8(17),13(16),14-ent-labdatrien-20,19-olide, 12(S)-hydroxy-15,16-epoxy-8(17),13(16),14-ent-labdatrien-20,19-olide, 10alpha,19-dihydroxy-15,16-epoxy-8(17),13(16),14-nor-ent-labdatriene, 19,20-dihydroxy-15,16-epoxy-8(17),13(16),14-ent-labdatriene, 15,16-epoxy-12-oxo-8(17),13(16),14-ent-labdatrien-19,20-olide, were isolated, together with the known potamogetonin, from the aquatic plant Potamogeton natans. Their structures were determined on the basis of their chemical and spectral data. The compounds showed in vitro phytotoxicity against Raphidocelis subcapitata, a microalga used in aquatic tests.

Toxicity evaluation of natural and synthetic phenanthrenes in aquatic systems

Seven natural 9,10-dihydrophenanthrenes were isolated from the common reed Juncus effusus by means of chromatographic processes and identified by spectroscopic means. Furthermore, mimics of natural isolated compounds were synthesized to try to evaluate the influence of functional groups on the dihydrophenanthrene skeleton. Syntheses of compounds were based on the cross-coupling of 1-(2-iodo-5-methoxy)phenyl-ethanol with variously substituted iodobenzenes by zerovalent nickel. All the chemicals were tested to evaluate their effects on freshwater organisms from different trophic levels. Toxicity tests were performed on reducers (the bacterium Escherichia coli); producers (the alga Raphidocelis subcapitata, previously known as Selenastrum capricornutum); and consumers including a rotifer (Brachionus calyciflorus), a cladoceran (Daphnia pulex), and an anostracan (Thamnocephalus platyurus). Results suggested no one organism was uniquely sensitive to the chemicals tested. Toxicity depended on the kind and position of substituents on the aromatic skeleton.

Solid-state photodimerization of cholest-4-en-3-one

Crystalline cholest-4-en-3-one undergoes solid-state dimerization by UV radiation to give two ring A - ring A connected dimers. No dimerization occurs in solution. The first dimer, characterized by a cyclobutane ring, is formed by connection of C-2 and C-3 of a moiety with C-5' and C-6' of another moiety, respectively. The latter dimer has a six-membered ketal ring formed by connection of C-2 with C-5' and of O, linked to C-3, with C-3'. The structures have been determined by spectroscopic means. X-ray analysis of title compound evidences the proximity of the axial H-2 of a molecule to the C-4' of a molecule in the upper layer. The transfer of the hydrogen and the connection between C-2 and C-5' might be the driving force of dimerization.

Lactone diterpenes from the aquatic plant Potamogeton natans

Four lactone diterpenes and two related glucosides with a labdane skeleton have been isolated from the aquatic plant Potamogeton natans. The structures of three new compounds were determined as 19-acetoxy-20-oxo-8(17),13-ent-labdadien-15-->16 lactone, 8(17), 13-ent-labdadien-15-->16,19-->20 dilactone and 6'-acetyl-19-glucopyranosyloxy-8(17),13-ent-labdadien-15-->16 lactone, respectively, by means of spectral analysis. Antialgal assays showed inhibitory activity for some compounds.

Antialgal ent-labdane diterpenes from Ruppia maritima

Seven ent-labdane diterpenes have been isolated from Ruppia maritima. The structures 15,16-epoxy-ent-labda-8(17),13(16),14-trien-19-al; 15,16-epoxy-ent-labda-8(17),13(16),14-trien-19-ol acetate; methyl 15,16-epoxy-12-oxo-ent-labda-8(17),13(16),14-trien-19-oate; 15,16-epoxy-ent-labd-8(17),13E-dien-15-ol and 13-oxo-15,16-bis-nor-ent-labd-8(17)-ene have been assigned to the five new compounds by spectroscopic means and chemical correlations. The phytotoxicity of the diterpenes has been assessed using the alga Selenastrum capricornutum as organism test.

Effect of recombinant human gonadotrophins on human, bovine and murine oocyte meiosis, fertilization and embryonic development in vitro

The response of murine, bovine and human oocytes to pure recombinant preparations of human follicle stimulating hormone (rFSH) and luteinizing hormone (rLH) for meiotic maturation and subsequent developmental competence in vitro were examined in the present experiments. Maturation of immature bovine oocytes to the metaphase II stage was significantly increased by the addition of 1 IU/ml of rFSH in combination with either 1 IU/ml rLH or 10 IU/ml rLH. Similarly, embryonic development to the blastocyst stage was improved in bovine oocytes treated with a 1:10 combination of rFSH:rLH. However, no significant difference was observed in the number of inner cell mass or trophectoderm cells of the resulting blastocysts. Although the increased maturation to metaphase II was not significant, human embryonic developmental competence was improved by maturing oocytes in the presence of a 1:10 ratio of rFSH:rLH as only those oocytes exposed to a 1:10 ratio of rFSH: rLH during maturation showed normal cleavage patterns beyond day 2. In addition, 1 IU/ml rFSH and 1 IU/ml rLH increased the expression of oocyte proteins in human oocytes. The inclusion of recombinant gonadotrophins, either singly or in combination, had no significant effect on the maturation, fertilization or embryonic development of in-vitro matured mouse oocytes. These data provide support for the responsiveness of human and bovine oocytes to gonadotrophins in vitro and the need to consider variations in the relative concentrations for optimization of oocyte developmental competence.

Pregnancies after activated oocyte transfer: a new option for infertility treatment

In this preliminary report, we describe a new technique involving the same-day transfer of activated oocytes to the uterus after intracytoplasmatic sperm injection (ICSI). The technique, termed activated oocyte transfer (AOT), offered to 19 couples, yielded a pregnancy rate per cycle of about 30%, equivalent to traditional in-vitro fertilization (IVF) and ICSI in a laboratory setting. AOT is performed 4 h after oocyte retrieval, permitting the patient to undergo treatment as an out-patient procedure.

Modification of the Talairach stereotactic system for CT-compatibility: technical note

A modification of the Talairach stereotactic system is described which is able to incorporate CT data and provides both co-ordinate calculations, directly from the CT console screen and by a fiducial reference system. The device maintains the original base plate, thus allowing its interfacing with all the accessories of the early apparatus and its direct use in the stereotactic operating room. The instrument has shown great reliability in the localisation of brain lesions and considerable flexibility in many stereotactic operations such as biopsy procedures, brachytherapy, radiosurgery and stereotactically assisted resections.

Preimplantation genetic diagnosis increases the implantation rate in human in vitro fertilization by avoiding the transfer of chromosomally abnormal embryos

OBJECTIVE

To verify the percentage of chromosomally abnormal preimplantation embryos in patients with a poor prognosis and possibly to increase the chance of implantation by selecting chromosomally normal embryos.

DESIGN

A prospective, randomized, controlled study.

SETTING

In vitro fertilization program at the Reproductive Medicine Unit of the Società Italiana Studi Medicina della Riproduzione, Bologna, Italy.

PATIENT(S)

In a total of 28 stimulated cycles, the maternal age was > or = 38 years and/or the patient had > or = 3 previous IVF failures, factors that indicated a poor prognosis. After consent, 11 patients underwent preimplantation genetic diagnosis for aneuploidy, whereas 17 controls underwent assisted zona hatching.

INTERVENTION(S)

Simultaneous analysis of chromosomes X, Y, 13, 18, and 21 in a blastomere biopsied from day-3 embryos. Chromosomal analysis was performed with fluorescence in situ hybridization. Assisted zona hatching was performed on day-3 embryos from the control-group patients.

MAIN OUTCOME MEASURE(S)

Embryo morphology, results of fluorescence in situ hybridization, clinical pregnancies, and implantation.

RESULT(S)

In the study group, a total of 61 embryos were analyzed by fluorescence in situ hybridization, and 55% were chromosomally abnormal. Embryo transfer with at least one normal embryo was performed in 10 cycles. Four clinical pregnancies resulted, with a 28.0% implantation rate. In the control group, 41 embryos were transferred in 17 cycles after the assisted zona hatching procedure, yielding four clinical pregnancies and an 11.9% implantation rate.

CONCLUSION(S)

Infertile patients classified as having a poor prognosis have a high percentage of chromosomally abnormal embryos. The advantage of selecting and transferring embryos with normal fluorescence in situ hybridization results has an immediate impact on implantation.

Will preimplantation genetic diagnosis assist patients with a poor prognosis to achieve pregnancy?

PGD (preimplantation genetic diagnosis) of aneuploidy for chromosomes X, Y, 13, 18 and 21 was carried out on 196 embryos from 36 infertile patients classified with a poor prognosis due to (i) maternal age, (ii) repeated in-vitro fertilization (IVF) failures and (iii) mosaic karyotype. The percentage of abnormal embryos was comparable in the three groups of patients: maternal age 63%, repeated IVF failure 57%, and mosaic karyotype 62%. The analysis of the overall data revealed an increased incidence of abnormal embryos in the older age categories (predominantly due to aneuploidy), even in embryos at the 7- to 8-cell stage. In addition, the percentage of chromosomally abnormal embryos was directly proportional to the number of IVF failures, where the increase in chromosomal abnormalities was not correlated to aneuploidy but to other aberrations such as mosaicism and polyploidy. Following PGD, 28 patients had at least one embryo transferred that appeared normal by fluorescent in-situ hybridization (FISH). Four clinical pregnancies resulted, with an implantation rate of 10% per normal embryo. In conclusion, the high rate of chromosomally abnormal embryos in poor prognosis patients may have been the cause of implantation failure in their previous IVF cycles. Therefore, the possibility of transferring embryos with a normal FISH complement could improve the chance of pregnancy in this category of patients.

Prolonged sperm-oocyte exposure and high sperm concentration affect human embryo viability and pregnancy rate

A reduced time interval of oocyte exposure to spermatozoa was investigated to assess whether it could enhance oocyte development and improve embryo viability, especially in cases of male factor infertility. A total of 167 patients were included in a prospective randomized study. They were randomly allocated to two major study groups, A (n = 85) and B (control group; n = 82). The oocytes from group A patients were exposed to spermatozoa for only 1 h; those from group B were exposed for 16 h. The two study groups were then subdivided according to semen quality for further analysis of the results. Significantly higher percentages were obtained in group A than in group B in terms of the fertilization rate (74 versus 68%, P < 0.025), cleavage rate (53 versus 41%, P < 0.005), pregnancy rate (27 versus 12%, P < 0.05) and implantation rate (11 versus 6%, P < 0.05). In addition, an increased fertilization rate was achieved in oocytes exposed to male factor spermatozoa for only 1 h compared with the conventional incubation period (78 versus 65%, P < 0.01). Advanced cellular stages (55 versus 41%, P < 0.02) and higher implantation rates (13 versus 4%, P < 0.05) were attained in the subgroup whose oocytes were exposed to normal spermatozoa for 1 h compared with the male factor spermatozoa with the standard culture interval. The higher fertilization rates, enhanced embryo development and viability achieved in group A indicate that prolonged exposure of oocytes to high concentrations of spermatozoa is detrimental, decreasing sperm-oocyte interaction and subsequent embryo implantation, particularly in male factor patients.

Improved cleavage rate of human embryos cultured in antibiotic-free medium

Retarded development and blastomere fragmentation of human preimplantation embryos represent a common phenomenon in in-vitro culture systems. Even though media composition is generally formulated to meet embryo nutritional requirements, the influence of antibiotic supplementation has not been investigated thoroughly. The present study was performed to evaluate the effects of antibiotics on embryo morphology and growth in modified culture media. A total of 196 zygotes from 18 couples was cultured in three different media: (i) conventional medium (n = 99, control group); (ii) medium modified with half the standard antibiotic concentration (n = 54; and (iii) antibiotic-free medium (n = 43); 49 embryos from the control group were selected at the zygote stage and transferred to the patients on day 2. The remaining 147 zygotes were cultured to the blastocyst stage for cryopreservation; their morphology and cell number were assessed daily at 40, 64, 88 and 112 h post-insemination. Overall cleavage rate was 95% and embryo scoring revealed 91% grade 1 embryos throughout the culture period in the three media. Significantly higher cleavage rates were obtained in the antibiotic-free medium at each observation, including the blastocyst stage, when compared to the other two groups. In addition, no notable improvement was observed in the embryos cultured in a reduced concentration of antibiotics. In conclusion, antibiotic supplementation of media has an adverse effect on the growth rate of preimplantation embryos, even in reduced concentrations, suggesting that antimicrobial drugs may interfere with the timing of cleavage events either by delaying or blocking embryo development.

Reducing the time of sperm-oocyte interaction in human in-vitro fertilization improves the implantation rate

Human oocyte development was evaluated after a reduced time exposure to spermatozoa in vitro. A total of 119 patients were assigned to two study groups in a randomized prospective study in which each patient's oocytes were exposed to spermatozoa for either 1 h (group 1 - 58 patients) or the standard 16 h incubation period (group 2 - 61 patients). The fertilization rate obtained in group 1 was higher than in group 2 (285/393, 73%, and 272/410, 66% respectively), suggesting that the spermatozoa-oocyte interaction occurs within 1 h. This was confirmed in a study in vitro using fluorescently labelled spermatozoa and normal oocyte-cumulus complexes. Spermatozoa enter the cumulus complex within 15 min, traverse the cumulus layer within 3 h, and first appear in the oocyte cortex at 4 h post-insemination. The incidence of polyspermy was higher in oocytes exposed to spermatozoa for 16 h (3%) than for 1 h (1%). There was no difference in the cleavage rate or morphological characteristics of embryos from both study groups. However, when evaluating the timing of embryo development, group 1 generated a significantly higher percentage of four to five cell embryos when compared to group 2 (55 versus 39%; P < 0.001), documented at 40 h post-insemination. The implantation and pregnancy rates for group 1 were 11 and 28%, while the corresponding rates for group 2 were 8 and 15%. This suggests that a reduced exposure of oocyte to spermatozoa favours embryo viability, possibly due to a decrease in potential damage from sperm metabolic waste products.

Human embryo co-culture: results of a randomized prospective study

OBJECTIVE

To evaluate in vitro culture of human embryos in the presence or absence of a Vero cell monolayer.

DESIGN

Randomized prospective analysis.

PATIENTS

Seventy-five couples were randomly allocated to either an experimental study group (embryos in co-culture) or a control group.

RESULTS

A significantly higher cleavage rate (92%) was obtained in the co-culture group compared with the control group (83%). In addition, a higher percentage of morphologically superior embryos was observed in the co-culture group than in the control group, although no significant difference was found between the two groups in blastocyst development or clinical outcome.

CONCLUSIONS

When taking final clinical results into consideration in a routine IVF program, the conventional method provides more practicality and efficiency if transfers are performed on either day 2 or 3. However, if embryos remain in culture, co-culture systems allow for replacements or cryopreservation at the blastocyst stage.

Progesterone bioconversion by microalgal cultures

Ten different strains of unicellular microalgae have been used in the bioconversion of progesterone. Regio and stereoselective reduction and hydroxylation of the title compound were induced. A 9,10-seco derivative was obtained in high yield by using Scenedesmus quadricauda.

Cycloartane glucosides from Juncus effusus

Five new cycloartane glucosides, juncosides I-V, have been isolated from Juncus effusus. The structures have been determined on the basis of chemical and spectroscopic studies.

Oleanane glycosides from Hydrocotyle ranunculoides

Six new oleanane glycosides, ranuncosides I-VI, have been isolated from Hydrocotyle ranunculoides. Their structures have been determined on the basis of chemical and spectroscopic studies.

Sperm:oocyte ratios in an in vitro fertilization (IVF) program

PURPOSE

During the past few years, many oocyte insemination techniques, including microinjection, have evolved in the treatment of male-factor infertility. This preliminary study was designed to evaluate whether microdroplet insemination could be considered a reliable technique, especially for semen samples with male-factor defects. The first objective was to assess fertilization rates obtained by inseminating sibling oocytes using both the conventional IVF and the microdroplet method (Group 1). The second objective was to evaluate subsequent embryo development and pregnancy rates resulting from microdroplet insemination, in addition to formulating adequate sperm:oocyte ratios for various semen categories (Group 2). Four semen categories were studied including fresh normal sperm, frozen/thawed normal sperm, and male-factor sperm with one defect and two or three defects.

RESULTS

Group 1 consisted of 54 couples; no statistical significance was found in the fertilization rates between test tube and microdroplet insemination in all four semen categories. Based on these results, patients from Group 2 (48 couples) had their oocytes inseminated only in microdroplets with sperm:oocyte ratios ranging from 2000 to 10,000 motile sperm:1 oocyte. The average fertilization rate for male-factor sperm was 55%, with a 91% cleavage rate.

CONCLUSION

Higher fertilization rates were observed in the lowest range of sperm:oocyte ratios (2000-4000:1) for male-factor sperm with one defect and in the highest range (8000-10,000:1) for male-factor sperm with two or three defects. Polyspermy occurred in only 0.4% of the oocytes inseminated. Microdroplet insemination is an alternative treatment for moderate to moderately severe male-factor infertility, establishing a bridge between conventional IVF and microinjection. With adequate sperm:oocyte ratios, this technique allows the natural selection process of fertilization in vitro to take place, without the high incidence of polyspermy or mechanical damage frequently observed in assisted fertilization techniques.

Biological factors affecting subzonal sperm microinjection results

One hundred and sixteen couples with severe male factor infertility underwent 139 subzonal sperm microinjection cycles. In total, 1343 oocytes were microinjected, resulting in a fertilization rate of 24%, followed by a cleavage rate of 65%. In 26% of the zygotes, fertilization was delayed and embryos derived from these zygotes demonstrated a poor capacity for further growth and implantation. In 102 of 139 cycles (73%) embryo transfer was performed, resulting in 9 pregnancies. This study followed the fate of injected oocytes and early embryo development to investigate biological factors that influence the results of subzonal injection.

Can iodine-131 whole-body scan be replaced by thyroglobulin measurement in the post-surgical follow-up of differentiated thyroid carcinoma?

This study compared serum thyroglobulin measurement and whole-body scans in the post-surgical follow-up of patients with differentiated thyroid carcinoma. Thyroglobulin levels were measured in 61 patients receiving L-thyroxine therapy after thyroidectomy, and again after suspension of therapy, before performing a whole-body scan with iodine-131. The sensitivity, specificity, and accuracy of thyroglobulin levels, measured during L-thyroxine therapy, for diagnosis of tumor residue or metastases were then calculated and compared with results obtained by diagnostic whole-body scanning. Our data show that neither thyroglobulin levels nor whole-body scans alone can discriminate between patients with or without metastases. Sensitivity reached 95.7%, specificity 100%, and accuracy 96.7% if results of both procedures were also taken into consideration. We conclude that in the management and follow-up of patients with differentiated thyroid carcinoma both parameters need to be evaluated.

Thyroid carcinoma with biphasic clinical course and evolution in medullary carcinoma-follicular variant. A case report and an immunocytochemical demonstration of calcitonin and thyroglobulin in the same neoplastic cells

The authors present an unusual case of thyroid neoplasia firstly diagnosed as an anaplastic carcinoma with no rise in plasma thyroglobulin (Tg) and treated with total thyroidectomy and radioiodine administration. After 18 months regional lymph node metastases were present with a rise in plasma calcitonin (Ct) (8000-14000 pg/ml); lymphectomy and external radiation were performed and histology revealed a metastasis from thyroid medullary carcinoma. After 3 years, mediastinal and right supraclavicular masses were present with a concomitant rise in plasma calcitonin (from 700 to 3400 pg/ml); all neoplastic lesions showed radioiodine uptake and plasma Tg was 8.9 ng/ml. A biopsy of the supraclavicular region was taken and 131I therapy was attempted, but the patient died after 6 months. Immunocytochemistry of the biopsy revealed the presence of a medullary carcinoma-follicular variant: the neoplastic cells were variably reacting with anti-Ct and anti Tg, and, moreover, the two antigens were sometimes observed in the same cell bodies. The metabolic pattern and the clinical course of this tumour are discussed, and the authors propose that Ct and Tg plasma levels be evaluated and a total body scan (WBS) with radioiodine be performed in all cases of medullary or poorly differentiated thyroid carcinomas.

[Organotherapy treatment in the course of normofunctional goiter. Long-term results in 104 patients]

Results of therapy with thyroid hormones (LT4 and/or LT3) were evaluated in 104 patients (95 females and 9 males) with simple diffuse or nodular goiter. The mean interval of observation was 7.2 years. The reported results were analysed in relation to patient's age at the onset of the pathology, time elapsed since its appearance, place of origin and sex of the patient, results of laboratory studies, and clinical signs.

Accessory to the Talairach's apparatus for orthogonal approaches. Technical note

A stereotactic device is described which, without modifying the main characteristics of the Talairach's stereotactic apparatus, increases its flexibility in orthogonal approaches. This accessory, which replaces the double-grid system, permits any orthogonal access on the X and Y coordinates and insertion of any type of electrode, catheter or probe, without the constraints of the double grid holes. Its use in different stereotactic operations (brain tumor biopsy or curietherapy, implantation of intracerebral depth electrodes for stereo-EEG recording) proved its wide working capability and great reliability.