SRAP markers as an alternative tool for Alternaria classification

Alternaria is one of the main fungal contaminants of cereal grains worldwide with the potential to produce mycotoxins hazardous to human and animal health. Many studies have been carried out to characterize Alternaria sp.-grp. using traditional morphology or polyphasic approach, but a good correlation between morphological sp.-grp., molecular, and chemotaxonomic groups has not always been achieved. For this reason, this study aimed to investigate the usefulness of a cheaper alternative tool, SRAP markers, in identifying Alternaria sp.-grps. obtained from Argentinean barley grains and to compare it with preliminary characterization using morphological traits, phylogeny, and metabolite profiles. Fifty-three Alternaria isolates from barley grains of the main producing regions of Argentina were analyzed with four combinations of SRAP markers. The UPGMA dendrogram, based on the Simple Matching similarity coefficient, revealed three distinct groups. SRAP markers allowed the separation of Alternaria from Infectoriae sections in agreement with the results of a polyphasic approach previously made. Besides, isolates of A. arborescens sp.-grp. were clustered in a separate group from isolates of A. tenuissima and A. alternata sp.-grp., which were grouped in the same cluster. SRAP markers are a recommended tool for classifying Alternaria isolates because of its simplicity, reliability, and cost-effectiveness compared to other molecular markers.

Perspectives in linear accelerator for FLASH VHEE: Study of a compact C-band system

PURPOSE

In order to translate the FLASH effect in clinical use and to treat deep tumors, Very High Electron Energy irradiations could represent a valid technique. Here, we address the main issues in the design of a VHEE FLASH machine. We present preliminary results for a compact C-band system aiming to reach a high accelerating gradient and high current necessary to deliver a Ultra High Dose Rate with a beam pulse duration of 3μs.

METHODS

The proposed system is composed by low energy high current injector linac followed by a high acceleration gradient structure able to reach 60-160 MeV energy range. To obtain the maximum energy, an energy pulse compressor options is considered. CST code was used to define the specifications RF parameters of the linac. To optimize the accelerated current and therefore the delivered dose, beam dynamics simulations was performed using TSTEP and ASTRA codes.

RESULTS

The VHEE parameters Linac suitable to satisfy FLASH criteria were simulated. Preliminary results allow to obtain a maximum energy of 160 MeV, with a peak current of 200 mA, which corresponds to a charge of 600 nC.

CONCLUSIONS

A promising preliminary design of VHEE linac for FLASH RT has been performed. Supplementary studies are on going to complete the characterization of the machine and to manufacture and test the RF prototypes.

Future technological developments in proton therapy - A predicted technological breakthrough

In the current spectrum of cancer treatments, despite high costs, a lack of robust evidence based on clinical outcomes or technical and radiobiological uncertainties, particle therapy and in particular proton therapy (PT) is rapidly growing. Despite proton therapy being more than fifty years old (first proposed by Wilson in 1946) and more than 220,000 patients having been treated with in 2020, many technological challenges remain and numerous new technical developments that must be integrated into existing systems. This article presents an overview of on-going technical developments and innovations that we felt were most important today, as well as those that have the potential to significantly shape the future of proton therapy. Indeed, efforts have been done continuously to improve the efficiency of a PT system, in terms of cost, technology and delivery technics, and a number of different developments pursued in the accelerator field will first be presented. Significant developments are also underway in terms of transport and spatial resolution achievable with pencil beam scanning, or conformation of the dose to the target: we will therefore discuss beam focusing and collimation issues which are important parameters for the development of these techniques, as well as proton arc therapy. State of the art and alternative approaches to adaptive PT and the future of adaptive PT will finally be reviewed. Through these overviews, we will finally see how advances in these different areas will allow the potential for robust dose shaping in proton therapy to be maximised, probably foreshadowing a future era of maturity for the PT technique.

Exploiting the full potential of proton therapy: An update on the specifics and innovations towards spatial or temporal optimisation of dose delivery

Prescription and delivery of protons are somewhat different compared to photons and may influence outcomes (tumour control and toxicity). These differences should be taken into account to fully exploit the clinical potential of proton therapy. Innovations in proton therapy treatment are also required to widen the therapeutic window and determine appropriate populations of patients that would benefit from new treatments. Therefore, strategies are now being developed to reduce side effects to critical normal tissues using alternative treatment configurations and new spatial or temporal-driven optimisation approaches. Indeed, spatiotemporal optimisation (based on flash, proton minibeam radiation therapy or hypofractionated delivery methods) has been gaining some attention in proton therapy as a mean of improving (biological and physical) dose distribution. In this short review, the main differences in planning and delivery between protons and photons, as well as some of the latest developments and methodological issues (in silico modelling) related to providing scientific evidence for these new techniques will be discussed.

First proton minibeam radiation therapy treatment plan evaluation

Proton minibeam radiation therapy (pMBRT) is a novel dose delivery method based on spatial dose fractionation. pMBRT has been shown to be promising in terms of reduced side effects and superior tumour control in high-grade glioma-bearing rats compared to standard irradiation. These findings, together with the recent optimized implementation of pMBRT in a clinical pencil beam scanning system, have triggered reflection on the possible application to patient treatments. In this context, the present study was designed to conduct a first theoretical investigation of the clinical potential of this technique. For this purpose, a dedicated dose engine was developed and used to evaluate two clinically relevant patient treatment plans (high-grade glioma and meningioma). Treatment plans were compared with standard proton therapy plans assessed by means of a commercial treatment planning system (ECLIPSE-Varian Medical systems) and Monte Carlo simulations. A multislit brass collimator consisting of 0.4 mm wide slits separated by a centre-to-centre distance of 4 or 6 mm was placed between the nozzle and the patient to shape the planar minibeams. For each plan, spread-out Bragg peaks and homogeneous dose distributions (±7% dose variations) can be obtained in target volumes. The Peak-to-Valley Dose Ratios (PVDR) were evaluated between 9.2 and 12.8 at a depth of 20 mm for meningioma and glioma, respectively. Dose volume histograms (DVHs) for target volumes and organs at risk were quantitatively compared, resulting in a slightly better target homogeneity with standard PT than with pMBRT plans, but similar DVHs for deep-seated organs-at-risk and lower average dose for shallow organs. The proposed delivery method evaluated in this work opens the way to an effective treatment for radioresistant tumours and will support the design of future clinical research.

Proton radiography with a commercial range telescope detector using dedicated post processing methods

Proton transmission imaging uses protons with high enough energy to fully traverse the phantom/patient and to be captured in a suitable detector placed behind it. The measured residual energy or residual range provide a direct estimate of the water equivalent thickness (WET) of the image volume. Requirements for proton imaging to be exploitable in clinical practice include: sufficient WET accuracy and integrability into the treatment room and the clinical workflow, as well as an acceptably low dose to the patient and a sufficient spatial resolution. In this work, we report on experiments performed at the Institut Curie-Proton therapy center in Orsay (IC-CPO), France, using a commercial range telescope commonly employed for quality assurance measurements. The purpose was to keep the experimental set-up as simple as possible and to achieve nonetheless high WET accuracy radiographies by developing and applying dedicated post processing methods. We explain these methods in detail and discuss their performance. We assess the WET accuracy based on two different reference phantoms: a CIRS electron density phantom with tissue equivalent inserts and a homogeneous step phantom. We find an agreement between the measured and the reference WET values of 0.2-0.5 mm. The lowest investigated dose was 10 mGy per acquisition. It could be lowered by modifying the irradiation plan and lowering the beam current, though the latter would impose slight optimisations of the detector hardware. Our work suggests that proton radiographies with good WET accuracy can be obtained with a reasonable experimental effort that would facilitate integration into clinical routine.

Calibration of imaging plate detectors to mono-energetic protons in the range 1-200 MeV

Responses of Fuji Imaging Plates (IPs) to proton have been measured in the range 1-200 MeV. Mono-energetic protons were produced with the 15 MV ALTO-Tandem accelerator of the Institute of Nuclear Physics (Orsay, France) and, at higher energies, with the 200-MeV isochronous cyclotron of the Institut Curie-Centre de Protonthérapie d'Orsay (Orsay, France). The experimental setups are described and the measured photo-stimulated luminescence responses for MS, SR, and TR IPs are presented and compared to existing data. For the interpretation of the results, a sensitivity model based on the Monte Carlo GEANT4 code has been developed. It enables the calculation of the response functions in a large energy range, from 0.1 to 200 MeV. Finally, we show that our model reproduces accurately the response of more complex detectors, i.e., stack of high-Z filters and IPs, which could be of great interest for diagnostics of Petawatt laser accelerated particles.

Proton minibeam radiation therapy: Experimental dosimetry evaluation

PURPOSE

Proton minibeam radiation therapy (pMBRT) is a new radiotherapy (RT) approach that allies the inherent physical advantages of protons with the normal tissue preservation observed when irradiated with submillimetric spatially fractionated beams. This dosimetry work aims at demonstrating the feasibility of the technical implementation of pMBRT. This has been performed at the Institut Curie - Proton Therapy Center in Orsay.

METHODS

Proton minibeams (400 and 700 μm-width) were generated by means of a brass multislit collimator. Center-to-center distances between consecutive beams of 3200 and 3500 μm, respectively, were employed. The (passive scattered) beam energy was 100 MeV corresponding to a range of 7.7 cm water equivalent. Absolute dosimetry was performed with a thimble ionization chamber (IBA CC13) in a water tank. Relative dosimetry was carried out irradiating radiochromic films interspersed in a IBA RW3 slab phantom. Depth dose curves and lateral profiles at different depths were evaluated. Peak-to-valley dose ratios (PVDR), beam widths, and output factors were also assessed as a function of depth.

RESULTS

A pattern of peaks and valleys was maintained in the transverse direction with PVDR values decreasing as a function of depth until 6.7 cm. From that depth, the transverse dose profiles became homogeneous due to multiple Coulomb scattering. Peak-to-valley dose ratio values extended from 8.2 ± 0.5 at the phantom surface to 1.08 ± 0.06 at the Bragg peak. This was the first time that dosimetry in such small proton field sizes was performed. Despite the challenge, a complete set of dosimetric data needed to guide the first biological experiments was achieved.

CONCLUSIONS

pMBRT is a novel strategy in order to reduce the side effects of RT. This works provides the experimental proof of concept of this new RT method: clinical proton beams might allow depositing a (high) uniform dose in a brain tumor located in the center of the brain (7.5 cm depth, the worst scenario), while a spatial fractionation of the dose is retained in the normal tissues in the beam path, potentially leading to a gain in tissue sparing. This is the first complete experimental implementation of this promising technique. Biological experiments are needed in order to confirm the clinical potential of pMBRT.

Temperature and water stress impacts on growth and production of altertoxin-II by strains of Alternaria tenuissima from Argentinean wheat

Alternaria tenuissima is commonly isolated from wheat in Argentina. The objective of this study was to examine the effects of temperature (15-34 °C) and water activity (0.98, 0.95 aw) on growth and temporal altertoxin II (ALTX-II) production by two strains over 14-21 days on a milled wheat agar. It was shown that growth occurred over the whole temperature range tested and was optimum at 25-30 °C and 0.98 aw, and 30 °C at 0.95 aw. The incubation time did not show any significant effect on ALTX-II accumulation. The optimum conditions for ALTX-II production were 0.98 aw and 30 °C for both strains. The strains also accumulated significant amounts of this toxin at 34 °C. This is the first study to evaluate the ecology of growth and production of ALTX-II by strains of A. tenuissima.

Water activity and temperature effects on mycotoxin production by Alternaria alternata on a synthetic tomato medium

Alternaria spp. have been reported to be the most frequent fungal species invading tomatoes. Certain species, in particular the most common one, A. alternata, are capable of producing several mycotoxins in infected plants and in agricultural commodities. Alternariol (AOH), alternariol monomethyl ether (AME), and tenuazonic acid (TA) are some of the main Alternaria mycotoxins that can be found as contaminants of food. The objective of this study was to determine the effect of water activity (a(w), 0.904, 0.922, 0.954, and 0.982) and temperature (6, 15, 21 and 35 degrees C) on mycotoxin production on a synthetic tomato medium of a cocktail inoculum of five strains of A. alternata isolated from tomato fruits affected by Blackmould. The optimum AOH production occurred at 0.954 a(w) after 28days of incubation at 21 degrees C. A temperature of 21 degrees C was the most favourable for AOH synthesis at all a(w) levels. The maximum concentration of AME was determined at 0.954 a(w) and 35 degrees C. The optimum conditions for TA accumulation were 0.982 a(w) and 21 degrees C. At the 0.904 a(w) no growth or germination was registered at 6 degrees C and 15 degrees C over the whole incubation period. At 21 degrees C and 35 degrees C growth occurred slowly but none of the toxins were detected at this a(w) level. In general, high a(w) levels were favourable for mycotoxin production. None of the other toxins was detected at quantifiable levels at 6 degrees C after the whole incubation period. A storage temperature of 6 degrees C or below could be considered as safe for tomato fruits and high moisture tomato products (a(w)>0.95), in relation with Alternaria toxins. The results obtained here could be extrapolated to evaluate the risk of spoilage in tomato fruits and tomato products caused by this pathogen.

Effect of water activity and temperature on growth of Alternaria alternata on a synthetic tomato medium

Alternaria alternata is a toxigenic fungus, predominantly responsible for Blackmould of ripe tomato fruits, a disease frequently causing substantial losses of tomatoes, especially those used for canning. The objective of this study was to determine the effect of water activity (a(w), 0.904, 0.922, 0.954, 0.982) and temperature (6, 15, 21 and 35 degrees C) on germination and radial growth rate on a synthetic tomato medium of a cocktail inoculum of five strains of A. alternata isolated from tomato fruits affected by Blackmould. The shortest germination time (1.5 days) was observed at 0.982 a(w), both at 21 degrees C and 35 degrees C. The germination time increased with a reduction on a(w). The fastest growth rate was registered at 0.982 a(w) and 21 degrees C (8.31 mm/day). Growth rates were higher when a(w) increased. No growth or germination was observed at the lowest a(w) level evaluated (0.904) after 100 days of incubation at 6 degrees C and 15 degrees C. A temperature of 6 degrees C caused a significant reduction in growth rates, even at the optimum a(w) level. The knowledge on the ecophysiology of the fungus in this substrate is necessary to elaborate future strategies to prevent its development and evaluate the consumer health risk.

Alternaria toxins in wheat during the 2004 to 2005 Argentinean harvest

The natural occurrence of Alternaria mycotoxins in Argentinean wheat from the zone 5 South during the 2004 to 2005 harvest was investigated in 64 wheat samples. All samples were highly contaminated with a wide range of fungal species. Alternaria was found as the main component of the mycota, with an infection percentage of 100%. Three mycotoxins produced by species of Alternaria were determined in wheat: alternariol, alternariol monomethyl ether, and tenuazonic acid. Alternariol was detected in 4 (6%) of 64 samples, with a range of 645 to 1,388 microg/kg (mean of 1,054 microg/kg); alternariol monomethyl ether, with a range of 566 to 7,451 microg/kg (mean of 2,118 microg/kg) in 15 (23%) of 64 samples; and tenuazonic acid in 12 (19%) of 64 samples, with a range of 1,001 to 8,814 microg/kg (mean, 2,313 microg/kg). Alternariol monomethyl ether was the predominant toxin, but tenuazonic acid was detected in higher concentrations. Alternariol was present in fewer samples and in lower levels than were the other toxins. Tenuazonic acid and alternariol monomethyl ether occurred together in four samples, while tenuazonic acid and alternariol co-occurred in one sample. This the first report of the natural occurrence of Alternaria mycotoxins in Argentinean wheat. Toxin levels were high, probably due to the heavy infection with Alternaria species found in the samples.

Mycotoxin production by Alternaria strains isolated from Argentinean wheat

The toxigenic potential of Alternaria strains isolated from Argentinean wheat was investigated. A total of 123 strains were assayed for the production of tenuazonic acid (TA), alternariol (AOH) and alternariol monomethyl ether (AME). All but one of the isolates were able to produce at least one of the three mycotoxins. TA was produced by 72% of the strains (1-14782 mg/kg), AOH by 87% (4-622 mg/kg) and AME by 91% (7-2625 mg/kg). The average level of TA detected for all strains (1757 mg/kg) was higher than the average level of both alternariols (162 mg/kg for AOH and 620 mg/kg for AME). TA was the toxin produced at the highest concentration but in lower frequency. Most of the strains were able to synthesize more than one toxin: 74 isolates (60%) were positive for all three toxins, 30 (24%) for both AOH and AME, 5 (4%) for both TA and AME, and 2 (2%) for TA and AOH. The widespread occurrence of Alternaria in wheat and its ability to produce mycotoxins suggests the possible occurrence of its toxins in wheat naturally infected with this fungus.

Effect of water activity and temperature on growth of ochratoxigenic strains of Aspergillus carbonarius isolated from Argentinean dried vine fruits

Aspergillus carbonarius is an ochratoxin A (OTA) producing fungus, predominantly responsible for the production of this mycotoxin in grapes, wine and dried vine fruits. The objective of this study was to determine the in vitro effects of water activity (a(w), 0.80-0.95) and temperature (15-35 degrees C) on lag phase extension and radial growth rate of a cocktail inoculum of four strains of A. carbonarius. The maximum growth rate was observed at 0.95 a(w) and 30 degrees C (17.46 mm day(-1)). In general, growth rates increased with the increment of a(w). No growth was observed at a(w) below 0.85. For all a(w) levels tested the highest growth rate was detected at 30 degrees C. At 15 degrees C growth only occurred at the higher a(w) levels evaluated (0.925 and 0.95) at a growth rate of 3.82 and 5.57 mm day(-1) respectively. The shortest lag phase (0.26 days) was found at 0.925 a(w) and 35 degrees C. At marginal conditions of a(w) and temperature the lag phases increased, being the highest registered at 20 degrees C and 0.89 a(w) (33.7 days). The pattern of effects of environmental factors on growth was similar among Argentinean A. carbonarius strains and those from several European countries, Israel and Australia.

Natural co-occurrence of aflatoxin and cyclopiazonic acid in peanuts grown in Argentina

Natural occurrence of aflatoxins and cyclopiazonic acid (CPA) contamination in peanuts was investigated. Co-occurrence of CPA and aflatoxins was detected in two of 50 samples analysed. The levels of these toxins found in positive samples were 4300 and 493 microg kg(-1) for CPA, 625 and 435 microg kg(-1) for aflatoxin B1 (AFB1), and 625 and 83 microg kg(-1) for aflatoxin G1 (AFG1), respectively. Levels of CPA contamination in the positive samples were similar to those registered in other substrates. This is the first report of natural co-occurrence of CPA and aflatoxins in Argentina.

Influence of water activity and temperature on the growth of Wallemia sebi: application of a predictive model

Germination and growth of Wallemia sebi were examined on media of a(w) adjusted with glycerol in the range of 0.96-0.77, at 25 degrees C and 30 degrees C. The effect of temperature on the germination time was significant except between 0.95 and 0.88 a(w). At low a(w) levels as well as above 0.95, the increase of temperature produced an increment in the germination time. The minimum a(w) for germination was also affected by temperature, being lower at 25 degrees C (0.80 a(w)) than at 30 degrees C (0.82 a(w)). Radial growth rates at 25 degrees C were higher than at 30 degrees C. The optimum a(w) value for growth of W. sebi was 0.94 at both temperatures. The minimum a(w) for growth was higher than minimum for germination and was also dependent on temperature (0.84 at 25 degrees C and 0.86 at 30 degrees C). An empirical mathematical model was fitted to the measured growth data, providing a good approach to the description of the effect of a(w) on the radial growth rate of W. sebi.

The use of intravenous immunoglobulin in sine causa or alloimmune recurrent spontaneous abortion (RSA)

BACKGROUND

Recurrent spontaneous abortion (RSA) has an incidence of 0.5%-1%. It is thought that immune reaction disorders in the mother may evolve in unexplained RSA, which has a higher incidence in women over 40 years old.

METHODS

Twenty-three patients with recurrent spontaneous abortion of unknown origin and two autoimmune cases were treated with intravenous specific immunoglobulins at the 5th-6th week of pregnancy and fifteen days later.

RESULTS

After treatment, nineteen patients brought their pregnancy to term, five aborted, one is pregnant at present.

CONCLUSIONS

The use of immunoglobulins seems to be efficacious in recurrent spontaneous abortion of unknown origin. Our results support the theory that this treatment is able to passively transfer the sparking off factor that allows the pregnancy to evolve.

Recurrent spontaneous abortion. Etiologic factors

BACKGROUND

Spontaneous abortion is the most common complication of pregnancy. It may be unique, remaining random and having no consequences on the reproductive process, or it can repeat itself, starting a clinical picture known as recurrent spontaneous abortion or habitual abortion. The term of RSA syndrome is used to define the repetition of three or more consecutive abortions before the 24th week.

METHODS

A population of 195 couples with recurrent spontaneous abortion were screened for genetic, metabolic, infective, morphological, endocrine and autoimmune factors. Eighty-five completed the investigation, 44 are being tested and 66 did not complete the diagnostic course. Causes of recurrent abortion were evaluated in relation to the period of abortion and number of embryo losses.

RESULTS

Forty-six percent of patients who completed the investigation turned out to be sine causa, which is in accordance with the findings in literature.

CONCLUSIONS

Couple with RSA require accurate counselling and it is fundamental to eliminate any pathologies that can be discovered so as to improve the likelihood of the pregnancy's reaching term.

[Ultrasonic monitoring as a method of preventing risks of ovarian hyperstimulation during drug therapy]

BACKGROUND AND AIMS

Ultrasonographic monitoring represents the most immediate method for an early confirmation of the onset of the worst complication of the pharmacological induction of ovulation: ovarian hyperstimulation. The aim of this study was to evaluate the incidence of this complication in a sample group of anovulatory patients receiving pharmacological treatment and undergoing repeated ultrasonographic monitoring.

METHODS

The authors analysed the controls performed during 1996-1997 in which a total of 413 cycles were stimulated. The patients included in the study group (mean age 28.5 years) were treated using clomiphene, oestradiol, FSH, LH and GnRH, and in 5 cases stimulation was preceded by suppression of the menstrual cycle using tryptorelin. Each patient was monitored with 3 scans, except for those treated with tryptorelin or GnRH who were more closely monitored.

RESULTS

In 413 patients included in this study the authors noted the onset of slight hyperstimulation in 6 cases (1.45%) which then resolved spontaneously without the need for hospitalisation.

CONCLUSIONS

The authors affirm that ultrasonographic monitoring represents a valid means of controlling and preventing the risks of ovarian hyperstimulation.

Transvaginal sonographic tubal patency testing using air and saline solution as contrast media in a routine infertility clinic setting

Tubal patency testing by transvaginal sonography has been implemented in our infertility clinic since 1991. We report our experience with this technique during the last year of routine outpatient activity. A total of 154 infertile patients, including three patients on two occasions, underwent tubal patency testing by transvaginal sonography; 36 also underwent laparoscopy or hysterosalpingography, with a further three undergoing both. A detailed account of the method used to visualize the passage of air and saline through the salpinx is described. The 'gold standard' for tubal patency was laparoscopy. In any cases that were doubtful or if there was tubal occlusion, laparoscopy was advised. The diagnoses by transvaginal sonography in the 154 patients consisted of: 106 with bilateral tubal patency (68.8%), 34 with unilateral tubal occlusions (22.1%), and 13 with bilateral occlusion (8.4%); one case was undiagnosed. Tubal disease was present in 25 out of the 36 (69.4%) patients undergoing laparoscopy or hysterosalpingography (69.4%). The sensitivity, specificity, accuracy, positive and negative predictive values were respectively 80, 85, 82.7, 85 and 80% for the 29 patients undergoing transvaginal sonography and laparoscopy. When the number of tubes examined was considered, these values were respectively 85, 91.6, 89.3, 85 and 91.6%. No discordance was observed in the ten patients undergoing hysterosalpingography. Demonstration of the tubal course relies on a positive contrast medium filling the tubal lumen. Air and saline were successful for this purpose. In our study, the results of tubal patency testing by transvaginal sonography were very similar to those of hysterosalpingography, but differed in about 10% of the cases from those of laparoscopy. The most difficult problem to rule out was distal tubal occlusion without hydrosalpinx. Tubal patency testing by transvaginal sonography can be used safely as a first-step examination of tubal patency. Easy tubal passage can allow medical treatment, while a doubtful or frankly occluded salpinx should be investigated by laparoscopy.

A new technique to test tubal patency under transvaginal sonographic control

OBJECTIVE

Since 1990 we have undertaken a trial to evaluate if TVS, even without contrast media, could diagnose tubal patency.

MATERIALS AND METHODS

A detailed description of the technique is given. Two hundred and seventy-three patients underwent sonosalpingography in our department in the period 1990-1993. The sonographic findings were matched in 43 cases to hysterosalpingography and in 55 cases to laparoscopy.

RESULTS

Tubal patency was demonstrated in 218 patients (80.5%), monolateral patency in 41 (15.1%) patients and bilateral tubal occlusion in 12 (4.4%) patients. In the 43 patients undergoing hysterosalpingography, discordance between the two examinations was observed in five cases (11.6%). However, only six out of 86 salpinxes had different results (6.9%). In only one case was total discordance observed. In three out of four other cases the difference was due to patency diagnosed at SSG and occlusion at HSG. Of the 55 patients undergoing laparoscopy 12 cases (21.8%) had discordant results. Complete discordance was observed in two cases while in ten cases one salpinx had a different patency report. The discordance goes to 12.7% when we take into account all the salpinxes evaluated.

CONCLUSION

Sonosalpingography gives very similar results to hysterosalpingography and may be used on clinical basis for tubal patency evaluation.

Transvaginal salpingo-sonography (TSSG) in the evaluation of tubal patency

Transvaginal sonography was used in 78 patients to evaluate tubal patency as a control in infertility workup. The cervix was fitted with a Semm cervix-adapter (Wisap); air and saline were injected through it. Careful scanning of the uterine angles and of the tubes permitted to demonstrate bilateral passage of the contrast medium in 52 of the 55 patients and monolateral passage in 3. 21 patients had also other conventional evaluations of tubal patency. Two patients were excluded from protocol. Total agreement with hysterosalpingography (HSG) was found in 69.2% of the cases, partial agreement in 23%. Total agreement with laparoscopy (LPS) was found in 83.3% of the cases. In conclusion transvaginal sonosalpingography (TSSG) can be used as a first ambulatorial evaluation of tubal patency in infertility work-up.

[Significance and problems of psychological consultation for infertility. Personal experience]

A sample group of 200 couples attending the Centre for the Diagnosis and Treatment of Sterility in the Couple were studied. All patients had one or more conversations with a psychologist in order to analyze the real desire for pregnancy and to encourage a better relationship between the medical team and the patients. The study throws light on many conflictual situations relating to both the individual's and the couple's desire to achieve pregnancy with the help of science. Nevertheless, it was not possible to utilise all the information gathered by the psychologist from the conversations to improve the relationship between the medical team and the patients.

[Ultrasonic evaluation of spontaneous and drug-induced cycles in a sterile population]

The scope of this study was to correlate the size and number of growing follicles contemporeaneously in 106 spontaneous cycles and in 126 cycles induced by the administration of clomiphene, gonadotropins and LH-RH microinfusers, in a total of 149 sterile patients with a mean age of 30.2 years. The results have shown that maximum follicular diameter is significantly larger in drug-induced cycles in comparison to spontaneous cycles (p less than 0.05). Nonetheless, ultrasound examination alone is not sufficient to establish follicular development and the time for administering HCG in order to diminish the percentage of hyperstimulation syndromes. Additional biochemical and biological (E2) tests should therefore be performed, as well as a careful study of the endometrial response to induction therapy.

[Correlation of positivity for serum anti-chlamydia antibodies and tubal damage as a cause of infertility. Preliminary study]

Chlamydia Trachomatis is one of the most frequently bound aetiological agents in acute salpingitis. Chlamydia infection often runs asymptomatically or with slight symptomatology, so patients do not call in their doctor. This hypothesis is backed by the observation that serum antibody positivity for Chlamydia and tubal infertility are often found together. The purpose of the present study was to determine the positivity of serum antibodies for Chlamydia in infertile women observed at this Centre and compare it with a control group of non-sterile patients. Further, in those patients in whom antibody positivity exists, it was also proposed to seek tubal lesions at hysterosalpingography or coelioscopy. The antibody titre in infertile women is compared with that of the control group. The study was carried out in 30 sterile women and in 30 patients in the definitely fertile control group. The "Ipazyme" (Sorin) immunoperoxidase test was used to seek IgG and IgA anti-Chlamydia antibodies. The geometric mean of the antibody titre was calculated in those women with a titre equal to or greater than 64 for IgG antibodies and equal to or greater than 16 for IgA antibodies. It is now intended to study whether the titre is higher in infertile women compared to the control group and if positivity is more significant in these patients.