P-641 Physicians’ practices towards hormone monitoring during ovarian stimulation in context of treatment with Assisted Reproductive Technology (ART). A global Survey conducted through IVFworldwide.com

Study question

What is the practice of routine hormone monitoring (HM) during ovarian stimulation (OS) in the context of ART treatment?

Summary answer

The majority of ART specialists (∼80%) use HM, along with ultrasound, for monitoring OS, especially for the prevention of ovarian hyperstimulation syndrome (OHSS).

What is known already

Ovarian stimulation (OS) is an essential part of ART and optimal monitoring is essential in order to optimize final outcome and ensure safety. Monitoring of OS can be either done with ultrasound (US) and/or hormonal monitoring in order to adjust gonadotropin dose, to trigger ovulation and to maximize success while avoiding the risk of OHSS. Clinical practice guidelines typically propose US monitoring as the cornerstone of OS monitoring during ART treatment. Although HM is practiced widely, the current attitude and practice of clinicians regarding HM has not been evaluated on a global scale.

Study design, size, duration

In a cross-sectional study carried out using a survey on current practice of blood HM, we evaluated physicians’ attitudes towards blood HM during OS in context of ART treatment. An open-access questionnaire was accessible to the members of IVF-Worldwide.com, from September 8 to October 13,2021 on IVF-Worldwide.com and was completed by 528 participants. Data analysis was performed using Excel (Microsoft Inc., USA), statistics were calculated once giving all survey entries an equal representation.

Participants/materials, setting, methods

An initial invitation and one reminder were sent to all 3845 registered members of IVF-Worldwide.com by email. In total, 528 participants answered the survey (13.7%). The survey was composed of 25 multiple-choice questions with mainly single answers. These questions asked about tests performed during any cycle monitoring visits during OS for ART treatment (blood hormone monitoring, ultrasound, timing, and frequency of prescribed tests), about monitoring to prevent OHSS as well as to adjust gonadotropin dose.

Main results and the role of chance

A total of 528 members from 88 countries responded to this web-based survey.

Most participants (87.9%) were clinicians and practiced reproductive medicine for more than 15 years (56.7%). Nearly half (46.2%) performed more than 500 oocyte aspiration cycles in their clinic annually.

Of the 528 respondents, the vast majority (98.9%) used US to monitor OS cycles during ART treatment. Hormone monitoring (HM) was widely accepted and performed by 420 (79.5%) of participants during any of the cycle monitoring visits for OS (from stimulation day 1 until the day before ovulation triggering (OT)).

Among different visits, participants most frequently monitored hormones on the day on or before the final oocyte maturation (71%) as compared with 57% on the first visit and 61% on the second and third visit during OS. The most frequent reason for HM was for prediction of OHSS (74%) and for adjusting gonadotropin dose (50%), whereas 45% of physicians considered HM for timing of OT.

Most respondents (60.7%) considered that hormones play an important role in monitoring ovarian response during OS and a 58% considered that blood hormone tests are important to guiding decision-making in preventing OHSS.

Limitations, reasons for caution

The survey was designed to represent self-reported statistics and opinions from experts in the field. It did not capture actual clinician performance or patient data.

Wider implications of the findings

Although several guidelines consider US monitoring as the cornerstone for monitoring ovarian response during OS for ART, the majority of ART specialists consider HM as essential. Good quality studies are needed to document the value of HM during OS, with respect to dose adjustment, ovulation triggering and prevention of OHSS.

Trial registration number

not applicable

O-070 Double stimulation in egg donors: is an adequate strategy to optimize the gamete donation program?

Study question

Is double stimulation (DuoStim) a viable strategy to optimize the performance of the egg donation program?

Summary answer

Carrying out two consecutive stimulations in the gamete donation program allows the number of donations to be increased, optimizing its efficiency while maintaining donor safety.

What is known already

DouStim (double stimulation) consists of two successive ovarian stimulations in the follicular and ensuing luteal phase with two oocyte retrievals at the end of both ovarian stimulations. This non-conventional strategy, developed to retrieve the greatest number of oocytes in the shortest possible time, was designed initially to optimize clinical outcomes in poor ovarian response, but double stimulation could be useful in patients with a good prognosis such as oocyte donors to optimize the program efficacy.

Study design, size, duration

Prospective and observational analysis performed in IVI Madrid between September and December 2019. Participants underwent the same stimulation protocol in the follicular phase and for luteal phase stimulation. The study was approved by an Institutional Review Board (1903-MADR-034-AR) and all women provided written informed consent.

Participants/materials, setting, methods

Follicular and luteal-phase stimulation was the same for all the donors; daily tablet of 10 mg of acetate of medroxyprogesterone (AMP) from first day of stimulation, 225 IU/day recombinant FSH and triggering with 0.1 mg GnRH agonist. To analyze the differences in clinical results between both phases of the cycle, independent donations were made after each oocyte retrieval. Statistical analyses were performed using the Statistical Package for Social Sciences 19.0 (IBM Corporation, Armonk, NY, USA).

Main results and the role of chance

We included 60 egg donors for a total of 88 recipients who received oocytes retrieved in both the follicular and luteal phases. Although the number of oocytes and metaphase II was significantly higher in the follicular phase compared to the luteal one, 19.8 ± 2.0 vs. 13.3 ± 2.2 oocytes, p < 0.001 and 16.4 ± 1.8 vs. 11.5 ± 2.1 MII, p < 0.001, then this disparity in the results disappears since the rate of usable blastocyst is similar with the same proportion of frozen embryos in both stimulation phases (4.0 ± 0.6 vs. 4.4 ± 0.8, p = 0.451). According to the clinical results, we did not observe significant differences between the follicular and the luteal phase neither for the implantation rate (69.8% vs. 66.1%, p = 0.783), nor for the clinical pregnancy rate (71.2% vs. 66.7%), confirming the possibility of being able to make independent donations of each of the stimulated phases without affecting the chances of success.

Limitations, reasons for caution

This is an observational study and thus possible confounders cannot be completely excluded. More data are needed to draw firm conclusions and it will be critical to increase the sample size to check if the results observed in this work remains in the general population

Wider implications of the findings

As far as we know, this is the first study in which a double stimulation protocol is applied in oocyte donors. The fact of being able to increase the number of donations in the same stimulation cycle allows us to improve the efficiency of the egg donation program.

Trial registration number

Not apply

P-796 Intraovarian injection of plasma rich in growth factors improves ovarian reserve and reproductive outcomes in women with diminished ovarian reserve

Study question

Does Plasma rich in growth factors (PRGF) ovarian injection increase the ovarian reserve biomarkers in women with diminished ovarian reserve?

Summary answer

PRGF injection increased Antimüllerian hormone (AMH) levels and antral follicular count (AFC) since the first follow-up after treatment allowing the initiation of ovarian stimulation cycles.

What is known already

Several techniques based on in vitro activation, ovarian fragmentation and stem cell ovarian transplantation have been proposed to reactivate ovarian function and increase IVF success in women with premature ovarian insufficiency and poor ovarian response. However, less invasive and feasible approaches are still required for those patients where egg donation is the only practical option.

Platelet rich plasma (PRP) and PRGF contain a high concentration of platelets, which carry more than 800 types of proteins, cytokines, hormones, and chemoattractants. Indeed, intraovarian PRP injection has recently been used in different case series and cohort studies of POI women with encouraging results.

Study design, size, duration

Retrospective study with 104 women aging 23-45 years who received a PRGF intraovarian injection (REGENERA-Ovario) was conducted between 2020 and 2021 at IVIRMA Alicante (Spain). Study was approved by the IRB committee of La Fe University Hospital (2112-FIVI-109-SH).

Participants/materials, setting, methods

Patients underwent a PRGF injection (Endoret kit; B.T.I. Biotechnology Institute S.L, Spain) in both ovaries and a follow up of ovarian reserve biomarkers (AFC, AMH) and follicle stimulating hormone (FSH) to evaluate follicular reactivation seeking IVF or spontaneous pregnancy. The follow up visits ranged from 1 to 5 months and were developed on a monthly basis after treatment or after menses recovery in POI. Study variables were compared to basal levels with a paired t-test.

Main results and the role of chance

Overall, 104 women (age: 38.7±2.0 years; BMI: 22.1±2.9) with diminished ovarian reserves underwent a PRGF intraovarian injection (3.3±0.8ml PRGF/each ovary). Prior to treatment, our cohort was characterized high serum FSH (21.8±4.1mIU/mL), low AMH levels (0.25±0.37ng/ml), and an ovarian volume of 6.3±2.3cm3.

Eighty-eight of them fulfilled the 1st follow up visit and showed an increase of serum AMH (0.25±0.37ng/ml vs. 0.32±0.36ng/ml, p = 0.008), and AFC in both ovaries (2.1±1.9 vs. 3.2±2.4, p < 0.0001) compared to basal levels, achieving ovarian reactivation in 55.9% of them and IVF cycle initiation in 19.3%. These improvements were higher 2 months after treatment (55 patients), with increased antral follicles (AFC-2: 2.9±2.5, p = 0.0001) and ovarian activation in 58.2%, and IVF start in 43.9% of patients. Similar results were observed during the 3rd follow up accomplished by 30 women and lasted until the 5th visit (n = 8), although the reduced patient number at this point.

A total of 44 IVF cycles were started and oocyte pick-up was successfully developed in 72.7% of them with a mean number of 3.3±4.2MII oocytes, 1.8±2.1 fertilized oocytes and 1.5±2.0 embryos per cycle. Indeed, 6 pregnancies were obtained during this period, 2 of them after embryo transfer and 4 by natural conception.

Limitations, reasons for caution

Our results are encouraging but a large cohort of patients with a longer follow up period is needed to establish the efficacy and duration of the PRGF positive ovarian effects. Moreover, a proper comparison with a control group with the same characteristics and no PRGF intervention is still required.

Wider implications of the findings

PRGF intraovarian injection reactivates follicle growth and allows IVF cycle initiation and embryo generation in a poor prognosis population of patients with diminished ovarian reserve. The effects persisted for several months after treatment.

Trial registration number

2112-FIVI-109-SH

Global COVID-19 lockdown highlights humans as both threats and custodians of the environment

The global lockdown to mitigate COVID-19 pandemic health risks has altered human interactions with nature. Here, we report immediate impacts of changes in human activities on wildlife and environmental threats during the early lockdown months of 2020, based on 877 qualitative reports and 332 quantitative assessments from 89 different studies. Hundreds of reports of unusual species observations from around the world suggest that animals quickly responded to the reductions in human presence. However, negative effects of lockdown on conservation also emerged, as confinement resulted in some park officials being unable to perform conservation, restoration and enforcement tasks, resulting in local increases in illegal activities such as hunting. Overall, there is a complex mixture of positive and negative effects of the pandemic lockdown on nature, all of which have the potential to lead to cascading responses which in turn impact wildlife and nature conservation. While the net effect of the lockdown will need to be assessed over years as data becomes available and persistent effects emerge, immediate responses were detected across the world. Thus, initial qualitative and quantitative data arising from this serendipitous global quasi-experimental perturbation highlights the dual role that humans play in threatening and protecting species and ecosystems. Pathways to favorably tilt this delicate balance include reducing impacts and increasing conservation effectiveness.

The COVID-19 pandemic as a pivot point for biological conservation

The COVID-19 lockdown reduced human mobility and led to immediate insights into how humans impact nature. Yet the strongest ecological impacts are likely to come. As we emerge from the pandemic, governments should avoid prioritizing short-term economic gains that compromise ecosystems and the services they provide humanity. Instead, the pandemic can be a pivot point for societal transformation to value longer term ecosystem and economic sustainability.

Small-sized follicles could contribute to high-order multiple pregnancies: outcomes of 6552 intrauterine insemination cycles

RESEARCH QUESTION

Can predictors of twin and high-order multiple pregnancy among women with multiple cycles of ovarian stimulation intrauterine insemination (IUI) be identified?

DESIGN

Retrospective cohort study of IUI cycles carried out between January 2014 and December 2015 in a private clinic in Spain. The 4879 women and 6552 cycles analysed in this study include single IUI with ovarian stimulation using recombinant FSH.

RESULTS

Number of follicles and follicle size were the only factors with a significant effect (P < 0.001) on the likelihood of achieving a twin or multifetal pregnancy. Follicles 12 mm or wider greatly increase the chances of achieving a twin or multifetal pregnancy. A total of 73 out of 127 (57.5%) twin pregnancies occurred in cycles with at least one additional follicle measuring 12 mm or wider, and 102 out of 127 twin pregnancies (80.3%) occurred in cycles with at least one additional follicle measuring 14 mm or wider. Cancellation criteria should consider the presence of follicles 12 mm or wider.

CONCLUSION

Follicles measuring 12 mm or wider increase the risk of having a twin or a high-order multiple pregnancy rate. These data may help clinicians balance decision-making between cancelling and performing the cycle within an IUI procedure.

Call Usage Learning by a Beluga (Delphinapterus leucas) in a Categorical Matching Task

The ability to modify the structure and context of vocalizations through learning plays a key role in the social interactions of many species. The investigation of categorical matching, an aspect of contextual vocal learning, is the first step toward determining how contextual learning plays a role in the use, comprehension, and categorization of sounds in the wild. To this end, we conducted a study at the Vancouver Aquarium to test the ability of a juvenile female beluga, Qila, to respond to playbacks of two types of in-air beluga calls with vocalizations that matched the category of call played (a scream, which is a vocalization type shaped over time with reinforcement and not part of this species'natural repertoire, and a pulse-train, a natural call category). We first tested Qila with random sequences of the same version of the two vocalizations with which she had been trained. Her overall success in matching all playback stimuli was above chance but not statistically so (66%). She had more difficulty matching screams (54% success) than pulse trains (80% success). We next played random sequences of six novel pulse-trains and seven novel screams, which Qila had not been trained with. She responded correctly to the set of novel stimuli of both call types in 64% of the trials, a success rate that did not differ statistically from chance. Again, she had more difficulty matching screams (55% success), relative to pulse trains (74% success). These results indicate that Qila successfully matched only pulse trains, the class that is part of this species’ natural repertoire. Her poor performance on matching screams might be partly explained by a difficulty to perceive categorically a signal that lacks a function in the natural repertoire of belugas.

A randomized comparison of different methods of analgesia in abortion using manual vacuum aspiration

OBJECTIVE

To estimate the effectiveness of different methods of analgesia among women treated with manual vacuum aspiration for spontaneous abortion.

MATERIALS AND METHODS

The 113 patients diagnosed with incomplete abortion and considered candidates for manual vacuum aspiration were randomly assigned to 3 groups of analgesic administration: diclofenac plus paracervical block; meperidine plus diclofenac; and meperidine alone. Pain levels were evaluated using the Wong Scale of Pain.

RESULTS

The mean pain scores for the three groups were: diclofenac and paracervical block 5.4; meperidine plus diclofenac 5.0; meperidine 5.7 (P=0.57). Analysis of pain using the levels mild (0-3), moderate (4-6), and severe (7-10) showed no statistical significance among the 3 groups of analgesics. Adverse effects were more common in the groups using analgesia containing meperidine.

CONCLUSIONS

There was no significant difference between the analgesics used among the 3 groups. Most of the patients, regardless of the analgesic used, reported moderate pain.

Repeat hepatectomy for colorectal liver metastases: A worthwhile operation?

BACKGROUND AND OBJECTIVES

After curative resection of hepatic colorectal metastases, 10-20% of patients experience a resectable hepatic recurrence. We wanted to assess the expected risk-to-benefit ratio in comparison to first hepatectomy and to determine the prognostic factors associated with survival.

METHODS

Twenty-nine patients from a group of 152 patients resected for colorectal liver metastases underwent 32 repeat hepatectomies.

RESULTS

In-hospital mortality was 3.5% (1/29 patients); the morbidity after repeat hepatectomy was lower than that after first hepatic resection. Combined extrahepatic surgery was performed on 34.5% of repeat hepatectomies vs. 6.9% of first hepatectomies (P = 0.01). Overall actuarial 3-year survival was 35.1%: four patients have survived more than 3 years and one survived for more than 5 years. The number of hepatic metastases and the carcinoembryonic antigen (CEA) serum levels were significant prognostic factors on univariate analysis. The synchronous resection of hepatic and extrahepatic disease was not associated with a lower survival rate when compared with that of patients without extrahepatic localization: three patients of the former group are alive and disease-free at more than 2 years.

CONCLUSIONS

Repeat hepatic resection can provide long-term survival rates similar to those of first liver resection, with comparable mortality and morbidity. The presence of resectable extrahepatic disease must not be an absolute contraindication to synchronous hepatectomy because long-term survival is possible.

Spontaneous rupture of hepatocelluar carcinoma: surgical resection and long-term survival

AIMS

Spontaneous rupture of hepatocellular carcinoma (HCC) is a life-threatening event, particularly in patients with associated cirrhosis. We present our experience of hepatic resection of ruptured HCC.

METHODS

We performed 199 resections of hepatocellular carcinoma between January 1984 and December 1999. Six (3%) of these patients were operated on as an emergency because of haemoperitoneum: in five the liver was cirrhotic.

RESULTS

The mean duration of the operation was 195+/-101 min; all the patients received blood transfusions. The overall morbidity was 50%, with a mortality rate of 16.5%. Three patients were alive at 50, 80 and 116 months respectively; two had an intrahepatic recurrence treated by chemoembolization.

CONCLUSIONS

Non-surgical treatment of spontaneously ruptured hepatocarcinoma should be performed only in patients with contraindication to surgery. Hepatic resection should be the treatment of choice since, according to our experience, long-term results are similar to those of elective surgery.

[Indications and results of radical treatment of gallbladder carcinoma]

Extended cholecystectomy is the only chance of a cure for patients with locally advanced cancer of the gallbladder. The aim of the study was to evaluate the short- and long-term results of surgical treatment and to define the prognostic factors associated with better survival. We conducted a retrospective study in 81 patients with gallbladder cancer admitted to our surgical department from 1985 to 1999. Radical surgery was performed on 39 patients. The type of surgical treatment was based on the TNM stage of the disease: all but stage I patients underwent extended cholecystectomy (resection of segment IVa-V, N1-2 lymph-node dissection). The mortality and morbidity rates were 5.1% and 28.2%, respectively. In the patients undergoing curative resection, the 5-year survival was 31.5% (75% in T1 patients, 57.1% in T2, 25.9% in T3 and 0% in T4. Long-term survival of patients with T1-2 tumours was significantly better than that of T3 (P = 0.02) or T4 patients (P = 0.0003); 53.6% of N0 patients were still alive at 5 years as against only 14.5% of N+ patients (P = 0.06). Depth of infiltration is an important prognostic factor. The presence of lymph-node metastases should not be a contraindication to surgery since long-term survival is possible.

Liver function and encephalopathy after partial vs direct side-to-side portacaval shunt: a prospective randomized clinical trial

BACKGROUND

The aim of this study was to determine, in a prospective randomized clinical trial, whether the partial portacaval shunt offers any advantage in terms of liver function and encephalopathy rate when compared with direct side-to-side direct portacaval shunt.

METHODS

Forty-six "good risk" patients with cirrhosis and with documented variceal hemorrhage were randomly assigned to either a partial shunt procedure (achieved by 10-mm diameter interposition portacaval H-graft) or direct small-diameter side-to-side portacaval anastomosis.

RESULTS

Operative mortality was zero in both groups. During the follow-up period, encephalopathy developed in 3 patients in the partial shunt group and 9 in the direct shunt group (P =.04). Kaplan-Meier analysis demonstrated that encephalopathy-free survival was significantly longer in the partial shunt group (P =.025). Direct shunt patients had significant hepatic functional deterioration postoperatively compared with the partial shunt group.

CONCLUSIONS

The partial portacaval shunt effectively controls variceal hemorrhage. Compared with direct side-to-side portacaval shunt, partial shunt preserves long-term hepatic function and minimizes postoperative encephalopathy. We conclude that the partial portacaval shunt is the preferred approach over direct shunts for patients with cirrhosis and with variceal bleeding.

Condiciones ambientales y posibilidad de autocontrol en crisis epilépticas de escolares chilenos

En búsqueda de tratamientos complementarios o alternativos se aplicó un cuestionario-entrevista a 50 escolares epilépticos refractarios a la fármacoterapia, cuyas edades fluctuaban entre los 7 y los 14 años. También se entrevistó a sus madres. El cuestionario estuvo destinado a precisar las condiciones ambientales y las eventuales posibilidades de autocontrol de las crisis convulsivas. Entre los resultados nos pareción que los más relevantes consisten en que un 76% de las crisis ocurren en la casa, el 68% en presencia de familiares, un 26% de los niños identifican señales previas a las crisis y un 24% dice lograr evitarlas. Estos resultados respaldan la opinión de que el apoyo psicológico consistente en identificar condiciones y comportamientos previos a las crisis convulsivas pueden eventualmente hacerlas menos probables.

[Osteopoikilosis. A clinical case]

We report a 35 years old female presenting with a right wrist pain. Physical examination was normal but, on a hand X ray examination, multiple dense para-articular bone foci were observed. Studying the rest of the skeleton, similar alterations were found in pelvis, knees, ankles, feet, shoulders and elbows. Osteopoikilosis is an infrequent sclerotic bone dysplasia. Its diagnosis is made by the observation of multiple dense, nodular and symmetrical images of para-articular location on bone X ray examinations. It has no clinical or pathological importance. Thus, it must be distinguished from osteoblastic bone metastases.

A critical appraisal of the small-diameter portacaval H-graft

BACKGROUND

The ideal portasystemic shunt should prevent variceal hemorrhage and preserve portal flow to reduce hepatic encephalopathy. The partial shunting proposed by Sarfeh effectively controls variceal bleeding while preserving prograde hepatic portal flow.

PATIENTS AND METHODS

We analyzed results of the partial portacaval shunt prospectively in 43 patients undergoing small-diameter (8-mm or 10-mm) portacaval H-graft. Patients entered into the study had Child-Pugh class A and class B cirrhosis, and all had documented previous variceal hemorrhages. We used the Sarfeh technique without performing portal collateral ligation.

RESULTS

Operative mortality was 5%. Acute graft thrombosis occurred in 3 patients, 2 of whom were successfully lysed by urokinase infusion angiographically, while later graft occlusion occurred in 1 case. Only 1 patient rebled from varices in our late follow-up (14 to 65 months). Prograde portal flow was maintained in 90% of patients undergoing repeat angiography 27 +/- 13 months postoperatively. The incidence of all encephalopathy episodes was 16%, with only 1 patient having this complication chronically.

CONCLUSIONS

The small-diameter portacaval H-graft of Sarfeh is an effective operation for controlling variceal hemorrhage. It preserves hepatic portal perfusion over time in the majority of patients, reducing the risk of encephalopathy. The procedure may be particularly suited for alcoholic cirrhotic patients with less advanced liver disease.

Metastatic involvement of the pancreas from renal cell carcinoma treated by surgery

A solitary late recurrence of renal cell carcinoma is very unusual. A case of triple pancreatic metastases of renal carcinoma is presented in a male patient who 9 years previously had undergone left radical nephrectomy. Although there are no specific signs, arteriography, computed tomography and intraoperative ultrasonography can give additional information to detect this rare localization. Surgical resection, when possible, is the most useful treatment for this metastatic lesion.

Colon cancer seeding after percutaneous fine needle aspiration of liver metastasis

Fine needle aspiration or biopsy is used for cytologic diagnosis of many intra-abdominal tumors including focal liver lesions. The incidence of needle tract seeding is quite low. In this paper the first case of cutaneous seeding after percutaneous fine needle aspiration of liver metastasis is reported in a case of colon cancer. We suggest using this method for cytologic diagnosis in hepatic tumors when surgical resection is not possible and when patients will be treated with invasive therapies and to avoid fine needle aspiration biopsy in patients undergoing surgical resection or when there is a confident diagnosis of HCC by non-invasive procedures.

Compensatory growth in broiler chicks fed on Lemna gibba

The growth of broiler chickens on diets containing various levels of Lemna gibba was evaluated. Groups of broiler chicks were fed on diets containing 0-400 g Lemna gibba/kg for 3 weeks. These chickens were then changed to standard diets for a further 2 weeks. As the level of Lemna gibba increased, feed consumption and weight gain decreased. However, when diets were changed to the standard diet, compensatory growth was observed. In a second experiment, diets were formulated with a metabolizable energy of 5.02 MJ (1200 kcal)/kg Lemna gibba and included a finer-milled Lemna gibba. Chickens were fed on diets containing 0-300 g Lemna gibba/kg for 4 weeks. Each group was then divided into two subgroups. For the next 2 weeks one of these sub-groups was maintained on the experimental (Lemna gibba) diets (LL), while the other sub-group was changed to a standard diet (LS). Bird fed at levels above 150 g Lemna gibba/kg had decreased consumption and weight gain. These birds when changed to a standard diet tended to have increased weight gain compared with chickens continuously fed standard rations. LS birds had significantly higher weight gains and feed consumption and lower feed conversion than LL birds. In contrast to older birds, chicks fed on Lemna gibba at high concentrations showed growth retardation. When changed back to a standard diet they demonstrated normal or compensatory growth.

[Spontaneous hematoma of the abdominal wall]

Spontaneous hematoma of the abdominal wall is an unusual event which has an aspecific symptomatology, common to other diseases. There are factors which create a predisposition to the formation of hematoma and others which trigger off this phenomenon. The paper reports 8 patients, aged between 35 and 85 years: predisposition, symptomatology, characteristics of hematoma and therapy are illustrated in a table. Diagnosis was generally made using ultrasonography and the prognosis was always benign.

[Aneurysm of the splenic artery. A clinical case and review of the literature]

The Authors report a case of splenic artery aneurysm (ASA) in a 64 years old woman. Most of patients affected by ASA are asymptomatic. Rupture represents a rare complication with high mortality rate. Finally the clinical, etiopathogenetic and anatomo-pathological aspects are considered.

Immunologic conditions and infectious complications in colon and rectal surgery for neoplasms

The authors evaluated the peroperative immunologic state of patients with colorectal tumors and controlled the postoperative incidence of infections. Twenty-one patients were studied, and delayed type hypersensitivity reactivity determined by the CMI multitest (Merieux) eight days before and eight days after surgery. A lymphocytogram was performed using monoclonal antibodies. A significant percentage of patients were anergic preoperatively. Immunologic analysis revealed lymphocytosis in the first postoperative period. The largest absolute quantitative increase was shown by NK CD16+ cells. It is possible that the results, obtained by dynamic monitoring of the main parameters of cellular immunity, will offer a new way for prognostic evaluation of surgical risk.

New differences between the Wistar rat and Octodon degus, a putative laboratory animal resistant to morphine

1. The effects of CNS depressants (methadone and alcohol) and natural neurotransmitters (NA and ACh) are studied in O. degus. 2. O. degus shows resistance to methadone in the formalin algesiometric test and EEG. 3. Ethanol elimination profile suggest the presence of an atypical alcohol dehydrogenase in O. degus 4. O. degus is extremely resistant to the pressor effects of noradrenaline 5. the isolated atrium of this rodent is 40 times more sensitive to the negative chronotropic effect of methadone, than the rat atrium. 6. These effects could be explained in terms of an important catecholamine and endorphin co-secretion from adrenal glands in O. degus.

Influence of chronic vagotomy on inotropic responses of isolated cat heart papillary muscle

Isolated cat heart papillary muscle bathed at 37 degrees C, electrically driven at the rate of 30 per min, subjected to high voltage stimulation, or the addition of tyramine 1.7 microM, or high doses of acetylcholine (0.55mM) induced a positive inotropic effect revealed by an increase of peak tension developed (PTD). Papillary muscles obtained from cats after 7 to 8 days chronic bilateral cervical vagotomy showed a basic PTD (mg) similar to papillary muscles from non vagotomized control or sham operated cats. The inotropic effect of both tyramine and high voltage stimulation was absent in these animals as compared to controls or sham operated cats. Nevertheless, the inotropic effect of high acetylcholine concentration was still present and was of similar magnitude than in muscles of sham operated cats. The results suggest the existence of a neural cholinergic mechanism that is suppressed by chronic vagotomy which might be necessary for the synthesis, storage and/or release of adrenergic neurotransmitter in ventricular myocardium. It is suggested also, that suppression of general trophic function of vagus nerve might interfere with inotropic actions mediated by norepinephrine release.