Fumonisins and zearalenone fed at low levels can persist several days in the liver of turkeys and broiler chickens after exposure to the contaminated diet was stopped.

Previous studies using zearalenone (ZEN) and fumonisins (FB) revealed alpha-zearalanol (α-ZOL) and FB1 in the liver of turkeys and chickens with no sign of toxicity. The aim of the present study was to determine whether contamination persists after distribution of a mycotoxin-free diet for several days. Turkeys and broilers were fed for 14 days with a diet containing respectively, 7.5 and 0.6 mg/kg of FB and ZEN, then fed for 0, 2 or 4 days with a mycotoxin-free diet. FB1 and total α-ZOL were the most abundant metabolites found, and their concentration decreased with time. The decrease was linear for FB1 (P < 0.001) and exponential for α-ZOL. Mean concentrations of FB1 on days 0, 2, and 4 were respectively, 4.9, 4, and 2.9 ng/g in turkeys, and respectively, 5, 2.3, and 1.3 ng/g in chickens. The decrease in concentration of FB1 with time was modeled by linear regression (P < 0.001). Mean concentrations of α-ZOL on days 0, 2 and 4, were respectively, 4.8, 0.8, and 0.5 ng/g in turkeys, whereas α-ZOL was only quantified in chickens on day 0 at 0.3 ng/g. A strong correlation was found between α-ZOL and ß-zearalenol (P < 0.001).

Toxicity of endophyte-infected ryegrass hay containing high ergovaline level in lactating ewes.

The symbiotic association of var. (formerly named ) with perennial ryegrass () leads to the production of ergovaline (EV) and lolitrem B (LB) that are toxic for livestock. The objectives of this study were to determine the effects of feeding endophyte-infected ryegrass (SE+) hay on 16 lactating ewes (BW 80 ± 10 kg) in comparison with endophyte-free ryegrass (SE-) hay to investigate the putative mechanisms of action of EV and LB and to evaluate their persistence in milk and animal tissues. The mean EV and LB concentrations in SE+ hay were 851 and 884 µg/kg DM, respectively, whereas these alkaloids were below the limit of detection in SE- hay. No effect of SE+ was observed on animal health and skin temperature whereas prolactin decreased and significant differences between hays were observed from d 7 to 28 of the study ( < 0.03) but had no effect on milk production. Hematocrit and biochemical analyses of plasma revealed no significant difference between SE+ and SE-, whereas cortisol concentration differed significantly on d 28 ( = 0.001). Measurement of oxidative damage and antioxidant enzyme activities in plasma, liver, and kidneys revealed a slight increase in some enzyme activities involved in defense against oxidative damage in the SE+ fed ewes. Slight variations in the activities of hepatic and kidney flavin monooxygenase enzymes were observed, whereas in the kidney, glutathione -transferase activity decreased significantly ( = 0.002) in the SE+ fed ewes, whereas uridine diphosphate glucuronosyltransferase activity increased ( = 0.001). After 28 d of exposure of ewes to the SE+ hay, low EV and LB concentrations were measured in tissues. The highest concentration of EV was observed in the liver (0.68 µg/kg) whereas fat contained the highest concentration of LB (2.39 µg/kg). Both toxins were also identified at the trace level in milk.

Ergovaline in tall fescue and its effect on health, milk quality, biochemical parameters, oxidative status, and drug metabolizing enzymes of lactating ewes.

Ergovaline (EV) produced by symbiotic association of Epichloë coenophiala with tall fescue (Lolium arundinaceum) causes toxicoses in livestock. In this study, 16 lactating ewes (BW 76.0 ± 0.6 kg) were used to determine the effects of feeding endophyte-infected (FE+) or endophyte free (FE-) tall fescue hay on animal health and performances and to investigate the putative mechanisms of action of EV. The mean EV concentrations in FE+ and FE- diets were 497 ± 52 and <5 µg/kg DM, respectively. Decreased hay consumption and BW were observed in the FE+ group. Prolactin (PRL) concentrations decreased (P < 0.02) in the FE+ group from d 3 to 28 of the study compared to the FE- group, but no consequences were observed on milk quantity or quality. Skin temperature and the thermocirculation index were lower (P < 0.05) in the FE+ than in the FE- group from d 3 to 7, but this effect disappeared from d 14 to 28. Hematocrit, mineral and biochemical, and enzymatic analyses of plasma revealed no differences between the 2 groups. Measurement of oxidative damage and antioxidant enzyme activities revealed a decrease in the activities of plasma catalase (P < 0.05), kidney glutathione reductase and peroxidase and in kidney total glutathione and malondialdehyde contents (P < 0.02) in ewes fed FE+. Hepatic flavin monooxygenase enzyme activities decreased (P < 0.01) in ewes fed FE+, except for a marked increase in the demethylation of erythromycin. This activity is linked to cytochrome P4503A content and is known to be involved in ergot alkaloid metabolism. Glutathione S-transferase activity in the kidneys decreased (P < 0.02) in the FE+ group, whereas no difference was observed in uridine diphosphate-glucuronosyltransferase activity in the liver or kidneys. The reversibility of the effect of FE+ hay on skin temperature and the increase in erythromycin N-demethylase activity may contribute to the relative resistance of ewes to EV toxicity.

Toxicokinetics of fumonisin B2 in ducks and turkeys.

Two extraction steps combined with HPLC with fluorescence detection were developed to determine the toxicokinetics of fumonisin B(2) (FB(2)) in ducks and turkeys. The limit of quantification of the method was 25 ng of FB(2)/mL. The mean extraction was 63%. After intravenous administration (single dose: 1 mg of FB(2)/kg of BW), plasma concentration time curves were best described by a 2-compartment open model. In ducks, elimination half-life, mean residence time, and clearance of FB(2) were 32 min, 12.9 min, and 9.3 mL/min per kilogram, respectively. In turkeys, these toxicokinetics parameters were 12.4 min, 5 min, and 8.7 mL/min per kilogram, respectively. Only a small amount of FB(2) was detected in plasma after oral dosing of 10 mg of FB(2)/kg of BW.

Variations in zearalenone activation in avian food species.

Zearalenone (ZEA), a widely distributed oestrogenic fusariotoxin, constitutes a potential risk for human and animal health. ZEA is metabolised to the main metabolites identified in vitro and in vivo: alpha-zearalenol (alpha-ZOL) and beta-zearalenol (beta-ZOL). The efficiency to produce alpha-reduced metabolites appears of particular interest in risk assessment as alpha-reduced metabolites constitute activated forms whereas beta-reduced metabolites are less oestrogenic than ZEA. In this study ZEA activation was compared in avian food species. ZEA and its reduced metabolites were quantified in subcellular fractions of six avian species and rat livers. The alpha-ZOL/beta-ZOL ratio in rats was 19. The various avian food species cannot be considered to be equivalent in terms of ZEA reduction (P<0.001). Quails represented high "beta reducers", with alpha-ZOL/beta-ZOL ratio less than two. Weak "beta reducers" included on one part ducks and chickens showing alpha-ZOL/beta-ZOL ratio greater than 3 and up to 5.6 and on a second part geese, showing a lower production of alpha-ZOL than other poultry. Comparisons of enzyme kinetics in ducks and in quails show that these variations can be explained by the action of various isoforms of dehydrogenases. These results are relevant to food safety, in the context of frequently inevitable contamination of animal feed.

Chronic toxicity of fumonisins in turkeys.

Fumonisins are mycotoxins that are found worldwide. They are mainly produced by Fusarium verticillioides during its development on corn. The main toxic effects of these molecules have been well characterized in poultry in the case of acute exposure, but the subclinical and economic effects of chronic exposure are less known. Whereas the latest European recommendations suggest that maximal levels of fumonisins in corn could reach 60 mg/kg and the maximal contamination of poultry feeds could reach 20 mg/kg, no study is available at this level in turkeys. The aim of the present work was thus to characterize the effects of exposure to fumonisins (concentrations of 0, 5, 10, and 20 mg of fumonisin B1 + fumonisin B2/kg of feed) on feed consumption and growth in turkeys over a period of 9 wk. Main biochemical parameters of the liver and alteration of sphingolipid metabolism were investigated in plasma, liver, and kidney. The main results showed no effect on feed consumption and growth in exposed turkeys. Moreover, no effect was observed on the weight of tissues and markers of liver injury. By contrast, a disruption of sphingolipid metabolism was clear at a level of exposure of 10 and 20 mg of fumonisin B1 + fumonisin B2 mg/kg of feed. Both hepatic and kidney concentrations of sphinganine increased gradually throughout the exposure period. These results reveal that disruption of sphingolipid metabolism is an early and sensitive biomarker of fumonisins exposure in turkeys; the consequences on these alterations remain to be established.

Serum sphinganine and the sphinganine to sphingosine ratio as a biomarker of dietary fumonisins during chronic exposure in ducks.

Sphinganine concentration (Sa) and sphinganine to sphingosine ratio (Sa/So) are sensitive biomarkers of fumonisin B1 (FB1) exposure in animals and have been proposed to reveal FB1 exposure in humans. They correlate with liver and kidney toxicity and often precede signs of toxicity. However, the use of Sa and Sa/So is confusing during chronic exposure. Indeed, some authors report altered sphingolipids metabolism, whereas others fail to demonstrate significant effect. The aim of this study was to investigate the kinetics of Sa and Sa/So in the serum of ducks over a 77-day exposure to 0, 2, 8, 32 and 128 mg FB1/kg feeds. Serum biochemistry was also investigated to reveal hepatotoxicity. The results obtained indicate that the kinetics of sphingolipids and serum biochemistry are closely linked with the duration of the exposure. After a strong and rapid increase Sa and Sa/So decrease then stabilize. The lowest investigated dose able to determine a detectable effect is 2 mg/kg feeds, the Sa/So ratio being the most sensitive biomarker of FB1 exposure.

Effects of fumonisins on liver and kidney sphinganine and the sphinganine to sphingosine ratio during chronic exposure in ducks.

Sa and the Sa/So ratio are very sensitive biomarkers of exposure to fumonisins in several species. We previously demonstrated that increases in Sa and in the Sa/So ratio in serum were less pronounced when ducks ingested fumonisins for more than 7 weeks than when animals were exposed for only 1-2 weeks [S.T. Tran, D. Tardieu, A. Auvergne, J.D. Bailly, R. Babilé, S. Durand, G. Benard, P. Guerre, Serum sphinganine and the sphinganine to sphingosine ratio as biomarker of dietary fumonisins during chronic exposure in ducks, Chem. Biol. Interact., in press]. The aim of this study was to investigate the kinetics of Sa and of the Sa/So in both liver and kidney of ducks that have been previously tested for Sa and the Sa/So ratio in serum. Analysis were performed on treatment days 0, 7, 14, 28 and 77 in five groups of ducks fed fumonisins obtained from an extract of Fusarium verticillioides culture material by daily gavage to obtain an exposure equal to 0, 2, 8, 32 and 128 mg FB1/kg feed. Sa and the Sa/So ratio in tissues were then correlated with Sa and the Sa/So ratio previously obtained in serum. The amounts on sphinganine 1-phosphate (Sa1P) and sphingosine1-phosphate (So1P) in the liver were also investigated. On day 7 of treatment, 2mg/kg FB1 in the feed were sufficient to increase Sa and the Sa/So ratio in liver (by 165 and 148%, respectively) and kidney (by 193 and 104%, respectively). At a rate of 128 mg/kg FB1 in the feed, a very high increase in Sa concentration was observed in both liver and kidney without mortality and/or signs of necrosis (respective increase of 2034 and 3768%). Although the precise mechanism of the resistance of ducks to fumonisin-induced hepatotoxicity is still uncertain, it might be linked to the rate at which the sphingoid bases sphinganine and sphingosine are converted to their 1-phosphate or other metabolite and eliminated from target tissues.

Chronic effects of fumonisin B1 on ducks.

Partially purified fumonisin B1 (FB1) was orally administrated for 77 d to 5 groups of 8 mule ducks starting at 7 d of age; the concentrations corresponded to 5 diets containing 0, 2, 8, 32, and 128 mg of FB1/kg of feed. No mortality was observed, and no effects on feed consumption and body weight gain were observed at the end of the treatment period. But, surprisingly, FB1 ingested at 32 and 128 mg/kg led to decreased body weight from d 28 to 63 and from d 7 to 63, respectively. FB1 had no effect on the relative weight of heart and breast muscle, whereas a significant increases in the relative weights of gizzard, spleen, and liver were measured in ducks receiving 32 and 128 mg of FB1/kg of feed without evidence of detectable microscopic modification of these organs. FB1 had no significant effect of the serum aspartate aminotransferase and gamma-glutamyltransferase levels but increased serum total protein, cholesterol, alanine aminotransferase, lactate dehydrogenase, alkaline phosphatase levels when 128 mg of FB1/kg of feed was given. Serum, liver, and kidney sphinganine to sphingosine ratio was significantly increased in ducks fed 8 to 128 mg of FB1/kg of feed. The biggest increase was observed in kidneys, suggesting that this organ is the most sensitive to detect FB1-induced disruption of sphingolipid metabolism.

Toxicity of maize containing known levels of fumonisin B1 during force-feeding of ducks.

The toxicity of maize containing known doses of fumonisin B1 (FB1) was investigated in mallard ducks during force-feeding. Seventy-five ducks at 12 wk of age were randomly divided into 3 groups of 25, and received control maize, naturally contaminated maize containing 20 mg/kg of FB1, or a mixture of control and contaminated maize (50/50, vol/vol). Force-feeding was performed during 12 d that correspond to a final average feed intake of approximately 10 kg of maize per duck. At the end of the study, 8% mortality was observed in ducks fed 20 mg of FB1/kg of feed, whereas no mortality occurred in the other groups. Liver weight, and plasma concentrations of protein, cholesterol, alanine aminotransferase (ALAT), and lactate dehydrogenase (LDH) were increased by force-feeding, whereas feed conversion ratio appeared decreased by the toxin. Microscopic examination of the liver showed that steatosis was mostly macrovacuolar in control ducks, whereas it was microvacuolar in ducks fed 20 mg of FB1/kg of feed. Free sphingolipid concentrations were measured in liver and plasma. Sphinganine (Sa) and sphinganine to sphingosine (Sa/So) ratio were increased in all treatment groups. These parameters were not affected by force-feeding and all individual values obtained in the treated ducks were higher than those obtained in control ducks. Our results suggest that free Sa level and Sa/So ratio can be used to reveal exposure of ducks to FB1 at doses of 10 mg/kg or greater in feed.

[Management of blunt abdominal trauma in children]. / Prise en charge des traumatismes fermés de l'abdomen chez l'enfant.

UNLABELLED: The aim of this study was to evaluate the radiological and therapeutic management of blunt abdominal trauma (BAT) in children, with retrospective data. POPULATION AND METHODS: During 6 years (Nov 1995-Oct 2001), 92 children were hospitalised for BAT (mean age 9.5 years; 61.9% boys). Falls (45.6%) and motor vehicle accidents (43.5%) were the most frequent causes. The initial management included abdominal plain film X-ray and ultrasonography, and sometimes computed tomography (CT). The non-operative treatment was used, unless the patient was hemodynamically unstable or had hollow visceral injury, diaphragmatic rupture or renal artery rupture. RESULTS: Among 92 BAT, 52 were minor traumas and 40 were associated with one or several abdominal injuries. The sensitivity of ultrasonography to find hemoperitoneum and/or abdominal injuries was 80.3%, but the initial diagnosis of such lesions was accurate in 21 cases (52.5%) and delayed in 19 cases (47.5%), ranging from 1 to 7 days. In the delayed cases, the diagnosis was possible in nine cases with ultrasonography, in five cases with CT, but also with transaminase, amylase or lipase assays in two cases, and surgery in three cases. Twenty-nine children had a non-operative treatment and stayed in hospital about 12 days on average. Three children had surgery in emergency (two bowel perforations and one splenic rupture) and eight with delay (four renal ruptures, one associated splenic nodes, one pancreatic pseudocyst and one duodenal perforation). Only seven children (17.5%) required blood transfusion and no death occurred. CONCLUSION: In a trauma centre, the management of abdominal injuries is possible with ultrasonography and its sensitivity is correct without increasing of morbidity and mortality. But, if in doubt, a CT must be performed because its sensitivity is better. Most of the time, the children can benefit from non-operative treatment.

Role of laparoscopy in vaginal malformation.

BACKGROUND: The aim of this study was to assess the role of laparoscopy in the management of vaginal malformations in children, a subject not often discussed in the literature. METHODS: Between 1980 and 2002, we treated 22 children for vaginal malformations. Two main patient populations were distinguished: younger children with asymptomatic hymenal imperforation and hydrocolpos, and adolescents with hematocolpos. A third of the malformations were identified on systematic clinic examination, a third on the basis of abdominal pain, and a third due to various other symptoms. Nine of the girls had associated malformations of the uterus, external genital organs, or urinary tract. Eight patients underwent laparoscopy, either to look for endometriosis in cases of hematocolpos, to make an accurate determination of malformations in cases where clinical and paraclinical methods failed, or to manage an abnormality. RESULTS: Eleven laparoscopic procedures were performed in eight patients. Three diagnostic laparoscopies enabled us to determine the exact nature of the malformations. One newborn underwent two laparoscopic procedures to treat peritoneal fibrous bands that had caused repeated episodes of obstruction. Six patients underwent exploratory laparoscopy to look for endometriosis, but none was found. CONCLUSION: Laparoscopy is not applied systematically in the management of any malformation, but it can be useful when complementary exams fail to make an accurate diagnosis of the anomaly or for the management of the rare complication of adhesions and bands. When used to search for endometriosis, MRI detects ~50% of lesions, but laparoscopy is certainly still appropriate for that purpose. However, the optimal timing of the procedure still needs to be established.

Sphinganine to sphingosine ratio and predictive biochemical markers of fumonisin B1 exposure in ducks.

The kinetics of free sphinganine (Sa), sphinganine to sphingosine ratio (Sa/So), proteins, cholesterol, alanine aminotransferase (ALAT) and lactate dehydrogenase (LDH) were investigated in the course of fumonisin B1 (FB1) exposure in ducks (20 growing males divided into four groups of 5 receiving, respectively, a daily dose of 0, 5, 15 or 45 mg/kg FB1 via oral administration over 12 days). Descriptive statistics of these parameters were also studied in a large number of ducks not exposed to mycotoxins and free of known pathology. Although the toxin at the end of the treatment affected all the parameters investigated, only 2 days of treatment appeared necessary to increase free Sa concentrations in serum, whereas 6 days were necessary to detect a significant effect on Sa/So ratio. Significant differences between control and treated ducks were observed after 4 days of treatment for ALAT and LDH and after 6 and 8 days for cholesterol and proteins concentrations. The minimum doses of FB1 required to determine an effect were assessed using three different methods. This approach reveals that FB1 has greater effects when it is ingested at a low dose for a long time than when ingested at a high dose for a short time. Although the minimum toxic dose of FB1 in ducks remains to be determined, this result must be considered in the context of chronic exposure to the toxin, not only in avian populations.

[Intestinal volvulus in extremely premature infants]. / Volvulus du grêle et grande prématurité.

UNLABELLED: Volvulus with or without malrotation are infrequent in the extremely premature newborn. CASE REPORTS: Intestinal volvulus in seven premature newborns are reported with abdominal distention, bright and tense skin without visible bowel loops and spiraled bowel loops on the abdominal X-ray. Intestinal resection was avoided due to early diagnosis. We identified abdominal wall massages as a risk factor, because no new cases have occurred since interdiction of these practices. CONCLUSIONS: Symptoms and radiologic findings are relatively specific for excluding the diagnosis of necrotizing enterocolitis in premature newborns. Abdominal nursing could be the incriminating factor.

The COX-2 inhibitor nimesulide suppresses superoxide and 8-hydroxy-deoxyguanosine formation, and stimulates apoptosis in mucosa during early colonic inflammation in rats.

As we have shown previously [Tardieu,D., Jaeg,J.P., Cadet,J., Embvani,E., Corpet,D.E. and Petit,C. (1998) Cancer Lett, 134, 1-5], a 48-h treatment of 6% dextran sodium sulphate (DSS) in drinking water led to a reproducible 2-fold increase of the mutagenic oxidative lesion 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo) in colonic mucosa DNA of rats in vivo. The aim of this study was to test the effect of nimesulide, a preferential COX-2 inhibitor, on the DSS-induced 8-oxodGuo increase. We show that nimesulide when administered orally, simultaneously with DSS at 5 mg/kg/day, not only totally prevents 8-oxodGuo formation but also suppresses the 5-fold increase of superoxide induced by DSS in the colonic mucosa. This was measured by in vivo formazan blue precipitation (P < 0.01 in the Wilcoxon test). Moreover, nimesulide enhances apoptosis by approximately 30% as compared with the already high level induced by DSS treatment (P < 0.01). It is suggested that the significant increase in mutagenic oxidative DNA damage, produced by mild acute colonic inflammation, could be important in the initiation of colon cancer in both animals and man. These effects may explain at least partly the well-documented protective action towards colon cancer by preferential COX-2 inhibitors, either xenobiotics such as nimesulide or natural nutrients.

[Treatment of blunt splenic trauma in children]. / Le traitement des ruptures de rate chez l'enfant.

UNLABELLED: The conservative management of blunt splenic trauma in children has been generally accepted for about twenty years, in order to avoid serious post-splenectomy infectious complications. The objective of this study was to evaluate the results of conservative management. PATIENTS AND METHODS: 21 cases of blunt splenic trauma were treated between 1 January 1991 and 31 December 1995. Eleven cases were isolated and 10 were associated with other visceral, musculoskeletal or head injuries. The lesion consisted of subcapsular or intraparenchymal haematoma in 8 cases and ruptured spleen in 13 cases. All children were initially managed conservatively, except in the case of unstable haemodynamic parameters after resuscitation, perforated viscus or secondary complication. RESULTS: Emergency surgery for blunt splenic trauma was never required over this 5-year period. Four children required secondary surgery, 2 for left renal lesion, 1 for pancreatic pseudocyst and 1 for epidermoid cyst of the spleen discovered incidentally at the time of the trauma (partial splenectomy). No associated bowel perforations were observed. Four children were transfused, 3 for an associated visceral lesion and only once because of ruptured spleen. The mean length of hospital stay was 18.2 days in the case of isolated rupture and 28.7 days for a ruptured spleen associated with other lesions. No immediate or long-term complications were observed with a mean follow-up of 6 months. CONCLUSION: Conservative management of blunt splenic trauma is possible under good conditions of security and total splenectomy was never required. The blood transfusion rate was very low.

Dextran sulfate enhances the level of an oxidative DNA damage biomarker, 8-oxo-7,8-dihydro-2'-deoxyguanosine, in rat colonic mucosa.

Dextran sodium sulfate (DSS) given in drinking water can induce colonic inflammation and produce colorectal tumors in rodents, although it is not directly genotoxic. The hypothesis that DSS can produce free radicals and induce oxidative DNA damage in colonic mucosa has been tested. In rats fed for 2 days with water containing 3% and 6% DSS, colonic inflammation manifestations were recorded and 8-oxo-7,8-dihydro-2'-deoxyguanosine (8-oxodGuo), a major biomarker of oxidative DNA damage, was assayed in colonic mucosa. As compared with control rats given pure water, inflammatory manifestations were seen in rats given DSS. At the same time, 8-oxodGuo levels in colonic mucosa were doubled (P < 0.001). These results suggest that formation of oxidative DNA damage in colonic mucosa depends on inflammation and maybe on the production of reactive oxygen species. This study shows that DSS can induce oxidative DNA damage within only 2 days, which could explain in part its carcinogenic properties.

Phenobarbital-type P-450 inducers protect rats against metaldehyde toxicity.

The mechanism of metaldehyde toxicity is unclear. It may be due to the compound itself or, at least in part, to acetaldehyde resulting from the hydrolysis of metaldehyde in the stomach. In this study, we orally dosed rats with twice the LD50 of metaldehyde following no pretreatment (control) or pretreatment with 1 of 3 different cytochrome P-450 inducers either phenobarbital or o,p'-DDD (inducers of cytochromes P-450 IIB and IIIA) or 3-methylcholanthrene (an inducer of P-450 IA). Our results show strong protection against metaldehyde poisoning afforded by the phenobarbital-DDD P-450 inducers, but only weak protection with 3-methylcholanthrene pretreatment. Acetaldehyde administered at the same molarity failed to produce the clinical signs of metaldehyde toxicity and no clinical differences were observed between any of the pretreated groups.

Laparoscopic versus open appendectomy in children--comparative study of 403 cases.

Laparoscopic appendectomy (LA) has not achieved widespread acceptance among surgeons, open appendectomy (OA) being a simple and secure technique. We compared retrospectively 200 LAs and 203 OAs in children and adolescents (mean age = 10 years) from January 1, 1989, to March 31, 1993. The introduction of LA did not modify our operative indications. Laparoscopic investigations found 22 right lower quadrant peritoneal adhesion diseases (11%), those lesions were totally unknown with OA. Operative complications are more frequent with LA (5% versus 1%--p < 0.02): bleeding of the appendiculary artery or of an epigastric vessel, intestinal perforation and burn of the ileum are the most serious complications that we had. On the other hand, the postoperative complications mostly occur after OAs (10.8% versus 1.5%--p < 0.001): 11 wound abscesses, 8 intraperitoneal infections and 4 obstructions after OA and only 1 wound abscess and 2 intra peritoneal abscesses after LA. The general anesthesia was significantly longer for LA (72 minutes vs 55 minutes--p < 0.001). Mean hospital stay was 4 days after LA and 6.4 days after OA. The postoperative complications involved 27 additional hospital days after LA and 162 days for OA. As a conclusion, OA is quicker and has few operative complications. But LA has many advantages: less traumatic, easy treatment of ectopic appendix, efficient lavage of the peritoneum, less frequent postoperative complications and better postoperative comfort. All this encourages us to go on with LA, all the more as the operative complications fall off with the training of the operator.