Target-controlled infusion during MitraClip procedures in deep-sedation with spontaneous breathing.

OBJECTIVE: Percutaneous mitral valve repair with the MitraClip system is an alternative procedure for high-risk patients not suitable for conventional surgery. The MitraClip can be safely performed under general anesthesia (GA) or deep sedation (DS) with spontaneous breathing using a combination of propofol and remifentanil. This study aimed to evaluate the benefits of target-controlled infusion (TCI) of remifentanil and administration of propofol during DS compared with manual administration of total intravenous anesthesia (TIVA) medication during GA in patients undergoing MitraClip. We assessed the impact of these procedures in terms of remifentanil dose, hemodynamic profile, adverse events, and days of hospital stay after the process. PATIENTS AND METHODS: From March 2013 to June 2015 (mean age 73.5 ± 9,54), patients underwent transcatheter MitraClip repair, 27 received DS via TCI and 27 GA with TIVA. RESULTS: Acute procedural success was 100%. DS-TCI group, in addition to a significant reduction of remifentanil dose administrated (249 µg vs. 2865, p < 0.01), resulted in a decrease in vasopressor drugs requirement for hemodynamic adjustments (29.6% vs. 63%, p = 0.03) during the procedure and a reduction of hypotension (p = 0.08). The duration of postoperative hospitalization did not differ between the two groups (5.4 days vs. 5.8 days, p = 0.4). CONCLUSIONS: Administration of remifentanil by TCI for DS in spontaneously breathing patients offers stable anesthesia conditions, with a lower amount of drugs, higher hemodynamic stability, and decreased side effects.

Update on percutaneous mitral valve therapy: clinical results and real life experience.

Mitral regurgitation (MR) is a common valvulopathy worldwide increasing in prevalence. Cardiac surgical intervention, preferable repair, is the standard of care, but a relevant number of patients with severe MR do not undergo surgery because of high peri-operative risk. Percutaneous mitral valve repair with the MitraClip System has evolved as a new tool for the treatment of severe MR. The procedure simulates the surgical edge-to-edge technique, developed by Alfieri in 1991, creating a double orifice valve by a permanent approximation of the two mitral valve leaflets. Several preclinical studies, registries and Food and Drug Administration approved clinical trials (EVEREST, ACCESS-EU) are currently available. The percutaneous approach has been recently studied in a randomized controlled trial, concluding that the device is less effective at reducing MR, when compared with surgery, by associated with a lower adverse event rate. The patients enrolled in this trial had a normal surgical risk and mainly degenerative MR with preserved left ventricular function. On the other hand, results derived from the clinical "real life" experience, show that patients actually treated in Europe present a higher surgical risk profile, more complex mitral valve anatomy and functional MR in the most of cases. Thus these data suggest that MitraClip procedure is feasible and safe in this subgroup of patients that should be excluded from the EVEREST trial due to rigid exclusion criteria. Despite the promising results clinical experience is still small, and no data related the durability are currently available. Therefore, MitraClip device should be reserved now to high risk or inoperable patients.

Reduction of mitral valve regurgitation with Mitraclip® percutaneous system.

Mitral regurgitation (MR) is the second most common heart valve disease worldwide and the current gold-standard treatment is surgical repair or replacement. Nevertheless, many patients do not undergo surgical intervention due to several comorbidities. Percutaneous "edge-to-edge" mitral valve repair using the MitraClip System is an emerging and effective option to this subset of patients. This device has been used to treat both functional and degenerative mitral valve regurgitation and has been compared to surgery in the Endovascular Valve Edge-to-Edge Repair Study II (EVEREST II) randomized trial. Although the field of percutaneous management of MR is at an early stage, it has been demonstrated that percutaneous approaches can reduce MR, suggesting there is a great deal of potential for clinical benefit to patients with MR.

Tumours and tumour-like lesions of the hip in the paediatric age: a review of the Rizzoli experience.

Bone tumours and tumour-like lesions of the hip in children are rare. Signs and symptoms of these tumours are generally nonspecific. Delay of diagnosis is not uncommon. A high index of suspicion in young patients presenting with persistent pain and without history of trauma, that is unresolved with conservative therapy should prompt further investigation, including radiographs or computed tomography scan of the pelvis. In the experience of the Istituto Rizzoli, in patients less than 14 years (mean 9 years, ranged from 6 months to 14 years), 752 tumours and tumours-like lesions occurred in the pelvis or proximal femur, involving the hip. Tumour-like lesions accounted for 322 cases (simple bone cyst in 255, eosinophilic granuloma in 43, aneurismal bone cyst in 34), benign tumours for 340 cases (osteoid osteoma in 229, fibrous dysplasia in 63, exostosis in 48) and malignant tumours for 80 cases (Ewing's sarcoma in 53 and osteosarcoma in 27). The epidemiology, pathology, clinical presentation, and radiograph findings are discussed for each of these tumours.Treatment of these tumours differs from observation or minimally invasive treatment for most pseudotumoural lesions, intralesional excision or termoablation for benign bone tumours and wide resection for malignant bone tumours. In this latter group, chemotherapy is required and often administered pre- and postoperatively.

Nitric oxide test during cardiac catheterization decreases the serum concentrations of S100B protein in adult patients with idiopathic pulmonary hypertension.

OBJECTIVE: Cardiac catheterization (CC) is a life-threatening procedure in adult patients. Complicated by idiopathic arterial pulmonary hypertension (IPAH), there is a potential risk of central nervous system (CNS) damage. We measured serum levels of a well-established brain damage marker, namely S100B, collected before, during and after CC in adult patients in whom the nitric oxide (NO) test had been performed. MATERIAL AND METHODS: In 12 adult patients who had undergone CC for IPAH diagnosis, we recorded clinical and standard monitoring procedures (laboratory variables and echocardiographic patterns) and serum concentrations of S100B before (time 0), during (time 1) and after the NO test (time 2) and at 24 h after (time 3) the procedure in samples obtained from the systemic and pulmonary circulation. Patients were subdivided into NO test responders (n=6) and non-responders (n=6). Neurological evaluation was performed at admission and at discharge from hospital. RESULTS: Adult patients subjected to CC showed no overt neurological injury at discharge from hospital. No significant differences (p > 0.05 for all) in S100B serum levels between groups at times 0, 1 and 3 have been shown independently from the sampling site. It was noteworthy that the concentration of protein in the responders group at time 2 was significantly decreased (p < 0.05, for all) compared to the responder group and to baseline values. A significant correlation was found between arterial oxygen partial pressure and individual S100B concentration in the pulmonary and systemic bloodstream in the entire study group (R = -0.66 and R = 0.71, respectively; p < 0.05, for both). CONCLUSIONS: The data suggest that S100B protein assessment, as well as the NO test, may be useful when monitoring possible CNS damage during CC in patients with IPAH, and may also be valuable in relation to brain functions, especially when performed as an emergency procedure in severely hypoxic patients.

[Tension-free laparoscopic versus open inguinal hernia repair]. / Ernioplastica laparoscopica versus ernioplastica laparotomica nel trattamento delle ernie inguinali primitive.

AIM: During the last decade laparoscopic techniques have been applied to the treatment of inguinal hernia to combine tension-free technique, esthetic, and functional benefits of mini-invasive surgery. Anyway controversy persists regarding the most effective inguinal hernia repair. The aim of this study is to compare the open technique and the laparoscopic approach concerning: complications, recurrences, recovery time and return to usual activity. METHODS: A randomized prospective analysis of 121 consecutive inguinal hernia repairs was performed over a 12-month period. Male well-informed patients with primary monolateral inguinal hernia (ASA I-II) were divided into 2 groups and consecutively treated; group A was treated with laparoscopic transabdominal preperitoneal approach (TAPP) (median age 47+/-7 years, 57 patients), group B with open mesh herniorrhaphy (45+/-6 years, 64 patients). RESULTS: Complication rate was 5.26% for group A (none needed conversion) and 4.68% for group B. All complications were considered minor. No recurrences were observed over a 12-month follow-up in both groups. Post-operative hospital stay and return to activity show statistically significant differences. Median post-hospital stay was 1.7 days for group A while it was longer (2.9 days) for group B. Significant difference was observed in the duration of convalescence too (group A 9.3+/-7.2 days; group B 12.1+/-7. 1 days). CONCLUSION: On the basis of our experience, even if a longer follow-up is needed, the validity of laparoscopic approach to inguinal hernia is confirmed. General anesthesia and higher costs are reasonable compromises for a shorter period of discomfort in patients with a low ASA index and busy job/sport activity.

Transoesophageal atrial pacing combined with transthoracic two dimensional echocardiography: experience in patients operated on with arterial switch operation for transposition of the great arteries.

OBJECTIVE: To assess the feasibility, safety, and diagnostic accuracy of transoesophageal atrial pacing stress echocardiography (TAPSE) combined with two dimensional transthoracic echocardiography (TTE) for evaluation of coronary perfusion in patients undergoing arterial switch operation for transposition of the great arteries. DESIGN: TAPSE combined with TTE was performed at the end of cardiac catheterisation. An ischaemic response was defined as > 1.5 mm horizontal or downsloping ST segment depression or as a new or worsened wall motion abnormality. The results were compared with results of coronary angiography. SETTING: Tertiary referral centre for paediatric cardiology and cardiac surgery. PATIENTS: 25 patients, mean (SD) age 29.5 (19) months, mean (SD) weight 12.5 (3.4) kg. MAIN OUTCOME MEASURES: Target heart rate (200 beats/min) was attained in 22 of 25 (88%) patients. Electrocardiographic ischaemic changes occurred in 4 of 25 (16%) and wall motion abnormalities in 3 of 25 (12%). Coronary obstructions were found in 2 of 25 (8%) patients. RESULTS: The test was feasible in all patients, without clinical complications requiring treatment. Compared with coronary angiography, the test had a sensitivity and a specificity of 100% and 95%, respectively, for the echocardiographic stress, and of 100% and 91%, respectively, for the electrocardiographic stress. The negative predictive value was 100% for both the echocardiographic and the electrocardiographic stress tests. The positive predictive value was 66% for the echocardiographic stress and 50% for the electrocardiographic stress tests. CONCLUSIONS: In these patients TAPSE combined with TTE was feasible and safe and apparently an accurate diagnostic method for evaluation of coronary perfusion. Patients with a negative test may have a low likelihood of major coronary abnormalities and may not require coronary angiography.

Paraplegia following percutaneous balloon angioplasty of aortic coarctation: a case report.

Balloon angioplasty of recurrent coarctation of the aorta is considered a low-risk procedure with high success rate. In the literature, the major complications are death, rupture of the aorta, recoarctation, aneurysm formation, cerebrovascular accident, and femoral artery thrombosis. Spinal cord ischemia as an unusual complication of balloon angioplasty is reported.

Analysis by mathematical model of haemodynamic data in the failing Fontan circulation.

Several late complications jeopardize the clinical performance of recipients of the Fontan operation. The underlying causes have been referred to disturbed flow dynamics in the cavopulmonary connections. Presumably, the large pressure drops occurring in the inferior and superior connections play a pivotal role in the pressure level of the entire circulation, especially in the venous. To address this issue, we retrospectively reviewed catheterization data of six patients with failing Fontan circulation and compared them with those of six patients with functioning Fontan circulation. The impact on the systemic and pulmonary pressure of the increase in the cavopulmonary connection resistances was studied through a steady-state mathematical model of the univentricular closed-loop circulation. In the patients with failing Fontan, pressure in the venae cavae was found to be significantly higher, especially at the inferior cava (19.3 +/- 2.2 versus 12.5 +/- 2.3 mmHg) with the pressure drop at the inferior cavopulmonary connection significantly increased (4.7 +/- 3.1 versus 0.33 +/- 0.82 mmHg). The proposed mathematical model permits us to clearly relate the pressure increase in the venae cavae to an increased resistance in the cavopulmonary connections. Therefore, the present analysis confirms that, to avoid possible congestion of venous circulation, the definitive palliation of univentricular heart should not cause pressure drops at the cavopulmonary connections.

Evaluation of the morphology of the oval fossa for placement of devices.

OBJECTIVES: First, to examine the morphology of heart specimens with defects of the oval fossa so as to define the factors that facilitate appropriate selection of the size of devices used for inteventional closure. Second, to examine the relationship between morphology and transthoracic and transesophageal echocardiography. BACKGROUND: The success of transcatheter closure is influenced by the variable morphology of deficiencies with the oval fossa, and of the relationship of the fossa itself to adjacent structures. More appropriate selection could reduce the incidence of failures. METHODS: From over 100 specimens in the cardiac registry at the University of California, San Francisco, we judged 16 hearts with atrial septal defects within the oval fossa, either in isolation or associated with other cardiac malformation, to be suitable for this study. We measured the dimensions of the defect and the surrounding rims of the fossa. All values were normalized to the diameter of the aortic root. RESULTS: A fenestrated defect was present in 9 specimens (56%). The shape defect itself was oval in all specimens, with a ratio of major to minor axes of 1.70 + 0.63. The major axis took one of three main directions with respect to the vertical plane: in 11 specimens (69%o) it was at horizontal; in 3 (19%) it was at oblique at an angle of 45 degrees; and in 2 (12%) it was vertical. Discordance was noted in some hearts between the major axis of the defect and that of the oval fossa. Structures closest to the rim of the fossa were the aortic mound, the coronary sinus, and the hinge point of the aortic leaflet of the mitral valve. CONCLUSIONS: Extrapolating from these specimens permitted identification of the major and minor axes of the atrial septal defect by transthoracic and transesophageal echocardiography. Our study has identified landmarks and dimensions that may be employed to improve effectiveness of selection of patients for transcatheter closure of defects within the oval fossa.

Autologous vein lined and vein covered stents in swine arteries. An experimental study to assess and compare patency and intimal hyperplastic response.

BACKGROUND: Despite the success of arterial angioplasty as well as arterial stent placement, restenosis remains a significant problem in prolonging blood vessel patency. This animal model was used to test the theory that a stent lined (VLS) or covered (VCS) with autologous vein would be more biologically compatible with the arterial intima. If successful, this technique would prevent angioplasty failure due to intimal hyperplasia (IH) by supplying a healthy endothelial surface and help to eliminate elastic recoil mechanism (ERM) by the use of a stent rendered less thrombogenic in both stenosed and restenosed arteries. There might in addition, be other applications for these modified stents. METHODS: Nine 50 kg -young pigs had Gianturco-Roubin VLS and VCS mounted on a balloon angioplasty catheter implanted via a transverse arteriotomy. VLS were implanted in 3 left iliac and 6 left carotid arteries and VCS were placed in the matching contralateral arteries. The change from iliac to carotid arteries was due to the initial perception that the iliac artery was the right size for this device. It proved to be too large and the carotid artery, which was initially felt to be too small proved to be the right size. Operative angiography was performed to ensure proper placement. Duplex imaging of the carotid artery placements were performed at 10-14 days. All animals were sacrificed at 30-33 days and specimens examined grossly and microscopically. Three 16.5% of the devices were found to be patent, two VILS and one VCS. The remaining 14 (78%) were occluded by distortion or thrombus or both. RESULTS: Five devices migrated distally, 2 of which remained patent albeit of smaller diameter. One device migrated to the brain, was not recovered and was presumed occluded. All arteries and veins, with two exceptions, demonstrated varying degrees of IH. We believe failure was due to the inability of the stents to resist ERM in these healthy pig arteries. The IH observed, we believe, is due to the forced dilatation required to seat the devices. CONCLUSIONS: Based on the observations of the patent devices we suggest that arteries can be relined and supported with modifications of this technique, using a more ERM resistant stent that may be placed without forceful dilatation. This will require further study.

Combined laparoendoscopic colon resection and anastomosis using the "no touch technique" and fibrin glue. An experimental study.

BACKGROUND: Laparoscopic colon anastomosis are technically demanding. A new technique for colon resection and anastomosis using a combined laparoendoscopic approach is presented. METHODS: In 10 pigs, pneumoperitoneum was induced and 5 trocars were placed. A sigmoid segment was isolated; a vein stripper was inserted from the anus, and the head was secured with a tie; the segment was intussuscepted pulling the stripper out; 4 seromuscular sutures were placed at the anastomotic site and fibrin glue was spread all around; an electrical wire loop, introduced via a colonoscope, was used to resect the intussuscepted segment that was removed from the anus. RESULTS: All animals but one survived until sacrifice at 30, 60, 90, and 120 days. Macroscopically, the anastomosis appeared well healed; microscopically, after 90 days, there was a complete restitutio ad integrum of the intestinal wall. CONCLUSIONS: This technique is feasible and quick; it could be used clinically in small tumors not removable endoscopically.

Aortic pulmonary autograft implant: medium-term follow-up with a note on a new right ventricular pulmonary artery conduit.

BACKGROUND: The Ross operation has been applied to various aortic valve pathologies, particularly when somatic growth is an issue. However, associated cardiac disease and technical problems may limit its use with regard to associated procedures and issues of right ventricular outflow reconstruction. MATERIALS AND METHODS: From December 1992 to March 1998, 24 patients underwent aortic pulmonary autograft implantation. There were 14 males and 10 females, 15+/-10 years of age (mean +/- SD) (range 1 to 50 years), weighing 42.8+/-20 kg (mean +/- SD) (range 8 to 78 kg). Aortic insufficiency was present in 15 (62.5%) patients, stenosis in 8 (33.3%) patients, and valvar stenosis associated with left ventricular outflow tract obstruction in 1 (4.1%) patient. Etiology was rheumatic in 17 patients and congenital in 7. The Ross procedure was accompanied by a partial-Konno left ventricular outflow enlargement in one patient, and mitral valve annuloplasty, mitral commissurotomy, and tricuspid valve replacement in three other patients, respectively. The right ventricular outflow was reconstructed with a valved pulmonary homograft in 14 patients and with a Shelhigh No-React porcine pulmonary conduit in 10 patients. Evaluation was done by New York Heart Association (NYHA) Class and by echocardiography at a follow-up of 22.8+/-24 months (mean +/- SD) (range 3 to 63 months). RESULTS: There were no operative mortalities and no postoperative arrhythmias. One (4.1%) patient required intra-aortic balloon pump (IABP) support for 3 days, one (4.1%) patient died 2 years later of probable arrhythmia, and one (4.1%) patient required mechanical aortic valve replacement 2 years later for severe autograft insufficiency. Left ventricular ejection fraction was unchanged (preoperative 62.4%+/-30%, postoperative 64.2%+/-30% [mean +/- SD], [p = NS]) and no significant gradient was documented by echocardiographic Doppler in the right and left ventricular outflow tracts. The aortic insufficiency scale decreased from a mean of 3.9+/-0.2 to a mean of 1+/-0 (p < 0.01). NYHA Class decreased to I in all patients, from III (10) and II (14). CONCLUSIONS: The pulmonary autograft in the aortic position is suitable for aortic valve replacement in pediatric and adult patients with good medium-term results and in patients with rheumatic etiology, and it provides a desirable solution in the presence of associated pathologies, such as left ventricular tract obstruction or associated multivalvular disease. The development of new means of right ventricular outflow reconstruction must parallel the progress achieved for the left side.

[Valvular lesions in the course of nonpenetrating thoracic trauma: their diagnosis by transesophageal echocardiography]. / Lesioni valvolari in corso di trauma toracico non penetrante: diagnosi mediante ecocardiografia transesofagea.

Two cases are reported with nonpenetrating chest trauma and involvement of mitral valve in one case and aortic valve cusps in the other, without aortic rupture. In both patients transesophageal echocardiography allowed us an accurate diagnosis, confirmed by surgical findings. In the patient with involvement of the aortic cusps, the regurgitation developed 3 months after the trauma. In conclusion, cardiac valve injuries are rare but not exceptional following nonpenetrating blunt chest trauma. Transesophageal echocardiography is the imaging technique of choice for these patients. The operator performing the study must be aware of the possible coexistence of different cardiac lesions secondary to blunt chest trauma. In the case of valvular regurgitation the accurate definition of the pathophysiological mechanism is mandatory in order to choose the appropriate surgical strategy. In the case of aortic incompetence of unknown origin, a nonpenetrating chest trauma must be searched out during the clinical interview.

Limitation of myocardial infarct size by nicorandil after sustained ischemia in pigs.

Nicorandil is a compound with hybrid properties of nitrates and adenosine triphosphate (ATP)-sensitive potassium channel (KATP) opening. The effects of nicorandil and isosorbide dinitrate (ISDN) were investigated in a model of 60-min coronary occlusion/180-min reperfusion in open chest pigs. Three groups of 10 pigs were randomly assessed to receive saline or equihypotensive doses of nicorandil or ISDN. Drug infusion was started at 30 min of ischemia and continued throughout reperfusion. Area at risk (AAR) and infarcted area (IA) were assessed by monastral blue dye-triphenyltetrazolium dual staining technique and calculated by planimetry. Myeloperoxidase concentration (MPO) in the non-ischemic area and in the IA was assessed as an index of presence of neutrophils. Measurements of reduced glutathione (GSH), oxidized glutathione (GSSG), lipofuscine, and malondialdehyde were performed on coronary vein blood as indexes of oxidative stress. IA, as a percentage of AAR, was 78 +/- 10% after saline, 61 +/- 12% after N (p < 0.05 vs. saline), and 69 +/- 14% after ISDN (not significant vs. saline). Cardiac output and left ventricular dP/dt were depressed during coronary occlusion in all groups and their recovery during reperfusion was earlier in the nicorandil group. In the saline group, MPO was increased in the IA compared to the nonischemic area (78 +/- 63 vs. 21 +/- 21 micrograms/mg prot, p = 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Role of pharmacologic tests in the treatment of primary pulmonary hypertension.

Primary pulmonary hypertension (PPH) is a rare disease of unknown etiology characterized by a constant progression toward right ventricular failure and death. Vasoconstriction is 1 of the pathophysiologic factors responsible for the increase of pulmonary vascular resistance (PVR) and pulmonary artery pressure (PAP) in patients with PPH. Thus vasodilator treatment is considered 1 of the logical approaches to medical therapy of such a condition. Acute drug challenge with a short-acting, titratable vasodilator during heart catheterization is recommended to select patients who are most likely to respond to long-term treatment. Accurate methodologic guidelines need to be followed to minimize the spontaneous variability of PAP and pulmonary arteriolar resistance. Pathophysiologic interpretation of pharmacologic trials requires analysis of the 2 components of the right ventricular hydraulic load, i.e., resistance and compliance of the pulmonary vascular bed. Reduction of the calculated PVR may be considered as a demonstration of pulmonary vasodilation only if PVR is assessed using the critical opening pressure or if it is associated with a simultaneous reduction of PAP. Only those patients in whom a reduction of PVR of > or = 20% is associated with a decrease in PAP of > or = 20% should be considered as "responders" to the acute tests. In clinical studies only 20-30% of the patients are short-term responders. The most intensively studied short-acting drug for short-term challenge is prostacyclin, but other agents such as acetylcholine, adenosine, and nitric oxide have been utilized. Prostacyclin has been shown to predict pulmonary vasodilator response to the administration of long-acting vasodilators, such as calcium channel antagonists.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile acid active and passive ileal transport in the rabbit: effect of luminal stirring.

The intestinal absorption of bile acids (BA) with different chemical structure has been evaluated in the rabbit, after intestinal infusion of different concentrations (0.25-30 mM) of BA, by mesenteric blood sampling. Cholic (CA), chenodeoxycholic (CDCA), ursodeoxycholic (UDCA) acid, free and taurine (T-) conjugated, together with glycocholic (GCA) acid and deoxycholic acid (DCA) were studied. The apparent uptake parameters were calculated. All conjugated BA showed active transport (T max, nmol min-1 cm-1 int.), with Tmax values in the following order: TCA > TUDCA > TCDCA; unconjugated BA showed passive uptake, with values in the following order: DCA > CDCA > UDCA > CA. GCA and CA showed both passive uptake and active transport. For all BA studied the % uptake in the ileal segment considered was less than 10%, BA uptake being thus limited by transport and/or diffusion kinetics, rather than by flow velocity. The liquid resistance to BA radial diffusion inside the lumen was evaluated, and the infusate-to-blood uptake parameters corrected for it, in order to get the uptake parameters from the epithelium-to-liquid interface to mesenteric blood: the apparent Km decreased, passive uptake coefficient increased, while Tmax was unchanged. The passive component of the uptake, corrected for the luminal resistance, correlated with the BA hydrophobicity (r = 0.963; P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Reduced neutrophil superoxide generation and plasma lipoperoxide levels in pigs fed with cod liver oil.

Circulating neutrophils, isolated from pigs fed for 8 weeks with a diet supplemented with CLO, had an accentuated n-3 fatty acid incorporation into the plasma membrane, as evidenced by an approximately four-fold greater n-3/n-6 ratio as compared with the control diet group. Moreover, the neutrophils of the CLO fed pigs produced less superoxide when stimulated with PMA or f-MLP, as well as showing a more prolonged latency period before O2(-)-generation. In the plasma of pigs fed with CLO there were higher levels of thiobarbituric reactive material and lipofuscin, while the content of GSSG was similar in both dietary groups. The results of this study indicate that dietary supplementation with CLO reduces the activation of circulating neutrophils and favours the presence in the plasma of lipoperoxides.