Factors associated with passive immunity transfer in dairy calves: combined effect of delivery time, amount and quality of the first colostrum meal.

Despite the well-known importance of an adequate colostral immunoglobulin (Ig) transfer to calf health and survival, failed transfer of passive immunity (FTPI) remains a widespread problem in dairy farming. The aim of this study was to investigate the management factors associated with FTPI in newborn calves, evaluating particularly the combined effect of delivery time, amount and quality of the first colostrum meal. The study was conducted from March to August 2014 on 21 Italian dairy farms. Farmers were asked as first to answer a farm-level questionnaire on calf management. Blood sampling was then performed on overall 244 calves (1 to 5 days of age) born from Holstein cows, and a sample of the first colostrum meal of each calf was collected. Individual information on calves and the respective colostrum management were recorded. Serum and colostrum Ig concentrations were assessed by electrophoresis. A mixed effects multivariable logistic regression model was used to investigate the association of the variables obtained from both the management questionnaire and the individual calf data with FTPI (calf serum Ig concentration 87.6 g/l) within 1.0 h from birth. Considerable improvements are still needed about colostrum management for newborn calves in dairy farms. The results of this study will help in developing farm-specific programs for reducing the occurrence of FTPI.

Differential effect of transdermal estrogen plus progestagen replacement therapy on insulin metabolism in postmenopausal women: relation to their insulinemic secretion.

OBJECTIVE: To evaluate the impact on glucose and insulin metabolism of transdermal estrogen patches before and after the addition of cyclic dydrogesterone in postmenopausal women. DESIGN: We studied 21 postmenopausal women seeking treatment for symptomatic menopause. All patients received transdermal 50 micrograms/day estradiol for 24 weeks. After 12 weeks of treatment, 10 mg/day dydrogesterone were added. METHODS: During both regimens, insulin and C-peptide plasma concentrations were evaluated after an oral glucose tolerance test (OGTT); insulin sensitivity was evaluated by a hyperinsulinemic euglycemic clamp technique. Insulin and C-peptide response to OGTT were expressed as area under the curve (AUC) and as incremental AUC; insulin sensitivity was expressed as mg/kg body weight. Fractional hepatic insulin extraction (FHIE) was estimated by the difference between the incremental AUC of the C-peptide and insulin divided by the incremental AUC of the C-peptide. Plasma hormone and lipid concentrations were assessed at baseline and at 12 and 24 weeks of treatment. RESULTS: Nine patients proved to be hyperinsulinemic and 12 were normoinsulinemic. Transdermal estrogen treatment significantly decreased the insulin AUC (P < 0.05) and the insulin incremental AUC in hyperinsulinemic patients; addition of dydrogesterone further decreased both the AUC and incremental AUC of insulin. Estrogen alone and combined with dydrogesterone evoked a significant increase in C-peptide AUC in hyperinsulinemic (79.2%) and normoinsulinemic (113%) patients. The treatment increased the values for FHIE and insulin sensitivity in all patients (P < 0.04) and in the hyperinsulinemic group (P < 0.01), whereas it did not affect such parameters in normoinsulinemic patients. CONCLUSIONS: Transdermal estrogen substitution alone and combined with cyclical dydrogesterone may ameliorate hyperinsulinemia in a selected population of postmenopausal women.

Antibiotic prophylaxis in gynecological surgery.

A randomized prospective study was undertaken at the Obstetrics and Gynecology Clinic of the Catholic University of Rome in order to evaluate the effectiveness of two wide spectrum antibiotics: mezlocillin and cefotetan. Both drugs were administered 2 g i.v. 15 to 20 minutes preoperatively to allow optimal serum and tissue levels of antibiotic at the moment of bacterial innoculation. 184 patients undergoing elective gynecological surgery for nonmalignant disease were considered eligible for the study (124 pts abdominal hysterectomy, 58 pts vaginal hysterectomy). We found no statistically significant differences between the results obtained with the two drugs.

[Splenic lymphoma with villous lymphocytes. A clinical case]. / Linfoma splenico con linfociti villosi. Caso clinico.

Splenic lymphoma with circulating villous lymphocytes is a rare B-lymphoproliferative disorder of the elderly which has been only recently defined. Clinical features are spleen enlargement of various degree without lymphadenopathy and an indolent course, with a long survival, in most cases. Absolute lymphocytosis is present; atypical circulating lymphocytes show a medium or large size, a small prominent nucleolus and a few short and thin cytoplasmic protrusions and projections (villi), which are distributed at one or both poles of cell surface. Reaction for tartrate-resistant acid phosphatase is almost always negative. Immunological markers are as follows: CD 19+, CD 20+, CD 22+, CD 11c+/-, CD 5-, CD 23-, CD 25-, HLA DR+, SmIg+. Differential diagnosis with other chronic lymphoproliferative disorders, particularly chronic lymphocytic leukemia, hairy cell leukemia, prolymphocytic leukemia, follicular and mantle-cell lymphoma in leukemic phase, is based on clinical and immunocytomorphologic criteria. Bone marrow biopsy shows involvement of different degree and pattern; splenic involvement mostly occurs in the white pulp; hepatic nodules in portal areas may be present. Cytogenetic alterations are often present but not specific, such as increased serum LDH and monoclonal gammopathy. No therapy should be made in asymptomatic patients. In case of systemic symptoms, symptomatic splenomegaly or cytopenias, treatment may consist on splenectomy, splenic irradiation or alkylating agents. A case of splenic lymphoma with circulating villous lymphocytes is reported; differential diagnosis, particularly with other B lymphoproliferative disorders, is discussed.

[Efficacy of estrogen therapy in urinary incontinence. A meta-analytic study]. / Efficacia della terapia estrogenica sull'incontinenza urinaria. Studio metanalitico.

OBJECTIVE: To analyze by meta-analysis the results of randomized controlled clinical trials on the efficacy of estrogen treatment in menopausal patients with urinary incontinence. STUDY DESIGN: Meta-analysis. MATERIALS AND METHODS: Randomized controlled clinical trials, published from January 1965 to December 1996, on estrogen therapy in patients with urinary incontinence, were selected. They included: trials with placebo vs estrogen therapy, studies on menopausal patients with confirmed diagnosis of urinary incontinence based on clinical and/or urodynamic tests, studies with sufficient statistical informations on the results obtained and with information about subjective and objective outcome. RESULTS: Out of 72 articles reviewed, 7 were selected and only 4 were considered on the basis of the requested criteria. Subjective outcome was statistically different in patients treated with estrogen therapy compared with patients treated with placebo. Objective clinical and urodynamic outcome was not statistically different in the two types of treatment (estrogen vs placebo treatment). CONCLUSIONS: There were few published randomized controlled studies on estrogen therapy in patients with urinary incontinence in medical literature. Different results between subjective and objective outcome showed by meta-analysis, could be explained either by an estrogen induced unperceivable improvement not registered by clinical and instrumental parameters or by insufficient systems used to collect subjective data. Therefore, it is suggested that, for future research, randomized controlled clinical trials on topical or transcutaneous systemic estrogen treatment with a more than 6 months follow-up will be carry out.

[Treatment in the event of antibiotic prophylaxis failure in gynecologic surgery. A retrospective study of 20 cases]. / Sul trattamento in caso di fallimento dell'antibiotico-profilassi in chirurgia ginecologica. Esame retrospettivo di 20 casi.

A retrospective study was performed of the type of treatment used in 20 patients undergoing gynecological surgery in whom antibiotic prophylaxis with Mezlocillin (2 g i.v.) had failed. Patients were subdivided into three groups: A) Initial therapy with Mezlocillin (8 patients, 2 g/die i.m.) or Cefotetan (2 patients, 2 g/die i.m.) and subsequent addition of Gentamicin (8 patients, 240 mg/die i.m.) or Tobramycin (2 patients, 200 mg/die i.m.) and subsequently Metronidazole (7 patients, 1.5 g/die per os). B) Therapy with Imipenem/Cilastatin (6 patients, 1.5 g/die i.m.). C) Therapy with Imipenem/Cilastatin (4 patients, 1.5 g/die i.m.) after a variety of antibiotics: Cotrimoxazole (Trimethoprim 160 mg/die and sulphamethoxazole 800 mg/die per os), Pefloxacin (800 mg/die per os), Cefotetan (2 g/die i.m.) and Mezlocillin (2 g/die i.m.). Time taken to lower temperature was shorter in Group B (3.5 days) compared to Group A (6.8 days) and Group C (10 days). Postoperative hospital stay was also shorter in Group B (9 days) compared to Group C (16.5 days) and Group A (11.1 days). The immediate administration of an antibiotic active against Gram+ and Gram- germs, aerobes and anaerobes is therefore useful in the event of failure of antibiotic prophylaxis, rather than the use in succession of associations of antibiotics with a limited spectrum.

Maternal ultrasound bone density in normal pregnancy.

OBJECTIVES: The aim of the study was to investigate the effect of pregnancy on maternal bone mineral density by an ultrasound device. STUDY METHODS: Two hundred and thirty consecutive healthy pregnant women were evaluated by ultrasound densitometry during the 1st (n=45), the 2nd (n=56) and the 3rd (n=129) trimester of pregnancy, measuring the velocity (SoS) and frequency attenuation (BUA) of an ultrasound wave as it passes through the os calcis. Speed of sound (SoS) and Broadband Ultrasound Attenuation (BUA) values are combined in order to express a relational variable (Stiffness), indicator of bone quality. RESULTS: Statistically significant reductions in SoS, BUD and Stiffness values were observed during the 3rd trimester vs the 1st and the 2nd trimesters. Negative statistically significant relations were found between the gestational age and ultrasound densitometry parameters. CONCLUSION: A linear reduction of ultrasound bone density was observed throughout pregnancy, reaching a statistical significance in the 3rd trimester, when the greatest calcium transfer from the mother to the fetus occurs.

[The use of ultrasounds in real time in the localization of intrauterine contraceptive devices (author's transl)].

PIP: 9 patients whose IUD strings had disappeared from the vaginal cavity were examined by ultrasonic technique, using an Echo Camera Aloka, model SS-D 207. In 3 of the cases examined the IUD had been expelled; in 6 cases the IUD resulted to be present within the uterine cavity; in 1 such case there was a 9 week pregnancy with the device in situ. The use of echotomography in real time allows a quicker examintion and more detailed images than with A-scan of B-scan models, and a much closer visualization of the whole uterus. Furthermore, ultrasonography does not cause ionigenic radiations, particularly dangerous to the ovaries or to a possible pregnancy.^ieng

2,3-diphosphoglycerate in normal and pathologic pregnancy: relationship to neonatal weight.

2,3-Diphosphoglycerate levels were assayed in 154 pregnant women in third trimester (61 normal, 52 diabetic, 19 with gestational hypertension, 7 with fetal macrosomia, and 15 with idiopathic fetal underdevelopment). A correlation was found between 2,3-diphosphoglycerate levels and birth weight (absolute and relative birth weight or birth weight expressed as percentile), which was negative in normal patients evaluated in the last 7 days before delivery (r = 0.38; p = 0.04) and positive in diabetic patients (evaluated in the third trimester and in the last 7 days before delivery) and in patients with gestational hypertension (evaluated in the third trimester) (r and p values differ according to whether birth weight is expressed as absolute, relative, or a percentile). No correlation was found between 2,3-diphosphoglycerate levels and birth weight in patients with neonatal underdevelopment or macrosomia of unknown origin. On the basis of these results we hypothesize that in some conditions the fetus can influence maternal 2,3-diphosphoglycerate levels and hence its own oxygen supply and growth in utero.

Water and ion metabolism in placenta (III). Net movement of water, monovalent and divalent cations in slices from rabbit placenta, at different periods of gestation, incubated under metabolically favorable conditions.

Rabbit placenta slices incubated at 38 degrees C in oxygenated medium, in the presence of endogenous substrates +5 mM glucose, after a period of preincubation of 120 min at 0--1 degrees C, show a net accumulation of potassium and extrusion of water, sodium and calcium. The movement of potassium, sodium and calcium appears to be related to the rate of oxygen consumption of the slices and to be inversely proportional to the age of the tissue. The efficiency of cations movement is also dependent on the nature and composition of the incubation medium. In this respect the potassium concentration of the medium plays a major role. The movement of water, on the other hand, seems to be completely independent from both the rate of respiration and the age of the tissue. The results are discussed in terms of relation between placenta age and senescence, and efficiency of the mechanisms devoted to the cell regulation of water and ions content.

Laparoscopically assisted vaginal hysterectomy as an alternative to abdominal hysterectomy. A pilot study.

Laparoscopically assisted vaginal hysterectomy (LAVH) allows for conversion of some abdominal hysterectomies to a vaginal route. LAVH may be particularly useful when adnexectomy is indicated. In this study the authors evaluate the results obtained in a series of 21 patients prospectively selected for LAVH. The mean operative time was 96 min (range 58-155), with an estimated blood loss of 218 ml (range 50-510). The mean uterine weight was 320 g (range 105-610). Intraoperative complications were limited to one case of bladder injury which occurred during the vaginal phase of the procedure. No patient required heterologous blood transfusion. No postoperative complications were observed. The average length of hospitalisation was 4.4 days (range 2-9). The authors conclude that LAVH allows for conversion of a significant number of abdominal hysterectomies to a vaginal route and that with respect to the former it is definitely less costly since it allows for earlier hospital discharge and resumal of a normal lifestyle.

The behaviour of microsomal mono-electron carriers in adult and fetal liver and in placenta throughout pregnancy.

The activities and contents of microsomal mono-electron carriers (NADPH-cytochrome c reductase, NADH-cytochrome b5 reductase, cytochrome P-450 and cytochrome b5) in the liver of 160 pregnant rabbits and their response to phenobarbital (PB) administration were found to be different to that of non pregnant animals and to vary depending on the period of gestation. In fetal liver and in placenta the activities and contents of mixed function oxidase system enzymes are very low and increase from the mid-gestation up to the term of pregnancy. PB has either effect or decreases the enzyme levels. The variations of enzyme content and activity in maternal liver and the different response to PB are related to the hormonal modifications of pregnancy. The behaviour of mono-electron carriers in fetal liver can be related to the process of maturation of this organ. The effect of PB can be due to the interference of the drug with steroid metabolism. The behaviour of mixed function oxidase system enzymes in placenta can be related to the processes of maturation and ageing of organ.