Effect of different gonadotrophin priming on IVM of oocytes from women with normal ovaries: a prospective randomized study.

This study was designed to determine if the efficiency of in-vitro maturation (IVM) in women with normal ovaries can be improved by gonadotrophin administration. 400 women were randomly allocated in four groups: group A, non-primed cycles; group B, human chorionic gonadotrophin (HCG)-primed cycles; group C, FSH-primed cycles; and group D, FSH- plus HCG-primed cycles. There were significant differences in the IVM rate among the groups. In groups where HCG was used, the overall maturation rate was higher (57.9% in group B and 77.4% in group D; 48.4% in group A and 50.8% in group C) and the percentage of total available metaphase II-stage oocytes was higher (60.4% in group B and 82.1% in group D; 48.4% in group A and 50.8% in group C). The overall clinical pregnancy rate per transfer (CPR) was 18.3% and the implantation rate (IR) was 10.6%. There was a difference in CPR among the groups: group D (29.9%) versus group A (15.3%), P = 0.023; group D versus group B (7.6%), P < 0.0001; group D versus group C (17.3%), P = 0.046. The results of this study are clearly in favour of FSH plus HCG priming. FSH priming and HCG priming alone showed no significant effects on clinical outcome.

Human oocyte cryopreservation: comparison between slow and ultrarapid methods.

The success of reproductive technologies is facilitated by the cryopreservation of embryos and gametes. In Italy, where legislation prohibits zygote and embryo cryopreservation, clinics have extensively introduced oocyte cryopreservation. Two different strategies of oocyte cryopreservation are available: slow freezing or ultrarapid cooling (vitrification). Although the results are very encouraging with both methods, there is still controversy regarding both the procedure itself and the most suitable method to use. This study reports the routine application of the two different oocyte cryopreservation methods in programmes running in two consecutive periods. The study centre carried out 286 thawing cycles for a total of 1348 thawed oocytes cryopreserved by the slow-freezing method and 59 warming cycles for a total of 285 warmed oocytes cryopreserved by vitrification. Comparison of the outcomes obtained with the slow-freezing method versus vitrification in women who underwent IVF for infertility showed survival, fertilization, pregnancy and implantation rates of 57.9% versus 78.9% (P < 0.0001), 64.6% versus 72.8% (P = 0.027), 7.6% versus 18.2% (P = 0.021) and 4.3% versus 9.3% (P = 0.043) respectively. These results suggest that oocyte vitrification is associated with a better outcome than the slow-freezing method.

Predictive factors in in-vitro maturation in unstimulated women with normal ovaries.

The in-vitro maturation protocol (IVM) is an intriguing tool in assisted reproduction since it omits the side-effects of drug stimulation and reduces the cost of the entire procedure, both in terms of time and patient/society costs. In the Biogenesi Reproductive Medicine Centre, the IVM technique has been applied for more than 3 years, obtaining successful results in terms of maturation and fertilization rates, number of pregnancies and healthy babies born. At present, IVM is widely accepted in polycystic ovary and polycystic ovarian syndrome patients but its application in other women is still controversial. This study has been carried out in order to determine the efficiency of unstimulated IVM in women with morphologically and endocrinologically normal ovaries. Body mass index, basal FSH and oestradiol concentrations, antral follicle count, endometrial thickness and lead follicle size were correlated with the outcome of the procedure so as to obtain useful criteria to select women with regular cycles for an IVM technique. It was found that basal oestradiol concentration, FSH concentration and antral follicle count are useful criteria in deciding whether to start and continue the procedure, while lead follicle size and endometrial thickness are important criteria in deciding the timing of oocyte retrieval.

IVM--the first choice for IVF in Italy.

In March 2004, a new law was introduced in Italy to regulate assisted reproduction; at present it is impossible to use more than a maximum of three oocytes per IVF cycle, nor can embryos or prezygotes (2PN cells) be selected or cryopreserved. The prohibitions introduced by the new law have, on the one hand, reduced the expectations of success of current techniques and, on the other hand, stimulated clinicians and embryologists to work on new therapeutic strategies so as to offer the highest chances of success with the lowest risks. In-vitro maturation (IVM) of oocytes fits very well with these new requirements: ovarian stimulation is avoided and the handling of spare oocytes is facilitated. The IVM protocol is an intriguing alternative to conventional IVF techniques, since it removes the side-effects of drug stimulation, especially ovarian hyperstimulation syndrome, and it also reduces the costs of the entire procedure, both in terms of 'time consumption' and 'patient/society costs for drugs'. In the authors' IVF centre the IVM technique has been used for more than a year, with significant success in terms of maturation and fertilization rates, percentage of embryo transfers, number of pregnancies and, finally, healthy babies born.

EPR spectrometer for clinical applications.

This article describes an EPR spectrometer specifically designed and constructed for EPR spectroscopy in humans. The spectrometer is based on a permanent magnet, suitable for measurements at 1200 MHz. The magnet has a full 50 cm gap between the poles, which facilitates accurate and comfortable placement of the subject for the EPR measurement at any location on the human body. The bridge includes features to facilitate clinical operations, including an indicator for phasing of the reference arm and a 2 level RF amplifier. Resonators with holders for each type and site of measurement have been developed that comfortably position the resonator and the patient and prevent artifacts due to motion. The initial applications for which the spectrometer has been designed are for oximetry using loops on the surface, oximetry using implanted resonators for measuring deep sites, and measurements in the teeth for determination of exposures to clinically significant doses of ionizing radiation.

[Ocular diseases in public health]. / Le patologie oculari: aspetti attuali di sanità pubblica.

The renewed sensibility towards the quality of life of disability has moved the authors to undertake a review to assess the low vision-blindness phenomenon as a public health problem. Particular attention has been paid to the aetiology and to the geographic distribution worldwide and in Italy. The prevention aspects of the main ocular diseases widespread in the industrialized countries, including the interventions focused on the patient and on the rehabilitation, have been analysed.

Efficacy of insulin pump therapy: mealtime delivery is the key factor.

OBJECTIVE: To investigate, in a clinical setting, the effect of implementation of continuous subcutaneous insulin infusion (CSII) on control of plasma glucose and to identify factors associated with improved glycemic control in patients with type 1 diabetes mellitus. METHODS: Nineteen patients (16 women and 3 men) with type 1 diabetes were studied retrospectively. Their mean age was 42.6 years (range, 30 to 58), and the mean duration of diabetes was 21 years. The subjects underwent follow-up for a mean of 14 months after conversion to CSII therapy. With use of paired t tests, pre-CSII and follow-up data were evaluated relative to changes in weight, insulin dosing, and glycosylated hemoglobin (HbA(1c)). RESULTS: At follow-up, the total daily dose of insulin had decreased by 18%, from a baseline mean value of 45.2 IU to 37.1 IU (P = 0.02). HbA(1c) was reduced from 8.4% to 7.7% (P<0.01). The total daily insulin-to-weight ratio also significantly decreased from 0.66 IU/kg to 0.53 IU/kg (P<0.05). Before insulin pump use, the regular/NPH insulin ratio was 0.5 IU; at follow-up, the pump bolus/basal insulin ratio was 1.0 IU (P = 0.02). No weight gain was observed; the mean weight of the study patients decreased 0.2 kg, from 69.4 kg at baseline to 69.2 kg at follow-up (not significantly different). CONCLUSION: In a clinical setting, CSII therapy in patients with type 1 diabetes improves glycemic control and lowers the total daily basal insulin dose without affecting weight. Improved glycemic control was associated with a shift in insulin therapy from a high percentage of intermediate-acting insulin to a greater percentage of insulin administered in a meal-associated bolus form. This study emphasizes the importance of mealtime insulin adjustment for tight glycemic control in patients using CSII therapy. Future studies evaluating the benefits of decreased total insulin and an increased bolus/basal insulin ratio may be important in helping to understand how to avoid long-term complications of diabetes.

[Noise and communal dining facilities]. / Rumore e ristorazione collettiva.

Noise is a sound which is unwanted, either because of its effect on humans, its effect on fatigue or multifunctions of physical equipment, or its interference with the perception or detection of other sounds. It is a part of environmental pollution which can, in certain circumstances, reach worrying levels for the population (130 dB cause pain). Unsuitable exposure to noise for even short periods of time is responsible for symptomology involving the hearing organs (hypoacusis) and other parts of the body such as the cardiovascular, muscular and digestive systems via the connection between the central and the autonomous nervous systems. Noise in communal eating areas can be classed as coming from 3 sources: 1) operation of cooking machinery; 2) banging of pans and equipment; 3) voices of both staff and diners. The intensity of noise on these premises varies generally between 60 and 80 dB (discomfort threshold). The Regulations governing this subject are D.Lgs n.277 of 15/8/1991 regarding the protection of employees, D.P.C.M. of 1/3/1991 which establishes the maximum levels of noise both in the home and outside, and the more recent D.P.C.M. of 21/5/1999 referring to noise in public places, which includes restaurants. To contain the exposure to noise in public eating places, we believe that action should be taken at legal levels with stricter limits than the recently passed level of 105 dB, in the building planning departments and also with technological intervention in order to reduce the effects that noise has on the auditive and extra-auditive organs and thus limit possible sublimal messages which certainly do not benefit the psycho-physical well-being of the diners.

Long-term medical treatment of ectopic ACTH syndrome.

BACKGROUND: The morbidity of hypercortisolemia due to ectopic production of ACTH by various tumors may be greater than the morbidity of the tumor itself. METHODS: We report three cases of long-term treatment of ectopic ACTH syndrome due to metastatic bronchial carcinoid, islet cell carcinoma, and malignant thymoma tumors. Clinical and biochemical eucortisolemia was achieved in each case and was sustained from 24 to 55 months. We review the therapeutic options and their reported efficacy. RESULTS: Cessation of therapy resulted in recurrence of hypercortisolemia in each case, showing the effectiveness of therapy. CONCLUSION: Long-term treatment of ectopic ACTH-induced hypercortisolemia by blocking adrenal steroidogenesis is clinically effective and well tolerated.

The effect of cigarette smoking on adrenal cortical hormones.

We assessed the association between cigarette smoking and basal levels of adrenal cortical hormones in 11 postmenopausal smokers and 11 postmenopausal nonsmokers and measured the acute adrenal effects of cigarettes in the smokers. After an overnight food, alcohol and tobacco fast, participants smoked or sham-smoked every hr for 8 hr and provided serum samples for hormone assay before and after every other cigarette/sham, as well as before and after a corticotropin stimulation test. The postmenopausal smokers had substantially higher basal levels of androstenedione (4.60 +/- 0.42 vs. 2.70 +/- 0.36 nmol/l, P < .05) and dihydroepiandrosterone sulfate (2.88 +/- 0.36 vs. 1.91 +/- 0.16 mumol/l, P < .05) and higher average levels of cortisol and androstenedione from 0800 to 1300 hr (351.0 +/- 17.5 vs. 295.5 +/- 17.1, nmol/l and 3.58 +/- 0.42 vs. 2.51 +/- 0.19 nmol/l, P = .03, and P < .05, respectively). There were small acute effects of individual cigarettes on the hormones, but the response to corticotropin was similar in smokers and nonsmokers. Our results indicate that cigarette smoking causes a generalized disturbance in adrenal cortical hormone levels. There is no evidence for acute tolerance to the adrenocortical affects of the hourly smoking of medium-nicotine cigarettes, but these acute effects do not explain the higher hormone levels in smokers. There is no evidence for a partial block in the cortisol synthesis pathway to explain the increased adrenal androgen levels in smokers.

Reduction of red cell glucose transporter intrinsic activity in diabetes running.

The function of the red blood cell glucose transporter was compared in samples from subjects with and without diabetes. Activity of the glucose transporting protein (GLUT-1) was measured by determining the first order rate constant for uptake of sorbose, a sugar transported by GLUT-1. Red cells were isolated from 13 patients with diabetes and 9 patients without diabetes and were washed free of intracellular glucose. The uptake rate constant was calculated from measurements of sorbose uptake at 0, 1, 2, 5 and 90 minutes at 37 degrees C. The rate constant was significantly decreased in cells isolated from patients with diabetes (0.242 vs 0.303 min-1 in non-diabetic subjects, p < 0.005). The number of GLUT-1 present per mg of membrane protein and clinical parameters such as weight, age, serum cholesterol and urea nitrogen were not significantly different between the groups. The rate constant per pmol of GLUT-1 was significantly decreased in the diabetic subjects. The relationship between diabetes control and the rate constant was not linear and there was no relationship between the calculated intrinsic activity and the HA1c. Because red cell GLUT-1 are not translocated and red cells do not synthesize new proteins, these data suggest that the intrinsic function of the glucose transporter from red cells of patients with diabetes is diminished. This may be due to alterations in the transporter or its membrane environment.

Approach to acute hypoglycemia.

Hypoglycemia is a common clinical disorder with a large number of possible causes. Hypoglycemia is defined for the clinician as a diagnosis rather than a symptom complex. Hypoglycemic states can be characterized initially as medication associated, fasting, or postprandial. An approach based on the physiologic mechanisms that support euglycemia is useful to sort through the differential diagnosis of hypoglycemia for both adults and children.

A prospective examination of octreotide-induced gall-bladder changes in acromegaly.

OBJECTIVE: We wished to determine the effects of octreotide acetate, a somatostatin analogue, on gall-bladder function during treatment of acromegaly. DESIGN: We used a prospective, open label trial of somatostatin analogue. PATIENTS: Seventeen patients with acromegaly took part. MEASUREMENTS: Ultrasonographic evaluation of gall-bladder contents were performed pretreatment, after 1 month, and subsequently at intervals of 3-6 months. RESULTS: Non-shadowing floating echogenic particles were observed in the gall-bladder in 12 of 17 patients after (mean +/- SEM) 2.5 +/- 0.6 months of treatment. During long-term treatment (mean 20.8 +/- 4.3, median 13, range 1-59 months), ultrasound evidence for cholelithiasis was observed in four patients after 20 +/- 4 months (range 4.2-43) months of octreotide therapy. No symptoms of biliary tract disease have been observed. Duration of acromegaly, average GH, average IGF-I, gender, age at entry, dose of analogue, and concurrent use of non-steroidal anti-inflammatory drugs did not affect the occurrence of sludge or gallstones. CONCLUSIONS: Formation of non-shadowing, floating echogenic particles occurs commonly during the first 6 months of treatment with octreotide acetate. Cholelithiasis is a risk of long-term treatment.

A unique collaborative network for diabetes education.

The DCNH is a unique collaborative venture in outpatient diabetes education. We believe it can serve as a model for rapidly developing standardized diabetes education in geographically dispersed communities. The heart of the organization is the educators' meeting, which enables an extensive sharing of ideas and information that benefit all patients in the region. The features crucial to our success have been (1) administrative leadership with a nursing management or educator background, (2) data collection and analysis, (3) local development of an educational curriculum based on ADA standards, and (4) centralized medical and administrative directors who are available to meet individual program needs. However, we are most indebted to the farsighted and strong commitment of our member hospitals to diabetes care in their communities.

[The food poisoning problem in communal restaurant facilities]. / Il problema delle tossinfezioni alimentari nelle strutture di ristorazione collettiva.

In view of the considerable development during the last few years of communal feeding facilities (factory, school, and university canteens, hospital kitchens, self service, fast food, and restaurants) in our country as well as elsewhere, the authors wish to supply detailed information on the incidence of food poisoning in Italy from 1979 to 1988 in such facilities. They report the findings of an epidemiological study they carried out in Rome and Lazio [correction of Latium] covering this period and which by and large confirmed the trend observed at the national level. As to prevention, the most recent techniques for food conservation are described.

Octreotide: a hormone for all diseases?

Octreotide is a new agent with many documented useful applications and a huge number of possible applications. Each documented therapeutic effect will require careful analysis. Particular care must be taken to design controls, use double-blind tests for objective study of subjective benefits, and frame questions to elicit precise answers. The most important guide is to keep an open mind when attempting to discern a mechanism of action.