Effect of body condition score and reuse of progesterone-releasing intravaginal devices on conception rate following timed artificial insemination in Nelore cows.

This study had the aim of investigating the efficiency of timed artificial insemination (TAI) through the progesterone-releasing intravaginal device (PRID), used in new condition and for the second and third times in Nelore cows. The effects of device reuse and body condition score (BCS) on the conception rate (CR) were evaluated in 1,122 multiparous Nelore cows (mean BCS of 2.7 ± 0.4), which were randomly distributed into three groups that received new (n = 330), once (n = 439) and twice used (n = 353) PRID. Among the 1,122 females that underwent TAI, 573 became pregnant, thus representing an overall CR of 51.06%. Cows with BCS between 2.75 and 4.0 had greater (p < .0001) CR (69.75%) than cows with BSC of 2.0-2.5 (32.98%). It was observed that the CR through using PRID was 60.00%, 51.71% and 41.93% for new, once and twice used PRID, respectively, with difference between all groups (p < .0001). Under tropical conditions, animals with BCS greater than 2.5 had a higher CR, and the CR decreased proportionally with the number of times that the PRID had been used.

Buffalo (Bubalus bubali) Late Embryo and Foetus Development: A Morphological Analysis.

Many researches describe the embryonic developmental features in domestic animals; however, in farm animals, they are scarce. Most farm animal studies are related to assisted reproduction and embryos transfer techniques. But, morphological features and size measure to estimate the age gestation are rarely reported in literature. Thus, in this study, we described the developmental changes in the bubaline (Bubalus bubali) concepts from 21 to 60 days of gestation. Our results revealed that buffalo embryos similar morphological characteristics similar to other mammalian species. Also, similarities between bovine and bubaline persist; except on foetal stages when buffalos have a faster development than bovine. Therefore, buffalo's gestation period exhibits some varieties and accurate embryo age is more difficult. Yet, when we use a combination of the crown-rump, macroscopic analysis and alizarin red, it is possible to describe better the whole embryogenesis stages of the buffalo and which can contribute for future reproduction researches and applications in veterinary practice.

Consistence and discrepancy of neuropathic pain screening tools DN4 and ID-Pain.

Pain is a subjective condition that cannot be objectively measured; for this reason, self patient-perspective is crucial. Recently, several screening tools to discriminate between nociceptive and neuropathic pain have been developed. We aimed at assessing the consistence and discrepancy of two widely used screening tools, The Douleur Neuropathique 4 (DN4) and the 6-item questionnaire (ID-Pain), by comparing their ability in discriminating neuropathic from nociceptive pain. DN4 and ID-Pain were administered to 392 Italian patients attending 16 outpatient services for peripheral nerve diseases. Based on medical history, clinical findings and diagnostic tools, patients were divided into two groups (neuropathic and nociceptive). Globally, ID-Pain identified neuropathic pain in 60 % of patients (38 % probable, 22 % likely). Interestingly also DN4 diagnosed neuropathic pain in 60 % of cases. A discrepancy was observed in 16 % of cases. DN4 and ID-Pain resulted to be highly interrelated in the identification of neuropathic pain. Sensitivity of DN4 was 82 % and specificity was 81 %, while ID-Pain (considering both probable and likely groups) showed sensitivity 78 % and specificity 74 %. Reliable screening tools for neuropathic pain are well related between them; hence, they are available for researchers and clinicians who may choose the most appropriate for their activity. Since the gold standard for the diagnosis and treatment of neuropathic pain cannot do without a neurological evaluation, perhaps DN4, that includes physician objective measures, may help reducing the percentage of dubious cases. Conversely, when needing a more agile tool (not needing a physician) ID-Pain may be adopted.

Early development and putative primordial germ cells characterization in dogs.

Previously, three distinct populations of putative primordial germ cells (PGCs), namely gonocytes, intermediate cells and pre-spermatogonia, have been described in the human foetal testis. According to our knowledge, these PGCs have not been studied in any other species. The aim of our study was to identify similar PGC populations in canine embryos. First, we develop a protocol for canine embryo isolation. Following our protocol, 15 canine embryos at 21-25 days of pregnancy were isolated by ovaryhysterectomy surgery. Our data indicate that dramatic changes occur in canine embryo development and PGCs specification between 21 to 25 days of gestation. At that moment, only two PGC populations with distinct morphology can be identified by histological analyses. Cell population 1 presented round nuclei with prominent nucleolus and a high nuclear to cytoplasm ratio, showing gonocyte morphology. Cell population 2 was often localized at the periphery of the testicular cords and presented typical features of PGC. Both germ cell populations were positively immunostained with anti-human OCT-4 antibody. However, at day 25, all cells of population 1 reacted positively with OCT-4, whereas in population 2, fewer cells were positive for this marker. These two PGCs populations present morphological features similar to gonocytes and intermediate cells from human foetal testis. It is expected that a population of pre-spermatogonia would be observed at later stages of canine foetus development. We also showed that anti-human OCT-4 antibody can be useful to identify canine PGC in vivo.

McKeown oesophagectomy and pulmonary wedge resection with a prone thoracoscopic and laparoscopic approach: a video report.

In the past few years, minimally invasive oesophagectomy has become an increasingly popular approach for oesophagectomy showing advantages in terms of fewer postoperative complications, shorter hospital stay and faster recovery. We present the case of a 60-year-old man with a lesion of the distal third of the oesophagus and solid pulmonary nodule who underwent McKeown subtotal oesophagectomy by laparoscopic and thoracoscopic approach in prone position with concomitant thoracoscopic pulmonary wedge resection. The postoperative course was smooth, and the patient was discharged on postoperative day 10. The procedure is feasible and safe, and combines better respiratory postoperative outcomes even when associated with other diagnostic or therapeutic lung procedures.

Laparoscopic repair of a giant hiatal hernia after minimally invasive oesophagectomy.

Minimally invasive oesophagectomy has become popular, but studies showed a higher rate of postoperative hiatus hernia compared with open oesophagectomy. Our video presents the laparoscopic biosynthetic mesh repair of a symptomatic giant hiatus hernia in a 71-year-old man who had undergone minimally invasive oesophagectomy one year earlier for distal adenocarcinoma of the oesophagus. The operative time was 120 minutes. The patient started oral intake on postoperative day one and was discharged on postoperative day three. Postoperative computed tomography at six months showed no signs of recurrence. In the setting of a symptomatic hiatus hernia post-minimally invasive oesophagectomy, we suggest an initial laparoscopic approach, because of its countless advantages.

Identification of three distinguishable phenotypes in golden retriever muscular dystrophy.

Duchenne muscular dystrophy (DMD) is a human disease characterized by progressive and irreversible skeletal muscle degeneration caused by mutations in genes coding for important muscle proteins. Unfortunately, there is no efficient treatment for this disease; it causes progressive loss of motor and muscular ability until death. The canine model (golden retriever muscular dystrophy) is similar to DMD, showing similar clinical signs. Fifteen dogs were followed from birth and closely observed for clinical signs. Dogs had their disease status confirmed by polymerase chain reaction analysis and genotyping. Clinical observations of musculoskeletal, morphological, gastrointestinal, respiratory, cardiovascular, and renal features allowed us to identify three distinguishable phenotypes in dystrophic dogs: mild (grade I), moderate (grade II) and severe (grade III). These three groups showed no difference in dystrophic alterations of muscle morphology and creatine kinase levels. This information will be useful for therapeutic trials, because DMD also shows significant, inter- and intra-familiar clinical variability. Additionally, being aware of phenotypic differences in this animal model is essential for correct interpretation and understanding of results obtained in pre-clinical trials.

Pisa syndrome in Parkinson's disease: electromyographic quantification of paraspinal and non-paraspinal muscle activity.

Patients with Parkinson's disease (PD) and Pisa syndrome (PS) may present tonic dystonic or compensatory (i.e. acting against gravity) hyperactivity in the paraspinal and non-paraspinal muscles. Electromyographic (EMG) activity was measured in nine patients with PD and PS, three with PD without PS, and five healthy controls. Fine-wire intramuscular electrodes were inserted bilaterally into the iliocostalis lumborum (ICL), iliocostalis thoracis (ICT), gluteus medius (GM), and external oblique (EO) muscles. The root mean square (RMS) of the EMG signal was calculated and normalized for each muscle. In stance condition, side-to-side muscle activity comparisons showed a higher RMS only for the contralateral ICL in PD patients with PS (p=0.028). Moreover, with increasing degrees of lateral flexion, the activity of the EO and the ICL muscles progressively increased and decreased, respectively. The present data suggest that contralateral paraspinal muscle activity plays a crucial compensatory role and can be dysfunctional in PD patients with PS.

Neurophysiology of the pelvic floor in clinical practice: a systematic literature review.

Neurophysiological testing of the pelvic floor is recognized as an essential tool to identify pathophysiological mechanisms of pelvic floor disorders, support clinical diagnosis, and aid in therapeutic decisions. Nevertheless, the diagnostic value of these tests in specific neurological diseases of the pelvic floor is not completely clarified. Seeking to fill this gap, the members of the Neurophysiology of the Pelvic Floor Study Group of the Italian Clinical Neurophysiology Society performed a systematic review of the literature to gather available evidence for and against the utility of neurophysiological tests. Our findings confirm the utility of some tests in specific clinical conditions [e.g. concentric needle electromyography, evaluation of sacral reflexes and of pudendal somatosensory evoked potentials (pSEPs) in cauda equina and conus medullaris lesions, and evaluation of pSEPs and perineal sympathetic skin response in spinal cord lesions], and support their use in clinical practice. Other tests, particularly those not currently supported by high-level evidence, when employed in individual patients, should be evaluated in the overall clinical context, or otherwise used for research purposes.

'Neurographic' palmaris brevis sign in type II degrees ulnar neuropathy at wrist.

OBJECTIVE: To investigate the source of an unusual and previously unreported volume conducted potential on motor nerve conduction studies. In a case of subacute ulnar neuropathy at wrist (UNW) selectively involving the deep motor branch, we recorded from the hypothenar eminence a large positive wave (2.5 ms-2 mV) preceding the negative takeoff of the delayed distal ulnar motor response. METHODS: We performed multiple channels motor and sensory ulnar nerve (UN) conduction studies; these included selective electrical stimulation and anaesthetic block of UN branches and also selective recording of motor responses by single fibre needles; data were confirmed by an intraoperative neurophysiological study and correlated with MRI and surgical findings. RESULTS: Detailed neurophysiological investigation demonstrated the generation of this waveform from the palmaris brevis (PB) muscle. MRI and surgical exploration documented a hypertrophy of this muscle. CONCLUSIONS: In type II degrees UNW, depolarization of a spared palmaris brevis muscle may be recorded as a positive wave preceding the delayed abductor digiti minimi motor response. SIGNIFICANCE: We underline the peculiar localizing value of this volume conducted 'meaningful artefact' in that particular setting. It actually represented an early neurographic analogue of what is known as the clinical 'Palmaris Brevis Sign' in long standing type II degrees UNW.

Symptoms and neurophysiological picture of carpal tunnel syndrome in pregnancy.

OBJECTIVE: To evaluate the incidence of carpal tunnel syndrome (CTS) in pregnancy through a validated and multiperspective assessment of CTS. METHODS: During 2000, the Italian CTS study group focussed on the occurrence of CTS in women during the final stages of pregnancy, enrolled in 7 Italian centers. In addition to the physician-centered and neurophysiologic traditional evaluations, we used a validated patient-oriented measurement to obtain more comprehensive and consistent data for severity of symptoms and functional impairment. RESULTS: In our study, CTS was clinically diagnosed in more than half of women (62%). Neurophysiological evaluation provided diagnosis of CTS in around half of women (43% were positive in one hand at least). Our study provides evidence, reported here for the first time, of a correlation between edema and neurophysiological picture. Similarly, our study provides a correlation between validated patient-oriented measurement and edema. Moreover, a significant correlation between a negative trend (subjectively assessed) and smoking and alcohol consumption was observed. CONCLUSIONS: Our observations confirm that the edema of the tissues in the carpal tunnel could induce a mechanical compression of the nerve. Moreover, our data suggest that smoking and alcohol consumption have a negative role in the evolution of the syndrome probably due to impairment of the microcirculation.

Sequential Gn-RH superagonist and medroxyprogesterone acetate treatment of uterine leiomyomata.

A group of 48 women with symptomatic leiomyomata were treated during 6 months with the short-acting Gn-RH superagonist analog buserelin. The first (group C) was followed up for an additional six months of no medication. The second (group M) was treated for 6 additional months with medroxyprogesterone acetate (MPA) at doses decreasing from 200 to 25 mg/day. Buserelin therapy significantly decreased uterine size (P less than 0.001) in all patients, the average final volume being 48.5% of the original (from 262 +/- 147 ml to 127 +/- 85.4 ml). In group C there was a significant (P less than 0.001) re-growth during the post-treatment observation period (from 120 +/- 81.0 ml to 198 +/- 77.2 ml); a significant (P less than 0.01) re-growth was also observed in group M during MPA medication (from 132 +/- 77.2 ml to 170 +/- 96.0 ml). The agonist had also a marked effect on fibroids: on average they decreased from 75.1 +/- 74.3 ml to 24.7 +/- 23.3 ml (P less than 0.025). In group C during the post-buserelin period of observation without treatment, there was a significant re-growth from 23.7 +/- 21.6 ml to 47.7 +/- 27.5 ml (P less than 0.001), whereas in group M treatment with MPA prevented any significant re-growth (from 25.6 +/- 24.8 to 30.6 +/- 32.9 ml; P greater than 0.3).

[Secretory lymphomas]. / I linfomi secernenti.

After a short introduction regarding the concept of "secreting" lymphoma and the most recent theories about the dynamics of normal and pathologic lymphocytes, resulting from the actual immunologic advancements and designed in order do give an explanation of some of the problems concerned with these diseases, such as "classification", "transmutation" of one type of lymphoma into another and the lymphoma/leukemia question, the authors go on describing few personal cases taken as examples. Finally, upon having pointed out that following now a day's whole population screening there is an always more increasing number of asymptomatic "secreting" lymphomas, casually diagnosed, the authors call the general practitioners' attention on the most common clinical and laboratory features that should lead to suspect a lymphoma of this type.

[Antiemetic protocol in oncohematologic polychemotherapy]. / Protocollo antiemetico in corso di polichemioterapia oncoematologica.

Authors, in an open and preliminary study, evaluate the beneficial effects on chemotherapy-induced nausea and vomiting of an association of three antiemetic drugs parenterally administered. Twenty-six patients receiving chemotherapy for Lymphomas (195 cycles) were treated with: Chlorpheniramine maleate 10 mg IM 45' before, Sulpiride 200 mg in normal saline 100 ml, at XXX gtt/m', 20' before, and 6-Methyl-Prednisolone 500 mg IV over 2'-3' immediately before chemotherapy. Patients were evaluated for emesis over 48 hours after chemotherapy: they were interviewed on nausea, vomiting and other possible side-effects. The antiemetic activity observed was: complete response in 73.1% (19/26); partial response 27.9% (7/26). Failure of response was never observed. 166/195 cycles were well tolerated. Our results demonstrate the antiemetic efficacy of this antiemetic regimen. Further studies should investigate its use in randomized trials.

[Psychosomatic disorders considered from an internist viewpoint. II. Problems of drug therapy]. / I disturbi psicosomatici considerati dal versante internistico. Nota II. Problemi di farmacoterapia.

Following a previous communication concerning some of the principal diagnostic and differential diagnostic questions regarding psychosomatic pathology, with the present note the authors wish to review the most common therapeutic problems related to these disorders. The text has been subdivided into two parts. In the first part it has been adjusted the approach to the pharmacological treatment of these disorders, following principally the authors' experience, and, in the second, have been analyzed some of the most common prejudices that have taken shape around this therapeutic praxis and that have contributed so much to handicap the diffusion of antidepressants in general practice. The authors conclude providing some clues both to those who, encouraged by the reading of this paper, should feel persuaded to deal with psychosomatic disorders from the general practitioners' point of view and to those who, for any reason, should not feel to tackle this task.

[Psychosomatic disorders considered from an internist viewpoint. I. Nosographic aspects and diagnostic problems]. / I disturbi psicosomatici considerati dal versante internistico. Nota I. Aspetti nosografici e problemi diagnostici.

After a brief introduction regarding the nosography of psychosomatic disorders and the main reasons that have little by little discouraged non-psychiatric physicians to deal with this type of pathology, considering its high incidence among all the areas of general practice, the Authors go on discussing the diagnostic problems and pointing out the most important aspects concerned with these. The Authors conclude by warning not to over-value the effects obtained with an antidepressant especially when it is set up only on the basis of the ex-juvantibus principle. The Authors also invite their colleagues general practitioners to take greater care in the fight for prevention and treatment of these disorders, side by side with the psychiatrist.

[Role and importance of antidepressants in general medicine. Bibliographic review and case contribution]. / Ruolo ed importanza degli antidepressivi in medicina generale. Riferimenti bibliografici e contributo casistico.

Starting from the consideration that communications relating to antidepressant drugs are chiefly reported by psychiatrists and that such reports deal with cases that we don't find in general practice, or at least marginally, the authors go on considering again their material consisting of 944 patients treated with antidepressants alone or associated with tranquilizers and/or with neuroplegic sedatives, hoping to gather usefull informations for a better definition of the role of these drugs in this large nosographic area. The authors could, therefore, by that way: confirm the high incidence of psychosomatic disorders among all the professional areas concerned with general practice; confirm the clear prevalence of the less symptomatic forms; verify in a high percentage of cases the coexistence of an organic disorder in way of progress or in outcome; confirm the double role of these drugs, diagnostic (ex-juvantibus) and therapeutical; suggest a third role of nosographic nature.

[Irritable colon and psychosomatic disease]. / Colon irritabile e psicosomatosi.

The authors, after having considered the close likeness between the collateral clinical picture described by others in regard to the irritable colon syndrome and the outstanding one pointed out by them in many cases of psychosomatic disorders, have analyzed again a large number of personal cases diagnosed as "psychosomatic" in order to find possible relations between these two unwholesome conditions. At the end of their examination, after having ascertained that the "Irritable colon" has not to be considered an isolated disease but a syndrome caused by many factors, hinged on a predisposing condition likely of constitutional nature, the authors remark how it may nest in the folds of a psychosomatic disorder and sometimes be its outbreaking feature. The authors by this way, don't want to conclude identifying the I.C. with a psychosomatic disorder and suggest that in such cases one may take this syndrome as the main manifestation of a condition marked by an impairment of the digestive tract motility inside a psychosomatic disorder with a somatic expression of this apparatus.

[A small epidemic focus of pulmonitis caused by Legionella]. / Su un piccolo focolaio epidemico di polmonite da legionella.

A mini-epidemic consisting of 5 cases of Legionnaire's disease treated during september 1983 is reported. These patients shared many of the symptoms distinguishing the most common form of this disease in its severe or very severe form and some characteristic features of this case series are emphasised. It was impossible to trace the source of the outbreak, in spite of the fact that the mini-epidemic took place in an open situation. It is underlined that diagnosis is mainly clinical. The Legionella pneumophila bacteria should always be considered as one of the causal agents of bronchopneumonia, particularly when the following conditions are fulfilled: a) the disease takes the form of a confined, out-of-season, mini-epidemic; b) it is accompanied by multisystemic symptomatology and/or much greater involvement of general conditions that is usually to be expected in normal cases of bronchopneumonia. Since the disease is often fatal, erythromycin or rifampicin treatment should be started upon the slightest suspicion of contagion.

[Acute puerperal uterine inversion: a report of 3 cases and an analysis of 358 cases in the literature]. / L'inversione uterina puerperale acuta: presentazione di 3 casi ed analisi di 358 casi della letteratura.

Acute puerperal uterine inversion is a rare but very feared obstetrical complication. It determines an almost immediate shock and serious metrorrhagia. It is a "glove-finger" introflexion of parietes uteri which takes place during the third stage of labor or during the first hours of puerperium. It can be distinguished in inversion of I, II or III degree according to the zone concerned by the introflexion: only the fundus of the uterus, all the corpus emerging in the vagina or the entirety of the uterus coming out from the vulvar orifice. The research carried out in the archives of the Department Obstetrics and Gynaecology of the University of Rome "La Sapienza" has showed, for the 20 years 1968-1988, 3 cases of uterine inversion out of a total of 69,677 childbirths. The uterine inversion was immediately diagnosed and in all the 3 cases a method of replacement by central taxis was practiced. In 2 cases, despite the packed tamponade, there was a recidivist or persistent uterine inversion of 1 degree, and in both cases a surgical reduction by laparatomy was practiced. In 1 of the 2 cases a hysterectomy was needed because of the persisting metratonia and metrorrhagia. The III case was treated with a manual replacement, a uterus massage from outside keeping the organ, with fist inside the cavity, in forced anteflexion in order to reach a good contractile activity. In 2 of the 3 cases the placental stage was operative, manual in 1 case and with fundal pressure applied abdominally in the other. We have found and analysed, in the international literature, 358 cases described from 1939 to 1989. The homogeneous data have been grouped in 21 tables for an easier visualization. Frequency varies from 1 out of 1,200 childbirths to 1 out of 57,393 childbirths. The medium value has been 1 out of 5,903 in the period from 1939 to 1989. The most significant data emerging from the analysis of the 358 cases of uterine inversion concern the placental stage. This was spontaneous in a number of cases equivalent to 28.9%; the number of fundal pressure applied abdominally was up to 30.9%; tractions over funicle up to 22.3%; manual delivery of the placenta up to 17.9%. Eighty-nine percent of cases were diagnosed by simple inspection, whilst for the resting ones an exploration was needed. For most of the cases the treatment was immediate (77%) especially by means of manual reduction vaginally (88%). Hysterectomy was needed for 14 cases that is up to 4.24%.(ABSTRACT TRUNCATED AT 400 WORDS)