Transporting bovine oocytes in a medium supplemented with different macromolecules and antioxidants: Effects on nuclear and cytoplasmic maturation and embryonic development in vitro

We investigated whether supplementing the medium used to transport bovine oocytes with different macromolecules [foetal calf serum (FCS) or bovine serum albumin (BSA)] or a mixture of antioxidants (cysteine, cysteamine and catalase) affects their nuclear and cytoplasmic maturation and thereby affects their subsequent embryonic development and cryotolerance. Oocytes were transported for 6 hr in a portable incubator and then subjected to standard in vitro maturation (IVM) for 18 hr. The oocytes in the control groups were cultured (standard IVM) for 24 hr in medium containing 10% FCS (Control FCS) or 10% FCS and the antioxidant mixture (Control FCS+Antiox). The intracellular concentrations of reactive oxygen species (ROS) at the end of IVM period were lower in the oocytes subjected to simulated transport in the presence of a macromolecular supplement or the antioxidant mixture than that of the control group (FCS: 0.62 and BSA: 0.66 vs. Control FCS: 1.00, p < .05; and Transp: 0.58 and Transp Antiox: 0.70 vs. Control FCS: 1.00, p < .05). After IVM, the mitochondrial membrane potentials of the transported oocytes were lower than those of the non-transported oocytes (FCS: 0.41 and BSA: 0.57 vs. Control FCS: 1.00, p < .05; and Transp: 0.48 and Transp Antiox: 0.51 vs. Control FCS: 1.00 and Control Antiox: 0.84, p < .05). The blastocyst formation rates (36.9% average) and the re-expansion rates of vitrified-warmed blastocysts (53%, average) were unaffected (p > .05) by the treatments. In conclusion, supplementing the medium in which bovine oocytes are transported with antioxidants or different macromolecules did not affect their in vitro production of embryos or their cryotolerance.

180 LONG-TERM TRANSPORTATION OF BOVINE OOCYTES WITH MEIOTIC BLOCKERS: EFFECTS ON NUCLEAR MATURATION

The aim of this study was to assess the blockade and the reversal of meiosis block in bovine oocytes treated with a cyclin-dependent kinase inhibitor (butyrolactone-I; BL) combined or not with a selective inhibitor of epidermal growth factor receptor protein (tyrphostin AG 1478; AG) in a prematuration (PM) culture during oocyte transport. Cumulus-oocyte complexes (n = 4107) were transported in PM medium (TCM-199 with bicarbonate and 0.3% BSA) supplemented with one of the following inhibitors: 50 µM BL; 100 µM BL; 1 µM AG; 50 µM BL + 1 µM AG; or 100 µM BL + 1µM AG. Cumulus-oocyte complexes were transported in well-sealed polystyrene tubes (30 oocytes/tube) containing 200 μL of PM medium covered with mineral oil and gassed with 5% O2, 5% CO2, and 90% N2. The tubes were packed in a portable incubator (Thawing Unit MT 35/42, Minitub, Tiefenbach, Germany) at 38.5°C for 22 h. Afterward, treated oocytes were removed from meiotic inhibitors, transferred to in vitro maturation (IVM) medium (TCM-199 with bicarbonate, 0.5 mg mL−1 of FSH, 100 IU mL−1 of hCG, and 10% FCS), and cultured in a bench-top incubator (Thermo Fisher Scientific, Waltham, MA, USA) under 38.5°C and 5% CO2 in air for 20, 22, 24, or 26 h. The control groups were IVM for 20, 22, 24, or 26 h in IVM medium in the bench-top incubator at 38.5°C and 5% CO2 in air (Control; C) or in the portable incubator under the same conditions used for the treated groups (Transport Control; TC). For meiosis evaluation, oocytes were stained with 1% Hoescht immediately after follicle removal (0 h), at 6 and 22 h of PM, and after 20, 22, 24, and 26 h of IVM, and were classified as immature (germinal vesicle; GV) or mature (metaphase II; MII); intermediate phases of meiosis (GV breakdown, metaphase I, anaphase I, or telophase I) were not demonstrated in this study. Data were analysed by ANOVA followed by Tukey’s test (P < 0.05) and are presented as mean ± standard error of the mean. The GV rates after 6 h of transport did not differ (P > 0.05) between 0-h oocytes (88.6 ± 2.3%) and the treated groups (70.3 ± 1.9% to 79.3 ± 2.2%); although GV rates of C (49.5 ± 2.4%) and TC (49.5 ± 2.4%) groups differed (P < 0.05) from 0-h oocytes, they did not differ from treated oocytes with the exception of the 1 µM AG group (79.3 ± 2.2%), which differed from TC (P < 0.05). After 22 h of transport, the GV rates of treated oocytes (50.3 ± 5.5 to 70.3 ± 6.6%) did not differ (P > 0.05) from 0-h oocytes (88.6 ± 2.3%) and were higher (P < 0.05) than C (4.6 ± 2.8%) and TC (8.3 ± 4.5%) that had the highest MII rates (68.4 ± 5.3 and 75.5 ± 2.0%, respectively, for C and TC) compared with the other groups (0 to 13.2 ± 10.2%). After meiotic inhibitors removal and IVM, meiosis block was fully reversed and there were no differences (P > 0.05) in the rates of MII between treated oocytes and C and TC groups after 20 (56.6%, averaged), 22 (57.7%, averaged), 24 (66.2%, averaged), or 26 h of IVM (57.0%, averaged). In conclusion, the meiotic inhibitors were effective in maintaining the majority of treated oocytes in GV stage after 22 h of transport and the inhibitory effect was fully reverted after its removal. Research was supported by FAPESP and CAPES.

153 SUPPLEMENTATION WITH LINOLENIC ACID AND L-CARNITINE DURING IVM REDUCED THE EXPRESSION OF GENES RELATED TO LIPOGENESIS BUT DID NOT ALTER THE LIPID CONTENT AND CRYOTOLERANCE OF IN VITRO-PRODUCED EMBRYOS

This study was conducted to evaluate the impact of supplementation during in vitro maturation (IVM) with linolenic acid (ALA), l-carnitine (L-car), or the combination of both supplements on the embryo intracellular lipid content and cryotolerance, as well as in the embryo expression of genes involved in lipid metabolism (lipogenesis regulation: SCD1, FASN, and SREBP1; and β-oxidation pathway: CPT1B and CPT2). Cumulus-oocyte complexes (n = 1076) were IVM for 22 h at 38.5°C and 5% CO2 in air, in TCM-199 medium with bicarbonate, hormones, and 10% FCS (control group), supplemented with 100 μM ALA (ALA group), 5 mM L-car (L-car group), or a combination of 100 μM ALA + 5 mM L-car (ALA + L-car group). After IVF, presumptive zygotes were in vitro cultured in SOFaa medium supplemented with 5 mg mL−1 BSA and 2.5% FCS, at 38.5°C and 5% CO2 in air during 7 days. Cleavage and blastocyst rates were evaluated on Day 3 and 7, respectively (IVF = Day 0). At Day 7, the blastocysts were stained with the lipophilic dye Sudan Black B (n = 60), vitrified/warmed (n = 260; Ingámed® protocol, Maringa-PR, Brazil), or collected for analysis of gene expression (n = 180). Embryonic development were analysed by ANOVA and the multiple comparisons of means were determined by Tukey’s test. The embryonic re-expansion data were subjected to chi-square test and the differences in gene expression among groups were evaluated by Duncan’s multiple range test (P < 0.05). Data are presented as means ± standard error means. There was no effect (P > 0.05) of the supplements used during IVM on cleavage (79.54 ± 2.76% to 82.16 ± 1.13%) and blastocyst rates (29.03 ± 3.07% to 30.46 ± 2.01%). Similarly, the intracellular lipid content in Day-7 blastocysts (1.03 ± 0.04 to 1.15 ± 0.07 pixels) and the embryonic cryotolerance, assessed by the re-expansion rates after 24 h (67.3 to 78.3%) hatching rates after 48 h (11.5 to 25.5%) of post-warming culture, were unaffected (P > 0.05) by the supplements of IVM medium. Although the treatments did not alter (P > 0.05) the expression of CPT1B and CPT2 genes, the expression of FASN gene was decreased (P < 0.05) in the ALA group and the expression of SREBP1 gene was decreased (P < 0.05) in the ALA and L-car groups. The expression of the gene SCD1 was reduced (P < 0.05) in all treatments compared with the control group. Thus, despite the lack of effects of the treatments performed during IVM on the intracellular lipid content and cryotolerance of the embryos derived from the treated oocytes, a reduction in the expression of genes related to lipogenesis was observed in Day-7 blastocysts. These results suggest that treatments performed in the oocytes during IVM may have prolonged effects, affecting the subsequent expression of genes in embryos. Further studies are needed to determine the mechanisms related to the differentiation of the oocyte machinery during maturation. Financial support was provided by FAPESP (#2012/10084–4 and #2013/07382–6).

203 SUPPLEMENTATION WITH LINOLENIC ACID, L-CARNITINE, ALONE OR ASSOCIATED, DURING IVM RESULTED IN DECREASE OF ROS LEVELS AND APOPTOTIC INDEX OF BOVINE IN VITRO PRODUCED EMBRYOS

Supplementation of in vitro maturation (IVM) medium with linolenic acid (ALA) has been used in order to reduce oocyte lipid content and have beneficial effects on maturation and acquisition of competence for embryonic development. Besides the effect of reducing cellular lipid content, l-carnitine (l-car) has an antioxidant effect by reducing the levels of reactive oxygen species (ROS) and protecting cells from apoptosis. However, the association of ALA and l-car has never been tested. This study was conducted to evaluate the effects of supplementation of IVM medium of bovine oocytes with ALA, l-car or the association of both (ALA+l-car) on embryonic development and blastocysts reactive oxygen species (ROS) levels and occurrence of apoptosis. Cumulus-oocyte complexes (n = 2241, in 11 replicates) were matured during 22 h at 38.5°C and 5% CO2 in air, in TCM-199 medium with bicarbonate, hormones and 10% FCS (control group), also supplemented with 100 μM ALA group; or 5 mM l-car (l-car group); or 100 μM ALA associated with 5 mM l-car (ALA+l-car group). After fertilisation (Day 0), zygotes were cultured 7 days in SOF that was supplemented with 0.5% BSA and 2.5% FCS, in 5% CO2 in air at 38.5°C. The cleavage and blastocysts rates were evaluated, respectively, at Days 3 and 7. Blastocysts were stained with 5 mM of H2DCFDA (Molecular Probes, Invitrogen, Carlsbad, CA, USA) and TUNEL (In Situ Cell Death Detection Kit, Roche Applied Science, Boston, MA, USA), to evaluate the ROS levels and the blastomers apoptotic index, respectively. The ROS (n = 115) and TUNEL (n = 102) stained blastocysts were evaluated under an epifluorescence microscope (excitation 495 nm/510–550 nm and emission 404 nm/590 nm), and the ROS levels (expressed as arbitrary fluorescence units) were measured by Q-Capture Pro image software (Q Imaging, Surrey, BC, Canada). The fluorescence intensity values were subtracted from mean values of background in the images. The variables were analysed by ANOVA followed by Tukey’s test (P < 0.05) and data are presented as mean ± s.e.m. There was no effect (P > 0.05) of the supplements during IVM on cleavage and blastocysts rates (%), respectively, for control (81.1 ± 1.8 and 29.0 ± 3.1), ALA (80.5 ± 2.1 and 29.7 ± 2.3), l-car (79.5 ± 2.8 and 29.2 ± 2.3), and ALA+l-car (82.2 ± 1.1 and 30.5 ± 2.0) groups. The oocytes supplementation resulted in a decrease (P < 0.05) in ROS levels for ALA (0.84 ± 0.04), l-car (0.85 ± 0.03) and ALA+l-car (0.82 ± 0.02) groups, compared to the Control (1.00 ± 0.05). Consequently, the percentage of apoptotic blastomeres decreased (P < 0.05) after ALA (6.9 ± 1.0%), l-car (7.5 ± 1.2%) and ALA+l-car (4.6 ± 0.7%) supplementations, unlike to the Control group (12.0 ± 1.2%). In conclusion, the supplementation with ALA, l-car or ALA+l-car during IVM did not affect the blastocyst development, but led to a reduction in ROS levels and in the apoptotic index of such blastocysts. These findings may be due to some antioxidant effect of these supplements in the oocytes and/or the produced embryos. Financial support was through FAPESP (#2012/10084–4 and #2013/07382–6).

200 EFFECTS OF MELATONIN ON REACTIVE OXYGEN SPECIES GENERATION AND ACQUISITION OF EMBRYONIC DEVELOPMENTAL COMPETENCE OF BOVINE OOCYTES MATURED IN VITRO

Reactive oxygen species (ROS) are produced under normal culture conditions, but when production increases, it generates a harmful condition called oxidative stress (OS), leading to apoptosis and developmental blocks. Addition of antioxidants as melatonin to culture media has been used to minimize the effects of OS. Our hypothesis was that melatonin could improve oocyte in vitro maturation (IVM) and protect oocytes from ROS under a standard culture condition, thus increasing embryonic development. To test, cumulus-oocyte complexes were matured in TCM-199 with bicarbonate, 0.5 mg mL–1 of FSH, 100 IU mL–1 of hCG, and 10% FCS without supplementation (control group) or supplemented with 10–5 (MT5), 10–7 (MT7) or 10–9 (MT9) M melatonin for 22 h at 38.5°C and 5% CO2 in air. After IVM, a sample of oocytes (control, n = 59; MT5, n = 64; MT7, n = 77; MT9, n = 57) was stained with 1 µg mL–1 Hoechst 33342 to assess the nuclear maturation, and oocytes were classified as being in the stages of germinal vesicle (GV), germinal vesicle breakdown (GVBD), metaphase I (MI), anaphase I or telophase I (A/T), or metaphase II (MII). To determine the intracellular ROS levels, other matured oocytes (control, n = 46; MT5, n = 59; MT7, n = 51; MT9, n = 61) were stained with 5 µM CellROX®Green (Molecular Probes, Eugene, OR, USA) and were evaluated immediately under an epifluorescence inverted microscope (excitation 485 nm; emission 520 nm). The images were recorded and further analysed by Q-Capture Pro image software. After subtraction of the background signal intensity from the measured fluorescent signal intensity values, 1 group was chosen as a calibrator (control group), and each treatment value was divided by the mean calibrator value to generate the relative expression level (in arbitrary fluorescence units). Finally, another sample of matured oocytes (control, n = 188; MT5, n = 173; MT7, n = 180; MT9, n = 178) was submitted to IVF (Day = 0), and the presumptive zygotes were cultured in SOF at 38.5°C and 5% CO2 in air, for up to 7 days. The cleavage rates and embryonic development were evaluated at Days 3 and 7 of IVC, respectively. Data were analysed by ANOVA followed by Tukey’s test (P < 0.05) and are presented as mean ± SEM. There was no effect (P > 0.05) of different concentrations of MT on nuclear status of matured oocytes, as we found no differences in the rates of GV (0% to 5.3% ± 3.4), GVBD (5.4% ± 3.2 to 16.3% ± 5.0), MI (1.7% ± 1.7 to 3.2% ± 3.2), AI/TI (0% to 5.4% ± 3.4), and MII (74.8% ± 2.7 to 87.5% ± 3.7). The cleavage rates did not differ (P > 0.05) among treatments (76.7% ± 4.4 to 83.8% ± 2.7), as well as the embryonic development to the blastocyst stage (31.2% ± 1.9 to 43.7% ± 5.7). The intracellular ROS levels decreased significantly (P < 0.05) in the MT9 group (0.75 ± 0.03) in comparison to Control (1.0 ± 0.06), MT5 (0.97 ± 0.05) and MT7 (0.94 ± 0.05). In conclusion, supplementation with 10–9 M melatonin during IVM reduced the intracellular ROS levels of oocytes without interfering with the nuclear maturation and the subsequent embryonic development to the blastocyst stage. Financial support was provided by FAPESP (#2013/07382–6).

92 INSULIN-LIKE GROWTH FACTOR-1 PROTECTS BOVINE PRE-IMPLANTATION EMBRYOS PRODUCED IN VITRO FROM ANTI-DEVELOPMENTAL ACTIONS OF MENADIONE

The objective of this study was to evaluate the protective effect of insulin-like growth factor (IGF-1) on blastocyst development and cryotolerance of bovine embryos in in vitro culture (IVC) under oxidative stress induced by menadione (MD). Cumulus-oocyte complexes (n = 1421) were matured in TCM-199 with bicarbonate, hormones, and 10% FCS for 22 h. After fertilization, the presumptive zygotes were cultured up to 7 days in SOF medium with 2.5% FCS and 0.5% BSA (control), and also supplemented with 100 μM IGF-1 (IGF). At Day 6, MD was included in the culture medium (0 μM, control; or 5.0 μM, MD) during 24 h. Cultures were conducted at 38.5°C in 5% CO2 in air. The cleavage and blastocysts rates were evaluated, respectively, at Days 3 and 7 (IVF = Day 0). At Day 7, a sample of the blastocysts was stained with 5 μM H2DCFDA (Molecular Probes, Canada) to evaluate the intracellular ROS levels or was stained for TUNEL (In Situ Cell Death Detection Kit, Roche, Indianapolis, IN, USA). Stained embryos were immediately evaluated under an epifluorescence microscope (excitation 495/550 nm and emission 404/590 nm, respectively, for ROS and TUNEL), and the images of embryos stained with H2DCFDA were analysed by Q-Capture Pro image software for determining the fluorescent intensity. Other blastocysts were vitrified (Ingámed®, Maringá-PR, Brazil), and after warming, they were cultured for 24 h to evaluate the re-expansion rates. The results were compared by ANOVA followed by Student’s t-test (mean ± s.e.M) and re-expansion rates by chi-square test (P < 0.05). The cleavage rates did not differ (P > 0.05) among groups (77.1 ± 1.9% to 82.75 ± 2.2%). The blastocyst rates were similar between control (35.4 ± 2.0%) and IGF (34.5 ± 3.7%), and both were higher (P < 0.05) than MD (21.3 ± 2.7%); the IGF+MD group (28.3 ± 1.6%) was similar (P > 0.05) to all groups. The intracellular levels of ROS were higher (P < 0.05) for the MD group (21.7 ± 0.7) than for control (17.0 ± 1.6), and both were similar (P > 0.05) to the IGF (19.2 ± 0.6) and IGF+MD (18.0 ± 1.0) groups. The highest rates of apoptosis were found in the MD group (22.3% ± 2.3) and the smallest in IGF (9.1% ± 0.7), and both differed (P < 0.05) from control (12.8% ± 1.0), and IGF+MD (15.6% ± 1.6). The re-expansion rates were similar between control (77.4%) and IGF (69.2%), and both were higher (P < 0.05) than MD (49.1%); however, the IGF+MD group (57.6%) was similar (P > 0.05) to IGF and MD groups. In conclusion, the supplementation with IGF-1 during IVC reversed the detrimental effects of MD on embryonic levels of ROS and apoptosis, as well as improved the embryo development and cryotolerance of blastocysts under oxidative stress. Financial support was provided by FAPESP (#2012/10083–8 and #2013/07382–6).

[Urinary 1-naphthol in the general population of Umbria]

INTRODUCTION

Naphthalene, the most volatile polycyclic aromatic hydrocarbon (PAH), was recently classified as possible human carcinogen by International Agencies for Research on Cancer Humans may be exposed to naphthalene from a wide variety of sources, including occupation, environment, personal habits. We assessed urinary excretion of 1-naphthol (1-NAF), biomarker of naphthalene exposure, in non-occupationally exposed subjects.

MATERIALS AND METHODS

Urinary 1-NAF, 1-hydroxypyrene (1-OHP), biomarker of exposure to pyrene and cotinine, biomarker of smoking habits, were measured in 104 adults (53 men, 51 women).

RESULTS

1-NAF concentrations overlapped in males and females (median: men 0.35 Microg/g creat; women: 0.46 microg/g creat). Median concentration of 1-NAF was 6-fold higher in smokers compared to nonsmokers (respectively, 7.7 microg/g creatinine vs 1.3 microg/g creatinine). Between smokers, urinary cotinine was positively correlated to 1-naphthol (rho: 0.69; p < 0.01) and 1-OHP (rho: 0.53; p < 0.01). Higher 1-OHP concentrations were found in smokers (median: smokers 0.16 microg/g creatinine, not-smokers 0.05 microg/g creatinine;).

CONCLUSIONS

In our study population, we found that 1-NAF excretion is much higher as compared to 1-OHP excretion. This is due to the ubiquitous presence of naphthalene in the environment. Smoking considerably increase the exposure to naftalene.

IIIB-T4 non-small cell lung cancer: indications and results of surgical treatment

AIM

T4 non-small cell lung cancer (NSCLC) is commonly considered a contraindication to surgery, indeed chemo-radiotherapy achieves a poor survival rate. We have reviewed our experience with T4 NSCLC patients who underwent surgery with the aim of debating the indications and results of surgical treatment in this highly selected group of patients.

METHODS

We investigated a cohort of 60 patients, 49 men and 11 women, who underwent surgery for NSCLC from January 1998 to December 2002 and whose pathological staging was T4N0-2M0. The median age was 65 years (range 46-82). The tumors were classified T4 for the following reasons: intralobar satellite metastasis in 24 cases, direct mediastinum invasion in 18 cases, malignant pleural effusion in 7 cases, involvement of the superior vena cava in 4 cases, marginal invasion of the vertebral body in 3 cases, involvement of the carena in 3 cases and invasion of the left atrium in 1 case. Thirteen patients had undergone neo-adjuvant chemotherapy while 39 underwent adjuvant therapies.

RESULTS

Thirty-two patients resulted with N0 disease, 5 with N1 and 23 with N2 disease. Forty patients relapsed (27 systemic and 13 local relapses). The mean survival was 20 months. Of the examined parameters only metastatic nodal involvement was significantly associated with a worse prognosis (P=0.007).

CONCLUSION

Surgery for T4 NSCLC may be effective in those patients without mediastinal (N2) lymph node involvement. The prognosis was neither affected by the subtype of T4 tumor nor by the use of adjuvant therapies and/or neoadjuvant chemotherapy but only by the N status. In the preoperative work-up, every possible effort should be made to achieve a careful evaluation of lymph-nodal status (primarily by mediastinoscopy and video operative staging).

Primary DNA damage in chrome-plating workers

In order to evaluate the primary DNA damage due to occupational exposure to chromium (VI), DNA strand-breaks and apoptosis in peripheral lymphocytes were measured in a group of 19 chrome-plating workers. DNA strand-breaks was assessed by alkaline (pH>13) single-cell microgel electrophoresis ('comet') assay, while apoptosis was measured by flow-cytometry after propidium iodide staining of the cells. Concentrations of chromium in urine, erythrocytes and lymphocytes were investigated as biological indicators of exposure. A group of 18 hospital workers (control group I) and another 20 university personnel (control group II) without exposure to chromium were also studied as controls. The results of the study show that chrome-plating workers have higher levels of chromium in urine, erythrocytes and lymphocytes than unexposed workers. Comet tail moment values, assumed as index of DNA damage, are increased in chromium-exposed workers and results are significantly correlated to chromium lymphocyte concentrations. No difference emerged in the percentage of apoptotic nuclei in exposed and unexposed workers. The study confirms that measurements of chromium in erythrocytes and lymphocytes may provide useful information about recent and past exposure to hexavalent chromium at the workplace. The increase in DNA strand-breaks measured by comet assay suggests this test is valid for the biological monitoring of workers exposed to genotoxic compounds such as chromium (VI).

Thymic carcinoma: a report of 13 cases

OBJECTIVE

Thymic carcinoma is a rare thymic neoplasm. It is more invasive and has a poorer prognosis than thymoma. We report our experience in the treatment of 13 thymic carcinomas.

METHODS

Thirteen patients with histologically confirmed thymic carcinoma were treated from June 1989. Six patients underwent surgery, followed by adjuvant therapy. Seven patients underwent neoadjuvant chemotherapy, followed by surgery and post-operative radiotherapy.

RESULTS

The diagnosis of thymic carcinoma was achieved in six cases by a mediastinotomy, in three cases by a ultrasound-guided or a CT-guided fine needle aspiration and in three cases the pre-operative diagnosis was thymoma. In one case we did not have the histological diagnosis. All seven patients treated with neoadjuvant chemotherapy responded. The surgical resection was complete in seven cases. Eight patients are still alive 8-142 months from the diagnosis, and six are disease-free.

CONCLUSIONS

Our experience supports the role of surgery and post-operative radiotherapy in thymic carcinomas. Pre-operative treatment of such neoplasms by multi-drug chemotherapy may improve the resectability and the survival rate.

Blood cadmium concentrations in the general population of Umbria, central Italy

The aims of this study were (a) to assess blood cadmium (B-Cd) concentrations and to establish a tentative reference interval; (b) to identify significant determinants of B-Cd, in a population from Umbria, Central Italy, which was not occupationally exposed to cadmium (Cd). Four hundred and thirty-four healthy blood-donors volunteered to answer a questionnaire and provide a blood sample for B-Cd analysis, which was performed by graphite furnace atomic absorption spectrophotometry. Blood Cd concentrations ranged from non-detectable values, i.e. below 0.1 microgram/l up to 3.4 micrograms/l and were not normally distributed. The median values and the 95th percentiles were 0.7 and 2.0 micrograms/l, respectively. Concentrations of B-Cd were more than double in smokers than in non-smokers, median values being 1.1 micrograms/l and 0.5 microgram/l, respectively. In current smokers, B-Cd values correlated with the number of cigarettes smoked daily (rs = 0.40, P = 0.0001) and with the cumulative exposure to cigarette smoke (rs = 0.35, P = 0.0001). Concentrations of B-Cd correlated with age in the non-smokers, but not in the smokers and were significantly higher in women than in men only in the non-smokers. Both in smokers and non-smokers, B-Cd concentrations were similar in subjects living in urban or in rural areas. In the whole study population the lower and the upper tentative reference limit were < 0.1 and 2.2 micrograms/l, respectively, as computed by a non-parametric rank-based method. The upper limit was approximately double in smokers than in non-smokers (3.1 micrograms/l and 1.6 micrograms/l, respectively). Our results show that B-Cd concentrations in a general population from Umbria are in the range reported for general populations in Northern Italy and other European Countries. Smoking was the strongest determinant of B-Cd concentrations and age had a lesser effect.

[Lead absorption in an Umbrian population from 1982 to 1992]

This report assessed lead absorption in community samples of the general population in Umbria, central Italy, in 1982 and in 1992. Each participant (128 subjects in 1982 and 479 in 1992) answered a questionnaire providing details of personal information and life style. Blood lead levels were determined by atomic absorption spectrophotometry. In 1992 hematocrit and glutamyltranspeptidase (gamma-GT) levels were also measured. In 1982 the mean blood lead level was 226 micrograms/l in males and 167 micrograms/l in females, and in 1992 it was still higher in males than in females (98 micrograms/l vs 61 micrograms/l) as were hematocrit and gamma-GT levels. Multiple regression analysis showed sex and age were the main factors accounting for 42% of the total variation in blood lead levels. They were followed by alcohol consumption, gamma-GT levels and smoking in this order. In conclusion, blood lead levels decreased significantly in central Italy in the decade 1982-92 and persistent lead absorption seems to be due to individual characteristics such as male sex, advanced age and a personal life style which includes alcohol consumption and smoking.

[Early gastric cancer]

The authors perform a retrospective analysis of 46 cases of EGC referred to the Surgical Division of Carrara Civic Hospital during the period 1980-1990 who subsequently underwent surgery. Data relating to age, symptomatology and endoscopic examinations were analysed in order to evaluate the real diagnostic penetration of the method in association with tumour biopsy, site, macroscopic aspect, possible lymph node involvement and the histology of lesions. The most frequent form of surgery in this series was subtotal gastrectomy and the 5- and 10-year survival rates, calculated using an actuarial method, were compared with data reported in the literature. The authors conclude by emphasising the need to improve the frequency of diagnosis of gastric cancer at an "early" stage and affirm that gastric resection associated with lymphoadenectomy of 1st and 2nd level lymph nodes is a sufficiently radical operation and less punitive for the patient compared to total gastrectomy given that the 5- and 10-year survival rates are comparable.

[Duodenopancreatectomy with conservation of the pylorus]

The authors report on their initial experience with pylorus-preserving pancreatoduodenectomy. In the last three years 11 patients with neoplastic disease of the pancreatic head and ampullary region underwent the above mentioned procedure. The surgical technique carefully preserved the blood supply and innervation to the antro-pyloric region and duodenum was transected 2 cm distal to the pylorus. Postoperative mortality was 9%. Postoperative nasogastric suction was required for eight days (median). Long term results are quite good with a satisfactory restoration of intestinal function and a weight gain of 95% of pre-illness weight. At the present time preserving the pylorus appears an usefull modification of Whipple procedure.

[Hepatic phlebography before and after portacaval anastomosis]

Wedged hepatic venography has been utilized in the hemodynamic staging of portal hypertension in 33 patients. The immediate postoperative evaluation in 18 cases, has outlined a portal vein filling in 14 end-to-side portacaval shunts, in 5 with presence of hepatofugal collateral veins between the ligated hepatic and shunted splanchnic sides of the portal system, and in 2 side-to-side. The sinusoidal filling pattern has been relatively unchanged after end-to-side portacaval shunts. The venographic appearance of "spontaneous" reversal of portal blood flow in hepatic cirrhosis must be confirmed by selective hepatic arteriography before affirming its presence.

[Aorto-iliac reconstructions]

The Authors refer their retrospective experience on 80 aorto-iliac reconstructions in 76 patients with a follow-up of 39.6 months (6-84). The patients have been classified in 6 functional classes and in 4 angiographic groups. The overall postoperative mortality has been 5.0% and the cumulative patency rate at five years 87.7%. Better functional results whether immediate or late in patients class C and group I.

[Occlusions of the subrenal abdominal aorta]

Personal surgical experience with 14 cases of total occlusion of the abdominal aorta is presented. In 11 cases the revascularization has been performed with thrombectomy from below and bifurcated aortic prothesis. In 5 cases of infrarenal aortic occlusion the thrombectomy has been accomplished with only temporary digital suprarenal compression. The postoperative mortality has been nil. No temporary or definitive renal complications.