Effects of a long-acting trace mineral rumen bolus upon range cow productivity.

The objectives were to determine if strategic supplementation of range cows in central Arizona with either two or four long acting (6 mo) trace mineral rumen boluses containing Cu, Se, and Co would: 1) decrease yearly calving interval; 2) increase cow body condition, milk production, or calf adjusted weaning weights; and 3) to see if any of the above traits varied by cow breed. There were 194 Hereford (H) and 132 Composite (CGC; 50% Red Angus, 25% Tarentaise, 25% Charolais) control cows, 173 H and 125 CGC 1X treated (2 boluses in late winter) cows, and 183 H and 117 CGC 2X treated (2 boluses in autumn and 2 in late winter) cows used over the 4-yr period. Cows were weighed and scored for body condition (1-9, 9 = fattest) in February, May, and September of each year. Milk production was determined by weigh-suckle-weigh on a subset of cows (n = 169) at an average of 50 d lactation. The outcomes were analyzed using a restricted maximum likelihood-based mixed-effects model that included the categorical, fixed effects of breed, bolus, and year with the interactions of breed × bolus, and breed × year. For adjusted weaning wt (WW), year × bolus was added. The random effect of cow was also included. Calving interval had only the breed × bolus interaction added to the main effects. Age of dam was added as a covariate to all models. Milk production used the same model as calving interval with the added covariate of postpartum interval. Cow body condition score and calf adjusted weaning weights differed by breed and treatment (P < 0.05) with WW being greater (P < 0.05) for calves from 2X cows than for control calves. Milk production differed by year (P < 0.0001) but did not differ by either breed or treatment (P > 0.05). Calving interval was 389 ± 2.7, 382 ± 3.2, and 378 ± 3.2 d for control, 1X, and 2X treatments, respectively and calving interval declined (P < 0.05) from the control to the 2X treatment group. Strategic supplementation via a long-acting trace mineral bolus was successful in decreasing calving interval and increasing calf-weaning weights from cattle grazed in an extensive rangeland environment.

Effects of housing and feeding systems on performance of neonatal Holstein bull calves.

As the dairy industry continues to grow, more dairy calves are available for dairy, beef, and veal purposes. Rearing systems must be highly efficient to make this industry cost efficient, making the evaluation of rearing methods important to establish the most practical method. A study was designed and conducted to evaluate effects of housing and feeding systems on performance of neonatal Holstein bull calves. Treatments (2 × 2 factorial arrangement) consisted of: 1) individually housed, bottle-fed (n = 5 bull calves); 2) individually housed, bucket-fed (n = 5 bull calves); 3) group-housed, bottle-fed (n = 5 pens; 4 bull calves/pen); and 4) group-housed, bucket- (trough) fed (n = 5 pens; 3 or 4 bull calves/pen). Feeding treatments began on d 7 when calves had been acclimated to their new environment. Body weight measurements were collected every 7 d and blood samples were collected on d 0, 28, 55, and 66 for ß-hydroxybutyrate (BHBA) concentration as a gross indicator of ruminal development. No housing × feeding interactions or feeding treatment effects were observed (P > 0.10). Average DMI (dry feed plus milk replacer) was increased (P < 0.05) for group-housed vs. individual animals after d 41, and final BW was greater (P < 0.05) for group-housed calves compared with individually housed calves. Feed efficiency and ADG, however, remained similar (P > 0.10) for all treatments. Fecal scores (P > 0.26), CV for BW (P > 0.26), and BHBA concentrations (P > 0.14) showed no differences among treatments. Housing system had greater effect on calf performance compared with milk feeding regimen.

Olive baboon (Papio anubis anubis) as a model for intrauterine research.

BACKGROUND: The Olive baboon is a popular animal model for reproductive and surgical research. The Institute of Primate Research, Nairobi, Kenya, has been using the animal for reproductive research for many years. In the baboon, compared with other smaller non-human primates, it is possible to insert uterine probes such as, catheters, curettes and other linear instruments (to cannulate cervix for uterine procedures like flushing, endometrium biopsy, embryo transfer, etc.). METHODS: However we noticed in a few animals this was difficult and problematic, particularly in some stages of the menstrual cycle, in retroverted uteri, in extensive adhesions or in some anatomically unique animals and we have developed a technique called 'Chai technique' for this purpose. RESULTS AND CONCLUSIONS: The Chai technique is unique to the baboon and not possible in human. It does not seem to cause injuries as frequently as uterine perforation and, in our experience, has been surprisingly successful.

Effects of a long-acting, trace mineral, reticulorumen bolus on range cow productivity and trace mineral profiles.

The objectives were to determine if strategic supplementation of range cows with a long-acting (6 mo), trace mineral, reticulorumen bolus containing Cu, Se, and Co would: (1) increase cow BCS and BW, and calf birth, weaning, and postweaning weights, or weight per day of age (WDA); (2) increase liver concentrations of Cu or Zn in cows, or blood Se, Cu, or Zn concentrations in cows and calves; and (3) vary by cow breed for any of these response variables. There were 192 control and 144 bolused Composite cows (C; 25% Hereford, Angus, Gelbevieh, and Senepol or Barzona); 236 control and 158 bolused Hereford (H) cows; and 208 control and 149 bolused Brahman cross (B) cows used in a 3-yr experiment. Cows were weighed and scored for body condition in January, May, and September, and all bolused cows received boluses in January. Each year, from among the 3 breed groups a subset of 15 control and 15 bolused cows (n = 90) had samples obtained in January and May for liver Cu and Zn, blood Se, and serum Cu and Zn. As for cows, blood and serum from the calves of these cows were sampled each year in May and September for Cu, Se, and Zn. There was a significant breed x year x treatment interaction (P = 0.001) for cow weight loss from January to May. Calf WDA, weaning, and postweaning weights did not differ (P > 0.40) between bolused and control cows, but there was a significant (P = 0.022) breed x year x treatment interaction for birth weight. Liver Cu was deficient (< 75 ppm; P < 0.001) in control cows and adequate (< 75 to 90 ppm) for bolused cows. Liver Cu differed by year (P < 0.001). Blood Se was adequate (< 0.1 ppm) for all cows except in January 2001 and 2002. There was no difference (P > 0.50) in blood Se between treatment groups in January, but bolused cows had greater (P < 0.01) blood Se in May. Breed differences for blood Se concentrations existed for bolused cows, with B having greater (P < 0.05) blood Se than either C or H cows. Breed differences also existed for control cows, with H having less blood Se (P < 0.04) than B or C cows. Calves from bolused cows had greater blood Se than calves from control cows (P = 0.01). Supplementation via a long-acting trace mineral bolus was successful in increasing liver Cu in cows and blood Se in cows and calves, but the responses varied by year. Bolus administration had variable effects on BW change in early lactation, depending on breed and year, which may indicate the need for breed- and year-specific supplementation programs.

Regulation of apoptosis in the atresia of dominant bovine follicles of the first follicular wave following ovulation.

During atresia of bovine follicles, granulosa cells are lost through the controlled form of cell death, apoptosis. The purpose of this study was to characterize the regulation of apoptotic death of granulosa cells in dominant bovine follicles during the first wave of follicular development. Dominant follicles were collected from Holstein heifers on days 4, 6 or 8 of the first follicular wave (n = 5/day). Regulation of apoptosis in granulosa cells was examined by annexin V and propidium iodide staining; measurement of relative levels of mRNA encoding Bcl-2, Bcl-xL and Bax; and activity of caspase-3, -8 and -9. Steady-state levels of mRNA encoding four oxidative stress-response proteins were determined. Compared with day 4, the incidence of apoptotic and nonviable granulosa cells tended to increase on day 6, and numbers of nonviable cells were higher on day 8. The ratios of relative levels of mRNA encoding Bcl-2 to Bax and Bcl-xL to Bax were higher on day 6 than days 4 and 8. Activity of caspases-3 and -9 in granulosa cells did not change among the 3 days, while caspase-8 activity decreased on day 8 compared with days 4 and 6. Amounts of GSHPx, MnSOD and Cu/ZnSOD mRNA in granulosa cells were higher on day 8 than day 6. In theca interna, amounts of Cu/ZnSOD mRNA decreased between days 4 and 6. From the decreased production of estradiol and increased numbers of apoptotic and nonviable granulosa cells, we conclude that atresia of the dominant follicle is initiated between days 4 and 6 of the first follicular wave. However, apoptosis of granulosa cells does not appear to be initiated by changes in expression of oxidative stress-response proteins.

The role of thecal androgen production in the regulation of estradiol biosynthesis by dominant bovine follicles during the first follicular wave.

The first wave of follicular development following ovulation in cattle is characterized by selection and growth of a large, estrogenic dominant follicle. After the follicle becomes morphologically dominant, concentrations of estradiol in its follicular fluid decrease abruptly. The purpose of this study was to determine whether this decrease in estrogen production is caused by an insufficient supply of androgen from theca interna or decreased aromatization of androgen precursor by granulosa cells. Dominant follicles were collected from Holstein heifers on d 4, 6, or 8 of the first follicular wave (n = 5/d). Amounts of 17alpha-hydroxylase mRNA in theca interna were sevenfold higher (P < 0.01) on d 4 than on d 8. After 3 h in culture, secretion of androstenedione by theca interna collected on d 4 (236 +/- 44 pg/microg of protein) tended to be lower (P = 0.055) compared with d 6 (517 +/- 162 pg/microg protein) and was lower (P < 0.05) compared with d 8 (387 +/- 51 pg/microg of protein). In granulosa cells, amounts of aromatase mRNA decreased (P < 0.05) on d 8 compared with d 6 but not d 4. In vitro secretion of estradiol was higher in granulosa cells collected on d 4 (3.5 +/- 0.8 ng/[10(5) cells x 3 h]) compared with d 6 (1.8 +/- 0.6 ng/[10(5) cells x 3 h]; P < 0.05) and tended to be higher on d 4 than on d 8 (2.2 +/- 0.2 ng/[10(5) cells x 3 h]; P = 0.058). We conclude that the decrease in estradiol production observed during atresia of the dominant follicle is not due to lack of androgen substrate for aromatization or downregulated expression of the aromatase gene, but may be the direct result of decreased activity of the aromatase enzyme within granulosa cells.

Effects of nicotine and cotinine on bovine theca interna and granulosa cells.

The purpose of this study was to determine if nicotine or cotinine inhibits steroidogenesis in the ovarian follicle. Theca interna and granulosa cells were isolated from bovine follicles, cultured with nicotine or cotinine for 24h, and culture media were assayed for androstenedione or estradiol. Treatment of theca interna with 6, 60, and 600 micro M nicotine decreased (P

Anterior tension-free repair of recurrent inguinal hernia under local anesthesia: a 7-year experience in a teaching hospital.

OBJECTIVE: To describe a 7-year experience with recurrent inguinal hernia repair performed mainly with tension-free mesh or plug technique under local anesthesia through the anterior approach, and to evaluate the safety and effectiveness of this method of treatment. METHODS: One hundred forty-five elective and 1 emergency herniorrhaphies for recurrent groin hernia were performed in 141 subjects (134 men and 7 women) with a mean age of 65 years (range 30-89). Concomitant medical and surgical problems were present in 73% and 8% of subjects, respectively. In 28 instances, the relapsed hernia had already been operated on once or twice for recurrence. A traditional hernioplasty had been previously performed in the vast majority of cases (136). Tension-free mesh or plug techniques through an anterior approach under local anesthesia were performed in 144 reoperations. Preperitoneal mesh repair and general or spinal anesthesia were used in all but one case when herniorrhaphy was performed during simultaneous operations. RESULTS: Mean hospital stay after surgery was 1.5 days (range 3 hours-14 days). No perioperative deaths occurred in this series. General complications were one case of acute intestinal bleeding and two cases of urinary retention. Local complications consisted of eight (5.5%) minor complications and one case of orchitis (0.7%) followed by testicular atrophy. In no instance was postoperative neuralgia or chronic pain reported. Two re-recurrences occurred. CONCLUSIONS: Given the low complication rate in this and other reported series and the absence of surgical or general complications described after preperitoneal open or laparoscopic repair and after general and spinal anesthesia, anterior mesh repair under local anesthesia seems to be a low-cost surgical technique that can be safely and effectively used even in a teaching hospital for the treatment of the majority of patients with recurrent groin hernias.

Role of impression cytology during hypovitaminosis A.

AIMS: Evaluation of the morphological damage to the ocular surface of patients operated for biliopancreatic diversion for pathological obesity and the correlation of impression cytology with vitamin A plasma levels, adaptometry, and other general variables. METHODS: 48 patients (15 males, 33 females, age range 21-73) and 34 normal subjects were examined with fluorescein and rose bengal, a plasma dose of vitamin A, and adaptometry. The results of the various tests were subdivided into three levels (0 = normal, 1 = moderately altered, 2 = seriously altered). The impression cytology and adaptometry results were correlated with vitamin A levels and other patient data (age, nutritional condition, time since operation, percentage weight loss). All the examinations were repeated after intramuscular therapy with vitamin A. RESULTS: Corneoconjunctival alterations visible with fluorescein and rose bengal staining were present in 67.7% of cases, impression cytology alterations in 93.7%, adaptometric alterations in 82.2%; vitamin A plasma levels were below normal in 95.8% of cases. After the therapy with vitamin A a significant reduction was found for every examination. The correlation between impression cytology and adaptometry and vitamin A plasma levels and between corneoconjunctival alterations and vitamin A plasma levels was significant. There was no significant correlation between impression cytology and nutritional condition, age time since operation, and percentage weight loss. CONCLUSION: These results show impression cytology is a specific indicator for hypovitaminosis A because it is not influenced by other factors related to the general condition of the patient. Many patients with hypovitaminosis A not demonstrating ocular symptoms of changes visible with fluorescein and rose bengal showed alterations with impression cytology.

Hernia repair in elderly patients.

BACKGROUND: This study evaluates a 5-year experience of the management of the most frequent abdominal wall hernias in an elderly population. METHODS: From April 1990 to December 1995, 231 inguinal, 12 femoral and seven umbilical hernias were repaired in 221 patients (mean age 74 (range 66-93) years). Concomitant diseases were present in 157 patients. A mesh repair was performed with 'tension-free' or 'plug' techniques in all but 23 inguinal and two femoral hernia repairs, in which the Bassini or Shouldice procedures were adopted. Ten emergency hernia repairs were performed for strangulation. A total of 232 operations, including four emergency hernia repairs, were carried out under local anaesthesia. RESULTS: There was no perioperative mortality. Acute intestinal bleeding occurred 2 days after surgery in a patient with colonic diverticular disease. Urinary retention occurred once following emergency hernia repair under general anaesthesia and twice after elective hernia repair under local anaesthesia. Local complications included four scrotal haematomas (2 per cent), three wound infections (1 per cent) and one case of orchitis with atrophy after repair of a recurrent hernia. There was one recurrence after a Bassini repair and one after Shouldice inguinal herniorrhaphy. No recurrence was observed after mesh repair. CONCLUSION: Local anaesthetic mesh hernia repair is safe and effective in elderly patients. Age should be no bar to elective hernia repair. This policy should avoid the complications of emergency operation.

[6 years of experience in inguinal and femoral hernioplasty in patients over 65 years of age]. / Sei anni di esperienza di ernioplastica inguinale e femorale nei soggetti con oltre 65 anni di età.

From April 1990 to November 1996, 313 inguinal and 14 femoral hernias were repaired in 295 subjects with a mean age of 74 years (66 to 97). Concomitant diseases increasing the operative risk were present in 206 subjects (70 per cent). A mesh repair was performed with "tension-free" or "plug" techniques in all but 23 inguinal and 2 femoral herniorrhaphies where the Bassini or the Shouldice procedures were adopted. Fifty-two inguinal hernias were recurrent, 11 emergency herniorrhaphies were performed for strangulation. Almost all operations (305), including 9 emergency herniorrhaphies, were carried out under local anaesthesia. There was no perioperative mortality. Acute intestinal bleeding occurred after surgery in a subject with colon diverticulosis. One urinary retention following emergency hernia repair under general anaesthesia and 2 following elective hernia repair under local anaesthesia in 2 subjects with hypertrophy of the prostate were observed. Some episodes of hypotension and/or bradycardia were observed either during or after surgery. Local complications following inguinal hernioplasty were 5 (1.5%) scrotal hematomas, 3 (0.9%) wound infections and 1 case (0.4%) of orchitis with atrophy after repair of a recurrent hernia. There were 1 recurrence after Bassini, 1 after Shouldice, and 1 (0.4%) after mesh inguinal hernioplasty. Using local anaesthesia and a mesh repair elective surgery of inguinal and femoral hernias can be safely and effectively performed in elderly patients. Consequently, early elective surgery should be recommended to avoid the risk of an emergency operation.

[Pregnancy after surgical therapy of obesity. Bibliographic review and our experience with biliopancreatic diversion]. / Gravidanza dopo terapia chirurgica dell'obesità. Revisione bibliografica e nostra esperienza con la diversione biliopancreatica.

BACKGROUND: An increasing number of women in childbearing age are submitted to surgical treatment of obesity; for this reason pregnancy represents a frequent event in operated patients. METHODS: In this study pregnancy in patients with morbid obesity submitted to jejunoileal bypass (JIB) and gastric bypass (GB) are reviewed from the literature and the analysis of our experience with biliopancreatic diversion (BPD) is reported. RESULTS: In 113 pregnancies after JIB reviewed from the literature, the results seem to be debated either about the course of pregnancy or about maternal and neonatal status. The data of literature concerning the pregnancies following GB are less debated but rather slight. One hundred and fifty-two pregnancies after BPD have a complete documentation concerning maternal conditions, modality of outcome and neonatal situation. CONCLUSIONS: Pregnancy occurred in the obese women represents an increased maternal-fetal risk. The excess weight loss, the weight maintenance and the reduced weight changes during pregnancy are an advantage in the operate women who, in any case, need accurate controls of the nutritional status during the whole gestational period. Keeping these cautions pregnancy following surgical treatment of obesity represents an event not only possible but even with less problems than in pregnancy in obese women.

[Surgical treatment of inguinal hernia using a "tension-free" technique and local anesthesia. Initial experience]. / Trattamento chirurgico dell'ernia inguinale con tecnica "tension-free" in anestesia locale. Eperienza iniziale.

Between January, 1991 and December, 1993, 208 subjects with monolateral and 19 with bilateral inguinal hernia were submitted to herniorrhaphy. Thirty-four were recurrent hernias. All but one bilateral hernias were treated at the same time. Eight cases were operated in emergency condition for acute strangulated hernia. Two-hundred and ten operations were performed under local, 17 under general and 1 under spinal anesthesia. Herniorrhaphy was performed in 14 cases with the Bassini and in 38 with the Shouldice technique. In 191 instances the "tension-free" and in 3 the "plug" techniques were adopted utilizing a polypropylene mesh. Following local anesthesia 13 episodes of bradycardia with hypotension were recorded during the operation and 4 in the early postop period. There were no general complications. Two elderly patients developed urinary retention following general anesthesia. Local complications included 6 (2.4%) cases of infection and 4 (1.6%) cases of hematoma of the wound, and 5 (2.0%) cases of edema with infiltration of the cord. Percentage of follow-up at 1, 2 and 3 years was 96, 95, and 93 percent respectively. Five recurrences were recorded: in 1 case following Bassini repair (7.6%), in 2 following Shouldice (5.6%), and in 2 following tension-free (1.5%). Local anesthesia has been confirmed to be well accepted by the patients, effective an safe, especially in the elderly patients with high operative risk. Similarly, the tension-free hernioplasty has been confirmed as a simple, easily reproducible technique, followed by less pain and disability as compared with other types of herniorrhaphies, and more effective mainly in the treatment of recurrent hernia.

Biliopancreatic diversion for obesity at eighteen years.

BACKGROUND: Surgical attempts to treat obesity began because of the discouraging results of conservative medical treatment, which successfully achieved initial weight loss but failed to maintain it. Gastric restrictive procedures, currently the most popular surgical methods for obesity therapy, have proved to be effective in initiating weight loss, but some concerns regarding their long-term efficacy in weight maintenance have arisen. METHODS: Of a total of 1968 obese patients who underwent biliopancreatic diversion since 1976, the last consecutive 1217 underwent the "ad hoc stomach" type of diversion with a 200 cm alimentary limb, a 50 cm common limb, and a gastric volume varying between 200 and 500 ml. Mean age was 37 years old (11 to 69 years), and mean excess weight was 117%. Maximum follow-up was 115 months with nearly 100% participation. RESULTS: In the last half of the series, operative mortality was 0.4% with no general complications and with early surgical complications of wound dehiscence and infection (total, 1.2%) and late complications of incisional hernia (8.7%) and intestinal obstruction (1.2%). Mean percent loss initial excess weight (IEW) at 2, 4, 6, and 8 years was 78 +/- 16, 75 +/- 16, 78 +/- 18, and 77 +/- 16 in the patients with IEW up to 120% and 74 +/- 12, 73 +/- 13, 73 +/- 12, and 72 +/- 10 in those with IEW more than 120%. A group of 40 patients who underwent the original "half-half" biliopancreatic diversion maintained a mean 70% reduction of IEW during a 15-year follow-up period. Specific late complications included anemia (less than 5%), stomal ulcer (2.8%), protein malnutrition (7% with 1.7% requiring surgical revision by common limb elongation or by restoration). Clinical problems from bone demineralization were minimal in the short term and almost absent in the long term. CONCLUSIONS: Biliopancreatic diversion is a very effective procedure but is potentially dangerous if used incorrectly.

[Preoperative eating behavior and weight loss after gastric banding for obesity]. / Comportamento alimentare preoperatorio e calo ponderale dopo "gastric banding" per l'obesità.

The relationships between the cognitive restraint and the tendency to disinhibition prior to gastric banding for obesity, as assessed by the Three Factor Eating Questionnaire, and the weight loss at one year following the operation were investigated. The amount of overall weight loss was correlated positively to the disinhibition and negatively to the cognitive restraint score. When the food consumption overtakes the proximal gastric pouch capacity, the patient feels a strong aversive stimulus, thus stopping eating. Therefore, more is the patient's tendency to lose the control on food intake more is the postoperative weight loss. On the contrary, the high restraint patient only seldom feels such an aversive stimulus, and only seldom stops eating, thus the weight loss is smaller. Except for the overeating due to the disinhibition, the aversive stimulus arising from the gastric restriction cannot influence by itself any other aspect of eating behavior.

Pregnancies in an 18-Year Follow-up after Biliopancreatic Diversion.

BACKGROUND: 239 pregnancies occurred in 1136 women who had undergone biliopancreatic diversion (BPD). METHODS: There were 73 abortions, and 14 pregnancies are presently in their course. The 152 term pregnancies (six twins) occurred in 129 women 2-173 months (mean 42.7) after BPD. Mean age and current excess weight were 31.4 years (20-42) and 29.1%(- 6.9-78.2), and mean excess weight loss was 72.9%(30.4-110.5). RESULTS: Mean weight gain during pregnancy was 6.2 kg (-21-25). In 32 patients (21%), parenteral nutritional support was needed. In all the other patients (79%), the usual supplementations were given. Of the newborns, 122 were delivered at term (84.7%) with a mean weight of 2842.4g (1760-4600g) and a mean length of 48.S cm (43-59 cm), while the 22 preterm babies (15.3%) weighed 2151.1 g (1400-3850 g) and had a length of 44.6 cm (33-56 cm). Forty infants (27.8%) were small for gestational age but 17 of them weighed more than 2500 g. Eleven twins (one, abortion at 26th week) were also delivered, with a mean weight of 2088.6 g (1200-3100 g) and a mean length of 45.6 cm (35-50 cm). Delivery was spontaneous in 85 instances (56%), while vacuum extractor was used in one, and 66 cesarean sections were performed. There were two birth malformations, one infant died after surgery for meconium obstruction and two died from unknown causes. Of the 129 women, 35 had been infertile before BPD. CONCLUSIONS: Disappearance of infertility and decrease of pregnancy risk are to be considered among the beneficial effects of weight reduction following BPD.

Wernicke-Korsakoff Encephalopathy Following Biliopancreatic Diversion.

Wernicke-Korsakoff disease with sensory-motor neuropathy was diagnosed in three out of a series of 1,663 patients (0.18%), with onset 2, 3 and 5 months after biliopancreatic diversion. Precipitating factors were vomiting, minimal food intake, anorexia, rapid weight loss, and glucose-containing intravenous feeding. Recovery was partial in two and complete in one of the patients. In the early postop, prophylactic thiamine should be given to the patients with excessively limited eating capacity. Larger doses of thiamine should be instituted parenterally either in the case of suspected Wernicke-Korsakoff encephalopathy or before starting feeding for protein malnutrition.

Intravenous nutritional support in pregnancy. Experience following biliopancreatic diversion.

11 pregnant women with protein malnutrition following biliopancreatic diversion for obesity were supported by parenteral nutrition (PN). In 2 cases high concentration glucose, lipid emulsions and standard aminoacid mixtures were infused via a central venous catheter; in the other subjects, because oral intake was normal or increased, only aminoacids with or without lipids were administered through a peripheral vein. PN promoted foetal growth and was very well tolerated and totally safe both for mother and infant.