Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19 / Telemedicine and epilepsy: healthcare experience of a national reference center during the COVID-19 pandemic

Introducción: El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos: Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados: Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones: La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.(AU)

Introduction: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. Patients and methods: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. Results: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. Conclusions: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.(AU)

[Telemedicine and epilepsy: healthcare experience of a national reference center during the COVID-19 pandemic]. / Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.

INTRODUCTION: Countries worldwide are having to cope with the COVID-19 pandemic caused by SARS-CoV-2. The burden on their national health systems is currently at unprecedented levels. Telemedicine care was initiated at an early stage in our centre. PATIENTS AND METHODS: We conducted a descriptive and retrospective study to evaluate the usefulness of telemedicine during lockdown in our centre. Patients included in the study had a clinical diagnosis of epilepsy, with two visits via telemedicine, who had been followed up for at least six months during the normal situation prior to the COVID-19 pandemic and two face-to-face consultations during the same period. RESULTS: A total of 115 patients were included. The average age was 29 years, 53% were males, 52.2% had focal epilepsy, 58.3% with a structural causation and 57.4% had difficult-to-treat epilepsy. The mean number of seizures prior to lockdown was 9.73/month and 6.54/month during lockdown. The number of patients who were seizure-free when lockdown ended was higher than that observed in the phase before it began: 54 versus 45 out of 115. CONCLUSIONS: Telemedicine is a very useful strategy for monitoring the course, progress and therapeutic changes in epileptic patients in the short and medium term. The reduction in the seizure frequency can be sustained in the medium term, not only in the short term as corroborated in previous studies. Telemedicine allows access to virtually all patients and closer monitoring.

TITLE: Telemedicina y epilepsia: experiencia asistencial de un centro de referencia nacional durante la pandemia de COVID-19.Introducción. El mundo entero está afrontando la pandemia por COVID-19 causada por el SARS-CoV-2. Los sistemas de salud nacionales están sometidos a niveles de sobrecarga sin precedentes. En nuestro centro se inició de forma temprana la asistencia a través de telemedicina. Pacientes y métodos. Es un estudio descriptivo y retrospectivo para evaluar la utilidad de la telemedicina durante el confinamiento en nuestro centro. Se incluyó a los pacientes con diagnóstico clínico de epilepsia, con dos asistencias a través de telemedicina, que tuvieran seguimiento durante al menos seis meses durante la situación de normalidad previa a la pandemia por COVID-19 y dos consultas presenciales durante ese mismo período. Resultados. Se incluyó a 115 pacientes. La media de edad fue de 29 años, el 53% fueron varones, el 52,2% con epilepsia focal, el 58,3% de etiología estructural y el 57,4% presentaba epilepsia de difícil control. La media de crisis preconfinamiento fue de 9,73/mes y de 6,54/mes durante el confinamiento. El número de pacientes libres de crisis fue mayor al final del confinamiento respecto a la fase preconfinamiento, 54 frente a 45/115. Conclusiones. La telemedicina es una estrategia de mucha utilidad en la monitorización de la evolución, el control evolutivo y los cambios terapéuticos en pacientes epilépticos a corto y medio plazo. La reducción de la frecuencia de crisis puede mantenerse a medio plazo, no sólo a corto plazo como se corroboró en estudios previos. La telemedicina permite acceder a prácticamente la totalidad de los pacientes y realizar un seguimiento más cercano.

Internalizing and externalizing symptoms and suicidal behaviour in young people: a systematic review and meta-analysis of longitudinal studies.

OBJECTIVE: To assess internalizing and externalizing symptoms as risk factors for suicidal behaviour and suicide among adolescents and young adults. METHOD: We conducted a systematic review of articles published until January 2017. We identified 26 883 potential papers; 1701 full-text articles were assessed for eligibility, of which 1479 were excluded because of methodological reasons. Diverse meta-analyses were performed for each group of symptoms. Odds ratios (ORs) and 95% confidence intervals (95% CI) or beta coefficients for categorical variables, and effect size (ES) were calculated for continuous variables. RESULTS: Finally, 41 studies were included, involving participants aged 12-26 years for a systematic review, and 24 articles were included for meta-analysis. The meta-analysis showed that youths with any internalizing (ES = 0.93) or externalizing symptoms (ES = 0.76 and OR = 2.59) were more likely to attempt suicide in future. This effect was also seen in depression symptoms (OR = 6.58 and ES = 1.00), legal problems (OR = 3.36), and anxiety (ES = 0.65). CONCLUSION: Reported internalizing and externalizing symptoms are predictors of suicide behaviour in young people; therefore, the detection and management of these symptoms in young populations could be a crucial strategy for preventing suicidality in this group.

Sexual orientation and suicidal behaviour in adolescents and young adults: systematic review and meta-analysis.

BackgroundResearch suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.AimsTo assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.MethodA systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12-26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.ResultsSexual orientation was significantly associated with suicide attempts in adolescents and youths (OR = 2.26, 95% CI 1.60-3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR = 2.21, 95% CI 1.21-4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.ConclusionsSexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.

Longitudinal association between self-injurious thoughts and behaviors and suicidal behavior in adolescents and young adults: A systematic review with meta-analysis.

BACKGROUND: Adolescents with previous self-injurious thoughts and behaviors (SITB) have over 2-fold risk of dying by suicide, higher than older ages. This meta-analysis aims to disentangle the association of each SITB with subsequent suicidal behavior in adolescence/young adulthood, the contribution of each SITB, and the proportion of suicide deaths with no previous suicide attempt. METHODS: We searched 6 databases until June 2015. INCLUSION CRITERIA: 1. Assessment of any previous SITB [a) suicidal thoughts and behaviors (ideation; threat/gesture; plan; attempt); b) non-suicidal thoughts and behaviors (thoughts; threat/gesture; self-injury); c) self-harm] as a risk factor of suicide attempt or suicide death; 2. Case-control or cohort studies; 3. Subjects aged 12-26y. Random effect models, metaregression analyses including mental health and environmental variables, and population attributable risks (PAR)s were estimated. RESULTS: From 23,682 potentially eligible articles, 29 were included in the meta-analysis (1,122,054 individuals). While 68% of all youth suicide deaths had no previous suicide attempt, suicide death was very strongly associated with any previous SITB (OR=22.53, 95%CI: 18.40-27.58). Suicide attempts were also associated with a history of previous SITB (OR=3.48, 95%CI: 2.71-4.43). There were no moderating effects for mental health and environmental features. The PAR of previous SITB to suicide attempts is 26%. LIMITATIONS: There is considerable heterogeneity between the available studies. Due to limitations in the original studies, an over-estimation of the proportion dying at their first attempt cannot be ruled out, since they might have missed unrecognized previous suicide attempts. CONCLUSIONS: Although more than two thirds of suicide deaths in adolescence/young adulthood have occurred with no previous suicidal behavior, previous SITBs have a much higher risk of dying by suicide than previously reported in this age group.

Exposure to violence, a risk for suicide in youths and young adults. A meta-analysis of longitudinal studies.

OBJECTIVE: To assess the association and magnitude of the effect of early exposure to different types of interpersonal violence (IPV) with suicide attempt and suicide death in youths and young adults. METHOD: We searched six databases until June 2015. Inclusion criteria were as follows: (1) assessment of any type of IPV as risk factor of suicide attempt or suicide: (i) child maltreatment [childhood physical, sexual, emotional abuse, neglect], (ii) bullying, (iii) dating violence, and (iv) community violence; (2) population-based case-control or cohort studies; and (3) subjects aged 12-26 years. Random models were used for meta-analyses (Reg: CRD42013005775). RESULTS: From 23 682 articles, 29 articles with 143 730 subjects for meta-analyses were included. For victims of any IPV, OR of subsequent suicide attempt was 1.99 (95% CI: 1.73-2.28); for child maltreatment, 2.25 (95% CI: 1.85-2.73); for bullying, 2.39 (95% CI: 1.89-3.01); for dating violence, 1.65 (95% CI: 1.40-1.94); and for community violence, 1.48 (95% CI: 1.16-1.87). Young victims of IPV had an OR of suicide death of 10.57 (95% CI: 4.46-25.07). CONCLUSION: Early exposure to IPV confers a risk of suicide attempts and particularly suicide death in youths and young adults. Future research should address the effectiveness of preventing and detecting early any type of IPV exposure in early ages.

Conciliación de la medicación: desde el ingreso hasta la atención primaria / Medication reconciliation: from admission to primary care

Objetivos. Implementar un circuito de conciliación de la medicación interniveles, integral y multidisciplinar en una organización sanitaria integrada. Medir las discrepancias detectadas en cada uno de los pasos estudiados. Método. Estudio de intervención, prospectivo y de un año de duración. La medicación se concilió en 3 momentos distintos del paso del paciente por el sistema sanitario: al ingreso en el hospital, al alta y cuando el paciente acudió a su médico de Atención Primaria. Se recogieron y resolvieron las discrepancias detectadas cada vez que se concilió la medicación, y se cuantificó el número total de medicamentos antes y después de cada proceso de conciliación. Resultados. Entre el 1 de noviembre de 2013 y el 30 de octubre de 2014 se concilió la medicación a 77 pacientes, 63% hombres, con una media de edad de 69,5 años. La media de discrepancias por paciente fue de 7,85 al ingreso, 3,67 al alta y 2,19 en Atención Primaria. Conclusiones. Este programa de conciliación de la medicación, además de detectar y resolver las discrepancias, ha sido un punto de partida para establecer nuevas vías de comunicación entre los diferentes profesionales sanitarios que han intervenido en el programa y difundir la cultura de seguridad dentro de la organización (AU)

Objectives. To implement a medication reconciliation circuit of inter-level, comprehensive and multidisciplinary approach in an integrated health organization. To measure the discrepancies detected in each of the steps studied. Method. A prospective intervention study of one-year duration. The medication is reconciled at admission to the hospital, at discharge and when the patient goes to his Primary Care physician. The number and type of discrepancies detected each time the medication is reconciled are collected and resolved, as well as the total number of drugs before and after each reconciliation process quantified. Results. Between November 1, 2013 and October 31, 2014 the medication had been reconciled to 77 patients, 63% male, mean age 69,5 years. Mean admission discrepancy per patient was 7,85, 3,67 at discharge and 2,19 at Primary Care. Conclusions. This program of medication reconciliation, in addition to detect and resolve discrepancies, has been a starting point for establishing new channels of communication between the different health professionals who have participated in the program and disseminate the safety culture within the organization (AU)

[Medication reconciliation: From admission to primary care]. / Conciliación de la medicación: desde el ingreso hasta la atención primaria.

OBJECTIVES: To implement a medication reconciliation circuit of inter-level, comprehensive and multidisciplinary approach in an integrated health organization. To measure the discrepancies detected in each of the steps studied. METHOD: A prospective intervention study of one-year duration. The medication is reconciled at admission to the hospital, at discharge and when the patient goes to his Primary Care physician. The number and type of discrepancies detected each time the medication is reconciled are collected and resolved, as well as the total number of drugs before and after each reconciliation process quantified. RESULTS: Between November 1, 2013 and October 31, 2014 the medication had been reconciled to 77 patients, 63% male, mean age 69,5 years. Mean admission discrepancy per patient was 7,85, 3,67 at discharge and 2,19 at Primary Care. CONCLUSIONS: This program of medication reconciliation, in addition to detect and resolve discrepancies, has been a starting point for establishing new channels of communication between the different health professionals who have participated in the program and disseminate the safety culture within the organization.

Characterisation and modelling of brain tissue for surgical simulation.

Interactive surgical simulators capable of providing a realistic visual and haptic feedback to users are a promising technology for medical training and surgery planification. However, modelling the physical behaviour of human organs and tissues for surgery simulation remains a challenge. On the one hand, this is due to the difficulty to characterise the physical properties of biological soft tissues. On the other hand, the challenge still remains in the computation time requirements of real-time simulation required in interactive systems. Real-time surgical simulation and medical training must employ a sufficiently accurate and simple model of soft tissues in order to provide a realistic haptic and visual response. This study attempts to characterise the brain tissue at similar conditions to those that take place on surgical procedures. With this aim, porcine brain tissue is characterised, as a surrogate of human brain, on a rotational rheometer at low strain rates and large strains. In order to model the brain tissue with an adequate level of accuracy and simplicity, linear elastic, hyperelastic and quasi-linear viscoelastic models are defined. These models are simulated using the ABAQUS finite element platform and compared with the obtained experimental data.

18F-FDG PET parece disponer de una buena eficacia diagnóstica para valorar tejido residual en pacientes con LH que han completado la primera línea de tratamiento; sin embargo, la literatura disponible es de baja calidad metodológica y puede sobreestimar la eficacia (tabla resumen 3 y tabla resultados 3) / No disponible

No disponible

[Hematometra & Listeria monocytogenes]. / Hematometra por Listeria monocytogenes.

The hematometra is a nosological entity that may not always be attributed to an embryonic defect of the paramesonefros; cervical-vaginal infections such as etiological possibilities due to Listeria monocytogenes (Lm), cervix malignant neoplasias, iatrogenias due to endometrial ablation with Lasser, traumatic bloody uterine curetage and because of cervical cryocoagulation or electrocoagulation are also mentioned. The case to be reported is from a woman in reproductive stage, who is 32 years old, and had menarca at the age of 13, starting her sexual life at 31, not using any method to control her fertility. When having an eight-week amenorrhea after 8 months of marriage, she visited the doctor for assumed pregnancy, within the prenatal analysis a pelvic echographic study was requested, finding out images that we concluded as hematometra, having been drained and demonstrated the presence of LM by anti-Lm antibodies, being administered Azitromicina and Espiramicina.

[Rh (D) alloimmunization and pregnancy. Analysis of the causes after prophylaxis introduction]. / Aloinmunización Rh (D) y embarazo. Análisis de las causas tras la introducción de la profilaxis.

PURPOSE: Prenatal and postnatal prophylaxis of the Rh (D) haemolytic disease of the newborn have clearly reduced the number of cases but still there are alloimmunizations. PATIENTS AND METHODS: All cases detected in our Hospital in the last 24 years have been reviewed and possible causes analyzed. RESULTS: From a total of 10,332 deliveries in Rh (D) negative women we have detected 114 anti-D in 86 women. In 74 women anti-D was the only antibody and in 12 there were more antibodies. Data were managed in 3-year periods and we see a progressive decrease in the incidence of alloimmunization with a minimum of 0.03 per 1000 pregnancies in the period 89-91 and a posterior progression to an incidence of 0.12 in the last 3-year period 95-97. The causes were: pregnancies before 1970 in 31, incorrect prophylaxis in 12, despite a correct prophylaxis in 6, previous pregnancies without complete information about the prophylaxis in 13, previous transfusion in 6, previous pregnancies or transfusion in 8 and indetermined in 10. CONCLUSION: It is desirable to reduce at minimum the number of Rh (D) alloimmunizations by strictly following the prophylaxis protocols.

Effects of a copper-bearing intrauterine device on the ovarian function, body weight gain and pregnancy rate of nulliparous heifers.

A copper-bearing intrauterine device (IUD), designed to cause a slight distention of the uterus, was inserted through the cervix into each uterine horn of 230 heifers; an additional 230 heifers served as the control group. Blood was drawn at 0, 1, 2, 20 and 120 d for progesterone and testosterone assays. The heifers were checked twice daily for estrus and examined at 0, 60 and 120 d for weight gain. Thereafter they were bred over a 120-d period. The IUD caused anestrus in 98% of the heifers, with a daily weight gain 25.5 % higher than in the control heifers. Moreover, the device was 100% effective in preventing pregnancy. At 20 and 120 d after IUD insertion progesterone levels averaged 0.7 ng/ml, which was 4 to 5 times lower than in the control animals, suggesting a failure in ovulation or in corpus luteum (CL) formation due to the IUD. Simultaneously, testosterone values were increased up to 8 times in IUD-treated heifers, reaching a mean concentration of 163 pg/ml. Associated histological evaluations of the ovaries from UD-treated heifers revealed the presence of 2 or more cysts per ovary, with marked hyperthecosis in many antral follicles in which the granulosa cell layers were either thinned or lacking. The results suggest that the action of the copper-releasing IUD used in this study resulted in high contraceptive efficiency but also in disturbance of ovarian function. Our findings further raise the possibility of a cause and effect relationship between hyperandrogenism and the higher body weight gain observed in heifers treated with the IUD.

[Results of preoperative autotransfusion with ferrous ascorbate prophylaxis in orthopedic surgery patients]. / Resultados de la autotransfusión preoperatoria con profilaxis con ascorbato ferroso en enfermos de cirugía ortopédica.

PURPOSE: Restrictive erythropoiesis caused by iron deficiency may hinder pre-deposit autotransfusion in surgical procedures. In order to evaluate the response to prophylactic ferrous ascorbate, a prospective study was conducted on patients subjected to orthopaedic surgery and autotransfusion. PATIENTS AND METHODS: Sixty-eight patients were included in the study: hip prostheses 67%, knee prostheses 25%, other procedures 7.4%. Their mean age was 61.3 +/- 10.2 years, and there were 42% male and 57% female. A mean of 2.8 +/- 0.6 units (450 mL) of blood were drawn to each patient in a month. Starting one week before their first blood donation and up to 2 months after surgery, each patient received 99 mg elementary iron per days as oral ferrous ascorbate. Blood cell counts were done at the beginning of the programme and after the first, second, third and fourth blood withdrawal, as well as one month after finishing the treatment. A survey of iron profile including serum iron, total iron binding capacity, transferrin saturation, serum ferritin and free erythrocyte protoporphyrin was carried out at onset and end of the programme in each patient. All data were analysed with the SPSS-PC 4.0 statistical programme. RESULTS: Haemoglobin rates decreased in every control, returning to values close to the initial ones by the end of the programme (mean figures are as follows: 14.63; 13.17; 12.70; 11.88; 14.11 g/dL); and similar changes were seen with respect to the other parameters of blood. The initial and final values for ferritin were 157.32 and 91.06 ng/mL, respectively, and no significant changes were appreciated in the other data from the iron profile, regardless of the number of blood units collected in a given case. Minor intolerance to ferrous ascorbate appeared in 11% of the patients. No significant differences with control patients were seen regarding hospitalization (16.54 vs 19.82 days) or postoperative fever (14.1% vs 17.11%). CONCLUSIONS: As opposed to others, we feel that iron treatment should be maintained up to 2 months after surgery since better results are thus attained. Recombinant erythropoietin is more expensive a method. Ferrous ascorbate is better tolerated than ferrous sulphate plus additives.

Interovarian communication for the control of follicular growth and corpus luteum function in the cebus monkey.

We have investigated the role of the utero-ovarian ligament (UOL) in the alternating ovulatory performance of the ovaries in the capuchin monkey. In intact animals, the ovulation rate was near 90%, with 67.5% of ovulations occurring in the left ovary. Sectioning the UOL in any phase of the cycle decreased the ovulation rate by 40%, and restricted ovulations to the ovary still connected to the uterus by the UOL. Estradiol and progesterone levels were significantly reduced throughout the following cycles in treated monkeys. Removal of the ovary that had been disconnected 18-20 months previous, restored both the ovulation rate and normal steroid levels. Histological study of the UOL revealed the presence of arteries, veins, lymph vessels, and nerves. Electrical stimulation of the UOL was followed by an abrupt discharge of estradiol by the ovary bearing the follicle, advancing ovulation which was followed by a normal luteal development. Conversely, stimulation of the ovary bearing a corpus luteum did not modify either the ovarian or the peripheral levels of ovarian steroids. The UOL ligament appeared to be functional for products arising from the uterus. The distribution and effects of hCG injected intrauterinely depended upon the day of the luteal phase. In the early luteal phase, hCG was distributed symmetrically between both ovaries, and increased the progesterone secretion by the ovulatory ovary only. In the late luteal phase, hCG was preferentially distributed to the ovulatory ovary, and increased the progesterone secretion by both ovaries. The present findings provide evidence for a local mechanism, throughout the UOL, controlling both the alternation of ovulation and the transfer of substances originating in the uterus that regulate the ovarian function in primates. © 1994 Wiley-Liss, Inc.

Interovarian relationship in the secretion of progesterone during the luteal phase of the capuchin monkey (Cebus apella).

In basal conditions, progesterone concentrations were similar in the ovarian veins of the ovary +CL (3211 +/- 526 ng/ml) and the ovary -CL (3165 +/- 554 ng/ml), but after blocking the blood flow between the ovary +CL and the uterus, the progesterone values in the vein draining the ovary -CL decreased to 1218 +/- 394 ng/ml (P less than 0.01). When [3H]progesterone was injected in the ovary +CL, the radioactivity appeared earlier and more concentrated in the vein draining the ovary -CL (30 sec, 0.53% of injected dose) than in the femoral vein (150 sec, 0.08% of injected dose). Removal of the ovary +CL was followed by a brief maintenance of peripheral progesterone within luteal-phase levels. The in-vitro progesterone production by a suspension of cells isolated from the corpus luteum was 47.5 +/- 12.8 ng/ml/2 h, whereas luteal-like cells isolated from the ovary -CL secreted 14.3 +/- 6.0 ng/ml/2 h (P less than 0.01) into the medium. We therefore suggest that the symmetrical and high secretion rate of progesterone by the ovaries of the capuchin monkey indicates a between-ovary communication system, and that the luteal-like tissue of the ovary -CL can produce relatively large amounts of progesterone.