Paragangliomas in an endemic area: from genetics to morphofunctional imaging. A pictorial essay.

The aim of this pictorial essay is to illustrate the morphological [computed tomography (CT) and magnetic resonance imaging (MRI)], vascular (angiography) and functional (nuclear medicine) features of paragangliomas, uncommon lesions of the head and neck region and even more of the thorax, abdomen and pelvis, arising in an endemic area in northern Italy. These hypervascular, well-circumscribed masses usually have innocuous clinical manifestations as slowly enlarging soft-tissue lesions; however, more rarely, they can cause cranial-nerve palsy, particularly lesions arising near the skull base, or symptoms related to their secreting activity. Most paragangliomas are benign and their prognosis is directly related to the location of the tumour: those arising at the carotid body have the best outcome, whereas those located at the skull base have a less favourable prognosis. Angiography is required preoperatively in larger paragangliomas for surgical planning (vascular mapping) and, rarely, for preoperative embolisation. Morphological and functional imaging is also mandatory for surgical and/or radiometabolic treatment planning and follow-up.

Randomized clinical trial of botulinum toxin injection for pain relief in patients with thrombosed external haemorrhoids.

BACKGROUND: Thrombosed external haemorrhoids are one of the most frequent anorectal emergencies. They are associated with swelling and intense pain. Internal sphincter hypertonicity plays a role in the aetiology of the pain. This study evaluated the efficacy and safety of an intrasphincteric injection of botulinum toxin for pain relief in patients with thrombosed external haemorrhoids. METHODS: Thirty patients with thrombosed external haemorrhoids who refused surgical operation were randomized into two groups. Patients received an intrasphincteric injection of either 0.6 ml saline or 0.6 ml of a solution containing 30 units botulinum toxin. Anorectal manometry was performed before treatment and 5 days afterwards. RESULTS: After 5 days of treatment, the maximum resting pressure fell in both groups, but was significantly lower in the botulinum toxin group (P = 0.004). Pain intensity was significantly reduced within 24 h of botulinum toxin treatment (P < 0.001), but only after 1 week in the placebo group (P = 0.019). CONCLUSION: A single injection of botulinum toxin into the anal sphincter seems to be effective in rapidly controlling the pain associated with thrombosed external haemorrhoids, and could represent an effective conservative treatment for this condition. REGISTRATION NUMBER: NCT00717782 (http://www.clinicaltrials.gov).

Production of cytokines at the operation site.

BACKGROUND AND AIM: Cytokines are part of a family of molecules involved in the initiation, control and termination of the events that occurs in wound healing process. Aim of this study was to evaluate the production of some cytokines [interleukin (IL)-6, IL-10, IL-1alpha, IL-1ra, interferon (IFN)-gamma] in the drainage wound fluid from patients undergoing incisional hernia repair. METHODS: Ten female patients with abdominal midline incisional hernia undergoing to surgical repair were included in this study. In all cases a closed suction drain was placed in the wound below the fascia and it was removed on the 4th postoperative day. Wound fluid was collected on the 1st, 2nd, 3rd and 4th day and its amount in each time was recorded. The production of IL-6, IL-10, IL-1alpha, IL-1ra and IFN-gamma were evaluated as quantity produced in 24 hour. RESULTS: In all patients the amount of drain fluid from surgical wound was highest on the 1st day after surgery, afterwards there is a significant reduction. The production of all cytokines evaluated was highest on the 1st day decreasing on the 2nd day except for IL-1alpha that not show any modification. The produciton of IL-1ra, IL-6, IL-1alpha and IL-10 was significantly reduced on the 3rd and 4th postoperative day in comparison with the respectively values recorded on the 1st day, whereas IFN-gamma levels were similar. CONCLUSIONS: The dosage of cytokines in the drain fluid led us to better evaluated the events that follow surgical wound and their analysis offers further information in the role of cytokines in healing process, with the goal to get supportive treatments to promote the best evolution.

[LithoRisk: A software for calculating and visualising nephrolithiasis risk profiles]. / LithoRisk: software per il calcolo e la visualizzazione dei profili di rischio di calcolosi renale.

BACKGROUND: The pathogenesis of nephrolithiasis, based on the anomalies of the urinary environment, demands metabolic and physicochemical assessment for the medical management of patients. Standard metabolic protocols include the measurement of pertinent urine chemistry values and the calculation of the extent of saturation in stone-forming salts. However, patients are often given fragmentary and hard-to-consult reports and so this weakens the strength of the therapeutic recommendations. This paper introduces LithoRisk, a dedicated software which graphically represents risk profiles of stone formation, including the extent of saturation. METHODS: LithoRisk uses the results of 24-h urine chemistry values widely available in hospital laboratories, i.e., sodium, potassium, calcium, magnesium, ammonia, phosphate, sulphate, citrate, oxalate, chloride, pH and urine volume. Uric acid and cystine are optional. The relative supersaturation (beta), estimated according to our own ab initio calculation, is given in a scale whereby beta=1 is saturation, beta < 1 under - and beta > 1 oversaturation. LithoRisk is available as a CD-ROM and can be loaded on Windows 95/98/Millenium/XP. Colour or laser printers are suitable for printed records. RESULTS: LithoRisk is easily loaded on any PC by following video instructions. Once the loading of the program is completed a grey icon LithoRisk appears on the Desktop. The program can be opened by clicking twice on the icon. The patients data page first appears on the screen and is followed by the evaluation page for the input of variables. This generates the graph representing the diagnostic lithorisk profile, which is drawn as a line connecting different values, according to a specific scale and related to an arbitrary normal point. Normal values are shown as green lines, whereas abnormal ones are red. The beta values for calcium oxalate and phosphate, uric acid and cystine are instantaneously calculated and reported on the graph. CONCLUSIONS: LithoRisk produces a complete, unique and easy to understand report that includes all relevant parameters, it therefore expresses the overall risk of stone formation. It requires the results of chemistry tests done on the same 24-h urine collection, and carried out using suitable preservatives. If the tests for unusual parameters, i.e. sulphate and ammonia, are unavailable, one can use default values with minimal alterations on beta calculation. In spite of being arbitrary, the normal thresholds values are based on widely accepted literature data. The risk profile recognises the most relevant abnormalities and enables the establishment of individual targets aimed at reducing the propensity towards stone formation.

Binding of 1,2,4-benzenetricarboxylate by open chain polyammonium cations.

The interaction of some open chain polyammonium cations with 1,2,4-benzenetricarboxylate was studied potentiometrically, at 25 degrees C. For all the investigated systems, the species ALHr(r-3) (r = 1,2 ... n + 2; n = number of aminogroups; A = amine; L = carboxylate) are formed. The stability of these complexes depends on charges in the polyammonium cation and in the carboxylic ligand, and for the reaction HiAi+ + HjL(j - 3) = ALHi + j(i + j - 3) we found a mean free energy contribution for salt bridge -delta G0 = 6.5 +/- 0.3 kJ mol-1 n-1 (n = number of possible salt bridges). The results of this investigation are compared with those of similar systems. By considering also the tricarboxylic ligands citrate and 1,2,3-propanetricarboxylate, we found for their complexes with polyammonium cations a fairly close stability. Calculations performed including complexes formed with these two ligands give -delta G0 = 6.6 +/- 0.4 kJ mol-1 n-1.

Binding of acrylic and sulphonic polyanions by open-chain polyammonium cations.

The interactions between some acrylic and sulphonic polyanions and some protonated amines (diamines NH(2)-(CH(2))(x)-NH(2), x=2,...,10; linear tri-, tetra-, penta- and hexa-amines) were studied potentiometrically in aqueous solution, at 25 degrees C. For both types of polyanions AL(2)H(i) (L(-), monomer of polyanion, A, amine) species are formed, with i=1,...,n (n=number of amino groups in the amine). The stability of these species is strictly dependent on the polyammonium cation charge, and fairly independent of the type of amine (in diamine species maximum stability is observed for x=4, 5). Acrylic and sulphonic polyanion complexes are considerably stronger than analogous species formed by low molecular weight anions. Mean stability can be expressed as logK=2.87zeta(2/3), for polyacrylic anions and logK=2.42zeta(2/3) for polysulphonic anions (zeta=absolute value for charge product of reactants).

Interaction of l-malic acid with alkaline metals and open chain polyammonium cations in aqueous solution.

This work reports a potentiometric, calorimetric and spectropolarimetric ultraviolet circular dichroism (UV/CD) study of the interaction of l-malic acid with alkaline metals or (poly)ammonium (methylamine, ethylenediamine, diethylenetriamine, triethylenetetramine, spermine, tetraethylenepentamine and pentaethylenehexamine) cations. Stability data (logK, DeltaG(0)) were obtained potentiometrically for the l-malic acid with (poly)ammonium cations systems; calorimetric measurements (25 degrees C) made it possible to obtain DeltaH(0) and TDeltaS(0) values for the complexes formed in the systems under examination. logK values calculated (for the reaction: H(i)A(i+)+H(j)L((j-z))=ALH(r)((i+j-z)), with r=i+j) range between 0.8 and 4.6, i.e., the interactions are from weak to fairly strong while maximum stability for each system is given by the species with the highest z(anion)xz(cation) (z=charge) value. Enthalpy changes associated with reactions H(n)A(n+)+L(2-)=ALH(n)((n-2)) and H(n)A(n+)+HL(-)=ALH(n+1)((n-1)) are always positive and increase progressively with n. The same is valid for T DeltaS(0) values, which indicate that these species are entropically stabilized, as expected for electrostatic interactions. It was verified that the UV/CD signal depends on both ionic medium and ionic strength value; for comparison, we used the l-malic acid signal recorded in tetramethylammonium chloride as baseline background salt (as in potentiometry). UV/CD spectra were recorded for solutions containing both cationic and anionic species. When the cation was a protonated polyamine, CD spectra calculations were performed for most stable ion pairs: the results show remarkable differences in Deltaepsilon (dm(3) mol(-1) cm(-1)) values at 205 nm (which is the l-malate UV/CD lambda(max)) between the chiral ligand and its complex with a polyamine.

Thermodynamic parameters for the binding of inorganic and organic anions by biogenic polyammonium cations.

Thermodynamic parameters for the interaction of protonated biogenic polyamines with inorganic or organic polyanions were studied potentiometrically (H(+)-glass electrode) and calorimetrically, at 25 degrees C. No background salt was used in the measurements to avoid interferences, and the formation constants and formation enthalpies were extrapolated to zero ionic strength. Species formed are ALH(r) [L=Cl(-), SO(4)(2-), HPO(4)(2-), P(2)O(7)(4-) and P(3)O(10)(5-); tartrate, malate, citrate, glutamate, 1,2,3-propanetricarboxylate, 1,2,3,4-butanetetracarboxylate], with r=1,2...(n+m-2) and r=1,2...(n+m-1) for inorganic and organic ligands, respectively (n, m=maximum degree of protonation of amine and ligand, respectively). The stability of the various species formed is a function of charges involved in the formation reaction. DeltaH(0) values are generally positive, and therefore these complexes are entropically stabilized. Results are discussed in connection with several previously reported data on similar systems. DeltaG(0) and TDeltaS(0) follow a linear trend as a function of polyammonium cation and inorganic or carboxylic anion charges. DeltaG(0) and TDeltaS(0) charge relationships are reported. In particular, mean values of DeltaG(0) and TDeltaS(0) for single interaction were calculated: DeltaG(0)=7.0 kJ mol(-1) n(-1), TDeltaS(0)=9.1 kJ mol(-1) n(-1) and DeltaG(0)=5.7 kJ mol(-1) n(-1) and TDeltaS(0)=8.7 kJ mol(-1) n(-1), for the species of inorganic and organic polyanions, respectively (n=number of possible salt bridges). A linear relationship was also found for TDeltaS(0) versus DeltaG(0), whose equation is TDeltaS(0)=-7-1.39 DeltaG(0) (with r=0.9409; r, correlation coefficient). The body of correlations found for these thermodynamic parameters shows quite good predictive value.

Binding of polyanions by biogenic amines. III. Formation and stability of protonated spermidine and spermine complexes with carboxylic ligands.

The formation and stability of protonated spermidine and spermine-carboxylic ligand complexes (seven systems) were studied potentiometrically (H(+)-glass electrode). ALH(r) species are formed (A=spermidine, spermine, L(z-)=acetate, malonate, 1,2,3-propanetricarboxylate, 1,2,3,4-butanetetracarboxylate; r=1...m+n-1, where m and n are the maximum degree of protonation of the amine and of the carboxylic ligand, respectively), and their stability is a function of charges involved in the formation reaction. For the equilibrium H(i)A(i+)+H(j)L((j-z))=ALH(i+j)((i+j-z)) the linear relationship logK(ij)=0.46 zeta (zeta=mid R:i(z-j)mid R:) was found. By means of this simple equation a mean free energy value can be obtained per salt bridge (n), namely -DeltaG degrees =5.25+/-0.15 kJ mol(-1)n(-1). Species formed by the highest charged ligands are quite stable (K>10(3) mol(-1) dm(3)) and potentially play an important role in the speciation of biofluids, as shown by speciation diagrams and simulated experiments.

Binding of polyanions by biogenic amines. II. Formation and stability of protonated putrescine and cadaverine complexes with carboxylic ligands.

The formation and stability of protonated diamines-carboxylic ligand complexes was studied potentiometrically (H(+)-glass electrode). Species formed are ALH(r) (A=cadaverine, putrescine, L=acetate, malate, tartrate, malonate, citrate, 1,2,3-propanetricarboxylate, 1,2,3,4-butanetetracarboxylate and glutamate; r=1...m+1, where m is the maximum degree of protonation of the carboxylic ligand), and their stability is a function of charges involved in the formation reaction. For the equilibrium H(i)A(i+)+H(j)L((j-z))=ALH((i+j-z))(i+j) the following linear relationships can be written: logK(1j)=-0.25+0.75 |j-z|, logK(2j)=0.50+0.90 |j-z| (by also considering some ethylenediamine and 1,2-diaminopropane complexes). Medium effects were considered. Comparison was made with analogous inorganic polyanion complexes. The simplest relationships -DeltaG(0)=6.5+/-0.3 and -DeltaG(0)=7.9+/-0.6 kJ mol(-1)n(-1) (n=number of possible salt bridges) were found for carboxylic and inorganic anions, respectively.

Binding of polyanions by biogenic amines. I. Formation and stability of protonated putrescine and cadaverine complexes with inorganic anions.

The formation and stability of proton diamine-inorganic anion [Cl(-), SO(4)(2-), HPO(4)(2-), P(2)O(7)(4-) and Fe(CN)(6)(4-)] complexes was studied potentiometrically [(H(+))-glass electrode] at 25 degrees C. Several general formula ALH(r) complexes are formed in these various systems. The stability of complexes formed between H(2)A(2+) and different anions ranges from one to six (log formation constants). The formation constants are slightly dependent on the length of the alkylic chain whilst they strongly depend on the anion charge. A general relationship [logK=-0.85+1.81z-0.055n] was found for the reaction H(2)A(2+)+L(z-)=ALH(2)((2-z)) [L=inorganic anions, A=NH(2)-(CH(2))(n)-NH(2) diamines with n=2...8].

Copper(II) complexes of N-(phosphonomethyl)glycine in aqueous solution: a thermodynamic and spectrophotometric study.

Copper(II) complexes with the herbicide N-(phosphonomethyl)glycine (glyphosate) have been investigated in aqueous solution by means of pH-metric measurements at different temperatures, 5

Formation and stability of pyrophosphate complexes with aliphatic amines in aqueous solution.

The complex formation between pyrophosphate (P(2)O(7)(4-)) and protonated methylamine, ethylenediamine, diethylenetriamine, triethylenetetramine, tetraethylenepentamine and pentaethylenehexamine, has been studied potentiometrically, in aqueous solution, at 25 degrees C. It was found that the species ALH(q)(A = amine, L = P(2)O(7)(4-)) are formed with q = 1 ... n(n = 3, 5, 6, 7, 7 and 8 for the above amines respectively). Mono- and di-amines form species A(p)LH(q) too. The stability of these species is quite high [e.g. H(4)A(4+) + HL(3-)ALH(5)(+): log K = 8.1 (A = pentaethylenehexamine)] and depends strictly on the charges involved in the formation reaction. Charges of reactants being equal, the stability trend is penten > tetren > trien > dien > en > meta and cationic mixed species are more stable than anionic ones. These results are discussed in relation to speciation problems in natural and biological fluids.

Solubility of some calcium-carboxylic ligand complexes in aqueous solution.

Insoluble species were identified in the systems Ca(2+)-hemimellitate, Ca(2+)-1,2,3,4-butanetetracarboxylate and Ca(2+)-citrate, and their solubilities were determined in aqueous solution at T = 25 degrees C. Values of pK(s0) were obtained for the species CaLH (L = benzene-1,2,3-tricarboxylate or hemimellitate), Ca(2)L (L = 1,2,3,4-butanetetracarboxylate), CaLH and Ca(3)L(2) (L = citrate), together with their dependence on ionic strength. Solid compounds were also characterized by thermogravimetry. The complex formation in solution for the system Na(+) - and Ca(2+)-hemimellitate was studied too.

Ionic strength dependence of formation constants-XVIII. The hydrolysis of iron(III) in aqueous KNO(3) solutions.

The hydrolysis of iron(III) was studied potentiometrically at different ionic strengths in KNO(3) aqueous solutions, at 25 degrees C, to determine the dependence of hydrolysis constants on ionic strength (nitrate media), to check the existence of nitrate-ferric ion interactions, and to confirm the formation of high polymeric species. Under the experimental conditions 0.03 I (KNO(3)) 1M, 0.3 C 12 mM, the species Fe(OH)(2+), Fe(2)(OH)(4+)(2), Fe(OH)(+)(2) and Fe(12)(OH)(2+)(34) were found, and the hydrolysis constants log beta(11) = 2.20, log beta(12) = -2.91, log beta(22) = -5.7, log beta(12,34) = -48.9 (I = 0M) were calculated. The ionic strength dependence of hydrolysis constants is quite close to that found for several protonation and metal complex formation constants reported elsewhere.

Ionic strength dependence of formation constant-XVI. Protonation of some nitrophenols and dihydroxybenzoic acids in aqueous (tetraethylammonium iodide) solution at 25 degrees.

The protonation of 2- and 3-nitrophenol (NO(2) Ph) and 2,X and 3,Y dihydroxybenzoic acids (DBA, X = 4,5,6; Y = 4,5) has been studied potentiometrically in aqueous tetraethylammonium iodide solutions, at T = 25 degrees in the ionic strength range 0.05:5

Mixed proton complexes of aminoacids and carboxylic ligands in aqueous solution.

Formation and stability of proton-mixed ligand complexes have been studied for the systems H(+)-lysine-aspartic acid, H(+)-lysine-succinic acid and H(+)-glycine malonic acid, in aqueous solution at 25 degrees , by potentiometric technique using the (H(+))-glass electrode. For all these systems it has been found that the species ABH(j) (A and B, first and second ligand, respectively; j = 1, 2, ... m + n - 1; m and n are the maximum protonation degrees of the two ligands, respectively) are formed. The stability of these species is discussed with respect to various factors and, in particular, as a function of speciation problems.

Serum calcium oxalate saturation in patients on maintenance haemodialysis for primary hyperoxaluria or oxalosis-unrelated renal diseases.

1. The serum oxalate concentration rises in chronic renal failure and it is only partially eliminated by regular dialysis treatment. However, the recent literature is not conclusive on whether progressive oxalate retention and secondary oxalosis should be expected in patients on regular dialysis treatment. 2. To further investigate this, we have estimated the state of saturation with respect to calcium oxalate monohydrate in plasma ultrafiltrates from 28 patients on maintenance haemodialysis and eight healthy control subjects, matched for sex and age. Five patients had type I primary hyperoxaluria and histologically proven oxalosis, whereas 23 had oxalosis-unrelated renal diseases. Dialysis efficiency was quantified as the KdTd/V of urea. Samples were obtained from each patient before, immediately after and 48 h after a dialysis session. Fasting samples were obtained from the control subjects. Oxalate was determined in both plasma ultrafiltrates and the whole dialysate by ion-exchange chromatography, after a non-delayed and [14C]oxalate-recovery-controlled procedure. The state of saturation with calcium oxalate monohydrate was estimated by means of a computer system which solved the interactions among 45 complex species. 3. The fasting plasma oxalate concentration (means +/- SD) in ultrafiltrates from healthy subjects was 3.8 +/- 1.5 (range 1.4-5.8) mumol/l, and the state of saturation with calcium oxalate monohydrate was 0.096 +/- 0.04.(ABSTRACT TRUNCATED AT 250 WORDS)

Ionic-strength dependence of formation constants-XII A model for the effect of background on the protonation constants of amines and amino-acids.

From analysis of literature data on the protonation of N-donor and N,O-donor ligands at 25 degrees , a simple model has been derived for the dependence of amine and amino-acid protonation constants on the background electrolytes, which takes into account the formation of weak complexes between the protonated forms of the amines (or amino-acids) and the background anions and between the amino-acid carboxylate group and alkali-metal cations.