Adverse and beneficial effects in Chinese hamster lung fibroblast cells following radiofrequency exposure.

In this study, the effect of radiofrequency (RF) exposure to 1950 MHz, Universal Mobile Telecommunication System signal, was investigated in Chinese hamster lung fibroblast cell line (V79). Genotoxic and cytotoxic effects of 20-h exposure at specific absorption rate (SAR) values from 0.15 W/kg to 1.25 W/kg were measured by means of cytokinesis-block micronucleus (MN) assay. Exposure was carried out blinded under strictly controlled conditions of dosimetry and temperature. The effect of RF exposure alone at four SAR values was tested, that is, 0.15, 0.3, 0.6, and 1.25 W/kg. A statistically significant increase in MN frequency was found in cultures exposed to 0.15 and 0.3 W/kg (P < 0.05) compared to sham-exposed ones, in the absence of cytotoxicity. SAR values of 0.6 and 1.25 W/kg did not exert any effect. Moreover, to evaluate the ability of RF to exert protective effects with respect to a chemical mutagen, cell cultures were also pre-exposed for 20 h at 0.3 or 1.25 W/kg, and then treated with 500 ng/ml of mitomycin-C (MMC). A significant reduction in the frequency of MN was detected in cultures pre-exposed to 1.25 W/kg compared to cultures treated with MMC alone (P < 0.05), indicating induction of adaptive response. Such a decrease was not induced by pre-exposure at 0.3 W/kg SAR. Taken together, our results indicated that V79 is a sensitive cell model to evidence either adverse or beneficial effects of RF exposure, depending on experimental conditions applied. Bioelectromagnetics. 38:245-254, 2017. © 2017 Wiley Periodicals, Inc.

Induced movements of giant vesicles by millimeter wave radiation.

Our previous study of interaction between low intensity radiation at 53.37GHz and cell-size system - such as giant vesicles - indicated that a vectorial movement of vesicles was induced. This effect among others, i.e. elongation, induced diffusion of fluorescent dye di-8-ANEPPS, and increased attractions between vesicles was attributed to the action of the field on charged and dipolar residues located at the membrane-water interface. In an attempt to improve the understanding on how millimeter wave radiation (MMW) can induce this movement we report here a real time evaluation of changes induced on the movement of giant vesicles. Direct optical observations of vesicles subjected to irradiation enabled the monitoring in real time of the response of vesicles. Changes of the direction of vesicle movement are demonstrated, which occur only during irradiation with a "switch on" of the effect. This MMW-induced effect was observed at a larger extent on giant vesicles prepared with negatively charged phospholipids. The monitoring of induced-by-irradiation temperature variation and numerical dosimetry indicate that the observed effects in vesicle movement cannot be attributed to local heating.

Influence of treatments in multiple sclerosis disability: a cohort study.

BACKGROUND AND OBJECTIVE: A critical aspect of multiple sclerosis (MS) treatments is understanding the effect of disease-modifying drugs (DMDs) on the long-term risk of disability and whether the effect is related to disability at start of treatment. METHODS: We performed an observational study on 3060 MS patients. The effect of therapy on progression to Expanded Disability Status Scale (EDSS) 3.0 and 6.0 from onset was analysed in treated vs untreated (UTP) patients using Cox regression analysis adjusted for propensity score and immortal time bias. RESULTS: Compared to UTP, the risks of EDSS 3.0 were 94% and 73% lower in immunomodulant (IMTP-) and immunosuppressant (ISTP-) treated patients, respectively, while the risk of EDSS 6.0 was 86% lower in IMTP. The risk of EDSS 6.0 was, respectively, 91% and 75% lower in 1275 IMTP before and 114 after EDSS 3.0 than in 539 UTP; the risk was higher in IMTP starting therapy after EDSS 3.0 than before (HR = 4.42). CONCLUSIONS: DMDs delayed long-term disability in MS patients treated either in the early or, to a lesser extent, in the later phase of the disease. Thus, the window of therapeutic opportunity is relatively extended, assuming that early is better than late treatment, but late is better than never.

Effect of millimetre waves on phosphatidylcholine membrane models: a non-thermal mechanism of interaction.

The nonthermal biological effects of millimeter waves have been mainly attributed to the interaction with biological membranes. Several data on biomimetic membrane systems seem to support this conclusion. In this paper a mechanistic hypothesis is evaluated to explain such an interaction taking into account experimental NMR data on deuterium-labeled phospholipid vesicles. These data showed that millimeter waves induce a time and a hydration-dependent reduction of the water ordering around the phosphocholine headgroups. This effect is here interpreted as a change in membrane water partitioning, due to the coupling of the radiation with the fast rotational dynamics of bound water molecules, that results in a measurable relocation of water molecules from the inner to the outer binding regions of the membrane interface. When millimeter wave exposure is performed in the vicinity of the transition point, this effect can lead to an upward shift of the membrane phase transition temperature from the fluid to the gel phase. At a macroscopic level, this unique sensitivity may be explained by the universal dynamic behaviour of the membranes in the vicinity of the transition point, where a pretransitional increase of membrane area fluctuations, i.e., of the mean area per phospholipid headgroup, is observed. Exposure to millimeter waves increases the above fluctuations and enhances the second order character of the transition.

Investigating the role of capacitive coupling between the operating table and the return electrode of an electrosurgery unit in the modification of the current density distribution within the patients' body.

BACKGROUND: Electrosurgery units are widely employed in modern surgery. Advances in technology have enhanced the safety of these devices, nevertheless, accidental burns are still regularly reported. This study focuses on possible causes of sacral burns as complication of the use of electrosurgery. Burns are caused by local densifications of the current, but the actual pathway of current within patient's body is unknown. Numerical electromagnetic analysis can help in understanding the issue. METHODS: To this aim, an accurate heterogeneous model of human body (including seventy-seven different tissues), electrosurgery electrodes, operating table and mattress was build to resemble a typical surgery condition. The patient lays supine on the mattress with the active electrode placed onto the thorax and the return electrode on his back. Common operating frequencies of electrosurgery units were considered. Finite Difference Time Domain electromagnetic analysis was carried out to compute the spatial distribution of current density within the patient's body. A differential analysis by changing the electrical properties of the operating table from a conductor to an insulator was also performed. RESULTS: Results revealed that distributed capacitive coupling between patient body and the conductive operating table offers an alternative path to the electrosurgery current. The patient's anatomy, the positioning and the different electromagnetic properties of tissues promote a densification of the current at the head and sacral region. In particular, high values of current density were located behind the sacral bone and beneath the skin. This did not occur in the case of non-conductive operating table. CONCLUSION: Results of the simulation highlight the role played from capacitive couplings between the return electrode and the conductive operating table. The concentration of current density may result in an undesired rise in temperature, originating burns in body region far from the electrodes. This outcome is concordant with the type of surgery-related sacral burns reported in literature. Such burns cannot be immediately detected after surgery, but appear later and can be confused with bedsores. In addition, the dosimetric analysis suggests that reducing the capacity coupling between the return electrode and the operating table can decrease or avoid this problem.

Evaluation of Chronic Kidney Disease Epidemiology Collaboration equation to estimate glomerular filtration rate in scleroderma patients.

OBJECTIVE: Renal involvement in SSc is often subclinical and chronic kidney disease (CKD) develops, with slow worsening of glomerular filtration rate (GFR). The present investigation was undertaken in order to study how well the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) correlates with measured GFR (mGFR) in a group of SSc patients with serum creatinine (sCr) in the normal range. METHODS: Forty-one scleroderma patients (37 females and 4 males) with a median age of 46 years were enrolled. GFR was measured using technetium-99 m DTPA (Tc-99 m DTPA). The modified Cockroft-Gault formula, 4- and 7-variable Modification of Diet in Renal Disease (MDRD) and CKD-EPI equations were used for estimated GFR (eGFR). RESULTS: mGFR showed a median value of 84 ml/min (range 32.8-121.2 ml/min). Seven patients had reduced GFR (<60 ml/min), 19 had GFR within 60-90 ml/min and 15 had GFR >90 ml/min. The results showed mild correlation between the BSA-modified Cockroft-Gault and mGFR (P > 0.05), mild statistically significant correlation with 4-variable MDRD (P < 0.05), high statistically significant correlation with 7-variable MDRD (P = 0.01), but the greatest correlation was obtained using CKD-EPI (P = 0.002). No correlation with age, disease duration or subset of disease was found. CONCLUSIONS: In scleroderma patients with normal sCr value, CKD-EPI is a useful formula to assess GFR.

Induction of an adaptive response in human blood lymphocytes exposed to radiofrequency fields: influence of the universal mobile telecommunication system (UMTS) signal and the specific absorption rate.

The induction of an adaptive response (AR) was examined in human peripheral blood lymphocytes exposed to non-ionizing radiofrequency fields (RF). Cells from nine healthy human volunteers were stimulated for 24h with phytohaemagglutinin and then exposed for 20h to an adaptive dose (AD) of a 1950MHz RF UMTS (universal mobile telecommunication system) signal used for mobile communications, at different specific absorption rates (SAR) of 1.25, 0.6, 0.3, and 0.15W/kg. This was followed by treatment of the cells at 48h with a challenge dose (CD) of 100ng/ml mitomycin C (MMC). Lymphocytes were collected at the end of the 72h total culture period. The cytokinesis-block method was used to record the frequency of micronuclei (MN) as genotoxicity end-point. When lymphocytes from six donors were pre-exposed to RF at 0.3W/kg SAR and then treated with MMC, these cells showed a significant reduction in the frequency of MN, compared with the cells treated with MMC alone; this result is indicative of induction of AR. The results from our earlier study indicated that lymphocytes that were stimulated for 24h, exposed for 20h to a 900MHz RF GSM (global system for mobile communication) signal at 1.25W/kg SAR and then treated with 100ng/ml MMC, also exhibited AR. These overall data suggest that the induction of AR depends on RF frequency, type of the signal and SAR. Further characterization of RF-induced AR is in progress.

Radiofrequency radiation at 1950 MHz (UMTS) does not affect key cellular endpoints in neuron-like PC12 cells.

In this study, rat pheochromocytoma (PC12) cells were exposed, as a model of neuron-like cells, to 1950 MHz radiofrequency (RF) radiation with a signal used by the 3G wireless technology of the Universal Mobile Telecommunications System (UMTS) to assess possible adverse effects. RF exposure for 24 h at a specific absorption rate (SAR) of 10 W/kg was carried out in a waveguide system under accurately controlled environmental and dosimetric parameters. DNA integrity, cell viability, and apoptosis were investigated as cellular endpoints relevant for carcinogenesis and other diseases of the central nervous system. Very sensitive biological assays were employed to assess the effects immediately after RF exposure and 24 h later, as demonstrated by the cellular response elicited in PC12 cells using positive control treatments provided for each assay. In our experimental conditions, 24 h of RF exposure at a carrier frequency and modulation scheme typical of a UMTS signal was not able to elicit any effect in the selected cellular endpoints in undifferentiated PC12 cells, despite the application of a higher SAR value than those applied in the majority of the studies reported in the literature.

Occupational exposure to electromagnetic fields in magnetic resonance environment: an update on regulation, exposure assessment techniques, health risk evaluation, and surveillance.

Magnetic resonance imaging (MRI) is one of the most-used diagnostic imaging methods worldwide. There are ∼50,000 MRI scanners worldwide each of which involves a minimum of five workers from different disciplines who spend their working days around MRI scanners. This review analyzes the state of the art of literature about the several aspects of the occupational exposure to electromagnetic fields (EMF) in MRI: regulations, literature studies on biological effects, and health surveillance are addressed here in detail, along with a summary of the main approaches for exposure assessment. The original research papers published from 2013 to 2021 in international peer-reviewed journals, in the English language, are analyzed, together with documents published by legislative bodies. The key points for each topic are identified and described together with useful tips for precise safeguarding of MRI operators, in terms of exposure assessment, studies on biological effects, and health surveillance.

Epidemiology of multiple sclerosis in south-western Sardinia.

BACKGROUND: Sardinia is a known high-risk area for multiple sclerosis (MS), but no data for south-western Sardinia (SWS) are available. SWS has a genetically homogeneous population, apart from St Peter Island, and represents a peculiar environment related to the industrial, mineralogical and military economy. OBJECTIVE: To estimate prevalence and incidence and to evaluate temporal trends and geographical distribution of MS in SWS. METHODS: MS prevalence was evaluated on 31 December 2007 and crude mean annual incidence rate was defined between 2003 and 2007. Temporal trend in MS incidence was assessed using the Armitage test. To identify MS clusters, Standard Morbidity Ratio (SMR) was calculated for each village and geographical distribution prevalence by means of a Bayesian hierarchical model. RESULTS: Total crude prevalence rate was 210.4 (95% CI 186.3-234.5): 280.3 (95% CI 241.4-319.3) for females, 138 (95% CI 110.1-165.8) for males. The crude mean annual incidence rate was 9.7/100,000 (95% CI 3.4-13.2): 4.7/100,000 (95% CI 2.4-17.0) and 14.6/100,000 (95% CI 11.8-34.8) for males and females respectively. MS incidence has increased over the last 50 years. Cluster analysis showed an SMR of 0.2 (95% CI 0.05-0.68, p = 0.002) on the island of San Pietro, and 2.0 (95% CI 1.35-2.95, p = 0.001) in Domusnovas. Spatial distribution of MS was confirmed by Bayesian geographical analysis. CONCLUSIONS: Our data confirm Sardinia as a high-risk area for MS and support the relevance of genetic factors in MS, as evidenced in St Peter Island. However, we found an unexpectedly high MS prevalence in one village, in particular in males, suggesting an environmental influence on MS occurrence.

The response of giant phospholipid vesicles to millimeter waves radiation.

Due to the increasing interest in millimeter waves (MMW) applications in medicine and telecommunications, the investigation of their potential biological effects is of utmost importance. Here we report results of the study of interaction between low-intensity radiation at 53.37 GHz and giant vesicles. Direct optical observations of vesicles subjected to irradiation enabled the monitoring in real time of the response of vesicles. Physical changes of vesicles, i.e. elongation, induced diffusion of fluorescent dye di-8-ANEPPS, and increased attractions between vesicles are demonstrated. These effects are reversible and occur only during irradiation with a "switch on" of the effect requiring a short time. Since the average temperature change was very small the effects could not be attributed to thermal mechanisms. We assume that the interaction of MMW with lipid membrane leads to changes at the membrane-water interface, where charged and dipolar residues are located.

Reactive oxygen species formation is not enhanced by exposure to UMTS 1950 MHz radiation and co-exposure to ferrous ions in Jurkat cells.

This study was designed to assess if radiofrequency (RF) radiation induces oxidative stress in cultured mammalian cells when given alone or in combination with ferrous ions (FeSO(4)). For this purpose the production of reactive oxygen species (ROS) was measured by flow cytometry in human lymphoblastoid cells exposed to 1950 MHz signal used by the third generation wireless technology of the Universal Mobile Telecommunication System (UMTS) at Specific Absorption Rate of 0.5 and 2.0 W/kg. Short (5-60 min) or long (24 h) duration exposures were carried out in a waveguide system under strictly controlled conditions of both dosimetry and environment. Cell viability was also measured after 24 h RF exposure using the Resazurin and Neutral Red assays. Several co-exposure protocols were applied to test if RF radiation is able to alter ROS formation induced by FeSO(4) (RF given before or concurrently to FeSO(4)). The results obtained indicate that non-thermal RF exposures do not increase spontaneous ROS formation in any of the experimental conditions investigated. Consistent with the lack of ROS production, no change in cell viability was observed in Jurkat cells exposed to RF radiation for 24 h. Similar results were obtained when co-exposures were considered: combined exposures to RF radiation and FeSO(4) did not increase ROS formation induced by the chemical treatment alone. In contrast, in cultures treated with FeSO(4) as positive control, a dose-dependent increase in ROS formation was recorded, validating the sensitivity of the method employed.

Clinical experience with pheochromocytoma in a single centre over 16 years.

BACKGROUND: Pheochromocytoma and paraganglioma are rare tumours of neuroectodermal origin. Pheochromocytoma occurs in 0.1-2% of people with hypertension, while the incidence rises to 4-5% in patients with incidental adrenal mass. AIM: To analyse the presentation, diagnosis and localization, pathology, molecular genetic aspects, surgical management and long-term outcome of a large series of patients with pheochromocytoma referred to a single centre. METHODS: From 1992 to 2008, we observed 91 patients with pheochromocytoma, 70 (77%) with the sporadic form and 21 (23%) with the hereditary form. In the group with the hereditary form, the mean age at diagnosis was significantly lower than the mean age of the group with the sporadic form (38 vs 48 years; p < 0.001). RESULTS: Eighty (88%) patients with pheochromocytoma were symptomatic and the classical triad of palpitations, headache and diaphoresis was present in 30% of patients. In 12% of patients, the pheochromocytoma was discovered during radiological images (adrenal incidentaloma). The unilateral adrenal localization was observed in 78% of patients, bilateral in 15% and extra-adrenal in 7% of patients. All pheochromocytoma patients underwent surgical procedure and the laparotomic approach was used in 49 (53%) patients, while the laparoscopic approach was performed in 42 (47%) patients. Pheochromocytoma was benign in 86 patients (93%) [mean size was 4.3 cm] and the malignant form was found in five patients (7%) [mean size was 10 cm]. CONCLUSIONS: These data from a large cohort of patients are consistent with those reported in the literature and show that pheochromocytoma is an in important challenge for clinicians.

SAR and efficiency evaluation of a 900 MHz waveguide chamber for cell exposure.

In this work we present the results of numerical and experimental dosimetry carried out for an in vitro exposure device to irradiate sample groups at 900 MHz. The cells are kept in 8 and 15 ml cell cultures, contained, respectively in T25 and T75 rectangular flasks. The dosimetric assessment of the distribution of the specific absorption rate (SAR) is performed for both the bottom of the flask and the whole volume of the sample to provide results for experiments on either the cell layer or the cell suspension. The irradiating chamber is a rectangular waveguide (WG). Different configurations are considered to assess the optimum orientation and positioning of the cell cultures inside the WG. The system performance is optimal when the electric field is parallel to the sample and the WG is terminated by a matched load. In this condition two 15 or four 8 ml cells cultures can be exposed. The efficiency (ratio between the power absorbed by the sample and the incident power) and the non-uniformity degree (ratio between the standard deviation of SAR values and the average SAR over the sample) are calculated and successfully verified through measurements of the scattering parameters and local temperature increases. In the chosen exposure configuration, the efficiency is 0.40 and the non-uniformity degree is 39% for the 15 ml samples. For the 8 ml samples, the efficiency is 0.19 and a low non-uniformity degree (15%) is found.

Formation of reactive oxygen species in L929 cells after exposure to 900 MHz RF radiation with and without co-exposure to 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone.

The aim of this study was to investigate the induction of reactive oxygen species in murine L929 fibrosarcoma cells exposed to radiofrequency (RF) radiation at 900 MHz, with or without co-exposure to 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX), a potent environmental carcinogen produced during chlorination of drinking water. Both continuous-wave and GSM mobile phone signals were applied for 10 or 30 min at specific absorption rates of 0.3 and 1 W/kg. Simultaneous sham exposures were performed for each exposure condition. MX treatment was performed at a subtoxic level of 500 microM, and the RF-field exposure was carried out during the first 10 or 30 min of the chemical treatment. The formation of reactive oxygen species was followed soon after the exposure and at different harvesting times until 1 h after RF-field treatment. The studied provided no indication that 900 MHz RF-field exposure, either alone or in combination with MX, induced formation of reactive oxygen species under any of the experimental conditions investigated. In contrast, exposure to MX resulted in a statistically significant increase in the formation of reactive oxygen species for all the treatment durations investigated, confirming that MX is an inductor of oxidative stress in L929 cells.

Experimental and numerical evaluations on palm microwave heating for Red Palm Weevil pest control.

The invasive Red Palm Weevil is the major pest of palms. Several control methods have been applied, however concern is raised regarding the treatments that can cause significant environmental pollution. In this context the use of microwaves is particularly attractive. Microwave heating applications are increasingly proposed in the management of a wide range of agricultural and wood pests, exploiting the thermal death induced in the insects that have a thermal tolerance lower than that of the host matrices. This paper describes research aiming to combat the Red Palm pest using microwave heating systems. An electromagnetic-thermal model was developed to better control the temperature profile inside the palm tissues. In this process both electromagnetic and thermal parameters are involved, the latter being particularly critical depending on plant physiology. Their evaluation was carried out by fitting experimental data and the thermal model with few free parameters. The results obtained by the simplified model well match with both that of a commercial software 3D model and measurements on treated Phoenix canariensis palms with a ring microwave applicator. This work confirms that microwave heating is a promising, eco-compatible solution to fight the spread of weevil.

Exposure Assessment and Biomonitoring of Workers in Magnetic Resonance Environment: An Exploratory Study.

Magnetic resonance imaging (MRI) has evolved rapidly over the past few decades as one of the most flexible tools in medical research and diagnostic imaging. MRI facilities are important sources of multiple exposure to electromagnetic fields for both patients and health-care staff, due to the presence of electromagnetic fields of multiple frequency ranges, different temporal variations, and field strengths. Due to the increasing use and technological advancements of MRI systems, clearer insights into exposure assessment and a better understanding of possible harmful effects due to long-term exposures are highly needed. In the present exploratory study, exposure assessment and biomonitoring of MRI workers at the Radio-diagnostics Unit of the National Cancer Institute of Naples "Pascale Foundation" (Naples, Italy) have been carried out. In particular, exposure to the MRI static magnetic field (SMF) has been evaluated by means of personal monitoring, while an application tool has been developed to provide an estimate of motion-induced, time-varying electric fields. Measurement results have highlighted a high day-to-day and worker-to-worker variability of the exposure to the SMF, which strongly depends on the characteristics of the environment and on personal behaviors, and the developed application tool can be adopted as an easy-to-use tool for rapid and qualitative evaluation of motion-induced, time-varying electric field exposure. Regarding biomonitoring, the 24 workers of the Radio-diagnostics Unit were enrolled to evaluate both spontaneous and mitomycin C-induced chromosomal fragility in human peripheral blood lymphocytes, by means of the cytokinesis-block micronucleus assay. The study subjects were 12 MRI workers, representative of different professional categories, as the exposed group, and 12 workers with no MRI exposure history, as the reference group. The results show a high worker-to-worker variability for both field exposure assessment and biomonitoring, as well as several critical issues and practicalities to be faced with in this type of investigations. The procedures for risk assessment and biomonitoring proposed here can be used to inform future research in this field, which will require a refinement of exposure assessment methods and an enlargement of the number of subjects enrolled in the biomonitoring study to gain robust statistics and reliable results.

Lack of effects on key cellular parameters of MRC-5 human lung fibroblasts exposed to 370 mT static magnetic field.

The last decades have seen increased interest toward possible adverse effects arising from exposure to intense static magnetic fields. This concern is mainly due to the wider and wider applications of such fields in industry and clinical practice; among them, Magnetic Resonance Imaging (MRI) facilities are the main sources of exposure to static magnetic fields for both general public (patients) and workers. In recent investigations, exposures to static magnetic fields have been demonstrated to elicit, in different cell models, both permanent and transient modifications in cellular endpoints critical for the carcinogenesis process. The World Health Organization has therefore recommended in vitro investigations as important research need, to be carried out under strictly controlled exposure conditions. Here we report on the absence of effects on cell viability, reactive oxygen species levels and DNA integrity in MRC-5 human foetal lung fibroblasts exposed to 370 mT magnetic induction level, under different exposure regimens. Exposures have been performed by using an experimental apparatus designed and realized for operating with the static magnetic field generated by permanent magnets, and confined in a magnetic circuit, to allow cell cultures exposure in absence of confounding factors like heating or electric field components.

Intraoperative gamma probe detection of head and neck paragangliomas with 111In-pentetreotide: a pilot study.

AIMS AND BACKGROUND: The aim of this study was to assess whether intraoperative radiolocalization of head and neck paragangliomas with 111In-pentetreotide may increase surgical effectiveness, reducing the risk of recurrence. METHODS: Our study included eight patients with untreated, recently diagnosed paragangliomas (four unilateral and four bilateral tumors of the carotid body). After i.v. injection of approximation 150 MBq 111In-pentetreotide, preoperative somatostatin receptor scintigraphy (SRS) was performed. SPECT of the neck was performed at four hours and planar images of the head and neck were also obtained at four and 24 hours post injection. Scintigraphy was always compared with the results of conventional imaging methods (MRI, angiography and sonography). Intraoperative detection was performed on 11 lesions 24 hours after radiopharmaceutical administration using a handheld gamma probe. RESULTS: Preoperative SRS showed high radiotracer uptake in all patients. All the intraoperatively detected lesions were radically resected and histologically confirmed to be involved by tumor. No false positive results were recorded. Gamma probe detection revealed a small intracranial extension not detected by other imaging methods in a patient with a paraganglioma of the right carotid, and partial involvement of the carotid artery in another patient. During follow-up (median 3.5 years; range, 4 months-7 years) all patients remained disease free according to all parameters. CONCLUSIONS: To our knowledge, this is the first experience of radioguided surgery in paraganglioma. Although our study included a relatively small number of patients, we suggest that intraoperative gamma probe detection may be a powerful tool to improve surgical effectiveness.