Posterior interosseous nerve palsy by synovial cyst of proximal radioulnar joint: our experience after 5 years.

AIM: The posterior interosseous nerve palsy is a neuropathy of radial nerve interesting its deep motor branch. The neuropathy can appear with a hollow in the proximal half of the forearm without significant swelling, a complete loss of extension of the fingers with radial deviation of the wrist during extension. In some cases, PIN compression may simulate tendon rupture in rheumatologic diseases, because the pain and the paralysis occur suddenly, so often can be difficult to make a diagnosis. The palsy is caused by compression of the posterior interosseous nerve from soft tissue tumours or tumour-like masses: ganglions, lipomas, rheumatoid synovitis, synovial chondromatosis, fibromas, neurofibromas, bursitis, synovial cysts of the elbow and radioulnar proximal joints. The aim of our research was to individuate the better treatment for the posterior interosseous nerve palsy. METHODS: From 2002 to 2007 we examined 8 patients: 2 female and 6 male. Median age was 43 years. The diagnosis was made by clinical examination, ultrasound, nerve conduction studies and magnetic resonance imaging (MRI). Patients underwent to decompressing posterior interosseous nerve surgery. RESULTS: After the surgical exploration in 8 cases a globular mass of around 2.5 cm to 4.5 cm diameter was discovered. At the histological examination, a synovial cyst of the elbow joint was found in 7 out of 8 patients and an hemangioma tumor in the one remaining patient. 12 months was the median time for a complete recovery after the operation, confirmed by EMG. CONCLUSION: The surgical treatment offers a complete resolution in all cases.

Influence of oligomer chain length on the antioxidant activity of procyanidins.

The antioxidant activity of catechin monomers and procyanidin (dimers to hexamers) fractions purified from cocoa was studied in two in vitro systems: liposomes and human LDL. Liposome oxidation (evaluated as formation of 2-thiobarbituric acid reactive substances) was initiated with 2,2'-azobis (2-amidinopropane) hydrochloride (AAPH), 2,2'-azobis (2,4-dimethylvaleronitrile) (AMVN), iron/ascorbate, or UV-C; LDL oxidation (evaluated as formation of conjugated dienes) was initiated with Cu(2+) or AAPH. Catechin monomers and procyanidin fractions inhibited both liposome and LDL oxidation. Monomers, dimers, and trimers fractions were the most effective antioxidants when liposome oxidation was initiated in the aqueous phase. When oxidation was initiated in the lipid domains, higher molecular weight procyanidins were the most effective. All fractions significantly inhibited Cu-mediated LDL oxidation; no significant effect of procyanidin molecular weight was observed. The hexamer fraction was the least effective with respect to preventing AAPH initiated LDL oxidation. Results reported herein give further evidence on the influence of the oligomer chain length on the antioxidant protection by procyanidins.

Catechins delay lipid oxidation and alpha-tocopherol and beta-carotene depletion following ascorbate depletion in human plasma.

Blood plasma was incubated with 50 mM AAPH [2, 2'-azobis-(2-amidinopropane) hydrochloride] in the absence or presence of catechins (5-100 microM). Lipid oxidation was evaluated by measuring the formation of 2-thiobarbituric acid reactive substances (TBARS). The concentration of alpha-tocopherol (AT), beta-carotene (BC), ascorbic acid (AA), and catechins was determined by reverse phase high performance liquid chromatography (HPLC) with electrochemical detection. All the assayed catechins inhibited plasma TBARS formation. Based on the calculated IC50, the order of effectiveness was: epicatechin gallate (ECG) > epigallocatechin gallate (EGCG) > epigallocatechin (EGC) > epicatechin (EC) > catechin (C). Catechins protected plasma AT and BC from AAPH-mediated oxidation. The order of effectiveness for AT protection was ECG > EGCG > EC = C > EGC; and for BC protection, the order was EGCG > ECG > EGC > > EC > C. The addition of catechins modified the kinetics of TBARS formation and AT depletion, but the rate of AA depletion was not affected. Catechin oxidation did not start until the complete depletion of AA, and it preceded AT depletion. These results indicate that catechins are effective antioxidants in human blood plasma, delaying the lipid oxidation and depletion of endogenous lipid-soluble antioxidants (AT and BC).

Epicatechin in human plasma: in vivo determination and effect of chocolate consumption on plasma oxidation status.

Diets that are rich in plant foods have been associated with a decreased risk for specific disease processes and certain chronic diseases. In addition to essential macronutrients and micronutrients, the flavonoids in a variety of plant foods may have health-enhancing properties. Chocolate is a food that is known to be rich in the flavan-3-ol epicatechin and procyanidin oligomers. However, the bioavailability and the biological effects of the chocolate flavonoids are poorly understood. To begin to address these issues, we developed a method based on HPLC coupled with electrochemical (coulometric) detection to determine the physiological levels of epicatechin, catechin and epicatechin dimers. This method allows for the determination of 20 pg (69 fmol) of epicatechin, which translates to plasma concentrations as low as 1 nmol/L. We next evaluated the absorption of epicatechin, from an 80-g semisweet chocolate (procyanidin-rich chocolate) bolus. By 2 h after ingestion, there was a 12-fold increase in plasma epicatechin, from 22 to 257 nmol/L (P < 0.01). Consistent with the antioxidant properties of epicatechin, within the same 2-h period, there was a significant increase of 31% in plasma total antioxidant capacity (P < 0.04) and a decrease of 40% in plasma 2-thiobarbituric acid reactive substances (P < 0.01). Plasma epicatechin and plasma antioxidant capacity approached baseline values by 6 h after ingestion. These results show that it is possible to determine basal levels of epicatechin in plasma. The data support the concept that the consumption of chocolate can result in significant increases in plasma epicatechin concentrations and decreases in plasma baseline oxidation products.

Induction of nitric oxide synthase activity in adrenal cells.

The induction of nitric oxide synthase (NOS) II by bacterial lypopolysaccharide (LPS) was studied in a steroidogenic mouse tumor adrenal cell line (Y1). Conditioned media from LPS-stimulated peritoneal macrophages induced an increase in NOS II expression as shown by western and northern blot analysis. Accordingly, in the presence of conditioned media an increase in nitrite levels was observed. In addition, steroid production was significantly decreased. In conclusion, NOS II expression could be induced in steroidogenic cells with a concomitant inhibition of steroid production.

Ascorbate protects (+)-catechin from oxidation both in a pure chemical system and human plasma.

We evaluated the interaction between ascorbic acid (AA) and (+)-catechin (CTCH) in potassium phosphate solution, pH 7.4 (PPS) and in human plasma. In both systems, the oxidation was started by adding 2,2'-azobis-(2-amidinopropane) clorhidrate (AAPH). The concentrations of AA and CTCH were determined by HPLC using electrochemical detection. In PPS, CTCH was oxidized by AAPH (50 mM), in either the absence or presence of different initial concentrations of AA (25-200 microM). In the presence of AA, CTCH depletion was delayed, an effect that was dependent upon the initial concentration of AA. When 100 microM AA was added after the oxidation had begun, CTCH depletion was arrested for 30 min. The kinetics of AA oxidation by AAPH was also characterized in PPS. AA (100 microM) was completely consumed after 60 min of reaction at 37 degrees C, in both the absence and presence of 100 mM CTCH. When human plasma was incubated with 50 mM AAPH in the absence of added CTCH, AA was completely consumed after 45-60 min. CTCH did not prevent AA depletion in human plasma at the concentrations tested (10, 50 100 microM). The results point out that AA is able to protect other aqueous soluble antioxidants, e.g.: CTCH.

Ascorbate protects (+)-catechin from oxidation both in a pure chemical system and human plasma

We evaluated the interaction between ascorbic acid (AA) and (+)-catechin (CTCH) in potassium phosphate solution, pH 7.4 (PPS) and in human plasma. In both systems, the oxidation was started by adding 2,2'-azobis-(2-amidinopropane) clorhidrate (AAPH). The concentrations of AA and CTCH were determined by HPLC using electrochemical detection. In PPS, CTCH was oxidized by AAPH (50 mM), in either the absence or presence of different initial concentrations of AA (25-200 microM). In the presence of AA, CTCH depletion was delayed, an effect that was dependent upon the initial concentration of AA. When 100 microM AA was added after the oxidation had begun, CTCH depletion was arrested for 30 min. The kinetics of AA oxidation by AAPH was also characterized in PPS. AA (100 microM) was completely consumed after 60 min of reaction at 37 degrees C, in both the absence and presence of 100 mM CTCH. When human plasma was incubated with 50 mM AAPH in the absence of added CTCH, AA was completely consumed after 45-60 min. CTCH did not prevent AA depletion in human plasma at the concentrations tested (10, 50 100 microM). The results point out that AA is able to protect other aqueous soluble antioxidants, e.g.: CTCH.

(+)-Catechin as antioxidant: mechanisms preventing human plasma oxidation and activity in red wines.

We evaluated the antioxidant effect of (+)-catechin (CTCH), in the presence of physiological antioxidant levels of ascorbic acid (AA), alpha-tocopherol (AT) and beta-carotene (BC), in human plasma oxidised with AAPH. Following a five-hour incubation, the formation of lipid oxidation products (TBARS) was almost doubled, and the concentrations of lipid soluble antioxidants were 10 to 30% from the initial levels. In these conditions, AA was consumed within the first hour of incubation. The addition of CTCH prevented AT and BC depletion and TBARS formation, but had no effect on AA consumption. When the kinetics of oxidation were analysed CTCH oxidation preceded lipid soluble antioxidant depletion, but no consumption of CTCH was associated to AA oxidation. Considering that CTCH could contribute to the antioxidant activity of red wine, we first characterised both the antioxidant capacity and CTCH content of several wines. The wines with highest content of CTCH and antioxidant activity were also the most effective in preventing AAPH-mediated oxidation of plasma vitamin E. Results support the idea that CTCH could have a role as a physiological antioxidant in human plasma, and that CTCH of wine could contribute to the antioxidant status of human plasma.

(+)-Catechin prevents human plasma oxidation.

Based on the recognized capacity of (+)-catechin (CTCH) to prevent free radical-mediated damage in different biological systems, its role in the protection of human plasma from oxidation was investigated. Samples of human blood plasma were incubated with 50 mM AAPH [2,2'-azobis-(2-amidinopropane) clorhidrate] or AMVN [2,2'-azobis(2,4-valeronitrile)], in the absence or the presence of CTCH (0.01 to 1 mM). Lipid oxidation was evaluated measuring the formation of 2-thiobarbituric acid reactive substances (TBARS). Alpha-tocopherol (AT), beta-carotene (BC), and CTCH were measured by reverse phase HPLC with electrochemical detection. TBARS formation was dependent on incubation time and on the nature of the azocompound, yielding 4.8 +/- 0.9, and 14.9 +/- 3.4 microM MDA, after 4 h, in AAPH and AMVN-exposed plasma, respectively. Plasma AT and BC were extensively depleted under these oxidant conditions. The addition of CTCH prevented or delayed the formation of TBARS, and the depletion of AT and BC in a dose dependent manner. This antioxidant effect was dependent on the concentration of CTCH and on the physical characteristics of the radical initiator. CTCH supplementation modified not only the lag time for the antioxidants depletion, but also the consumption rate. These results indicate that CTCH was an effective antioxidant in human blood plasma, delaying the consumption of endogenous lipid soluble antioxidants (AT and BC) and inhibiting lipid oxidation.

[Recurrent leiomyoma of the rectum treated by endoscopic transanal microsurgery]. / Leiomioma recidivo del retto trattato mediante microchirurgia endoscopica transanale.

The Authors report a case of recurrent leiomyoma of the rectum treated by Transanal Endoscopic Microsurgery (T.E.M.). Leiomyoma of the rectum is a rare entity (0.1-0.3%) (the incidence of smooth muscle tumours being 7% in the digestive tract). Benign leiomyomas are usually asymptomatic; discomfort or pain, related or not to defecation, sensation of foreign body, change in bowel habits, rectal bleeding are rarely reported. The distinction between a benign leiomyoma and a leiomyosarcoma is often difficult and requires an accurate microscopic study. In most cases rectal leiomyoma is detected incidentally in the course of a rectal examination. Endoscopic examination of the rectum with biopsies and endorectal ultrasonography are useful for the diagnosis, while rarely a plain radiologic examination is sufficient. Leiomyoma of the rectum also presents a high tendency to local recurrence (31%). Therefore the choice of an adequate treatment is often difficult. The Authors believe that the treatment of rectal leiomyoma by T.E.M. may substitute conventional methodics (transanal excision, proctectomy with or without amputation of the sphincter and coloanal anastomosis, endoscopic electroexcision of the neoplasm). T.E.M. allows short-term hospitalization and implies minimal surgical trauma.

[The use of laser through thoracoscopy in the treatment of spontaneous pneumothorax. Presentation of a clinical case]. / L'impiego del laser per via toracoscopica nel trattamento del pneumatorace spontaneo. Presentazione di un caso clinico.

The authors present the case of a patient with right plurirecidive pneumothorax. During the 12 months before the operation the patient suffered from 3 episodes of pneumothorax, treated with the insertion of an intrapleural drainage. Preoperative exams showed the presence of multiple emphysematous blebs with diameter ranging from 0.5 cm to 3 cm. The patient was treated with Nd:YAG laser photocoagulation of the blebs and mechanical abrasion of the parietal pleura through thoracoscopy. The laser photocoagulation of the blebs was performed using the contact technique and a 25 Watt power. After operation a TX of the thorax, using the high resolution technique, showed the presence of residual blebs involving the apex and the mediastinal surface of the inferior lobe of the right lung. After a 12 month follow-up no recidive pneumothorax occurred and the general conditions of the patient were good. The authors state that the laser treatment of spontaneous pneumothorax secondary to bullous emphysema is effective and safe and it is also successful in patients with multiple blebs. As it is often difficult to find and treat all the blebs, it may be useful to perform thoracography during thoracoscopy.

[Nodular fasciitis: a case arising from the splenius cervicis muscle]. / La fascite nodulare: un caso del muscolo splenio del collo.

An unusual case of nodular fasciitis, arising from the splenius muscle, is presented. This uncommon lesion is always benign, but a local spread in the surrounding muscular tissue is possible. Through a Literature review, the main pathological, clinical and therapeutic features are discussed.

[Retroperitoneal sarcomas: recent advances in nosographic framework, diagnosis and integrated surgical treatment]. / I sarcomi retroperitoneali: recenti acquisizioni in tema di inquadramento nosografico, diagnosi e terapia chirurgica integrata.

In this paper the Authors reviewed the recent literature for a more comprehensive and clear vision of the epidemiological and pathological aspects of retroperitoneal sarcomas. The most effective procedures for a an early and accurate diagnosis were identified. Moreover, the different therapeutic choices were taken into account focusing on those provided of the major potential in terms of oncologically valid treatment.

[Acute abdominal pain in emergency surgery. Clinical epidemiologic study of 450 patients]. / Il dolore addominale acuto in chirurgia d'urgenza. Studio clinico-epidemiologico su 450 pazienti.

A retrospective study on 450 patients admitted in emergency with acute abdominal pain in a general surgical unit of the Ist Institute of Surgery of the University of Rome "La Sapienza" was carried out during a 7 years period. The aim of the study was to identify the most frequent causes of acute abdominal pain correlated with age, sex, onset of pain and other conditions in order to improve diagnosis and reduce mobility for mortality. Appendicitis was the most frequent diagnosis (75 pts = 16.4%). Non-specific abdominal pain (NSAP), found in 71 pts (15.5%), cholelithiasis in 57 pts (12.5%), abdominal malignancy in 47 pts (10.3%) were other frequent conditions. The largest number of admissions occurred in the age groups 60-70 years (16.6%) and 20-30 years (14.2%). Surgical operations were performed in 206 patients (45.7%). The overall mortality was 4.2% (19/450 pts) and the rate increased significantly in patients aged > 60 years. Postoperative mortality was 5.8% (12/206 pts) while mortality rate in non-operated patients was 2.8%. The causes of perioperative death included perforated peptic ulcer, abdominal malignancies (15.4%) and urgent colonic resections (9.4%). The duration of inpatients stay increased significantly with the age of the patients, including those with nsap. The results of the study indicate a need to review the methods of diagnosis of appendicitis and to obtain a better clinical performance in patients with nsap.

[Complications of surgery of Dupuytren disease. Comparison of total and partial aponeurectomy]. / Le complicanze nella chirurgia della malattia di Dupuytren. Confronto tra aponeurectomia totale e parziale.

Total and partial aponeurectomy are the most usual operations performed for the treatment of Dupuytren's disease. Eighteen patients, for a sum of 23 treated hands, were submitted to total aponeurectomy in 20 cases and to partial aponeurectomy in 3 cases. Recurrence was present in 4 cases. Postoperative morbidity was 50% (10/20 cases) following total aponeurectomy and 0% (0/3 cases) following partial aponeurectomy. In patient with recurrence disease postoperative complications were present in 3/4 cases (75%) while in patients, operated for the first time, morbidity rate was 36.8% (7/19 cases). Postoperative complications following total aponeurectomy are extremely frequent, especially if recurrence is present. Partial aponeurectomy allows to achieve functional result as good as total aponeurectomy with significative reduction of postoperative morbidity.

Relationships between genotype x environment interactions and rank orders for a set of genotypes tested in different environments.

Multilocation trials in plant breeding lead to cross-classified data sets with rows=genotypes and columns=environments, where the breeder is particularly interested in the rank orders of the genotypes in the different environments. Non-identical rank orders are the result of genotype x environment interactions. Not every interaction, however, causes rank changes among the genotypes (rank-interaction). From a breeder's point of view, interaction is tolerable only as long as it does not affect the rank orders. Therefore, the question arises of under which circumstances does interaction become rank-interaction. This paper contributes to our understanding of this topic. In our study we emphasized the detection of relationships between the similarity of the rank orders (measured by Kendall's coefficient of concordance W) and the functions of the diverse variance components (genotypes, environments, interaction, error). On the basis of extensive data sets on different agricultural crops (faba bean, fodder beet, sugar beet, oats, winter rape) obtained from registration trials (1985-1989) carried out in the Federal Republic of Germany, we obtained the following as main result: W ≅ σ 2 (g) /(σ 2 (g) + σ 2 (v) ) where σ 2 (g) =genotypic variance and σ 2 (v) = σ 2 (ge) + σ 2 (o) /L with σ 2 (ge) =interaction variance, σ 2 (o) =error variance and L=number of replications.

Limits of tumour treatment follow up by surface coil 31P magnetic resonance spectroscopy. The case of sarcosinamide-CNU treated ependymoblastoma.

Ependymoblastoma tumour bearing mice were treated with sarcosinamide-CNU and compared with untreated mice with regard to tumour growth, pathological examinations and levels of phosphorylated metabolites measured by in vivo nuclear magnetic resonance spectroscopy. The response to the drug was demonstrated by its effect on tumour growth and with pathological examinations. Spectra evolution was different from controls for only four treated tumours out of eight.

In vivo 1H NMR spectroscopy of an intracerebral glioma in the rat.

High-resolution 1H surface coil NMR spectroscopy (MRS) was used to evaluate in vivo the cerebral metabolism changes in rat brain induced by a glial tumor growing in situ. Tumor cells (C6 glioma cells) were stereotaxically placed in the right hemisphere superficially. 1H MRS was performed using 5-mm surface coils implanted over the right hemisphere and the water was suppressed using a binomial sequence. As the intracerebral tumor size increased, there was a marked decrease in the N-acetyl aspartate level and an increase in the 1.3 ppm peak. Edition of this peak showed that lactate increased but lipids increased much more than lactate. Moreover the ratio between the choline-phosphocholine and creatine-phosphocreatine peaks changed. This study demonstrates that high-resolution surface coil 1H MRS can be used to monitor changes in metabolism associated with growth of an experimentally induced rat brain tumor in situ.

Correlation between intracellular pH and lactate levels in the rat brain during potassium cyanide induced metabolism blockade: a combined 31P-1H in vivo nuclear magnetic spectroscopy study.

Female Sprague-Dawley rats were chronically implanted with nuclear magnetic resonance (NMR) surface coils tuned to both 31P and 1H NMR frequencies. Alternated 31P and 1H NMR spectra were recorded at 2.5 min intervals in waking rats or rats under pentobarbital or chloral hydrate anesthesia. After a reference period, the metabolic changes were observed following intraperitoneal injection of potassium cyanide (KCN, 5 mg/kg). Among previously observed changes typical of cellular anoxia, attention was specifically paid to the relationship between the intracellular pH values and the lactate levels. The results show a strong lactate-pH correlation in waking rats, a partial decoupling under nembutal anesthesia and a complete decoupling under chloral hydrate anesthesia.