Role of fungal trehalose and bacterial thiamine in the improved survival and growth of the ectomycorrhizal fungus Laccaria bicolor S238N and the helper bacterium Pseudomonas fluorescens BBc6R8

The mycorrhiza helper bacterial strain Pseudomonas fluorescens BBc6R8 enhances the establishment of Laccaria bicolor S238N ectomycorrhizae by improving the pre-symbiotic growth and survival of the fungus. Nothing is known about the effect of the ectomycorrhizal fungus on the helper bacteria or the molecules that are involved in the interaction. In this study, we have monitored the population density of the helper strain P. fluorescens BBc6R8 in soils inoculated with L. bicolor and in control soils and found that the ectomycorhizal fungus improves the survival of the helper bacteria. We investigated the identity of the fungal and bacterial metabolites involved in this reciprocal growth-promoting effect using a combination of growth measurements, chemoattractant assays, HPLC and in silico genome analyses. We showed that trehalose, a disaccharide that accumulates to high levels in the fungal hyphae, chemoattracted and promoted the growth of the helper bacteria. Meanwhile, P. fluorescens BBc6R8 produced thiamine at concentrations that enhanced the fungal growth in vitro. Altogether our data indicate that the interaction between the two microorganisms is beneficial for both species and relies, at least in part, on trophic mutualism.

Metabotropic P2Y receptors inhibit P2X3 receptor-channels via G protein-dependent facilitation of their desensitization

BACKGROUND AND PURPOSE

The aim of the present study was to investigate whether the endogenous metabotropic P2Y receptors modulate ionotropic P2X(3) receptor-channels.

EXPERIMENTAL APPROACH

Whole-cell patch-clamp experiments were carried out on HEK293 cells permanently transfected with human P2X(3) receptors (HEK293-hP2X(3) cells) and rat dorsal root ganglion (DRG) neurons.

KEY RESULTS

In both cell types, the P2Y(1,12,13) receptor agonist, ADP-beta-S, inhibited P2X(3) currents evoked by the selective agonist, alpha,beta-methylene ATP (alpha,beta-meATP). This inhibition could be markedly counteracted by replacing in the pipette solution the usual GTP with GDP-beta-S, a procedure known to block all G protein heterotrimers. P2X(3) currents evoked by ATP, activating both P2Y and P2X receptors, caused a smaller peak amplitude and desensitized faster than those currents evoked by the selective P2X(3) receptor agonist alpha,beta-meATP. In the presence of intracellular GDP-beta-S, ATP- and alpha,beta-meATP-induced currents were identical. Recovery from P2X(3) receptor desensitization induced by repetitive ATP application was slower than the recovery from alpha,beta-meATP-induced desensitization. When G proteins were blocked by intracellular GDP-beta-S, the recovery from the ATP- and alpha,beta-meATP-induced desensitization were of comparable speed.

CONCLUSIONS AND IMPLICATIONS

Our results suggest that the activation of P2Y receptors G protein-dependently facilitates the desensitization of P2X(3) receptors and suppresses the recovery from the desensitized state. Hence, the concomitant stimulation of P2X(3) and P2Y receptors of DRG neurons by ATP may result both in an algesic effect and a partly counterbalancing analgesic activity.

A multi-approach study of the interaction of the Cu(II) and Ni(II) ions with alanylglycylhistamine, a mimicking pseudopeptide of the serum albumine N-terminal residue

The protonation equilibria of alanylglycylhistamine (Ala-Gly-Ha) and the complexation of this ligand with Cu(II) and Ni(II) have been studied by pH-potentiometry, 1H and 14N NMR spectroscopy, electrospray ionization mass spectrometry (ESI-MS), circular dichroism (CD), UV-Vis spectrophotometry and electron paramagnetic resonance (EPR). From pH approximately 2-12, the following complexes: MLH, MLH(-1), MLH(-2) and MLH(-3) are successively formed in aqueous solutions, the ligand under its neutral form being noted L. At physiological pH, the MLH(-2) complex is predominant. The coordination in this complex is assumed by one amino, two deprotonated peptide and one imidazole nitrogen atoms. The ESI-MS study confirmed the formation of the MLH(-1), MLH(-2) and MLH(-3) complexes. The structure of MLH(-2) was determined by single crystal X-ray analysis. CD and UV-Vis techniques allowed us to propose that the imidazole-N3 nitrogen acts as the anchor group for the coordination to the metal(II) ions rather than the amino group. At high pH values, the further deprotonation of the N-H imidazole group, leading to the formation of MLH(-3), occurs, as revealed by 1H NMR spectroscopy.

Somatic and axonal effects of ATP via P2X2 but not P2X7 receptors in rat thoracolumbar sympathetic neurones

Excitatory ATP responses in rat cultured thoracolumbar sympathetic neurones are mediated by somatic P2X(2) receptors. The present study investigated a possible role of axonal P2X(2) as well as P2X(7) receptors on the same preparation. Confocal laser scanning microscopy demonstrated P2X(2) and P2X(7) immunoreactivity along the axons as well as P2X(7) immunoreactivity surrounding the cell nuclei. P2X(7) mRNA expression was detected in individual neurones using a single-cell RT-PCR approach. Adenosine triphosphate (ATP) caused a significant increase in axonal Ca(2+) concentration which was dependent on external Ca(2+) but insensitive to depletion of the cellular Ca(2+) pools by cyclopiazonic acid. Pyridoxal-phosphate-6-azophenyl-2',4'-disulfonate (PPADS; 30 micro m) virtually abolished the ATP response, whereas brilliant blue G (0.1 micro m), a selective P2X(7) receptor antagonist, had no effect. Dibenzoyl-ATP (BzATP; 100 micro m) induced a much smaller increase in axonal [Ca(2+)] concentration than ATP at equimolar concentrations. The response to BzATP was distinctly reduced by PPADS but not by brilliant blue G. The overall pharmacological profile of the axonal P2X receptors resembled closely that of the somatic P2X(2) receptors. In conclusion, the present data suggest the occurrence of axonal excitatory P2X(2) receptors in thoracolumbar sympathetic neurones. However, the functional significance of axonal and (peri)-nuclear P2X(7) receptors has still to be proven.

Interactions of aluminium(III) with glycerolphosphates and glycerophosphorylcholine

The complexation of aluminium(III) with glycerol-1-phosphate (G1P) and glycerol-2-phosphate (G2P) in aqueous solutions has been studied as a function of pH, by pH-potentiometry, 31P NMR spectroscopy and ESI mass spectrometry. Various mononuclear complexes (MLH(2)(3+), MLH(2+), ML(+), ML(2)H, ML(2)(-)) and polynuclear species (M(3)L(3)H(-1)(2+), M(3)L(2)H(-n)((n-5)-) with n=5, 6, 7, M(2)L(2)H(-1)(+) ) are formed in the system where the full protonated ligands are noted LH(2). NMR experiments clearly show that G1P and G2P already interact with Al(III) at pH 1. The potentiometric results are confirmed by ESI measurements and 31P NMR studies. No metal ion-induced deprotonation and coordination of the alcoholic-OH functions seem to occur during the complexation. The situation is very different for the glycerophosphorylcholine ligand (GPC identical with LH). Only the complex ML(3+) is formed in aqueous solution with a relatively low formation constant (K=5 at 37 degrees C). This species is clearly identified in 31P and 27Al NMR spectra. The complexation study as a function of the temperature allowed us to determine the thermodynamic parameters of the complex formation. The complexation is not governed by the reaction enthalpy that is found to be positive but by the entropy that is largely positive.

[Prevalence of atherosclerosis in renal transplant recipients]

BACKGROUND

Cardiovascular diseases are a major cause of morbidity and mortality after kidney transplantation. Renal transplant recipients have in fact accelerated atherosclerosis because of prolonged hemodialysis, arterial hypertension, dyslipidemia and other vascular risk factors. Studies concerning carotid and lower limb atherosclerotic changes in renal transplanted patients are at present scant.

METHODS

In the present study the prevalence of carotid and iliac-femoro-popliteal atherosclerosis was evaluated by color flow Doppler in 99 patients 64 +/- 41 DS months after renal transplantation. Statistical analysis was used to correlate the presence and grade of atherosclerotic lesions with vascular risk factors and other clinical-laboratoristic parameters of the patients.

RESULTS

The overall incidence of atherosclerotic lesions in the population studied was 54.5%; 46.5% of patients presented atherosclerotic plaques at carotid district, 43.4% at lower limb arteries and 35.4% at both districts. Two of these patients were symptomatic; one patient affected by claudicatio intermittens was submitted to conservative therapy, whereas another patient with abdominal aortic aneurysm underwent to surgical treatment. Univariate analysis showed a significant difference between males and females for lower limb atherosclerotic lesions (p=0.0013), whereas no correlation was found between carotid lesions and sex, or between smoke and atherosclerosis. Significant correlations were found by multiple correlations analisys between: the grade of atherosclerotic lesions in both districts and the patient age (p<0.0001); the grade of carotid atherosclerotic plaques and duration of pretransplantation dialysis (p<0.01); the grade of lower limb atherosclerosis and respectively glicemic (p<0.01), hematocrit (p<0.01), potassium (p<0.002) values, systolic blood pressure (p<0.02).

CONCLUSIONS

Relevant rates of renal transplant recipients have carotid and peripheral atherosclerotic lesions. The study of aorto-iliac and lower extremity vascular atherosclerosis have important implications for the transplanted kidney functionality. Color flow Doppler represents a sensitive method for the follow-up examination of these patients.

Gallbladder injury in blunt abdominal trauma

A 36-year-old woman was admitted to the hospital for an abdominal blunt trauma. At ultrasound (US) and computed tomography (CT), a gallbladder lesion was suspected, along with a tear of the liver. The patient was submitted to a diagnostic laparoscopy. The gallbladder was partially avulsed and bile was infiltrated in the hepatoduodenal ligament. Intraoperative cholangiography and Kocher's maneuver excluded other lesions. Laparoscopic cholecystectomy was performed, but due to severe hemorrhage from the liver tear, the operation was converted to an open procedure. Gallbladder lesions in blunt trauma are rare occurrences, but they are often associated with other organ injuries. US and CT scan are valuable for their diagnosis, but if a lesion is suspected, diagnostic laparoscopy is advisable in stable patients. It should be accompanied by a cystic duct cholangiography and a Kocher's maneuver to evaluate the integrity of the biliary tree. Laparoscopic cholecystectomy is generally feasible. Associated lesions require laparotomy when they are not amenable to laparoscopic treatment.

[Inflammatory abdominal aortic aneurysms]

The authors present a review of the literature on inflammatory abdominal aortic aneurysms. These aneurysms represent from 3 to 10% of all abdominal aortic aneurysms. Progress has occurred in the technical approach to these aneurysms, and operative morbidity and mortality have been remarkably reduced. However, the pathogenesis remains poorly understood. Early reports have considered the inflammatory aneurysm as a distinct clinical and pathological entity, whereas recent evidences suggest a common etiopathogenetic mechanism for both atherosclerotic and inflammatory aneurysms. Finally, genetic and environmental factors, such as tobacco use, may predispose certain persons to the development of non-inflammatory aneurysms and others to a wide spectrum of inflammatory reactions until inflammatory aneurysms development. The most common clinical features of these aneurysms are represented by symptoms, such as abdominal or back pain, obstructive uropathy and by an elevated erythrocyte sedimentation rate. Computed tomography (CT) allows a specific diagnosis by the typical image of soft tissue surrounding the aortic wall enhancing with contrast administration. Ultrasonography is less sensitive whereas nuclear magnetic resonance (RNM) is a promising technique. Excretory urography may suggest the diagnosis by demonstration of ureter entrapment. Surgical therapy, by a technique of limited dissection represents the definitive treatment. Evolution of fibrosis after surgery is still debated because some studies have reported complete regression of inflammation and other partial regression or persistence of fibrotic process. At present, endovascular treatment of these aneurysms is occasionally reported, although preliminary results appear satisfactory.

Complexes of aluminium(III) with glucose-6-phosphate in aqueous solutions

The interaction of aluminium(III) with glucose-6-phosphate (GP: LH2) in aqueous solutions has been studied from pH 1 to pH 8, by pH-potentiometry and multinuclear (31P, 27Al, 13C) NMR spectroscopy. Various mononuclear species (MLH2, MLH, ML, ML2H, ML2 and MLH(-3)) and dinuclear complexes M2L2H-n (n=1-4) are formed in the system. NMR clearly indicates that GP is already bound to Al(III) at pH 1. The potentiometric speciation results are confirmed and completed by spectroscopic experiments. Many peaks are observed in the 31P NMR spectra suggesting the formation of isomeric species. An attempt to assign the signals to the corresponding complexes is made, allowing a discussion about their structure. Interestingly enough no metal ion-induced deprotonation and coordination of the alcoholic-OH functions have been observed.

[Vascular homografts: clinical results]

The authors review the results of clinical experiences regarding arterial and venous homografts. For the treatment of mycotic aneurysms and infected prostheses, in situ repair with vascular homografts represents a valuable alternative to conventional surgical treatments. In fact the large caliber arterial homografts allow safe in situ reconstruction, decrease early and midterm mortality and reinfection rates; the best results are achieved in case of infected grafts, whereas the prognosis of vasculo-enteric fistula remains very poor. The small caliber arterial homografts also have demonstrated satisfactory results in term of patency, although further experiences with longer follow-up are required. Vein homograft constitutes an alternative by-pass conduit for limb revascularisation in patients who lack adequate autogenous vein: although limb salvage rate is satisfactory, long term patency rate is poor when compared with autogenous veins. Improvement of preservation methodics, pharmacological control of rejection and tissue engineering represent the future perspectives in this field.

Potentiometric and spectroscopic studies on the dimethyltin(IV) complexes of 2-hydroxyhippuric acid

Equilibrium and spectroscopic (1H, 13C NMR and 119Sn Mössbauer) studies in aqueous solution are reported for dimethyltin(IV) complexes of 2-hydroxyhippuric acid (Sal-Gly). Below pH 4, oxygen-coordinated complexes MLH and ML are formed. In the pH range 5-8.5, the species MLH(-1), predominates at any metal-to-ligand ratio. The ligand exchange of this species is slow on the NMR time scale, which allows its structural characterization by NMR spectroscopy: the coordination polyhedron around the tin atom is distorted trigonal bipyramidal, with tridentate [O-,N-,COO-] coordination of Sal-Gly, involving two equatorial methyl groups. The NMR results reveal that the main cause of the distortion of the polyhedron is the large CH3-Sn-CH3 angle of 136+/-4 degrees. The presented results supplement the data available on the dimethyltin(IV)-promoted amide deprotonation of peptides, and provide further arguments for the fundamental role of the carboxylate as an anchoring group in this process.

[Laparoscopic fundoplication in gastroesophageal reflux disease: reflexions on a personal caseload]

Ninety-two patients with severe, proton-pump-inhibitor-dependent gastro-oesophageal reflux disease were submitted to surgery and operated on by the same surgeon (SC) over the past 7 years (mean age: 42; range: 23-74 years). Partial fundoplication was performed in 14 patients with impaired oesophageal motility, while 78 total fundoplications were done in the others, 51 without, and 27 with division of the short gastric vessels. The mean follow-up was 29.5 months (range: 1-85 months). Conversion to open surgery was necessary in 6 patients (all in the first 40 cases). Perforation of the gastric fundus and early migration of the stomach into the mediastinum were the two most important complications observed. The mortality was nil. 39% of the patients complained of postoperative dysphagia but only five required endoscopic (4) or surgical (1) treatment. The percentages of dysphagia after partial fundoplication and total fundoplication with or without division of the short gastric vessels were 28%, 37% and 47%, respectively. In 83.7% the patients were satisfied with the clinical results and in 84% of cases medical treatment was avoided after surgery. On the basis of these data, laparoscopic surgery appears to be a good option for gastro-oeophageal reflux disease in selected patients with a poor response to, or dependent on medical treatment. However, the results of surgery may be subject to the limitations of a learning curve, as in all complex laparoscopic procedures.

[Diagnosis and treatment of pheochromocytoma]

Early detection of a pheochromocytoma is necessary to avoid the cardiovascular complications of hypertension and to recognize the 10% of malignant neoplasms. Hypertensive changes, particularly hypertensive spikes and stable hypertension are the most common clinical features. A pheochromocytoma must be suspected in presence of various symptoms of which cephalea, tachycardia, diaphoresis are the most frequently encountered. Plasma catecholamines and 24-hours urine metabolites measurements have 60-100% and 72-99% sensitivity respectively. Radiologic procedures commonly used to locate a pheochromocytoma include CT and RM: they achieve 100% sensitivity for unilateral adrenal lesions and respectively 64% and 88% sensitivity for extra-adrenal lesions. Scintigraphic localization with MIBG provides functional informations and is recommended for follow-up of the recurrent or metastatic pheochromocytoma. Preoperative medical treatment using alpha and beta blocking agents or calcium channel blockers has contributed to reduce perioperative morbidity and mortality. Anterior transabdominal approach is advocated as the standard operative procedure; this approach allows ready access to any site where tumors are obviously present and permits thorough exploration of the abdominal cavity for additional contralateral adrenal or extra-adrenal lesions. An accurate preoperative localization of a sporadic, unilateral, of less than 7-10 cm, benign neoplasm constitutes the indication for the laparoscopic adrenalectomy. Pheochromocytoma-free survival were 92% and 80% at 5 and 10 years respectively; in living patients without recurrence, hypertension-free survival was 74% and 45% at 5 and 10 years respectively. Extra-adrenal pheochromocytomas are frequently malignant (36%) and are associated with a high incidence of persistent or recurrent disease (32%).

The radial artery: which place in coronary operation?

Previous long-term studies have shown unsatisfactory patency of saphenous vein grafts, compared with internal mammary artery grafts. Recently, the use of the radial artery as a coronary artery bypass graft has enjoyed a revival, on the basis of the belief that it will help improving long-term results of coronary operations. The recent report of encouraging 5-year patency rates, supports its continued use as a bypass graft. In this paper, we review the current knowledge about the radial artery as a bypass graft, with special emphasis on the clinical results.

Coronary and major vascular disease: aggressive screening and priority-based therapy

It is well know that atherosclerosis can simultaneously affect different vascular subsystems, and patients with diffuse atherosclerosis can be a major management problem both for preoperative evaluation and for intraoperative management. The authors have conducted a prospective study to evaluate the prevalence of coronary artery disease in arteriopathic patients, and vice versa, to assess the effectiveness of aggressive screening together with a priority-based approach. Study 1 consisted of 1,000 consecutive non-emergent patients who were affected by abdominal aortic or carotid disease and were screened for the presence of coronary artery disease before surgery with a newly developed clinical risk assessment. They were stratified into three risk categories with different preoperative evaluation strategies. When coronary artery disease was concomitantly demonstrated in these patients, the choice of surgical method was based on priorities, and the use of combined surgical procedures as required. In study 2, 1,000 consecutive patients that required coronary angiography for suspected coronary artery disease were screened for the presence of carotid or abdominal aortic pathology, directly in the cardiac catheter laboratory during coronary angiography, by obtaining views of the aortic arch and abdominal aorta. Surgical approaches paralleled those of study 1. The results for study 1 showed that 720 patients (72%) were affected by abdominal aortic disease, 238 (24%) by carotid disease and 42 (4%) by both pathologies. Significant coronary artery disease was found in 152 patients (15%), of these 123 (81.5%) were affected by abdominal aortic disease and 29 (18.5%) by carotid artery disease. Abdominal aortic surgery was performed directly or after myocardial revascularization, with an overall mortality rate of 4/718 (0.6%), and a perioperative myocardial infarction rate of 10/718 (1.4%). For patients with carotid artery disease, the completed screening and possible therapy for coronary artery disease resulted in an in-hospital mortality rate of 2/238 (0.8%), and a perioperative myocardial infarction rate of 2/238 (0.8%). There were no significant differences in these rates between patients with or without coronary artery disease. Results for study 2 showed that of the 1000 consecutive patients enrolled for suspicion of coronary artery disease, 767 (77%) were affected by significant coronary artery disease. Among these, 38 (4.9%) had a surgically correctable aortic disease and 31 (4%) a surgically correctable carotid disease, which was monolateral and bilateral in 22 (74%) and nine (26%) patients, respectively, and four (0.5%) were diagnosed with both pathologies. These arteriopathic patients were treated for their coronary and vascular disease with no in-hospital mortality nor perioperative myocardial infarction. In patients with multiple vascular involvement, both coronary and vascular surgery can be performed with low risk when aggressive screening and priority-based therapy are adopted.

[Assessment and treatment of incidentally discovered adrenal tumors]

An incidentally discovered adrenal mass involves two main questions: the first is the evaluation of the hormonal activity of incidentalomas, that by definition are considered clinically silent. The second problem is to establish preoperatively the biologic behaviour of the masses, whether they are benign or malignant. An essential endocrinological screening of these masses includes the 24 hour urine VMA determination, serum potassium level, and a 1 mg overnight dexamethasone suppression test. Furthermore, the recent observation of a possible partial deficit of 21-hydroxylase suggests the advantage of 17-hydroxyprogesterone dosage after ACTH stimulation. At present no biochemical or radiologic markers can reliably distinguish benign from malignant masses. For this reason the association of imaging study with scintigraphy seems to be helpful, providing "concordant" or "discordant" patterns with CT images. As regard to therapeutic indications, the resection of all hypersecretive masses, proved malignant or increased in diameter tumors is suggested. As regards to biochemically silent lesions, the tumor size has been deemed to be the most helpful determinant of the nature although controversy remains over the size cutoff below which the masses can safely be presumed to be benign and therefore observed. The threshold to proceed surgically has been based on the perceived risk of cancer balanced against the operative risk. However it seems reasonable to recommend excision or surgical exploration for hormonally silent tumors greater than 3 cm, particularly in younger patients. According to personal opinion the laparoscopic approach might represent the gold standard in the treatment of incidentally discovered adrenal masses.

[Incidentaloma of the adrenal glands: analysis of 9 surgical cases]

In the assessment of incidentally discovered adrenal masses the detection of hormonal activity and the evaluation of benignity or malignity, either primary or metastatic, constitute the most important issues. This article reports 9 asymptomatic adrenal masses: The histopathological diagnosis consisted of cortical adenoma in 5 cases, adrenal metastatic mass in 2, respectively from a pulmonary microcytoma and from a renal carcinoma, a myelolipoma with leukemic infiltration and an hemorrhagic pseudocyst in the remnants. Evaluation of biochemical activity showed no endocrinological abnormality in all patients except in two cases of adenoma: the positivity of the 1 mg dexamethasone test, the low serum DHEAS levels and a concordant scintigraphic uptake were consistent with the pre-Cushing syndrome in the first case, whereas the ACTH inhibition revealed by low serum DHEAS levels without other hormonal alterations were the biochemical pattern in the second. Ultrasonography has been helpful in the diagnosis of adrenal mass in 6 cases, whereas CT scan allowed an etiopathogenetic diagnosis in 8 cases. All patients were submitted to adrenalectomy through the conventional surgical accesses; in 4 cases the adrenalectomy was performed as a associated intervention during vascular or gastrointestinal surgery. No postoperative death occurred. At follow-up ranging from 3 to 6 years, we recorded 4 deaths: the causes were represented by the progression of the primary malignancy in 2 patients that have been operated on for adrenal metastatic tumors, by hemorrhagic shock from an aorto-duodenal fistula and by systemic infectious complications respectively in the remnant two cases. The other patients were well and the endocrinological assessment showed normal findings. The Authors, according with data from literature, suggest an essential biochemical screening to evaluate the adrenal function in case of incidentally discovered mass: it is characterized by determination of plasma and urinary electrolytes, catecholamines, serum DHEAS and 17-OH progesterone levels, dexamethasone suppression test. In case of asymptomatic mass suspect for pheochromocytoma we advocate the MIBG scintigraphy.. The adrenocortical scintigraphy (NP 59) provides both anatomical and functional characterization of the adrenal glands: the concordant or discordant imaging patterns are useful in the diagnosis of benignity or malignancy. Although the management of patients with incidentally discovered masses remain controversial, we advocate adrenalectomy when they are hormonally hypersecreting, increasing in the diameter or malignant and in association with other abdominal operation.

[Carcinoid of the appendix. Observations on 4 cases]

Four cases of carcinoid tumors of the vermiform appendix are reported. Clinical presentation in 3 cases was suggestive of acute appendicitis and they were submitted to appendicectomy. The carcinoid tumor was discovered by the pathologist on specimen of appendix. The tumors's size, less than 2 cm, the absence of serosal involvement and lymphatics invasion suggested that simple appendicectomy was a satisfactory treatment for such patients. Occasionally clinical presentation of appendiceal carcinoid is characterized by symptoms of intestinal obstruction or intussusception, palpable mass, bleeding. In the fourth patient, that had symptoms consistent with ileal occlusion, we found at laparotomy a bulky tumor of the base of appendix infiltrating and obstructing the cecum and right colon, without liver metastases. A right hemicolectomy with end-to-end anastomosis was performed. Aggressive behaviour of this tumor was also revealed by the single pulmonary metastasis, finding very uncommon in carcinoid of appendix. This patient died postoperatively, at 25th day, of septic abdominal complications, secondary to anastomotic leak. The former patients at clinical and radiological (CT scan) follow-up performed at 3, 12, 36 months respectively, are still alive and disease free.

[Uninodular bronchioalveolar carcinoma. Apropos of 10 operated cases]

BACKGROUND

This study reports 10 cases of uninodular bronchiolo-alveolar carcinoma (BAC) operated on in the General Surgery and Organ Transplantation Institute of the University of Parma between January 1st 1981 and December 31st 1995.

METHODS

Seven patients were males and three females, mean age was 65 (DS 11, range 37-75) and globally accounted for 6.4% of all surgically treated lung malignant tumors.

RESULTS

Hospital mortality was null; one patient was treated with assisted ventilation four days after surgery for respiratory insufficiency. Actuarial survival at 36 and 60 months was 48% and 36% respectively; survival rates were not significantly different at log-rank test from squamous carcinoma (46.2% at 36 months, 35% at 60 months) and adenocarcinoma (50.5% at 36 months, 34.3% at 60 months). The analysis of other series of literature shows significantly higher survival rates at 5 years for BAC than for adenocarcinoma (55.6% vs 40%).

CONCLUSIONS

Broader series are needed for statistical confrontation with other histological types by stage and grade. There is no evidence of peculiar prognostic or clinical features in this histological type of pulmonary malignancy, prognosis so far is in fact conditioned by the same factors of other non small cell lung carcinomas.

[Hemorrhagic pseudocyst of the adrenal gland: a case report]

A case of haemorrhagic cyst of the adrenal gland (pseudocyst) is reported. The interest is related to the histologic and pathogenetic aspects which are still controversial. In this case the cyst may be explained as a consequence of an hamartomatous vascular anomaly or as a traumatic consequence: the histopathological finding characterized by the presence of irregular vascular channels in the outer fibrous wall of the cyst may suggest that haemorrhage occurred in a preexisting blood vascular anomaly, whereas the anamnestic information of a trauma in the past suggests a traumatic origin of the mass. Clinical findings were characterized by lumbar tension and pain without palpable mass; the specific diagnosis was made preoperatively by ultrasonography and CT scan of the abdomen. Left adrenalectomy was performed through an anterior extraperitoneal approach following a supraumbilical incision.

[Clinical suspicion and instrumental diagnosis of ruptured aneurysm of the abdominal aorta. Analysis of our experience]

The authors report their experience in the management of 54 patients who underwent emergency surgery for rupture of an abdominal aortic aneurysm, correlating results to time of diagnosis. The overall mortality rate was 55.5%. The extent and the site of bleeding, free blood in peritoneal cavity or retroperitoneal hematoma alone, were critical factors influencing survival and were correlated to early of diagnosis. Patients with small hematomas had no mortality; cases with more extensive hematomas had a mortality rate of 53%; in case of intraperitoneal bleeding the mortality rose to 73% (p = 0.001). The median times between symptoms' onset and surgical intervention was correlated with a significant value to extent of retroperitoneal hematoma (p = 0.003). This time is also significantly different in dead patients compared to survivors (p < 0.001). In patients with incorrect admitting diagnosis the mean times between onset of symptoms and surgical treatment was significantly different from time of correctly diagnosed patients (p < 0.001). Our findings emphasize the need for rapid recognition of prodromal symptoms of rupture and the earlier referral of patients with known abdominal aneurysm; we suggest that in an unstable patient with a suspected ruptured aneurysm immediate surgery should be performed without delay for confirmatory tests or full resuscitation.

Determination of the (17)O Quadrupolar Coupling Constant and of the (13)C Chemical Shielding Tensor Anisotropy of the CO Groups of Pentane-2,4-dione and beta-Diketonate Complexes in Solution. NMR Relaxation Study

13C NMR relaxation times T(1) of the carbonyl groups of pentane-2,4-dione and beta-diketonate complexes Al(acac)(3) and Zr(acac)(4) (acac: pentanedionate anion) were measured for various magnetic field strengths, allowing a determination of the contribution of the chemical shift anisotropy mechanism to the total relaxation. NOE and T(1) measurements for the (13)C nucleus of the central methine carbon furnished the correlation time tau(c) for the reorientation of theses species. The chemical shift tensor anisotropy Deltasigma could be deduced and compared to the values obtained in the solid state. The quadrupolar coupling constant (QCC) of the (17)O nucleus could also be determined by measuring the line width of the (17)O NMR signal and using the tau(c) value. QCC values for the complexes are in the same range as for the pentane-2,4-dione molecule, indicating similar electronic distribution and symmetry around the oxygen atom of these different species. Deltasigma for the complexes are close together, and the values obtained in solution are approximately those obtained in the solid state. They are close to the value reported in the literature for tetraacetylethane, which can be considered as a dimer of a beta-diketone, but slight differences are observed for the individual components of the chemical shielding tensor.

Experimental administration of 19-nortestosterone and dexamethasone in cattle: elimination of the two drugs in different biological matrices

19-Nortestosterone (19-NT) is one of the mostly recurrent anabolic agents on the black market of illicit drugs. Dexamethasone (DEXA) is licensed for therapy in veterinary practice but its misuse, although often suspected, has seldom been demonstrated. The excretion of 19-NT and DEXA is well documented when the compounds are administered independently but poor information is available in literature for instances when both drugs are administered as a mixture. To evaluate a radioimmunoassay (RIA) for anabolic residues in urine, blood and faeces, the effect of the simultaneous administration and the subsequent elimination of the two drugs, two animals were injected (4 times) with 19-NT and another two (4 times) with 19-NT-DEXA. After preparation and a sequential clean-up on C18 and alumina columns, the samples were analysed by means of a specific 19-NT radioimmunoassay kit and an anti-DEXA antibody. Detection limits for both drugs were 0.5 ppb in blood samples and 2.0 ppb in urine and faecal samples. After the final treatment, positive 19-NT results were recorded at 14 and 21 d in urine and faecal samples, respectively. In the same matrices, positive DEXA values were found at 11 and 28 d, respectively. In the same matrices, positive DEXA values were found at 11 and 28 d, respectively. Urinary excretion was the main metabolic path both for 19-NT and DEXA; only 30% of the residues were excreted via the faeces. The simultaneous injection of DEXA and 19-NT increased the urinary excretion of 19-NT; however, the excretion of 19-NT via faecal matter was similar for both groups.

[Defibrotide and heparin in the prevention of deep venous thromboses. A controlled study]

Forty-one surgical patients at risk of deep venous thrombosis (DVT) were treated with defibrotide (400 mg/b.i.d./i.v.) or with heparin (5000 UI/t.i.d./s.c.). Neither DVT nor pulmonary embolism was evidenced. In the heparin group the healing rate was longer and during the first three days bleeding from the surgical wound was more pronounced. In particular one patient of the heparin group had to interrupt the treatment for haemorrhage.

Opiate receptor binding studies in the mouse vas deferens exhibiting tolerance without dependence

The apparent lack of dependence in highly opiate-tolerant isolated mouse vas deferens may conflict with unitary theories postulating a common biochemical mechanism for both phenomena. Therefore, attention focused on binding sites of the opiate receptors which in this tissue are located presynaptically. Binding studies conducted with homogenate of highly tolerant vasa deferentia revealed no significant different results as compared to naive tissues. Further studies examined the effect of guanine nucleotide on opiate receptor interaction. Apparently, mu-, delta- and kappa-opiate receptors in the mouse vas deferens proved resistant to the regulatory action of guanine nucleotide in naive and tolerant tissues. From these experiments, it is concluded that the binding characteristics of opiate receptors in the mouse vas deferens do not change with chronic activation. In addition, the lack of an effect of guanine nucleotide on opiate binding leads to the suggestion that binding sites are not coupled to adenylate cyclase in this tissue. Taken together, these findings draw the attention to the coupling mechanism of opiate receptors in the mouse vas deferens which may play a key role in the adaptational mechanisms following chronic opiate exposure.

Functional opiate receptors in the guinea-pig ileum: their differentiation by means of selective tolerance development

A differentiation of multiple opiate receptors in the electrically stimulated longitudinal muscle-myenteric plexus preparation of the guinea-pig ileum is described employing the technique of tolerance development of selective opiate receptors. Apparently, mu- and kappa-opiate receptors are clearly differentiated in this tissue, since highly tolerant mu-receptors (80-fold) coexist with kappa-receptors of almost normal sensitivity and vice versa. Attempts to demonstrate delta-receptors failed, as there was complete cross-tolerance between mu- and delta-agonists. It is proposed that delta-agonists bring about their action via mu-receptors in this preparation. Although mu- and kappa-receptors have been demonstrated, neither of them appear to represent a uniform population.