Natural Hexavalent Chromium in the Pollino Massif Groundwater (Southern Apennines, Italy): Occurrence, Geochemistry and Preliminary Remediation Tests by Means of Innovative Adsorbent Nanomaterials

In this study Cr(tot), Cr(VI), major and trace elements were determined in groundwater of northern sector of the Pollino Massif (southern Italy). The investigated area is characterized by ophiolitic rocks consisting of metabasites, shales and calcschists and fractured serpentinites. Two main hydro-facies were observed, reflecting low temperature water-rock interaction. The Mg-HCO₃ hydrofacies is due to the weathering of serpentinites, Ca-HCO₃ groundwaters are linked to the interaction with calcschist and metabasites. High Cr(VI) concentrations were detected, exceeding the maximum admissible concentrations by Italian regulation, due to the release of Cr(III) from ophiolitic rocks into water and its oxidation to the hexavalent state. Remediation tests were carried out using two synthetized nanomaterials, Fe(0) and magnetite, characterized by a mean size lower than 50 nm. The experiments were conducted at fixed nanoparticles/Cr(VI) molar ratio and according to previous studies. In addition, the kinetic data were interpreted with a suitable mathematical model.

Hexavalent chromium reduction in contaminated soil: A comparison between ferrous sulphate and nanoscale zero-valent iron

Iron sulphate (FeSO4) and colloidal nano zero-valent iron (nZVI) as reducing agents were compared, with the aim of assessing their effectiveness in hexavalent chromium [Cr(VI)] removal from a contaminated industrial soil. Experiments were performed on soil samples collected from an industrial site where a nickel contamination, caused by a long-term productive activity, was also verified. The influence of reducing agents amount with respect to chromium content and the effectiveness of deoxygenation of the slurry were discussed. The soil was fully characterized before and after each test, and sequential extractions were performed to assess chemico-physical modifications and evaluate metals mobility induced by washing. Results show that both the reducing agents successfully lowered the amount of Cr(VI) in the soil below the threshold allowed by Italian Environmental Regulation for industrial reuse. Cr(VI) reduction by colloidal nZVI proved to be faster and more effective: the civil reuse of soil [Cr(VI)<2mg/kg] was only achieved using colloidal nZVI within 60min adopting a nZVI/Cr(VI) molar ratio of 30. The reducing treatment resulted in an increase in the amount of chromium in the oxide-hydroxide fraction, thus confirming a mechanism of chromium-iron hydroxides precipitation. In addition, a decrease of nickel (Ni) and lead (Pb) content in soil was also observed when acidic conditions were established.

Batch and column tests of metal mobilization in soil impacted by landfill leachate

The percolation of landfill leachate, even in the absence of a high concentration of specific pollutant, may induce a strong modification of soil chemical and physical characteristics, due to the alteration of the natural equilibrium between the aqueous phase and the soil matrix. As a result, a huge amount of cations can be solubilized, thus inducing groundwater pollution. In this work batch and column experiments of metal mobilization from a soil sampled down gradient of a municipal waste landfill in Northern Italy are presented. The experiments were initially performed in batch scale on soil slurries at different pH and Eh. Distilled water was used first and then a groundwater sampled down-gradient in the same site. Subsequently, to better simulate the aquifer conditions, 50 d column tests were performed on 15 kg of saturated soil. The concentrations of Fe, Mn, and Ni were evaluated when these selected environmental parameters were altered. Results indicated a greater release when acidic conditions were achieved, a positive effect in this case of the addition of an oxidant and a great Mn mobilization when negative redox potentials were established.

Discrepancy between recalled and recorded bowel habits in irritable bowel syndrome

BACKGROUND

A discrepancy between recalled and recorded bowel habit subtypes has been reported in irritable bowel syndrome (IBS), but the reasons for it remain unclear.

AIM

To assess the agreement between recalled and recorded bowel habit subtypes; to determine whether any discrepancy is related to stool form variability or psychological factors; and to test the correlations of recalled and recorded stool form with colonic transit time.

METHODS

Bowel habit subtype was established in 54 IBS patients at the enrolment visit (recalled) and with the aid of diary cards (recorded). Colonic transit time, the variability of stool form and the patients' psychological profiles were also recorded.

RESULTS

Recalled and recorded bowel habit subtypes agreed in only 54% of the patients (kappa = 0.28). Stool form variability was greater among the patients whose recalled and recorded bowel habit subtypes were discordant (P = 0.03), whereas the psychological profiles were not different. Colonic transit time significantly correlated with stool form only when it was recorded on diary cards.

CONCLUSION

The discrepancy between recalled and recorded bowel habits in IBS patients is related more to stool form variability than an altered psychological profile. Diary cards should be used to ensure that stool form reflects colonic transit time.

The effect of disk rotational speed on oxygen transfer in rotating biological contactors

Lab-scale experiments using a synthetic wastewater were carried out to assess the influence of disk rotational speed on oxygen transfer rate in a RBC unit in the presence of biomass. The overall oxygen transfer coefficient (K(L)a) was computed. Five different disk rotational speeds were tested, in the typical RBC operating range (3-10 RPM). The soluble organic substrate was monitored through TOC analysis. Influent hydraulic organic loadings were in the range of 5.4-35.2 g TOC/m(2)d. The set of kinetic coefficients calculated fitting the experimental data by the selected model resulted in good agreement with the value reported in literature. A correlation for K(L)a as a function of disk rotational speed and disk diameter was obtained. Accordingly, a new expression of the enhancement factor of oxygen transfer was found, and compared to literature data.

Experimental validation of a model describing the cycle of nitrogen in a step sludge recirculation activated sludge system with denitrification

In this paper, a model describing the cycle of nitrogen in a Step Sludge Recirculation (SSR) reactor, was developed. The SSR reactor is a multistage, continuous stirred tank reactor where the recycled biomass is distributed over all stages. The SSR system provides a uniform treatment of the wastewater and high purification efficiency for both carbon and nitrogen removal. The objective of this work was to develop a mathematical model of the SSR system, based on the analysis of various parameters that are present in the system. The simplified form of the IWA-ASM model was adapted to include the carbon removal, nitrification and denitrification processes. For model validation, a SSR pilot plant fed with synthetic wastewater was operated for approximately four months. The experimental results show that the SSR system seems to be appropriate to attain maximum TOC and nitrogen removal with minimum sludge production. The proposed model seems to be capable of expressing the behavior of carbon removal, nitrification, denitrification and various microorganism species in a SSR configuration of a nitrogen cycle. When the experimental results were compared with those estimated by the proposed model, the model predictions matched well with the experimental results.

Heavy metals mobilization from harbour sediments using EDTA and citric acid as chelating agents

In this paper experimental tests of heavy metals mobilization from sediments collected from an Italian harbour are presented and discussed. Batch tests of washing with an aqueous solution of chelating agent were performed at selected liquid/solid (L/S) ratios and chelant concentration (0.01, 0.05 and 0.1M). Two chelating agents were chosen: EDTA and citric acid. The objective of the tests was to investigate metal mobilization and soil mineral dissolution promoted by the washing treatment. The study was focused on the mobilization of Pb, Zn, and Cu: their concentrations in the contact solution, together with Fe and Ca concentration, were monitored along time for 144h. Results of experimental tests performed at different chelant concentration and L/S ratio show EDTA effectiveness in mobilizing metals bond to the sediment. The overall amount of the three selected metals (Cu, Pb and Zn) extracted in the tests with EDTA varied in a quite narrow range (from 2.262 to 2.724mmol), while the higher was the EDTA concentration in the washing solution, the higher the dissolution of other competitive cations, such as Ca and Fe. In addition, a general difficulty in copper extraction from the organic fraction of the sediment was observed, due to the high stability of copper humate. The mechanism of metals extraction was found to involve the initial metals salts dissolution, that was pH-dependant, followed by the development of exchange reactions between the metal-EDTA complexes previously formed. Depending upon the pH of the washing solution an initial high Ca dissolution was observed, followed by dramatic reduction in Ca(2+) content, mainly determined by calcium carbonate precipitation, as a result of the increase of pH during mixing. Metal mobilization was evaluated performing sequential extraction tests: the dissolution of Cu, Pb and Zn from the carbonate fraction of the sediment was almost total, as the mobilization of Pb and Zn from the Fe-Mn oxides and hydroxides fraction. On the contrary, as a consequence of the mobilization induced by washing treatment, about 17% of the remaining Cu and 10% of the remaining Zn resulted in the exchangeable fraction. At the investigated operating conditions, citric acid was unable to extract Pb and Cu from the sediment, while at the strong acidic conditions maintained during the extractions with citric acid, a Zn mobilization up to the 80% of the initial amount was observed, depending upon the operating conditions in the extractions. In addition, because of the great affinity between citric acid and Fe, and the strong acidic conditions maintained during extraction, a high Fe dissolution was observed (up to about the 39% of the total Fe content in the sediment).

Use of EAF dust as heterogeneous catalyst in Fenton oxidation of PCP contaminated wastewaters

In this study, chemical oxidation tests using H2O2 were performed on a solution contaminated with 100 mg l(-1) of pentachlorophenol (PCP). The effectiveness of electric arc furnace dust and hematite as heterogeneous catalysts was evaluated. Reactions were conducted at pH 2 for 24 h. Either H2O2 stabilized with KH2PO4 or un-stabilized H2O2 was used. Total organic carbon (T.O.C.) removal and chloride release from PCP molecule were monitored. Results showed that the maximum removal yields for electric arc furnace (EAF) dust (49.2% T.O.C., 56.7% Cl) were achieved when H2O2:PCP ratio was 10:1 and Fe:H2O2 = 1:5 for unstabilized H2O2 and when H2O2:PCP = 10:1 and Fe:H2O2 = 1:1 for stabilized H2O2 (48% T.O.C., 60.6% Cl). The maximum yield using hematite (45.2% T.O.C., 55.2% Cl) was obtained when H2O2:PCP ratio was 10:1 and Fe:H2O2 was 1:2. When EAF dust was used and Fe:H2O2 > 1:5, Cl release was higher than the one expected from T.O.C. removal.

Heavy metals extraction from contaminated soil: recovery of the flushing solution

The optimum conditions for the recovery of copper from a contaminated soil by using the soil flushing technique are evaluated. Tests on a soil artificially contaminated with copper chloride were carried out in order to evaluate the influence of the speed of percolation and of the chelating agent concentration (aqueous solution of an ethylendiaminotetraacetic acid di-sodium salt Na2-EDTA). At pH=7.3 an efficiency up to 93.9% for copper extraction was achieved by flushing 500 ml of Na2-EDTA 0.05 M solution and 100 ml of pure water at 0.792 cm/h. At these operating conditions the formation of EDTA complexes with other competitive cations (calcium and iron) was negligible. The experimental results were in agreement with the ones obtained using a model describing the chemistry of metal extraction. This model assessed that above pH=6 the formation of calcium and iron EDTA complexes was excluded and only the chelation of copper was allowed. The recovery of 91.6% of EDTA was also achieved by evaporating and acidifying the extracted solution: after filtration, solid EDTA was obtained, through the addition of sodium hydroxide Na2-EDTA. About 99.5% of the extracted copper was finally precipitated under alkaline conditions from the liquid phase.

Copper leaching from a sandy soil: mechanism and parameters affecting EDTA extraction

A series of 24h batch tests of copper extraction from a sandy soil were performed by washing the soil with aqueous solution of ethylenediaminetetraacetic acid, EDTA. EDTA versus copper molar ratio were in the range between 1 (equimolar tests) and 13.3. The tests were performed at three selected liquid/solid ratio, 5, 12.5 and 25. Results show that decreasing the pH of the washing solution an higher copper extraction yield was achieved: an almost complete copper extraction was achieved after 23 h of mixing at a L/S = 5, and after 5 h of mixing at an L/S = 12.5. The mechanism of copper extraction was found to involve two sequential processes: the former dissolution of metal salts, that lead to an initial high concentration of both copper and some competitive cations (essentially Ca(2+)), and the following EDTA exchange reaction between calcium and copper complexes, which corresponded an increase of pH in the washing solution. A negligible extraction of Fe(3+) was also observed at the investigated operative conditions.

Experimental evaluation of inhibition effects of saline wastewater on activated sludge

Industrial wastewater often has a high salt content, due to specific factories and to the use of seawater in coastal areas. Once it has reached the activated sludge treatment, saline wastewater may cause biomass inhibition and dramatic loss in purification efficiency. In the present work, the inhibiting effect of saline influent was experimentally evaluated through respirometric tests on samples of the incoming wastewater. Activated sludge was grown in bench-scale continuous flow stirred tank reactor (CFSTR), supplied with synthetic wastewater. Synthetic saline wastewater was prepared using sodium chloride and sodium sulphate at different concentrations. Samples of mixed liquor were drawn from the CFSTR reactor and fed with saline wastewater in shock-load or in continuous mode, then respiration activity and carbon removal yield were evaluated. In batch mode (shock-load), salt/biomass ratios between 0.37 and 30.7 gsalt gvss(-1) gave respiration inhibition between 4% and 84% respectively. The respirometry bioassay required a short response time and the values of respiration inhibition predicted the loss in carbon removal efficiency with a good accuracy. In continuous mode, for salt/biomass ratio of 35.5 gsaltgvss(-1), respiration inhibition of 81% was obtained. This work showed that a relation between inhibition in shock-load and inhibition in continuous mode can be determined, therefore, the procedure herein proposed allows performing offline bioassays on real biological plants, to assess in real time the inhibiting effect of the incoming wastewater before it reaches the activated sludge reactor.

EDTA leaching of copper from contaminated soils: experimental study and transport model application for parameters estimation

EDTA column's extraction were performed on four artificially contaminated soils, followed by the percolation of pure water to ensure the removal of EDTA entrapped in soil. The investigated soils were characterized by a content of organic matter ranging from 1% to 25%. A mathematical model was developed for copper leaching from the soils. The correlation of experimental data shows that while the EDTA transport was not affected by the soil organic fraction, the simulated transport of Cu-EDTA complexes in solution exhibited a delay effect due to the chemical adsorption of such complexes onto the soil organic matter. The distribution coefficient (Kd), between the solid and liquid phases showed a logarithmic increase when the organic content of soil increased. The column's hydrodynamic characteristics (alphaL) and the kinetic coefficients (k) of chelant extraction were estimated independently for each soil. A correlation of kinetic coefficients data versus soil's organic content was also proposed: experimental data showed, in the investigated range, a logarithmic dependence of k on the organic content of soil.

Experimental assessment of the operative conditions of copper extraction from three contaminated soils

Column experiments of EDTA extraction of copper from a sandy, a calcareous, and a highly organic soil, were performed. The influence of EDTA concentration, pH, and the flow rate of a flushing solution on copper extraction yield was investigated. Extraction yields of 84.8%, 93.0% and 96.9% were achieved respectively for sandy soil, calcareous soil and highly organic soil, after the injection of a volume of flushing solution equal to 15 pore volumes. TOC measurements performed on the extracted solution showed that, after the extraction phase, the percolation of an equal volume of water was necessary to ensure complete EDTA removal from the treated soils. In addition, results showed that the simultaneous dissolution of calcite consumed approximately 93.6% of the chelant agent when EDTA concentration in the flushing solution was 0.05 M.

Effect of ethanol on the oxidation of atrazine in the remediation of contaminated soil

The oxidation of an atrazine solution obtained from a flushing treatment of a contaminated soil was investigated. Experimental tests were performed on an artificially contaminated standard soil. Atrazine was removed from the soil by flushing with an aqueous solution at 5% volume of ethanol. Oxidative Fenton-type treatment on the extracted solution was then performed in order to transform atrazine into its by-products. The influence of different concentration of ethanol on atrazine oxidation was studied. Results show that the oxidative treatment is strongly affected by the ethanol residual amount. The degradation mechanism of atrazine during oxidation with Fenton's reagent in the presence of ethanol was also investigated.

Recovery of EDTA and metal precipitation from soil flushing solutions

This work studies the effectiveness of a process proposed for the recovery of ethylenediaminetetraacetic acid (EDTA) and metal precipitation from soil flushing solutions. Two series of experimental tests were carried out on two samples of a soil artificially contaminated with copper or lead. The metals were extracted from the soil by flushing with a 0.05 M aqueous solution of EDTA sodium salt (E-Na(2)). Cu or Pb extraction efficiencies of about 95 and 98% were observed, respectively. The two extracted solutions were then treated to obtain EDTA recovery and metal precipitation from the aqueous solution. EDTA recovery was achieved in two steps. An initial evaporation treatment lead to reduce the solution volume by about 75%. This was followed by the acidification of the residue solution, which precipitated more than 93% of the used EDTA. The precipitated EDTA was removed by filtration, and was suitable for reuse after adding an alkaline agent. Metal precipitation from the filtered solution was performed using two different methods: an almost total (99.5%) Pb precipitation in alkaline conditions was achieved after complex destabilization through the sequential addition of ferric ions and sodium phosphate, while 93.6% copper precipitation was achieved with ferrous sulfate as a destabilization agent.

Experimental study of the remediation of atrazine contaminated soils through soil extraction and subsequent peroxidation

This paper presents a feasibility study in the field of the remediation of soils contaminated with atrazine. Experimental tests were performed on an artificially contaminated synthetic soil. Atrazine was removed from the soil by flushing with an aqueous solution at 5 vol.% of ethanol. Experimental tests of evaporation and Fenton's oxidation on the extracted solution were then performed in order to transform atrazine into its oxidation products. Tests were performed in the presence of a peroxide excess the ratio between Fe(2+) and H(2)O(2) was 1:10. Peroxide was first added in order to reduce the consumption of hydroxyl radicals by their reaction with the excess of Fe(2+). The degradation mechanism of atrazine during oxidation with Fenton's reagent in the presence of ethanol was investigated. Results showed that due to the non selective nature of Fenton's reagent a high consumption of reagent was needed to achieve a significant atrazine oxidation from solutions at 4.5 vol.% of ethanol. While at a Fe(2+) concentration of 3mM atrazine practically disappeared from pure aqueous solutions within 2h, a degradation yield of only 28.1% was observed in the presence of ethanol even when Fe(2+) concentration was 15 mM.

A steady-state model for the evaluation of disk rotational speed influence on RBC kinetic: model presentation

The physical and biological mechanisms of attached-biomass growth were analyzed and a steady-state model was proposed to determine the soluble carbonaceous removal in an RBC unit for different organic loading rates in the reactor. The objective of the model was the prediction of the organic loading rate corresponding to the maximum removal capacity in the system. A system of equations was solved where the influent soluble carbonaceous substrate concentration was the main variable. Monod's rate law was used for the growth of microorganism: the soluble carbonaceous substrate was the limiting substrate. Endogenous decay was neglected. The influence of disk rotational speed on the RBC removal capacity was investigated, the disk rotational speed being a parameter acting on oxygen transfer in the biofilm. The criteria for the evaluation of the kinetic parameter in the model were proposed.

Assessment of the leaching of metallic elements in the technology of solidification in aqueous solution

Results are presented of experiments performed to optimize the solidification/stabilization system for metallic elements in aqueous solution. This system involves mixing cement and a solution of metallic elements in a conventional mixer: the paste thus obtained is transferred drop by drop into a recipient filled with an aqueous solution of NaOH at 20% by weight, in which it solidifies immediately. The separate use of chloride solutions of Li+, Cr3+, Pb2+ and Zn2+ makes it possible to obtain granules displaying various levels of compressive strength. Three different inertization matrices were used in the experiments, the first consisting solely of Portland cement, the second of Portland cement and a superplasticizer additive, and the third of Portland cement partially replaced with silica-fume and superplasticizer. The results of the tests performed showed a very low level of leaching into the alkaline solidification solution for Cr3+, the quantity leached being under 2% as against higher levels for the other metallic elements. For all the considered elements, the best results were obtained by using silica-fume in the inertization matrix.

Recovery of copper from contaminated soil by flushing

In this work the development of a process for the recovery of copper from contaminated industrial soils is presented. Experimental tests on a standard soil contaminated with a solution of copper chloride were carried out. The metal was extracted from the contaminated soil by flushing with a 0.1 M aqueous solution of an ethylenediaminetetraacetic acid (EDTA) sodium salt. A maximum copper extraction efficiency of about 60% was observed. Copper was then separated from the extracted solution by precipitation with sodium hydroxide after addition of ferric sulfate.

Innovative methods for removing phosphorus from wastewaters

Wastewater containing a mixture of hypophosphites and phosphites was treated in order to assess the possibility of attaining high levels of phosphorus oxidation to phosphate. An initial series of tests based on chemical oxidation by means of Fenton's reagent demonstrated the feasibility of this process for solutions containing 250-750 mg/l of phosphorus. Removal yields of up to 98% were attained at pH 3.5 by using variable ratios of [H2O2]/[Fe2+]. The second series involved the electrolytic generation of Fenton's reagent at pH 2-2.5 through cathodic oxygen reduction. This demonstrated the possibility of obtaining quantitative yields for solutions containing 80-160 mg/l P with a constant [H2O2]/[Fe2+] ratio of 3.94. Economic comparison of the two processes showed that the operative cost of the electrochemical treatment is comparable to that of the chemical process.

Mammography with synchrotron radiation: phase-detection techniques

The authors evaluated the effect on mammographic examinations of the use of synchrotron radiation to detect phase-perturbation effects, which are higher than absorption effects for soft tissue in the energy range of 15-25 keV. Detection of phase-perturbation effects was possible because of the high degree of coherence of synchrotron radiation sources. Synchrotron radiation images were obtained of a mammographic phantom and in vitro breast tissue specimens and compared with conventional mammographic studies. On the basis of grades assigned by three reviewers, image quality of the former was considerably higher, and the delivered dose was fully compatible.

Diagnostic imaging and interventional therapy of hepatocellular carcinoma

Diagnostic imaging has many important roles in the management of patients with hepatocellular carcinoma (HCC). In diagnosis, lipiodol CT (LCT) has been shown to be the most sensitive imaging modality (90-97%) for all sizes of lesions; all other modalities have high sensitivities for lesions 1-3 cm but low sensitivities for lesions < 1 cm (ultrasound 33-37%, conventional CT 20-42% and digital subtraction angiography 40-55%). All imaging modalities understage HCC. Once again LCT is the most accurate method of evaluating the extent of tumour, but even this method does not identify all satellite nodules. Ultrasound has been proposed as a screening method, but this cannot be justified on the basis of its results or cost benefit analysis. Both CT and dynamic MRI play useful roles in evaluating the efficacy and follow-up of patients undergoing chemoembolization (TACE) and percutaneous ethanol injection (PEI). Although surgery remains the best treatment of HCC, it is unsuitable in most of the cases which would be better treated with interventional therapy. This article presents a review of the literature regarding the use of TACE, PEI or a combination of both procedures in the treatment of HCC. A multicentric study has shown that patients with monofocal lesions less than 5 cm in diameter are better treated with PEI, which is therefore a good alternative to the surgical treatment; patients with multifocal lesions (maximum of three lesions) show a better survival with TACE. Combined treatment with TACE and PEI proves to be effective in patients with large HCC.

Effects of a dimeric vs a monomeric nonionic contrast medium on renal function in patients with mild to moderate renal insufficiency: a double-blind, randomized clinical trial

The efficacy and safety of nonionic dimeric contrast media in subjects with impaired renal function is largely unknown. The present study was aimed at determining the risk of tubular nephrotoxicity in patients with mild to moderate renal insufficiency who underwent intravenous urography (IVU) with the nonionic dimeric contrast agent iodixanol (Visipaque, Nycomed Imaging, Oslo, Norway). In a double-blind protocol 64 patients (55 males; mean age 68.3 years) with serum creatinine between 135 and 265 micromol/l who were to undergo IVU were randomized to receive iodixanol (a nonionic dimer) or iopromide (a nonionic monomer), 600 mg I/kg b. w. Renal function was evaluated before and 1 h, 6 h, 24 h, 48 h and 7 days after IVU with analysis of serum creatinine, urinary enzymes alanylaminopeptidase and N-acetyl-beta-glucosaminidase, and urinary microproteins alpha-1-microglobulin and albumin. Renal function remained stable in both contrast medium groups during the follow-up period. No statistically significant differences were observed between the monomer and the dimer in terms of urinary enzyme and microprotein excretion or serum creatinine. Transient radiocontrast-induced nephropathy developed in 1 patient who had received iodixanol. The administration of the nonionic dimeric contrast medium iodixanol, or of the nonionic monomer iopromide, entailed a low nephrotoxic potential in patients with mild to moderate renal insufficiency undergoing excretory urography.

A linear array silicon pixel detector: images of a mammographic test object and evaluation of delivered doses

We present images of a mammographic test object obtained using a linear array silicon pixel detector capable of single-photon counting. The detector pixel size was 200 x 300 microns2 and images were acquired by scanning the test object between the laminar detector and the x-ray source with a scanning step of 100 microns. A molybdenum anode tube was used with two different filtrations: 2 mm aluminium and 25 microns molybdenum. Conventional film-screen images were also obtained in order to compare spatial and contrast resolution. In our digital images it is possible to recognize low-contrast details having dimensions smaller than or equal to the dimensions of details visible by means of a clinical mammographic unit. The detection of microcalcifications smaller than 150 microns was possible only when using the Mo filtration. However a copper wire of 50 microns diameter was detectable when embedded in a simulated tissue. We discuss in detail the mean glandular doses (MGDs) delivered during the image acquisition. The MGDs necessary to obtain good-quality images are always smaller than at a conventional mammographic unit. Since MGDs depend on the x-ray spectrum, the dose reduction becomes larger when the applied spectrum is harder than in film-screen acquisition (Al filtration and 35 kVp).

Arthroscopic treatment of anterior ankle impingement

Ankle arthroscopy has recently allowed the elaboration of less invasive techniques for the treatment of anterior impingement. Its indications, advantages, and drawbacks in this application are discussed. Between 1987 and 1994, 133 patients were treated for ankle impingement. Among them, 58 patients, 37 men and 21 women (mean age, 28.5 years), who had failed a trial of conservative treatment were treated by means of tibiotalar arthroscopy. Twenty-seven were athletes engaged in sports with abnormal stressing of the ankle. According to McDermott's radiological classification, there were 15 stage I cases, 23 stage II, 13 stage III, and 7 stage IV. Preoperative evaluation with a modified version of McGuire's scoring system gave 50 cases rated as "poor" (< 60 points) and 8 cases rated as "fair" (60-67 points). Treatment consisted of removal of adhesions, cartilage shaving, and removal of the bone impingement with powered instruments, curettes, or small osteotomes. Follow-up was from 8 to 62 months (mean, 21.5 months). The postoperative McGuire ratings were 37 good, 13 fair, and 8 poor. There were no major complications. Recurrence of impingement was observed in four cases of stage III and IV. The conclusion is drawn that ankle arthroscopy is a sound method for the treatment of anterior impingement. Even in cases with severe joint cartilage impairment, it plays a therapeutic role as a means of postponing a possible arthrodesis.

Construction of age-related reference limits for 24-h blood pressure pattern

Blood pressure (BP) is recursively variable during the day-night cycle because of a physiological circadian rhythm. The aim of this study is, therefore, to show how to construct the population reference limits (desms) for BP in its time varying 24-h pattern, starting from a small sample, in order to facilitate their use in a local context. The sample for standardization comprised 427 clinically healthy subjects (211 males and 216 females), ranging in age from 16 to 100 years, attending their routine activities. The procedure begins with the statistical biometry related to the sample, and proceeds with the computation of the BP desms related to (1) the time-qualified discrete values; (2) the parameters of circadian rhythm; (3) the daily pressure load. The pertaining rules are explained step by stop, allowing each one to prepare the proper local desms for BP 24-h pattern. These standards may be useful for validating the individual BP monitoring according to the upper limits of the circadian physiological variability in the diagnostic procedure for identifying hypertensive subjects.

Chronobiometric identification of disorders of hunger sensation in essential obesity: therapeutic effects of dexfenfluramine

In human beings, hunger is a proprioceptive signal that shows intraday (circadian components) and within-day (ultradian components) recursivity. Both periodic components can be investigated by chronobiometric procedures by combining the Cosinor method with spectral analysis. A 24-hour profile of hunger sensation (HS) can be plotted on a 1-to-10 scale of intensity using self-rated scores performed every half-hour of the day. Circadian and ultradian components were studied in 60 patients affected by essential obesity (20 men and 40 women; mean age, 38.4 years; mean body weight, 101 kg) before and after treatment with dexfenfluramine (Isomeride; Servier, Orléans, France) 15 mg orally twice daily, for 30 days. The control group consisted of 30 clinically healthy subjects (15 men and 15 women; mean age, 37.5 years; mean body weight, 69 kg). Chronobiometric analysis shows three patterns in obese patients, which suggests that HS may be normal (eurectic obesity), exaggerated (hyperrectic obesity), or diminished (hyporectic obesity). After dexfenfluramine administration, HS was showed a substantial decrease in the daily mean level. The spectrum of resolution in circadian and ultradian components was found to be maintained in eurectic obesity and partially readjusted in hyperrectic and hyporectic obesities. This demonstrates that dexfenfluramine acts not only as an anorectic but also as a chronizer by interfering with the recursive components of HS. The anorectic and chronizing effects suggest that dexfenfluramine is a "chronoanorectic drug" that interacts with the chronobiologic properties of the serotoninergic system.

Interaction of trace elements in a longitudinal study of human milk from full-term and preterm mothers

Concentrations of 8 trace elements (Fe, Cu, Zn, Se, Br, Pb, Rb, and Sr) at different lactation time were measured by the PIXE multi-elemental technique. Time dependence and interelement correlations were studied. A total of 200 milk samples from 32 lactating mothers were supplied from 2 to 120 d after delivery of 26 full-term and 6 preterm infants. All elements showed a lognormal frequency-distribution. The Fe, Cu, Zn, and Se contents in preterm milk were found to be somewhat different with respect to full-term milk. Cu, Zn, Se, Br, Pb, and Rb concentrations declined with lactation time, both in pre- and full-term samples. Sr and Fe contents did not show any change with time. Detailed analysis of data by partial correlation and multiple regression methods was performed. No substantial differences between preterm and full-term samples were found in the results of partial correlation analysis. Cu and Zn were found to be correlated with lactation time, whereas the measured time dependence for the other elements has to be attributed to the effect of the existing interelement correlation. All the measured elements appeared to be correlated with at least one other element. In particular, Se was inversely correlated with Zn and directly with Cu. The zinc and copper contents in milk can therefore depend on the variation in the mother selenium intake.

[Chronobiological standards of 24-hour arterial blood pressure validated by bayesian criteria]

The monodiagnosis of hypertension via ambulatory (A) blood pressure (BP) monitoring (M) is erroneous by definition. Its use has to be substituted by the chronodiagnosis. Because of the lack of an international standardization, the BP chronobiologic reference limits have to be computed on a small sample size. For this compilation, it is, however, unavoidable the recruitment of normotensive subjects using the WHO's fixed limits. These chronobiologic standards are by principle contaminated by false negatives and need a bayesian validation. Such a depuration has been made by reclassifying each subject using the BP time-qualified standards. A secondary sample was constituted on the true normotensive reclassified. This sample provided the a posteriori reference standards for BP. The bayesian chronobiologic reference standards seem to be the limits with which the chronodiagnosis of hypertension can be suitably done via ABPM.

Trace element content of human milk during lactation

Human milk is believed to provide all the nutrients necessary for normal infant growth. The present study is concerned with the evaluation of longitudinal changes in Fe, Cu, Zn, Se, Br, Pb, Rb, and Sr milk contents over a long period of lactation. A total of 140 milk samples from 26 lactating mothers were supplied from the 2nd to the 180th day after delivery of a full-term healthy infant. Cu, Zn, and Se showed a time-dependent decrease, with similar 10-day half-times. Br and Pb showed correlations with time, but the data fitting produced very short (2-3 days) half-times. The Fe, Rb, and Sr contents were constant over the lactation time. After about one month of lactation, trace element contents tend to stabilise, as do other milk components.

Twenty-four-hour pattern of atrial natriuretic peptide in heart transplantation: evidence for lack of circadian rhythm. Temporal inter-relationships with plasma renin activity, aldosterone and cortisol

We have investigated the circadian rhythm of plasma atrial natriuretic peptide in 13 stable output heart transplanted patients, all without evidence of histological rejection and cardiac impairment, following antirejection therapy with Cyclosporine, Azathioprine and Prednisone. The 24-h pattern of plasma renin activity, plasma aldosterone and plasma cortisol has been studied as well. All the investigated variables were assayed six times over the 24-h span. The circadian time-qualified data were analyzed by ANOVA and Cosinor method. The 24-h mean levels of atrial natriuretic peptide, plasma renin activity and plasma aldosterone are significantly increased, while the concentrations of plasma cortisol are reduced in the heart transplanted recipients. ANOVA detected a significant within-day variability of all these humoral variables only in healthy subjects. A statistically significant circadian rhythm was validated by Cosinor procedure for all the investigated molecules in healthy subjects but not in heart transplanted patients. In our opinion, the increase of atrial natriuretic peptide is a counterregulatory mechanism aimed to compensate the cyclosporine-mediated activation of the renin-angiotensin-aldosterone system. The disappearance of the plasma renin activity, aldosterone and atrial natriuretic peptide circadian rhythm can be ascribed to the constant activation of the renin-angiotensin-aldosterone system. The hypocortisolism is due, in our opinion, both to glucocorticoid therapy and increase of plasma ANP concentration.

Lack of circadian rhythm of plasma concentrations of vasoactive intestinal peptide in patients with orthotopic heart transplants

OBJECTIVE

To study the circadian pattern of plasma concentrations of vasoactive intestinal peptide (VIP) in patients with orthotopic heart transplants. Circulating VIP is known to have neural and immunological sources.

PATIENTS AND METHODS

13 patients with orthotopic heart transplants were studied 12-53 months (mean 31.8 months) after operation. All were haemodynamically compensated and had no histological evidence of rejection. They were being treated with cyclosporin, azathioprine, and prednisone. Ten healthy individuals were studied as controls. Circulating VIP was assayed six times within a 24h period. Time qualified data were analysed by ANOVA and the cosinor method. Student's t test for unpaired data and Bingham's test for cosinor-derived parameters were used for statistical comparisons.

RESULTS

Plasma concentrations of VIP were lower in the patients with orthotopic heart transplants than in the controls (p < 0.001). ANOVA and the cosinor method respectively showed a statistically significant within-day variability and circadian rhythm in the controls but not in the patients with heart transplants.

DISCUSSION

The low plasma concentrations of VIP in the patients with heart transplants could be the result of the lack of contribution by the cardiac VIPergic fibres, a reduction of VIP release by the pharmacologically suppressed immune system, the inhibitory effects of cyclosporin on neural function and humoral secretions, and the effects of negative feedback on VIP release of high concentrations of atrial natriuretic peptide. The lack of the circadian rhythm suggests a structural disorder, which should be further investigated.

Blood pressure 24-hour pattern in two industrialized countries (Italy and Japan) with a different culture in salt intake

This study investigates the blood pressure (BP) 24-hour pattern in representative samples of 2 industrialized countries, Italy and Japan, showing different cultures in salt intake. BP was monitored by means of a noninvasive ambulatory device whose readings were analyzed by means of chronobiometric procedures. The results show that the 24-hour BP pattern is not substantially different in Italian and Japanese subjects. In particular, the expected lower BP in the Italians was not detected despite their lower salt intake. Because the 24-hour mean BP value was seen not to be proportional to salt intake, the hypothesis is formulated that maintenance of the pressure regimen within a given range of variability is a principle of human physiology. To comply with this rule the Japanese people are supposed to have ethnically developed a certain resistance to dietary salt for which their cardiovascular apparatus is protected (phyletic escape to dietary sodium excess).

A chronobiological approach to circulating levels of renin, angiotensin-converting enzyme, aldosterone, ACTH, and cortisol in Addison's disease

This study deals with a chronobiological approach to the circadian rhythm of the renin-angiotensin-aldosterone system (RAAS) and the ACTH-cortisol axis (ACA) in patients with Addison's disease (PAD). The aim is to explore the mechanism(s) for which the circadian rhythmicity of the RAAS and ACA takes place. The study has shown that both the RAAS and ACA are devoid of a circadian rhythm in PAD. The lack of rhythmicity for renin and ACTH provides indirect evidence that their rhythmic secretion is in some way related to the circadian oscillation of aldosterone and cortisol. This implies a new concept: a positive feedback may be included among the mechanisms which chronoregulate the RAAS and ACA.

Circadian rhythm of blood pressure and heart rate in cardiopathic patients before and after heart transplantation

The aim of this study was to investigate the natural history of the circadian rhythm of blood pressure (BP) and heart rate (HR) in 10 patients with heart failure (class IV of the New York Heart Association), who underwent heart transplantation because of primary congestive cardiomyopathy. The control group was 10 age-matched clinically healthy subjects. The BP and HR monitorings were performed before and after transplantation. Preoperatively, analysis of variance and cosinor methods validated the occurrence of a statistically significant BP and HR circadian rhythm in cardiopathic patients. Over the 4 days after surgery, both the cosinor method and serial section analysis were unable to validate a 24-h periodicity for BP and HR in patients with heart transplants. Six months after surgery, the BP and HR circadian rhythm was not detected as well. One year after transplantation, the BP and HR circadian rhythm was statistically validated. The recovery of the BP and HR circadian rhythm 1 year after heart transplantation can be regarded as a clinical sign of a reacquired susceptibility to neurovegetative chronoregulation.

Circadian rhythm of cardiac output, peripheral vascular resistance, and related variables by a beat-to-beat monitoring

This study aimed to explore the 24-h patterns of stroke volume, cardiac output, and peripheral vascular resistance along with other correlated variables, such as left ventricular ejection time, ejection velocity index, thoracic fluid index, heart rate, and blood pressure. The study was performed on 12 clinically healthy subjects by means of a noninvasive beat-to-beat monitoring using the thoracic electric bioimpedance technique associated with the automated sphygmomanometric recording. Time data series were analyzed by means of chronobiological procedures. The results documented the occurrence of a circadian rhythm for all the variables investigated, giving relevance to the beat-to-beat bioperiodicity of cardiac output and peripheral vascular resistance. Temporal quantification of the investigated variables may be useful for a better insight of the chronophysiology of the cardiovascular apparatus.

Erythrocyte transmembrane Na and K fluxes in pseudohypoaldosteronism

Pseudohypoaldosteronism (PHA) is a disease characterized by hyponatremia, hypotension, and dehydratation, despite the presence of hyperreninemic hyperaldosteronism. The membrane-bound Na,K ATPase activity and the transmembrane Na and K transport systems have been studied in vitro in red blood cells of two subjects, son and mother, affected by pseudohypoaldosteronism with different degrees of clinical involvement. Both parameters were significantly altered suggesting that the refractory response to mineralocorticoids is detectable, not only in kidneys and salivary and sweat glands, but also in red blood cells. Since pseudohypoaldosteronism, in its asymptomatic form, may be much more common than expected, we suggest the use of the tests described herein as a practical approach to the early diagnosis of pseudohypoaldosteronism in the investigation of sodium wasting syndromes.

Effect of aging on circadian rhythm of atrial natriuretic peptide, plasma renin activity, and plasma aldosterone

Atrial natriuretic peptide (ANP) shows a nychtohemeral fluctuation and an age-related trend. The aim of this study was to explore the circadian rhythm of ANP as a function of age. Circadian rhythms of plasma renin activity (PRA), aldosterone (PA), and cortisol (PC) were explored as well. Twenty clinically healthy subjects, 10 young (20-25 yrs) and 10 elderly (65-75 yrs), were investigated, while recumbent, after synchronization to light-dark regimen and meal timing. Blood samples for RIA tests were collected six times during the 24-hr span. The chronobiologic analysis in young subjects demonstrated a significant circadian rhythm for all the investigated variables with an acrophase-timing located at 16.48 for ANP, 4.44 for PRA, 5.32 for PA, and 7.12 for PC. In elderly subjects we documented an important increase of 24-hr mean plasma levels but not a statistically significant circadian rhythm for ANP, and a decrease in mean value of PRA which maintained, however, a significant periodic 24-hr oscillation in parallel with PA and PC. The results in young subjects reinforce the concept that ANP plays physiologically an inhibitory role on the phasic secretion of renin. The lack of the circadian rhythm for ANP along with the divergent changes in ANP and PRA 24-hr mean concentration of elderly subjects both suggest that ANP exerts with advancing age only a counterregulatory role on the tonic rather than the phasic release of renin.

Pre-Cushing's syndrome: a case report

A 67-year-old man affected by prostate cancer was incidentally found to have a nodular enlargement of the left adrenal gland without apparent changes in hormonal status. The adrenal mass was found to be scintigraphically active, the radiolabelled compound being concentrated in its context with a consensual suppression of the contralateral uptake. The patient underwent a resection of the adrenal tumor. Histologically and biochemically, the adrenal mass was found to be a non-functioning adenoma. The radioisotopic uptake along with the non-hormonal activity prompted us to call this tumor "Pre-Cushing's syndrome" of the adrenal cortex.

Nocturnal headache-hypertension syndrome: a chronobiologic disorder

The study of blood pressure (BP) monitoring in essential hypertensive patients recurrently suffering from nocturnal headache revealed a rhythmic elevation of sphygmomanometric values during the night. Such a finding was not detected in essential hypertensive patients suffering from occasional headache. The nocturnal elevation of BP was seen to be paralleled by the circadian peak of heart rate, suggesting that the disorder is a systemic phenomenon. Importantly, the headache episodes were seen to disappear after antihypertensive therapy that was adjusted to lower the nocturnal increase of BP. The therapeutic results suggested that the nocturnal headache was dependent on the phasic elevation of BP. The beneficial effects further suggested that the nocturnal headache and the nocturnal elevation of BP may represent a particular syndrome with a cause-effect relationship. The term "nocturnal headache-hypertension syndrome" is proposed.

The circadian rhythm of atrial natriuretic peptide, vasoactive intestinal peptide, beta-endorphin and cortisol in healthy young and elderly subjects

Atrial natriuretic peptide, vasoactive intestinal peptide, beta-endorphin and cortisol are humoral variables characterized by a 24-h periodicity. We evaluated the circadian rhythm of these peptides and hormones in healthy subjects who were young (between 20-25 years) or elderly (between 65-75 years). All were on controlled diets. Blood samples were collected six times during a 24-h period (at 06.00, 08.00, 12.00, 18.00, 20.00 and 24.00 h) beginning 8-h after start of recumbency. The time-related data were analysed by the Cosinor method in order to validate the circadian rhythm and to quantify rhythmometric parameters which included the midline estimate of rhythm (mesor). In contrast to the young subjects, Cosinor analysis failed to reveal a significant circadian rhythm in elderly subjects, for plasma cortisol. In elderly subjects oscillation (mesor) of atrial nutriuretic peptide was higher, while that of vasoactive intestinal peptide and beta-endorphins was lower. The results suggest changes in the physiological secretion of these three peptides in healthy elderly subjects.

Describing and interpreting 24-hour blood pressure patterns in physiologic pregnancy

The time course of blood pressure in clinically healthy (pregnant and nonpregnant) women was followed by automatic ambulatory monitoring. Chronobiologic methods revealed the time course of dynamic rhythm characteristics as a function of gestational age. Differences were found between nonpregnant and pregnant women with an overall lowering during pregnancy of the rhythm-adjusted midline estimating statistic of rhythm (mesor).

Secondary aldosteronism documented by plasma renin and aldosterone circadian rhythm in subjects with kidney or heart transplantation

The circadian rhythm (CR) of plasma renin activity (PRA), plasma aldosterone (PA), and plasma cortisol (PC) was investigated in 8 patients with kidney transplantation, and in 10 patients with heart transplantation. Ten clinically healthy subjects were studied as controls. The transplanted patients were all under cyclosporine treatment associated with prednisone (PDN). Time-qualified levels of PRA and PA were seen to be higher than normal in both groups of transplanted patients. The analysis of PRA and PA circadian rhythm provided evidence for a systematically higher level of within-day concentrations. The higher level of oscillation suggests the occurrence of a condition of hyperreninemic hyperaldosteronism. The higher levels of PRA and PA 24-h values show no periodicity. The finding suggests the abrogation of the rhythmic function for renin-aldosterone system. The disappearance of PRA-PA circadian rhythm seems to be attributable to a side effect of immunosuppressive therapy.

[24-hour blood pressure: effects of sports in aged subjects]

The present study deals with the blood pressure (BP) and heart rate (HR) 24-h pattern in aged people of both sexes ranging in age from 66 to 75 years. 20 subjects were active in agonistic sports (running and swimming), 20 others had sedentary habits. BP and HR were studied by non-invasive monitoring along with chronobiometric analysis. The BP and HR 24-h pattern was seen to preserve its circadian rhythm in both aged athletes and sedentary elderly. The analysis reveals that the aged athletes show a higher mesor for systolic BP and a lower mesor for diastolic BP and HR. The daily pressure load, as the integral of the BP 24-h values multiplied by the HR mesor, is lower in aged people practising sport as compared to age-matched individuals with sedentary habits. The spectral analysis reveals that physical exercise acts to change the time structure of BP and HR 24-h patterns. The conclusion is drawn that active sport plays beneficial effects in aged people because of a lower pressure load.

Vasoactive intestinal peptide fluctuates in human blood with a circadian rhythm

The vasoactive intestinal peptide (VIP) may be radioimmunoassayed in systemic venous blood. The plasma concentrations of VIP were investigated in human blood according to a chronobiological design. The study documented a circadian rhythmicity in time-qualified concentrations of VIP. Accordingly, VIP may be ascribed to biological variables characterized by periodicity in their physiological attributes. The rhythmic physiology of VIP is, however, highly disturbed in its tonic and phasic properties during senescence.