Condensation of triethyl ester of 1,1,5-pentanetricarboxylic acid (XI) with substituted guanidines XXII - XXIX gave acids II - IX, which were converted into esters XI - XIX. The acid II and the ester XI were obtained as mixtures of positional isomers. Analogously, condensation of the triester XXI with dicyanodiamide gave rise to acid X, whose nitrile group, under conditions of esterification of a carboxyl group, produced iminoether XX. In pharmacological tests for antineoplastic activity the compounds prepared exhibited weaker efficacy than 5-(2-amino-6-hydroxy-4-oxo-3,4-dihydro-5-pyrimidinyl)pentanoic acid (I), employed as standard.
“Reflex sympathetic dystrophy” and “causalgia” are now classified by the International Association for the Study of Pain as Complex Regional Pain Syndromes I and II. Sympathetically maintained pain is a frequent but variable component of these syndromes, as the sympathetic and somatosensory pathways are no longer functionally distinct. Pain is the cardinal feature of CRPS, but the constellation of symptoms and signs may also include sensory changes, autonomic dysfunction, trophic changes, motor impairment and psychological changes. Diagnosis is based on the clinical picture, with additional information regarding the presence of sympathetically maintained pain or autonomic dysfunction being provided by carefully performed and interpreted supplemental tests. Clinical experience supports early intervention with sympatholytic procedures (pharmacological or nerve block techniques), but further scientific data is required to confirm the appropriate timing and relative efficacy of different procedures. Patients with recurrent or refractory symptoms are best managed in a multi-disciplinary pain clinic as more invasive and intensive treatment will be required to minimize ongoing pain and disability.
Complex Regional Pain Syndromes: Including “Reflex Sympathetic Dystrophy” and “Causalgia”