Emotional outbursts and post-traumatic stress disorder during intracarotid amobarbital procedure.

Severe emotional outbursts (SEOs) during intracarotid amobarbital procedures (IAP) rarely jeopardize preoperative language and memory testing. Four of four patients (100%) with outbursts had experienced significant emotional trauma (three were raped and one witnessed a decapitation), compared with 26 of 546 patients (4.8%) without outbursts (chi2 = 69.8, p < 0. 0001). Evocative injections were ipsilateral to seizure focus. IAP may disrupt emotional balance in some traumatized patients. Counseling may prevent SEOs.

Epilepsy and behavior: a brief history.

Behavioral changes-both real and imagined-have formed a halo around epilepsy since antiquity. The myth of epilepsy as a curse has been largely vanquished in modern cultures, but the disorder remains a social stigma for many patients. In ancient Rome people with epilepsy were avoided for fear of contagion, in the Middle Ages they were hunted as witches, and in the first half of our century they were labeled deviants and their marriage and reproduction were restricted by eugenistic medical doctors. Religious conversion experiences can occur in temporal relationship to changes in seizure frequency. Many religious leaders may have had epilepsy. However, changes in religious sentiment are not characteristic of epilepsy patients. Recognized since the late 19th century, postictal psychosis has stimulated theories regarding the mechanism of mania and psychosis. Understanding the pathophysiology of behavioral changes in epilepsy may offer insight into the psychopathology of other diseases.

Modulation of adrenergic contraction of dog pulmonary arteries by nitric oxide and prostacyclin.

The aim of this work was to investigate the influence of endothelium-derived nitric oxide and prostaglandins on the contractile responses of isolated dog pulmonary arteries to electrical field stimulation and noradrenaline. Electrical field stimulation (1-8 Hz, 20 v, 0.25 ms duration, for 30 s) produced frequency-dependent contractions that were abolished by tetrodotoxin, guanethidine and, prazosin (all at 10(-6) M). Noradrenaline induced concentration-dependent contractions with an EC50, of 1.85 x 10(-6) M. The increases in tension induced by electrical stimulation and noradrenaline were of greater magnitude in arteries denuded of endothelium. In segments with endothelium, N(G)-nitro-L-arginine methyl ester (10(-4) M) or indomethacin (10(-5) M) had no effects on the basal tone, but significantly enhanced the neurogenic and noradrenaline-induced contractions. The potentiation by N(G)-nitro-L-arginine methyl ester of electrical stimulation-induced contractile responses was partially reversed by L-arginine (10(-4) M). In the presence of N(G)-nitro-L-arginine methyl ester together with indomethacin the electrical stimulation-induced contractile responses were higher than those obtained when only N(G)-nitro-L-arginine methyl ester or indomethacin was used. N(G)-nitro-L-arginine methyl ester and indomethacin did not influence neurogenic-induced contractile responses of endothelium-denuded arteries. The results suggest that endothelial cells of isolated dog pulmonary arteries depress the contractile response to electrical field stimulation of intramural nerves and that endothelium-derived dilator prostaglandins and nitric oxide may interact to inhibit contractile effects of adrenergic stimulation.

Quantitative neuronal c-fos and c-jun expression in Alzheimer's disease.

Apoptosis, or programmed cell death, has been proposed as a mechanism of neuropathology in Alzheimer's disease (AD). Activation of immediate early genes (IEG) c-jun and c-fos appears to be required for the initiation of apoptosis. Furthermore, the expression of c-jun is induced in cultured neurons that undergo beta-amyloid-mediated apoptosis suggesting a direct role for c-jun in the apoptosis of AD neurons. Using immunohistochemical methods, we calculated the average number of neuronal profiles per unit area expressing c-Jun and c-Fos within hippocampal regions CA1, CA2/3, and CA4 in postmortem brain samples from AD patients and age-matched non-AD patients. There was an increase in c-Jun-positive and c-Fos-positive neuronal profile density in nearly all AD hippocampal regions examined. In cerebellum there was no evidence of apoptosis as determined by using TUNEL technique, and negligible c-Jun labeling.

[Ventricular afterload and transmitral Doppler flow profile: effects of the diving test]. / Postcarico ventricolare e profilo Doppler di flusso transmitralico: effetto del diving test.

The influence of loading conditions on mitral flow velocity profile was studies by pulsed wave Doppler echocardiography in 10 normal subjects during diving test (5 min face exposure to iced water). The cold stimulus increased blood pressure (p less than 0.001), peripheral resistances (p less than 0.001), peak-systolic and end-systolic left ventricular (LV) meridional wall stresses (p less than 0.005). No significant change was found in heart rate. LV end-diastolic volume was unchanged, while LV end-systolic volume increased (p less than 0.005). Consequently, LV fractional shortening decreased (p less than 0.001). Thus, in spite of enhanced LV contractility (assessed by a significant increase in LV end-systolic stress to volume ratio, p less than 0.02) LV pump performance fell, because of prevailing afterload as well as lack of acute recruitment of LV preload reserve (afterload-contractility mismatch). Such an increase in LV afterload was associated with remarkable changes in LV diastolic dynamics: isovolumic relaxation time (IRT) was prolonged (p less than 0.001) and ventricular filling was relatively displaced towards late diastole (peak early to peak atrial velocities ratio, pE/pA: 1.5 +/- 0.3 vs 1.9 +/- 0.3 p less than 0.001; peak atrial filling rate: 326 +/- 47 vs 242 +/- 38 ml/s; p less than 0.001; normalized late diastolic velocity: 0.87 +/- 0.10 vs 0.73 +/- 0.06; p less than 0.01). Also, IRT values significantly correlated with pE/pA values (r = -0.75; p less than 0.001). In conclusion, diving test produced important changes in LV hemodynamics which, in turn, influenced LV relaxation and filling pattern. Our results indicate that operative LV loading conditions should be considered when assessing diastolic function by the analysis of transmitral Doppler flow profile.

[Mechanical anastomosis without purse-string suture in esophageal surgery]. / Anastomosi meccaniche senza borsa di tabacco in chirurgia esofagea.

A new surgical procedure for oesophago-enterostomy using staplers without purse-string suture is described. This technique is possible only using the CEEAP stapler, thanks to its new technical features.

Evidence for a direct and non-receptor-mediated action of 5HT2 antagonists on transmembrane cation transport systems.

Changes in transmembrane sodium fluxes have been reported in normotensive and in hypertensive subjects after ketanserin administration. In this study, the effects of the serotonergic system on transmembrane sodium transport mechanisms have been investigated in vitro. In erythrocytes drawn from ten healthy subjects, we studied the effects of serotonin (5HT) on the Na/K pump, Na/K cotransport, Na/Li countertransport, and passive permeability of Na. No significant changes were found. A direct, non-receptor-mediated action of ketanserin was then suspected, and the effects of two concentrations of ketanserin (5 x 10(-8) and 5 x 10(-7) M) were evaluated in erythrocytes from 12 normal volunteers. Both concentrations of ketanserin significantly decreased the activity of the Na/K pump and increased the activity of Na/Li countertransport. Na/K cotransport and passive permeability were not affected. Indirect evidence of the action of ketanserin on sodium transmembrane fluxes came from other experiments. In the red blood cells taken from five normal subjects and incubated for 2 hours in a plasma pool, we evaluated the changes in intracellular sodium concentration induced by the presence of 5HT or ketanserin. A significant decrease in intracellular sodium concentration occurred only with ketanserin. This study indicates that ketanserin has a direct influence on transmembrane sodium fluxes. If this action were also present in other cells, it might contribute to the actions of the drug at vascular, nervous, and renal tubular levels.

[Intraoperative pancreatic echography]. / L'ecografia pancreatica intraoperatoria.

The US intraoperative diagnostic procedure is useful either for the higher sensitivity rate or for the surgical decision making. The Authors' intraoperative diagnostic experience in pancreatic diseases is reported: 23 exocrine and endocrine neoplasms, 3 chronic pancreatitis and 8 acute pancreatitis cases are discussed.

[Thyroid metastasis of carcinoma of the breast. Considerations on 2 cases]. / Metastasi tiroidee da carcinoma della mammella. Considerazioni su due casi.

Two cases of thyroid metastasis from breast cancer are reported, both occurring in patients previously given radical mastectomies. It is emphasised that postoperative follow-up should also monitor rarely affected sites of metastasis from breast cancer.